NHS Ayrshire and Arran

Objectives: This study aims to retrospectively analyse the outcome of palliative endoscopic biliary stenting (EBS) in very elderly patients aged 80 years and above with choledocholithiasis.Methods: Between September 2017 and January 2022, the endoscopy unit at Universiti Malaya Medical Centre (UMMC) conducted 85 ERCP procedures on patients aged 80 and above, who had been diagnosed with choledocholithiasis. The study sample was narrowed down to 11 patients who had received palliative EBS after excluding cases where stone removal was done and patients undergoing active management. Information regarding the patients’ medical records, including their past medical history, details of the endoscopic retrograde cholangiopancreatography (ERCP) procedure with palliative EBS, and their subsequent follow-up records, was gathered from the UMMC electronic medical record.Results: Out of the 11 patients included in the study, six patients (54.44%) experienced recurrent cholangitis, with a median interval of 534 days from the date of index ERCP to the onset of the first recurrence. Two of the six patients (33.33%) who experienced recurrence were able to achieve stone clearance after undergoing repeat ERCP. Among the five patients who remained recurrence-free, the median follow-up duration was 120 days. In addition, out of the study cohort, seven patients (63.64%) passed away during the follow-up period, with only one patient (14.29%) dying due to recurrent cholangitis, while the other six patients (85.71%) died of their co-morbidities.Conclusion: ERCP with palliative EBS can be a feasible alternative for very elderly patients with complex medical issues; however, it is imperative to ensure close follow-up and careful monitoring during the post-treatment period.

Maritime traffic poses a variety of risks to both the marine environment and marine wildlife. To quantify and predict risk, accurate data on the distribution and densities of vessel traffic is required, yet currently there is no single data type that captures all vessel traffic. Most commonly, AIS (Automatic Identification System) vessel tracking data is used, despite awareness that AIS data does not fully capture all vessels present. Therefore, evaluations using only AIS likely underestimate the potential impacts. To estimate the scale of underestimation, vessel presence within six of Scotland's Marine Protected Areas (MPAs) were recorded during >1800 h of land-based and at-sea surveys, and compared with AIS data collected from a network of receivers deployed around Scotland. Non-AIS vessels were present within MPAs during 62 % of the surveyed period, with 64 % of vessels sighted not broadcasting AIS. AIS transmission rates varied between MPA, season and vessel type. Given that AIS data is the most commonly used data type for quantifying vessel activity and predicting associated impacts, consideration must be given to the volume of vessel traffic not represented within AIS datasets, particularly within MPAs. Underestimation of actual vessel traffic is likely leading to insufficient management or mitigation efforts within areas designated for protection. • AIS (Automatic Identification System) data often used to represent vessel traffic. • Surveys conducted across Scottish Marine Protected Areas. • AIS data did not represent vessel traffic within MPAs 62 % of the time. • 64 % of powered vessels sighted within MPAs were not broadcasting AIS. • Risk predictions using only AIS would underestimate the scale of potential impacts.

Background People with a learning disability (PWLD) are living longer with a greater need for palliative care. Research has identified that people with a learning disability experience challenges when accessing palliative care with concerns that person-centred care is not being achieved. Aim The overall aim of this study is to present a meta-synthesis of qualitative studies. Focusing on the challenges of achieving person-centred care for PWLD and palliative care needs, to gain a deeper understanding of the challenges they experience. Method A qualitative meta-synthesis literature review using a seven-phased model by Noblit and Hare was undertaken. An online literature search was conducted between 8 July 2024 and 31 July 2024 across four databases: SAGE publications, PubMed, Wiley Online Library and CINAHL. Results 10 studies were reviewed with 226 participants ranging from PWLD, support workers, health professionals and family members. Main themes identified were: a deficiency of knowledge, the importance of the environment, challenges in achieving effective communication and advance care planning to achieve better outcomes. Conclusion This qualitative meta-synthesis identifies the challenges of achieving person-centred care for PWLD and palliative care needs. It draws attention to person-centred theory and how this supports good person-centred care for PWLD. This paper went further to identify how person-centred theory links with the wider context of healthcare practice while exploring recommendations to improve practice and gaps in research.

Traditional single-specialty approaches may be insufficient for managing surgical interventions in women with stress urinary incontinence (SUI). Limited data exist on the effectiveness of multidisciplinary teams (MDTs) in the decision-making process since NICE introduced the concept in 2013. This study evaluates the impact of a purpose-designed MDT on SUI management from 2017 to 2019. Monthly MDT meetings at a university hospital and a district general hospital reviewed cases of women considering invasive treatment for primary SUI. Attendees included gynaecologists, urologists, continence nurses, physiotherapists, and administrative staff. Discussions focussed on patient history, urodynamics, treatment preferences, and final recommendations. Data on age, parity, BMI, diagnoses, and treatment plans were analysed using SPSS Statistics (version 23). A total of 123 women were discussed (mean age 54.5 years, mean BMI 30.8). Of 96 cases with MDT decisions, colposuspension was most recommended (46.9%), followed by bulking agent injection (37.5%) and autologous fascial sling (8.3%). MDTs altered management in 19/123 cases (15.4%), primarily shifting towards less invasive interventions. No mesh tape procedures were recommended despite availability. Among 86 women who identified priorities, cure from leakage (96.5%) and avoiding repeat surgery (47.7%) ranked highest. MDT discussions influenced treatment decisions by favouring conservative management options in many women. Patient preferences were fully considered during MDT discussions. Further studies should be conducted to assess long-term clinical outcomes following MDT recommendations.

ABSTRACT Background Approximately half of the global population resides in remote regions, yet healthcare resources remain disproportionately concentrated in urban areas. Social and geographical isolation exacerbate health disparities, resulting in limited access to services for rural, remote and island communities. This paper explores how arts-based health interventions respond to these inequalities. Methods We conducted a literature review of research studies published over the past two decades. Results Arts-based health interventions have emerged as a promising approach to addressing disparities and enhancing overall health and wellbeing. The arts support healthcare literacy, individual agency, self-expression and a strengthened sense of community presence and identity. Creative practices rooted in local and Indigenous traditions foster sustainable and meaningful relationships between people and place, enabling a sense of connected belonging and intergenerational historicity. Active community participation, trustful relationships between stakeholders and communities, and an appreciation of cultural differences are seen to increase the effectiveness of these interventions. Conclusion The findings of this review aim to inform policymakers, practitioners and researchers about the potential and challenges of arts-based health interventions in remote and marginalised communities.

Medical ultrasound is a widely utilised diagnostic tool, offering healthcare professionals a safe, real-time imaging solution effective across various disciplines and care settings. Despite extensive clinical use, ultrasound receives limited focus from AI and imaging research, due to the lack of extensive datasets. Unlike CT and MRI, where scan recording is part of the workflow, creating large databases ideal for study, ultrasound is a live modality where only limited recording is performed, and results are not generally collated into significant datasets. Therefore, capturing an ultrasound dataset for imaging research is time-consuming and expensive due to clinical and ethical hurdles involved in scanning patients, making it inaccessible to many researchers. This study investigates Thiel cadavers as a more accessible and cost-effective sample for early-stage ultrasound research compared to in-vivo patient scanning. We present a dataset of 37 abdominal scans and provide an initial review of their suitability for ultrasound imaging studies. Thiel cadavers are preserved using a liquid embalming method that maintains many tissue properties essential for ultrasound scanning. Over 70 % of the scans were deemed of sufficient quality, when compared against similar patient scans, for use in imaging research. Changes in the fluid balance within tissues and abdominal cavity were the main limitation in obtaining quality scans. This study demonstrates that Thiel cadavers maintain sufficient tissue properties for diverse ultrasound imaging research, providing a cost-effective, low-risk option for speculative research in abdominal ultrasound AI where clinical trials are not yet feasible, and existing datasets are unavailable.

Dementia is a life-limiting condition and a leading cause of death in the UK and globally. Advance care planning (ACP) is of particular relevance to people living with dementia due to the gradual loss of decision-making capacity and ability to communicate that they typically experience. However, many people living with dementia are not given the opportunity to undertake ACP. As a consequence, their end of life care needs often remain unmet. As part of the multidisciplinary team, nurses are well placed to engage people living with dementia and those close to them in timely ACP conversations so that the person's future care aligns with their expressed values, wishes and preferences. Collaborative healthcare services that normalise ACP as part of routine dementia care and provide staff with ACP training and mentoring are essential for supporting nurses to undertake ACP with people living with dementia and their families.

Purpose The focus of this research is to understand the financial situation of people in Malaysia, hence analyzing the impact of financial income level, savings and expenditures in financial well-being. The study also examines moderating effects of marital status on these relationships, particularly when it comes to increasing cost of living. Design/methodology/approach Data were collected through a structured online questionnaire distributed via convenience sampling, targeting B40 and M40 income groups. From the 407 households contacted, 327 provided complete and useable responses. To analyze the data, we used partial least squares structural equation modeling (PLS-SEM) and Statistical Package for the Social Sciences (SPSS). Findings The findings show that while income alone did not show a significant relationship with financial well-being in this study, expenses, savings and the interaction between marital status and income were significant factors. These findings underscore the multidimensional nature of financial well-being and highlight the importance of considering interactions and broader financial behaviors in understanding individuals' financial health. Research limitations/implications The subject selection in this research is only the Klang Valley households, and therefore the findings of this study may not be applicable in other areas of Malaysia or any other different economic and culture background countries.This study employed convenience sampling technique to gather information and this may limit generality of the results by developing biases toward the sample. In convenience sampling, the participants are chosen based on their accessibility or willingness to be sampled, thus a possibility of extreme selective sampling. This can potentially lead to selection bias and other deficits rendering the findings as a whole restricted in terms of generalizability to larger population frames who may not be like this latter kind of individual. Originality/value The study seeks to find out the effects of marriage status to the income, saving and spending the theories and models on the financial position of individuals. It demonstrates how the role of family can change influence of money factors on well-being which is a lacking research area. The implications of the findings are expected to be of importance to practitioners such as policymakers, financial advisors and would be investors who are in search for suitable financial management strategies. The study contributes to the theoretical framework of financial behavior and welfare and provide policy implications at local and beyond levels. Peer review The peer-review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2024-0701