Cathy Johnman

Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients

Objective To assess short-term and medium-term outcomes following radial and femoral artery access for primary or rescue percutaneous coronary intervention (PCI). Design Retrospective cohort study. Setting Scotland-wide. Patients All 4534 patients undergoing primary or rescue PCI in Scotland between April 2000 and March 2009 using the Scottish Coronary Revascularisation Register. Intervention Primary or rescue PCI. Main outcome measures Procedural success; peri-procedural complications; 30-day and 1-year mortality, myocardial infarction or stroke and long-term mortality. Results Use of the radial approach increased from no cases in 2000 to 924 (80.5%) in 2009 (p<0.001). Patients in whom the radial approach was used were more likely to be male (p=0.041) and to have multiple comorbidities (p<0.001), including hypertension (p<0.001) and left ventricular dysfunction (p<0.001). They were less likely to have renal impairment (p=0.017), multi-vessel coronary disease (p=0.001) and cardiogenic shock (p<0.001). In multivariable analyses, use of radial artery access was associated with greater procedural success (adjusted OR 1.89, 95% CI 1.26 – 2.82, p=0.002) and a lower risk of any complications (adjusted OR 0.67, 95% CI 0.51 – 0.87, p=0.001) or access site bleeding complications (adjusted OR 0.21, 0.08 – 0.56, p=0.002), as well as a lower risk of myocardial infarction (adjusted OR 0.66, 95% CI 0.51–0.87, p=0.003) or death within 30 days (adjusted OR 0.51, 95% CI 0.04 – 0.52, p<0.001). The differences in myocardial infarction and death remained significant up to 9 years of follow-up. Conclusion Use of the radial artery for primary or rescue PCI is associated with improved clinical outcomes.

Percutaneous Coronary Intervention in the Elderly Changes in Case-Mix and Periprocedural Outcomes in 31 758 Patients Treated Between 2000 and 2007

Background— The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time. Methods and Results— The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (χ2 tests, all P <0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, χ2 test P <0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ2 test for trend, P <0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (χ2 test for trend, P =0.142) or overall (χ2 test for trend, P =0.083). Conclusions— Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.Background—The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time. Methods and Results—The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (&khgr;2 tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, &khgr;2 test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (&khgr;2 test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (&khgr;2 test for trend, P=0.142) or overall (&khgr;2 test for trend, P=0.083). Conclusions—Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.

Percutaneous Coronary Intervention in the ElderlyClinical Perspective

Background— The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time. Methods and Results— The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (χ2 tests, all P <0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, χ2 test P <0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ2 test for trend, P <0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (χ2 test for trend, P =0.142) or overall (χ2 test for trend, P =0.083). Conclusions— Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.Background—The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time. Methods and Results—The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (&khgr;2 tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, &khgr;2 test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (&khgr;2 test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (&khgr;2 test for trend, P=0.142) or overall (&khgr;2 test for trend, P=0.083). Conclusions—Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.

Recent outbreaks of infectious syphilis, United Kingdom, January 2012 to April 2014

Six outbreaks of infectious syphilis in the United Kingdom, ongoing since 2012, have been investigated among men who have sex with men (MSM) and heterosexual men and women aged under 25 years. Interventions included case finding and raising awareness among healthcare professionals and the public. Targeting at-risk populations was complicated as many sexual encounters involved anonymous partners. Outbreaks among MSM were influenced by the use of geospatial real-time networking applications that allow users to locate other MSM within close proximity.

Quality of life following percutaneous coronary interventions in octogenarians: a systematic review

Objective Overall, percutaneous coronary intervention (PCI) can improve the symptoms and quality of life (QoL) of patients with coronary artery disease. Older patients account for an increasing number and proportion of PCIs, however they are more prone to adverse events. This study systematically reviews the QoL benefits in this sub-group. Design and setting A systematic review was undertaken, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines, using Medline, Embase and Science Direct databases. The search was limited to studies available in English; last run on 31 December 2012. Patients Patients aged ≥80 years. Intervention PCI. Main outcome measure QoL. Results The process identified 11 articles which reported QoL outcomes in octogenarians following PCI. In total, there were 700 octogenarian patients identified within the 11 studies with a mean age of 82.9 years. Studies were heterogeneity in the populations, methodology and QoL tools utilised. Overall, the literature suggests that QoL for octogenarians improves following PCI. Older patients improve at least as much as younger patients and may gain more in the areas of physical functioning and improved angina status. The benefits are greatest in the first 6 months and may continue until at least 3 years. Conclusions QoL following PCI in octogenarians improves at least as much as in younger patients. Given the small number of studies resulting in a total of 700 octogenarian patients, further studies would be useful in determining those octogenarian patients who are likely to derive the greatest benefit.

Chemokines in depression in health and in inflammatory illness: a systematic review and meta-analysis

Inflammatory illness is associated with depression. Preclinical work has shown that chemokines are linked with peripheral–central crosstalk and may be important in mediating depressive behaviours. We sought to establish what evidence exists that differences in blood or cerebrospinal fluid chemokine concentration discriminate between individuals with depression and those without. Following PRISMA guidelines, we systematically searched Embase, PsycINFO and Medline databases. We included participants with physical illness for subgroup analysis, and excluded participants with comorbid psychiatric diagnoses. Seventy-three studies met the inclusion criteria for the meta-analysis. Individuals with depression had higher levels of blood CXCL4 and CXCL7 and lower levels of blood CCL4. Sensitivity analysis of studies with only physically healthy participants identified higher blood levels of CCL2, CCL3, CCL11, CXCL7 and CXCL8 and lower blood levels of CCL4. All other chemokines examined did not reveal significant differences (blood CCL5, CCL7, CXCL9, CXCL10 and cerebrospinal fluid CXCL8 and CXCL10). Analysis of the clinical utility of the effect size of plasma CXCL8 in healthy individuals found a negative predictive value 93.5%, given the population prevalence of depression of 10%. Overall, our meta-analysis finds evidence linking abnormalities of blood chemokines with depression in humans. Furthermore, we have demonstrated the possibility of classifying individuals with depression based on their inflammatory biomarker profile. Future research should explore putative mechanisms underlying this association, attempt to replicate existing findings in larger populations and aim to develop new diagnostic and therapeutic strategies.

Linkage of data in the study of ethnic inequalities and inequities in health outcomes in Scotland, New Zealand and the Netherlands: Insights for global study of ethnicity and health

Reducing inequalities in health is a global priority. An essential tool in achieving this reduction is the ability to provide valid measurements of inequalities, which are comparable over time and ultimately across countries and continents. With valid data a true understanding of inequalities can be ascertained, which can begin to inform effective legislation and policy. In this workshop, the speakers described in three different countries, Scotland, New Zealand and The Netherlands, how record linkage has been used to link ethnic status to health and health care measures and so to determine ethnic inequalities in health with the ultimate aim of reducing these inequalities.

Impact of approaches in improving male partner involvement in the prevention of mother-to-child transmission (PMTCT) of HIV on the uptake of PMTCT services in sub-Saharan Africa: a protocol of a systematic review and meta-analysis

Introduction Several studies have reported approaches used in improving the delivery of prevention of mother-to-child transmission (PMTCT) of HIV services through the involvement of male partners, but evidence from a systematic review is limited. We aim at determining the impact of male partner involvement on PMTCT in sub-Saharan Africa. Methods and analysis This will be a systematic review of published literature. Interventional and observational studies on male involvement in PMTCT carried out in sub-Saharan Africa will be included irrespective of the year and language of publication. OVID Medline, Embase, PschINFO, and Cochrane database of controlled trials will be searched. After manual searching of articles, authors shall be contacted for further information. 2 authors (NFT and CJ) will independently screen potential articles for eligibility using defined inclusion and exclusion criteria. Critical Appraisal Skills Programme (CASP) tools, Jadad scale and the STROBE checklist will be used for critical appraisal, and the 2 authors will independently assess the quality of articles. Authors will independently extract data from studies using a pre-established data collection form, and any discrepancies will be sorted by a third author (TRK). Outcomes will be analysed using STATA V.12.0. The random effect model will be used to produce forest plots. The heterogeneity χ2 statistics and I2 will be used to assess for heterogeneity. Publication bias will be assessed using funnel plots. This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. Ethics and dissemination No ethical approval since included studies will be published studies that had already obtained ethical approvals. The findings will guide HIV programmes on the best approaches towards involving male partners in PMTCT with a view to improving PMTCT services in sub-Saharan Africa. PROSPERO registration number 42016032673.

Who do you think you are

17-24 1 & 1⁄2 fwd R turn, L side point, L fwd, R side point, R fwd 1-2 Turning 1⁄2 right step L back, turning 1⁄2 right step R forward 3-4 Turning 1⁄2 right step L back, step R back (3 o’clock) Alternative: 1-4 Turning 1⁄4 right step L back, step R back, step L back, step R back (backward dromedary steps – bit like moon walking this is the way they used to be described many years ago) 5-6 Point L side, cross L forward 7-8 Point R side, cross R forward

Association between telomere length, inflammation and cardiovascular risk

Background Leukocyte telomere length is an indicator of biological aging and is associated with chronic inflammation and clinical cardiovascular (CVD) diseases. Many studies have related shorter telomere length to CVD risk such as using Framingham risk score. The ASSIGN score is the first to incorporate Scottish Index of Multiple Deprivation (SIMD) as a CVD risk factor in Scotland. However, association between telomere attrition and ASSIGN score is unclear. Our …