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The mortality gap between patients with and without serious mental illness (SMI) is around 15–20 years. Here, we aim to identify some of the factors contributing to that gap via poor physical health and sub-optimal medical management. We report the results of a detailed cross-sectional study of physical health parameters in an in-patient rehabilitation population in Scotland, including a consideration of concordance with guidelines and comparisons to healthy populations. Data was collected from 57 of all 62 in-patients. 42% were obese (compared to 28% of the population), 84% were smokers (vs 16%), 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK >10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed screening uptake compared to the Scottish population was low: Cervical (30% vs 69%), Bowel (8% vs 64%), Breast (23% vs 72%), Abdominal Aortic Aneurysm (0% vs 78%). Patients generally had up to date recorded weight (100%), blood pressure (98.2%), heart rate (98.2%) and lipids (89.4%), but not ECG's (61.4%) or Diabetes screening (59.6%). Following review, 17 referrals were made to medics/surgeons, 29 to broader specialties, 24 medications were started, 9 stopped and 27 changed: most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients). The findings highlight cardiovascular risk factors and cancer screening as specific areas to target for improving poor physical health in populations with SMI. Patients are often willing to engage but specific ways to lower the barriers to screening and treatment are required. • Raised CV risk factors: 42% obese, 84% smokers, 22% raised HbA1c, 47% QRISK >10%. • Low cancer screening; Cervical (30% vs 69%), Bowel (8% vs 64%), Breast (23% vs 72%). • Service improvement: Patients not up to date in ECG's 61.4%, and Diabetes 59.6%. • Unmet need: 17 referrals to medics/surgeons, 29 to MDT's, 60 med changes. • One suggestion is including cancer screening into national psychiatric guidelines. [ABSTRACT FROM AUTHOR]

Background: Scottish Antimicrobial Prescribing Group (SAPG) recommendations to reduce broad-spectrum antimicrobial use led to an increase in gentamicin and vancomycin prescribing. In 2009, SAPG introduced national guidance to standardize dosage regimens, reduce calculation errors and improve the monitoring of these antibiotics. Studies conducted in 2010 and 2011 identified limitations in guideline implementation.Objectives: To develop, implement and assess the long-term impact of quality improvement (QI) resources to support gentamicin and vancomycin prescribing, administration and monitoring.Methods: New resources, comprising revised guidelines, online and mobile app dose calculators, educational material and specialized prescribing and monitoring charts were developed in collaboration with antimicrobial specialists and implemented throughout Scotland during 2013-16. An online survey in 2017 evaluated the use of these resources and a before (2011) and after (2018) point prevalence study assessed their impact.Results: All 12 boards who responded to the survey (80%) were using the guidance, electronic calculators and gentamicin prescription chart; 8 used a vancomycin chart. The percentage of patients who received the recommended gentamicin dose increased from 44% to 89% (OR 10.99, 95% CI = 6.37-18.95) between 2011 and 2018. For vancomycin, the correct loading dose increased from 50% to 85% (OR = 5.69, CI = 2.76-11.71) and the correct maintenance dose from 55% to 90% (OR = 7.17, CI = 3.01-17.07).Conclusions: This study demonstrated improvements in the national prescribing of gentamicin and vancomycin through the development and coordinated implementation of a range of QI resources and engagement with local and national multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Background: Concern about increasing carbapenem and piperacillin/tazobactam use led the Scottish Antimicrobial Prescribing Group (SAPG) to develop national guidance on optimal use of these agents, and to implement a quality improvement programme to assess the impact of guidance on practice.Objectives: To evaluate how SAPG guidance had been implemented by health boards, assess how this translated into clinical practice, and investigate clinicians' views and behaviours about prescribing carbapenems and alternative agents.Methods: Local implementation of SAPG guidance was assessed using an online survey. A bespoke point prevalence survey was used to evaluate prescribing. Clinicians' experience of using carbapenems and alternatives was examined through semi-structured interviews. National prescribing data were analysed to assess the impact of the programme.Results: There were greater local restrictions for carbapenems than for piperacillin/tazobactam. Laboratory result suppression was inconsistent between boards and carbapenem-sparing antibiotics were not widely available. Compliance with local guidelines was good for meropenem but lower for piperacillin/tazobactam. Indication for use was well documented but review/stop dates were poorly documented for both antibiotics. Decisions to prescribe a carbapenem were influenced by local guidelines and specialist advice. Many clinicians lacked confidence to de-escalate treatment. Use of both antibiotics decreased during the course of the programme.Conclusions: A multifaceted quality improvement programme was used to gather intelligence, promote behaviour change, and focus interventions on the use of carbapenems and piperacillin/tazobactam. Use of these antimicrobials decreased during the programme-a trend not seen elsewhere in Europe. The programme could be generalized to other antimicrobials. [ABSTRACT FROM AUTHOR]

• Detailed characterisation of pot ale and spent wash from 22 Scotch Whisky distilleries. • Identification of pot ale/spent wash as a renewable source of critical raw materials (including magnesium and phosphate). • Sustainable resources (protein, carbohydrate, lactic acid, succinic acid, lysine) available in both pot ale and spent wash. • PCA identified differences in chemical composition between pot ale from malt and spent wash from grain distilleries. Scotch Whisky is an important global commodity which generates extensive co-product known as pot ale or spent wash (> 10 L co-product per L whisky). Whilst this is often used as fertiliser or animal feed, a proportion requires disposal resulting in cost to the distillery along with the negative impact on the carbon footprint due to transportation. This study examined the composition of the soluble fraction of pot ale from twenty-two distilleries in Scotland in order to assess the potential for resource recovery and transition to a more circular economy. The results reinforced previous studies, demonstrating that pot ale is an excellent source of protein with a potential for recovery >150, 000 t per annum in Scotland based on Whisky production data. Lactic acid, an important industrial platform chemical, was the major organic acid produced with concentrations ranging from 0.3 to 6.6 g L −1, representing a potential opportunity for recovery for applications such as manufacture of biodegradable polylactic acid for plastics (> 15,000 t per annum based on mean values). Other important platform chemicals, succinic acid and lysine were also identified and considered in sufficient amounts for future use. Pot ale was also shown to contain significant amounts of critical raw materials, magnesium and phosphate, which could be reclaimed for use in fertiliser/feed supporting the development of a new circular economy whilst at the same time reducing the burden of mining and transportation on the environment. The data in this study demonstrated a potential 13.8 kt recoverable phosphate per annum representing more than half of the annual fertiliser consumption in Scotland. Whisky co-products can contribute to sustainable energy, food and platform chemicals with the added value that metal concentrations are not sufficiently high to prevent its utilisation. [Display omitted] [ABSTRACT FROM AUTHOR]

The catchment area of the South Glasgow Child Psychiatry Team includes a high proportion of families of South Asian origin, yet few are referred for services. For those who are referred, team members, all white British, have found that there is often a gulf between their understanding of the child's problems and that of the family, which makes provision of an adequate service difficult. We made a review of all available case notes of South Asian families attending the service in the preceding year with the aim of identifying barriers to referral, assessment and treatment. Assessments were complex and often unsatisfactory, although around half of families eventually reached consensus on diagnosis and treatment with the clinician(s). A larger proportion of South Asian children were diagnosed with and treated for ADHD compared with the general population of children being seen at that time. A minority of families did not receive the treatment of choice because of language mismatch or lack of consensus over the child's diagnosis. The implications of the difficulties with shared language and other aspects of communication for practice and for further research are discussed. [ABSTRACT FROM AUTHOR]

Focuses on fetal alcohol syndrome in Scotland. Deficiencies of children affected by the ailment; Characteristics of mothers; Association between maternal alcohol abuse during pregnancy and the rate of mortality of children.

(1) Background: Our aim was to develop robust and reliable systems for antimicrobial stewardship (AMS) in Keta Municipal Hospital and Ghana Police Hospital. Objectives were to build capacity through training staff in each hospital, establish AMS teams, collect data on antibiotic use and support local quality improvement initiatives. (2) Methods: The Scottish team visited Ghana hospitals on three occasions and the Ghanaian partners paid one visit to Scotland. Regular virtual meetings and email communication were used between visits to review progress and agree on actions. (3) Results: Multi-professional AMS teams established and met monthly with formal minutes and action plans; point prevalence surveys (PPS) carried out and data collected informed a training session; 60 staff participated in training delivered by the Scottish team and Ghanaian team cascaded training to over 100 staff; evaluation of training impact demonstrated significant positive change in knowledge of antimicrobial resistance (AMR) and appropriate antibiotic use as well as improved participant attitudes and behaviours towards AMR, their role in AMS, and confidence in using the Ghana Standard Treatment Guidelines and antimicrobial app. (4) Conclusions: Key objectives were achieved and a sustainable model for AMS established in both hospitals. [ABSTRACT FROM AUTHOR]

Determines the measurement on the prevalence of breast feeding and value of using information collected on Guthrie cards in Scotland. Analysis of the information collected; Measurement on the prevalence of breast feeding in the maternity units; Essence of government intervention to increase breast feeding prevalence. INSET: Clinical implications.