Scottish Medical Journal最新文献

{"title":"Digitalization of healthcare in India: Have we jumped on the campaign yet?","authors":"Anna Javed","doi":"10.1177/00369330231166121","DOIUrl":"https://doi.org/10.1177/00369330231166121","url":null,"abstract":"India is a vast country with a population of 1.4 billion. With billions of lives on the line, access to healthcare and support systems should be the number one priority. Digitalization is a key to implementing decision making in a country of the size of India. Its implementation is expected to improve the overall efficiency, effectiveness, and transparency in Indian Healthcare and encourage the seamless delivery of personalized solutions making healthcare more patient-centric in India. As a result, advanced digital and data-enabled technologies increasingly diffuse the healthcare market, which undergoes a costly and massive digital transformation. According to a report, the Indian hospital industry accounts for 80% of the total healthcare market which is expected to touch US$132 billion by 2023. The digital health concept was first introduced in 2000 by Frank. Digital Health refers to “Integrating information Technology into Health care services and encompasses an array of components.” It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalized and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics. Not just modern healthcare, but, in fact, our whole routine life is difficult to imagine without the use of technology. This has been acutely realized during the COVID-19 pandemic recently forcing the entire globe to adopt digital health and health technologies on a large scale.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 2","pages":"39-40"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scottish Cardiac Society: 31st Annual General Meeting, 16-17 September 2022.","authors":"","doi":"10.1177/00369330231152988","DOIUrl":"https://doi.org/10.1177/00369330231152988","url":null,"abstract":"Introduction: Inherited Long QT syndrome (iLQTS) car-ries a risk of arrhythmic sudden cardiac death (SCD) and accurate diagnosis is important to allow preventative therapy. Clinical assessment is complicated as (i) QTc prolonga-tion may be acquired and (ii) QTc ranges in iLQTS patients overlap with the normal population. Use of a clinical risk score (Schwartz score, SS 1 ) >3.5 is recommended prior to genetic testing. 2 We audited SS of patients undergoing genetic testing for suspected iLQTS in the West of Scotland (WoS). Methods: Caldicott Guardian approval for the audit was granted by NHS GGC. Genetic test samples sent for diagnostic LQTS testing from the WoS between 2013 and 2021 were included. Demographic data were summarised. Test rates were expressed per 1000 population using publicly available estimates of population by health board. In a subgroup of patients from GGC (n = 81), health records were reviewed to determine SS. Receiver operating curves were used for sensitivity analysis. Results: LQTS testing results from 508 patients were included (62% female, mean age 38 years). Test rates per 100,000 population ranged from 7 (D&G) to 26 (GGC). Ninety-two tests (18%) were positive, 34 (7%) identi fi ed a VUS and 382 (75%) were negative. There were no signi fi - cant differences in results by age or gender. VUS result was more frequent with NGS versus Sanger sequencing (20/ 209 vs. 14/299, p < 0.05). Of positive tests, 63% were KCNQ1 (LQT1), 21% KCNH2 (LQT2) and 16% SCN5A (LQT3","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 2","pages":"NP1-NP11"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9497552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning, artificial intelligence, and digitalisation of healthcare: Convergence of science and technology.","authors":"Ghulam Nabi","doi":"10.1177/00369330231173302","DOIUrl":"https://doi.org/10.1177/00369330231173302","url":null,"abstract":"In this May, 2023 issue of Scottish Medical Journaloldest medical journal in the British medical journalism, you will come across a number of exciting papers looking at education of trainees, improving training opportunities through creating a culture of training and burnout in medical profession. But an article which has been invited as editorial from India, summarises opportunities and challenges of digitalisation of healthcare in India. Dr Javed provides us a glimpse of issues related to making healthcare universal in India and the way country is grappling with modernising data collection through the use of power of digital technology. Digital technology could push boundaries of learning and education through sharing and co-creation of innovations. Machine learning and artificial intelligence could be built around data mining to transform healthcare universally. Digital technology could unleash its power in decision-making particularly in the allocation of resources where these are required most. Digital inclusion through improvement of literacy should address long-standing issues of healthcare in marginalised groups such as ethnic minority population. One of the major areas of digitalisation of data is imaging. Images of any part of body carry a wealth of information and tell us more than what can be seen by unaided eyes. Digitalisation improves knowledge exchange and innovations. When encountered with a rare case or a rare image (Figure 1), one can immediately connect with colleagues across the globe and learn from experience of others. Accumulation of data can then be used for machine learning through various algorithms and technologies to create new therapeutic models (Figure 2). The delivery and follow-up can be delivered close to patient chosen place without any issues. Similarly, feedback and suggestions following delivery of services can be gathered through use of smart phones and other devices. The convergence of science and technology is taking place around us. This has potential to improve our precision in managing our patients through easy and better characterisation of disease and health. Neural networks (Figure 2) remain key to machine learning in imaging and are certainly a step towards recreating higher functions of brain through use of advanced computers. Just like human brain, neural networks contain multiple layers with input layer receiving data and hidden layers extract imaging features relevant to answer a particular diagnostic/research question. These layers assign a particular classification to the extracted features and provide relevant information to the operators. Training these networks with superior quality data is key to the entire process. Larger the data, better the prediction models. Later cannot be possible without large international collaborations in particularly for rare disease manifestation such as perirenal lymphoma.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 2","pages":"37-38"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9690944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ureteroscopic biopsy for upper tract urothelial cancers: A valuable double-edged tool in the era of a risk-stratified approach.","authors":"Morgan Rouprêt,&nbsp;Giorgio Calleris","doi":"10.1177/00369330221130763","DOIUrl":"https://doi.org/10.1177/00369330221130763","url":null,"abstract":"A large multicentre retrospective cohort study investigating the impact of a ureteroscopic biopsy (URS-Bx) on urinary bladder recurrences (UBR) rates after radical nephroureterectomy (RNU) is presented by Anbarasan, Nabi and coll. on the current issue of the Scottish Medical Journal, addressing a “ hot topic ” in upper urinary tract urothelial carcinoma (UTUC) management.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"2-3"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lasso algorithm and support vector machine strategy to screen pulmonary arterial hypertension gene diagnostic markers.","authors":"Chenyang Jiang,&nbsp;Weidong Jiang","doi":"10.1177/00369330221132158","DOIUrl":"https://doi.org/10.1177/00369330221132158","url":null,"abstract":"<p><strong>Background: </strong>This study employs machine learning strategy algorithms to screen the optimal gene signature of pulmonary arterial hypertension (PAH) under big data in the medical field.</p><p><strong>Methods: </strong>The public database Gene Expression Omnibus (GEO) was used to analyze datasets of 32 normal controls and 37 PAH disease samples. The enrichment analysis was performed after selecting the differentially expressed genes. Two machine learning methods, the least absolute shrinkage and selection operator (LASSO) and support vector machine (SVM), were used to identify the candidate genes. The external validation data set further tests the expression level and diagnostic value of candidate diagnostic genes. The diagnostic effectiveness was evaluated by obtaining the receiver operating characteristic curve (ROC). The convolution tool CIBERSORT was used to estimate the composition pattern of the immune cell subtypes and to perform correlation analysis based on the combined training dataset.</p><p><strong>Results: </strong>A total of 564 differentially expressed genes (DEGs) were screened in normal control and pulmonary hypertension samples. The enrichment analysis results were found to be closely related to cardiovascular diseases, inflammatory diseases, and immune-related pathways. The LASSO and SVM algorithms in machine learning used 5 × cross-validation to identify 9 and 7 characteristic genes. The two machine learning algorithms shared Caldesmon 1 (<i>CALD1</i>) and Solute Carrier Family 7 Member 11 (<i>SLC7A11</i>) as genetic signals highly correlated with PAH. The results showed that the area under ROC (AUC) of the specific characteristic diagnostic genes were <i>CALD1</i> (AUC = 0.924) and <i>SLC7A11</i> (AUC = 0.962), indicating that the two diagnostic genes have high diagnostic value.</p><p><strong>Conclusion: </strong><i>CALD1</i> and <i>SLC7A11</i> can be used as diagnostic markers of PAH to obtain new insights for the further study of the immune mechanism involved in PAH.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"21-31"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10729238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scottish Society of Physicians 64^th Annual Meeting.","authors":"","doi":"10.1177/00369330221140333","DOIUrl":"https://doi.org/10.1177/00369330221140333","url":null,"abstract":"BOOK Venue: Hybrid Event: The Townhouse Hotel, Melrose & Microsoft Teams Scottish Society of Physicians is a charity registered in Scotland. No. SC029462","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"NP1-NP10"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10848483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary bladder recurrences following ureteroscopic biopsies of upper tract urothelial cancers: a multi-centre observational study with genomic assessment for clonality.","authors":"Thineskrishna Anbarasan,&nbsp;Sheikh Nissar,&nbsp;Julie Turbitt,&nbsp;Kathryn Walls,&nbsp;Sarah McLuckie,&nbsp;Caroline Clark,&nbsp;Jean-Christophe Bourdon,&nbsp;Joel Tracey,&nbsp;Susan Bray,&nbsp;Atlaf Shamsuddin,&nbsp;Jason Alcorn,&nbsp;Sunjay Jain,&nbsp;Robert Hislop,&nbsp;Chandra Shekhar Biyani,&nbsp;Ghulam Nabi","doi":"10.1177/00369330221134233","DOIUrl":"https://doi.org/10.1177/00369330221134233","url":null,"abstract":"<p><strong>Background and aims: </strong>Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC.</p><p><strong>Methods: </strong>Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions were identified. Clonal relatedness between primary UTUC and subsequent UBR in a sub-cohort was assessed using next-generation sequencing. A Kaplan-Meier curve was used to assess differences in UBR between two groups (with or without ureteroscopic biopsy).</p><p><strong>Results: </strong>Of 267 patients with complete records, 73 (27.3%) had UBR during follow-up. The five-year UBR-free survival in all patients was 64.7%. The five-year UBR-free-survival was inferior in patients who underwent URS biopsy compared with patients who did not undergo ureteroscopic biopsy (49.9% vs 76.4%, <i>p</i> < 0.001). History of bladder tumour (HR, 95% CI; 2.94, 1.73-5.00, <i>p</i> < 0.001), ureteroscopic biopsy (HR, 95% CI; 2.21, 1.38-3.53, <i>p</i> = 0.001) and preoperative urine cytology ≥C3 (HR, 95% CI; 2.06, 1.24-3.40, <i>p</i> = 0.005) were independently associated with UBR. Patients with ureteroscopic biopsy (n = 3/5) showed identical mutational changes for common genes (<i>TP53</i> and <i>FGFR3</i>) between primary UTUC and subsequent UBR.</p><p><strong>Conclusions: </strong>Ureteroscopic biopsy of UTUC is a significant risk factor for UBR. Qualitative clonality assessment showed identical mutational signatures between primary UTUC and UBR.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"4-13"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10786743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Half a century of the inverse care law: A comparison of general practitioner job satisfaction and patient satisfaction in deprived and affluent areas of Scotland.","authors":"Stewart W Mercer,&nbsp;Carey J Lunan,&nbsp;Clare MacRae,&nbsp;David Ag Henderson,&nbsp;Bridie Fitzpatrick,&nbsp;John Gillies,&nbsp;Bruce Guthrie,&nbsp;Johanna Reilly","doi":"10.1177/00369330221132156","DOIUrl":"https://doi.org/10.1177/00369330221132156","url":null,"abstract":"<p><strong>Background and aims: </strong>The 'inverse care law', first described in 1971, results from a mismatch of healthcare need and healthcare supply in deprived areas. GPs in such areas struggle to cope with the high levels of demand resulting in shorter consultations and poorer patient outcomes. We compare recent national GP and patient satisfaction data to investigate the ongoing existence of this disparity in Scotland.</p><p><strong>Methods and results: </strong>Secondary analysis of cross-sectional national surveys (2017/2018) on upper and lower deprivation quintiles. GP measures; job satisfaction, job stressors, positive and negative job attributes. Patient measures; percentage positive responses per practice on survey questions on access and consultation quality. GPs in high deprivation areas reported lower job satisfaction and positive job attributes, and higher job stressors and negative job attributes compared with GPs in low deprivation areas. Patients living in high deprivation areas reported lower satisfaction with access and consultation quality than patients in low deprivation areas. These differences in GP and patient satisfaction persisted after adjusting for confounding variables.</p><p><strong>Conclusions: </strong>Lower GP work satisfaction in deprived areas was mirrored by lower patient satisfaction. These findings add to the evidence that the inverse care law persists in Scotland, over 50 years after it was first described.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"14-20"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10729233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanistic research closes the gap in knowledge gained from observational findings.","authors":"Ghulam Nabi","doi":"10.1177/00369330231151800","DOIUrl":"https://doi.org/10.1177/00369330231151800","url":null,"abstract":"When you will get the February issue of Scottish Medical Journal in your hands, we will be in 2023 and recovered from our festive breaks and all set to face challenges of the world. Similar to expected and unexpected future challenges, one of the difficult issues in Medical Research has been lack of knowledge and understanding of mechanisms involved in disease processes and their differential responses to interventions. The February issue of SMJ reports a multi-institutional observational study of upper tract urothelial cancers (Figure) and confirms a higher rate of urinary bladder recurrences following ureteroscopic biopsy procedures. The paper further attempts to explore the mechanistic basis of this observation and showed clonal relatedness between upper tract urothelial cancers and urinary bladder recurrences. What is interesting about this study is the use of targeted next-generation sequencing of Colon and Lung Cancer Research Panel v2. Previous studies used MSK-IMPACT and in-house targeted sequences but concluded similar to us. The second important difference between previous studies and ours is the use of stained slides to extract tissue material (microdissection) as DNA resources.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10859605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A triangulation model for assessment of change in classroom behavior of medical teachers participating in faculty development program on lecturing skills.","authors":"Syed Muhammad Hammad Ali,&nbsp;Noor Fatima Ahsen,&nbsp;Ahsan Zil-E-Ali","doi":"10.1177/00369330221130766","DOIUrl":"https://doi.org/10.1177/00369330221130766","url":null,"abstract":"<p><strong>Background & aims: </strong>We utilized a triangulation method of a faculty development program's (FDP) evaluation comprising short-course workshops on classroom behaviors and lecturing skills of basic sciences faculty in a medical school.</p><p><strong>Methods & results: </strong>This study utilized data from the pre and post evaluation of classroom lectures by an expert observer. Course participants were observed before the inception of a 4-month FDP and after 6-months of program completion. Findings at 6-month post-FDP interval were supplemented with students' and participant's self-evaluation. Expert evaluation of 15 participants showed that more participants were summarizing lectures at the end of their class (p = 0.021), utilizing more than one teaching tool (p  =  0.008) and showing a well-structured flow of information (p = 0.013). Among the students, majority (95.5%, n  =  728) agreed on \"teachers were well-prepared for the lecture\", however, a low number (66.1%, n  =  504) agreed on \"teachers were able to make the lecture interesting\". On self-evaluation (n =  12), majority of the participants (91.7%, n  =  11) thought these FDP workshops had a positive impact on their role as a teacher.</p><p><strong>Conclusions: </strong>Gathering feedback from multiple sources can provide a more holistic insight into the impact of an FDP and can provide a robust framework for setting up future FDP targets.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"68 1","pages":"32-36"},"PeriodicalIF":2.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9279684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}