Search

Synthetic cannabinoid receptor agonists (SCRAs) have been a concern to forensic toxicologists since their emergence as drugs of abuse in the mid-late 2000s. The extent of their use in Scotland appears to be low especially when compared to other drug groups such as opioids and benzodiazepines. There is a concern, however, that the use is widespread in prison populations in particular. In this work, samples of blood and urine collected during routine postmortem examination between April 2017 and March 2019 were subjected to analysis of SCRA compounds. Circumstantial and demographic information was collected on positive cases to build up a body of evidence for where SCRAs may be most likely to contribute to the cause of death. Thirteen out of 133 cases (10%) tested were positive for one or more compound in one or more matrix. Overall, the detection of 5F-MDMB-PINACA or its O -desmethyl acid metabolite was most common, followed by the metabolite shared by AB-FUBINACA and MMB-FUBINACA. SCRA-positive cases were predominantly males (92%), and the age range of all decedents was 21–49 years old (median 36 years). The majority of cases were certified as drug-related deaths (DRDs, 38%), natural/medical (31%) or suicide (23%), and two of the DRDs mentioned SCRAs specifically in the cause of death. The concentrations of SCRAs detected did not seem to be as important to the determination of the cause of death as their mere presence, but quantitative results were reported (where possible) in order to build up a body of evidence for SCRA concentrations in different case types. [ABSTRACT FROM AUTHOR]

Long‐finned pilot whale (Globicephala melas) mitochondrial (mtDNA) genetic diversity is considered low, especially in the North Atlantic, where only seven haplotypes have been recorded in previous studies using a 345 bp control region fragment. Such studies have not included samples from Ireland or the Netherlands. In this study we analyzed a longer sequence of the mtDNA control region (631 bp) from individuals stranded around Ireland, Scotland, and the Netherlands between 1995 and 2019 (n = 180). Nine haplotypes were identified, of which five were newly described (haplotype diversity h = 0.511). Pairwise tests revealed significant differentiation between the Irish and Scottish samples. Potential confounding factors are discussed but given that failure to recognize population structure may compromise conservation efforts, the findings show the need for further investigation using nuclear markers. Six mass stranding events were included, of which one event reported two haplotypes among individuals confirming a mixing of matrilineal groups. Although the permanence of this combination cannot be determined, this is the first record of such an occurrence within the North Atlantic. This study shows that stranding sample databases are a useful resource for genetic studies and provides new insights into genetic diversity of long‐finned pilot whales in the eastern North Atlantic and adjacent waters. [ABSTRACT FROM AUTHOR]

Background: Playlist for Life is a brief, inexpensive music listening intervention which originated in dementia care, but is increasingly being used for people at the end of life. However, there is a lack of robust empirical research on its application in the hospice setting. Our patient and public involvement group originated the idea for this study. The aim of this feasibility study was to inform the design of a larger effectiveness study on the use of Playlist for Life in the hospice setting. Method: This study was a mixed-methods feasibility study involving adults at the end of life, family members and hospice staff from one in-patient hospice in Scotland. Eligible patient/family member dyads were approached by hospice staff and if interested, recruited by the researcher. All included participants received the intervention, which involved the provision of an MP3 player and assistance to set up a playlist. Participants were asked to listen to the playlist daily during the intervention period (7 days). Data were collected through patient reported outcome measures and on days 1, 3 and 7 of the intervention period and through participant observation session. Patient/family member dyads and hospice staff also took part in qualitative interviews (Appendix 1) post-intervention, which were audio-recorded, transcribed and analysed thematically. Semi-structured interviews at the end of the intervention period were used to evaluate feasibility and acceptability. An advisory group including patients, family members and staff gave helpful feedback on the qualitative interview questions. Interview questions were the same for all participants and all the questions were asked to all participants. Results: N = 15 participants were recruited (n = 5 patients, n = 5 family, n = 5 staff. The intervention was appraised positively, particularly regarding its beneficial effect on patient/family relationships. The study design was deemed feasible and acceptable. Conclusion: The findings of this study will inform the development of a future randomised cluster trial designed to assess the usability and effectiveness of the Playlist for Life personalised music intervention. Trial registration: This study was not registered as this was a small feasibility study, conducted prior to a pilot study not testing for effectiveness. In addition, the study was non-randomised. The study is registered with NHS ethics and the hospice research and governance team [ABSTRACT FROM AUTHOR]

Background: Physical activity is recommended after stroke but levels for stroke survivors are typically low. The use of indoor recumbent cycling, delivered through local government leisure facilities, may increase access to exercise among stroke survivors. Objective: This study aimed to evaluate the acceptability and feasibility of an indoor cycling program delivered through existing local government services. Methods: Participants were recruited through stroke liaison nurses and public advertising. After a home visit to assess eligibility and conduct psychological and general health assessments, participants attended their local leisure center for an initial fitness test and short battery of physical tests. Then, an 8 week training program was designed with weekly goals. Following the program the assessments were retaken along with an evaluation questionnaire. In-depth, semi-structured, interviews were conducted with 15 participants and five fitness coaches. Results: One hundred fifteen individuals volunteered to participate during a 10-month recruitment period, 77 met the inclusion criteria and consented, 66/77 (86%) completed the program including all nine non-ambulatory participants. The program and procedures (recruitment and outcome measures) were feasible and acceptable to participants (81% reported following the program). Participants were generally very positive about the experience. Significant improvements in sit-to-stand capacity (Mpre = 25.2 s, Mpost = 19.0 s, p =.002), activities of daily living (NEADL, Mpre = 12.2, Mpost = 13.2, p =.002), psychosocial functioning (SAQOL, Mpre = 3.82, Mpost = 4.15, p =.001), energy (SAQOL, Mpre = 3.75, Mpost = 4.02, p =.018) and depression (GHQ, Mpre =.97, Mpost =.55, p =.009) were observed. Conclusion: A cycling-based exercise program delivered through local leisure center staff and facilities was shown to be feasible and acceptable for people living with stroke. [ABSTRACT FROM AUTHOR]

Ethylphenidate is a psychostimulant and analogue of methylphenidate. Interestingly it is also produced as a metabolite from the co-ingestion of methylphenidate and alcohol (ethanol). In the UK, between April and June 2015, ethylphenidate and 6 other methylphenidate based novel psychoactive substances (NPS) were subjected to a temporary class drug order under the Misuse of Drugs Act 1971. Ethylphenidate is being abused by both novel and habitual drug users, more prominently in the East of Scotland. What is unknown in the literature is the contribution of ethylphenidate in deaths. A search was conducted for an 18 month period (July 2013 to December 2014) to identify cases where ethylphenidate was detected during post-mortem toxicological analysis. Nineteen cases were identified and these cases were examined with regards to case circumstances, pathology findings, toxicology results and adverse effects. The individuals ranged in age from 20 to 54 (median 37) and the majority were male (n=14) and from the East of Scotland (n=16), more specifically Edinburgh and surrounding area. Current or previous heroin abuse was a common theme in these cases (n=16) and injection was a common route of administration of "legal highs" or "burst". The concentration of ethylphenidate in the cases ranged from 0.008 mg/L to over 2 mg/L in post-mortem femoral blood (median 0.25 mg/L, average 0.39 mg/L). Other drugs commonly detected were benzodiazepines (n=15), followed by opiates (n=11, 4 of which were positive for 6-monoacetylmorphine) and then methadone (n=8). All 19 cases received a full post-mortem examination and there were 10 cases where drug toxicity was the sole or potentially contributory factor to the cause of death. Ethylphenidate was specifically mentioned in the cause of death for 5 cases, chronic intravenous (IV) drug use was named as part of the cause of death for 2 cases and in 6 cases there was evidence of complications and infections through IV drug use. As far as it is known to the authors, this is the first review of post-mortem cases involving the use of ethylphenidate in East and West Scotland. This study can be used as a guide for toxicologists and pathologists when interpreting cases which are positive for ethylphenidate. [ABSTRACT FROM AUTHOR]

Purpose -- Learning Disability Statistics Scotland collects information on adults with learning disabilities who are known to local authorities in Scotland and the services they use. The data collection supports national and local government policy making and is focused on monitoring the implementation of learning disability policy. The paper aims to discuss these issues. Design/methodology/approach -- Individual level data are requested from all 32 local authorities on adults aged 16-17 who are not in full-time education and those aged 18 and over . Annual data guidance is developed in conjunction with local authorities prior to the collection and is issued to standardise the process and manage avoidable error . The collated data are extracted from local authority administrative data and records are provided on each adult regardless of whether they are currently receiving a service. Anonymisation takes place prior to upload and strict guidelines are followed to ensure it is not possible to identify individuals. Findings -- The paper provides insights to the project's processes, uses, challenges and future plans. It details the position of the data outputs within a policy context and the role these might play within a broader research agenda. Research limitations/implications -- This data includes only adults known to local authority services. Originality/value -- The value of the project lies in its strength as a national social care data set comprised of individual level data. This methodology increases the analytical potential of the data set. This paper will be of interest to those interested in data on learning disability and those with an interest in the analytical potential of an individual level national data set. [ABSTRACT FROM AUTHOR]

Context: In recent years numbers of referrals to intensive care units (ICU) throughout the United Kingdom has been increasing. A number of referrals to the ICU are considered to be inappropriate for a variety of reasons, including those patients who are felt to be either too well for admission, or have comorbidities making survival unlikely and aggressive interventions unsuitable. Objectives: This study aims to examine the outcomes and symptoms in those patients who are unsuitable for admission to ICU. By looking at this population we hope to ascertain if this is an at-risk group in terms of symptomatic or care needs at the end of life. Methods: This was as an observational prospective study with the sample population identified via the ICU referrals process. All patients referred to the ICU for admission but deemed unsuitable were recorded and followed up by researchers on the wards. Results: Fifty patients were identified between January and April 2009. Outcomes at one week were split between 'death' (34%), 'discharge' (24%), and ongoing illness/rehabilitation (40%). Levels of comorbidity were high, with a corresponding prevalence of severe breathlessness in all outcome groups. Conclusion: The results suggest there are small numbers of patients with uncontrolled symptoms who could benefit from specialist input from the palliative care team. The identification of the imminently dying should facilitate appropriate communication of this by clinical staff and allow the relevant social, psychological, and spiritual preparations for death that are the hallmark of good care of the dying. [ABSTRACT FROM AUTHOR]

The role of anaesthetic practitioner was established in England using the National Anaesthesia Practitioner Curriculum Framework (Department of Health 2005) and is now being adopted in Scotland. This article reports part of a 29-month evaluation of the first two cohorts of physician assistant (anaesthesia) students as they progressed through their education programme, and discusses the management of integrating this role in clinical practice. [ABSTRACT FROM AUTHOR]

The article examines the social-housing scheme of Westerton Road project completed by Page + Park Architects in Grangemouth, Scotland. It is stated that the project reveals the necessary self-efficacy honesty and endeavor deployed to make good domestic spaces and good place to live. The project has 52 housing units to the hectare and its location is a compact quasi-urban centre with a working port and an important transport interchange.

The aim of this population based study was to assess the incidence, mechanisms, management, and outcome of patients who sustained hepatic trauma in Scotland (population 5 million) over the period 1992–2002. The Scottish Trauma Audit Group database was searched for details of any patient with liver trauma. Data on identified patients were analyzed for demographic information, mechanisms of injury, associated injuries, hemodynamic stability on presentation, management, and outcome. A total of 783 patients were identified as having sustained liver trauma. The male-to-female ratio was 3:1 with a median age of 31 years. Blunt trauma (especially road traffic accidents) accounted for 69% of injuries. Liver trauma was associated with injuries to the chest, head, and abdominal injuries other than liver injury: most commonly spleen and kidneys. In all, 166 patients died in the emergency department, and a further 164 died in hospital. The mortality rate was higher in patients with increasing age (p < 0.001), hemodynamic instability (p < 0.001), blunt trauma (p < 0.001), and increasing severity of liver injury (p < 0.001). The incidence of liver trauma in Scotland is low, but it accounts for significant mortality. Associated injuries were common. Outcome was worse in patients with advanced age, blunt trauma, multiple injuries and those requiring an immediate laparotomy. [ABSTRACT FROM AUTHOR]

Presents a study assessing the incidence, mechanisms, management and outcome of patients who sustained hepatic trauma in Scotland. Prevalence of road traffic accidents; Association of liver trauma with injuries to the chest, head and spine; Correlation of mortality with increasing age, hemodynamic instability, blunt trauma and increasing severity of the injury.

Substantial uncertainties exist regarding how future climate change will affect storminess (storm frequency and intensity) in Ireland and the United Kingdom (UK). Knowledge about spatiotemporal variations of past storminess gives us a better understanding of its mechanisms on centennial to millennial time scales, as well as the impact of external forcing on future storminess in climate models. Here, we present the oldest storm record to date from Ireland, covering the last 8000 years, reconstructed from the Roycarter Bog, a coastal blanket bog in north-western Ireland. The sequence was analysed for grain-size, chemical, mineral and organic molecular composition. The chronology was built on 11 AMS radiocarbon dates. The deposit characteristics, location and low inorganic content suggest aeolian transport of particles to the bog throughout the studied period. Cluster analysis of the grain-size frequency curves, along with the coarse to fine sand ratio, allowed the identification of eleven storm periods (cal yr BP): 6150–5500 (1); 4970–4130 (2); 4000 (3); 3490–3290 (4); 3230 (5); 2850–2590 (6); 2170–1920 (7); 1440 (8); 1225–890 (9); 620–470 (10); and 290–230 (11). During the mid-Holocene, the relative sea level was lower and the local beach sources located further away, giving a longer transport distance compared to the late Holocene. In the latter part of the mid-Holocene (6150–4130 cal yr BP), during the Holocene thermal maximum, increased storminess and wind strengths were inferred for north-western Ireland, manifested as two longer storm periods. During the late Holocene the storm frequency increased, and a greater number (9) of shorter storm periods were recorded. Comparison between our results and regional peat palaeostorm records from Scotland, north of our study site, showed an antiphase relationship between storminess in Ireland and Scotland during the latter part of the mid-Holocene, but mostly in-phase storminess over the last 3000 years. Taken together, enhanced wind strength and storminess were recorded during the warmer mid-Holocene, while an increased frequency of storm events occurred in the cooler late Holocene. Mid-Holocene storm periods occurred during locally wet periods, while most of the storm periods during late Holocene occurred during drier phases. Alternatively, the elevated mineral input during late Holocene promoted microbial activity and peat decomposition. The apparent variability in cyclicity and frequency between the mid- and late Holocene indicates that the processes governing storminess in the region shifted. This calls for further studies ahead, including climate modelling, to disentangle the complex processes governing storminess on millennial to centennial time scale. • Multiproxy palaeostorminess reconstruction from northwestern Ireland. • 11 storm periods (SP) inferred during the last 8000 years. • SP varied in duration and frequency between the mid- and late Holocene. • Comparison with regional palaeostorm studies indicates spatial shifts in the storm track. • The driving mechanisms likely shifted between the mid- and late Holocene. [ABSTRACT FROM AUTHOR]

Aim The emergency department (ED) is an area where major airway difficulties can occur, often as complications of rapid sequence induction (RSI). We undertook a prospective, observational study of tracheal intubation performed in a large, urban UK ED to study this further. Methods We reviewed data on every intubation attempt made in our ED between January 1999 and December 2011. We recorded techniques and drugs used, intubator details, success rate, and associated complications. Tracheal intubation in our ED is managed jointly by emergency physicians and anaesthetists; an anaesthetist is contacted to attend to support ED staff when RSI is being performed. Results We included 3738 intubations in analysis. 2749 (74%) were RSIs, 361 (10%) were other drug combinations, and 628 (17%) received no drugs. Emergency physicians performed 78% and anaesthetists 22% of intubations. Tracheal intubation was successful in 3724 patients (99.6%). First time success rate was 85%; 98% of patients were successfully intubated with two or fewer attempts, and three patients (0.1%) had more than three attempts. Intubation failed in 14 patients; five (0.13%) had a surgical airway performed. Associated complications occurred in 286 (8%) patients. The incidence of complications was associated with the number of attempts made; 7% in one attempt, 15% in two attempts, and 32% in three attempts ( p < 0.001). Conclusion A collaborative approach between emergency physicians and anaesthetists contributed to a high rate of successful intubation and a low rate of complications. Close collaboration in training and delivery of service models is essential to maintain these high standards and achieve further improvement where possible. [ABSTRACT FROM AUTHOR]

Summary Background: Intubation of children in the emergency department setting is uncommon. This prospective observational study examines the practice of paediatric intubation in Scottish adult/paediatric urban emergency departments. Methods: A prospective observational study of every intubation attempt was performed in seven urban Scottish emergency departments in 1999 and 2000. Children were defined as those patients who were less than 13 years of age on the day of presentation. Prehospital intubations were only included if they were performed by a mobile medical team doctor from one of the seven hospitals. Results: A total of 1713 patients were identified, 44 of whom (2.6%) were children. The median age was 4 years (range 0–12 years), and 57% (25 of 44) of intubations were performed on patients with traumatic injuries. Emergency physicians attempted intubation in 27% (12 of 44) of cases, anaesthetists in 73% (32 of 44); 18% (eight of 44) of patients were intubated in nontraumatic cardiac arrest, 68% (30 of 44) underwent rapid sequence intubation (RSI), one (2%) had inhalational anaesthesia and 13 (30%) were intubated without drugs. Eighty per cent (35 of 44) of patients were intubated at the first attempt; eight patients required two attempts, and one required three attempts. Three children were intubated prehospital by mobile medical teams. Emergency physicians intubated more patients with ‘physiological compromise’ (100% vs 91%). Conclusions: Paediatric intubation in the emergency department is uncommon. Collaboration and appropriate training for doctors in emergency medicine, anaesthesia and paediatrics is essential. [ABSTRACT FROM AUTHOR]

Objective: Motor neuron disease is a rapidly progressing neurological condition. People with life-limiting conditions generally prefer to die at home and avoid hospital admissions, with Specialist Palliative Care Team involvement often pivotal. Our aim was to investigate the role of advance care planning, Specialist Palliative Care Team input and other relevant variables on place of death and unscheduled hospital admissions in a Scottish population of people with motor neuron disease. Methods: National CARE-MND audit data, primary and secondary care data, and local Palliative Care records were interrogated. Chi-square, point-biserial correlation and binary logistic regression analysed associations (p < 0.05 statistically significant). Participants (188) were deceased, having a verified motor neuron disease diagnosis between 2015-2017, diagnosis occurring ≥28 days before death. Results: Advance care planning and Specialist Palliative Care Team input of ≥28 days were associated with increased odds of dying outside hospital (BLR:OR 3.937, CI 1.558-9.948, p = 0.004 and OR 2.657, CI 1.135-6.222, p = 0.024 respectively). Non-invasive ventilation decreased the odds of dying outside hospital (BLR:OR 0.311, CI 0.124-0.781, p = 0.013). Having a gastrostomy increased odds of ≥1 admissions in the last year of life (BLR:OR 5.142, CI 1.715-15.417, p = 0.003). Statistical significance was retained with removal of gastrostomy-related complications. Conclusion: Early Specialist Palliative Care input and advance care planning may increase the likelihood of death outside of hospital for persons with motor neuron disease. Further research is warranted into barriers of facilitating death outside of hospital with home non-invasive ventilation use and the association between gastrostomy status and unscheduled admissions., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population., Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a 'typical' caseload from 2019., Design: Service evaluation based on a retrospective cohort review of patient records., Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020., Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a 'typical' caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p  < 0.001) and had a higher death rate (80.6% vs 30.3%; p  < 0.001). The COVID-19 cohort replaced 'typical' caseload; overall numbers of referrals were not increased., Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from 'typical' caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.

Background: Due to a growing drug misuse problem in Scotland, GPs increasingly are being called upon to deal with and treat misusers. With the publication of government guidelines in 1999, debate on this subject has intensified, with some GPs questioning their role in the treatment of drug misuse., Objectives: This study explored, in depth, GPs' views and experiences of providing services for drug misusers such as methadone maintenance, use of guidelines and shared care schemes. Factors influencing their treatment of drug misusers were covered., Methods: Forty-eight semi-structured GP telephone interviews were conducted and their responses recorded, transcribed and analysed using qualitative content analysis. The sample was purposive and included a spread of individuals from varying age groups, levels of involvement with drug misuse and training, as well as gender and health board. Transcripts were validated with a 50% sample of interviewees, allowing them to correct any opinions they felt were not represented accurately., Results: GPs increasingly accept a role in the treatment of drug dependency, although a shared care model was preferred due to the workload implications of this patient group. A drawback of shared care was long waiting lists. Patient behaviour emerged as a strong theme influencing treatment, and safety concerns were evident. Views of methadone maintenance were mixed, and it was considered as the only real option available., Conclusion: Themes identified from the interviews reinforced the patterns of past research. GPs are becoming more confident and comfortable with misusers, and more positive towards methadone and methadone maintenance treatment, but still feel that they lack the necessary knowledge and skills.