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A 13-year-old male asthmatic presented to the general paediatric clinic with papilloedema identified following a check-up with his optician due to blurred vision. His asthma was well controlled on a moderate dose of inhaled corticosteroid and there had been no recent increase or decrease in the dose. A diagnosis of benign intracranial hypertension (BIH) was made based on a raised cerebrospinal fluid opening pressure, papilloedema, a normal neurological examination and normal neuroimaging. The only associated risk factor was his inhaled corticosteroids. He was commenced on acetazolamide and the inhaled corticosteroid dose was reduced, resulting in resolution of his papilloedema. This case serves to highlight that steroid side effects including BIH may occur at moderate doses of inhaled corticosteroids and that inhaled corticosteroid dose should be regularly reviewed and decreased to the lowest dose that maintains asthma control.

We assess outcomes of endoscopic orbital decompression for Graves’ ophthalmopathy. A review of endoscopic orbital decompressions of the medial and partial inferior wall between July 2004 and July 2017 was carried out. Outcome was assessed by comparing pre- and post-operative measurements of exophthalmometry and visual acuity. Results were evaluated by repeated measures analysis of variance. A total of 41 orbits in 25 patients underwent endoscopic orbital decompression for Graves’ ophthalmopathy in the time period; however, six orbits in three patients had insufficient data for inclusion. Eleven patients required concurrent septoplasty to allow access. Measurements were taken at a mean of 11 days, 32 days, and 95 days post-operatively. Reduction in mean proptosis was 2.81 mm at 1-month post-decompression and 3.26 mm at 3 months. There was no significant difference between those treated for compressive optic neuropathy compared with those treated for cosmetic reasons. Colour vision by Ishihara plate improved significantly by a mean score of 2.67 post-operatively. Using LogMAR conversion for visual acuity, measured by a best-corrected Snellen chart, improvement of 0.18 was achieved at 1-month post-decompression, equivalent to approximately two lines on the Snellen chart. There was minimal (0.04) further improvement at 3 months. The improvement in visual acuity was greater in cases treated for compressive optic neuropathy than cosmesis, but this did not reach statistical significance (p = 0.06). Three cases required revision surgery. Diplopia disimproved or developed in four cases and squint surgery was required in three cases. Endoscopic orbital decompression offers an effective, safe and minimally invasive treatment for Graves’ ophthalmopathy. There is a trend towards continued improvement in outcomes over the course of 3 months post-operatively.

ObjectiveTo conduct patient and public involvement (PPI) to gain insight into the experience of healthy eating and weight management advice during pregnancy.DesignPPI in the planning and development of health interventions, aiming to ensure patient-centred care. Optimum nutrition and weight management are vital for successful pregnancy outcomes, yet many services report poor attendance and engagement.SettingCommunity venues in Liverpool and Ulster (UK).ParticipantsTwo PPI representatives were involved in all aspects of the study: design, interview questions, recruitment and collection/analysis of feedback.InterventionFeedback was collected via note taking during group discussions, two in Liverpool (n = 10 & 5); two in Ulster (n = 7 & 9) and an interview (n = 1, in Ulster).Main Outcome MeasuresTranscript data were collated and thematic analysis was applied in analysis.ResultsThematic analysis identified three themes: (i) weight gain is inevitable in pregnancy; (ii) healthy eating advice is important but currently lacks consistency and depth and (iii) expectations regarding the type of knowledge/support.ConclusionsPPI provides opportunity to enhance research design and offers valuable insight towards the needs of healthcare users. Pregnant women want positive health messages, with a focus on what they can/should do, rather than what they should not do. Midwives need to consider their communication with pregnant women, to ensure that their unique relationship is maintained, especially when the topics of diet and weight management are addressed. A well-designed digital intervention could improve access to pregnancy-specific nutrition information; empowering midwives to communicate patient-centred, healthy eating messages with confidence. This has the potential to change dietary and weight management behaviour in pregnant women.

UNLABELLED Chronic ethanol consumption for 40 weeks in adult rats results in dilation of the extensive smooth endoplasmic reticulum (SER), a major component of the calcium homeostatic system within Purkinje neuron (PN) dendrites. AIMS The aim of the present study was to determine whether chronic ethanol consumption results in alterations of the sarco/endoplasmic reticulum Ca(2+) ATPase pump (SERCA) on the SER membrane of PN dendrites. The density of calreticulin, a calcium chaperone, was also investigated in the PN along with balancing ability. METHODS Ninety 8-month-old rats were exposed to rat chow, the AIN-93 M liquid control or ethanol diets (30/diet) for a duration of 10, 20 or 40 weeks (30/duration). Age changes relative to the rat chow controls were assessed with 3-month-old control rats (n = 10). Balance was assessed prior to euthanasia. Quantitative immunocytochemistry was used to determine the density of SERCA 2b + dendrites and calreticulin + PN soma and nuclei. Molecular layer volumes were also determined. RESULTS Following 40 weeks of ethanol treatment, there were ethanol-induced decreases in SERCA 2b densities within the dendritic arbor and decreased balancing ability on the more difficult round rod balance test. There were no ethanol-induced changes in calreticulin densities. CONCLUSION It can be concluded that ethanol-induced decreases in the SERCA pump accompany SER dilation and contribute to previously reported ethanol-induced dendritic regression in PN. Ethanol-induced changes in balance also occurred. Chronic ethanol consumption does not alter calreticulin expression in PN.

To describe the shared care and outcomes of patients with periocular skin tumours who underwent Mohs micrographic surgery (MMS) performed by dermatologists, followed by oculoplastic reconstruction undertaken by ophthalmologists at two teaching and one private hospital in Ireland. This was a retrospective chart review at the Royal Victoria Eye and Ear Hospital, St James Hospital and the Hermitage Clinic. One hundred and twenty seven patients had periocular Mohs surgery between November 2006 and January 2013 mainly indicated for basal cell carcinoma. The mean follow-up time was 2 years and to date there have been no local recurrences. MMS is available in Ireland and should be considered for patients with facial tumours in the ocular region.

Introduction and aims With Scottish Government’s integration of health and social care, social care teams are increasingly leading the care for elderly clients and their families who are living with a terminal illness and also have multiple complex care needs. Addressing the palliative care learning needs of social care workers is essential to ensure the provision of high quality palliative care in families’ in their preferred place of care, and to reduce emergency admissions to hospital where avoidable. The education programme aimed to increase the knowledge and confidence of social care workers working in a care home or home care setting in Lothian. Methods Through consultation, a tiered approach to learning was developed. Care workers attended a single training day, with a portion going on to complete an online module. The module was contextualised to reflect the Lothian focus. Care workers were supported by a workplace mentor. Results 500 social care workers will have completed the single day training and 75 will have gone on to have completed the online professional development module by the conference date. Single day evaluation, pre and post knowledge and confidence questionnaire and focus groups are being used to evaluate the programme and its transferability. Conclusions To achieve the aims set out in the Strategic Framework for Action on Palliative and End of Life Care, it is essential that social care teams are adequately supported and trained to provide high quality palliative care for people and their families living with a terminal illness. References Bliss J, While A.Decision-making in palliative and continuing care in the community: an analysis of the published literature with reference to the context of UK care provision. Inter J Nurs Studies 2003; 40 :881–888 Kelly D, Gould D, White I, Jane BE. Modernising cancer and palliative care education in the UK: insights from one cancer network. European J Oncol Nurs 2006; 10 :187–197 Scottish Government. Strategic Framework for Action on Palliative and End of Life Care. Edinburgh: The Scottish Government; 2015

This report highlights the use of multisite training for psychiatry and psychology postdoctoral fellows developing careers in academic clinical research in the field of mental health. The objective is to describe a model of training for young investigators to establish independent academic clinical research careers, including (1) program structure and eligibility, (2) program goals and development of a multisite curriculum, (3) use of technology for implementing the program across multiple sites, and (4) advantages and challenges of this multisite approach. In 2000, in collaboration with the Veterans Affairs (VA) Mental Illness Research, Education and Clinical Centers (MIRECCs), the VA Office of Academic Affiliations launched the Special Fellowship Program in Advanced Psychiatry and Psychology. Each of the 10 currently participating VA sites across the United States is affiliated with a MIRECC and an academic medical institution. In the first five years of this fellowship program, 83 fellows (34 psychiatrists and 49 psychologists) have participated. The success of this multisite approach is evidenced by the 58 fellows who have already graduated from the program: 70% have entered academic clinical research positions, and over 25 have obtained independent extramural grant support from the VA or the National Institutes of Health. Multisite training results in a greater transfer of knowledge and capitalizes on the nationwide availability of experts, creating unique networking and learning opportunities for trainees. The VA's multisite fellowship program plays a valuable role in preparing substantial numbers of psychiatry and psychology trainees for a range of academic clinical research and leadership positions in the field of mental health.

This article reports preliminary data on trauma and post-traumatic stress disorder (PTSD) prevalence, as well as test psychometrics, among 35 cognitively intact veterans residing in long-term care settings. Participants received a traumatic event screening, the Mini-Mental Status Examination, Combat Exposure Scale (CES), PTSD Checklist (PCL), and Mississippi Combat PTSD Scale (M-PTSD). Results demonstrated adequate reliability for the CES, PCL, and M-PTSD for use in these settings, with several significant intercorrelations. A high prevalence of trauma exposure was found, in particular combat. Based on the PCL and M-PTSD, although most veterans did not meet full PTSD diagnostic criteria, a moderate proportion met partial criteria. The need for assessment and treatment of trauma exposure and PTSD in Veterans Affairs long-term care settings is emphasized.

This descriptive study examined reports of behavioral problems among older patients hospitalized in acute care medical settings. Greater numbers of behavioral problems were reported by nursing staff on the Neuropsychiatric Inventory-Questionnaire than were documented in medical charts over the same time period. Such underreporting may have clinical and administrative implications.

This report describes a case of primary oncocytic adenocarcinoma of the ethmoidal sinus presenting as a unilateral proptosis and reduction of visual acuity.

In a single blind randomised trial on 20 patients with newly diagnosed open angle glaucoma, intraocular pressures were found to be significantly (p>0.01) lower in those patients who read for 10 min than in those who regarded a fixed target at 6 metres

Objectives: (a) To determine the quantity and quality of behavioral problems in older hospitalized patients on acute care units; (b) to determine the burden of these behaviors on staff; and (c) to identify predictors of behavioral problems. Methods: Upon admission, patients performed the Mini-Mental State Exam (MMSE), the Geriatric Depression Scale (GDS), and information was obtained on age, ethnicity, level of education, living arrangement, and psychiatric history. Two days post-admission, a clinical staff member caring for each patient, performed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) to assess patients' behavioral problems and staff distress. Participants and setting : Forty-two patients, over 60 years of age, admitted to medical and surgical units of the Veterans Affairs Hospitals in Palo Alto and San Francisco, participated. Results: Twenty-three of 42 (55%) patients exhibited behavioral problems. Anxiety, depression, irritability, and agitation/aggression were the most frequently observed behaviors. The severity of the behavioral problems was significantly correlated with staff distress. Lower performance on the MMSE at admission was significantly associated with higher NPI-Q ratings. Specifically, of those cases with scores less than or equal to 27 on the MMSE, 66% had behavioral problems during hospitalization, compared to only 31% of those with scores greater than 27. Conclusion: Behavioral problems in older hospitalized patients appear to occur frequently, are a significant source of distress to staff, and can result in the need for psychiatric consultation. Assessment of the mental status of older adults at admission to hospital may be valuable in identifying individuals at increased risk for behavioral problems during hospitalization.

Single dosages of DMEP (1,000-2,000 mg/kg), GMCH (50 mg/kg), ECH (25 and 50 mg/kg), FA (100 and 200 mg/kg), and MMS (100-400 mg/kg) were administered orally to 10 week old male Wistar rats. The rats were necropsied on the 11th day following dosing. The testes were weighed, homogenised and sonicated; numbers of sperm heads (total and abnormal) were counted and percentage sperm head abnormalities were calculated. Testes weights were significantly reduced only in rats exposed to 1,500 and 2,000 mg DMEP/kg. Compared with controls, there were significant increases in the incidence of abnormal sperm at all dose levels of MMS and the higher dose levels of DMEP (1,500 and 2,000 mg/kg), ECH and FA. No toxicologically significant effects upon total sperm counts were seen following the oral administration of any of the five chemicals tested. However, an additional group of rats given 100 mg MMS/kg intraperitoneally (i.p.) showed significant reductions in testes weight and total sperm head counts compared with control animals. It is concluded that this testicular sperm head counting technique is a useful tool in the detection of selective adverse effects of chemicals upon testicular sperm but requires further evaluation.

Reviewing our small series of cases we may say that on the whole the results have been eminently satisfactory and that further experience in the selection of suitable cases for this method of treatment will prove still more successful.

We have looked at the outcome of pregnancy in women with type 1 (insulin-dependent) diabetes mellitus who were confined at Glasgow Royal Maternity Hospital between 1971 and 1984. Of 134 pregnancies, 123 proceeded beyond 28 weeks' gestation and yielded 125 live infants. The perinatal mortality rate was 16/1000, due solely to congenital foetal malformation. Malformations were not related either to the severity of maternal diabetes (as graded by the White classification) or the glycaemic control in the first trimester (as judged by maternal glycosylated haemoglobin concentration). Over the period of study, there has been a marked reduction in the frequency of ketoacidosis during pregnancy and in the delivery of small-for-dates babies; more mature lecithin:sphingomyelin ratios have been obtained by amniocentesis; and better Apgar scores have been demonstrated in the infants at delivery. The Caesarean section rate has fallen from 83 to 30 per cent, and babies now spend less time separated from their mothers in paediatric units. These improvements largely reflect better diabetic treatment (improved insulin regimens and glycaemic control) and closer obstetric assessment. Foetal malformation occurred overall in 11.4 per cent of pregnancies and did not become less frequent over the period of study. Further major improvement in the outcome of diabetic pregnancy will only come from a reduction in the congenital malformation rate, which implies better diabetic control at and around the time of conception.