Aberdeen Royal Infirmary (ARI) is the largest hospital in the Grampian area, located on the Foresterhill site in Aberdeen, Scotland. ARI is a teaching hospital with around 900 inpatient beds, offering tertiary care for a population of over 600,000 across the North of Scotland. It offers all medical specialities with the exception of heart and liver transplants. It is managed by NHS Grampian...
BACKGROUND:There has been little examination of rural-urban residency and cancer screening. We investigated rural-urban variations in breast, cervical, and colorectal cancer screening uptake across Scotland. METHODS:Using aggregate data and cross-sectional analyses, we calculated uptake and detection rates (breast and bowel screening). We modelled uptake by urban and rural residency, age group, sex (bowel screening only), year, health board, and deprivation using multivariable logistic regression with appropriate interaction terms. RESULTS:Cervical screening uptake was higher in rural than urban areas (under 50s: 75.9% vs. 69.1%; 50+: 77.5% vs. 75.3%). Mammography uptake was: 77.0% in rural; 71.0% in urban areas. Bowel screening uptake was: 56.6% in urban; 62.5% in rural areas. In multivariable models, two-way interaction effects between residency and deprivation, and between residency and health board, were statistically significant (P < .05). Rural residency did not confer universally higher uptake. Breast and bowel cancer detection were similar in both areas. CONCLUSIONS:The relationship between residence and cancer screening uptake varied across Scotland. Uptake patterns were complex and not consistent across all rural areas, likely reflecting Scotland's topography and characteristics of the screening eligible. Efforts to improve screening uptake would likely benefit from local rather than national public health policies.
Importance:In the emergency department, patients at low risk of myocardial infarction can be identified at presentation using a single cardiac troponin measurement with high-sensitivity assay. Objectives:To define a threshold to identify patients at low risk of myocardial infarction for the sixth-generation high-sensitivity cardiac troponin T (hs-cTnT) assay and to evaluate the impact of applying this in an early rule-out pathway. Design, Setting, and Participants:This was a prospective multicenter cohort study conducted from 2022 to 2025 (derivation cohort) and 2014 to 2019 (validation cohort). The setting included emergency departments at hospitals in Scotland (derivation cohort) and Czechia, Italy, Poland, Spain, and Switzerland (validation cohort). Participants included adults with possible non-ST-segment elevation myocardial infarction (both cohorts). Study data were analyzed from May to October 2025. Exposures:Cardiac troponin concentration measured at presentation and on serial samples using fifth-generation and novel sixth-generation hs-cTnT assays. Main Outcomes and Measures:Outcomes included the highest threshold at presentation with negative predictive value (NPV) greater than or equal to 99.5% and sensitivity greater than or equal to 99% for an adjudicated primary outcome of type 1, 4b, or 4c myocardial infarction or cardiac death at 30 days. Performance of an early rule-out pathway with the sixth-generation assay. Results:In total, 987 patients (median [IQR] age, 59 [50-70] years; 611 male [62%]) were recruited, with 82 (8.3%) meeting the primary outcome. At presentation, 601 patients (61%) had a cardiac troponin T concentration less than 13 ng/L using the sixth-generation hs-cTnT assay, with an NPV of 99.9% (95% credible interval [CrI], 99.7%-100%) and sensitivity of 99.4% (95% CrI, 97.7%-100%). More patients were identified as low risk at presentation in the early rule-out pathway when using the sixth-generation assay compared with fifth-generation assay (376 [41.0%] vs 160 [17.4%]; P < .001). In the external validation cohort, 782 of 1721 patients (45.4%) had a sixth-generation hs-cTnT measurement less than 13 ng/L at presentation with an NPV of 99.0% (95% Cr, 98.3%-99.6%) and sensitivity of 97.5% (95% Cr, 95.8%-99.0%), compared with 118 (6.9%) below the low risk-stratification threshold of the fifth-generation hs-cTnT assay (P < .001). Conclusions and Relevance:Results of this cohort study suggest that compared with the fifth-generation hs-cTnT assay, use of the sixth-generation assay with a risk-stratification threshold based on clinical performance could double identification of patients at low risk of myocardial infarction or cardiac death at presentation. Prospective studies are required to evaluate the impact of implementation on practice.
Worldwide estimate is that 10 million people are currently living with either upper or lower limb amputation. 30% of these people suffer from upper limb amputation, with the traumatic ethology of upper arm amputation making it rarer than its lower limb counterpart, in which vascular disease is the most populous causative ethology and in which field most currently literature exists. An estimated 3 million people worldwide currently live with upper limb amputations.
Quantitative studies show that rural-dwelling cancer patients experience poorer survival than urban residents, but the mechanisms remain unclear. This study explored how rural versus urban residence shaped cancer care experiences among patients interviewed after primary treatment in Northeast Scotland, including treatment access, follow-up, recovery, and ongoing engagement with services. Semi-structured interviews were conducted with adults diagnosed within the previous 6–12 months, post-primary treatment, and attending oncology follow-up at Aberdeen Royal Infirmary. Topic guides were informed by a socioecological model of rural cancer disadvantage. Interviews were audio-recorded, transcribed verbatim, anonymised, and analysed using the Framework Method. Sampling was purposive for geography, age, and sex. Ethical approval was granted by the North of Scotland Research Ethics Committee (REC 19/NS/0032). Twenty participants (mean age 67; 13 men, 7 women; 9 rural, 11 urban) described experiences of colorectal (n = 12), prostate (n = 3), and other cancers (n = 5). Four themes were identified: (1) impact of distance and travel time—travel amplified fatigue, costs, and uncertainty; (2) access, trust, and communication—variable GP access but high trust in the cancer centre; (3) physical and social infrastructure—benefits of improved roads, direct bus routes, and third-sector support; (4) pros and cons of rural life—rural lifestyle benefits often offset travel burdens. Men tended to rely mainly on partners, while women reported broader networks. Cancer type and age intersected with geography to shape burdens such as continence-related travel constraints after prostate surgery. Geography influenced the burden of accessing rather than the quality of care. Person-centred scheduling, local delivery of peripheral care, transport-aware planning, and collaboration with third-sector providers could mitigate inequities.
Objectives To explore the relative contributions of practice size, socioeconomic deprivation and rurality to patient experience in Scotland and to examine temporal trends in patient satisfaction.Design Secondary analysis of repeated cross-sectional national survey data.Setting Primary care in Scotland, using data from the Scottish Health and Care Experience (HACE) survey conducted biennially between 2009–2010 and 2021–2022, linked to publicly available national datasets.Participants Data from 632 general medical practices (63% of the original 1008 participant practices) were analysed. Practices were excluded for reasons including potential closures or mergers, changes in urban–rural classification or missing population size data. Response rates were 16%–38%, highest in the most remote and least deprived areas.Primary and secondary outcome measures Practice-level percentage positive responses to seven HACE survey items, relating to patient-centred care and continuity of care, were assessed based on questions where respondents were asked to indicate their level of agreement. The relative importance method and regression models were used to examine the contribution of eightfold urban-rural classification, area deprivation quintile and practice size quintile to models of patient satisfaction within the latest dataset.Results Satisfaction levels captured by most questions remained broadly constant until 2019-2020, but there was a marked decline in reported satisfaction in the 2021-2022 survey. Participants in the more rural areas and patients registered with smaller practices consistently reported higher satisfaction levels over time. Participants registered with practices in more affluent areas expressed moderately higher levels of satisfaction in most domains. The relative importance analysis emphasised the dominant role of socioeconomic status and practice size in influencing patient satisfaction across most survey items (area deprivation accounting for up to 71% and practice population for up to 86% of explained variance for individual items), while rurality made a smaller contribution (5%–18%). Findings were confirmed in sensitivity analyses, excluding large practice size changes and minor changes in survey wording.Conclusions Patient satisfaction underwent a marked decline after 2019–2020. Patients living in more rural and more affluent areas, and those registered with smaller practices, generally reported the highest levels of satisfaction. In the most recent survey, socioeconomic status and practice size were most strongly associated with patient satisfaction across most survey items. Further work is needed to clarify the mechanisms behind these findings.
