NHS Fife

Purpose This study aims to conduct an extended evaluation of the emotional resources group (ERG), a brief emotion regulation group intervention routinely delivered in a secondary care adult mental health setting in NHS Scotland. Design/methodology/approach The service evaluation used a within-subjects repeated measures design to assess change in emotional regulation, self-efficacy, well-being and functioning for those who attended the ERG. Findings Analysis of those who completed the programme found highly statistically significant improvements in measures of emotion regulation, self-efficacy, well-being and functioning. Large effect sizes were observed on all measures other than functioning, which was moderate to large. Analysis of a conservative intent to treat sample mirrored these findings with highly significant improvements on all measures. Moderate to large effect sizes were also observed on all measures other than functioning, which was moderate. In addition, good rates of reliable and clinically significant change were found for the primary measure of emotional regulation across both completers and the intent to treat sample. In addition, good rates of reliable and clinically significant change were found for the primary measure of emotional regulation across both completers and the intent to treat sample. Originality/value This evaluation builds on previous research by extending the evidence of ERG’s effectiveness in an extended real-world NHS clinical setting. It establishes the credibility and acceptability of the intervention in secondary care outpatient adult mental health service settings.

Background: Prenatal alcohol exposure (PAE) can cause adverse physical and neurocognitive fetal development. Numerous underlying mechanisms of PAE-risk have been hypothesized; however, these have predominantly focused on health-, interpersonal-, and social-related factors. Evidence suggests that stable personality traits, such as behavioral activation (BA) and behavioral inhibition (BI) may contribute toward risk of alcohol misuse. We posit that BA and BI may therefore increase risk of PAE. The potential of BA and BI to underpin both pre- and during-pregnancy alcohol use was thus explored in a sample of UK-based pregnant and recently-pregnant mothers. Methods: Participants (n = 1371) completed an anonymous online questionnaire, containing the Behavioral Inhibition System/Behavioral Activation System scale; (“BIS/BAS”) and the Alcohol Use Disorders Identification Test – Consumption (“AUDIT-C”); completed twice to reflect both pre- and during-pregnancy alcohol use. Results: In the initial regression model, the BIS/BAS subfactor “Fun Seeking” remained significant in predicting pre-pregnancy alcohol use (β = 0.119, p < 0.001) after correcting for other PAE-risk factors (maternal age, pregnancy intention, educational attainment, and mental wellbeing status). In the second regression model, “Fun Seeking” also emerged as a significant predictor (β = 0.120, p < 0.001) of alcohol use during pregnancy, even after correcting for pre-pregnancy alcohol use and participant demographics (β = 0.088, p = 0.005). Conclusions: Fun seeking played a small yet significant role in PAE-risk. It therefore appears that targeting malleable personality traits during PAE-prevention interventions, alongside aggravating health, personal, and interpersonal factors, may minimize the risk of alcohol-exposed pregnancies.

IntroductionPre-operative CT sinus reports are essential for identifying high-risk anatomical variants during functional endoscopic sinus surgery (FESS). The widely accepted CLOSE criteria provide a structured framework for this reporting. The objective of this quality improvement (QI) project was to assess the completeness of CT sinus reporting for patients likely to undergo FESS using the CLOSE framework and introduce interventions to standardise reporting and improve patient safety.MethodsThis three-cycle QI project was conducted at a single NHS health board, reviewing 92 retrospective CT sinus reports between February 2025 and September 2025. Educational interventions were implemented following each cycle, including the distribution of a poster to relevant radiology departments and an NHS-partnered teleradiology company, the collection of feedback, and the reinforcement of changes at departmental meetings. An accompanying survey was sent out to ENT consultants to gather qualitative data. Compliance rates between cycle one and cycle three were compared using the chi-square test.ResultsComparing cycle one to cycle three, a significant increase in compliance was observed. Full documentation of all CLOSE components rose from a baseline of 8/51 (15.7%) to 11/21 (52.4%). For reports demonstrating high-risk anatomical variants relevant to surgical planning, overall compliance rose from 5/51 (9.8%) to 9/21 (42.9%) (χ2=10.375, p<0.01).Our predominantly Scottish cohort showed that Keros type II and sellar sphenoid sinus pneumatisation were the most common findings, with 36/92 (39%) patients exhibiting supraorbital pneumatisation.The consultant survey (n=11) showed that identifying high-risk anatomy was the most important feature (11/11 (100%) respondents). While 9/11 (82%) respondents were familiar with the CLOSE framework, 5/11 (45%) considered the existing CLOSE criteria only partly sufficient.ConclusionThe successful implementation of a systematic, recognised checklist like the CLOSE criteria substantially improved the quality and consistency of CT sinus reporting. This replicable methodology enhances surgical planning, improves patient safety, and strengthens communication between radiology and ENT departments.

Background: Minimally invasive surgical therapies (MISTs) for bladder outflow obstruction are now commonplace in many urological centers, often performed as day case procedures under general anesthetic or local anesthetic (LA) with sedation. Our center has adopted an outpatient clinic LA-only setting to deliver Rezum, Urolift, and iTind using prostatic block and LA gel. We present our 1-year outcomes to determine the feasibility of delivering MIST in this setting. Methods: We retrospectively audited outcomes, collecting data on patient demographics, pre- and postoperative symptom questionnaires, flowmetry tests, and visual analogue scores (VASs) during the procedure. We compared pre- and postoperative changes using a paired t test, using a p value of <0.05 as significant. Results: There were 81 procedures performed: 38 (46.9%) Rezum, 22 (27.2%) Urolift, and 21 (25.9%) iTind. The median age was 68 (interquartile range: 63-74). Preoperatively the mean International Prostate Symptom Score (IPSS) was 20.2 (±7), quality of life (QOL) score 4.6 (±1.4), Qmax 10.7 mL/s (±5.3), prostate serum antigen 2.5 (±3.1), and prostate size 48.8 mLs (±20.9). 70.4% of patients were on an α-blocker, and 44.4% on a 5-α-reductase inhibitors (ARI). The mean VAS was 4.3 (±2.8) out of 10. The total immediate postoperative complication rate was 11.1%, all less than Clavien-Dindo III. 91.4% attended the 3-month follow-up. Postoperatively the mean IPSS was 11.3 (±7.1) (44.1% reduction, p < 0.01), the QOL score 2.4 (±1.5) (47.8% reduction, p < 0.01), and the Qmax 13.1 mL/s (±5.5) (22.4% improvement, p < 0.01). Patients on an α-blocker had reduced to 34.6%, and 5ARIs to 13.6%. Conclusion: We demonstrate the feasibility of delivering MIST under LA alone, without sedation, and report significant improvements in symptom scores and flowmetry outcomes. Patients tolerate the treatment well without sedation and have a short stay for their procedure, enabling the service to be delivered in an outpatient clinic setting, improving inpatient waiting lists and resource allocation to outpatient setting. Further research is required for long-term outcomes, but early results are promising in driving a change in the delivery of MIST.

Preoperative templating in Total Hip Arthroplasty (THA) is an essential tool in arthroplasty surgery. This study investigates the efficacy of CT-based templating in robotic total hip arthroplasty (rTHA) compared to traditional 2D digital x-ray templating and evaluates intra-observer variability among 3 arthroplasty consultants. A total of 37 patients scheduled for primary hybrid rTHA using the Mako robot (Stryker) were included in the study. Independent, 2D digital templating (Materialise Orthoview) was performed by 3 experienced orthopaedic arthroplasty consultants, and the results were compared with a CT templating system (Stryker) and the postoperative implant size after CT based rTHA. Intra-observer reliability among the surgeons was determined using Fleiss' Kappa, individual surgeons were compared to the CT-templating system and the postoperative implant using Cohen's Kappa. Intra-observer reliability among surgeons was low, with significant variability and no variable showing strong agreement. 2D digital templating demonstrated poor predictive value for the post-operative implant size. There was considerable variance between surgeons and their agreement with the CT demonstrated superior predictive values for the postoperative implants as compared to the 2D digital templating technique. This study suggests that the predictive value of the CT templating system was superior to that of surgeon based 2D digital templating for CT templating based rTHA.

Patient reported outcomes are important measures in clinical trials. We assessed two bronchiectasis disease specific quality of life questionnaires in patients with bronchiectasis due to PCD. The Bronchiectasis Health Questionnaire is a ten question disease-specific tool with a total score ranging from 0-100 with 100 being best quality of life. The QoL-B has 37 items in 8 domains. Questionnaires were administered in 86 people with PCD from 11 centres in 9 European countries as part of the EMBARC-BRIDGE study Average patient age was 44yrs (+/-16yrs), 31 male (36%), FEV1%pred (66% +/- 24). Average BHQ score was 60.9, range from 42.91-83.83. Average QoLB-Respiratory score was 63 (11.1-88.9). BHQ Total score and Qol-B Resp showed good correlation with disease severity (BSI score r= -0.41; 95%CI -0.64 to -0.26, r=-0.34 95%CI -0.60-0.02) and breathlessness (MRC dyspnoea score r= -0.61; 95%CI -0.74 to -0.44, r=-0.55 95%CI -0.73 to -0.31), but not sputum volume or lung function p>0.05. There was good correlation between BHQ and all QoL-B domains (Physical r=0.61, Role 0.60, Vitality 0.80, Emotion, 0.54, Social 0.44, Treatment Burden 0.50, Health 0.70 and Respiration 0.73, all p<0.001). Patients with worse BHQ and QoLB-Resp scores had more annual exacerbations [no exacerbations (BHQ 65.8 CI 61.7-70.2, QolB 68.5 CI 59.4-77.8) vs 1-2 (61.35 56.4-66.4; 54.2 CI 45.4-63.0) vs 3+ (56.1, CI 53.1-59.9 ; 54.5. CI 42.2 – 66.7)]. MCID was calculated using 0.5stdev of the mean as 5.1 points for BHQ and 9.7 for QoLB-Resp. QOL-B and BHQ scores correlate with disease severity and clinical outcomes in adults with PCD.

Abstract Aim This study aimed to identify which LFTs best predict the presence of gallstones in the common bile duct (CBD). A secondary objective was to evaluate whether combining multiple LFTs improves positive predictive value (PPV). Methods A retrospective analysis was conducted on patients evaluated for gallstone disease at NHS Fife between April 2022 and April 2023. The sensitivity and PPV of individual and combination of LFTs for detecting CBD stones assessed using magnetic resonance cholangiopancreatography (MRCP). Results A total of 989 patients were reviewed. The PPVs for individual LFTs were: ALP (33.2%), ALT (32.9%), bilirubin (37.2%), and GGT (13.9%). When paired, the PPVs were: ALP &amp; ALT (38.5%), ALP &amp; Bili (43.2%), ALP &amp; GGT (44.1%), ALT &amp; Bili (41.5%), ALT &amp; GGT (40.3%), and Bili &amp; GGT (45.1%). Three-test combinations yielded PPVs of ALP/ALT/Bili (44.7%), ALP/ALT/GGT (47.9%), ALP/Bili/GGT (50.0%), and ALT/Bili/GGT (50.0%). Conclusions Relying on a single LFT has a lower positive predictive value than a combination of LFTs for the prediction of CBD stones.