SUMMARY Beta adrenoreceptor blocking drugs have been used for the prevention of haemorrhage from oesophageal varices. However, it is possible that these agents, by virtue of their effects on hepatic blood flow, may impair liver function and precipitate hepatic encephalopathy. We have therefore studied the effect of the beta blocking drug propranolol on hepatic encephalopathy in patients with cirrhosis and portal hypertension. Twenty patients were randomly assigned to receive 4 weeks treatment with propranolol or an identical‐looking placebo, the former given in a dose sufficient to reduce resting pulse rate by ≥ 25%. Before and after treatment patients were assessed for the severity of liver disease and the presence of encephalopathy. EEG mean cycle frequency and fasting arterial ammonia concentrations were also measured, and in order to detect latent hepatic encephalopathy, each patient underwent a battery of psychometric tests. Patients were blinded as to their treatment, as were those assessing their responses. Neither propranolol nor placebo had any significant effect on the parameters measured. On propranolol median EEG mean cycle frequency fell from 9.08 ct s −1 (range 8.63–11.0 ct s −1 ) to 8.73 ct s −1 (range 8.27–11.44 ct s −1 ), and median fasting arterial ammonia concentration fell from 66 μmol litre −1 (range 40–329 μmol litre −1 ) to 49 μmol litre −1 (range 37–188 μmol litre −1 ). Psychometric test values, while initially abnormal and suggestive of latent hepatic encephalopathy in the majority of patients, did not change significantly during the study.
The open-access high dependency bleeding unit in Aberdeen admits all patients with suspected gastrointestinal bleeding from a stable adult population of 468,000. The aim is to reduce mortality, morbidity and hospital stay, and create a prospective whole community database. An agreed management protocol is based on prompt resuscitation and early diagnosis. From October 1991 to September 1993 there were 1,602 consecutive admissions with suspected upper or lower gastrointestinal haemorrhage. Bleeding was confirmed in 1,098 of 1,324 patients with presumed upper gastrointestinal haemorrhage, (117 bleeding episodes per 100,000 per year). The overall 30-day mortality was 3.9%, with all deaths attributable to significant concurrent illness. Mortality from peptic ulcer bleeding was 5.3%, with an operation rate of 17% and surgical mortality of 8%. Rapid diagnosis allowed 48% of 523 patients with trivial bleeds to be discharged after a median stay of 24 hours. Centralised expertise and equipment is the essence of the unit's success. The interests of patient care are better served, nursing skills are better developed and teaching opportunities better structured. The major improvement in clinical care, welcomed by hospital colleagues, management and general practitioners, makes the unit an indispensable part of acute medical provision.
To assess the feasibility of monitoring health outcomes in a routine hospital setting and the value of feedback of outcomes data to clinicians by using the SF 36 health survey questionnaire.Administration of the questionnaire at baseline and three months, with analysis and interpretation of health status data after adjustments for sociodemographic variables and in conjunction with clinical data. Exploration of usefulness of outcomes data to clinicians through feedback discussion sessions and by an evaluation questionnaire.One gastroenterology outpatient department in Aberdeen Royal Hospitals Trust, Scotland.All (573) patients attending the department during one month (April 1993).Ability to obtain patient based outcomes data and requisite clinical information and feed it back to the clinicians in a useful and accessible form.Questionnaires were completed by 542 (95%) patients at baseline and 450 (87%) patients at follow up. Baseline health status data and health outcomes data for the eight different aspects of health were analysed for individual patients, key groups of patients, and the total recruited patient population. Significant differences were shown between patients and the general population and between different groups of patients, and in health status over time. After adjustment for differences in sociodemography and main diagnosis patients with particularly poor scores were identified and discussed. Clinicians judged that this type of assessment could be useful for individual patients if the results were available at the time of consultation or for a well defined group of patients if used as part of a clinical trial.Monitoring routine outcomes is feasible and instruments to achieve this, such as the SF 36 questionnaire, have potential value in an outpatient setting.If data on outcomes are to provide a basis for clinical and managerial decision making, information systems will be required to collect, analyse, interpret, and feed it back regularly and in good time.
Journal Article Cholestatic jaundice due to terbinafine Get access C.M Dwyer, C.M Dwyer Departments of Dermatology Aberdeen Royal Hospital NHS Trust. Foresterhill. Aberdeen AB9 2ZB. U.K. Search for other works by this author on: Oxford Academic Google Scholar M.I White, M.I White Departments of Dermatology Aberdeen Royal Hospital NHS Trust. Foresterhill. Aberdeen AB9 2ZB. U.K. Search for other works by this author on: Oxford Academic Google Scholar T.S Sinclair T.S Sinclair Departments of Dermatology Gastroenterology. Aberdeen Royal Hospital NHS Trust. Foresterhill. Aberdeen AB9 2ZB. U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 136, Issue 6, 1 June 1997, Pages 976–977, https://doi.org/10.1111/j.1365-2133.1997.tb03954.x Published: 01 June 1997
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