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...
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.
Lecanemab is an anti-amyloid monoclonal antibody, recently approved in the UK as a treatment for mild cognitive impairment (MCI) and mild dementia due to Alzheimer’s disease (AD) in adults who are apolipoprotein E ε4 gene ( APOE4 ) heterozygotes or non-carriers. A group of UK neurologists, old age psychiatrists and geriatricians with expertise in AD convened to agree appropriate use recommendations for lecanemab in UK clinical practice. The primary focus of these recommendations is safety. Eligibility criteria for lecanemab in the UK include (a) a clinical diagnosis of MCI or mild dementia due to AD, (b) the presence of amyloid-β pathology, confirmed using approved methods (ie, an amyloid positron emission tomography scan or cerebrospinal fluid assay) and (c) APOE4 heterozygous or non-carrier status. Eligibility screening should be conducted in secondary care and those identified as being potentially eligible for lecanemab should be referred to a specialist centre for confirmation of the likely pathological diagnosis, APOE4 counselling and testing and a multidisciplinary consensus decision regarding treatment eligibility. Lecanemab is administered as an intravenous infusion every 2 weeks, and those eligible for treatment should have brain magnetic resonance imaging (MRI) scans prior to the 1st, 5th, 7th and 14th infusions. Specific guidance is provided for safety monitoring and management of potential adverse reactions, including amyloid-related imaging abnormalities and infusion-related reactions. The introduction of lecanemab into UK clinical practice provides an important opportunity to improve services for all people living with dementia, not just those eligible for lecanemab treatment.
BACKGROUND:Surveillance of individuals with a familial predisposition to pancreatic ductal adenocarcinoma (PDAC) is likely to increase overall survival. Our objective was to determine the impact of EUROPAC risk-stratification (Family Risk, FR), in such predisposed individuals. METHODS:Observational study of registered asymptomatic individuals undergoing surveillance for PDAC. Individuals without a known pathogenic variant (PV-), ineligible for genetic assessment in the NHS, in whom significant pancreatic lesions were found, were subjected to additional germline testing. RESULTS:Between January 2000 and April 2025, 893 individuals started surveillance, median age of 52 years. 508 individuals (404 PV- and 104 with a pathogenic variant (PV+)) in the 20 years prior to 2020 without stratification were compared to 385 (269 PV- and 116 PV+) in the five years from 2020 who had FR risk-stratification applied. Four (0·8 %) individuals had actionable pancreatic findings prior to risk stratification vs. 14 (3·6 %), who underwent risk-stratified surveillance (p = 0·001). Pancreatic lesions deemed operable were found in three (0·6 %) and 11 (3 %), p = 0·007, with two (0·4 %) and nine (2 %) undergoing resection, p = 0·009, respectively. PV- individuals with significant findings were subsequently found to contain mutations, many not in the UK genetics test directory, provided the FR was > 30. The median (IQR) time in surveillance prior to a lesion being detected was four (2 - 7) years. Overall, 78 % of EUROPAC detected precursor lesions or pancreatic cancers were stage II or lower. CONCLUSION:The risk-stratified group (FR) identifies neoplastic pancreatic lesion in individuals, regardless of PV status suggesting the key usefulness of this approach.
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.
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.
