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There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident's quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family-staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

Objectives: This study aimed to develop and explore feasibility of SettleIN, a staff-led programme about healthy adjustment for people with dementia following care home placement. The main foci were intervention feasibility and the impact of the programme on resident quality of life and mood., Method: A manualised intervention developed through consultation with 47 experts was trialled using a mixed-method design. Thirteen new residents with dementia and 24 staff were recruited from six UK care homes. Outcomes were measured at baseline, intervention completion and four-week follow-up. Analysis of staff interviews and field notes is reported., Results: Most experts deemed SettleIN to be well structured, comprehensive and appropriate. However, uptake of SettleIN was low. When implemented, staff emphasised integration ease and staff benefits, but that SettleIN may not be universally suitable. High attrition, most commonly due to death and hospitalisation, and partial results from only four participants meant that there was a lack of support for the positive outcomes. Feasibility problems included a lack of staff time and dependency on families for some components., Conclusion: SettleIN is acceptable to a wide range of stakeholders though does not appear to be feasible in its current form and improvements are recommended. A second pilot phase is required, which will address the reasons for the high attrition rate in this study and amend the methodology accordingly. This is an important work, as a manualised and standardised approach to healthy adjustment in care is unique and could have huge clinical significance if effective.

The authors examined the feasibility of delivering an adapted version of SettleIN, a manualised staff-led programme designed to facilitate adjustment to care for new residents with dementia. The effects of SettleIN on resident adjustment, mood and quality of life were also investigated. A pilot randomised controlled trial was conducted. Nineteen new residents with dementia and 21 staff participants were recruited. Residents were randomly assigned to receive the SettleIN programme or residential care as usual. Resident quality of life, mood and overall adjustment were measured at baseline and post-intervention, in week seven. Interviews were conducted with staff in week seven to explore intervention feasibility. Despite medium to large effect sizes, there was no significant difference in mean change scores between the two conditions, with regards to quality of life, psychological wellbeing or overall adjustment outcomes. Qualitative feedback indicated that SettleIN was not feasible across all areas, with problems around recruitment and practicality. However, SettleIN was deemed feasible in terms of retention and acceptability among staff. The majority of staff felt that SettleIN was beneficial for residents but that organisational and programme factors impacted upon intervention feasibility. Further exploration of organisational barriers is needed in order to reduce the impact of such factors on care home research.

The quoted combined mortality and morbidity following carotid endarterectomy is about 5-7%. In an attempt to identify a subgroup of high risk patients, a review has been undertaken of 404 carotid endarterectomies performed between January 1985 and March 1994. The perioperative mortality rate was 2%, with 3.4% of patients experiencing transient neurological deficits and 4% permanent strokes. Multiple logistic regression analysis was used to estimate the influence on outcome of age, gender, indication for surgery, bilateral internal carotid artery disease, hypertension and smoking. No significant explanators were identified.

The recent North American Symptomatic Carotid Endarterectomy Trial has answered fairly conclusively the questions concerning the optimal management of patients with symptoms who have a > 70% stenosis of the internal carotid artery. It has also had the effect of refocusing attention on carotid pathology. The main question still to be answered is whether surgical management is the optimum treatment for other groups of patients with carotid disease. From various studies done on the natural history of carotid plaques it is apparent that there are subgroups who may benefit from surgery, namely those who will progress to stroke if not treated. The problem comes in identifying these subgroups by the factors which cause them to progress. This paper aims to review the role that plaque morphology has in the development of symptoms and whether it should be included with degree of stenosis in assessing the risk of a carotid plaque. The non-invasive assessment of plaque morphology is also reviewed. The evidence from this review does not support the use of plaque morphology as a discriminating factor for carotid endarterectomy at present.

The ability of vein to dilate may allow smaller veins to be used for bypass if this change could be predicted. Sixty patients undergoing femorodistal popliteal or infrapopliteal bypass have had their long saphenous vein studied. Diameter measurements of the long saphenous vein have been performed using an ATL Duplex scanner at the groin, mid-thigh and knee. Measurements were performed preoperatively both at rest and with a venous occlusion cuff to dilate the vein and subsequently at 7 days and 3, 6, 9, 12 months after implantation. The mean diameter of the vein at the mid thigh was 4.2 mm non dilated, 5.1 mm with occlusion, 5.4 mm 7 days postoperatively and 5.5 mm at 12 months (p < 0.01 ANOVA). The mean diameter of the vein at the knee was 3.8 mm non-dilated, 4.8 mm with occlusion, 4.8 mm at 7 days and 5.0 mm at 12 months after operation (p < 0.01 ANOVA). If the minimum resting internal diameter of vein regarded as being suitable for bypass was 3 mm, this technique would have increased the vein utilisation rate by 22%. These results show that by using a technique of venous occlusion at the time of preoperative vein mapping the adaptive response of the vein can be predicted and this can result in an increased rate of vein utilisation.

Velocity measurements in major blood vessels were obtained in studies of volunteers using magnetic resonance imaging (MRI) and compared with Doppler ultrasound (US). The vessels studied were the abdominal aorta, superior mesenteric artery, common carotid artery, superficial femoral artery and middle cerebral artery. Using a paired t-test, no significant difference was found between velocity values estimated by MRI and US (p > 0.08). The relative advantages of each technique in radiological practice are discussed.

BIPAS, a computerised vascular audit has been used to analyse the results of 203 carotid endarterectomies performed over a 5-year period in a vascular unit. In addition, all but two patients have been followed up with regular duplex scans. The indications and surgical techniques have remained similar over the study period though preoperative carotid arteriography is no longer considered essential and intraoperative monitoring with transcranial Doppler insonation is becoming routine. There were six perioperative deaths and 20 postoperative neurological defects. However, only three survivors had any long-term disability. It was not possible to identify any particular patients at high risk of perioperative stroke, although simultaneous major surgery and significant bilateral carotid endarterectomy seemed to be more hazardous. Routine follow-up using duplex scanning identified patients with late occlusion (5%) and restenosis (8%), but only three patients (1.5%) suffered a late stroke. Once the perioperative hazards of death and permanent stroke (4.4% in this series) have been overcome, carotid endarterectomy provides good protection against subsequent stroke.

This audit of vascular surgical operations from a Teaching Hospital vascular unit was facilitated by computerised data collection. A total of 2075 patients had 2628 procedures over the 6-year period 1985-1990. Vascular workload increased by 50% to almost 350 primary reconstructions per year. In Bristol, vascular patients now occupy 19% of surgical bed-days. Mean stay for vascular patients is twice as long as for general surgical patients (14 days vs. 6 days) and three times as long for patients having secondary reconstructions (18 days) or those with critical limb ischaemia (21 days). Mortality and reoperation rates remained relatively constant throughout the study period. The overall mortality rate was 10.4%, being highest for ruptured aortic aneurysms (31.9%) and lowest for carotid endarterectomy (1.7%). Early reoperation for the complications of vascular reconstruction was required in 9.1% cases, being most frequent for femoro-tibial grafts (26.1%) and least for carotid endarterectomy (1.7%). Vascular surgery is expensive, time consuming and on the increase in Bristol. Comprehensive computerised audit of vascular operating is essential both for patients who benefit from the maintenance of high standards, and also for surgeons whose results this year will determine the cost and volume of next year's contracts.

The diameter of the long saphenous vein has been shown to affect the outcome of femoro-distal bypass. Many surgeons regard a vein with a diameter of less than 3 mm as being unsuitable. The long saphenous vein was studied in 35 patients undergoing femoro-distal bypass. Diameter measurements of the vein were performed using an ATL duplex scanner at the groin, mid-thigh and knee. Measurements were performed preoperatively both at rest and with a venous occlusion cuff to dilate the vein, and subsequently at 7 days and 2 months after implantation. The mean diameter of the vein at the mid-thigh was 4.1 mm non-dilated, 5.1 mm with occlusion, 5.0 mm 7 days postoperatively and 5.2 mm at 2 months (ANOVA, p less than 0.05). The mean diameter of the vein at the knee was 3.9 mm non-dilated, 4.8 mm with occlusion, 4.8 mm at 7 days and 4.9 mm at 2 months after operation (ANOVA, p less than 0.025). In all five patients whose preoperative resting vein diameter at the knee or mid-thigh was less than 3 mm, preoperative dilatation occurred, such that the diameter became greater than 3 mm. These results suggest that by using a technique of venous occlusion at the time of pre-operative vein mapping, the functional diameter of the vein can be predicted and vein utilisation may be increased.