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Summary: The following case report documents the investigation and progression of two cases of hepatic failure and hyperferraemia in Shetland ponies in Scotland exposed to high environmental levels of iron in groundwater, and to the authors' knowledge describes the first use of deferoxamine in adult ponies. The importance of consideration of serum iron levels in cases of equine hepatic disease is highlighted and it is suggested that reduction in serum iron by phlebotomy or treatment with deferoxamine may be beneficial in cases displaying hyperferraemia. [ABSTRACT FROM AUTHOR]

27 strains representing eight new Prevotella species were isolated from rumen of a single sheep in eight weeks interval. One of the putative species encompassing the highest number of isolated strains which also exhibited some genetic variability in preliminary data, was then selected for description of a novel species. We examined six strains in genomic and phenotypic detail, two of which may actually be the same strain isolated nearly three weeks apart. Other strains formed clearly diverged intraspecies lineages as evidenced by core genome phylogeny and phenotypic differences. Strains of the proposed new Prevotella species are strictly saccharolytic as is usual for rumen Prevotella , and use plant cell-wall xylans and pectins for growth. However, the range of cell-wall polysaccharides utilised for growth is rather limited compared to rumen generalists such as Prevotella bryantii or Prevotella ruminicola and this extends also to the inability to utilise starch, which is unexpected for the members of the genus Prevotella. Based on the data obtained, we propose Prevotella communis sp. nov. to accommodate strain E1-9T as well as other strains with the similar properties. The proposed species is widespread: two other strains were previously isolated from sheep in Japan and is also common in metagenomic data of cattle and sheep rumen samples from Scotland and New Zealand. It was also found in a collection of metagenome-assembled genomes originating from cattle in Scotland. Thus, it is a ubiquitous bacterium of domesticated ruminants specialising in degradation of a somewhat restricted set of plant cell wall components. [ABSTRACT FROM AUTHOR]

Background: Many acute hospital specialties are experiencing low recruitment and high attrition of trainees. Understanding what is important to current trainees is critical in terms of identifying and addressing factors which adversely affect recruitment and retention.Objectives: To identify and explore factors involved in anaesthetic trainees' career decision making.Methods: This was a mixed methods study using a questionnaire survey (assessing how influential 18 different factors were when choosing anaesthetics, using a five-point Likert scale), supplemented by semi-structured interviews, carried out in August-December 2014, in Scotland, UK.Results: 42/68 (62%) completed responses were received, representing over half of all core (58%) and Acute Care Common Stem (65%) trainees across Scotland. Overall, questionnaire data indicated that the following were most important in career decision making: perceived job satisfaction among those already in the specialty, structured training, the nature of the work (practical, varied, immediate outcomes). Thirteen interviews were carried out. These highlighted that prior positive exposure and experience with anaesthetists encouraged trainees into the specialty. Enthusiastic, supportive colleagues and structured training (including clear milestones, regular teaching and feedback) were considered to enhance the quality of training. Sustainable working conditions, flexibility within programme and out-of-programme opportunities were valued. Respondents reported concerns about the impact of increasing service delivery demands on training quality.Conclusions: Many of the elements important to today's anaesthetics trainees are related to positive learning and working environments. This fits with research findings from other professional groups. These findings can inform the development of programmes which cultivate trainee commitment to, and enthusiasm for, anaesthetics. [ABSTRACT FROM AUTHOR]

Cognitive--behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapist-delivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapist-delivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at posttreatment, the outcome for CBT12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT 12 and CBT6, but could not be statistically distinguished from either treatment The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation. [ABSTRACT FROM AUTHOR]

In 2000, a survey was conducted on whale-watching tourists in west Scotland. Slightly more females went whale-watching than expected and generally whale watchers were middle-aged, although there was a notable proportion of younger participants. Whale-watchers were more likely to be accompanied by children than general tourists. Whale-watchers were also predominantly middle-class and well educated. Most (83.8%) were British, a quarter of which were Scottish. Seventy percent were repeat visitors to the area. Sixty-two per cent of whale-watchers stated that they were on their first whale-watching trip, and of those who had been whale watching before, the majority (43.3%) had done so in the UK (90.4% in Scotland). Most whale-watchers (81.4%) had previously been aware of the occurrence of cetaceans in West Scotland and 75.2% could correctly name at least one local species; the most commonly cited species being the minke whale (31.7%). However, fewer than half of the tourists were aware of whale-watching opportunities in the region and 40%of whale-watchers had only become aware of whale-watching opportunities when they arrived in the area, demonstrating a need to publicise and promote the availability of whale-watching trips in West Scotland. [ABSTRACT FROM AUTHOR]

This article establishes the prevalence of Tuberous sclerosis in the Grampian region which is situated in the North East of Scotland. A list of 17 patients was drawn up from the sources within the Grampian Health Boardsources. The hospital records of these patients were reviewed using the primary criteria like: adenoma sebaceum, peri or subungual fibromas; cortical tubers, subependymal tumours and retinal hamartomas. On 30 June 1973, the prevalence for the total population was 2.93 per 1,00,000.

Objectives: A more sustainable work-life balance is desired by trainees, and increasing access to flexibility in training may improve staff morale and retention. Although a number of less than full-time (LTFT) trainees are increasing, only a minority identify as men. This study aimed to explore the perception and experience of LTFT training among postgraduate medical trainees (PMTs) identifying as men in Scotland., Design: We carried out a qualitative study using semistructured interviews with 26 male trainees who had current or previous personal experience of training LTFT in Scotland. Interviews were audio recorded, transcribed verbatim, and data was analysed inductively and iteratively using thematic analysis., Results: Our work identified four main themes: (1) the culture of work in medicine , (2) traditional gender norms and the feminisation of LTFT training , (3) the lived experience of LTFT trainees and (4) 'push and pull' factors influencing male LTFT trainees . Being an 'ideal worker' was felt to gain respect among peers and enhance masculine identity. Participants described the persistence of implicit and explicit gender norms and felt, at best, unusual and, at worst, stigmatised by their decision to train LTFT. Personal and professional benefits to LTFT training were highlighted; however, experience was varied and influenced by personal circumstances and departmental support. Both perceptual and practical barriers for male LTFT applicants were identified., Conclusions: Our study demonstrates the influence of training environment and culture on LTFT applications in Scotland. Multifaceted interventions targeting medical culture, the LTFT application process, workforce planning and communication with trainees are recommended., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Factors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not., Methods: This is a cohort study including all women delivering in Scottish hospitals between 01/01/2005 and 31/12/2018, using national healthcare databases. The primary exposure was intensive care unit (ICU) admission, while secondary exposures included high dependency unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth, and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes., Results: Of 762,918 deliveries, 1449 (0.18%) women were admitted to ICU, most commonly due to post-partum hemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations [24.5% (n = 299) vs 8.9% (n = 68,029)]. This association persisted after confounder adjustment (HR 1.93, 95% confidence interval [CI] 1.33, 2.81, p < 0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR 40.06, 95% CI 24.04, 66.76, p < 0.001), stillbirth (OR 12.31, 95% CI 7.95,19.08, p < 0.001) and neonatal critical care admission (OR 6.99, 95% CI 5.64,8.67, p < 0.001) after confounder adjustment., Conclusion: Critical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimizing long-term post-partum care may benefit maternal critical illness survivors., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To evaluate the lived experiences of doctors from minority ethnic (ME) backgrounds during postgraduate medical training, in particular their experiences of discrimination (if any); any impact of intersectionality and perceptions on how ME doctors may be better supported in their learning and working environments., Design: This was a qualitative study grounded in social constructivism, using semi-structured online individual interviews as the data collection method and an exploratory thematic analysis process., Setting: Participants were recruited from postgraduate specialist medical training programmes within one Deanery (Scotland Deanery) in the UK., Participants: Fourteen doctors in postgraduate medical specialist training, who self-identified as being from a ME background, were recruited into the study., Results: Doctors from ME backgrounds faced: Barriers to authentic interpersonal connections, with a perceived lack of social inclusion in the workplace community. ME doctors faced challenges in earning others' trust and experienced microaggressions and exclusion behaviours that affected their self-confidence. Impacts on identity and sense of belonging , with perceived challenges in being understood across diverse cultures. Doctors felt negatively pre-judged (by patients and colleagues), with additional challenges of being pre-judged in contexts of intersectionality; and ME doctors felt they needed to conceal parts of their identity in order to assimilate. Unjust systems-a playing field that is not level, where doctors felt unsupported and unable to effectively report/challenge discrimination. ME doctors perceived a lack of appropriate adjustments to the learning environment (e.g., fuller orientation) as well as inequitable processes (e.g., job and academic opportunities for those requiring visas)., Conclusions: Focused interventions to address unjust systems as well as improve intercultural awareness and understanding between all doctors may help to address some of the current inequities in medical education. Any such interventions require appropriate evaluation to determine their efficacy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: A recent review recommended UK postgraduate medical education should produce doctors capable of providing general care in broad specialties across a range of different settings. Responding to this, broad-based training (BBT) was introduced in Scotland in 2018 to provide postgraduate trainees with a grounding in four specialties. Introduced as an option for trainees after initial postgraduate 'Foundation' training, it comprises 6 months in general medicine, general practice, paediatrics and psychiatry.This study addresses two key BBT outcomes. It examines how successful BBT is in developing trainees who perceive they are able to work beyond traditional specialty boundaries to care for patients with complex, multifactorial healthcare needs. Second, it explores how well BBT prepares trainees for their next stage in training., Design: A longitudinal qualitative study using semistructured interviews to collect data from BBT trainees, trainers and 'programme architects'. Fifty-one interviews were conducted, 31 with trainees (with up to three interviews per trainee across BBT and immediately afterwards (post-BBT)) and 20 with trainers. Data were subject to thematic analysis., Results: Two overarching themes were identified: (1) trainees able to work beyond specialty boundaries and (2) preparation for the next stage in training. BBT trainees were able to see the links and overlap between different specialties and understand the interface between primary and secondary care. They did not perceive that BBT (as compared with single-specialty early-stage training) disadvantaged them, other than in terms of specialty examination preparation. BBT was seen as a way to keep career options open in a system where it is difficult to switch training pathway., Conclusions: BBT has the capacity to create doctors who will carry on using their generalist skills to care for patients more holistically, even if they end up working in focused practice areas. BBT helps to keep options open for longer, which is beneficial in a highly structured training environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: The continued professional development of staff and associate specialist doctors in the UK was ill served prior to the introduction of the new staff and associate specialist doctor's contract in 2008. The aim of this study was to independently evaluate NHS Education for Scotland's approach to improving professional development for staff and associate specialist doctors, the staff and associate specialist Professional Development Fund., Methods: Semi-structured telephone interviews with key stakeholders, framed by a realistic approach to evaluate what works, for whom and in how and under what circumstances. An inductive and data-driven thematic analysis was carried out and then the realist framework was applied to the data., Results: We interviewed 22 key stakeholders: staff and associate specialist doctors, staff and associate specialist educational advisors, programme architects and clinical directors, between end February and May 2014. The resultant data indicated five broad themes: organisational barriers to continued professional development for staff and associate specialist doctors, the purpose of funding, gains from funding, the need for better communication about the staff and associate specialist Programme Development Fund, and the interplay between individual and systems factors., Conclusion: The staff and associate specialist Programme Development Fund has changed the opportunities available to staff and associate specialist doctors in Scotland and, in that sense, has changed the context for this group - or at least those who have realised the opportunities., (© The Author(s) 2016.)

Context: Setting research priorities is important when exploring complex issues with limited resources. Only two countries (Canada and New Zealand) have previously conducted priority-setting exercises for medical education research (MER). This study aimed to identify the views of multiple stakeholders on MER priorities in Scotland., Methods: This study utilised a two-stage design to explore the views of stakeholders across the medical education continuum using online questionnaires. In Stage 1, key informants outlined their top three MER priorities and justified their choices. In Stage 2, participants rated 21 topics generated in Stage 1 according to importance and identified or justified their top priorities. A combination of qualitative (i.e. framework analysis) and quantitative (e.g. exploratory factor analysis) data analyses were employed., Results: Views were gathered from over 1300 stakeholders. A total of 21 subthemes (or priority areas) identified in Stage 1 were explored further in Stage 2. The 21 items loaded onto five factors: the culture of learning together in the workplace; enhancing and valuing the role of educators; curriculum integration and innovation; bridging the gap between assessment and feedback, and building a resilient workforce. Within Stage 2, the top priority subthemes were: balancing conflicts between service and training; providing useful feedback; promoting resiliency and well-being; creating an effective workplace learning culture; selecting and recruiting doctors to reflect need, and ensuring that curricula prepare trainees for practice. Participant characteristics were related to the perceived importance of the factors. Finally, five themes explaining why participants prioritised items were identified: patient safety; quality of care; investing for the future; policy and political agendas, and evidence-based education., Conclusions: This study indicates that, across the spectrum of stakeholders and geography, certain MER priorities are consistently identified. These priority areas are in harmony with a range of current drivers in UK medical education. They provide a platform of evidence on which to base decisions about MER programmes in Scotland and beyond., (© 2014 John Wiley & Sons Ltd.)