NHS Lothian is one of the 14 regions of NHS Scotland. It provides healthcare services in the City of Edinburgh, East Lothian, Midlothian and West Lothian areas.
Pilot randomised-controlled trial of nortriptyline and escitalopram compared to placebo for depressive symptoms in people with Parkinson’s disease (PD). Participants with PD and depressive symptoms received either nortriptyline, escitalopram or placebo with assessments at baseline and 8 weeks. Feasibility of the full trial was assessed using recruitment rate, loss to follow up before the 8-week primary endpoint, adherence to trial medication and rate of clinically significant adverse reactions. Intended efficacy outcomes included the BDI-II, Patient Health Questionnaire (PHQ-9), Parkinson Anxiety Scale (PAS), MDS-UPDRS and adverse effects. The aim was to recruit 46 participants to determine feasibility of the full trial. 52 participants were recruited from 24 NHS sites and randomised to nortriptyline (n = 16), escitalopram (n = 17) or placebo (n = 19). However, despite multiple strategies, recruitment took two years, and the study therefore did not reach its feasibility aim. Exploratory analyses showed that at 8 weeks depressive symptoms decreased significantly in all three arms. There was no difference in BDI-II score changes between the nortriptyline or the escitalopram when compared to the placebo arm, but PHQ-9 scores showed a greater reduction compared to placebo with nortriptyline (-3.4, 95
Background and Objective: Surgical management of bladder outflow obstruction (BOO) caused by benign prostatic enlargement (BPE) has proven challenging, with increased pressure on National Health Service (NHS) resources. Traditionally, transurethral resection of prostate (TURP) was performed requiring an average inpatient stay of 2-4 days. If complications occur, the patient's stay in the urology ward is extended. Limited bed availability can result in the cancellation of elective surgeries. This continues to pose a challenge with the surge of COVID and respiratory infections during the winter season, resulting in a very limited bed availability. In recent decades, multiple new interventions for bladder outflow obstruction have emerged and proven safe and efficacious in multiple large studies. Our study's aim was to demonstrate GreenLight Laser Prostatectomy's (GLLP) feasibility as a 'true' day-case procedure. Materials and methods: Data collection for both GLLP and bipolar TURP was done as a retrospective observational cohort study in a single institution. Both cohorts underwent primary operation; primary GLLP cases were performed in 2021/2022, and primary bipolar TURP between 2023/2024. Greenlight laser prostatectomy was performed using the 180 W GreenLight XPS (TM) laser therapy system, and bipolar TURP using standard Olympus/Richard Wolf resectoscopes. Multiple preoperative, operative, and postoperative parameters were collected, with a primary focus on day-case discharge after the procedure. Results: A total of 180 patients underwent bladder outflow surgery, of which 90 patients (50%) had GLLP and the other 90 patients (50%) had TURP. The mean age for the GLLP group was 73.9 and for the TURP group was 71.9. We have observed a statistically significant difference in prostate volume between the two groups, with a mean volume of 98.9 cc for the GLLP group and 76.9 cc for the TURP group (p = 0.01). Even though prostates in the GLLP group were larger in size, the operation time was significantly shorter in the GLLP group, with a mean of 57.3 minutes, compared to 66.9 minutes for TURP (p = 0.01). In terms of hospital stay postoperatively, we observed a significant difference in the day-case discharge rate: 94.4% of patients in the GLLP group were discharged as day cases compared to only 4.4% in the TURP group (p < 0.001). Both the GLLP group (72 participants, 80%) and the TURP group (83 participants, 92.2%) achieved successful Trial to Void Without Catheter (TWOC), representing a significant difference in favour of TURP (p = 0.018). A survey regarding the patients' experience was conducted with the operative and postoperative processes has shown that 71.1% of participants in the GLLP group were satisfied, compared to 51.1% in the TURP group, which was statistically significant in favour of the GLLP (p < 0.001). Conclusion: Based on our observations, GLLP is a safe day-case operation with a good patient satisfaction rate and an acceptable success rate. It effectively addresses bladder outflow issues in hospitals with limited bed capacity. When implemented via a well-designed pathway, it can help reduce the waiting times in the NHS.
Introduction Prehospital emergency anaesthesia is recognised as a high-risk clinical intervention. These updated guidelines consider changes in prehospital practice and parallel changes in the practice of in-hospital emergency anaesthesia, with the aim of encouraging standardised safe anaesthetic practice in a challenging clinical area. Method A working group was set up by the Association of Anaesthetists to include experts and resident doctors working in prehospital emergency medicine, anaesthesia, intensive care medicine and emergency medicine. There was also representation from relevant specialist groups and societies. We used a modified Delphi process and conducted targeted literature reviews to inform recommendations. Results We formulated recommendations in several key areas of prehospital emergency anaesthetic practice including general techniques; sedation before prehospital emergency anaesthesia; personnel and training; equipment and monitoring; prehospital emergency anaesthesia in children; and transport. Discussion Clinical teams that provide prehospital emergency anaesthesia must be well trained and competent to deliver the procedure to the same standards as their colleagues in the receiving emergency department. Although patients requiring prehospital emergency anaesthesia are often physiologically unstable and have pathology associated with a high mortality, there is good evidence that prehospital emergency anaesthesia can be delivered safely and to high standards.
Therapies with robust visual outcomes and reduced patient and healthcare system treatment burden are needed amidst the rising incidence of neovascular age-related macular degeneration (nAMD). Aflibercept 8 mg is an additional treatment option with demonstrated potential for extended dosing intervals of up to 24 weeks. The objective of this publication is to introduce a clinical care pathway, developed by expert consensus of experienced UK clinicians, to support best practice with aflibercept 8 mg in nAMD. A structured, face-to-face roundtable meeting of 13 UK retina specialists was held on 8 October 2024, organised and funded by Bayer. The expert panel reached consensus following review of key clinical trial data and consideration of current NHS clinical practice to provide guidance on the use of intravitreal aflibercept 8 mg in nAMD. The panel provided recommendations for an aflibercept 8 mg treat-and-extend pathway for both treatment-naïve and previously treated patients with nAMD. Criteria were developed to guide dosing interval extension, reduction or maintenance based on visual acuity and optical coherence tomography imaging. More detailed guidance includes considerations for switching treatments to or from aflibercept 8 mg, monitoring, and discontinuing treatment. Aflibercept 8 mg may offer opportunities for longer treatment intervals and reduced patient and clinic burden compared with first-generation agents. The proposed treatment pathway is practical and accounts for variability in healthcare structures and capacity pressures, providing clinicians with flexibility in implementing these recommendations while addressing patient needs.
The digitalisation of health data has helped drive initiatives like the Scottish Collaborative Optometry-Ophthalmology Network eResearch (SCONe), which links retinal images from community optometry practices with other routinely collected health data to enhance disease detection. As data-driven approaches expand throughout the healthcare system, patient and public involvement and engagement (PPIE) is increasingly recognised as essential for improving the quality, relevance, and acceptability of health research. However, despite growing endorsement, challenges remain, including inconsistent terminology, varying levels of involvement, limited implementation guidance, and a lack of evidence on its impact. These challenges are even more pronounced in data science, particularly within large-scale research, where PPIE is often underreported, leaving the field without a clear framework for meaningful implementation. This article offers a reflective account of the challenges and barriers encountered by SCONe in developing a PPIE strategy. By documenting this process, it provides insights into the complexities of implementing PPIE in large research consortia and offers practical guidance for future initiatives seeking to enhance the impact and relevance of public partnerships in large scale data science research.
