NHS Tayside

Pain associated with claudication in peripheral arterial disease (PAD) is a key barrier to physical activity, limiting walking ability and impacting quality of life. Transcutaneous Electrical Nerve Stimulation (TENS) may offer non-pharmacological pain relief and has shown potential to improve walking performance. However, little is known about patients' experiences using TENS in everyday life. To explore the lived experience of using TENS at home among individuals with PAD and claudication. Six participants with PAD and claudication received training in the use of a TENS device for home use during daily walking activities. After four weeks, experiences were explored through a focus group and an individual interview. Data were analysed using thematic analysis. Four themes emerged: Pain, Expectations, Usability, and Physical and social functioning. While some participants reported reduced pain and improved walking ability, others expressed disappointment when TENS did not fully meet their expectations. Variability in use and perceived benefit was influenced by prior knowledge, usability challenges, and personal preferences. TENS may support self-management of claudication pain and enhance physical activity in some individuals with PAD. However, managing patient expectations and addressing device usability are essential to optimise outcomes. Healthcare practitioners may play a key role in supporting education, tailoring advice, and evaluating the appropriateness of TENS as part of individualised care plans.

Women are more likely to report suicidal ideation and make suicide attempts, while men are more likely to die by suicide. There has been much discussion of the possible contribution of masculinity (i.e., attitudes, beliefs, and behaviours understood to be 'masculine' through construction of gendered identities in local contexts) to this gender paradox of suicide. Here we report the first systematic literature review, meta-analysis, and meta-regression testing relationships between measures of masculinity and suicidality. We searched for articles using the following search terms in Google Scholar, Web of Science, PubMed, and APA PsychINFO in July 2024 (("gender role*" OR "gender-role*" OR "sex role*" OR "sex-role*" OR "masculin*" (TOPIC)) AND ("suicid*" (TOPIC))). We excluded papers which examined non-suicidal self-injury, were not based on individual-level valid and reliable quantitative measures of masculinity and suicidality, and which did not provide sufficient statistical information to compute effect size. Across 23 studies the relationship between the multiple and diverse measures of masculinity and of suicidality overall was non-significant (r = 0·03 [95% CI: -0·01, 0·1], z = 1.75, p = 0.341) and showed significant heterogeneity. Given the range of operationalisations of masculinity included, and the high heterogeneity, we urge caution in interpreting the pooled overall relationship. Meta-regression showed moderation of the overall relationship by both measure of masculinity and suicidality. That is, the positive relationship between masculinity and suicidality was stronger for measures of masculinity that focussed on emotional restriction and pursuit of status, and for suicidal action than ideation. Conversely, there were inverse relationships between strength-based measures of masculinity and suicidality. Our results demonstrated significant heterogeneity, and measures of masculinity are likely to be largely outdated. Our results suggest there is value in further work identifying specific aspects of contemporary psychological masculinity which link to suicidality, which is of relevance to clinical assessment and management of suicidality.

Youth violence is a serious public health and criminological issue, with adverse childhood experiences (ACEs) and school exclusions identified as key risk factors. This study sought to determine the relative impacts of ACEs and school exclusions on youth offending behaviour. Cross-sectional study. Analysis of data from a youth justice cohort (N=214) was undertaken. Analyses explored the relative contribution of ACEs and multiple school exclusions to various outcomes (i.e. youth violence perpetration, child to parent/caregiver violence (CAPVA), child criminal exploitation (CCE), county lines (CL), and risk of re-offending). ACEs and multiple school exclusions were significantly associated (p<0.05); 98.2% of those with multiple school exclusions had at least 1 ACE, and 55.4% experienced 4+ ACEs. Adjusted prevalence of CCE and CL was highest when there were 4+ ACEs and multiple school exclusions. Adjusted prevalence of youth violence was highest amongst those with multiple school exclusions regardless of number of ACEs. Only those with 4+ ACEs and multiple school exclusions had significantly higher odds of CAPVA compared to those with no ACEs or multiple exclusions. Risk of re-offending was associated with having either ACEs and/or multiple school exclusions. Prevalence of ACEs and multiple school exclusions were substantially higher in the current youth justice cohort compared to national figures in general population samples. Findings from the current study showed that ACEs and school exclusions have different relative contributions to offending and victimisation outcomes. ACEs and school exclusion are preventable risk factors for youth offending and current study findings emphasise the need to address both factors to prevent and reduce youth offending, and achieve positive outcomes for children, and wider benefits for local communities.

Dipeptidyl peptidase-1 (DPP-1), also known as cathepsin C, processes and activates neutrophil serine proteases. Brensocatib (an oral, reversible, competitive DPP-1 inhibitor) is a novel therapy for bronchiectasis previously shown to reduce sputum protease activity and prevent exacerbations. Broader effects of DPP-1 inhibition on the immune response have not been investigated. We sought to profile effects of DPP-1 inhibition using a secondary analysis of the STOP-COVID19 trial. The STOP-COVID19 trial was a randomized placebo-controlled trial of brensocatib 25 mg in patients hospitalized for severe coronavirus disease 2019 (COVID-19) in the United Kingdom. In the primary analysis, brensocatib did not improve clinical outcomes at day 29. A prespecified substudy was performed at 2 UK hospitals to explore the effects of DPP-1 inhibition on the immune response. Blood samples were obtained at baseline and days 8, 15, and 29. Analyses included peripheral blood neutrophil mass spectrometry, neutrophil functional testing, serum cytokine analysis, whole blood mRNA sequencing, and measurement of circulating neutrophil-associated markers. Between June 2020 and January 2021, 161 patients were enrolled (brensocatib: n = 80; placebo: n = 81). Neutrophil proteomics showed significant alterations in 15 proteins (false discovery rate-adjusted P < .01) including reductions in cathepsin G and the pseudoenzyme azurocidin-1 (Azu-1) (false discovery rate-adjusted P < .0001) by day 29. In serum, Azu-1 levels, but not total elastase or proteinase 3, were significantly reduced (P < .0001). Neutrophil surface expression of protease-cleavable C5aR1/CD88 was significantly increased by day 29 (P < .05). There were no differences in neutrophil extracellular traps, phagocytosis, circulating immune cell proportions, or gene expression between treatment groups. Brensocatib treatment in COVID-19 altered multiple neutrophil proteins including profound effects on Azu-1, identifying this as a key DPP-1 target and potentially highly sensitive biomarker of treatment efficacy.

BackgroundCommunity pharmacists are the most publicly accessible health professionals in high-income countries. There is increasing interest in conducting randomised controlled trials (RCT)—the benchmark of original evidence in the medical field—in community pharmacies. However, little evidence exists examining the challenges and opportunities of conducting RCTs in pharmacies, particularly with respect to project management. In this work, we aim to provide a narrative of lessons learned in conducting two RCTs in community pharmacies in two high-income countries.MethodsWe retrospectively reviewed multiple data sources including administrative and trial activity records. We conducted face-to-face and online sessions to create a list of lessons learned from our experiences and created a stakeholder map for the trials examined. We framed our findings using the Project Managements Institute’s model of the project life cycle, and descriptive statistics were used to estimate the outcomes reported.ResultsNinety-six pharmacies were recruited. Across the project phases, seven high-level tasks within Initiation; 30 within Planning, 43 within Execution/Monitoring and Controlling, and 14 in Closure, were identified. Recruitment of pharmacies, developing documentation for trial drug supply, participant recruitment, and negotiation with pharmacy contracting bodies took longest to complete. Eight key stakeholder groups were identified, including public services/agencies; community pharmacies, communications actors; funders/sponsors; universities/research institutes; healthcare providers; suppliers; and regulators. Thirty lessons were identified, most critically across engaging and managing stakeholders; selecting and supporting trial sites; streamlining trial processes to minimise burden; optimising data collection and accuracy; and considering pharmacy constraints and costs.ConclusionsConducting RCTs in community pharmacies presents unique challenges across the project life cycle. Key lessons include the importance of early planning, streamlining processes to reduce staff burden, and addressing pharmacy constraints. The complexity of the work necessitates dedicated and well-resourced trial management staff to enhance stakeholder management and offer tailored supports where required.Trial registration.Not applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09196-9.

Despite chemotherapy-related toxicities being more likely in older patients, no routine prediction tool has been validated for the UK population. Previous research within the TOASTIE (tolerance of anti-cancer systemic therapy in the elderly) study found a low predictive performance of the Cancer and Aging Research Group (CARG) score for severe chemotherapy-related toxicities. Building on this, the TOASTIE study dataset was used to assess the viability of developing a predictive model with baseline variables and frailty scores for severe chemotherapy-related toxicities in older patients. All patients from the TOASTIE dataset were included, with the inclusion/exclusion criteria detailed in the TOASTIE protocol. Demographic factors, self-assessment scores, Rockwood Clinical Frailty Score and researcher's estimated risks of toxicity were assessed for their association with severe chemotherapy-related toxicities. After data partition into 70:15:15 train/validation/test, models were built on the training dataset using logistic regression (LR), LASSO and random forest (RF). Models were optimized with a validation set with LR and LASSO; cross-validation was used with RF. Model performance was assessed with balanced accuracy, NPV and AUC. Of the 322 patients included, the incidence of severe toxicities was 22% (n = 71). Ten variables were statistically significant, albeit weakly associated with severe toxicities: primarily patient-reported factors, Performance Status and high baseline neutrophil count. LR models gave the best balanced accuracies of 0.6382 (AUC 0.6950, NPV 0.8696) and 0.6469 (AUC 0.6469, NPV 0.4286) with LASSO, and 0.6294 (AUC 0.6557, NPV 0.6557) with RF. Models lack sufficiently robust results for clinical utility. However, a high NPV in predicting no toxicity could help identify lower-risk patients who may not require dose reductions, potentially improving overall outcomes.

BackgroundLong covid has emerged as a complex health condition for millions of people worldwide following the COVID-19 pandemic. Previously, we have categorised healthcare pathways for patients after discharge from hospital with COVID-19 across 45 UK sites. The aim of this work was to estimate the clinical and cost-effectiveness of these pathways.MethodsWe examined prospectively collected data from 1013 patients at 12 months postdischarge on whether they felt fully recovered (self-report), number of newly diagnosed conditions (NDC), quality of life (EuroQoL-five dimension-five level (EQ-5D-5L) utility score compared with pre-COVID estimate) and healthcare resource costs (healthcare records). An analysis of the cost-effectiveness was performed by combining the healthcare resource cost and 1-year EQ-5D (giving a quality-adjusted life-year (QALY)) using statistical models that accounted for observed confounding.ResultsAt 1 year, 29% of participants felt fully recovered, and 41% of patients had an NDC. The most comprehensive services, where all patients could potentially access assessment, rehabilitation and mental health services, were more clinically effective when compared with either no service or light touch services (mean (SE) QALY 0.789 (0.012) vs 0.725 (0.026)), with an estimated cost per QALY of £1700 (95% uncertainty interval: dominated to £24 800).ConclusionOur analysis supports the need for proactive, stratified, comprehensive follow-up, particularly assessment and rehabilitation for adults after hospitalisation with COVID-19, showing these services are likely to be both clinically and cost-effective according to commonly accepted thresholds.

The career aspirations of undergraduate radiography students have previously been surveyed but there is little in the literature exploring nuclear medicine as a career specialism. This study aimed to explore the relationship between clinical placement and career choice within third and fourth year diagnostic radiography undergraduates in Scotland. University ethical approval was obtained; gatekeepers were appointed from each university and distributed the survey. The online survey was conducted consisting of 22 questions including 4 open ended. Descriptive results were summarised using tables and graphs, whilst inferential statistics were collated using R. The survey response rate was 30.3 % (n = 64/211). Students were predominantly female (89 %). The preferred modality for specialising was general radiography (weighted average = 98.99) whilst nuclear medicine was the least favored career choice (weighted average = 18.69). Clinical placement was the most influential factor in career planning for radiography students, and students expressed a desire to learn more about nuclear medicine. There was a statistical difference in length of time spent in nuclear medicine between the three universities (p = .021). The study helped to establish the link between career planning and clinical placement. Students were more likely to choose a modality based on a positive clinical experience. Notably students spent the least amount of clinical time within NM and also favour this modality the least for their future career. Students have demonstrated a need to learn more about the modality and experience it within a clinical placement setting. It is recommended that the radiography curriculum is modified to incorporate learning objectives with a minimum of one week within NM.