West Of Scotland Research Articles

20 A Minap-Like e-registry for the First Time in NHS Scotland? A Proof-of-Concept Report from the Pilot Project

Background The Myocardial Ischaemia National Audit Project (MINAP) provides data on national standards of care for patients with myocardial infarction (MI) in England and Wales but not in Scotland. In the West of Scotland (WoS), electronic patient records are being implemented in place of paper records. We aimed to record-link hospital patient episodes using the new e-systems in order to develop a secondary care e-registry for hospitalised patients with an acute coronary syndrome (ACS), including suspected STEMI, NSTEMI or unstable angina (UA). Methods The systems are (1) Trakcare Patient Admin System with extracts data based on ICD-10 diagnosis codes, (2) SCI-Gateway e-referrals for invasive cardiovascular procedures, (3) a hospital-level integrated patient record including cardiac catheter laboratory data (CATHI), (4) the WoS NHS Safe Haven for healthcare data including hospitalisation and mortality. We implemented a pilot study with data extraction for 1 Oct – 31 Dec 2013 for all admissions with an ICD-10 diagnosis of angina (I200-I209), MI (I210-I229), Other Ischaemic Heart Disease (IHD) (I240-I249), and heart failure (I50). The project involved identification of the NHS referral pathways, case e-record linkage, and quality assurance. Results The regional ACS network involves 7 acute hospitals in WoS (population 2.2 million) including the Golden Jubilee National Hospital, a regional hub for invasive cardiology. During the 3-month pilot, 930 unique patients had 1090 admissions involving 969 distinct spells (i.e. index admission and early out-patient re-admission for angiography). Of these spells, the final diagnosis was IHD in 775 (80%) patients, including 164 (16.9%) with STEMI, 287 (29.6%) with NSTEMI, 26 (2.7%) with unstable angina, 249 (25.7%) with stable angina, 5 with other IHD (0.5%), 43 (4.4%) with ‘other chest pain’ and 194 with a non-IHD final diagnosis (20%) (e.g. pericarditis). The pathways were mapped in 100% of the patients including 25.8% admitted directly to the invasive centre, 5.6% via local A&E to the invasive centre, 22.3% via the local hospital followed by in-patient transfer to the invasive centre, 8.9% discharged from the local hospital then readmitted to the invasive centre for planned early out-patient angiography, 4.6% within the local hospital only (no transfer), and 32.8% directly admitted on an elective basis to the invasive centre (non-acute). The mean duration of stay was similar for patients with a diagnosis of STEMI (5.2 days) or NSTEMI (4.6 days), but less for patients with UA (2.2 days) and more for other IHD diagnosis (9.1 days). Data on health outcomes will be presented at the conference. Conclusions For the first time, the pilot e-Registry has generated MINAP-like data in NHS Scotland. Information on admissions with or without a final ACS diagnosis is collected. NHS Scotland has emerging potential to contribute to MINAP.

PWE-289 A regional audit on outcomes of endoscopic mucosal resection for colonic polyp cancer

Introduction Since the introduction of national colonic screening, the incidence of detection of colonic polyp cancer has increased significantly. Endoscopic mucosal resection (EMR) is the standard technique for excision of polyps. We aim to assess the outcome of polyp cancer management from a prospectively collected database from our regional centralised pathology department. Method Our study period was from 01/06/2012—31/07/2013. The census date was 30/01/2015. A prospectively collected database of all polyp cancer patients from the West of Scotland centralised pathology unit was assessed. Management outcome including endoscopic malignant suspicion, resection completeness, recurrence, and subsequent intervention were assessed through electronic patient record. Results 35 polyp cancer were detected in 33 patients over 13 month period. Median age of diagnosis was 66.5 (Max 80.4 – Min 52.4). The median size was 15 mm ((Max 34 mm Min 3 mm). EMR was attempted in 32 (91%) polyp cancer. 1 (3%) polyp cancer was managed by transanal minimally invasive surgery. 2 (6%) were treated by primary resection surgery. Of the cancers treated by EMR, 30 (94%) were located in the descending, sigmoid colon and rectum. 7 (22%) had complete excision based on pathology. At census date, 1 patient had recurrence and required colectomy. In 25 (78%) patients, completeness of excision could not be assessed. 6 (24%) patients were managed by surveillance endoscopy and none were found to have recurrence. No complication was observed in surveillance group. 19 (76%) patients were managed by colectomy. 14 (74%) had no evidence of residual disease in the specimen. The morbidity rate was 20%; these included: 1 (5%) pneumonia, 2 (10%) wound infection and 1 (5%) dehiscence. 1 (5%) patient with liver cirrhosis died within thirty days of operation. Conclusion A low number of disease recurrence was observed after EMR. Despite the relatively small size and distal position of most detected polyp cancers, completeness of excision could not be assessed in a high number of cases. This leads to a significant number of unnecessary surgery with associated morbitidy and mortality. An increase in adoption of surveillance endoscopy, endoscopic submucosal dissection and flexible endoscopic multitasking platform may improve the management of this group of patients. Disclosure of interest None Declared. References Logan RFA, Patnick J, Nickerson C et al . Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012;61:1439–1446 Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, et al . A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video) Gastrointest Endosc. 2010;72:1217–1225

Gene dynamics of toll-like receptor 4 through a population bottleneck in an insular population of water voles (Arvicola amphibius)

Understanding the extent to which diversity at immunologically important genes is reduced by demographic perturbations such as population bottlenecks, and the resulting consequences this has on individual fitness, is of fundamental importance for the effective management of genetic resources in natural populations. Toll-like receptors are key immunological genes with well-established links to fitness. Here, levels of allelic diversity and heterozygosity at the toll-like receptor 4 locus (Tlr4) were characterised across 280 water voles (Arvicola amphibius) from an isolated, island population in north west Scotland that went through a severe population bottleneck between 2004 and 2006 that eroded neutral microsatellite variation. Two functional Tlr4 alleles were resolved prior to the population crash at frequencies close to parity and an excess of heterozygote genotypes relative to Hardy–Weinberg expectations. Through the population bottleneck both alleles were retained with genotype frequencies conforming to Hardy–Weinberg expectations. Tlr4 genotype was significantly associated with gamasid mite, flea (Megabothris walkeri) and sheep tick larva (Ixodes ricinus) burdens among individuals, suggesting a mechanism through which parasite mediated selection could affect Tlr4 diversity. The results are examined with recourse to the extent that they are consistent with the effects of genetic drift and balancing selection, and their significance is discussed in relation to identifying target genes that assay ecological and adaptively meaningful genetic variation in a conservation context.

P109 “love thy neighbour”: an evaluation of religion as a potential barrier to accessing sexual health services for gay and bisexual men in the west of scotland

Background/introduction Outcome 5 of the Blood Bourne Virus Framework aims for a society where attitudes towards sexual health and HIV are supportive and non-stigmatising. Currently, there is no research as to whether religion is a barrier to attending sexual health services for gay and bisexual men. Aim(s)/objectives To explore the influence of religion and its relationship to sexuality for gay and bisexual men. To explore if religious beliefs affect attendance at sexual health services and whether current standards of care at sexual health services meet their needs. Methods Nine participants participated in semi-structured interviews; five sexual health staff; four non-NHS staff including three ordained Ministers from different religions. Questions were about their views around the influence of religious beliefs on the sexual health of gay and bisexual men in the West of Scotland. Results Four themes were identified: barriers to attending sexual health services, influences of religion/coping behaviour, societal influences and provision of sexual health services. Seven of the nine participants identified that religion is a potential barrier to attending sexual health services. Potential conflict between faith and sexuality affect health seeking behaviour. Implications for practice included staff training, outreach work and referral to Chaplains. Discussion/conclusion This study finds that religion is a potential barrier to attending sexual health services for gay and bisexual men, particularly if their religion and sexuality are in conflict. It can be linked to risk taking behaviour and stigma is a considerable issue. Recommendations were made for improvements in service provision. Further research is required.

Grey seal predation impairs recovery of an over‐exploited fish stock

Summary Grey seal predation has been blamed by fishers for the decline of Atlantic cod stocks and has led to calls for seal culls. In the West of Scotland, estimates of cod consumption by seals have exceeded reported catches and spawning biomass, focussing attention on the interaction between fishers and seals. Bayesian models making different assumptions about seal predation were used to estimate the size of the West of Scotland cod stock between 1985 and 2005 and the mortalities due to fishing and seal foraging. A simple population model was used to identify the likely direction of cod population change at recent mortality rates. All model configurations suggest that the total mortality of cod has remained fairly stable and high for many years regardless of the assumptions on seal predation. The high mortality explains the long‐term decline of the stock. The best‐fitting model suggests that mortality due to fishing reduced substantially in the decade up to 2005, but has been replaced by increased seal predation mortality on a smaller cod stock. Given total mortality estimates, the stock is unlikely to recover even at present reduced levels of fishing. Synthesis and applications. Our model offers a method of estimating seal predation mortality as part of routine stock assessments that inform fishery management. The analysis shows that predation by seals can be an important component of the total stock mortality. It also shows that assuming invariant natural mortality, as adopted in many standard fish stock assessments, may lead to incorrect perceptions of fishing mortality, over‐estimating the benefits of reducing fishing mortality when there is density‐dependent predation. It is essential to consider predation by top predators when formulating appropriate advice for managing the fishery.

High prevalence and diversity of bovine astroviruses in the faeces of healthy and diarrhoeic calves in South West Scotland

Astroviruses (AstV) are single-stranded, positive-sense RNA viruses and one of the major causes of infant diarrhoea worldwide. Diarrhoea is a common and important cause of morbidity and mortality in calves; therefore, we investigated whether the presence of AstV is associated with calf diarrhoea. We identified diverse AstV lineages from faecal samples of both healthy and diarrhoeic calves and healthy adult cattle in South West Scotland. AstV was common in calves (present in 74% (85/115) of samples) but uncommon in adult cattle (present in 15% (3/20) of samples). No association was found between the presence of AstV and calf diarrhoea or the presence of a specific AstV lineage and calf diarrhoea. AstV was strongly associated with the presence of rotavirus Group A (RVA), and a protective effect of age was evident for both AstV and RVA. Co-infections with multiple AstV lineages were detected in several calves and serial infection with different viruses could also be seen by longitudinal sampling of individuals. In summary, our study found genotypically diverse AstV in the faeces of calves in South West Scotland. However, no association was identified between AstV and calf diarrhoea, which suggests the virus does not play a primary role in the aetiology of calf diarrhoea in the group studied.

Evaluating holistic needs assessment in outpatient cancer care—a randomised controlled trial: the study protocol

IntroductionPeople living with and beyond cancer are vulnerable to a number of physical, functional and psychological issues. Undertaking a holistic needs assessment (HNA) is one way to support a structured...

Abstract P2-13-14: Does therapeutic mammoplasty reduce mastectomy rates?

Abstract Introduction: Therapeutic mammoplasty (TM) is increasing in popularity as a method for enhancing breast conserving surgery. Studies have shown it’s oncologically safe, whilst improving cosmetic outcome1,2,3. Therapeutic mammoplasty has been gaining popularity in West of Scotland over the past five years. Initially it was thought this may reduce requirement for mastectomy and immediate reconstruction. We have recorded type of surgery patients would have required had they not been suitable for TM, looking at changing demographic of surgical workload. Methods: Prospective data collected about patients undergoing TM in West of Scotland since 2011 in Victoria Infirmary, Western Infirmary and in NHS Lanarkshire. We reviewed clinical indications for TM, surgical alternative, Body Mass Index (BMI) and smoker status. Results: Seventy-nine patients were identified. In 67 cases, alternative surgical option of mastectomy or standard conservation was recorded. Mean BMI was 29. 41% of patients had contralateral surgery for symmetry at the same time. In 28 cases (35%) TM avoided need for mastectomy. In 39 cases (49%) it was felt that cosmetic result would be improved by TM compared with standard conservation. During the study period, rates of mastectomy with immediate reconstruction as a proportion of total number of treated cancers have remained similar. Conclusions: Whilst introduction of therapeutic mammoplasty in our region has improved options offered to patients and likely cosmetic outcomes, it has not had a major impact in reducing mastectomy rates or demand for immediate reconstruction. It has probably increased surgical workload of plastic surgeons as these cases are often performed as joint procedures.

G528(P) A daily regional conference call: maximising efficiency of repatriation. the impact on neonatal units in the west of scotland

Context This project has been carried out between the regional neonatal units, the Neonatal Managed Clinical Network (NMCN) and the Neonatal Transport team (NTS). It has involved multidisciplinary team work between all the health boards in the region with input from key medical, nursing and network staff. Problem It became apparent to the NMCN that neonatal cot capacity in the region was frequently highly occupied and under pressure. We wanted to have a proactive method of identifying cot capacity issues early and maximise our repatriation processes whilst identifying any delays. As a trainee representative at the NMCN meetings, I suggested setting up a regional teleconference call to address these issues. A multidisciplinary team were tasked with setting up this call. Assessment of problem and analysis of its causes The working group contacted key staff within the region’s neonatal community to canvass opinion with regards to regional cot capacity issues. Discussions confirmed that issues with limited availability of cots often became apparent late in the day and left clinicians spending significant amounts of time locating cots. Units and NTS were not always aware what was happening elsewhere until multiple phone calls and time had been spent trying to find out such information. Consent was gained to set up a daily teleconference call between the units and NTS to obtain information about the regional cot capacity. Intervention The call takes place each day at 12.30pm, chaired by the Transport Consultant. Each unit is represented by the Duty Consultant and/or Nurse in Charge. Information is collected upon unit status, staffing issues, cot availability, expected admissions and babies awaiting repatriation or transfer for specialist investigation. The call takes less than 15 min. The information is recorded by NTS and electronically shared with Network administration where it is regularly analysed. Study design A PDSA cycle was undertaken to set-up, test, implement and analyse effectiveness of the intervention. Strategy for change Mock calls were undertaken by the working group to trial the call, test the process of change and refine the data to be collected. Following small adjustments the call went live. A start date, time and telephone number was communicated with senior staff within the region. Data was collated. Measurement of improvement Data was collated as above then analysed and shared with unit managers using real time figures and run charts. Analysis revealed that there were no delays in transport due NTS but that delays in repatriation due to receiving unit cot capacity issues are not uncommon. Effects of changes When units are busy, other units in the region have worked together to relieve capacity issues when able. Units and NTS are aware earlier in the day what the cot issues are. Units are including the regional activity information in their handovers. The call allows efficient planning of workload and implementation of solutions more effectively. The teleconference call has now been extended to include large units elsewhere in the country. Lessons learnt Through feedback and analysis, we have further refined the data collected, maximising call effectiveness. Data collection has demonstrated significant issues with cot capacity which will be used to campaign for funding for more cots and staff. Message for others The conference call was rapid to implement and embed into clinical practice. This is because it is quick and addresses issues close to the priorities of all users. Transfers can be undertaken more efficiently, ultimately saving clinician time.

G359 The diagnosis, management and outcomes of paediatric eosinophilic oesophagitis: a five-year retrospective analysis of the west of scotland population

Background Eosinophilic oesophagitis (EO) is a recently described allergic condition characterised by oesophageal dysmotility with progression to stricture formation in severe cases. Diagnosis is histological, based on >15 per high-powered field in oesophageal biopsies. Treatment options remain limited to dietary modification (including elemental feeds), proton pump inhibitors (PPI) and topical/systemic steroids. There is sparse population data on the condition. To report demographic data on children with EO, establish the current burden of disease and review effectiveness of treatments with clinical and histopathological outcomes. Methods All patients diagnosed with EO between 2008–2013 in RHSC Glasgow were retrospectively identified by joint review of all oesophageal histopathology reports (n = 1060) with a Consultant Paediatric Pathologist (DP) and findings correlated with clinical symptoms, treatment and outcomes. Data was analysed using Microsoft Excel 2007 and SPSS version 22.0. Results Within the West of Scotland 30 children (mean age 9.1, range 0.7–15.2) were diagnosed with EO between January 2008 and May 2013 with no obvious increase in annual incidence. 22 (73%) were male. The most common presenting symptoms were abdominal pain (43%), vomiting (37%) and dysphagia (33%), with food bolus obstruction in 27%. Most (77%) had concurrent atopic disease. At diagnosis the mean number of oesophageal eosinophils per high-powered field was 61, ascertained with a mean of 5 biopsies from 3 different oesophageal regions. The mean peripheral eosinophil count at diagnosis was 1.8 (range 0.0–27.0). PPIs were clinically effective in 19/21 (70%) patients and 14/16 showed histological improvement. All 17 patients receiving dietary therapy demonstrated clinical improvement and 14/15 showed histological improvement; 11 (40%) had topical steroids, clinically effective in 10/11 patients with 7/9 showing histological improvement. However, 4 (13%) progressed to oral steroids. There was considerable overlap between treatments. At one year follow-up 93% were clinically improved and 86% showed endoscopic improvement. Conclusions The total numbers of patients diagnosed was surprisingly small. Whilst treatment with PPI is effective, most patients also required dietary or steroid therapy. A significant number required oral steroids. A departmental guideline is being developed on the basis of these results and further work is required to establish frequency of repeat endoscopy.

A late medieval farmstead at Corsankell, near Stevenston, North Ayrshire

Historical, placename and archaeological evidence have been brought together at Corsankell Farm to indicate that the search for medieval settlement in the west of Scotland can bear fruit. Archaeological excavation found evidence of later medieval settlement remains, and the historical and placename research suggests a date for the settlement of Corsankell back into the 12th century or earlier. The focus of the settlement has shifted at least twice in the history of Corsankell, and physical remains from the 12th century were not found, but this work demonstrates that medieval settlement can be revealed by examining modern-day farms.

Audit of intrathecal drug delivery for patients with difficult-to-control cancer pain shows a sustained reduction in pain severity scores over a 6-month period

Background: Intrathecal drug delivery is known to be effective in alleviating cancer pain in patients for whom the conventional World Health Organization approach has proved insufficient. A multidisciplinary interventional cancer pain service was established in the West of Scotland in 2008 with the aim of providing a safe and effective intrathecal drug delivery service for patients with difficult-to-control cancer pain. Aim: The aim of the intrathecal drug delivery service is to improve pain scores as evaluated by pain scores before and after insertion of an intrathecal drug delivery device. Design: Pain is monitored before and after intrathecal drug delivery implantation using the Brief Pain Inventory. Following implantation, pumps are refilled fortnightly and repeat Brief Pain Inventory assessments are undertaken. This prospective case series analyses change in Brief Pain Inventory domains for patients who had an intrathecal drug delivery implanted using a paired sample t-test. Results: Data are presented from 2008–2013 for 22 patients receiving an intrathecal drug delivery system who experienced an immediate improvement in their pain that was both clinically and statistically significant. One week after insertion, the average pain score on the Brief Pain Inventory fell from 6.8 (pre–intrathecal drug delivery) to 3.0 (post–intrathecal drug delivery). Improvement in pain scores was sustained over a 6-month period. Conclusion: Evaluation of results of this case series shows that with the appropriate use of intrathecal drug delivery systems, patients with difficult-to-control cancer pain can benefit from effective pain relief for many months.

Range expansion of an invasive species through a heterogeneous landscape – the case of American mink in Scotland

AbstractAimThe impact of invasive species is one of the main causes of biodiversity loss world‐wide, and as a result, there is much interest in understanding the pattern and rate of expansion of species outside their native range. We aimed to characterize the range expansion of the American mink (Neovison vison) invading from multiple introduction points through a varied landscape bounded by coastline to better understand and manage its spread.LocationScotland, UK.MethodWe collated and used records of mink presence to calculate the historical range and rate of range expansion at successive time intervals. We used a presence‐only model to predict habitat suitability and a newly developed individual‐based modelling platform, RangeShifter, to simulate range expansion.ResultsRecords showed that mink were distributed throughout Scotland, except in the far north. We found that the rate of spread varied both spatially and temporally and was related to landscape heterogeneity. Habitat suitable for mink in west Scotland is restricted to the coast.Main conclusionsWe concluded that temporal and spatial variation in range expansion is attributable to heterogeneity within the landscape and also demonstrated that the potential for long‐distance dispersal does not necessarily facilitate range expansion when availability of suitable habitat occurs in narrow strips and/or is fragmented. We have highlighted methodological gaps in calculating rates of expansion in invasive species but have demonstrated alternative methods that successfully utilize presence‐only data. Our study reaffirms that invasive species will colonize less favourable habitats and highlights the need to remain vigilant of their potential for expansion even when distribution appears to be static for a time.

Financial incentives for smoking cessation in pregnancy: randomised controlled trial

Objective To assess the efficacy of a financial incentive added to routine specialist pregnancy stop smoking services versus routine care to help pregnant smokers quit. Design Phase II therapeutic exploratory...

Incidence of brain metastasis in esophageal cancer.

46 Background: Brain metastasis in oesophageal cancer is a rare but often fatal complication. In previous studies the incidence has ranged from 1.4% - 13% with the largest studies from China and Japan that have been retrospectively based over fifteen to twenty years. (Ogawa K, Toita T, Sueyama H. Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome. Cancer. 2002 Feb 1;94(3):759-64.) With improving diagnostic techniques and differing histology of oesophageal cancer from Eastern countries we undertook a study to determine the incidence of brain metastases in oesophageal cancers in the West of Scotland. Methods: Data from all the new patients diagnosed with oesophageal cancer was obtained with permission from the Regional Managed Clinical Network from the years 2011 and 2012 yielding a total of 701 patients. The individual clinical records were examined to ascertain if the patient developed brain metastases on CT/MRI scan, their tumour type and management. Results: Of the 701 patients diagnosed with oesophageal cancer, 19 developed brain metastasis demonstrating an incidence of 2.7%. 12 of these patients primary diagnosis was adenocarcinoma. The others were small cell (3), neuroendocrine (2), squamous (1) and no histology (1). At the time of writing 17 out of 19 patients had died from their oesophageal cancer. The 2 surviving patients had a single brain metastasis that was resected and treated with adjuvant radiotherapy. 6 other patients had whole brain radiotherapy, 1 patient had partial brain radiotherapy and 10 were managed with best supportive care. Mean survival from diagnosis of brain metastasis for best supportive care was 26 +/- 14 days versus mean survival for radiotherapy treatment from 100+/- 57 days (p = 0.003) demonstrating a difference between the groups. Conclusions: The incidence of brain metastasis in oesophageal cancer in the West of Scotland was 2.7% with the prognosis generally poor unless resected.

Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data.

BackgroundRegional differences in population levels of alcohol-related harm exist across Great Britain, but these are not entirely consistent with differences in population levels of alcohol consumption. This incongruence may be due to the use of self-report surveys to estimate consumption. Survey data are subject to various biases and typically produce consumption estimates much lower than those based on objective alcohol sales data. However, sales data have never been used to estimate regional consumption within Great Britain (GB). This ecological study uses alcohol retail sales data to provide novel insights into regional alcohol consumption in GB, and to explore the relationship between alcohol consumption and alcohol-related mortality.MethodsAlcohol sales estimates derived from electronic sales, delivery records and retail outlet sampling were obtained. The volume of pure alcohol sold was used to estimate per adult consumption, by market sector and drink type, across eleven GB regions in 2010–11. Alcohol-related mortality rates were calculated for the same regions and a cross-sectional correlation analysis between consumption and mortality was performed.ResultsPer adult consumption in northern England was above the GB average and characterised by high beer sales. A high level of consumption in South West England was driven by on-trade sales of cider and spirits and off-trade wine sales. Scottish regions had substantially higher spirits sales than elsewhere in GB, particularly through the off-trade. London had the lowest per adult consumption, attributable to lower off-trade sales across most drink types. Alcohol-related mortality was generally higher in regions with higher per adult consumption. The relationship was weakened by the South West and Central Scotland regions, which had the highest consumption levels, but discordantly low and very high alcohol-related mortality rates, respectively.ConclusionsThis study provides support for the ecological relationship between alcohol-related mortality and alcohol consumption. The synthesis of knowledge from a combination of sales, survey and mortality data, as well as primary research studies, is key to ensuring that regional alcohol consumption, and its relationship with alcohol-related harms, is better understood.

Ischemic stroke management in West Scotland: a chart review

BackgroundLittle information is available about the long-term management of ischemic stroke (IS) in West Scotland. In this study we aim to describe the management of IS at onset, admission, and during follow-up among patients who survived an IS event.MethodsGeneral practitioners (GPs) (n=20) were randomly selected to recruit IS patients and extract data about patient characteristics, hospitalizations, discharge, and ambulatory care from GP databases, hospital letters, and direct contact with patients and their relatives. Descriptive analyses were conducted.ResultsOne hundred and one patients were included, with a mean age of 65.6±13.4. About half of the patients contacted their GPs at the time of onset (45.4%). Cardiovascular history was prevalent in 29.7% of cases, and 14% of all cases were recurrences. Of the patients, 89 (88%) were hospitalized with mean length of stay (LOS) 11.8 days. Treatment was administered on average within 12.9 hours of admission and 23.6% of the admitted patients received thrombolytic treatment. During the 1-year follow-up period, 33.6% of patients were rehospitalized and the mean LOS was 15.1±29.5 days. Further, patients on average sought nursing care (10.9%), physical therapy (45.5%), occupational therapy (27.7%), speech therapy (12.9%), and professional caregivers (12%).ConclusionThe health-care resource utilization of IS patients is a major driver of economic burden.

Guilt by Genetic Association

Michael R. Graham1, Bruce Davies2 and Julien S. Baker*3 1Llantarnam Health Care, Parc-y-Bont, UK 2Department of Health and Exercise Science, University of South Wales, UK 3Department of Health and Exercise Science, University of the West of Scotland, UK *Corresponding author: Julien S Baker, Professor, Department of Health and Exercise Science, Director of Research, Institute of Clinical Exercise and Health Science, Exercise Science Research Laboratory, School of Science, University of the West of Scotland, Hamilton, Lanarkshire, Scotland, ML3 OJB, UK, Tel: 01698 283100; Fax: 01698 894404; E-mail: jsbaker@uws.ac.uk

Can we Learn from Past Iatrogenic Effects When Managing Obesity?

Graham MR1, Bruce Davies2 and Julien S Baker3* 1Parc-y-Bont, Newport Road, Llantarnam, Cwmbran, NP44 3AF, UK 2Department of Health and Exercise Science, University of South Wales, UK 3Department of Exercise and Health Sciences, University of the West of Scotland, UK *Corresponding author: Julien S Baker, Professor, Department of Exercise and Health Sciences, University of the West of Scotland, Director of Research, Institute of Clinical Exercise and Health Science, Exercise Science Research Laboratory, School of Science, Hamilton, Lanarkshire, Scotland, ML3 OJB, UK, Tel: 01698 283100; Fax: 01698 894404; E-mail: jsbaker@uws.ac.uk

Epigenetics, Diet or Exercise?

Michael R. Graham1, Bruce Davies2 and Julien S Baker3* 1Parc-y-Bont, Newport Road, Llantarnam, Cwmbran, NP44 3AF, UK 2Department of Health and Exercise Science, University of South Wales, UK 3Department of Exercise and Health Sciences, University of the West of Scotland, UK *Corresponding author: Julien S Baker, Professor, Department of Exercise and Health Sciences, Director of Research, Institute of Clinical Exercise and Health Science, Applied Physiology Research Laboratory, School of Science and Sport, University of the West of Scotland, Hamilton, Lanarkshire, ML3 OJB, Scotland, UK, Tel: 01698 283100; Fax: 01698 894404; E-mail: jsbaker@uws.ac.uk