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The core function of joint registries is to collect, collate, and present data about patients who undergo joint replacement surgery, and afford clinicians and administrators a range of analytic functions to monitor service performance. This article describes the development, evolution, and future of arthroplasty registries, drawing particularly from the experience of the Scottish Arthroplasty Project (SAP). The SAP was established in 1999 and is one of the oldest arthroplasty registries in the world. It collects information on patients undergoing hip, knee, ankle, shoulder, and elbow arthroplasty. The primary aim is to encourage continual improvement in the quality of care provided for arthroplasty patients in Scotland. It is distinct in terms of administration and methodology from the National Joint Registry (NJR) of England, Wales, and Northern Ireland as it monitors patients rather than implants. Since its inception, its work has contributed to a reduction in overall complication rates and a significant decrease in hospital length of stay for the growing number of patients undergoing arthroplasty. It continues to provide a robust database that is used to underpin national guidance through data-driven research. The research carried out by dedicated SAP fellows has enhanced the research portfolio of the SAP and raised its profile through high quality peer-reviewed publications. The SAP continues to evolve and by collaborating with other Scottish registries it will provide larger datasets containing greater diversity and granularity of information. These developments as well as ongoing analysis of existing areas ensure that the SAP continues to maintain and improve standards in arthroplasty across Scotland. [ABSTRACT FROM AUTHOR]

A skin integrity prevalence audit was conducted in two health boards in Scotland in 2022, involving 186 care homes and assessment of 6,510 residents. Data collection involved in person and online contact with care home managers and senior care staff by specialist tissue viability nurses and care home support team members. Data was analysed to generate prevalence rates per 1,000 residents. The findings identified an overall wound rate of 138.6 per 1,000 residents and further skin integrity needs (lower limb oedema) of 79.4 per 1,000 residents. There was variation in the incidence of wounds and lower limb oedema in the two health board settings. This is the first study at this scale and d serves as an important benchmark for understanding skin integrity needs in the care home sector. There are important implications for education, training and support of care home staff as well as workforce planning for specialist nursing care to ensure appropriate prevention and management of skin care for residents. [ABSTRACT FROM AUTHOR]

Introduction: The Faculty of Pain Medicine recently published the first UK-focused Core Standards for Pain Management Services (CSPMS). We present an audit checklist tool developed to map compliance to the CSPMS, which offers a practical method of auditing any pain management service against the standards. Methods: The checklist tool was developed and its utility was field-tested in the Scottish National Residential Pain Management Programme (SNRPMP), a newly established service offering residential service to people in Scotland. Results: The checklist tool developed provides an easy and practical approach to evaluating any pain service against the national standards. Its application to evaluate the SNRPMP indicates that the service meets the majority of CSPMS standards and highlights aspects of the service requiring improvement. Conclusion: The layout of the developed checklist tool offers an alternative format for the structuring of the national standards in possible future revisions. The audit checklist tool enables evaluation of services with a numerical score, enabling monitoring of their compliance with national standards as well as comparisons between pain services. [ABSTRACT FROM AUTHOR]

Background This scoping survey is a preliminary part of the Scottish Care of Older People (SCoOP) audit programme, which aims to assess specialist service provision for older people with frailty in Scotland, and provide benchmarking data for improving services. Methods The survey was distributed to nominated consultant geriatricians based in 12 of the 14 Scottish health boards who completed data to the 'best of their knowledge'. Data collected were: consultant and specialty doctor level workforce; days of frailty unit operation; multidisciplinary team discussion frequency; and, physiotherapy and occupational therapy availability. Consultant cover was correlated with population data, and scores for service components used to derive separate acute and community service provision scores. Results Consultant geriatrician availability varies widely across Scottish health boards with a median of 1.45 [range: 0.54-2.40; interquartile range (IQR): 0.71-2.28] full-time equivalent consultant geriatricians per 10,000 people =65 years. Variation was also present in the service provision scores [score range 0 (none) to 1.0 (very good)]: for acute services, the median national service provision score was 0.81 (range: 0.50-0.89; IQR: 0.75-0.85) and for community services 0.60 (range: 0.48-0.82; IQR: 0.52-0.65). Conclusions This report clearly demonstrates mismatch between workforce and services in both acute and community settings in the context of the population size. Future surveys will build on this preliminary information to audit service provision for older people at an individual hospital level. [ABSTRACT FROM AUTHOR]

Hip fracture is the most common serious orthopaedic injury affecting older people. In Scotland, 7000 patients sustain a hip fracture each year, and this is projected to rise to 10,300 a year by 2029. In this narrative review, we describe the origin and evolution of the Scottish Hip Fracture Audit, including key elements which have improved hip fracture care and outcomes within Scotland, and the current state of play of hip fracture registries around the world. We go on to discuss future directions for data driven improvements in hip fracture care, including international standardised data collection and a global minimum common dataset for hip fracture registries. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence that both low surgeon and centre case volumes are associated with poorer outcomes following Revision Knee Arthroplasty (rTKA). Given the unique challenges faced in Scotland relating to funding and geography, understanding details on the complexity of cases is required to guide development of future rTKA services., Methods: Utilising the Scottish Collaborative Orthopaedic Trainee Research Network (SCOTnet) a retrospective review of all Scottish 2019 rTKA cases was undertaken. Regional leads co-ordinated local data collection using individual case note review. The number of cases performed by regions, hospitals and individual surgeons were identified. Patient demographics and case complexity (Revision Knee Complexity Classification [RKCC]) were also collected. Results were compared against current standards., Results: 17 units performed rTKA, delivered by 77 surgeons. A total of 506 cases were included. The mean age was 69 years (46% male). Revision for infection accounted for 147/506 (29%) cases. Extensor compromise was present in 35/506 (7%) and 11/506 (2%) required soft tissue reconstruction. According to the RKCC - 214/503 (43%) were classified as R1 (Less complex cases), 228/503 (45%) R2 (complex cases), and 61/503 (12%) R3 (most complex / salvage cases). 5/17 (29%) units met current national guidelines for case volume/year, with only 11/77 (14%) surgeons meeting recommended individual case volumes. 37/77 (48%) surgeons performed ≤ 2 cases per year., Conclusions: Most individual centre volumes could be increased by re-organising services or locations providing rTKA within a region. This should provide better access to Multidisciplinary Team (MDT) involvement. We recorded a significant number of very low volume surgeons (≤2 year) that is contradictory to current evidence-based practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: This audit assessed inguinal hernia surgery in Scotland and measured compliance with British Hernia Society Guidelines (2013), specifically regarding management of bilateral and recurrent inguinal hernias. It also assessed the feasibility of a national trainee-led audit, evaluated regional variations in practise and gauged operative exposure of trainees.Methods: A prospective audit of adult inguinal hernia repairs across every region in Scotland (30 hospitals in 14 NHS boards) over 2-weeks was co-ordinated by the Scottish Surgical Research Group (SSRG).Results: 235 patients (223 male, median age 61) were identified and 96 % of cases were elective. Anaesthesia was 91 % general, 5 % spinal and 3 % local. Prophylactic antibiotics were administered in 18 %. Laparoscopic repair was used in 33 % (30 % trainee-performed). Open repair was used in 67 % (42 % trainee-performed). Elective primary bilateral hernia repairs were laparoscopic in 97 % while guideline compliance for an elective recurrence was 77 %. For elective primary unilateral hernias, the use of laparoscopic repair varied significantly by region (South East 43 %, North 14 %, East 7 % and West 6 %, p < 0.001) as did repair under local anaesthesia for open cases (North 21 %, South East 4 %, West 2 % and East 0 %, p = 0.001). Trainees independently performed 9 % of procedures. There were no significant differences in trainee or unsupervised trainee operator rates between laparoscopic and open cases. Mean hospital stay was 0.7-days with day case surgery performed in 69 %.Conclusions: This trainee-lead audit provides a contemporary view of inguinal hernia surgery in Scotland. Increased compliance on recurrent cases appears indicated. National re-audit could ensure improved adherence and would be feasible through the SSRG. [ABSTRACT FROM AUTHOR]

The Scottish Intercollegiate Guidelines Network (SIGN) 121 and National Institute for Health and Care Excellence (NICE) 153 offer guidance on diagnosis and management of psoriasis. Key recommendations include performing Psoriasis Assessment Severity Index (PASI) and Dermatology Life Quality Index (DLQI) serially to assess the severity of disease, and that patients with severe psoriasis should have an annual health check. The authors conducted a clinical audit to assess the ease of implementation of these recommendations in a secondary care setting. This paper describes the audit cycle and outcomes. Data was collected over a four-month period from six general and nurse-led dermatology clinics. There were a total of 207 patients: PASI and DLQI were calculated in 93% of patients and an annual health check was performed on 94% of patients. During the audit period we felt we offered a more comprehensive assessment and holistic approach when managing patients; however, its execution was time-consuming for clinicians, as well as for assisting outpatient nursing staff. Although monitoring patients' progress with assessment tools and performing health checks is desirable, ongoing resource limitations make this difficult to achieve. [ABSTRACT FROM AUTHOR]

Background In 2006, the Scottish Government made a commitment to reduce admissions of young people to adult psychiatric wards. This study investigates the impact of a Child and Adolescent Mental Health ( CAMH) Intensive Treatment Service ( ITS) and service redesign on psychiatric admission rates. Method Referral data were obtained for the first year of the ITS, between 23 April 2010 and 1 April 2011. Data on psychiatric admission rates were obtained up until 30 June 2011. Results Median length of adolescent inpatient stay reduced from 28 to 15 days and admissions of young people to adult wards significantly reduced by 65%. The number of admissions and readmissions to the adolescent inpatient unit increased. Conclusions A CAMH ITS and accompanying service redesign can reduce length of adolescent inpatient stay and significantly reduce the number of young people admitted to adult psychiatric wards. [ABSTRACT FROM AUTHOR]

Objective:To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure.Methods:This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores.Results:In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent.Conclusion:Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. [ABSTRACT FROM PUBLISHER]

Background The Scottish Intercollegiate Guideline Network (SIGN) published Postoperative Management in Adults in 2004, advocating post-operative assessments to optimize post-operative care. Our aim was to improve post-operative assessments in a surgical high-dependency unit (HDU). Methods A prospective audit of post-operative admissions to surgical HDU over two 4-week periods was performed. Medical and nursing documentations were reviewed. A tailored multi-modal approach targeting specific barriers to change was used to implement changes; education of staff, introduction of designated HDU bleeps and a post-operative assessment pro forma. Re-audit was performed after 6 months. Main findings The first cycle included 72 patients and the second included 62 patients. Time to assessment improved after changes. Forty-six (74%) patients compared with 27 (37%) patients before were assessed within 4 hours. The number of individual reviews increased and number of reviews due to nursing concerns decreased. Thirty-eight (61%) patients compared with 15 (21%) patients before were assessed through an individual review and one (2%) patient compared with 23 (32%) patients due to nursing concerns. Documentation improved. Documentation of relevant past medical history, medications, allergies, complications and post-operative instructions improved from 2 (3%), 1 (1%), 0, 8 (11%) and 26 (36%), to 18 (29%), 28 (45%), 20 (32%), 18 (29%) and 55 (89%), respectively. Difference between first and second cycles was highly significant throughout ( P < 0.001). Conclusion Clinical practice was improved by a tailored multi-modal approach. Educating staff, improving communication and documentation, and re-audit has shown significant improvement. However, further improvements are required to reach best practice. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This study examined the trends in mortality and contributing adverse events associated with death under surgical care for patients with oesophageal cancer. Methods: Adverse events in surgical care were prospectively audited in patients who died with cancer of the oesophagus or oesophago-gastric junction under surgical care in Scotland from 1994 to 2005 through the Scottish Audit of Surgical Mortality (SASM). Results: Between 1994 and 2005 (inclusive), 1424 patients with oesophageal cancer (median age 72, 62% male) died. The proportion of oesophageal cancer patients dying on a surgical ward fell significantly from 17% to 13% (p = 0.005). There has been a significant decrease in the annual number of major surgical resections for oesophageal cancer in Scotland from 324 in 1994 to 193 in 2005 (p < 0.001). The proportion of patients operated on in specialist cancer centres increased since 2000. In the period 1996 to 2005, 1157 patients died under surgical care with oesophageal cancer and were audited by SASM. One hundred and thirty five patients (12%) had 239 adverse events. Overall, the number of adverse events decreased over time with 65/130 of those who died following a cancer resection had adverse events. An anastomotic leak was a factor in 25 of these patients. There was a significant decrease in the proportion of deaths following therapeutic endoscopy (p = 0.011). Conclusion: There has been a significant decrease in the number of cancer resections, adverse events and mortality associated with oesophageal cancer surgery at a time of increasing surgical specialisation. [Copyright &y& Elsevier]

Purpose -- This paper aims to describe the development and evaluation of a resource for use by practitioners to self-evaluate their policy and practice in relation to the Adult Support and Protection (Scotland) Act 2007. Design/methodology/approach -- The self-evaluation resource was developed in the context of multi-agency adult protection policy and legislation to reflect key quality indicators relevant to stakeholders, the community, practitioners and their agencies. Findings -- The quality indicators were selectively piloted by 15 of the 28 multiagency partners in Scotland. The utility of the resource was demonstrated and in some cases the outcomes led to changes in policy and practice. The effect of resource restrictions was reported to have a bearing on the utility of the resource in some partnerships. Research limitations/implications -- The quality indicators were not equally piloted with participants focusing on evaluation of case outcomes rather than wider structural and agency-wide aspects of adult protection. Practical implications -- The adult protection, self-evaluation resource has been identified as a potential means of enabling multi-agency partnerships to establish the effectiveness of their own policy and practice and offers the potential for cross-Scotland comparisons and bench marking. Social implications -- The resource provides the basis for self-evaluation and improvement in adult support and protection that will make the lives of adults at risk of harm safer . Originality/value -- An innovative approach is described to enable self-evaluation by adult protection practitioners and policy makers to judge the effectiveness of their own performance and ensure improved performance. [ABSTRACT FROM AUTHOR]

Purpose – Alcohol misuse is internationally recognised as a major public health problem. The link between alcohol and crime is strong and offenders have a higher prevalence of alcohol problems when compared with the general population. Alcohol-related crime is estimated to cost the Scottish economy over £700 m per annum. The purpose of this paper is to measure the nature and prevalence of Alcohol Use Disorders (AUDs) in adult male prisoners on remand in a prison in Scotland. Design/methodology/approach – Using the Alcohol Use Disorders Identification Test (AUDIT) screening tool, all new remand prisoners were screened over a two week period. Findings – Prevalence of alcohol problems within the sample was high: 73 per cent of the sample was identified with an AUD, with 43 per cent with scores indicating possible alcohol dependence. Originality/value – This is the first study to focus solely on a remand prisoner population and the results show high levels of need. The criminal justice setting is ideally placed to identify and treat alcohol problems in this hard to reach population. [ABSTRACT FROM AUTHOR]

This paper illustrates the process by which a clinical 'hunch' about what triggers spiritual pain can through an audit project improve clinical practice and then illustrates how research takes the evidence one step deeper and provides the basis on which best practice can be founded. [ABSTRACT FROM AUTHOR]

Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards. Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug. The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20-29) and 27% an affective illness (ICD-10 F30-39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous. In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated. [ABSTRACT FROM AUTHOR]

This paper presents observations on the nature of school audit methods in light of the implementation of Scotland's incoming Curriculum for Excellence and the major normative, technological, and cultural changes affecting schools. It points to a mismatch between the concepts and structures of the incoming curriculum and that of the universalistic yet atheoretical grading schemas used in Scottish school inspections. The analysis demonstrates how school inspection with its basis in specifications and fixed measures conflicts with the formative agenda of the incoming curriculum, causing a barrier to its creative realisation in schools. An alternative framework of school developmental engagement is presented via interpretative processes, theoretically grounded purposes and systems thinking. [ABSTRACT FROM AUTHOR]

Background and aims Peer feedback is well placed to play a key role in satisfying educational and governance standards in general practice. Although the participation of general practitioners (GPs) as reviewers of evidence will be crucial to the process, the professional, practical and emotional issues associated with peer review are largely unknown. This study explored the experiences of GP reviewers who make educational judgements on colleagues' significant event analyses (SEAs) in an established peer feedback system. Methods Focus groups of trained GP peer reviewers in the west of Scotland. Interviews were taped, transcribed and analysed for content. Results Consensus on the value of feedback in improving SEA attempts by colleagues was apparent, but there was disagreement and discomfort about making a dichotomous ‘satisfactory’ or ‘unsatisfactory’ judgement. Differing views on how peer feedback should be used to compliment the appraisal process were described. Some concern was expressed about professional and legal obligations to colleagues and to patients seriously harmed as a result of significant events. Regular training of peer reviewers using several different educational methods was thought essential in enhancing or maintaining their skills. Involvement of the participants in the development of the feedback instrument and the peer review system was highly valued and motivating. Conclusions Acting as a peer reviewer is perceived by this group of GPs to be an important professional duty. However, the difficulties, emotions and tensions they experience when making professional judgements on aspects of colleagues' work need to be considered when developing a feasible and rigorous system of educational feedback. This is especially important if peer review is to facilitate the ‘external verification’ of evidence for appraisal and governance. [ABSTRACT FROM AUTHOR]

GP appraisal may, in future, have to include objective and verifiable elements. This condition could be achieved by developing peer review of core areas of clinical practice. The setting for the study was two regions of NHS Education for Scotland (NES) without existing peer review systems (Figure 1). The South East region was further divided into South and East areas. A triangulation methodology was adopted to reflect the perspectives of peer reviewers, GPs submitting materials and the GPs appraising them (Figure 2). Outcomes measures included peer reviewers' feedback, learning needs identified by peer review, feedback from contributors and appraisers' perception of making judgements within GP appraisal. 1 Peer reviewers were recruited, trained and allocated to provide feedback on significant event analysis (SEA), criterion audit or video consultation submitted by professional colleagues. 2 GP appraisers voluntarily submitted materials for peer review then commented on feedback provided by peer reviewers. 3 A focus group of appraisers examined issues relating to professional judgement and national standards within appraisal. 4 All 15 peer reviewers recruited considered the project successful. Peer reviewers thought the model piloted could be delivered nationally if adequately resourced and supported by GPs. 5 Twenty six items (14 SEAs, nine audits and three videos) were submitted for peer review, which demonstrated moderate or high levels of learning need among GP participants. 6 In the focus group, most appraisers expressed difficulty making 'professional judgements' within appraisal but demonstrated a clear willingness to accept peer-reviewed material as evidence for discussion and development. Appraisers identified a range of educational material with the potential to conform to a national standard. There is potential for peer review to contribute to the development of objective and verifiable elements in GP appraisal, encouraging GPs to achieve agreed educational standards independent of the appraisal process. This small study suggests that a national system of peer review to support GP appraisal may be desirable among relevant stakeholders and should be explored further. Additional resources would clearly be required. A comparative review of different systems in other countries suggests further research is necessary to provide greater evidence of feasibility, acceptability and educational benefit of such a system in the UK. [ABSTRACT FROM AUTHOR]

Aim: There is increasing pressure to provide palliative care to patients on the basis of need, not diagnosis. Additionally, there is a paucity of literature describing how the palliative care community is rising to this challenge. Methods: This retrospective audit investigated the number of patients without cancer admitted to a regional hospice in Dundee, Scotland, in 2003 compared with 2006 and whether these patients had different characteristics to patients with cancer. Results: There was a significant rise in the number of patients admitted with non-malignant conditions; 6/328 patients were admitted during 2003 with nonmalignant conditions compared with 23/340 in 2006 (P = 0.0037). There were no differences in age (P = 0.5), length of stay (P = 0.57), outcome of admission (P = 0.59) or reason for admission (P = 0.7) when those without cancer were compared with a contemporaneous group of 60 consecutive patients admitted with cancer. Discussion: Local increases in non-malignant admissions mirror national figures. Underlying reasons for the local increase were unable to be studied in this retrospective audit and would require further study. More needs to be known about how patients, their carers and staff feel about hospice care for those with advanced non-malignant conditions and where, how and by whom palliative care for all should be provided. [ABSTRACT FROM AUTHOR]

This paper appraises the theory and practice of Best Value Audit in Scotland, and in particular the central assumption that a robust performance management system is essential for continuous improvement in service delivery, within a rational planning model of governance. The reviews of Best Value Audit in practice reveal important gaps between theory and practice, with an overemphasis on monitoring process rather than performance. There is, therefore, considerable scope to reduce the demands of the audit process on local government, and Best Value Audit, needs to move from a theoretical model to an evidence-based model of good practice if real progress is to be made. [ABSTRACT FROM AUTHOR]

In this article, the author explores the development of a minimum dataset audit tool for the Hand Hygiene Campaign of the Scottish National Health Service (NHS). According to the author, after a review of available tools and a consultation period with identified stakeholders, both an electronic and paper audit tool have been developed and made available to Scottish NHS boards. She also highlights the involvement of the Nurse Consultant Infection Control from the Health Protection Scotland's infection control team as clinical lead in the campaign.

Background: Hospital malnutrition (undernutrition) continues to attract concern. The implementation of standards for food and fluids in Scotland provided the stimulus for an audit of current practices in NHS Fife hospitals in order to provide baseline data with which to evaluate progress. Methods: One hundred and fifty in-patients were recruited from wards likely to yield those with a high risk of malnutrition. Using patient records and anthropometry, data were collected on weight, weight change, body mass index (BMI), mid-upper-arm circumference (MUAC), dietetic referral, therapeutic diets and patients’ perceptions of nutritional status. Malnutrition was estimated by comparing BMI, weight change and MUAC with the Malnutrition Universal Screening Tool (MUST) and standards published by the Scottish Intercollegiate Guidelines Network (SIGN). Results: Depending upon the standard used, the minimum risk of malnutrition varied from 14 to 25%. The prevalence was lower than that reported previously, although methods were not directly comparable. Obesity was also evident with 42% of patients having a BMI > 25. Mean weight change from admission to audit was +0.4 kg, with a wide range (−11 kg to +13 kg). Most patients identified as malnourished were referred to the dietitian or given nutritional support. Conclusions: Fewer patients were at risk of malnutrition than expected. However, improving the provision of food and fluids remains a priority in Fife as malnutrition and eating problems can occur across the entire BMI spectrum. [ABSTRACT FROM AUTHOR]

This article's aim is to describe the processes used and results found when conducting an audit of nutritional care within a health board area in Scotland. Nutritional standards and an audit tool were developed by a multidisciplinary team and all in-patient clinical areas took part. The results demonstrate that there is still a considerable amount of work that needs to be undertaken to ensure that patients are getting the most effective and efficient nutritional care and this article denotes some of the initiatives instilled to address areas of identified challenges. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to assess the value of a defined follow-up protocol for patients undergoing potentially curative hepatic resection for colorectal hepatic metastases. Methods: A standard protocol for the duration of the study consisted of clinical assessment, serum carcinoembryonic antigen (CEA) and computed tomography. Patterns of recurrence, method and timing of diagnosis and outcome were recorded. Results: One hundred and ninety-one patients underwent potentially curative resection from 1989 to 2004 of whom 103 developed recurrence. The median (inter-quartile range) follow-up was 24.4 (6.5–42.3) months. The median (IQR) time to recurrence and overall survival was 25.0 (10 –not yet reached) and 45.2 (21–123) months, respectively. Seventeen patients (8.9%) underwent further surgery with curative intent. Fifty-five patients (57.9%) had recurrence diagnosed at routine follow-up with 71% (44/62) being diagnosed by CEA and CT. The CEA was elevated in 85.7% (72/84 patients) at the time of diagnosis of recurrence. Conclusion: Although the detection of recurrent disease is common during follow-up after hepatic resection for colorectal metastases, few patients will be suitable for further intervention with curative intent. The exact nature of the follow-up protocol remains to be determined but if it is going to be performed it should be most intensive within the first 3 years. [Copyright &y& Elsevier]

This study assessed trainers' ability to identify criterion audit cycle projects judged to be below a standard acceptable for summative assessment by trained audit markers. Confidence with teaching audit, as well as an ability to assess an audit cycle using the summative assessment eight-criteria marking schedule, was compared before and after a workshop designed to offer guidance on these issues. The impact of a trainer submitting a completed audit cycle by the same peer review system as registrars was considered. All 57 trainers in Greater Glasgow Primary Care Trust area were invited to be involved in the study and in the preparation, planning and assessment of the study design. Significantly better skills in identifying unsatisfactory summative assessment audit projects were demonstrated in trainers who had themselves submitted an audit project for peer review. Following a workshop aimed at enhancing skills, there was no difference between trainers who had and had not submitted an audit project for peer review. There was a significant improvement in confidence in both the teaching of audit and in the use of the eight-criteria marking schedule after the workshop. The results of this study suggest that a requirement for trainers to submit a completed audit cycle for peer review by the same method as their general practice registrars may improve skill in the teaching of criterion audit methodology. We believe ongoing participation in the audit process is likely to offer durability of learned skills. [ABSTRACT FROM AUTHOR]

This questionnaire survey of a representative sample of practitioners in Scotland sought to establish specifically how widely guidance on child protection issued by the Scottish Executive Health Department was being followed by practitioners, NHS Trusts and health boards. It aimed to identify the medical practitioners involved and the range of current practice in child sexual abuse examinations throughout Scotland. The results suggest that the medical assessment of children who disclose sexual abuse is a low-volume, highly specialized activity, practised by about one in five paediatricians and forensic medical examiners in Scotland. Most (79%) are aged between 41 and 60 years; 59.8% have less than 10 years' experience in the field; and the majority (86.3%) perform fewer than two examinations per week. Available guidance is comprehensive and uniform, highlighting the importance of joint specialist working, use of the colposcope for photodocumentation, training and continuing professional development in this specialized area of work. Despite this, the results of our survey of practitioners show that throughout Scotland, the care offered to children and the service provided to the courts are suboptimal. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Following the murder of a young child by her stepfather a ministerial review of child protection across Scotland was established. It was carried out by a multidisciplinary team of representatives from education, health-nursing, health-medical, police, social work and the Reporter to the Children's Hearing. The review comprised a number of subprojects and included a direct audit of the practice of all the key agencies. The views of the general public, parents, children and professionals were obtained via a set of consultation subprojects. The audit of practice was built around a set of individual, in-depth case studies. The cases were drawn from the spectrum of child care and protection cases by sampling from cases known to health visitors, education departments, the police and social work departments. The audit considered compliance with guidance, but the key focus was on outcomes for children. The findings indicated that although there were many examples of good practice with children, a significant number of children were left unprotected or their needs were not met. The issues were not unique to Scotland and are discussed under four key areas. The paper sets out the extent of chronic need amongst the child population that the audit revealed, looks at the messages from consultation about issues of accessing help for children or by children directly, and describes some shortcomings of the current system. Finally the paper analyses the ways that the different agencies interact and sets out a model for how the system can provide a protective network for children who are in need of protection and support. [ABSTRACT FROM AUTHOR]

The Scottish Talipes Register is a record of all newly diagnosed cases of idiopathic congenital talipes equinovarus (CTEV) in Scotland over a four-year period. Two hundred and sixteen children were entered into the register, which recorded initial management and all subsequent interventions, both non-operative and operative. The data, therefore, represent a record of the different management regimens used within Scotland highlighting the variations in duration of conservative management and variations in surgical intervention following different methods of conservative management. [ABSTRACT FROM AUTHOR]

Background: A prospective, longitudinal audit of pain management in patients with cancer was conducted in an unselected community population in Lanarkshire, Scotland. Methods: Using a modified Delphi technique, a recording form was developed and a dedicated project manager was appointed to oversee the development and implementation of the audit. Community staff recorded pain level and analgesic prescribing on consecutive home visits to patients with cancer-related pain. Areas of good and poor prescribing were assessed using standards previously developed for the Scottish Cancer Pain Audit. These results were fed back to prescribers in a variety of ways and used as a focus for a programme of primary care-based education. Results: Five hundred and forty-one patients have been entered in the audit between May 1999 and end October 2002. A total of 3259 visits have been recorded and 88% of general practices in Lanarkshire submitted forms during this period. Pain scores were recorded in 90% of visits. Specific gaps in prescribing practice were identified. Conclusion: The audit demonstrated that it is possible to engage primary care teams in a continuing audit of cancer pain management, which is achievable within the context of normal care. It provided a means to collect and analyse serial data on pain level and pain management and to identify areas of prescribing in need of improvement. Concerted efforts to establish the legitimacy and relevance of the project in the eyes of key stakeholders proved fundamental to encouraging longer-term behavioural change in the management of cancer pain. [ABSTRACT FROM AUTHOR]

In 2001 the Scottish Minister for Education, Europe and External Affairs ordered a multi-disciplinary review of child protection across Scotland. The review was carried out by a multi-disciplinary team with representatives from each professional group of education, the police, medicine, nursing and the Scottish Children's Reporters. A major part of the review was a direct examination of the practice of all the key agencies involved in child protection. This article sets out the development of a methodology that enabled the team to both describe and evaluate practice. As well as drawing on existing inspection and audit techniques a new qualitative audit methodology was developed that was informed by developments in qualitative research. The methodology incorporated an evaluation of each agency's practice for each child as well as an evaluation of the overall outcome as a result of all agencies' endeavours. The strengths and drawbacks of the methodology are examined. [ABSTRACT FROM AUTHOR]

Objectives To examine patterns of referral, management and survival of men with prostate cancer, and to document changes over time. Patients and methods All men registered with prostate cancer in 1988 and 1993 were identified from the Scottish Cancer Registry. Data were abstracted according to standard definitions from the available medical records of 930 men in 1988 and 1355 in 1993. Results There was limited evidence of multidisciplinary care, with only 8% of patients in 1988 being managed by both a urologist and a clinical oncologist within a year of diagnosis, increasing to 13% in 1993. Only a small proportion of patients were managed by clinical oncologists during the first year of care (14% in 1988 and 20% in 1993). Documentation of thorough staging information was poor, with a T stage being recorded in <30% of cases in both years. Documentation of metastatic status increased from 53% to 63% between 1988 and 1993, paralleling an increase in the use of bone scans. The proportion of cases with pathological grading obtained at diagnosis increased from 63% in 1988 to 68% by 1993. The use of PSA testing and core biopsies increased between the years while the use of transurethral prostatectomy decreased. More patients received radical radiotherapy within a year of diagnosis in 1993 than 1988, increasing from 6% to 9%, and more radical prostatectomies were also undertaken (0.2% to 2.3%). Nonetheless, most patients (81% in 1993) with no documented evidence of metastases received no active intervention (radical radiotherapy, radical prostatectomy, or ‘watchful waiting’). The survival at 5 years increased nonsignificantly from 34% for the 1988 cohort to 38% for the 1993 cohort. Conclusion This audit reveals considerable inconsistency in the management of men with prostate cancer in Scotland. Against a background of controversy about numerous aspects of the management of this disease, the need for a multidisciplinary approach, comprehensive staging and... [ABSTRACT FROM AUTHOR]

Aims: The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission., Methods: A nationwide multicentre retrospective cohort study was conducted of all patients presenting with a hip fracture to 17 Scottish centres in March and April 2020. Demographics, presentation blood tests, COVID-19 status, Nottingham Hip Fracture Score, management, length of stay, and 30-day mortality were recorded., Results: In all, 78/833 (9.4%) patients were diagnosed with COVID-19. The 30-day survival of patients with COVID-19 was significantly lower than for those without (65.4% vs 91%; p < 0.001). Diagnosis of COVID-19 within seven days of admission (likely community acquired) was independently associated with male sex (odds ratio (OR) 2.34, p = 0.040, confidence interval (CI) 1.04 to 5.25) and symptoms of COVID-19 (OR 15.56, CI 6.61 to 36.60, p < 0.001). Diagnosis of COVID-19 made between seven and 30 days of admission to hospital (likely hospital acquired) was independently associated with male sex (OR 1.73, CI 1.05 to 2.87, p = 0.032), Nottingham Hip Fracture Score ≥ 7 (OR 1.91, CI 1.09 to 3.34, p = 0.024), pulmonary disease (OR 1.68, CI 1.00 to 2.81, p = 0.049), American Society of Anesthesiologists (ASA) grade ≥ 3 (OR 2.37, CI 1.13 to 4.97, p = 0.022), and length of stay ≥ nine days (OR 1.98, CI 1.18 to 3.31, p = 0.009). A total of 38 (58.5%) COVID-19 cases were probably hospital acquired infections. The false-negative rate of a negative swab on admission was 0% in asymptomatic patients and 2.9% in symptomatic patients., Conclusion: COVID-19 was independently associated with a three times increased 30-day mortality rate. Nosocomial transmission may have accounted for approximately half of all cases during the first wave of the pandemic. Identification of risk factors for having COVID-19 on admission or acquiring COVID-19 in hospital may guide pathways for isolating or shielding patients respectively. Length of stay was the only modifiable risk factor, which emphasizes the importance of high-quality and timely care in this patient group. Cite this article: Bone Joint J  2021;103-B(5):888-897.

Background: Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds., Methods: We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes., Results: In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47-0.68%, p = 2.0 × 10-8-1.0 × 10-10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10-8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10-6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10-11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10-7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10-16)., Conclusions: AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.

Partner notification (PN) is a vital tool used by genitourinary (GU) medicine services in the public health control of sexually transmitted infections. We audited our PN outcomes for syphilis and HIV, over an 18-month period, at the Edinburgh GUM clinic. Follow-up information on testing was only available for 58% of traceable syphilis contacts and 59% of traceable HIV contacts, though substantially larger percentages in each case, respectively 78% and 90%, were informed regarding their risk of exposure. Furthermore, the department achieved screening verification in 78% of identifiable syphilis contacts and 94% of identifiable HIV partners. [ABSTRACT FROM AUTHOR]

A national Scottish audit of 282 patients with HIV infection attending 11 clinics showed the following levels of performance against quality improvement Scotland Sexual Health Services Standards: syphilis serology was offered in the previous six months to 55% of patients (range: 12-97% of patients in individual clinics), sexual history documented within four weeks of initial HIV diagnosis in 67% (12-100%) and offer of tests for sexually transmitted infections (STIs) documented within four weeks of HIV diagnosis in 45% (4-96%). Considerable variation in performance exists between clinics. The audit prompted interventions to further improve the sexual health care of people living with HIV infection. [ABSTRACT FROM AUTHOR]

Practice related to hepatitis B vaccination of men who have sex with men (MSM) in Scottish genitourinary medicine clinics was audited against targets based on the offer and completion of vaccination set by the British Association of Sexual Health and HIV. Of 521cases audited from 11 clinics, 215 (41%) were eligible for vaccination and 175 (81%) of eligible MSM were offered vaccination. Of those, 144 (82%) accepted vaccination. The super-accelerated schedule was most commonly prescribed but only 29% of those starting this schedule completed it, compared with 57% of those receiving the standard course. The overall vaccination completion rate was 31% and 82% of those completing vaccination had antisurface antibodies measured. A more robust recall system and uniformity in vaccination policies addressing the balance of patient compliance and immunogenicity of vaccine schedule are needed to improve completion rates. [ABSTRACT FROM AUTHOR]

Timely treatment of sexually transmitted infections can reduce complications and prevent onward transmission. Several audit standards exist in this area. We audited the timeliness of treatment of 538 episodes of chlamydia at 12 Scottish genitourinary medicine clinics against a national standard and against a local best practice target. Three clinics treated 95% of patients within two weeks and 10 clinics treated 95% of patients within four weeks. All clinics treated 60% of patients within four weeks. Overall, all clinics performed well against published standards, but less well against the best practice target. [ABSTRACT FROM AUTHOR]

Until discontinued in 2008, the Scottish Hip Fracture Audit collected and reported on data relating to the quality of care of hip fracture patients in Scotland. In 2013, the audit was recommenced under the umbrella of the MSK Audit group, which audits high volume orthopaedic pathways across Scotland. Our aim is to report on the changes in the demographics of hip fracture patients in Scotland between 2003 and 2013. There was an increase in the proportion of male patients from 2003 to 2013 (22.4% to 29.5%; p < 0.0001). An increased percentage of hip fracture patients were admitted from their own home (63.9% to 73.1%; p < 0.0001). Both these factors have deleterious effects on the outcome, and use of necessary resources, following hip fracture. There was also an increase in the percentage of patients who were American Society of Anesthesiologists Grade 3 (52.9% to 56.4%). Over the last decade, there has been a shift in the demographics of Scotland's hip fracture patients. If hip fracture incidence increases as predicted, this potentially more-challenging case-mix will likely impact on multiple health resources.

Objective: This audit aimed to assess the quality of communication between dental students/qualified dentists and dental technicians, increase the percentage of satisfactorily completed laboratory prescriptions and reduce the number of errors that can result from poor communication. A subsidiary aim was to educate students and staff in this respect., Method: An audit of laboratory prescription completion was conducted within Dundee Dental Hospital. Four hundred and eighteen prescriptions for indirect fixed restorations completed by dental undergraduates and qualified staff were audited over a three month period (first audit cycle). Educational reminders on laboratory prescriptions were then provided to undergraduates and qualified staff, a further three hundred and twenty-two prescriptions were audited (second audit cycle) and compared with the first cycle., Results: Satisfactorily completed prescriptions increased from 28% to 43% following basic educational intervention. However, this percentage still signifies a poor level of completion and the need for improvement. Some aspects of the prescription were completed better than others, but overall the standard remained poor with a significant number failing to comply with guidelines set by the UK General Dental Council, the European Union's Medical Devices Directive and the British Society for Restorative Dentistry (BSRD)., Conclusion: Further undergraduate and staff training on laboratory prescription writing will be necessary through staff training events and developments in the undergraduate curriculum., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis., Methods: A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services., Results: Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = <0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = <0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality (p ≤ 0.005)., Conclusion: Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.