NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland, and one of the four systems which make up the National Health Service in the United Kingdom. It operates fourteen territorial NHS boards across Scotland, seven special non-geographic health boards and NHS Health Scotland.At the founding of the National Health Service in the United Kingdom, three separate institutions were created in Scotland, England and Wales and Northern Ireland. The NHS in Scotland was accountable to the Secretary of State for Scotland rather than the Secretary of State for Health as in England and Wales. Prior to 1948, a publicly funded healthcare system, the Highlands and Islands Medical Service, had been established in Scotland in 1913, recognising the geographical and demographic challenges of delivering healthcare in that region.Following Scottish devolution in 1999, health and social care policy and funding became devolved to the Scottish Parliament. It is currently administered through the Health and Social Care Directorates of the Scottish Government.The current Cabinet Secretary for Health and Social Care is Humza Yousaf, and the head of staff is the director-general health and social care and chief executive of NHS Scotland, Caroline Lamb.
How can recovery trajectories after critical illness in very old ICU survivors be better understood and potentially modified across the continuum of care? Recovery trajectories in very old ICU survivors are highly heterogeneous and result from the interaction between baseline vulnerability (frailty, multimorbidity, social factors), the acute stress of critical illness, and individual resilience. Opportunities to influence these trajectories exist at multiple stages, including prehabilitation before ICU admission,brain- and neuromuscular-protective strategies during ICU stay, and structured, transdisciplinary post-ICU follow-up. A shift from survival-focused metrics to a trajectory-based, transdisciplinary approach is essential to improve functional recovery and quality of life in very old ICU survivors.
Objective The UK faces a significant obesity crisis, and multiple management options are now available, including pharmacotherapy, endoscopic and surgical interventions. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a National Institute for Health and Care Excellence-approved, minimally invasive obesity care procedure, which is a safe and effective option for selected patients. Despite its promise, National Health Service (NHS) providers lack standardised guidance for the implementation of this intervention. This initiative is aimed at creating a comprehensive pathway for the implementation of ESG within the NHS using a diverse stakeholder approach.Methods A modified nominal group technique (NGT) was employed, bringing together a diverse group of healthcare professionals (HCPs) involved in obesity management from primary and secondary care, commissioner representatives and patient groups in an iterative consensus-building process. The NGT methodology allowed for structured discussion, prioritisation of key elements and sequential refinement of the pathway through multiple rounds of expert input and feedback.Results The panel reached agreement on HCP requirements, resource allocation and identified key considerations for successful ESG implementation. Critical elements included primary care engagement, dietetic support, psychological assessment and anaesthetic involvement alongside the procedural aspects of training and mentoring, patient selection and technical factors. Notably, no areas of significant disagreement were identified throughout the process, enabling the development of a comprehensive framework for ESG delivery.Conclusion This framework provides practical proposals to facilitate ESG implementation across NHS centres, supporting multidisciplinary care delivery while acknowledging operational feasibility within existing NHS resource constraints.
Ant–plant mutualisms are widespread, with over 4000 angiosperm species worldwide bearing extra-floral nectaries where sugar is secreted in exchange for protection against herbivores. Turnera velutina, an endemic Mexican shrub, has facultative mutualist interactions with different ant species, and these interactions have variable effects on its fitness. Specifically, the presence of Camponotus ants have been linked to the highest T. velutina’s fruit production, in comparison with the presence of other patrolling ant species. Whether this outcome is because Camponotus ants are the most aggressive, the largest, the fastest at locating herbivores, and/or more gregarious with many workers patrolling/attacking herbivores, has not yet been formally investigated. In this study, we assessed the defensive behavior and repelling capacity of six ant species against larvae of Euptoieta hegesia (Lepidoptera), the main herbivore of T. velutina in the studied population. Contrary to our expectations, Camponotus ants were not the most effective defenders, and they were only better than Cephalotes ants, a genus that has been found to be opportunistic in other plant systems. Surprisingly, the two smallest ants, Dorymyrmex bicolor and Brachymyrmex sp., were the best defenders and the fastest at repelling herbivores, partly because many workers simultaneously attacked the larvae. We discuss how different ants may impact various aspects of a species’ fitness, highlighting the dynamic and complex outcomes of ant–plant interactions, as a function of species identity and their impacts on herbivores.
Aims: ADHD is treated in CAMHS and may involve non-pharmacological treatments, suchas behavioural therapy. It may also involve pharmacological treatments, such as methylphenidate, lisdexamfetamine, atomoxetine, and guanfacine. Medication side effects include hypertension, weight loss, arrhythmias, and loss of appetite, all of which are detrimental to childhood development. The aim of this closed-loop audit was to improve Attention Deficit Hyperactivity Disorder (ADHD) monitoring within the Child & Adolescent Mental Health Services (CAMHS) in West Glasgow. Patients’ height, weight, blood pressure, and heart rate, along with respective centiles and growth charts, were assessed in accordance with NICE guidelines. Methods: In the initial audit, a retrospective data search using electronic health records identified a sample of 33 patients under 18 with a diagnosis of ADHD who took ADHD medication within the previous 6 months. The results of this initial audit were presented at a local department meeting. Posters of the NICE guidelines were then distributed. The same methods as the initial audit were used to identify 45 patients on ADHD medication for the follow-up cycle to assess improvement in monitoring. Results: In the initial audit, 97% of the 33 patients had their height and weight recorded, and 100% had their blood pressure and heart rate recorded. 85% of patients had their height centile, weight centile, and growth charts recorded. 10% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded. In the second cycle, 100% of the 45 patients had their height, height centiles, weight, weight centiles, heart rate, blood pressure, and growth charts recorded. 2% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded. Conclusion: There was a significant increase in the monitoring of height, height centiles,weight, weight centiles, heart rate, blood pressure, and growth charts in the second cycle compared with the first cycle. However, blood pressure and heart rate centiles still did not meet NICE guidelines. This was clinically significant due to the variance in heart rate and blood pressure in children. The electronic health system’s inability to convert raw figures of blood pressure and heart rate to percentiles likely impacted the ability to monitor these specific percentiles.
