Original Articles

CMJ | 30 Mar 2014 | Original Articles


Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaque in the coronary arteries; resulting in limited myocardial perfusion. CAD has high levels of global morbidity and mortality and is well researched. Asymptomatic coronary artery disease (ACAD) is the precursor subclinical state and is inadequately detected and researched. The aim of this article was to cross-examine the current research on ACAD. Emphasis was placed on methods of assessment and screening of ACAD.

Materials and Methods: A review of the literature was completed following a structured protocol; search engines, inclusion and exclusion criteria were defined a priori.

Results: Forty-eight articles met all inclusion criteria and were retrieved for detailed analysis. Outcome-based evidence suggested that cardiovascular disease risk stratification followed by imaging based assessments in low-to-moderate risk candidates were shown to be of clinical value in ACAD. A ‘treat all’ primary preventative approach was shown to be of most benefit; however the social and financial implications of this remain unclear.

Conclusions: Effective management of ACAD is essential to lower the worldwide incidence, morbidity and mortality of CAD. Further outcome-based evidence highlighting the benefits of identification, screening and early primary prevention of ACAD is urgently needed.

Keywords: Asymptomatic coronary artery disease, asymptomatic coronary atherosclerosis, subclinical coronary artery disease, subclinical coronary atherosclerosis, asymptomatic coronary artery disease screening, asymptomatic coronary artery disease investigations, asymptomatic coronary artery disease management

CMJ | 13 Mar 2014 | Original Articles

We are pleased to be able to publish the abstracts from the 6th Annual National ATRIUM Conference, which took place on 22nd February 2014 at the Chancellor’s Building, New Royal Infirmary of Edinburgh. This annual conference is organised by ATRIUM, a student-run organisation at the University of Edinburgh which aims to encourage research amongst undergraduate medical students. Their website is http://www.atriumsoc.co.uk/

There were a mixture of oral and poster presentations, which are listed below. The name of the presenting student is in bold.

Oral presentations

CMJ | 8 Mar 2014 | Original Articles

It is our pleasure to once again be able to publish the abstracts for posters presented at the recent CamSurg conference, which took place on Saturday 22nd February, 2014, at Addenbrooke's Hospital in Cambridge. Following on from the successful 2013 conference, CamSurg organised an interesting mix of keynote speakers, workshops and oral and poster presentations. The full programme can be found on the CamSurg website http://www.camsurg.co.uk/CamSurg/#

The following abstracts were put forward for presentation at the conference:

CMJ | 12 Jan 2014 | Original Articles

At some point within your medical training, whether it’s during your first Obstetrics attachment or if you venture to the Radiology department, you are likely to encounter the use of Obstetric ultrasound scanning. However, it can be a complex subject to master and is not covered extensively in the undergraduate core curriculum or textbooks. This article discusses the key essentials that will help you make the most of your learning experience in these situations.

CMJ | 11 Jan 2014 | Original Articles


Patients diagnosed with Coeliac disease are known to be at higher risk of suffering a low-impact fracture, and even as children it is important to detect and correct malabsorption due to Coeliac since this may have a lasting impact on their lifelong fracture risk. The British Society of Gastroenterologists recommends that those Coeliac patients with two or more additional risk factors for osteoporotic fracture undergo a dual X-ray absorptiometry (DEXA) scan to determine their bone density. This audit addressed the question of whether this standard was being adhered to in a general practice setting in the south-east of England. The capture of cases represented a prevalence of 1:275 (similar to previously reported figures for the prevalence of this condition). The rate of DEXA scanning in this population was disappointingly low (only 37%), and since many of those Coeliac patients who should have been scanned, and were not, possessed ‘minor’ risk factors such as smoking or female gender, the low pick-up rate may be attributable to a lack of awareness of the small but significant risk that these factors pose. Of those DEXA scans performed, the bone mineral densities of the patients concerned was inversely proportional to the number of risk factors they possessed, supporting the stance of the BSG. Practitioner education alone was not sufficient to improve the rate of scanning, which actually declined following a period of raising awareness of the need for such scans.

CMJ | 29 May 2013 | Original Articles


Objective: To assess whether patients who required surgery for hip fractures were being operated on within 48 hours of admission (NICE guideline). To determine cause of delays and also analyse other patient information (for example, mobility status, length of stay and discharge destination).

Methods: Data was collected prospectively from patients at the Royal Gwent Hospital (RGH), Newport.

Results: Data from 25 patients was collected and analysed (15F:10M).Mean age of the patients was 80.5years (±11.3). 4% of patients were delayed to surgery due to institutional factors and 36% due to patient factors.

Conclusion: Most patients were operated on within the recommended time.

CMJ | 18 Mar 2013 | Original Articles

On Saturday the 23rd March 2013, ATRIUM will be hosting the second annual conference of the National Student Association of Medical Research at the Chancellor's Building, New Royal Infirmary of Edinburgh.

CMJ | 13 Mar 2013 | Original Articles

The first annual CamSurg conference took place on Saturday 9th of February 2013 at the University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital.

CMJ | 2 Jan 2013 | Original Articles


Background: The incidence of work related mental health problems and sickness absences are increasing. The most vulnerable group are health care workers. The majority of health care workers are employed by the National Health Service.
Aims: To identify rates and degree of anxiety, depression and stress at work amongst National Health Service employees in five trusts attending the occupational health department. To describe the demographics of employees returning to work and characteristics of their work patterns, and what interventions were used if needed.
Methods: A retrospective observational study on 226 employees from October 2000 to November 2007 was carried out.
Results: Stress at work was associated with either anxiety or depression or both. Age, number of years in the NHS, past psychiatric history and shift work also influenced stress at work factors. Nurses were the most vulnerable group followed by administrative staff. With effective intervention, nearly 86% of employees were able to return to work.
Conclusions: The study supports that intervention by multiple approaches has a significant role for a successful fitness and early return to work.

CMJ | 13 Dec 2012 | Original Articles


Multiple Myeloma is a fascinating haematological malignancy which may present in myriad ways. Whilst it may involve, directly or indirectly, many organ systems some of its most severe manifestations arise in the kidney and renal diseases are second only to infection as a cause of death secondary to multiple myeloma. This article gives an overview of the mechanisms by which multiple myeloma may affect the kidneys, with a particular focus on myeloma cast nephropathy, and reviews the current best treatments in these situations.

CMJ | 10 Dec 2012 | Original Articles


Suicide is the second most common cause of death among young men in England and Wales. Gatekeeper training aims to reduce suicide rates by teaching members of the public how to recognise individuals at risk, intervene when necessary and direct them safely to professional help. In addition, the training aims to challenge taboo, promote open discussion about suicide and improve confidence to intervene with at-risk individuals. Gatekeeper training is currently employed around the globe, but the evidence base for its use is not yet fully established. Our aim was therefore to determine, using the currently available literature, if gatekeeper training is an effective suicide prevention strategy as analysed in the context of the Kirkpatrick model. The studies analysed may suggest a positive impact of training upon both trainee knowledge and, more tentatively, behaviour. However, this is by no means a universal finding and it is difficult to conclude whether or not improvements persist over time. The nature of the training used and the demographic targeted appear to be important, but variation in the standard of available studies as well as differences in their results make it difficult to draw firm conclusions. The authors therefore conclude that the currently available literature does not enable a reliable assessment of whether or not gatekeeper training is an effective suicide prevention strategy.

CMJ | 9 Dec 2012 | Original Articles


Acute lymphoblastic leukaemia (ALL) is the most common malignant disease of childhood, but can also occur in adults. Whilst long-term survival rates in childhood ALL have steadily improved over the past 50 years, adults with ALL fare much more poorly, a problem due in part to the lack of large-scale randomised trials in treating adult ALL. The largest ever study to look specifically at adult ALL is the International ALL trial, initiated in 1993, and its results have recently been published, addressing in particular the role of stem cell transplantation in ALL treatment. The trial (known as UKALL XII in the UK) confirms the efficacy of current chemotherapy in inducing disease remission. It addresses the issue of whether patients with the Philadelphia chromosome should receive allogeneic stem cell transplants, reporting that this gives a small but significant improvement in outcome, and challenges the current view that in Philadelphia-negative ALL, patients deemed to be ‘higher-risk’ benefit more from transplantation. Autologous stem cell transplantation, previously thought to prolong survival in adult ALL, is shown to be worse than conventional chemotherapy. The UKALL XII data have not yet been published for imatinib, a BCR-ABL fusion protein inhibitor useful in Philadelphia-positive disease, but will undoubtedly add to a growing body of knowledge with the potential to improve outcomes in this often overlooked form of cancer.

CMJ | 21 Nov 2012 | Original Articles

Homer once wrote: “taught by time, my heart has learn’d to glow for others’ good, and melt at others’ woe” [1]. While a poet attempts to describe empathy in verse, it is neurologically complex. It can be argued that empathy defines mankind and severe deficits are considered a key part of the social difficulties that is a defining feature of autism spectrum conditions (ASC). The autism spectrum is often viewed as a triad of difficulties.

CMJ | 9 Nov 2011 | Original Articles

The 4th annual ATRIUM conference was held on Saturday 5th November 2011 at the Chancellor’s Building, Royal Infirmary of Edinburgh.

CMJ | 7 Oct 2011 | Original Articles

Osteoporosis is a major cause of morbidity and mortality in people over the age of 50. Calcium and vitamin D supplements are recommended as adjuncts to other pharmacological therapies for osteoporosis in this group. Recent evidence suggests that, whilst calcium supplements co-administered with vitamin D may reduce osteoporotic fracture risk, calcium supplements given alone have little, if any, effect on fracture risk, and are associated with a 30% increase in the risk of myocardial infarction.

CMJ | 1 Oct 2011 | Original Articles

Trauma is the leading cause of death in young adults in the UK with road traffic accidents being the commonest mechanism. Trauma is responsible for a burden of morbidity with socio-economic implications which are often overlooked by the media. It would seem logical to assume that the management protocol for a serious, not uncommon presentation was well established, but this is not the case: the appropriate diagnostic imaging for this patient is a contentious topic.

CMJ | 24 Mar 2011 | Original Articles

Systemic lupus erythematosus (SLE) is a variable disease which has been a source of fascination, and perplexity, for physicians over the years. The muddled early descriptions of the disease and evolving diagnostic criteria testify to its complexity. This article summarises past and present diagnostics and treatments, and relates these to current ideas of SLE pathogenesis.

CMJ | 14 Feb 2011 | Original Articles

Cambridge University Clinical Research Society (CUCRS): Proceedings of the National Conference 2011

The CUCRS is a student-led initiative which attempts to foster interest in research amongst medical students. It aims to create an environment facilitating interaction between researchers and students, allowing the free exchange of ideas and concepts and rewarding excellence in research.

CMJ | 4 Feb 2011 | Original Articles

It is well recognised that cardiovascular disease is one of the leading causes of mortality in western societies. The British Heart Foundation in 2004 [1] stated that 1-3 people per 500 per annum suffer myocardial infarction. The natural history of this pathological process is the development of a fibrotic, non-contracting region of the ventricular wall, which physiologically manifests as reduced ventricular function.

CMJ | 30 Sep 2010 | Original Articles

When the use of DES is warranted, options currently available in the United States for treatment of stenotic coronary arteries < 2.5mm in diameter include the placement of an under-inflated 2.5 mm DES or deployment of a 2 or 2.25 mm bare metal stent (BMS). The significant risk of restenosis by the use of BMS makes the latter option less attractive, however clinical outcomes of target-vessel restenosis in patients receiving underdeployed drug eluting stents have not been studied sufficiently.