NHS Ayrshire and Arran is one of the fourteen regions of NHS Scotland. It was formed on 1 April 2004.It has a responsibility to provide health and social care to almost 400,000 people with an operating budget of around £700 million (for 2013–2014), and planned budgets of £720 (for 2019-2020), £762.4 million (for 2020-2021) and £774.5 million (for 2021-2022).
People who use substances are disproportionately affected by both death and nondeath losses and have vulnerabilities that can hinder the processing of the associated grief. While there is an established and growing quantitative research base demonstrating the complexities between grief and substance use, the qualitative literature remains fragmented. This study aims to systematically review the grief experiences of people who use substances to enhance understanding and inform service delivery. A systematic search of four electronic databases identified 18 studies, which were quality assessed using the Critical Appraisal Skills Program. A thematic synthesis was conducted which involved line-by-line coding of findings, development of descriptive themes, and generation of analytical themes. This process identified three themes: Locked in Loss and Addiction, Defeated and Defended, and Routes to Recovery. Findings highlight the reinforcing relationship between grief and substance use, identify grief responses relevant to people who use substances, and offer an aggregated insight into their grieving experiences. This has important implications regarding the integration and provision of grief-informed support in clinical practice.
OBJECTIVE:To characterise contemporary practice patterns in female radical cystectomy (RC) across the UK and Ireland, focusing on preoperative counselling, operative strategies, and postoperative care. SUBJECTS AND METHODS:A 36-item survey was distributed to consultant urologists performing RC, identified via the British Association of Urological Surgeons (BAUS) and Cancer Alliances. The questionnaire addressed surgeon demographics, preoperative assessment and counselling, operative decision-making including organ- and nerve-sparing techniques, and survivorship care. Responses were analysed descriptively; group comparisons were made using the Wilcoxon rank-sum and Fisher's exact tests. RESULTS:A total of 64 surgeons responded (56.1% [64/114]), representing 41 cystectomy centres (70.7% [41/58]). Preoperative assessment of sexual activity (68.8%) and menopausal status (78.1%) was common, whereas sexual orientation (15.6%) and prolapse (26.6%) were rarely addressed. Female surgeons were significantly more likely to enquire about menopausal status (P = 0.025). Counselling on sexual dysfunction (98.4%) and vaginal shortening (96.9%) was routine, but other complications, including prolapse (68.8%), menopause (82.8%), or fistula (6.3%), were inconsistently discussed. Organ-sparing practice varied: 28.1% rarely or never performed organ preservation, citing oncological concerns. High-volume centres were more likely to offer organ-sparing RC (P = 0.013). Over half reported inadequate access to female-specific rehabilitation services, with most centres lacking formal pathways for vaginal complications. CONCLUSIONS:Female RC practice across the UK and Ireland is heterogeneous, with clear gaps in preoperative counselling, uptake of organ-sparing techniques, and survivorship care. There is an urgent need for standardised, evidence-based pathways and consensus guidance to optimise outcomes for female patients.
Personalized and precise classification of neurodegenerative diseases (Alzheimer’s and brain tumors) is crucial for early diagnosis and patient care. Brain tumors and Alzheimer’s disease are challenging to classify due to their varied shapes and features. In this work, we propose a novel four-block residual attention model for the classification of brain lesions and Alzheimer’s disease in magnetic resonance imaging (MRI). The 4-block attention model integrates a channel attention module (CAMB) and a spatial attention module (SAMB) into each of its four blocks. We also implemented the Residual Attention Network (RAN) to improve overall disease information further and achieve better classification and generalization. An ablation study was conducted to determine the optimal number of blocks, testing RAN models with 2, 3, 4, and 5 blocks for training and validation. The proposed 4-block RAN model achieved an accuracy of 96.8
BACKGROUND:Wire-guided localizations have been the historical standard for breast lesion localization; however, they have logistical constraints and can dislodge in the preoperative period. Radar-guided localization has the potential to uncouple localization from the day of surgery, but the technique needs to be evaluated in a direct comparison with wire-guided localization to ensure efficacy and safety. METHODS:The iBRA-NET localization study is a prospective platform IDEAL 2a/2b study comparing wire-guided localization with new generation localization devices. This arm describes SCOUT® radar localization for impalpable breast lesions performed between June 2021 and December 2024, compared with a historical cohort of wire-guided localization performed between August 2018 and August 2020. Primary outcome was identification of the index lesion in the excision specimen. Secondary endpoints included safety (complications), margin re-excision, magnetic resonance imaging bloom size, and specimen weight. RESULTS:Data were accrued from 1297 radar localized patients in 27 units. Index lesion identification was 95.2% in radar-guided excisions versus 99.1% in wire-guided excisions (P = 0.001). In a sensitivity analysis excluding patients receiving neoadjuvant chemotherapy, identification rates were 98.9% versus 99.6% (P = 0.114). For a subset of patients having a simple lumpectomy for a unifocal, unilateral breast lesion with no neoadjuvant treatment (1627), positive margins were seen in the main excision specimen in 1003 (15.0%) wire-guided versus 624 (9.0%) radar-guided excisions (P < 0.001). Re-excision was required in 131 (13.2%) wire-guided versus 91 (14.7%) radar-guided excisions (P = 0.442). There was a significant difference in specimen weight/size2 (0.138 g/mm2 wire-guided localization versus 0.182 g/mm2 radar; P < 0.001). The median start time for surgery was earlier in the day for radar-guided localizations compared with wire-guided (12:27 versus 13:40; P < 0.001). All radar placements in axillary nodes (13) led to successful nodal retrieval. CONCLUSION:SCOUT® radar localizations are a safe and effective localization technique in both the breast and axilla, with outcomes comparable to wires. There were demonstrable logistical advantages in operative start time when using a radar reflector.
