NHS Greater Glasgow and Clyde
  • Glasgow, United Kingdom
Recent publications
Background: Gay, bisexual and other men who have sex with men (GBMSM) are at far greater risk of experiencing poor mental health (MH) than wider society. This disparity was exacerbated by additional 'unique to sexual minority status' COVID-19 stressors. Objective: This sequential, mixed-methods study examined remote MH help-seeking among GBMSM in the U.K. and Ireland during the first COVID-19 lockdown. Methods and Results: Quantitative survey data (n = 1368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n = 18) data identified multiple barriers and enablers to GBMSM seeking remote MH help, with the help primarily sought from GBMSM-facing organisations and generic online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. Implications: We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM's MH needs, post COVID-19.
Background Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence. Methods Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP). Findings Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26–2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42–4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32–3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01–1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23–36.41), selling sex (aOR 1.45, 95%CI: 1.27–1.65), and PrEP use (aOR 3.02, 95%CI: 2.30–3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77–4.05), selling sex (aIRR 4.39, 95%CI: 4.19–4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29–6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010. Interpretation Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe. Funding European Centre for Disease Prevention and Control.
Introduction The role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE. Aim This study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles. Methods Data was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol. Results A total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development. Conclusion Radiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training. Implications for practice Guidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.
Objective Vagus Nerve Stimulation (VNS) paired with rehabilitation delivered by the Vivistim® Paired VNS™ System was approved by the FDA in 2021 to improve motor deficits in chronic ischemic stroke survivors with moderate to severe arm and hand impairment. Vagus nerve stimulators have previously been implanted in over 125,000 patients for treatment-resistant epilepsy and the surgical procedure is generally well-tolerated and safe. In this report, we describe the Vivistim implantation procedure, perioperative management, and complications for chronic stroke survivors enrolled in the pivotal trial. Methods The pivotal, multisite, randomized, triple-blind, sham-controlled trial (VNS-REHAB) enrolled 108 participants. All participants were implanted with the VNS device in an outpatient procedure. Thrombolytic agents were temporarily discontinued during the perioperative period. Participants were discharged within 48 hrs and started rehabilitation therapy approximately 10 days after the Procedure. Results The rate of surgery-related adverse events was lower than previously reported for VNS implantation for epilepsy and depression. One participant had vocal cord paresis that eventually resolved. There were no serious adverse events related to device stimulation. Over 90% of participants were taking antiplatelet drugs (APD) or anticoagulants and no adverse events or serious adverse events were reported as a result of withholding these medications during the perioperative period. Conclusions This study is the largest, randomized, controlled trial in which a VNS device was implanted in chronic stroke survivors. Results support the use of the Vivistim System in chronic stroke survivors, with a safety profile similar to VNS implantations for epilepsy and depression.
Background Accelerated partner therapy has shown promise in improving contact tracing. We aimed to evaluate the effectiveness of accelerated partner therapy in addition to usual contact tracing compared with usual practice alone in heterosexual people with chlamydia, using a biological primary outcome measure. Methods We did a crossover cluster-randomised controlled trial in 17 sexual health clinics (clusters) across England and Scotland. Participants were heterosexual people aged 16 years or older with a positive Chlamydia trachomatis test result, or a clinical diagnosis of conditions for which presumptive chlamydia treatment and contact tracing are initially provided, and their sexual partners. We allocated phase order for clinics through random permutation within strata. In the control phase, participants received usual care (health-care professional advised the index patient to tell their sexual partner[s] to attend clinic for sexually transmitted infection screening and treatment). In the intervention phase, participants received usual care plus an offer of accelerated partner therapy (health-care professional assessed sexual partner[s] by telephone, then sent or gave the index patient antibiotics and sexually transmitted infection self-sampling kits for their sexual partner[s]). Each phase lasted 6 months, with a 2-week washout at crossover. The primary outcome was the proportion of index patients with a positive C trachomatis test result at 12–24 weeks after contact tracing consultation. Secondary outcomes included proportions and types of sexual partners treated. Analysis was done by intention-to-treat, fitting random effects logistic regression models. This trial is registered with the ISRCTN registry, 15996256. Findings Between Oct 24, 2018, and Nov 17, 2019, 1536 patients were enrolled in the intervention phase and 1724 were enrolled in the control phase. All clinics completed both phases. In total, 4807 sexual partners were reported, of whom 1636 (34%) were steady established partners. Overall, 293 (19%) of 1536 index patients chose accelerated partner therapy for a total of 305 partners, of whom 248 (81%) accepted. 666 (43%) of 1536 index patients in the intervention phase and 800 (46%) of 1724 in the control phase were tested for C trachomatis at 12–24 weeks after contact tracing consultation; 31 (4·7%) in the intervention phase and 53 (6·6%) in the control phase had a positive C trachomatis test result (adjusted odds ratio [OR] 0·66 [95% CI 0·41 to 1·04]; p=0·071; marginal absolute difference –2·2% [95% CI –4·7 to 0·3]). Among index patients with treatment status recorded, 775 (88·0%) of 881 patients in the intervention phase and 760 (84·6%) of 898 in the control phase had at least one treated sexual partner at 2–4 weeks after contact tracing consultation (adjusted OR 1·27 [95% CI 0·96 to 1·68]; p=0·10; marginal absolute difference 2·7% [95% CI –0·5 to 6·0]). No clinically significant harms were reported. Interpretation Although the evidence that the intervention reduces repeat infection was not conclusive, the trial results suggest that accelerated partner therapy can be safely offered as a contact tracing option and is also likely to be cost saving. Future research should find ways to increase uptake of accelerated partner therapy and develop alternative interventions for one-off sexual partners. Funding National Institute for Health Research.
NEPHwork was established in 2020 as a renal specialty trainee-driven national quality improvement and research network with the aim of coupling the benefits of trainee-led collaboration with the rich data collection infrastructure established by the UK renal registry. NEPHwork was established to support the development, coordination and delivery of audit and research projects by renal trainees on a national scale. The first collaborative project centred on the compliance with care quality standards in managing acute kidney injury. The project enabled a large amount of data to be collected over a relatively short period of time and allowed comparison between renal units involved in contributing to the data. The initiation of the NEPHwork collaboration had to overcome delays and service pressure related to the COVID-19 pandemic. Furthermore, the method of linkage analysis used in the data collection and lack of cohesion with regional information technology (IT) services prevented trainees from certain regions from contributing to the project and this is a key priority for the next NEPHwork collaboration.
Objectives Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness. Design In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections. Setting 14 hospital sites in the USA, UK and Australia. Participants Patients and caregivers, who had been admitted to critical care from three continents. Results 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems. Conclusions Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one’s social network, economic security and access to healthcare is required following discharge from critical care.
Background: Difficult-to-control asthma associated with elevated body mass index (BMI) is challenging with limited treatment options. The effects of pulmonary rehabilitation (PR) in this population are uncertain. Methods: This is a randomised controlled trial of an eight-week asthma-tailored PR programme versus usual care (UC) in participants with difficult-to-control asthma and BMI ≥ 25 kg/m2. PR comprised two hours of education and supervised exercise per week, with encouragement for two individual exercise sessions. Primary outcome was difference in change in Asthma Quality of Life Questionnaire (AQLQ) in PR versus UC groups between visits. Secondary outcomes included difference in change in Asthma Control Questionnaire-6 (ACQ6), and a responder analysis comparing proportion reaching minimum clinically important difference for AQLQ and ACQ6. Results: 95 participants were randomised 1:1 to PR or UC. Median age was 54 years, 60% were female and median BMI was 33.8 kg/m2. Mean (SD) AQLQ was 3.9 (+/-1.2) and median (IQR) ACQ6 2.8(1.8-3.6). 77 participants attended a second visit and had results analysed. Median (IQR) change in AQLQ was not significantly different: 0.3 (- 0.2 to 0.6) in PR and - 0.1 (- 0.5 to 0.4) in UC, p = 0.139. Mean change in ACQ6 was significantly different: - 0.4 (95% CI - 0.6 to - 0.2) in PR and 0 (- 0.3 to + 0.3) in UC, p = 0.015, but below minimum clinically important difference. In ACQ6 responder analysis, minimum clinically important difference was reached by 18 PR participants (54.5%) versus 10 UC (22.7%), p = 0.009. Dropout rate was 31% between visits in PR group, and time to completion was significantly prolonged in PR group at 94 (70-107) days versus 63 (56-73) in UC, p < 0.001. Conclusions: PR improved asthma control and reduced perceived breathlessness in participants with difficult-to-control asthma and elevated BMI. However, this format appears to be suboptimal for this population with high drop-out rates and prolonged time to completion. Trial registration Clinicaltrials.gov. ID NCT03630432. Retrospectively registered, submitted May 26th 2017, posted August 14th 2018.
Background The impact of policing practices on the engagement of people who use drugs (PWUD) with harm reduction services is well evidenced. Although the police have traditionally taken an enforcement role in responding to drug use, it is increasingly clear that they can play an important part in multiagency delivery of harm reduction interventions. Despite this, there have been no studies exploring police officer perceptions of drug checking services (DCS), which provide analytical testing of client drug samples alongside harm reduction support and advice. Methods Semi-structured interviews were conducted with 10 police officers to explore the policing and legal challenges which could be encountered in the delivery of DCS in Scotland. Results Participants expressed general support for DCS and described this support as part of a wider organisational shift towards public health-oriented policing. Participants also discussed different potential approaches to the policing of areas surrounding DCS including: formal limits on police presence around the service and/or stop and search powers in relation to personal possession; the effective decriminalisation of personal possession within a specified boundary around the service; and informal agreements between local divisions and DCS outlining expected policing practices. Any formal limitation on the capacity of police officers to respond to community concerns was viewed as problematic and as having the potential to erode public confidence in policing. Participants also highlighted the potential for frontline officers to utilise discretion in ways which could undermine public health goals. Legislative change, or national strategic guidance from relevant stakeholders, was seen as a means of providing ‘cover’, enabling local divisions to support the operation of drug checking. Conclusions Despite a small sample of participants, this study summarises key challenges to be addressed in the implementation and operation of DCS in Scotland, and more widely. The paper concludes with suggested opportunities to develop approaches to policing that can facilitate rather than impede implementation and operation of these services.
Legislative change to cannabis use has generated significant interest into the therapeutic utility of cannabis-derived medical products, particularly in the field of oncology. However, much of this research has focused on adults, leaving physicians and caregivers uncertain as to the safety and efficacy of cannabinoids amongst the pediatric demographic. To this end, the aim of this review is to examine the scope of pharmaceutical cannabis in treatment of pediatric cancer, evaluating its utility as an anti-cancer therapeutic as well as symptom relief agent. This systematic review was conducted following the PRISMA guidelines. 30 included articles comprised of 16 clinical and 14 preclinical studies. There is reasonable evidence to support the use of cannabis in CINV, with plausible utility for other facets of symptomatic relief. Preclinical pediatric cancer models, investigating anti-cancer cannabinoid effect, have provided evidence that may warrant first phase clinical trials.
Liver ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient “abnormal LFT” US, and its efficacy in the risk stratification of liver disease. Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication “abnormal LFTs” 04–17/10/21. Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported – this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery – on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. Of the 281 scans reporting “fatty liver”, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 16% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the terminology “cirrhosis” was mentioned in only 5 of these scan reports (11%) and referral to Gastroenterology recommended in only 1 – implying at least 884 missed opportunities to diagnose cirrhosis in Scotland per year. Conclusions Current liver ultrasound practice is heterogenous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways.
The COVID-19 pandemic has presented unique challenges. Beyond the direct COVID-related mortality in those with liver disease, we sought to determine the effect of lockdown on people with liver disease in Scotland. The effect of lockdown on those with alcohol-related disease is of interest; and whether there were associated implications for a change in alcohol intake and consequent presentations with decompensated disease.We performed a retrospective analysis of patients admitted to seven Scottish hospitals with a history of liver disease between 1 April and 30 April 2020 (n=111) and compared across the same time in 2017, 2018 and 2019 (n=348). We also repeated an intermediate assessment based on a single centre to examine for delayed effects between 1 April and 31 July 2020 (n=89) compared to the same time period in 2017–2019 (n=284). Information was collected on patient demographics, disease characteristics, length of stay and inpatient mortality. We found that results and outcomes for patients admitted in 2020 were similar to those in previous years in terms of morbidity, mortality, and length of stay. In the Scotland-wide cohort: admission UKELD (United Kingdom Model for End-Stage Liver Disease) (56 (52–60) vs 54 (50–60); p<0.01), inpatient mortality ((10.9% vs 8.6%); p=0.499) and length of stay (8 days (4–15) vs 7 days (4–13); p=0.140). In the single centre cohort: admission UKELD (57 (53–62) vs 57 (53–60); p=0.246), inpatient mortality ((13.7% vs 10.1%; p=0.373) and length of stay (7 days (4–14) vs 7 days (3.5–14); p=0.525)). In the Scotland wide cohort, patients admitted in 2020 had a significantly higher serum sodium at presentation (137 (132–140) vs 135 (130–138) p<0.01)This group also had lower rates of HCC (1.8% vs 7.2%; p=0.04) In the single centre cohort, patients admitted in 2020 had lower rates of hepatic encephalopathy (21.3% vs 35.9%; p=0.01) and were less likely to be admitted due to decompensation (70.8% vs 82.7%; p=0.01). This assessment of immediate and medium-term lockdown impacts on those with chronic liver disease suggested a minimal effect on the presentation of decompensated liver disease to secondary care in terms of patient outcomes.
Variceal haemorrhage is a life-threatening complication of advanced portal hypertension. Studies have demonstrated that despite developments in medical management in-hospital mortality is around 15%¹ and 6-week mortality around 20%.² Endoscopic band ligation (EBL) is the mainstay of treatment. A recent randomised control trial from our unit demonstrated that early-transjugular intrahepatic porto-systemic shunt (TIPSS) reduced variceal rebleeding but had no effect on 1-year outcome.³ We aimed to determine the longer-term survival for the two groups.We reviewed the records for all the patients included in the aforementioned study. Data were collected on patient demographics, severity of liver disease at enrolment in the trial and which arm they were randomised to (TIPSS or EBL). Data were also collected on survival at 6 weeks, 1 year and 2 years as well as long term mortality. 57 patients were included. 2 patients from the original study were excluded due to lack of follow up data. 26 patients received early TIPSS and 31 EBL. Median age at enrolment was 52 years (43–60) and the majority were male (n=38; 66.7%). Patients had advanced liver disease at the time of enrolment (median MELD: 13 (10–16); median UKELD: 56 (54–59). There was no significant difference in MELD (12 (9–15) vs. 13 (11–16); p=0.221) or UKELD (55 (53–58) vs. 56 (54–59); p=0.236) between the TIPSS and EBL groups. Median Child-Pugh score was 10 (9–11) with no significant difference between the two groups (10 (9–10) vs. 10 (9–11); p=0.379) At 6 weeks, 3 patients (11.5%) had died in the TIPSS group compared to 0 patients in the EBL group (p=0.05). At 12 months, 6 patients (23.1%) had died in the TIPSS group compared to 6 patients (19.4%) in the EBL group (p=0.731). At 2 years, 13 patients (50%) had died in the TIPSS group compared to 9 patients (29%) in the EBL group (p=0.105). Patients randomised to TIPSS were more than twice as likely to have died at 2 years compared to those undergoing EBL. (OR=2.44 (0.820–7.285)) In a Kaplan-Meier analysis patients had a significantly improved long term survival benefit in the EBL group (median 1440 days (95% CI: 1050–1831)) compared to the TIPSS group (832 days (572–1093) p=0.020). Patients undergoing EBL had a significant long term survival advantage compared to those that underwent TIPSS. These findings are unique as no other long-term data are reported and are contrary to the presumed benefits of TIPSS elsewhere References • Jaraith V, et al. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit. Dig Liver Dis. 2014; 46 : 419–426. • Stokkeland K, et al. Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969–2002. Hepatology. 2006; 43 :500–5. • Dunne P, et al. Randomised clinical trial: standard of care versus early transjugular intrahepatic porto-systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding. Aliment PharmacolTher. 2020; 52 :98–106.
Introduction Chronic hepatitis B is one of the main causes of hepatocellular carcinoma (HCC) worldwide, even in the absence of liver cirrhosis. Factors increasing this risk include Asian and African ethnicity, older age, advanced liver fibrosis and family history of HCC. As international guidelines differ on recommendations for surveillance, local consensus guidelines have been developed to identify those most at risk. We aimed to investigate adherence to these guidelines and identify any factors associated with over or under surveillance. We also compared those identified as needing surveillance in the guidelines, with those deemed most at risk by the REACH-B score. Methods Patients attending HBV clinics over the past 8 years in our hospital were screened and included if they had a positive hepatitis B surface antigen for longer than 6 months. Clinical, pathological and viral features were recorded for each patient. Data was analysed using GraphPad Prism v8.4 to identify any associations between patient characteristics and under surveillance under local guidelines. A REACH-B score of 13 was used to identify patients at high risk of hepatocellular carcinoma (>1.5% risk a year) and comparison made to the surveillance population. Results Data from 234 patients were collected. Date of last follow up varied from 2014 to 2022. 14 patients were excluded due to 1 patient clearing the infection and 13 being non-attenders after diagnosis.56.6%(124) of patients were Asian ethnicity, 16%(35) Black ethnicity(15%(33) Black African) and 21.5%(47) white ethnicity. 12.8%(28) were >65 years old and 66.2%(145) male. 3.1%(6) had liver cirrhosis and 2.3%(5) were diagnosed with hepatocellular carcinoma during the follow up period. In total 157 patients (69.9%) met the criteria for HCC surveillance, 15 of these were not enrolled in a surveillance programme. There was a significant association with Black African ethnicity and under surveillance (p=0.026). No other associations with under surveillance were identified. Only 1 patient in our cohort had a REACH B score ≥13 with no association between a REACH B score ≥13 and under surveillance for hepatocellular carcinoma p=0.5288. View this table: • View inline • View popup Abstract P77 Table 1 Conclusions Our data suggests those of Black African ethnicity are being under surveilled for hepatocellular carcinoma. This may be due to lack of awareness of increased risk in these individuals or due to recording of ethnicity on electronic records, further quality improvement work to rectify this is planned. The REACH B score did not provide any additional benefit in identifying patients for surveillance.
Chronic liver disease continues to be a significant cause of morbidity and mortality yet remains challenging to prognosticate. This difficulty in prognostication is one of the key challenges in implementing palliative care, particularly at an early stage. The Bristol Prognostication Score (BPS) was developed in an attempt to identify patients predicted to have a life expectancy less than 12 months to therefore act as a trigger for referral to palliative care services. This study retrospectively evaluated the accuracy of the BPS in a cohort of patients admitted to three Scottish hospitals.Routinely collected healthcare data were gathered retrospectively from patients admitted with decompensated liver disease to three gastroenterology units across Scotland over two 90-day periods. Statistical analysis was undertaken to assess performance of the BPS in predicting mortality and to compare this with the original Bristol cohort. There were 276 patients included in the final analysis. Participants tended to be late middle-aged men, socioeconomically deprived and have alcohol-related liver disease. A similar proportion was BPS +ve (>3). When compared with the original Bristol cohort the Scottish cohort had more hospital admissions, higher ongoing alcohol use and poorer performance status. BPS performed poorer in this non-Bristol group with sensitivity 54.9% (72.2% in original study), specificity 58% (83.8%) and positive predictive value (PPV) 43.4% (81.3%). Can we predict 1-year mortality in patients with decompensated cirrhosis? Results of a multi-centre evaluation of the Bristol Prognostication Score. View this table: • View inline • View popup Abstract OP16 Table 1 The prevalence of individual criteria of the BPS compared to the Bristol cohort The BPS was unable to accurately predict mortality in this Scottish cohort. These results highlight the ongoing challenge of prognostication in patients with chronic liver disease, furthering the call for more work in this field.
Objective To retrospectively compare the efficacy and technical performance of a novel lead used for percutaneous nerve evaluation (PNE) during the testing phase for sacral nerve neuromodulation with the existing lead currently used. Materials and methods Sixty-three PNE leads were inserted in 45 consecutive patients who underwent PNE with the novel helical electrodes, and the intra-operative and return clinic sensory threshold currents were recorded. This resulted in current measurements for 63 individual electrodes. Measurements were compared with 46 consecutive patients who previously underwent PNE using the standard lead with measurements for 63 individual electrodes. Current difference distributions for the two leads were compared using a Wilcoxon signed-rank test. Results There was a statistically significant difference observed between the two types of PNE electrode. The new PNE lead demonstrated less drift in sensory threshold current during a 12-day test period in comparison to the old lead. Conclusion The novel helical PNE electrodes demonstrate a significant improvement in current drift compared with the old style leads over a 12-day test period. Level of evidence Level III
Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.
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Christos Skouras
  • General Surgery
Derek Brown
  • Scottish Microbiology Reference Laboratories
Mark S Duxbury
  • Department of Hepatobiliary & Pancreatic Surgery
Jamie P Traynor
  • Department of Renal Services
Gary A Nicholson
  • Department of Surgery
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