Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study

OBJECTIVE: To determine whether the priority given to patients referred for cardiac surgery is associated with socioeconomic status. DESIGN: Retrospective study with multivariate logistic regression analysis of the association between deprivation and classification of urgency with allowance for age, sex, and type of operation. Multivariate linear regression analysis was used to determine association between deprivation and waiting time within each category of urgency, with allowance for age, sex, and type of operation. SETTING: NHS waiting lists in Scotland. PARTICIPANTS: 26 642 patients waiting for cardiac surgery, 1 January 1986 to 31 December 1997. MAIN OUTCOME MEASURES: Deprivation as measured by Carstairs deprivation category. Time spent on NHS waiting list. RESULTS: Patients who were most deprived tended to be younger and were more likely to be female. Patients in deprivation categories 6 and 7 (most deprived) waited about three weeks longer for surgery than those in category 1 (mean difference 24 days, 95% confidence interval 15 to 32). Deprived patients had an odds ratio of 0.5 (0.46 to 0.61) for having their operations classified as urgent compared with the least deprived, after allowance for age, sex, and type of operation. When urgent and routine cases were considered separately, there was no significant difference in waiting times between the most and least deprived categories. CONCLUSIONS: Socioeconomically deprived patients are thought to be more likely to develop coronary heart disease but are less likely to be investigated and offered surgery once it has developed. Such patients may be further disadvantaged by having to wait longer for surgery because of being given lower priority

Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31758 patients treated between 2000 and 2007

<p>Background: The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time.</p> <p>Methods and Results: The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (χ2 tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, χ2 test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ2 test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (χ2 test for trend, P=0.142) or overall (χ2 test for trend, P=0.083).</p> <p>Conclusions: Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.</p&gt

Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy

Objectives: To develop a decision analysis based and computerised clinical guidance programme (CGP) that provides patient specific guidance on the decision whether or not to undergo a prophylactic oophorectomy to reduce the risk of subsequent ovarian cancer and to undertake a preliminary pilot and evaluation. Subjects: Women who had already agreed to have a hysterectomy who otherwise had no ovarian pathology. Setting: Oophorectomy decision consultation at the outpatient or pre-admission clinic. Methods: A CGP was developed with advice from gynaecologists and patient groups, incorporating a set of Markov models within a decision analytical framework to evaluate the benefits of undergoing a prophylactic oophorectomy or not on the basis of quality adjusted life expectancy, life expectancy, and for varying durations of hormone replacement therapy. Sensitivity analysis and preliminary testing of the CGP were undertaken to compare its overall performance with established guidelines and practice. A small convenience sample of women invited to use the CGP were interviewed, the interviews were taped and transcribed, and a thematic analysis was undertaken. Results: The run time of the programme was 20 minutes, depending on the use of opt outs to default values. The CGP functioned well in preliminary testing. Women were able to use the programme and expressed overall satisfaction with it. Some had reservations about the computerised format and some were surprised at the specificity of the guidance given. Conclusions: A CGP can be developed for a complex healthcare decision. It can give evidence-based health guidance which can be adjusted to account for individual risk factors and reflects a patient’s own values and preferences concerning health outcomes. Future decision aids and support systems need to be developed and evaluated in a way which takes account of the variation in patients’ preferences for inclusion in the decision making process

Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

Purpose: Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. Methods: We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945–1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. Results: There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21–1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50–1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. Conclusions: The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated

Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis

No abstract available

Student experiences of the relationship between teaching and research consultancy: the case of a new university

The relationship between research and teaching in higher education has been the subject of much academic inquiry and research activity over the last decade and a half. The majority of these investigations have been conducted from the perspective of the academic teacher and researcher, but recently there has been a growth of interest in asking about the nature of the student learning experience in relation to research, and this study adds to what is known about the way students understand and experience (staff) research. Firstly, it may be argued that learning through teaching and research is the primary function of higher education. Secondly, the integration of research with teaching finds a resonance with the enhancement of learning through inquiry that it promotes. The rise in interest in academic scholarship an.d professional and pedagogic development has also promoted new approaches to academic work, where the division between research and teaching is seen as simplistic, and overlooking critical linkages. So the nexus is complex and not necessarily one-way, with teaching having an equal share in the balance. The research uses a mixed-method approach over two stages of data collection. Initially an electronic questionnaire survey is conducted to obtain an appropriate sample population of students and to determine the aspects of the student learning experience to be tested further in the subsequent smallgroup discussions. These discussion groups build on the questionnaire to explore the issues it raises, and allow students the chance to develop and articulate their experiences of and beliefs about, teaching and research. Nearly 200 students figure in the questionnaire survey and 17 are included in I the subsequent small-group discussions. There are both undergraduates and postgraduates at each stage of the data collection. The research takes place in a single new university and is the first to ask students explicitly about consultancy, seen as a complement to previous investigations specifically into research. From the research undertaken it can be concluded first that students are generally positive about research and consultancy. There are disciplinary differences in the findings which support the findings of previous studentcentred research, as well as variations between levels of study. lt is argued that the negative consequences of research and consultancy can be largely resolved through readdressing staff-student relationships and effective management of the relationship between teaching and research at departmental level. A model of student learning is proposed which responds to the main findings of this current research by reconceptualising the relationship between academic staff and students The relationship between research and teaching is central to this model

Broadband solid-state MAS NMR of paramagnetic systems.

The combination of new magnet and probe technology with increasingly sophisticated pulse sequences has resulted in an increase in the number of applications of solid-state nuclear magnetic resonance (NMR) spectroscopy to paramagnetic materials and biomolecules. The interaction between the paramagnetic metal ions and the NMR-active nuclei often yields crucial structural or electronic information about the system. In particular the application of magic-angle spinning (MAS) has been shown to be crucial to obtaining resolution that is sufficiently high for studying complex systems. However such systems are generally extremely difficult to study as the shifts and shift anisotropies resulting from the same paramagnetic interaction broaden the spectrum beyond excitation and detection, and the paramagnetic relaxation enhancement (PRE) shortens the lifetimes of the excited signals considerably. One specific area that has therefore been receiving significant attention in recent years, and for which great improvements have been seen, is the development of broadband NMR sequences. The development of new excitation and inversion sequences for paramagnetic systems under MAS has often made the difference between the spectrum being unobtainable, and a complete NMR study being possible. However the development of the new sequences must explicitly take account of the modulation of the anisotropic shift interactions due to the sample rotation, with the resulting spin dynamics often being complicated considerably. The NMR sequences can either be helped or hindered by MAS, with the efficiency of some pulse schemes being destroyed, and others being greatly enhanced. This review describes the pulse sequences that have recently been proposed for broadband excitation, inversion, and refocussing of the signal components of paramagnetic systems. In doing so we define exactly what is meant by "broadband" under spinning conditions, and what the perfect pulse scheme should deliver. We also give a unified description of the spin dynamics under MAS which highlights the strengths and weaknesses of the various schemes, and which can be used as guidance for future research in this area. All the reviewed pulse schemes are evaluated both with simulations and experimental data obtained on the battery material LiFe(0.5)Mn(0.5)PO(4) which is typical of the complexity of the paramagnetic systems that are currently under study.A.J.P. was supported by the LABEX iMUST (ANR-10-LABX-0064) of the Université de Lyon, within the program Investissements d’Avenir (ANR-11-IDEX-0007) operated by the Agence Nationale de la Recherche (ANR). The research leading to these results has received funding from the People Programme (Marie Curie Actions Initial Training Networks (ITN)) of the European Union’s Seventh Framework Programme FP7/2007-2013/ under REA grant agreement No. 317127, the “pNMR” project.This is the accepted manuscript. The final version is available from Elsevier at http://www.sciencedirect.com/science/article/pii/S0079656514000910#

Association between body mass index and mental health among Scottish adult population: a cross-sectional study of 37,272 participants

<b>Background:</b> The evidence is conflicting as to whether body mass index (BMI) is associated with mental health and, if so, to what extent it varies by sex and age. We studied mental health across the full spectrum of BMI among the general population, and conducted subgroup analyses by sex and age.<p></p> <b>Method:</b> We undertook a cross-sectional study of a representative sample of the Scottish adult population. The Scottish Health Survey provided data on mental health, measured by the General Health Questionnaire-12 (GHQ), BMI, demographic and life-style information. Good mental health was defined as a GHQ score <4, and poor mental health as a GHQ score ≥4. Logistic regression models were applied. Results Of the 37 272 participants, 5739 (15.4%) had poor mental health. Overall, overweight participants had better mental health than the normal-weight group [adjusted odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87–0.99, p = 0.049], and individuals who were underweight, class II or class III obese had poorer mental health (class III obese group: adjusted OR 1.26, 95% CI 1.05–1.51, p = 0.013). There were significant interactions of BMI with sex (p = 0.013) and with age (p < 0.001). Being overweight was associated with significantly better mental health in middle-aged men only. In contrast, being underweight at all ages or obese at a young age was associated with significantly poorer mental health in women only.<p></p> <b>Conclusions:</b> The adverse associations between adiposity and mental health are specific to women. Underweight women and young women who are obese have poorer mental health. In contrast, middle-aged overweight men have better mental health.<p></p&gt