Primary care transformation in Scotland: a comparison two cross-sectional national surveys of general practitioners' views in 2018 and 2023.

Background: The 2018 Scottish GP contract established GP Clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested sub-optimal progress.

Aim: To quantify progress since the introduction of the new contract.

Lessons learned from bovine subclinical endometritis: A systematic review exploring its potential relevance to chronic endometritis in women.

Chronic endometritis (CE) in humans is asymptomatic inflammation of the endometrium, associated with poor reproductive outcomes. Similarly asymptomatic endometrial inflammation in cows, termed subclinical endometritis (SCE), is associated with adverse reproductive outcomes. While the pathophysiology and treatment options for CE in humans remains poorly defined, the financial implications of SCE in dairy cows mean it has been intensively researched.

Patient stratification using plasma cytokines and their regulators in sepsis: relationship to outcomes, treatment effect and leucocyte transcriptomic subphenotypes.

Rationale: Heterogeneity of the host response within sepsis, acute respiratory distress syndrome (ARDS) and more widely critical illness, limits discovery and targeting of immunomodulatory therapies. Clustering approaches using clinical and circulating biomarkers have defined hyper-inflammatory and hypo-inflammatory subphenotypes in ARDS associated with differential treatment response. It is unknown if similar subphenotypes exist in sepsis populations where leucocyte transcriptomic-defined subphenotypes have been reported.

CD, or not CD, that is the question: a digital interobserver agreement study in coeliac disease.

Objective: Coeliac disease (CD) diagnosis generally depends on histological examination of duodenal biopsies. We present the first study analysing the concordance in examination of duodenal biopsies using digitised whole-slide images (WSIs). We further investigate whether the inclusion of immunoglobulin A tissue transglutaminase (IgA tTG) and haemoglobin (Hb) data improves the interobserver agreement of diagnosis.

Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome.

Background: The diagnosis of acute aortic syndrome (AAS) is commonly delayed or missed in the ED. We describe characteristics of ED attendances with symptoms potentially associated with AAS, diagnostic performance of clinical decision tools (CDTs) and physicians and yield of CT aorta angiogram (CTA).

Methods: This was a multicentre observational cohort study of adults attending 27 UK EDs between 26 September 2022 and 30 November 2022, with potential AAS symptoms: chest, back or abdominal pain, syncope or symptoms related to malperfusion.

Quantitative measurement of empathy and analysis of its correlation to clinical factors in korean patients with chronic diseases.

Background: Empathy is the core of the physician-patient relationship. The Consultation and Relational Empathy (CARE) measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in chronic disease patients in Korea.

Extent of illicit cigarette market from single stick sales in Ghana: findings from a cross-sectional survey.

Objective: This study aims to measure the extent of illicit cigarette consumption from single stick sales, to determine the nature and types of illicit cigarettes present in Ghana, and to identify the factors associated with illicit cigarette consumption in Ghana.

Design: A cross-sectional study using empty cigarette packs generated by 1 day's single stick cigarette sales collected from cigarette vendors.

Setting: Five large cities (Accra, Kumasi, Takoradi, Tamale and Bolgatanga) and three border towns (Aflao, Paga/Hamele and Elubo) in the northern, middle and coastal belt of Ghana.

Treatment and outcomes of non-aneurysmal perimesencephalic subarachnoid haemorrhage: A 5 year retrospective study in a tertiary care centre.

Purpose: Perimesencephalic Subarachnoid Haemorrhage (PMSAH) is an uncommon type of SAH. Severity of PMSAH can be graded by the presence of blood in the Sylvian fissure. No study compares the outcomes from PMSAH with blood present or absent in the Sylvian fissure.

Chronic disease care integration into primary care services in sub-Saharan Africa: a 'best fit' framework synthesis and new conceptual model.

Objective: To examine the relevance of existing chronic care models to the integration of chronic disease care into primary care services in sub-Saharan Africa and determine whether additional context-specific model elements should be considered.

Design: 'Best fit' framework synthesis comprising two systematic reviews. First systematic review of existing chronic care conceptual models with construction of a priori framework.

Duration of External Neck Stabilisation (DENS) following odontoid fracture in older or frail adults: protocol for a randomised controlled trial of collar versus no collar.

Introduction: Fractures of the odontoid process frequently result from low impact falls in frail or older adults. These are increasing in incidence and importance as the population ages. In the UK, odontoid fractures in older adults are usually managed in hard collars to immobilise the fracture and promote bony healing.

Survey to identify research priorities for primary care in Scotland during and following the COVID-19 pandemic.

Objectives: To identify research priorities for primary care in Scotland following the COVID-19 pandemic.

Design: Modified James Lind Alliance methodology; respondents completed an online survey to make research suggestions and rank research themes in order of priority.

Setting: Scotland primary care.

Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme.

Background: There is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence.

Aim: To qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme.

Marked and widening socioeconomic inequalities in type 2 diabetes prevalence in Scotland.

Background: This study investigated the association between socioeconomic status and type 2 diabetes (T2D) prevalence in Scotland in 2021 and tested the null hypothesis that inequalities had not changed since they were last described for 2001-2007.

Methods: Data from a national population-based diabetes database for 35-to-84-year-olds in Scotland for 2021 and mid-year population estimates for 2019 stratified by sex and fifths of the Scottish Index of Multiple Deprivation were used to calculate age-specific prevalence of T2D. Age-standardised prevalence was estimated using the European Standard Population with relative risks (RRs) compared between the most (Q1) and least (Q5) deprived fifths for each sex, and compared against similar estimates from 2001 to 2007.

Measuring differential attainment: a longitudinal analysis of assessment results for 1512 medical students at four Scottish medical schools.

Objective: To measure Differential Attainment (DA) among Scottish medical students and to explore whether attainment gaps increase or decrease during medical school.

Design: A retrospective analysis of undergraduate medical student performance on written assessment, measured at the start and end of medical school.

Setting: Four Scottish medical schools (universities of Aberdeen, Dundee, Edinburgh and Glasgow).

100 years on: the impact of the discovery of insulin on clinical outcomes.

Throughout history, up to the early part of the 20th century, diabetes has been a devastating disorder, particularly when diagnosed in childhood when it was usually fatal. Consequently, the successful pancreatic extraction of insulin in 1921 was a miraculous, life-changing advance. In this review, the truly transformative effect that insulin has had on the lives of people with type 1 diabetes and on those with type 2 diabetes who are also dependent on insulin is described, from the time of its first successful use to the present day.

COVID-19-associated ischaemic stroke despite use of anticoagulation.

A 64-year-old female nurse was admitted to hospital following fever, cough, shortness of breath and low blood pressure. She tested positive for COVID-19 and was treated on a high-dependency unit and prescribed enoxaparin, a prophylactic anticoagulant. Eight days later, she suffered a left middle cerebral artery ischaemic stroke.

Progressive encephalomyelitis with rigidity and myoclonus (PERM).

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a subtype of stiff-person syndrome (formerly stiff-man syndrome). It is rare and disabling, and characterised by brainstem symptoms, muscle stiffness, breathing issues and autonomic dysfunction. We describe a 65-year-old man who presented with odynophagia together with tongue and neck swelling, followed by multiple cranial nerve palsies culminating in bilateral vocal cord paralysis with acute stridor.

Congenitally corrected transposition of the great arteries (CCTGA).

A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema.

Cerebral microbleeds: from depiction to interpretation.

Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation.