South East Scotland Research Articles

​​Solace of Substance​: Agency, Surrender, and Consolation in Addiction and Polydrug Use

Although preceding its association with substance use, early uses of the term ‘addiction’ signified intense attachment or ‘devotion’ to an activity or pursuit, indicating compromised autonomy, a necessary ‘culling’ of conflicting obligations, such as family and other concerns, and a potentially dangerous surrender (Lemon 2018). Recent advances in biomedical and neuroscientific understandings of addiction, as a relapsing neurological disorder, have sharpened notions of substance use as being outside of conscious control. Yet framing addiction in terms of individual, neurobiological predispositions towards addictive behaviour, continues to impact how we view agency, responsibility, and autonomy, even as substances are ascribed their own powerful agencies. Based on long-term ethnographic fieldwork with individuals and third sector services in south-east Scotland, this article attends to ambiguous notions of agency attributed to and by people who use substances, and to substances themselves. It asks how responsibility for recovery becomes divested onto individuals, and how a moral ‘devotion’ to one’s recovery is mandated by medical and judicial institutions. The article further highlights how dyadic and intimate relationships with heroin are emplaced within wider webs of relations, and how heroin itself is suffused with agency and intentionality: becoming at once a force for destruction and source of life-giving surrender.

Preterm birth as a determinant of neurodevelopment and cognition in children (PRENCOG): protocol for an exposure-based cohort study in the UK

IntroductionPreterm birth (PTB) is strongly associated with encephalopathy of prematurity (EoP) and neurocognitive impairment. The biological axes linking PTB with atypical brain development are uncertain. We aim to elucidate the...

Incidence and prevalence of asthma, COPD, and ILD across England, Wales, and South-East Scotland – a harmonised approach to data analysis

ObjectiveThis study aimed to create harmonised datasets for asthma, chronic obstructive pulmonary disease (COPD), and Interstitial Lung Disease (ILD), and subsequently use them to calculate the incidence and prevalence of these diseases across three UK nations (England, Wales, and South-East Scotland). ApproachHarmonised research-ready datasets were created using three electronic healthcare record databases. Records were selected between 01/01/2004 and 31/12/2019, with yearly age and sex standardised incidence and prevalence rates calculated. ResultsIn 2019, the incidence rates for asthma were: England, 0.89 (95%CI: 0.88–0.90); Wales, 0.66 (0.65–0.68); and South-East Scotland, 0.67 (0.64–0.71), which were all lower than in 2004. Incidence rates of COPD in England were 0.83 (0.82–0.85) and 0.67 (0.65–0.69) in Wales, which were both lower than in 2004, but Scotland remained similar at 1.06 (0.99–1.13). Incidence rates of ILD were: England, 3.27 (3.05–3.50); Wales, 1.39 (1.27–1.53); and Scotland, 1.63 (1.36–1.95), which were all higher than in 2004. Between 2004 and 2019, the prevalence of all three diseases increased across all three nations. ConclusionsSolving differences in coding between CPRD, SAIL Databank, and DataLoch databases enabled comparable cohorts to be created and the first harmonised UK estimates of incidence and prevalence for asthma, ILD, and COPD. ImplicationsHarmonised studies of asthma, COPD, and ILD across the UK can now be performed. The code produced is publicly available to facilitate future research, which can be adapted for other conditions and databases.

Pushing health data access boundaries - adapting NHS governance for 3 challenges: clinical free-text, safe commercial access and AI development

This presentation will demonstrate expansions to TRE governance frameworks developed to facilitate safe data access in three advanced areas: commercial access, clinical free-text, and innovation with AI/Machine Learning. NHS research governance frameworks - originally set up for clinical trials and expanded into the TRE and secondary data use space – are not an immediate fit for advanced techniques in data science research. Over 2 years, public, expert and user engagement approaches were utilised to support developing frameworks within DataLoch, a Health and Social Care TRE and data access service in South-East Scotland. Surveys, workshops and continuous user and data controller feedback allowed the testing of tools and assessments to adapt traditional NHS governance structures. These frameworks utilise the Five Safes framework to make NHS data controllers supportive of innovative research in the public and health service’s benefit. The presentation will summarise the challenges faced for one TRE and researchers working to support these areas, and the frameworks that are now are being tested within an NHS Scotland Health Board. The development and implementation demonstrates that governance structures can be adapted collaboratively and paves the way for more flexible TRE governance to allow the use of NHS patient data to remain legally and ethically robust while supporting advanced techniques of analysis.

MOY 2 - ‘Cachexia Index’ for Prognostication in Surgical Patients with Locally Advanced Oesophageal or Gastric Cancer: A Multicentre Cohort Study

Abstract Background Features of cancer cachexia are known to adversely influence patient outcomes, yet few currently inform clinical decision-making. This study assessed the value of ‘cachexia index’ (CXI), a novel prognostic marker, in patients planned for curative multimodal therapy (neoadjuvant chemotherapy (NAC) and surgery) for oesophagogastric cancer. Methods Consecutive patients newly diagnosed with locally advanced (T3/4 or ≥N1) oesophagogastric cancer were identified through the West of Scotland and South-East Scotland Cancer Networks. CXI was calculated as (L3 skeletal muscle index) x (serum albumin) / (neutrophil-lymphocyte-ratio). Sex-stratified cut-off values were determined based on area under the curve (AUC), and patients were divided into low and normal CXI groups. Primary outcomes of interest were disease progression during NAC and overall survival (≥5-years follow-up). Results Overall, 385 patients (72% male, median 66 years) were treated with NAC for oesophageal (n=274) or gastric (n=111) cancer across the study period. While patients with a low CXI (males: <52 [AUC: 0.691] and females: <41 [AUC: 0.759]) were older and more comorbid, disease characteristics were comparable to those with a normal CXI. Rates of disease progression during neoadjuvant chemotherapy, leading to inoperability, were higher in patients with low CXI (28% vs. 12%, aOR: 3.07 (95% CI: 1.67-5.64), p<0.001). Moreover, low CXI was associated with worsened post-operative mortality (p=0.019) and decreased overall survival (median: 14.9 vs. 56.9 months, aHR: 1.85 (95% CI: 1.42-2.42), p<0.001). Conclusion CXI represents a valuable marker of ‘host stage’, and a potential adjunct to routine tumour staging. This could improve prognostication and decision-making in patients with locally advanced oesophagogastric cancer.

522. MULTI-SLICE, VOLUMETRIC COMPUTED TOMOGRAPHY BODY COMPOSITION ANALYSIS IN PATIENTS WITH OESOPHAGOGASTRIC CANCER

Abstract Background Single-slice computed tomography (CT) body composition has been studied extensively for prognostication in patients with cancer. New software packages can also provide multi-slice volumetric measurements, but the clinical utility of these remains under explored. This study aimed to evaluate the concordance between single- and multi-slice body composition analyses in patients with oesophagogastric cancer, and to explore the association between these measures and overall survival. Methods Consecutive patients with newly diagnosed oesophagogastric cancer were identified through the prospectively maintained regional database of the South-East Scotland Cancer Network across a 2-year study period. CT body composition analyses were undertaken using scans collected during routine clinical care. Single-slice (cross-sectional area at mid L3) and multi-slice (volume between T12-L4) measurements were obtained for skeletal muscle (SKM), subcutaneous adipose (SAT), visceral adipose (VAT) and intermuscular adipose (IMAT). Agreement between sex-stratified z-scores was quantified using Pearson correlation coefficients and Bland–Altman analyses. Cox proportional hazard modelling was used to estimate the effect of these measures on overall survival. Results Overall, 504 patients (67.9% male, median 72 years) were newly diagnosed with oesophagogastric cancer during the study period. Treatment was commenced with curative intent for 131 patients (26.0%). Single-slice area and multi-slice measurements were highly correlated for SKM (R: 0.97, p<0.001), SAT (R: 0.98, p<0.001) and VAT (R: 0.97, p<0.001), SKM radiodensity (R: 0.93, p<0.001) and IMAT (R: 0.88, p<0.001). Bias on Bland-Altman analysis was 0.00 for all tissue measurements. Limits of agreement (LoA) were narrowest for SAT (± 0.43), VAT (± 0.46) and SKM (± 0.48), but slightly wider for SKM radiodensity (± 0.73) and IMAT (± 0.96). Adipose tissue ‘outliers’ (those where agreement between single- and multi-slice z-scores was outside the LoA) had a higher median weight and body mass index (BMI), suggestive of poorer agreement in patients with obesity. Sensitivity analysis, excluding those with BMI >30, narrowed the LoA for SKM, VAT, SAT and IMAT. Direction and magnitudes of observed effect sizes for overall survival were all highly comparable, with hazard ratios for each tissue type varying by ≤0.04 between single- and multi-slice adjusted estimates. Conclusions Single-slice and multi-slice assessments of CT body composition provide highly correlated measurements for skeletal muscle, subcutaneous fat, visceral fat, and intra-muscular fat amongst patients with OG cancer. However, agreement between measurements is poorer in patients with obesity. The associations between these tissues measurements and overall survival are comparable across both types of body composition analysis.

1116P Application of the Scottish inflammatory prognostic score to the south-east Scotland cancer network real-world melanoma cohort

1116P Application of the Scottish inflammatory prognostic score to the south-east Scotland cancer network real-world melanoma cohort

New models of health and social care for people in later life: mapping of innovation in services in two regions of the United Kingdom using a mixed method approach

BackgroundInnovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse.MethodsWe mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively.ResultsOne hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves).ConclusionsWe found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread.

Effects of implementation of a care bundle on rates of necrotising enterocolitis and own mother’s milk feeding in the East Midlands: protocol for a mixed methods impact and process evaluation study

IntroductionPrevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother’s milk helps prevent NEC. Rates of own mother’s milk feeding in the East Midlands are lower...

DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care

BackgroundMultidomain interventions in older adults offer the best opportunity to prevent, delay or reverse existing symptoms in the earlier stages of frailty and improve independence but can be costly, and...

2011 Review of the requirement and impact of the medicine for the Elderly Major Trauma Service in South-East Scotland

Abstract Introduction It is well established that older adults with hip fracture benefit from comprehensive geriatric assessment (CGA), but there is less evidence for its use in major trauma. Since 2012 Major Trauma Centres (MTCs) have opened across the UK, with varying access to CGA. We report the requirement and impact of CGA in a MTC in its first year of opening. Methods We reviewed all adult patients admitted under the South-East Scotland MTC included in the Scottish Trauma Audit Group (STAG) database from 1st November 2021 – 31st October 2022. We compared: patients under 65y, patients ≥65y who did not undergo CGA, and patients ≥65y who underwent CGA. Outcomes were: review by ED consultant within one hour of presentation, trauma team activation, injury severity score (ISS), CGA within 7 days when CFS≥5, and mortality at 30 days. Results 1323 patients were identified (mean age 63.7y, SD20.9): <65y (n=690, 45.5y, SD14.0), ≥65y without CGA (n=401, 77.2y, SD8.2), and ≥65y with CGA (n=289, 84.6y, SD 7.3). The commonest mechanism of injury in all three groups was fall from standing height (29.1%, 59.6%, and 73.4% respectively). ED consultant review within 1 hour occurred in 37%, 25% and 18% of cases, with trauma team activation occurring in 32%, 18% and 7%. Average ISS were: 13, 12 and 11, and commonest sites of injury in those over 65 were external (e.g. skin), chest and limb. CGA was undertaken within 7 days in 95.1% of those with a documented CFS≥5. Mortality at 30 days was 2.9%, 12% and 8%. Conclusions A fifth of patients admitted to our MTC in the first year were older adults with CFS≥5. These patients were under-triaged at several stages despite comparable average ISS across groups. CGA may reduce 30-day mortality. We recommend further research into the benefit of CGA within MTCs.

The Impact of Biologic Therapies on Rate of Colectomy in Paediatric-onset Ulcerative Colitis - A Population-Based Cohort Study

AimBiologic therapies have been associated with reduced rate of colectomy in ulcerative colitis (UC) in adults, but data are limited in paediatric-onset UC. Our aim was to define the rate of colectomy in paediatric-onset UC, including post-transition into adult care, and to evaluate the impact of biologic therapies on rate of colectomy. MethodAll prevalent patients diagnosed with paediatric-onset UC in South-East Scotland were identified from a prospectively accrued database at our regional tertiary centre. Patients exposed to biologics or surgery were identified and further data collected from health records. Kaplan–Meier analysis was used to calculate cumulative risk of colectomy over time. Results145 prevalent patients were identified between 2000 and 2021. Median follow-up was 7.9 years (IQR 4.1–13.1). 23 patients (16 %) underwent a colectomy. 50/145 (34 %) patients received biologic therapy, and 13/23 (57 %) patients who underwent colectomy received biologics. The cumulative risk of colectomy across the whole cohort at 1, 5, and 10 years was 3 %, 13 % and 16 %, respectively. Patients exposed to biologics had a higher colectomy rate at 5 and 10 years (22 % and 34 %). Patients in the pre-biologic era (2000–2008) had non-significantly reduced time from diagnosis to colectomy (2.4 vs 3.7 years, p = 0.204). ConclusionWe have defined the 1-, 5-, and 10-year colectomy rate in a population-based cohort of Paediatric-onset UC patients. Patients who received biologic therapy had a significantly increased risk of colectomy. Increased severity of disease in these patients may account for the greater colectomy risk. Level of EvidenceLevel 1.

Scottish Index of Multiple Deprivation (SIMD) indicators as predictors of mortality among patients hospitalised with COVID-19 disease in the Lothian Region, Scotland during the first wave: a cohort study

BackgroundSars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality.MethodsThis was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome.ResultsAfter adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99–3.08, p = 0.053 and OR 2.17, CI 1.22–3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20–3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28–3.00) p = 0.002)).ConclusionsSIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.

P11 Acrodermatitis chronica atrophicans: a sign of late lyme disease

Abstract Borrelia infection manifests a variety of signs and symptoms, and its insidiousness and heterogeneity mean that its diagnosis can be delayed. We describe two patients from south-east Scotland who presented with unilateral asymptomatic atrophic areas of skin discoloration. The first was a 71-year-old woman, who presented with a 4-month history of a nonprogressive, mottled, erythematous rash involving her right thigh, buttock and calf. Case 2 was a 56-year-old woman with a 2-year history of an erythematous area of atrophic skin involving the medial aspect of her left thigh and shin. Histology from case 1 showed a normal epidermis with a largely ‘top-heavy’ superficial and deep, predominantly interstitial and focally perivascular, lymphohistiocytic infiltrate, with a predominance of mononuclear histiocytes and with focal extension to deep reticular dermis. Scattered plasma cells were identified, but eosinophils were not a prominent feature. Well-formed granulomas were absent, as were interface dermatitic activity and vasculitic changes. On close questioning, each patient remembered ‘insect’ bites in the vicinity of the cutaneous changes, although neither recalled rashes that could have been consistent with erythema chronicum migrans. In both cases, serology confirmed infection with Borrelia burgdorferi (sensu lato) and diagnoses of acrodermatitis chronica atrophicans (ACA) were made. Both patients responded well to oral treatment with doxycycline. ACA is a cutaneous sign of late-stage Lyme disease and is caused by ongoing active skin infection by tick-borne bacteria of the Lyme disease group of Borrelia species. The tick bite has usually occurred months or years before symptom onset. Typically, there is an early, unilateral inflammatory stage with bluish-red discoloration of the skin and an oedematous appearance. This is followed by an atrophic stage where the skin becomes thin and wrinkled (‘cigarette paper’-like), with the loss of epidermal and dermal structures. Histological features usually include marked atrophy of the epidermis and dermis, loss of adnexal structures and an absence of elastic tissue. A band-like lymphocytic infiltration with plasma cells and mast cells is seen in the dermis, especially in the early stage of disease. Laboratory-confirmed cases of Lyme borreliosis in the UK have risen steadily since reporting began in 1986. ACA is likely to be underdiagnosed and, if there is a clinical suspicion, a detailed history, careful skin examination, Borrelia serology and skin biopsy should be undertaken. Early recognition and treatment reduce the risk of irreversible skin changes and systemic symptoms.

VIKING II, a worldwide observational cohort of volunteers with northern isles ancestry.

The purpose of VIKING II is to create an observational cohort of volunteers with ancestry from the Northern Isles of Scotland, primarily for identifying genetic variants influencing disease. The new online protocol is separate to, but follows on from, earlier genetic epidemiological clinic-based studies in the isolated populations of Orkney and Shetland. These populations are favourable for the study of rarer genetic variants due to genetic drift, the large number of relatives, and availability of pedigree information. They are known to be genetically distinct from mainland British populations. Online methods are being used to recruit ~4,000 people who have Northern Isles ancestry, living anywhere in the world. The option for participants to have actionable genetic results returned is offered. Consent will be taken electronically. Data will be collected at baseline through an online questionnaire and longitudinally through linkage to NHS data in the electronic health record. The questionnaire collects a variety of phenotypes including personal and family health. DNA will be extracted from saliva samples then genome-wide genotyped and exome sequenced. VIKING II aims to capitalise on the special features of the Northern Isles populations to create a research cohort that will facilitate the analysis of genetic variants associated with a broad range of traits and disease endpoints, including otherwise rare variants that have drifted to high frequency in these populations. The South East Scotland Research Ethics Committee gave the study a favourable opinion. VIKING II is sponsored by the University of Edinburgh and NHS Lothian. Summary research findings will be disseminated to participants and funding bodies, presented at conferences and reported in peer-reviewed publications. Strengths and limitations of this studyDetailed data and biological sample collection of research volunteers with unique ancestry.Consent for access to routinely collected clinical EHR data and for future re-contact, providing a longitudinal component.Optional consent for return of actionable genetic results.~4,000 participants is a relatively small number for certain types of genetic analyses, so the cohort is underpowered on its own, in some study designs.Resources to maintain the cohort, and to store data and DNA samples, are significant, with sustainability dependent on infrastructure support and funding.

Feasibility randomised controlled trial of online group Acceptance and Commitment Therapy for Functional Cognitive Disorder (ACT4FCD)

IntroductionFunctional cognitive disorder (FCD) is seen increasingly in clinics commissioned to assess cognitive disorders. Patients report frequent cognitive, especially memory, failures. The diagnosis can be made clinically, and unnecessary investigations...

Long-term follow-up to assess criteria for ovarian tissue cryopreservation for fertility preservation in young women and girls with cancer.

Do the Edinburgh Selection Criteria correctly identify female cancer patients under the age of 18 who are at risk of premature ovarian insufficiency (POI) as candidates for ovarian tissue cryopreservation (OTC)? Patient assessment using these criteria accurately identifies those at risk of POI, who can be offered OTC and future transplantation as a means of fertility preservation. Treatment for childhood cancer can have adverse consequences on future fertility; at the time of diagnosis, fertility risk assessment should be undertaken in order to identify patients to whom fertility preservation should be offered. The Edinburgh selection criteria, based on planned cancer treatment and patient health status, are utilized to identify those at high risk and therefore eligible for OTC. However, this procedure is not without risk and there are few data on the efficacy of the procedure in prepubertal patients. As such, long-term follow-up of reproductive outcomes is necessary, to ensure that OTC is being offered appropriately. Cohort study encompassing all females diagnosed with cancer under the age of 18 in South East Scotland, from 1 January 1996 to 30 April 2020. Patients were followed up for reproductive outcomes to assess for diagnosis of POI. A total of 638 eligible patients were identified; patients under the age of 12 or deceased before the age of 12 were excluded from the study, leaving a study population of 431 patients. Electronic records were reviewed for reproductive function, assessed by current menstruation, pregnancy (in the absence of POI diagnosis), reproductive hormone measurements, pubertal progression, or diagnosis of POI. Patients on hormonal contraception (other than for treatment of POI or panhypopituitarism with no history of gonadatoxic treatment) were excluded from analysis (n = 9). Analysis on remaining 422 patients was carried out using the Kaplan-Meier methods, with POI as the defined event, and Cox proportional hazards model. In the study population of 431 patients, median ages at diagnosis and analysis were 9.8 and 22.2 years, respectively. Reproductive outcomes were unavailable in 142 patients; the assumption was made that these patients did not have POI, but a subanalysis excluding these patients was also performed. Of the 422 patients aged >12 at analysis and not taking hormonal contraception, OTC was offered to 37 patients and successfully performed in 25 patients. Of the 37 patients offered OTC (one at time of relapse), nine (24.3%) developed POI. Of the 386 not offered OTC, 11 (2.9%) developed POI. The probability of developing POI was significantly higher in those offered OTC (hazard ratio [HR] 8.7 [95% CI 3.6-21]; P < 0.0001), even when those patients with unknown outcomes were excluded from the analysis (HR 8.1 [95% CI 3.4-20]; P < 0.001). All patients offered OTC who developed POI did so after treatment for primary disease; in those not offered OTC, five patients (45.5%) developed POI after treatment for disease relapse. A significant number of patients had unknown reproductive outcomes; many of these patients were engaged in ongoing follow-up but did not have documented reproductive assessment. This may have introduced bias to the analysis and highlights the need for reproductive follow-up as part of routine cancer aftercare. In addition, the relatively young age of the patient population and short duration of follow-up in some cases demonstrates the need for ongoing follow-up of this cohort. The prevalence of POI after childhood cancer is low, but the Edinburgh selection criteria remain a robust tool for selecting those at high risk at the time of diagnosis, to offer OTC appropriately. However, disease relapse necessitating more intensive treatments remains a challenge. This study additionally highlights the importance of routine assessment and documentation of reproductive status in haematology/oncology follow-up. K.D. is supported by a CRUK grant (C157/A25193). This work was undertaken in part in the MRC Centre for Reproductive Health, (supported by MRC grant MR/N022556/1). R.A.A. has received consulting fees from Ferring and Roche Diagnostics; payment from Merck and IBSA for educational events; and laboratory materials from Roche Diagnostics. The other authors have no competing interests to declare. N/A.

Cover Photograph

Front cover: A polar orbiter METOP‐C pass over the UK, timed at 1012 utc 18 January 2023 obtained by the Nowcasting Satellite Application Facility (NWC SAF). In the preceding days, cold Arctic air had become established over the country. Convective clouds associated with a polar low can be seen in the North Sea. In the west, convection in a region of cold‐air advection is organised along mesoscale trough features. Patchy snow cover can be seen over north and northwest England, the North York Moors and southeast Scotland. (© 2023 EUMETSAT.)image

Ambulatory antenatal fetal electrocardiography in high-risk pregnancies (AMBER): protocol for a pilot prospective cohort study

IntroductionFetal heart rate (FHR) monitoring is a vital aspect of fetal well-being assessment, and the current method of computerised cardiotocography (cCTG) is limited to the hospital setting. Non-invasive fetal ECG...

The research interest, capacity and culture of NHS staff in South East Scotland and changes in attitude to research following the pandemic: a cross-sectional survey

BackgroundThe UK National Health Service (NHS) is ideally placed to undertake research. The UK Government recently launched its vision of research within the NHS to improve research culture and activity amongst its staff. Currently, little is known about the research interest, capacity and culture of staff in one Health Board in South East Scotland and how their attitudes to research may have changed as a result of the SARS-CoV-2 pandemic.MethodsWe used the validated Research Capacity and Culture tool in an online survey of staff working in one Health Board in South East Scotland to explore attitudes to research at the organisation, team and individual level together with involvement in, barriers to and motivators to engage in research. Questions included changes in attitude to research as a result of the pandemic. Staff were identified by professional group: nurses/midwives, medical/dental, allied health professionals (AHP), other therapeutic and administrative roles. Median scores and interquartile ranges were reported and differences between groups assessed using the Chi-square and Kruskal-Wallis tests with P < 0.05 accepted as statistical significance. Free-text entries were analysed using content analysis.ResultsReplies were received from 503/9145 potential respondents (5.5% response), of these 278 (3.0% response) completed all sections of the questionnaire. Differences between groups were noted in the proportions of those with research as part of their role (P = 0.012) and in being research-active (P < 0.001). Respondents reported high scores for promoting evidence-based practice and for finding and critically reviewing literature. Low scores were returned for preparing reports and securing grants. Overall, medical and other therapeutic staff reported higher levels of practical skills compared with other groups. Principal barriers to research were pressure of clinical work and lack of time, backfill and funds. 171/503 (34%) had changed their attitude to research as a result of the pandemic with 92% of 205 respondents more likely to volunteer for a study themselves.ConclusionWe found a positive change in attitude to research arising from the SARS-CoV-2 pandemic. Research engagement may increase after addressing the barriers cited. The present results provide a baseline against which future initiatives introduced to increase research capability and capacity may be assessed.