NHS Lanarkshire

NHS Lanarkshire (NHSL) Physiotherapy Musculoskeletal (MSK) service receives approximately 30,000 referrals annually, facing long waiting times and workforce pressures. To address these challenges, NHSL piloted Community Appointment Days (CADs)-a patient-centred model offering same-day assessment, advice, and community support in non-medical settings. A mixed-methods service evaluation was conducted using retrospective analysis of data from ten CADs delivered across three leisure centres in 2024-2025. Quantitative data from the Patient Management System included attendance, outcomes, and re-access rates. Qualitative data were collected via patient passports, surveys, and interviews. Objectives were to assess impact on waiting times, patient experience, cost avoidance, and sustainability. Of 2,287 patients booked, 1,866 attended. Outcomes included discharge (10%), patient-initiated review (PIR) (53%), and return appointment (37%). Average time per CAD was 69 minutes. PIR return rate was 8%, with 0% ED attendances for the same condition. CADs enabled a 3.7-fold increase in new patient capacity on the day, reducing waiting times in targeted waiting lists by 5 weeks in 2024 and 9 weeks in 2025. Initial setup costs were £16,388; subsequent CADs projected cost avoidance of £4,132 each. Patient feedback was highly positive, with strong Care CollaboRATE scores, though some reported environmental challenges. Staff reported CADs as less stressful or similar to routine work. CADs are a scalable, patient-centred model that improves access, reduces waiting times, and supports self-management while maintaining safety. Future work should refine triage, enhance booking systems, and evaluate long-term outcomes to ensure sustainability.

ObjectivesUp to 25% of patients receiving OPAT will develop a complication of their infection or treatment, requiring unplanned assessment or admission. In our institution, patients attending daily for IV antibiotics, or receiving home administration by district nurses, routinely have daily monitoring of their vital signs. However, patients who are self-administering (or having antibiotics administered by a carer) do not have daily observations. In this pilot study, we assessed the advantages and disadvantages of a novel system for remote monitoring of vital signs in the patient’s home.MethodsA remote monitoring system known as DOCCLA was used. Patients were given equipment for home measurement of blood pressure, pulse, temperature, respiratory rate and oxygen saturation. They were asked to complete observations and a questionnaire daily regarding their symptoms. Results were returned electronically to a team of clinicians who were available 24/7 to respond to abnormal observations or change in symptoms. Where necessary, these clinicians contacted the patient direct and arranged acute interventions.ResultsFifteen patients on IV antibiotics via OPAT were referred for remote monitoring, of whom 13 submitted observations and questionnaire responses. A median of 17.5% (range 6.6-24.2) of clinical observations were flagged as outside predefined reference ranges. None of these led to urgent in-person clinical review. Patients reported a range of symptoms, including pain, nausea, dizziness, constipation and malaise. No patients required urgent in-person review due to symptoms reported on the daily questionnaire. One patient contacted the clinical team out of hours as she felt unwell. She was referred urgently to a hospital assessment unit but did not require admission. Anonymized patient feedback demonstrated that patients felt reassured by regular monitoring of vital signs and availability of clinicians for advice and support 24/7. Many reported initial apprehension in setting up and using the system, however, were pleased that they were able to do this successfully. Some patients felt anxious at abnormal observation results when they were feeling well. Some logistic issues with the service were also reported.ConclusionsIn this pilot study, patients were generally supportive of the system for daily clinical observations and symptom monitoring and felt reassured by having 24/7 direct access to clinical support, something that most OPAT services are unable to provide. However, flagged observation results were generally non-significant and generated workload for the clinical team and anxiety for patients. Further work is needed to develop a more personalized approach to reference ranges for observations, and to determine which OPAT patient groups are most likely to benefit from remote monitoring.

Little is known about people with intellectual disabilities' views of facial attractiveness and and how desirable they feel they are (self-desirability). Twenty-four adults with intellectual disabilities and twenty-five adults without disabilities were recruited from further education colleges and voluntary community organisations. Participants were asked to rate the attractiveness of facial images of typically developing individuals and individuals with Down syndrome. This was followed by a semi-structured interview, exploring participants with intellectual disabilities' perceptions of self-desirability. The participants with intellectual disabilities gave consistent attractiveness ratings when evaluating images of people with an intellectual disability. They were also more likely, than not, to perceive themselves as desirable to those they found attractive. The findings suggest that people with intellectual disabilities make sophisticated intuitive judgments about the facial attractiveness of other people with and without intellectual disabilities, and remain positive about their own attractiveness.

Urban areas are altered from natural landscapes in several ways that can impact wildlife. Birds are widespread in urban areas, and it is well documented that there are phenotypic differences between urban and non‐urban conspecifics. However, little is known about which characteristics of the urban environment are driving differences. We used 9 years of data from nest boxes spread across 20 sites along a 40‐km urban–non‐urban gradient in Scotland to test whether characteristics of the urban environment (native, non‐native, native oak (Quercus spp.), birch (Betula spp.) foliage availability, temperature and human population density, and the interaction between foliage and temperature) influenced phenology and reproductive success in blue tits (Cyanistes caeruleus). We found that higher foliage availability of native foliage, and specifically of the most common native genus, oak, was associated at the territory level with earlier first egg laying date. Higher non‐native foliage availability at both a site and territory level was negatively related to clutch size. The number of fledglings produced was reduced at sites with higher levels of non‐native foliage and increased at sites with greater amounts of native oak foliage present. We also found territories with a higher human population density had reduced fledging success. Temperature was negatively related to first egg laying date, clutch size and the number of fledglings produced. Moreover, the number of Lepidopteran larvae, blue tits' preferred prey, that were collected over the breeding season was positively related to native oak foliage availability. Our results strongly indicate that the presence of native trees, such as oak, are beneficial to breeding insectivores by increasing the number of fledglings they can successfully raise, likely due to the increased availability of invertebrate prey. We suggest that urban planting regimes should be carefully considered, selecting tree species that are native or non‐native congeneric species, and most importantly that will host Lepidoptera larvae. This will not only help to support complete food chains, but also to maximize biodiversity and ecosystem services of urban green spaces.

An international panel of 27 experts (pediatric and movement disorder neurologists, psychiatrists, and parent representatives) from all continents participated in a Delphi process to establish international consensus guidelines for the evaluation, diagnosis, and management of children with Sydenham chorea (SC) based on best evidence and expert opinion. In total, 88 recommendations reached consensus. Practitioners should identify key signs of SC (chorea and hypotonia), screen for behavioral, mobility, swallowing, speech, and cognitive impairments, and acute rheumatic fever (ARF) features including carditis. Etiological evaluation will differ according to population ARF risk. At all times, patients, families, and educators should receive support, information, and guidance to minimize the impact of SC on academic and social functioning. Antibiotic treatment is recommended at first presentation. Long-term secondary antibiotic prophylaxis should follow international or local guidelines, and measures to reduce pain and distress associated with intramuscular antibiotics will aid in adherence. Immunotherapy (corticosteroids) is recommended in moderate to severe SC. In those with inadequate recovery, intravenous immunoglobulin or plasma exchange should be given. In SC relapse, repeat clinical assessments, etiological investigation, and antibiotics plus corticosteroid therapy should be considered. This consensus guideline will standardize the evaluation and management of patients with SC and direct future research to improve the lived experience and outcomes of patients and families.

Incomplete congenital stationary night blindness (icCSNB) is a subtype of inherited, non-progressive retinal diseases. Most cases of icCSNB result from mutations in the X-linked gene CACNA1F. We describe the clinical findings of two male siblings diagnosed with icCSNB, both carrying a novel variant c.4008 + 5G > T in CACNA1F inherited from their mother. We carried out a comprehensive ophthalmic assessment, including fundus imaging, optical coherence tomography (OCT) scanning and electroretinography. We performed genetic testing with next generation sequencing, in-silico and functional analyses to further characterise the novel variant. Two male siblings presented with high myopia and reduced visual acuities at age three. Examination and OCT demonstrated no significant abnormalities in both siblings. Full-field electroretinogram (ffERG) testing demonstrated markedly reduced amplitude to weak flashes and an electronegative waveform to strong flashes in dark-adapted ERGs, resembling that of icCSNB, leading to its diagnosis in both children. Next generation sequencing in the older sibling identified a novel hemizygous c.4008 + 5G > T variant in CACNA1F. In-silico analysis of this variant predicted that it would disrupt normal splicing of CACNA1F, though it was not possible to confirm this by RNA sequencing. This same variant was found in the younger sibling, as well as in their mother who had normal examination and ffERG findings. We report a novel CACNA1F variant not previously identified in the literature in three patients. Although functional analyses were unable to confirm pathogenicity of this variant, in-silico tools predicted that its effect is consistent with the pathogenesis of icCSNB. Reporting of this family further widens the genotypic spectrum of icCSNB.

SUMMARY Clozapine is the only medication specifically recommended for treatment-resistant schizophrenia, but research suggests that it is universally underprescribed, particularly among children and adolescents. This article discusses clinicians’ reluctance to prescribe clozapine for all age groups, and outlines its benefits for treatment-resistant schizophrenia in young people. It summarises guidelines on clozapine therapy for adults, including initiation, monitoring and adverse and side-effects, and describes how they can be applied to a younger population. Psychiatrists who care for younger people have consistently highlighted a wish for more learning opportunities focusing on clozapine, such as the content of this article.

Clean Hospitals Day is an annual celebration every 20th of October. It aims to increase awareness of healthcare environmental hygiene (HEH), foster facility engagement and appreciation of environmental services (EVS) staff. This year’s theme is “Human Factors and Collaboration”, highlighting the role that both human excellence and error play in infection prevention and control (IPC), and how focusing on how environmental service (EVS) workers and their management is crucial to providing quality care.

Abstract Using transaction–level data and exploiting a credible quasi–natural experiment set provided by India’s unexpected tax–related policy announcement, we examine the impact of policy–related information uncertainty (PIU) on the trading behavior of foreign institutional investors (FII). Based on transaction–level data, we compute the daily net equity trading by all FII of each listed Indian firm. We find that FII reacts quickly and withdraws significant investments during the PIU period. However, the investments of the FII do not become positive immediately when policymakers eliminate the relevant PIU. Further analysis reveals that the impact of PIU subdues and FII equity flow returns to the pre–PIU level in the long term. The results suggest that policymakers, particularly in capital–constrained emerging markets, should be highly conscious of generating PIU if they wish to attract and retain overseas investors.