Queen Margaret University

Background The COVID-19 pandemic posed significant challenges to health systems globally, particularly in low-resource settings like Sierra Leone. Understanding the effectiveness of leadership, health workforce performance, community engagement, and service delivery during the pandemic is critical for strengthening future pandemic, preparedness and response. Methods A cross-sectional study was conducted with 303 respondents, including stakeholders from the Ministry of Health, district health management teams, and community health workers. Data were collected using structured questionnaires and analyzed to assess perceptions of leadership, workforce performance, community participation, and disruptions to health services. Results Leadership and governance were rated as “effective” or “very effective” by 58% of respondents, with key challenges including inadequate communication, delays in resource mobilization, and limited transparency. The health workforce demonstrated strong commitment (62%), but gaps in infection prevention and control training (48%) and shortages of personal protective equipment (39%) were significant barriers. Community engagement was moderately effective, with 54% rating it as “effective” or “very effective.” However, low trust in the health sector and misinformation hindered compliance with preventive measures. Maternal and child health services were the most disrupted, but innovative approaches such as telemedicine and mobile health units were adopted to mitigate service interruptions. Conclusion Sierra Leone’s COVID-19 response highlighted both achievements and challenges. While leadership structures, workforce dedication, and community health worker contributions were notable strengths, gaps in communication, resource availability, and community trust limited the overall effectiveness of the response. Strengthening communication channels, investing in workforce training and resources, and enhancing community engagement strategies are critical for improving preparedness and response in future health emergencies.

This commentary paper emphasises the pivotal role of effective communication in the field of podiatry and advocates for its comprehensive integration into the educational curriculum. It argues that the combination of strong academic performance and well-developed communication skills equips podiatry students to improve diagnoses and successful future treatment outcomes. These skills should be comprehensively taught and carefully assessed as part of the patient-centered care approach for podiatry students. The paper explores the multifaceted role of communication in podiatry, highlighting its importance in various aspects of the profession. These include building rapport with patients, interpreting complex medical information, and fostering a therapeutic alliance that is conducive to successful treatment outcomes. It also underscores the significance of communication in collaborating with interdisciplinary teams and advocating for patient wellbeing. Proficiency in communicating with patients can contribute to the development of a wide range of career competencies in podiatric medicine, including clinical skills, research and innovation, cultural competence, and effective teamwork, both nationally and internationally. The paper also delves into various topics such as gathering patient history, explaining diagnoses and treatment options, providing patient education, and enhancing patient outcomes through interprofessional practice. This commentary paper explores the role of communication in research participation and the teaching and assessment of communication skills through innovative methods such as role-playing, simulations, and standardized patients. In conclusion, by reiterating that the essence of podiatry extends beyond technical proficiency to include meaningful interactions between the podiatrist and the patient, which are facilitated by strong communication skills. This paper may serve as a call to action for universities nationally and internationally to place greater emphasis in integrating and thoroughly assessing communication skills in their podiatric medicine programs.

Background Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications. Methods This prospective cohort study enrolled children <18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event‐free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes. Results Eighty‐two patients (median [interquartile range] 3.9 (1.9–8.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios = 0.161, 95% CI = 1.000–1.002, p = 0.032). Higher ferritin was associated with increased number of treatment‐related complications ( B = 7.3E−5, 95% CI = 1.5E−5–0.000, p = 0.013). Folate status showed significant association with body mass index category ( χ 2 = 9.564, p = 0.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate ( F (2.9); p = 0.06; −2LL (1381)). Haematological malignancies ( F (2.8); p = 0.05; −2LL (4244)) and medium and high treatment intensity ( F (2.4); p = 0.09; −2LL 4262)) were associated with higher ferritin levels over 18 months. Conclusions Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large‐scale population‐based studies and clinical trials are now warranted.

Due to a drastic increase in child and adolescent mental health difficulties worldwide, there is a constant need to evaluate current practices and further develop person-centred practices. The importance of person-centred practices is highlighted in research worldwide. This study will look into the potential development of person-centred practices within a child and adolecent mental health in-patient unit, the Young People’s Unit. Initially the current care practices, and person-centred moments were explored, which then lead to the development of pathways to create person-centred practices. This study followed a philosophical inquiry based on the SECI model and the concept of Ba developed by Ikujiro Nonaka. Data was collected from 15 young persons admitted to the Young People’s Unit. 15 main caregivers and the healthcare professionals which were part of the multi-discplinary team within the unit. 3 Different methods were used, the Draw, Write & Tell with the young persons, semi-structured interviews with the main caregivers, and observations by the researcher using the WCCAT-R tool and the world cafe method with the multidisciplinary team. The use of different methods ensured that the methods used were age appropriate. The externalistion and combination stage of the SECI model were done collaboratively with two young persons, two main care givers and 2 healthcare professionals who were initially participants in the data collection of the research. The involvement of different stakeholder in the data analysis resulted in the investigation of different aspects of the data which otherwise may have been missed. This study also looks into how Ba was created throughout the research process, and shows how this is congruent with the principles which are adopted in person-centred research.

Background Haemodialysis patients are at high risk of myopenic obesity, necessitating effective nutritional status monitoring and intervention strategies. This combined analysis of two clinical trials (PEDAL trial and CYCLE‐HD study) aimed to (i) determine the clinical utility of body mass index (BMI) in comparison to fat tissue index (FTI) and lean tissue index (LTI) and (ii) assess the effect of a 6‐month intradialytic exercise intervention compared to usual care on FTI and LTI. Methods A priori secondary endpoints in both trials included BMI, FTI and LTI. BMI was classified by World Health Organisation definitions (underweight, healthy, overweight or obese). FTI and LTI were determined by Bioelectrical Impedance Spectroscopy and classified by previous research evidence (FTI of 4–15 kg/m² and LTI of 15–20 kg/m² being associated with best survival). For aim (i), BMI was compared to FTI and LTI by correlation and classification. For aim (ii), changes over 6 months in FTI and LTI were compared between exercise intervention and control groups. Results Across both studies, 298 and 209 participants had bioelectrical impedance spectroscopy measurement at baseline and 6 months, respectively. Mean (SD) age: 58 (15) years; BMI: 28.2(6.3) kg/m²; male: 65%. At baseline, only 47 of 298 participants (16%) had an FTI and LTI associated with best survival. BMI correlated with FTI (r = 0.79; p < 0.0001). However, 34% of participants were misclassified by BMI (e.g., 9% of patients were classified as obese by BMI yet FTI revealed their body composition was healthy). BMI did not correlate with LTI (p = 0.15), and 86% of participants were misclassified by BMI (e.g., 73% of patients were classified as healthy, overweight or obese by BMI yet LTI revealed they were myopenic). There was no difference between exercise intervention and control groups in mean change (95% CI) over 6 months for LTI (−0.3 [−1.1 to 0.4] kg/m²; p = 0.4) or FTI (0.2 [−0.7 to 1.0] kg/m²; p = 0.7). Conclusions Worryingly, only a minority (16%) of haemodialysis patients had both LTI and FTI within the range associated with best survival. Body composition misclassification using conventional BMI cut‐offs was common: despite having healthy, overweight or even obese BMI, the majority (73%) of patients had hidden myopenia according to LTI. Six months of intradialytic aerobic exercise did not improve body composition. This study identified that common measures of nutritional status in haemodialysis patients such as BMI are misleading and that interventions other than intradialytic cycling are urgently required to target myopenic obesity.

The use of arthroscopy of the hand and wrist has recently increased sharply in the elective setting and this, not surprisingly, has been followed by an increasing use in the trauma setting. Advocates for the use of arthroscopy in these patients cite the improved assessment of the displacement and reduction of fractures and the early diagnosis of associated injuries, while others temper this with concerns about increased operating time and possible complications. The data relating to patient-reported benefits and costs are limited. The aim of this review was to discuss the current available literature for the use of arthroscopy in the management of injuries of the hand and wrist. Cite this article: Bone Joint J 2025;107-B(3):291–295.

Background In Sierra Leone, women of reproductive age represent a significant portion of the population and face heightened mental health challenges due to the lasting effects of civil war, the Ebola epidemic, and the COVID-19 pandemic. This study aimed to culturally adapt the Friendship Bench Intervention (FBI) for perinatal psychological distress in Sierra Leone. Method We utilized the ADAPT-ITT framework and Bernal’s Ecological Validity Model (EVM) for culturally adapting the FBI’s process and content. The adaptation stages included a formative study to assess perinatal women’s mental health needs. We screened the FBI for modifications based on the data from the formative study and EVM. The initial FBI manual was presented to mother-mother support groups (MMSGs, n=5) and primary health workers (n=3) for feedback (version 1.0). A theatre test with perinatal women (n=10) was conducted led by MMSGs, yielding further feedback (version 2.0). The revised manual was then reviewed by topical experts (n=2), whose insights were incorporated (version 3.0). Results The Friendship Bench manual for Sierra Leone has been revised to better meet the cultural needs of perinatal women. The cover now illustrates an elderly woman conversing with a new mother, emphasizing community support. Culturally relevant idioms, such as “poil at” and “mind not steady,” replace previous terms, and new screening tools, the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS) and the Function Scale, have been introduced. The problem-solving therapy was simplified from seven to four steps, and training duration was reduced from nine days to two, using visual aids to enhance comprehension for those with low literacy levels. Conclusion Through this systematic approach, we successfully culturally adapted the FBI for treating perinatal psychological distress in Sierra Leone. The next step is to evaluate it feasibility, acceptability, and preliminary effectiveness in perinatal care settings.

Intergenerational programmes, involving activity-based interventions designed to promote mutually beneficial interactions between participants, have been used in Scotland and further afield as a means of generating social inclusion between different age groups. There is growing interest in the potential outcomes of intergenerational programmes for people living with dementia in particular, with policy in Scotland recognising that people living with dementia and their carers may be at greater risk of loneliness and social isolation. Given this interest, there is a need to explore what ‘intergenerational best practice’ may look like for people living with dementia. Using data from semi-structured interviews with thirteen stakeholders involved in intergenerational practice and/or dementia policymaking, this study explored the contextual factors, mechanisms, and outcomes of intergenerational programmes in the Scottish context. Stakeholders perceived the concerns of carers, perceptions of risk, along with inaccessible venues and transportation to be important contextual factors. Mechanisms that helped ensure programmes offered full and appropriate participation opportunities included ongoing, flexible programme planning; the provision of purpose and roles; and the use of older participants’ preferences, lived experience, and personhood. Overall intergenerational programmes were perceived to have the potential to promote beneficial outcomes for older participants living with dementia in Scotland.

Background Various approaches to physical rehabilitation to improve function and mobility are used after stroke. There is considerable controversy around the relative effectiveness of approaches, and little known about optimal delivery and dose. Some physiotherapists base their treatments on a single approach; others use components from several different approaches. Objectives Primary objective: To determine whether physical rehabilitation is effective for recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach. Secondary objective: To explore factors that may impact the effectiveness of physical rehabilitation approaches, including time after stroke, geographical location of study, intervention dose/duration, intervention provider, and treatment components. Stakeholder involvement: Key aims were to clarify the focus of the review, inform decisions about subgroup analyses, and co‐produce statements relating to key implications. Search methods For this update, we searched the Cochrane Stroke Trials Register (last searched November 2022), CENTRAL (2022, Issue 10), MEDLINE (1966 to November 2022), Embase (1980 to November 2022), AMED (1985 to November 2022), CINAHL (1982 to November 2022), and the Chinese Biomedical Literature Database (to November 2022). Selection criteria Inclusion criteria: Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Exclusion criteria: RCTs of upper limb function or single treatment components. Primary outcomes: measures of independence in activities of daily living (IADL) and motor function. Secondary outcomes: balance, gait velocity, and length of stay. Data collection and analysis Two independent authors selected studies according to pre‐defined eligibility criteria, extracted data, and assessed the risk of bias in the included studies. We used GRADE to assess the certainty of evidence. Main results In this review update, we included 267 studies (21,838 participants). Studies were conducted in 36 countries, with half (133/267) in China. Generally, studies were heterogeneous, and often poorly reported. We judged only 14 studies in meta‐analyses as at low risk of bias for all domains and, on average, we considered 33% of studies in analyses of primary outcomes at high risk of bias. Is physical rehabilitation more effective than no (or minimal) physical rehabilitation? Compared to no physical rehabilitation, physical rehabilitation may improve IADL (standardised mean difference (SMD) 1.32, 95% confidence interval (CI) 1.08 to 1.56; 52 studies, 5403 participants; low‐certainty evidence) and motor function (SMD 1.01, 95% CI 0.80 to 1.22; 50 studies, 5669 participants; low‐certainty evidence). There was evidence of long‐term benefits for these outcomes. Physical rehabilitation may improve balance (MD 4.54, 95% CI 1.36 to 7.72; 9 studies, 452 participants; low‐certainty evidence) and likely improves gait velocity (SMD 0.23, 95% CI 0.05 to 0.42; 18 studies, 1131 participants; moderate‐certainty evidence), but with no evidence of long‐term benefits. Is physical rehabilitation more effective than attention control? The evidence is very uncertain about the effects of physical rehabilitation, as compared to attention control, on IADL (SMD 0.91, 95% CI 0.06 to 1.75; 2 studies, 106 participants), motor function (SMD 0.13, 95% CI ‐0.13 to 0.38; 5 studies, 237 participants), and balance (MD 6.61, 95% CI ‐0.45 to 13.66; 4 studies, 240 participants). Physical rehabilitation likely improves gait speed when compared to attention control (SMD 0.34, 95% CI 0.14 to 0.54; 7 studies, 405 participants; moderate‐certainty evidence). Does additional physical rehabilitation improve outcomes? Additional physical rehabilitation may improve IADL (SMD 1.26, 95% CI 0.82 to 1.71; 21 studies, 1972 participants; low‐certainty evidence) and motor function (SMD 0.69, 95% CI 0.46 to 0.92; 22 studies, 1965 participants; low‐certainty evidence). Very few studies assessed these outcomes at long‐term follow‐up. Additional physical rehabilitation may improve balance (MD 5.74, 95% CI 3.78 to 7.71; 15 studies, 795 participants; low‐certainty evidence) and gait velocity (SMD 0.59, 95% CI 0.26 to 0.91; 19 studies, 1004 participants; low‐certainty evidence). Very few studies assessed these outcomes at long‐term follow‐up. Is any one approach to physical rehabilitation more effective than any other approach? Compared to other approaches, those that focus on functional task training may improve IADL (SMD 0.58, 95% CI 0.29 to 0.87; 22 studies, 1535 participants; low‐certainty evidence) and motor function (SMD 0.72, 95% CI 0.21 to 1.22; 20 studies, 1671 participants; very low‐certainty evidence) but the evidence in the latter is very uncertain. The benefit was sustained long‐term. The evidence is very uncertain about the effect of functional task training on balance (MD 2.16, 95% CI ‐0.24 to 4.55) and gait velocity (SMD 0.28, 95% CI ‐0.01 to 0.56). Compared to other approaches, neurophysiological approaches may be less effective than other approaches in improving IADL (SMD ‐0.34, 95% CI ‐0.63 to ‐0.06; 14 studies, 737 participants; low‐certainty evidence), and there may be no difference in improving motor function (SMD ‐0.60, 95% CI ‐1.32 to 0.12; 13 studies, 663 participants; low‐certainty evidence), balance (MD ‐0.60, 95% CI ‐5.90 to 6.03; 9 studies, 292 participants; low‐certainty evidence), and gait velocity (SMD ‐0.17, 95% CI ‐0.62 to 0.27; 16 studies, 630 participants; very low‐certainty evidence), but the evidence is very uncertain about the effect on gait velocity. For all comparisons, the evidence is very uncertain about the effects of physical rehabilitation on adverse events and length of hospital stay. Authors' conclusions Physical rehabilitation, using a mix of different treatment components, likely improves recovery of function and mobility after stroke. Additional physical rehabilitation, delivered as an adjunct to 'usual' rehabilitation, may provide added benefits. Physical rehabilitation approaches that focus on functional task training may be useful. Neurophysiological approaches to physical rehabilitation may be no different from, or less effective than, other physical rehabilitation approaches. Certainty in this evidence is limited due to substantial heterogeneity, with mainly small studies and important differences between study populations and interventions. We feel it is unlikely that any studies published since November 2022 would alter our conclusions. Given the size of this review, future updates warrant consensus discussion amongst stakeholders to ensure the most relevant questions are explored for optimal decision‐making.

Psychological distress is widely recognized as a significant health concern that poses a potential risk to the overall mental wellbeing of individuals. This study investigated the psychological distress associated with the COVID-19 pandemic and the coping methods employed by adults in Bo district, Sierra Leone. This research used a snapshot approach (cross-sectional design) to describe the prevalence of psychological distress during the COVID-19 pandemic among 502 adults residing in Bo district, Sierra Leone. We collected study data using a structured questionnaire that comprised of participant’s demographics, Kessler Psychological Distress Scale (K10), Fear of COVID-19Scale (FCV-19S), Brief Resilient Coping Scale (BRCS), and Duke-UNC Functional Social Support instrument. We used backward stepwise binary logistic regression to identify the key factors linked to psychological distress. The average psychological stress score was 22.96±11.35, with approximately one-third of participants (n = 160, 31.9%) exhibiting very high levels of psychological distress. The mean score for fear of COVID-19 was 29.71±6.84, with the majority (n = 420,83.7%) being fearful of COVID-19. The mean score for the Brief Resilient Coping Mechanism was 12.49±4.51, with half of the participants considered low resilient copers (n = 257,51.2%). The mean score for functional social support was 25.35±8.85, with (n = 240, 47.8%) having increased social support. Individuals with a known health condition [aOR = 4.415, 95% CI = 1.859–10.484], who provided care to a family member/patient with known/suspected COVID-19 [aOR = 4.485, 95% CI = 1.575–12.775], who knew someone who died from COVID-19 [aOR = 3.117, 95% CI = 1.579–6.154], with an increased fear of COVID-19 [aOR = 4.344, 95% CI = 2.199–8.580] had higher odds of moderate to severe psychological distress. Moderate resilient copers [aOR = 0.523, 95% CI = 0.296–0.925] had lower odds of psychological distress compared to the low resilient copers. Participants with increased social support had lower odds of psychological distress than those with low support [aOR = 0.253, 95% CI = 0.147–0.434]. A significant proportion of the study cohort residing in Bo, Sierra Leone, experienced high levels of mental stress because of the COVID-19 pandemic. This study shows the importance of designing and implementing programs that minimize COVID-19 stressors and enhance the coping skills and social support network.

The last two decades have seen increased awareness of the impact of mental health issues on the population of Sierra Leone. Local capacity to respond to these needs is severely limited. In 2017, the Ministry of Health and Sanitation (MoHS) worked with staff of the College of Medicine and Allied Health Sciences (COMAHS – part of the University of Sierra Leone) and Queen Margaret University (QMU) in Edinburgh – and other stakeholders, including members of the Mental Health Coalition Sierra Leone – to define a research agenda that would support the development of community-based mental health and systems support in the community. This paper summarizes work over the course of the following six years in relation to this agenda, and indicates its relevance to ongoing and planned service developments. In terms of research advance, studies have – through participatory and ethnographically-informed methods – identified both local idioms and social determinants of distress and mapped health seeking pathways and barriers to care. This information was utilized in the development and validation of two culturally appropriate measures: the Sierra Leone Psychological Distress Scale (to assess mental health and psychosocial needs at the community level) and the Sierra Leone Perinatal Psychological Distress Scale (to identify common perinatal mental disorder in amongst pregnant and lactating mothers). For this latter population, a culturally adapted form of a problem solving intervention delivered through existing mother-to-mother supports has been shown to be feasible, acceptable and potentially effective. This work has major policy and practice implications, and early evidence of uptake is noted. This includes mental health capacity development through the online availability of training guides for the developed assessment scales and plans for incorporation of material regarding idioms and social determinants of distress in pre-and post-professional training curriculum. In terms of community-based initiatives, there has been evidence of uptake from the Mental Health Coalition Sierra Leone. In terms of policy, findings reinforce key principles regarding community-based provision, integration of mental health care into primary health care, and actions to reduce stigma associated with mental health.

Background Over the last decades, universal health coverage (UHC) has been promoted in south-east Asia (SEA), where many countries still need to ensure adequate financial protection to their populations. However, successful health financing reforms involve complex interactions among a range of stakeholders, as well as with context factors, including shocks and crises of different nature. In this article, we examine recent health financing reforms in Nepal, Thailand and Indonesia, using a political economy lens. The objective is to understand whether and how crises can be utilised to progress UHC and to analyse the strategies used by reformers to benefit from potential windows of opportunity. Methods The study adopted a retrospective, comparative case study design, using a shared framework and tools. The case studies mapped the contexts, including economic, political, social trends and any shocks which had recently occurred. A focal health financing reform was chosen in each setting to examine, probing the role of crisis in relation to it, through the key elements of the reform process, content and actors. Data sources were largely qualitative and included literature and document review (144 documents included across the three cases) and key informant interviews (26 in total). Results The findings, which bring out similarities and differences in the roles played by change teams across the settings, highlight the importance of working closely with political leaders and using a wide range of strategies to build coalitions and engage or block opponents. Changing decision rules to block veto points was significant in one case, and all three cases used participation and dialogue strategically to further reforms. More broadly, the links with context emerged as important, with prior conflicts and economic crises creating a sense of urgency about addressing health inequities, while in all countries appeal was made to underlying values to enhance the legitimacy of the reforms. Conclusion The lessons from these case studies include that technical teams can and should engage in Political Economy Analysis (PEA) thinking and strategizing, including being aware of and adaptable to the changing PEA landscape and prepared to take advantage of windows of opportunity, including, but not limited to, those emerging from crisis. There is a need for more empirical studies in this area and sharing of lessons to support future reforms to increase health coverage and financial protection, including in the face of likely shocks.

In low- and middle-income countries like Sierra Leone, there is a significant gap in the treatment of perinatal mental health disorders such as anxiety, depression and somatization. This study explored the feasibility, acceptability and preliminary effectiveness of a culturally adapted Problem-Solving Therapy – Friendship Bench Intervention (PST-FBI) delivered by nonspecialists, mother-to-mother support groups (MMSGs), to perinatal women experiencing psychological distress. MMSGs provide 4 weeks of home-based, individual PST-FBI, followed by a peer-led group session called col at sacul (circle of serenity). The intervention targeted peri-urban pregnant women and new mothers screened for psychological distress. This was a two-armed, pre–post, waitlist-controlled study that employed the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS) to screen and measure their outcomes. Feasibility and acceptability were examined through in-depth interviews using the Consolidated Framework for Implementation Research, analyzed thematically, while preliminary effectiveness was evaluated with chi-squared analysis for categorical and t-test for continuous variables. Twenty of the 25 women completed all four PST-FBI sessions delivered by five MMSGs. The individual PST and the peer-led session were viewed as beneficial for problem-sharing and skill building. The SLPPDS scores significantly dropped by 58.9% (17.1–8.4) in the intervention group, while the control group showed a 31.6% (18.0–12.3) decrease. The intervention’s effect size was d = 0.40 (p < 0.05). The MMSG-led PST-FBI, including the col at sacul session, proved feasible, acceptable and with preliminary effectiveness in improving the mental health of peri-urban pregnant women and new mothers in Sierra Leone. Further randomized-controlled trials are recommended before nationwide implementation.

Background COVID-19 caused a huge backlog of patients in glaucoma clinics. This study describes redesign of an entire glaucoma service with electronic patient triage to three levels and utilisation of the Scottish optometry infrastructure of upskilled optometrists. Methods 2276 patients in glaucoma clinics were identified and triaged to three levels in keeping with Glauc-strat-fast guidance with local amendments. Every patient detail was entered into a bespoke glaucoma database to include demographics, clinical findings and social deprivation scores. The database generated automatic patient, GP and optometrist letters. Level one patients (482) were discharged within the Scottish general optometry service contract. Level two patients (714) were discharged to glaucoma accredited community optometry clinics. The glaucoma consultants would discuss the optometry decision making through screen share once a week. Level three patients (1080) were retained in hospital. All outcomes were audited and analysed 24 months after the new service. Results Statistically significant parameters were found between the three groups, to include more normal eyes, less mean deviation on visual fields and less social deprivation in level one patients. After 24 months level one patients had a return rate of 40.2%, mainly for other diseases with only 20.4% retained within hospital or level two. 9.4% of level two patients returned to hospital with retention of only 2.7% in hospital at 24 months. Conclusion Glaucoma patients in Scotland can be appropriately triaged to glaucoma accredited community optometry clinics. This frees capacity within hospital to see patients with moderate and severe disease in a timely fashion, for best visual outcomes.

This paper seeks to extend the debate around the contested concept of the ‘reflective practitioner.’ This concept has influenced practice-based learning across a range of disciplines, including social work, nursing and teaching and although assumptions are commonly made about its value to the developing practitioner, it has also been subject to critique. From the perspective of Scottish teacher-education, we propose moving beyond commonly accepted reflective practices to arrive at a reframing of it as a ‘more than human’ (Strom and Viesca, 2021) endeavour, in a way that decentres the practitioner from the process of reflection. We firstly consider some benefits and limitations of commonly used, human-centric models of reflection in teacher education; both in practice and in regulation. We then use two familiar classroom scenarios to demonstrate how these models of reflection can constrain the reflective process, and student-teachers’ agentic possibilities. We explore how a theoretical reframing of the problem through connectivism (Downes, 2007; Siemens, 2005), offers a fresh perspective that challenges the practitioner to reflect in multiple dimensions; on their means of connecting with others and the ‘matter’ of their practices – the material, physical and conceptual objects that are drawn into the orbit of the day-to-day work of teaching and learning. The proposed approach invites student-teachers to decentre themselves from their reality and consider a range of realities, allowing their reflections to more genuinely, critically and authentically reflect the realities of their experiences in the classroom. Although situated in the context of Scottish teacher education, this provocation offers fresh consideration of a problem that is currently of relevance to student-teachers and those involved in teacher education in both a UK-wide and international context.

Smartwatch technology is increasingly being used to support the management of chronic health conditions. Yet, many new digital health innovations fail because the correct foundations are not well established. This exploratory study aims to uncover the challenges experienced during the setup phase of a smartwatch intervention, to support the prototype development of a digital health intervention for children. Five children with a chronic health condition were asked to wear a smartwatch for 14 days that collects health data (pain levels, medication adherence, and physical activity performance). To explore the experiences of these children, their parents and the research team, all written records were analysed using READ’s four steps of document analysis and reported using the Standards for Reporting Qualitative Research checklist. The following three themes emerged: 1.) Infrastructure limitations: inexpensive smartphones prevented connection, and outpatient clinics’ internet black spots constrained setup and training; 2.) Personal phone restrictions: limited setup, training, and engagement; 3.) Elimination of the parent’s phone: provided children with digital support (a smartphone, pre-installed apps, cellular data) to allow active participation. Overall, we identified barriers hindering the use of smartwatch technology in clinical practice. More resources are needed to ensure paediatric preparedness for digital health support.

This paper examines how the creative power of storytelling through documentary film can contribute to the debate around racism and racial discrimination in Scottish Higher Education using the qualitative approach of filmed interviews with Nigerian migrants studying and working at Higher Education Institutions (HEIs). Using Critical Race Theory for data analysis, I argue that storytelling provides insights into the lived experiences of Nigerian migrants in Scotland at Scottish HEIs. The data collected for this study shows that they are not being supported or heard enough in schools based on their experiences of racism and racial discrimination and the Equality Act 2010 does not offer adequate protection for them.