Gartnavel Royal Hospital is a mental health facility based in the west end of Glasgow, Scotland. It provides inpatient psychiatric care for the population of the West of the City. It used to house the regional adolescent psychiatric unit but this has recently moved to a new psychiatric unit at Stobhill Hospital. The Hospital is a venue used by the Mental Health Tribunal for Scotland. Some parts of the hospital are classified as a category A building and are also deemed at risk.
Background Angina is a debilitating condition caused by coronary artery disease and microvascular dysfunction. Following coronary angiography angina and no obstructive coronary arteries is a common outcome, and women are disproportionately affected. The objectives are first, to assess causes of angina in patients undergoing invasive management; and second, to assess effects of coronary function test-guided management on clinical outcomes. Methods This is an international, multicenter, prospective, registry-based study and nested, randomized, controlled, triple-blind, and endpoint trial. Participants, community care providers, and outcomes assessors are masked. Consented participants enter the registry. Participants without obstructive coronary artery disease (luminal stenosis <50%, or fractional flow reserve >0.80) are eligible for randomization. Index of microcirculatory resistance (IMR; abnormal ≥25) and coronary flow reserve (CFR; abnormal <2.0; gray zone 2.0-2.5) are measured by bolus thermodilution, and results are disclosed (intervention) or not (control group) to the attending cardiologist. Results The primary outcome of the registry is the Seattle Angina Questionnaire summary score at baseline described by coronary artery disease status. Secondary outcomes include the prevalence of obstructive coronary artery disease, patient reported outcome measures and clinical outcomes. The primary outcome of the randomized trial is the within-individual change in Seattle Angina Questionnaire summary score at 12-months from baseline. Secondary outcomes include safety, diagnostic accuracy, patient reported outcome measures for quality of life, physical and psychological function, cardiovascular risk, clinical outcomes, health economics and mechanistic biomarkers. The first patient was screened on December 18, 2020 and the last patient was enrolled on June 30, 2026. Forty sites were included in the United Kingdom (n = 35), Republic of Ireland (n = 2), Holland (n = 2), and Poland (n = 1). In total, 1,483 participants were enrolled into the registry of whom 1,047 were randomized and 386 were not randomized (registry-only). Conclusion This international, registry-based clinical trial will provide novel evidence on the natural history of angina and stratified therapy for angina with no obstructive coronary arteries. Clinical trial registration https://clinicaltrials.gov/study/NCT04674449. Unique identifier NCT04674449
Aims: Structured risk assessment is a core component of safe community mental health practice. Within NHS Greater Glasgow and Clyde, the Clinical Risk Assessment Framework for Teams (CRAFT) is used to document and review clinical risk for patients open to Community Mental Health Teams (CMHTs). Local guidance requires that CRAFT is updated at least annually, or sooner if risk changes. This audit aimed to assess compliance with annual CRAFT review within an elderly CMHT, identify factors contributing to non-compliance, and evaluate the impact of targeted interventions through a re-audit cycle. Methods: A retrospective two-cycle clinical audit was undertaken using electronic health records (EMIS). In cycle one, we reviewed all outpatients in medical clinics from 16 December 2024 to 14 March 2025, and nurse-led clinics from mid-February 2025 to mid-March 2025. We excluded patients who did not attend, inpatients, and those no longer open to the team. For each included patient, EMIS was searched for a CRAFT dated within the previous 12 months (i.e., dated March 2024 or later) and compliance was recorded as yes/no. Following cycle one, findings were presented and discussed in the community multidisciplinary team meeting, and an email was circulated to clinicians with updated guidance on CRAFT completion and method for identifying the date of the most recent CRAFT by searching with the keywords. Cycle two was completed three months later using medical clinics from mid-April to mid-July 2025, and nurse-led clinics from mid-June to mid-July 2025, applying the same inclusion/exclusion criteria and outcome measures. Results: In the first audit, 132 eligible outpatients were reviewed. 108/132 had a CRAFT updated within the preceding year, giving an overall compliance rate of 81.8%. There was 77.6 % (83/107) compliance within the medical team and 100% (25/25) within the nursing team. The plausible contributors to non-compliance were time pressure in medical clinics and the absence of automated prompts within EMIS. In cycle two, medical clinic compliance improved to 83.6% (102/122). Nurse-led clinics maintained a high compliance rate of 95% (38/40). Overall compliance increased to 86.4% in the re-audit. Conclusion: Compliance with annual CRAFT review in this elderly CMHT was high but not universal. A simple intervention, consisting of multidisciplinary feedback with practical guidance on screening for last CRAFT update, was associated with measurable improvement. Introducing electronic prompts and continuing periodic re-audit may help sustain gains and standardize accessible risk documentation across the team.
Introduction International medical graduates (IMGs) constitute a significant proportion of the global physician workforce, with Pakistan as a leading source country. Despite many Pakistani physicians emigrating for training and employment, limited research exists on the well-being of those who return. This study aimed to assess satisfaction with life (SWL) in foreign-trained, repatriated Pakistani physicians and examine its associations with affect balance and flourishing. Methods A cross-sectional survey was conducted between April 2022 and November 2023, recruiting 109 repatriated physicians via purposive sampling. Data was collected using the Scale of Positive and Negative Emotions (SPANE), the Flourishing Scale, and the SWL Scale. Relationships among these variables were assessed using correlation analysis, and logistic regression was used to identify predictors of SWL. Results Of the 109 participants, 70.6% were male, 83.5% resided in Punjab, 68.8% had trained in the US/Canada, and 69.7% worked in the private sector. The mean age was 47.31 (SD=7.9) years, and 58.7% held dual nationality. Overall, 90.8% reported being satisfied with life. Men (p=0.03) and married individuals (p=0.04) demonstrated higher SWL, whereas participants from Sindh and Khyber Pakhtunkhwa scored lower (p=0.007). SWL correlated moderately with flourishing (r=0.488), positive emotions (r=0.391), and affect balance (r=0.327). Each one-unit increase in flourishing was associated with a 1.236-fold higher odds of SWL (p=0.005). Conclusions Foreign-trained, repatriated Pakistani physicians in this study exhibited high SWL, closely linked to flourishing and positive affect. The repatriated physicians may significantly contribute to healthcare systems in lower-middle-income countries. Future research should examine broader samples, include locally trained or expatriated comparison groups, and explore repatriation challenges to further elucidate factors that influence physician well-being.
