Best practice statement : use of ankle-foot orthoses following stroke

NHS Quality Improvement Scotland (NHSQIS) leads the use of knowledge to promote improvement in the quality of health care for the people of Scotland and performs three key functions. It provides advice and guidance on effective clinical practice, including setting standards; drives and supports implementation of improvements in quality, and assessing the performance of the NHS, reporting and publishing findings

Best Practice Statement : Use of Ankle-Foot Orthoses Following Stroke

The development of this Best Practice Statement (BPS) was a collaboration between NHS Quality Improvement Scotland (NHS QIS), National Centre for Prosthetics and Orthotics, University of Strathclyde and a multidisciplinary group of relevant specialists. NHS QIS is a strategic health board which has a lead role in supporting the NHS in Scotland to improve the quality of healthcare. It does this by producing advice and evidence in a number of different formats, including BPS. These statements reflect the commitment of NHS QIS to sharing local excellence at a national level, and the current emphasis on delivering care that is patient-centred, cost-effective and fair. As part of a scoping exercise commissioned by NHS QIS in 2007, allied health professionals (AHPs) across Scotland identified the use of AFOs following stroke in adults as a clinical improvement priority. Orthotic intervention following stroke has been recognised as a treatment option for many years, but there is wide variation in current practice, and a lack of evidence-based research to determine the optimal rehabilitation programme for individuals following stroke. Stroke is the most frequent cause of severe adult disability in Scotland, with approximately 8,500 diagnoses of first-ever stroke each year, and more than 70,000 individuals affected by the condition. A recent Scottish Government strategy document confirms stroke as a national clinical priority for the Scottish NHS. In addition to developing a BPS and sharing this with healthcare professionals across Scotland, the initiative also sought to develop resource material to support the implementation of the BPS and to share the work internationally. In order to inform the development of the BPS a systematic literature review on AFO use following stroke was undertaken, including work of both a qualitative and quantitative nature. The full literature review, together with recommendations for future research, was included in the BPS. As it was felt that many medical professionals and AHPs may be unfamiliar with the principles underpinning orthotic practice, additional educational resources that would improve understanding of the reasons why the recommendations were being made were developed and included in the BPS. In addition to the full BPS, the key recommendations were summarised as a two-page 'quick reference guide' for ease of use in a clinical setting

The challenges of change:Exploring the dynamics of police reform in Scotland

Despite a long tradition of pessimism regarding the scope for meaningful change in police practices, recent structural reforms to police organizations in several European countries suggest that significant change in policing is possible. Drawing on recent research into the establishment and consequences of a national police force in Scotland, this article uses instrumental, cultural and myth perspectives taken from organization theory to examine how change happened and with what effects. It highlights how police reform involves a complex interplay between the strategic aims of government, the cultural norms of police organizations and the importance of alignment with wider views about the nature of the public sector. The article concludes by identifying a set of wider lessons from the experience of organizational change in policing

Syndromic surveillance of influenza-like illness in Scotland during the influenza A H1N1v pandemic and beyond

Syndromic surveillance refers to the rapid monitoring of syndromic data to highlight and follow outbreaks of infectious diseases, increasing situational awareness. Such systems are based upon statistical models to described routinely collected health data. We describe a working exception reporting system (ERS) currently used in Scotland to monitor calls received to the NHS telephone helpline, NHS24. We demonstrate the utility of the system to describe the time series data from NHS24 both at an aggregated Scotland level and at the individual health board level for two case studies, firstly during the initial phase of the 2009 Influenza A H1N1v and secondly for the emergence of seasonal influenza in each winter season from 2006/07 and 2010/11. In particular, we focus on a localised cluster of infection in the Highland health board and the ability of the system to highlight this outbreak. Caveats of the system, including the effect of media reporting of the pandemic on the results and the associated statistical issues, will be discussed. We discuss the adaptability and timeliness of the system and how this continues to form part of a suite of surveillance used to give early warnings to public health decision makers

Notes on Ipomoea (Convolvulaceae) from the Amazonian periphery

Attention is drawn to the relatively low number of Ipomoea species found in the Amazon basin as well as to the rarity of most species restricted to the region. Six new species from the Amazonian periphery are described: Ipomoea acrensis J. R. I. Wood and Scotland and I. altoamazonica J. R. I. Wood and Scotland from Brazil and Peru, I. maranyonensis J. R. I. Wood and Scotland from Peru, I. macarenaensis J. R. I. Wood and Scotland from Colombia, I. pogonocalyx J. R. I. Wood and Scotland from Brazil and I. deminuta J. R. I. Wood and Scotland from Bolivia. Variation in I. megapotamica is discussed and two subspecies are recognised, subsp. megapotamica from southern South America and subsp. velutina J. R. I. Wood and Scotland from northern Brazil and Venezuela. Plants treated as I. chenopodiifolia M. Martens and Galeotti from Venezuela are recognised as I. retropilosa (Pittier) D. F. Austin. Two subspecies of this species are proposed, subsp. retropilosa being endemic to the Venezuelan Andes whereas the newly described subsp. cundinamarcana J. R. I. Wood and Scotland is restricted to Colombia. I. austinii Infante-Bet. is treated as a synonym of the African I. involucrata P. Beauv., one of a number of Old World species now established in the neotropics

'Help for hay fever', a goal-focused intervention for people with intermittent allergic rhinitis, delivered in Scottish community pharmacies: study protocol for a pilot cluster randomized controlled trial

<b>Background</b> Despite the availability of evidence-based guidelines for managing allergic rhinitis in primary care, management of the condition in the United Kingdom (UK) remains sub-optimal. Its high prevalence and negative effects on quality of life, school performance, productivity and co-morbid respiratory conditions (in particular, asthma), and high health and societal costs, make this a priority for developing novel models of care. Recent Australian research demonstrated the potential of a community pharmacy-based ‘goal-focused’ intervention to help people with intermittent allergic rhinitis to self-manage their condition better, reduce symptom severity and improve quality of life. In this pilot study we will assess the transferability of the goal-focused intervention to a UK context, the suitability of the intervention materials, procedures and outcome measures and collect data to inform a future definitive UK randomized controlled trial (RCT). <p></p> <b>Methods/design</b> A pilot cluster RCT with associated preliminary economic analysis and embedded qualitative evaluation. The pilot trial will take place in two Scottish Health Board areas: Grampian and Greater Glasgow and Clyde. Twelve community pharmacies will be randomly assigned to intervention or usual care group. Each will recruit 12 customers seeking advice or treatment for intermittent allergic rhinitis. Pharmacy staff in intervention pharmacies will support recruited customers in developing strategies for setting and achieving goals that aim to avoid/minimize triggers for, and eliminate/minimize symptoms of allergic rhinitis. Customers recruited in non-intervention pharmacies will receive usual care. The co-primary outcome measures, selected to inform a sample size calculation for a future RCT, are: community pharmacy and customer recruitment and completion rates; and effect size of change in the validated mini-Rhinoconjunctivitis Quality of Life Questionnaire between baseline, one-week and six-weeks post-intervention. Secondary outcome measures relate to changes in symptom severity, productivity, medication adherence and self-efficacy. Quantitative data about accrual, retention and economic measures, and qualitative data about participants’ experiences during the trial will be collected to inform the future RCT.<P></P> <b>Discussion</b> This work will lay the foundations for a definitive RCT of a community pharmacy-based ‘goal-focused’ self-management intervention for people with intermittent allergic rhinitis. Results of the pilot trial are expected to be available in April 2013

Using a realist approach to evaluate smoking cessation interventions targeting pregnant women and young people

Background This paper describes a study protocol designed to evaluate a programme of smoking cessation interventions targeting pregnant women and young people living in urban and rural locations in Northeast Scotland. The study design was developed on so-called 'realist' evaluation principles, which are concerned with the implementation of interventions as well as their outcomes. Methods/design A two-phased study was designed based on the Theory of Change (TOC) using mixed methods to assess both process and outcome factors. The study was designed with input from the relevant stakeholders. The mixed-methods approach consists of semi-structured interviews with planners, service providers, service users and non-users. These qualitative interviews will be analysed using a thematic framework approach. The quantitative element of the study will include the analysis of routinely collected data and specific project monitoring data, such as data on service engagement, service use, quit rates and changes in smoking status. Discussion The process of involving key stakeholders was conducted using logic modelling and TOC tools. Engaging stakeholders, including those responsible for funding, developing and delivering, and those intended to benefit from interventions aimed at them, in their evaluation design, are considered by many to increase the validity and rigour of the subsequent evidence generated. This study is intended to determine not only the components and processes, but also the possible effectiveness of this set of health interventions, and contribute to the evidence base about smoking cessation interventions aimed at priority groups in Scotland. It is also anticipated that this study will contribute to the ongoing debate about the role and challenges of 'realist' evaluation approaches in general, and the utility of logic modelling and TOC approaches in particular, for evaluation of complex health interventions

From teaching physics to teaching children : beginning teachers learning from pupils

This paper discusses the development of beginning physics teachers' pedagogical content knowledge (PCK) in the context of teaching basic electricity during a one-year Professional Graduate Diploma in Education course (PGDE) and beyond. This longitudinal study used repeated semi-structured interviews over a period of four-and-a-half years. The interview schedule followed a line of development through the secondary school electrical syllabus in Scotland. Fifteen student teachers were interviewed during the PGDE year. Six of them were followed up at the end of the Induction Year (their first year as a newly qualified teacher), and again two-and-a-half years later. Thematic analysis of the interviews showed that before the beginning teachers had taught any classes, their initial focus was on how to transform their own subject matter knowledge (SMK) about electricity into forms that were accessible to pupils. As the beginning teachers gained experience working with classes, they gave vivid descriptions of interacting with particular pupils when teaching electricity which showed the development of their pedagogical knowledge. This played a significant role in the teachers' change of focus from teaching physics to teaching children as they transformed their SMK into forms that were accessible to pupils and developed their general pedagogical knowledge

Examination of the risk of reinfection with hepatitis C among injecting drug users who have been tested in Glasgow

Unsafe injecting practices put injecting drug users (IDUs) at repeat exposure to infection with the hepatitis C virus (HCV). It has not yet been determined if spontaneously clearing one's primary infection influences the risk of reinfection; our aim was to estimate the relative risk of reinfection in IDUs who have cleared the virus. We conducted a retrospective study using a large database of HCV test results covering Greater Glasgow Health Board during 1993–2007 to calculate rates of infection and reinfection in current/former IDUs. The relative risk of (re)infection in previously infected compared with never-infected IDUs was estimated using Poisson regression, adjusting for age at study entry, sex, and calendar period of test. Although the rate of reinfection in IDUs who were HCV antibody-positive, RNA-negative at baseline was lower (7/100 person-years, 95% CI: 5–9) than the rate of acute infection in IDUs who were HCV antibody-negative at baseline (10/100 person-years, 95% CI: 9–12), the risk of reinfection was not significantly different than the risk of initial infection (adjusted rate ratio = 0.78, 95% CI: 0.57–1.08). We found only weak evidence for a reduced risk of HCV reinfection in IDUs who had cleared their previous infection. Further research among those who have cleared infection through antiviral therapy is needed to help inform decisions regarding treatment of IDUs

The ral exchange factor rgl2 promotes cardiomyocyte survival and inhibits cardiac fibrosis

Cardiomyocytes compensate to acute cardiac stress by increasing in size and contractile function. However, prolonged stress leads to a decompensated response characterized by cardiomyocyte death, tissue fibrosis and loss of cardiac function. Identifying approaches to inhibit this transition to a decompensated response may reveal important targets for treating heart failure. The Ral guanine nucleotide disassociation (RalGDS) proteins are Ras-interacting proteins that are upregulated by hypertrophic stimuli. The Ral guanine nucleotide dissociation stimulator-like 2 (Rgl2) is a member of the RalGDS family that modulates expression of hypertrophic genes in cardiomyocytes. However, the pathophysiologic consequence of increased Rgl2 expression in cardiomyoctyes remains unclear. To evaluate the effect of increasing Rgl2 activity in the heart, transgenic mice with cardiac-targeted over-expression of Rgl2 were generated. Although Ral activation was increased, there were no apparent morphologic or histological differences between the hearts of Rgl2 transgenic and nontransgenic mice indicating that increased Rgl2 expression had no effect on basal cardiac phenotype. To determine if Rgl2 modulates the cardiac response to stress, mice were infused with the ß-adrenergic receptor agonist, isoproterenol. Isoproterenol infusion increased heart mass in both Rgl2 transgenic and nontransgenic mice. However, unlike nontransgenic mice, Rgl2 transgenic mice showed no morphologic evidence of cardiomyocyte damage or increased cardiac fibrosis following isoproterenol infusion. Increased Rgl2 expression in cultured cardiomyocytes stimulated Ral activation and inhibited staurosporine-induced apoptosis via increased activation of PI3-kinase. Activation of the PI3-kinase signaling pathway was confirmed in hearts isolated from Rgl2 transgenic mice. Increased expression and function of Rgl2 in cardiomyocytes promotes activation of the PI3-kinase signaling cascade and protects from carciomyocyte death and pathologic cardiac fibrosis. Taken further, these results suggest that Rgl2 upregulation in hypertrophic hearts may be a protetive mechanism, and that Rgl2 may be a novel therapeutic target in treating heart disease