NHS Highland

Workforce shortages cause disparity in access to health care for patients. Exploring non-traditional (off campus) routes to healthcare professional degree may widen access to professional registration. The aim of this scoping review is to explore the published literature describing non-traditional routes to healthcare professional degree, with relevance to pharmacy degree education. A systematic search of the international literature was conducted using four electronic databases (Medline, Embase, Education Resources Information Center, and Cumulative Index to Nursing and Allied Health Literature). Articles were eligible for inclusion if they were published in English and comprehensively described non-traditional routes to healthcare professional degree. Articles were collated and tabulated to facilitate a narrative analysis of the non-traditional routes found. There were eight non-traditional routes to healthcare professional degree found in the literature (n= 35) across five countries. These were: online and digital; hub and spoke; community-based distance education; degree apprenticeship; academic medical centre; articulation; accelerated degree; and longitudinal. Most papers related to the apprenticeship route (n= 14) and medical profession (n= 19). The main barriers to implementation included: regulatory and infrastructure complexity, adequate resources (staff recruitment; financial; technology), lack of targeted student selection & support, and cultural resistance. Facilitators included collaborative partnerships, adequate resources (technical support; funding; staffing), community engagement and need, targeted student selection, and measuring and sharing outcomes. This review found that the following non-traditional routes offer the most in terms of flexible degree-level programmes to enhance current provision of pharmacy degree programmes: online and digital; community-based distance education; and longitudinal placements. All future non-traditional approaches to pharmacy degree should be evaluated and published.

Long COVID (LC) is a chronic, multisystem condition affecting millions globally, with significant personal, social and economic consequences. Despite increasing recognition of its impact, healthcare services for LC remain inconsistent with patients frequently encountering fragmented services, scepticism and delays leading to patient-voiced frustration. Therefore, understanding patient priorities is crucial for optimising service provision. To explore what individuals with LC want from healthcare services-drawing on their lived experience and collaborative insights with clinicians and researchers, to inform principles for improving care delivery, barriers to access, expectations for service improvement, and the role of multidisciplinary care in managing LC. A qualitative study using thematic analysis was conducted, incorporating multiple data sources, including semi-structured interviews, workshops, and a patient-led audit. Key themes were identified, focusing on healthcare access, clinical assessments, treatment options, and service organisation. Twenty-seven LC sufferers from the LOCOMOTION Patient Advisory Group (PAG) and Patient Advisory Network (PAN), along with clinicians and researchers involved in LC service provision across the United Kingdom, participated in the study. Three major themes emerged: (1) Who the services are for: Equity of access for all those with LC. Barriers such as stigma, inequitable access and lack of clinician awareness need to be addressed. (2) What services should do: Consistent and standardised assessments and diagnostic clarity-particularly for modifiable conditions like autonomic dysfunction-and an emphasis on the need for early medical intervention, not just rehabilitation. (3) How services should operate: Care should be coordinated, proactive and adaptable to evolving evidence. Patients should not be discharged without ongoing review. Multidisciplinary collaboration should be patient-centred and informed by up-to-date research. LC services should be designed to provide equitable, standardised and evidence-based care. Early intervention, appropriate medical testing and sustained follow-up are critical to improving patient outcomes. Patients emphasised the importance of being heard and the value of receiving timely care that reflects the latest scientific understanding and recognises their condition as real, treatable and deserving of ongoing clinical attention. Incorporating these insights into healthcare design may improve outcomes, service efficiency and trust between patients and providers. Patients led all phases of this study, including design, analysis and writing, through active co-production with the LOCOMOTION research team. The paper was born out of discussions within the LOCOMOTION study's Patient Advisory Group (PAG). It was taken forward by C.R., N.S. and R.M., all members of the PAG, working closely with N.B., H.d.K. and G.M.

Polar bears are only found in Arctic areas with sufficient access to sea ice and seals on which they prey. Studies have highlighted negative effects on condition and demographics in areas where sea ice cover is declining due to warmer climate, but condition of the Barents Sea polar bear population have not been examined yet. Loss of sea ice rate has been considerably higher here than in other areas with polar bears. We investigated variation in body condition index (BCI) among 770 adult bears, 1188 captures, in March-May 1995-2019, in Svalbard, Norway (western part of the Barents Sea). We assessed how intrinsic (female reproductive state, age) and both males and females, BCI declined until 2000, but increased afterwards, during a period with rapid loss of sea ice. In models including sea ice metrics and climate (Arctic Oscillation), there was no support for the predicted negative effect of warmer weather and habitat loss. This indicates a complex relationship between habitat, ecosystem structure, energy intake, and energy expenditure. Increases in some prey species, including harbour seals, reindeer, and walrus, may partly offset reduced access to seals. Our findings underline the importance not to extrapolate findings across populations.

Surveillance colonoscopy is recommended for follow up of colorectal cancer and polyps. It has, however, a low yield in this setting and presents a significant strain on endoscopy capacity. Colon capsule endoscopy (CCE) is an alternative diagnostic. We aimed to determine the utility of this test in surveillance patients. A retrospective analysis of a prospectively collated service evaluation data was conducted looking at all surveillance CCE patients in NHS Highland. The primary outcomes were the need for follow up endoscopy and capacity saved. Secondary outcomes included the CCE completion rate, and patient specific factors that contribute to an unsuccessful CCE or the need for a follow up endoscopy. One hundred forty-six patients underwent surveillance CCE between May 2023 and January 2025. Ninety-three (63.7%) required follow up endoscopy. Capacity saved was up to 35.2% of the time slots that would have otherwise been used if all had undergone colonoscopy. Opiate use was associated with CCE failure. Polyp, as opposed to cancer, surveillance and a history of multiple polyps on previous endoscopy were associated with increased follow up rate. CCE resulted in endoscopy capacity savings in this surveillance cohort, but it should be used selectively in view of the high follow up investigation rate. The benefit may be improved with careful patient selection and the exclusion of patients on opiates, tricyclic antidepresants, or who have a history of polyposis.

Abstract Aims In Scotland, a small number of early surgical trainees have undertaken a core surgical training (CST) placement in small rural hospitals. This study aimed to explore and determine characteristics of surgical training in Scottish rural hospitals, identifying any advantages or capacity for improvement in these training environments. Methods Semi-structured interviews of individuals who have undertaken a CST placement in a Scottish rural hospital. Interview transcripts were anonymised and thematically analysed. Results Ten trainees were interviewed and 4 themes that highlight the benefits and challenges of rural surgical training were identified. Themes were identified from the trainees' reflections on their training experience. Theme 1 “Training as an opportunity to gain technical and non-technical skills” The findings reveal a complex landscape where rural trainees often experience high autonomy in clinical decision-making and broad-based clinical exposure. This exposure enriched their learning experience, provided comprehensive preparation for exams, and was complemented by excellent exposure to non-technical aspects of surgery. Theme 2 “Training as an opportunity to understand the healthcare environment” which trainees reported allowed them to see the struggles of the rural surgeon and skills needed as a generalist. Theme 3 “Training as a community experience” Trainees reported on the community within and outside the hospital. Theme 4 “Training as an overall self-development experience” where trainees report on the experience uniqueness and its importance for their growth. Conclusion Rural surgical training offers a unique and valuable experience, fostering not only technical skills but also essential non-technical competencies in a supportive and collaborative environment.

Recreational use of psychotogenic drugs has become more common in the last 30years with consequent increase in drug-induced psychosis; 25-50% of such psychoses progress to schizophrenia within 5years. Most cases result from abuse of methamphetamine or cannabis. The spread of methamphetamine psychosis has occurred without any liberalisation of laws; it is highly addictive and easy to make in small "kitchen" labs. The increase in cannabis use has been facilitated by asoftening of attitudes towards the drug, and in some countries, especially in North America, by legalisation for so-called "medicinal use" and then recreational use. The potency of cannabis has greatly increased, especially in countries that have legalised its use, and the worldwide legal sales of cannabis for 2025 are estimated at $65billion. The consequences are being seen with many reports of increases in the incidence of cannabis-psychosis and schizophrenia. In the 1980s some physicians predicted an epidemic of obesity and diabetes due to changes in diet and life style. Sadly, their predictions were correct. We are now at the beginning of asimilar epidemic of drug-induced psychosis. Public education campaigns of the type that decreased tobacco smoking are necessary to avoid psychiatric services being overwhelmed.

Two million people in the UK suffer from Long COVID (LC), imposing substantial health economic impacts. This study aimed to: 1) assess longitudinal changes in health utility scores and economic costs of LC, and number of services received at LC specialist clinics and clinic region to capture care intensity; 2) assess whether volume of services received responded to health needs; and 3) estimate the national economic impact of LC. LC patients from 10 specialist clinics participated in the LOCOMOTION study. Patient-reported outcomes measures (EQ-5D-5L, C19-YRS and Health Economics Questionnaire) were completed on a digital platform. Associations were assessed between changes in economic outcomes (EQ-5D-3L utility, health economic costs) and number/type of LC specialist services received and region. Per-person values of quality-adjusted life-year losses, public sector costs, productivity losses and informal care costs were multiplied by LC prevalence to estimate national economic impacts. There was a statistically significant reduction in public sector costs over time. There was no significant association between the number of specialist services received and change in health utility scores. LC specialist clinic and outpatient service utilisation corresponded to health need and had significant regional variation after controlling for health need. LC is associated with a substantial economic impact nationally, estimated at £8.1 billion annually and £24.2 billion since its emergence, comparable to the annual cost of £9.4 billion for stroke. The effectiveness of LC specialist clinic services warrants further research. The substantial national economic impact of LC warrants a nationwide LC care strategy.

BackgroundWhen a stoma is formed, people with a stoma have to adjust to managing this on a daily basis. There are a number of factors that can impact their self-efficacy to self-manage and their quality of life, including complications with their stoma, body image concerns, stigma, and the changes to their daily routine. Ecological momentary assessment studies in other populations have suggested that these constructs may vary over short periods of time and could be influenced by contextual factors. We, however, do not currently understand how context-specific factors such as what an individual is doing, who they are with, or where they are could impact upon quality of life and self-efficacy in people with a stoma.ObjectiveThis study aimed to understand whether quality of life and self-efficacy fluctuated over time and whether contextual factors (eg, activity, location, or company) and time of day were associated with quality of life and self-efficacy over the course of a week.MethodsA smartphone-based ecological momentary assessment study was conducted over a 7-day period with measurements taken 3 times a day (morning, afternoon, and evening). Measures included demographic and clinical characteristics of age, gender, and time with a stoma, and self-reported self-efficacy and quality of life in the moment rated from 0 to 100 (with 100 being the best). Multilevel modeling was conducted due to the clustering of responses within individuals, with models run for both self-efficacy and quality of life.ResultsIn total, 62 participants completed the ecological momentary assessment protocol. Null multilevel models indicated that both self-efficacy and the quality of life varied over time, with around 35% of total variance explained by within-person variability, which suggests that there are intraindividual fluctuations over time. Results indicated that, for the self-efficacy model, people reporting from home had higher levels of self-efficacy than those outside the home (β=−3.8, 95% CI −6.4 to −1.3). In the quality of life model, there was increasing levels of quality of life throughout the day (afternoon: β=2.0, 95% CI 0.8-3.2, evening: β=3.9, 95% CI 2.6-5.2).ConclusionsTo the best of our knowledge, this is the first study to use ecological momentary assessment in this population. These findings indicate that, among people with a stoma, self-efficacy and quality of life do vary from moment to moment. Furthermore, contextual factors such as location and time of day are associated with self-efficacy and quality of life. There is a need to explore how future self-management interventions could enhance self-efficacy to self-manage outside of the home environment, with the potential for more dynamic and tailored interventions.

Flourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave. To systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals. We identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science - Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility. Searches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie. Alienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady.