Peterhead Community Hospital

OBJECTIVE: To determine diurnal variability of symptoms in chronic obstructive pulmonary disease (COPD) and to assess the impact of COPD upon patients' morning activities and routines. RESEARCH DESIGN AND METHODS: Quantitative internet interviews with 803 COPD patients from Europe and the USA, including 289 patients with severe COPD. Severe COPD was defined according to regular use of COPD medication, third level of breathlessness or above using the modified Medical Research Council (MRC) dyspnoea scale (MRC dyspnoea score > or =3) and one or more COPD exacerbations in the preceding 12 months. RESULTS: Morning was the worst time of day for COPD symptoms, particularly in patients with severe COPD (reported by 46% of severe patients). In these patients, shortness of breath was the most frequently reported symptom, correlating strongly with problems experienced with morning activities. Morning activities most affected by COPD were walking up and down stairs, putting on shoes and socks, making the bed, dressing, showering or bathing and drying. The majority of patients were not taking their medication in time for it to exert its optimal effect. CONCLUSIONS: Many patients consider the impact of COPD on morning activities to be substantial. Physicians should question patients about morning activities to assess disease impact and to advise regarding the optimal time to use therapy. This was an internet-based questionnaire survey and possible bias in patient selection and self-reported diagnosis of COPD and its severity should be taken into account.

BACKGROUND: Pollen-food syndrome (PFS), a food allergy affecting pollen-sensitized individuals, is likely to be the most prevalent food allergy in adults, estimated to affect 50-90% of people allergic to birch tree pollen. OBJECTIVE: A validated PFS diagnostic questionnaire (PFSDQ2) was used to determine the prevalence of PFS and also to characterize those who report reactions to foods. METHODS: Five UK General practices each sent the PFSDQ2 by post to 2000 patients aged 18-75 years randomly selected from their practice database. The validated questionnaire was accompanied by an additional set of questions to ascertain the demographic of the population, the foods involved and the age of onset. RESULTS: There were 3590 subjects who returned completed questionnaires, with an average return rate from each practice of 36% (range 22-47%). Of these, 73 were diagnosed with PFS according to the questionnaire (PFS+ve) giving a population prevalence of 2%. A further 482 subjects reported reactions to foods but did not fulfil the diagnostic criteria for PFS. The greatest prevalence of PFS was in the Croydon (SE England) urban practice (4.1%) and the lowest in the Aberdeen (Scotland) urban practice (0.8%) (P < 0.001).The most frequently reported trigger foods were apples, hazelnuts and kiwifruit and the majority of those with PFS first experienced symptoms below the age of 20 years. PFS+ve subjects were also more likely to be female and have a higher socio-economic status than those who did not report reactions to foods. CONCLUSIONS: The UK prevalence of PFS was 2%, although this varied according to the location of the practice population. The majority of PFS+ve subjects first reported symptoms in their teens. The reported age of onset has important implications for the diagnosis of primary and cross-reactive peanut and tree nut allergies in teenagers and young adults. The continuing rise in aeroallergen sensitization is likely to result in an increased frequency of PFS presenting in both primary and secondary care.

LEARNING OBJECTIVES: • Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions. ABSTRACT: Electroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.

Reflects on e‐learning with respect to other forms of learning and endeavours to put it into perspective given the extent to which it is currently being hyped. Appraises e‐learning from the point of view of the learner given certain assumptions. Attempts to provide a balanced picture of the pros and cons of e‐learning. Contends that the e‐learning industry is overselling its merits and not focusing appropriately on the learner’s needs. Concludes with some practical suggestions for improving e‐learning performance and acceptance.

AIM: To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective. BACKGROUND: Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care. METHOD: Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients' records for three years from diagnosis ('newly diagnosed' patients) or for the most recent three years ('established' patients). FINDINGS: Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and 'newly diagnosed' patients were significantly more likely to visit their GP for pain management than 'established' patients. Although 'newly diagnosed' patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups. CONCLUSION: This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use.

Killarny * lake ; nor can Europe thew a na= tural wonder equal to the Gyant's Caufeway in the north of Ireland.The excellence and number of our fprings (whether medicinal or incrufting) are well known to common inquirers.RaelOur minerals are as great in quantity, as rich in quality: of gold, indeed, we cannot produce many fpecimens, yet fufficient tofhew that it is found in this ifland-+-; but filver is found in great abundance in our lead ores, and veins of native filver in the copper ore of Muckrus, on the lake of Killarny.The hzematites iron ores of Cumberland, and the beautiful columnar iron ores of the foreft of Dean, are fufficient to difplay our riches in that ufeful commodity.No country produces fo great a quantity of tin as Cornwall; and that county, and feveral others in the north have been long noted for their inex~ hauftible veins of copper; nor lefs famous * In the county of Kerry.+ That our country produces gold, appears in Dr. Borla/e's Hiftory of Corzwall, p.214.So late as the year 1753, feveral ' therine's near Edinburgh.Our amber and our jet, together with our inexhauftible firata of coal found in fo many parts of this kingdom, will, in the article of bitumens, give us the fuperiority over thefe fo much boafted productions of Sweden.* Jn the county of Kerry.a 4 To Ved Vill Oe Roy BA ES Ago ae ee To avoid a tedious enumeration, we thall only mention our wonderful mines of rock | falt ; our allum and our vitriol works; our various marbles, alabafters, and ftonés ; our moft excellent clays and earths *; all which articles, and many more unnoted here, might have furnifhed us with an ample field sa panegyric, Our botanical Sectoid 1s are not lefs abundant; but the works of Ray, which have * If the inguifitive reader is defirous of a farther account of the number and excellence of our fubterraneous produc-tions, we refer him to the learned Dr. Woodward's Cata-Jocue of the Exglifo Fofils, London 1729, particularly to p. 5. parade: " BORO ES, FY Ast GC ER parade of ufelefs declamation, and fhail only add, that as few countries receive more advantages from their natural breed of quadrupeds, unmixed with any beaft that preys on man, fo, few can boaft a greater variety of birds, whether local, or migratory.This is a general view of the natural hiftory of our own country; why then fhould we neglect inquiring into the various benefits that refult from thefe inftances of the wifdom of our.Creator, which his divine munificence has fo liberally, and fo immediately placed before us?Such a neglect is certainly highly to be blamed, for (to exprefs ourfelves in the words of an eminent writer) "the Creator did not beftow fo much "< curiofity, and workmanfhip on his crea-."' tures, to be looked on with a carelefs in-"* curious eye, efpecially to have them flight-"'ed or contemned; but to be admired by '* the rational part of the world, to magnify "* his own power to all the world, and the "* ages thereof; and fince the works of the "creation are all of them fo many demon-'* {trations of the infinite wifdom and power '© of God, they may ferve to us, as fo ma-** ny arguments exciting us to a conftant fear Plurimus inde labor tabulas imitando juvabit Egregias, operumque typos, fed plura docebit Natura ante oculos prefens, nam firmat et auget Vim genii, ex illaque artem experientia complet +}.* That great artift, Mr. Ridinger, of dufburg, exceeds allothers in the three laft particulars; nothing can equal his prints of animals for propriety of attitudes, for a juft idea of their way of life, and for the beautiful and natural fcenery that accompanies them.His fineft works are, his WildeThiere, Kleine Thiere, and 'Fagdbare Thiere; but there are fearce any of his performances that can fail giving pleafure to all admnirers of nature reprefented as herfelf.4 Frefnoy de arte graph.lin.537+

-antitrypsin deficiency (AATD) significantly increases the risk of developing chronic obstructive pulmonary disease (COPD), and testing of all COPD patients for AATD is recommended by the World Health Organization, European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease (GOLD). We aimed to determine trends for testing and diagnosing AATD from 1990 to 2014.This study analysed all patients diagnosed with COPD from about 550 UK Optimum Patient Care Research Database general practices, including a subgroup of those diagnosed before the age of 60 years.We identified 107 024 COPD individuals, of whom 29 596 (27.6%) were diagnosed before 60 years of age. Of them, only 2.2% (95% CI 2.09-2.43%) had any record of being tested for AATD. Of those tested, 23.7% (95% CI 20.5-27.1%) were diagnosed with AATD. Between 1994 and 2013 the incidence of AATD diagnosis generally increased. A diagnosis of AATD was associated with being male, being an ex-smoker, more severe COPD with a lower forced expiratory volume in 1 s % pred and higher GOLD 2017 stages (all p<0.05).Despite an increase in the frequency of AATD testing since 1990, only 2.2% of patients diagnosed with COPD before the age of 60 years were tested. AATD prevalence was 23.7% in those tested. Thus, it appears that AATD remains markedly underdiagnosed in COPD patients.

Summary Eyewitnesses are often asked to describe the appearance of an offender's face, normally as part of a cognitive interview (CI), and then to construct a facial composite of it by selecting hair, eyes, nose, and so on. Recent research indicates that facial composites of this type are rendered much more identifiable when constructors focus on global character (holistic) judgements of the face after having recalled it in detail. Here, we investigated whether components of this so‐called holistic CI (H‐CI) were applicable to newer ‘evolving’ (Darwinian) methods of face construction. We found that the face description component of the interview promoted better‐quality composites than the holistic component, but the most identifiable composites emerged when both components were used together in the same interview as an H‐CI. Composites were also more identifiable following description of all features of the face than an alternative involving description of hair. Implications are discussed for real‐world face construction using evolving systems. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Killarny * lake ; nor can Europe thew a na= tural wonder equal to the Gyant's Caufeway in the north of Ireland.The excellence and number of our fprings (whether medicinal or incrufting) are well known to common inquirers.RaelOur minerals are as great in quantity, as rich in quality: of gold, indeed, we cannot produce many fpecimens, yet fufficient tofhew that it is found in this ifland-+-; but filver is found in great abundance in our lead ores, and veins of native filver in the copper ore of Muckrus, on the lake of Killarny.The hzematites iron ores of Cumberland, and the beautiful columnar iron ores of the foreft of Dean, are fufficient to difplay our riches in that ufeful commodity.No country produces fo great a quantity of tin as Cornwall; and that county, and feveral others in the north have been long noted for their inex~ hauftible veins of copper; nor lefs famous * In the county of Kerry.+ That our country produces gold, appears in Dr. Borla/e's Hiftory of Corzwall, p.214.So late as the year 1753, feveral ' therine's near Edinburgh.Our amber and our jet, together with our inexhauftible firata of coal found in fo many parts of this kingdom, will, in the article of bitumens, give us the fuperiority over thefe fo much boafted productions of Sweden.* Jn the county of Kerry.a 4 To Ved Vill Oe Roy BA ES Ago ae ee To avoid a tedious enumeration, we thall only mention our wonderful mines of rock | falt ; our allum and our vitriol works; our various marbles, alabafters, and ftonés ; our moft excellent clays and earths *; all which articles, and many more unnoted here, might have furnifhed us with an ample field sa panegyric, Our botanical Sectoid 1s are not lefs abundant; but the works of Ray, which have * If the inguifitive reader is defirous of a farther account of the number and excellence of our fubterraneous produc-tions, we refer him to the learned Dr. Woodward's Cata-Jocue of the Exglifo Fofils, London 1729, particularly to p. 5. parade: " BORO ES, FY Ast GC ER parade of ufelefs declamation, and fhail only add, that as few countries receive more advantages from their natural breed of quadrupeds, unmixed with any beaft that preys on man, fo, few can boaft a greater variety of birds, whether local, or migratory.This is a general view of the natural hiftory of our own country; why then fhould we neglect inquiring into the various benefits that refult from thefe inftances of the wifdom of our.Creator, which his divine munificence has fo liberally, and fo immediately placed before us?Such a neglect is certainly highly to be blamed, for (to exprefs ourfelves in the words of an eminent writer) "the Creator did not beftow fo much "< curiofity, and workmanfhip on his crea-."' tures, to be looked on with a carelefs in-"* curious eye, efpecially to have them flight-"'ed or contemned; but to be admired by '* the rational part of the world, to magnify "* his own power to all the world, and the "* ages thereof; and fince the works of the "creation are all of them fo many demon-'* {trations of the infinite wifdom and power '© of God, they may ferve to us, as fo ma-** ny arguments exciting us to a conftant fear Plurimus inde labor tabulas imitando juvabit Egregias, operumque typos, fed plura docebit Natura ante oculos prefens, nam firmat et auget Vim genii, ex illaque artem experientia complet +}.* That great artift, Mr. Ridinger, of dufburg, exceeds allothers in the three laft particulars; nothing can equal his prints of animals for propriety of attitudes, for a juft idea of their way of life, and for the beautiful and natural fcenery that accompanies them.His fineft works are, his WildeThiere, Kleine Thiere, and 'Fagdbare Thiere; but there are fearce any of his performances that can fail giving pleafure to all admnirers of nature reprefented as herfelf.4 Frefnoy de arte graph.lin.537+

Abstract Describing a person's face can temporarily interfere with face recognition ability. We explored whether this so-called ‘verbal overshadowing effect’ (VOE) might interfere with the construction of a traditional facial composite, a face produced by the selection of individual features: hair, eyes, mouth, etc. Participants looked at an unfamiliar target and two days later constructed a single composite after (a) describing the face (verbal no-delay), (b) without describing (no-description) or (c) 30 minutes after describing (verbal delay). Composite quality was overall of poor quality but it was worse in the verbal no-delay group relative to the no-description group, suggesting the involvement of a VOE, but equivalent between verbal delay and no-description, suggesting the presence of a ‘release’ from overshadowing. The data support the revised ‘transfer inappropriate retrieval’ explanation of the VOE, and suggest that witnesses to real crimes should not proceed directly from face description to feature selection. Keywords: facial compositeverbal overshadowing effectwitnessmemory

This chapter contains sections titled: Introduction Soil Sampling Errors Associated with Soil Sampling and Preparation Overview of the Current Situation Scale and Variability Conclusions References

BACKGROUND: The use of menopausal hormone therapy (MHT) was significantly reduced following the publication of the Women's Health Initiative study results and has remained low ever since. However, from 2015 onwards, the UK has seen a substantial increase in MHT prescribing compared to other European countries. OBJECTIVES: To evaluate the factors contributing to the shift in women's and healthcare professionals' (HCPs) perception of MHT in the United Kingdom and to provide learning points for other European countries. DESIGN: An exploratory, descriptive and qualitative study. METHODS: An interactive virtual panel discussion in which seven UK-based HCPs with a special interest in the menopause discussed the evolution of its management in the United Kingdom. RESULTS: In the last 8 years, there has been a substantial increase in MHT prescriptions in the United Kingdom due to improved menopause awareness and acceptance of MHT. Accessibility to accurate, scientific, information and guidance from respected institutions is one of the main drivers of this change. Social media has increased that reach with 'influencers' empowering women to seek help. Women are demanding access to menopause health care so that they can receive holistic and individualized treatment based on their clinical conditions and needs. Standardized education of HCPs is an essential pillar to provide appropriate and equitable care to menopausal women and to guarantee safe prescribing of MHT. Furthermore, up to date and factually correct menopausal education would benefit all the population. CONCLUSIONS: Publication of new scientific data reporting a more favourable benefit/risk ratio with MHT, production of national guidance and an increased awareness via social media have led to the significant rise in MHT prescribing and improvement of menopause care in the United Kingdom. The lessons learned may benefit other European countries.

INTRODUCTION: We wished to obtain a snapshot of current service provision and how this could best be developed approximately one year on from the introduction of the National Institute for Clinical Excellence (NICE) guidelines for the management of chronic obstructive pulmonary disease (COPD) and the inclusion of COPD care in the New GMS Contract Quality and Outcomes Framework (QOF). METHODOLOGY: A questionnaire-based survey sent to every general practice (n = 84) in Grampian. RESULTS: Responses were received from 75 of 84 practices (89%). Questionnaires were returned by both general practitioners (GPs) and practice nurses in 45 practices (54%). All responding practices reported that they had COPD registers. 60/75 (80%) of practices reported having a dedicated COPD clinic; 70/75 (93%) had a spirometer. Areas identified for service development were: quality assuring training in COPD care and spirometry; expanding pulmonary rehabilitation provision (86%), delivering this service locally (54%) and in primary care (75%); standardising referral, assessment and communication about provision of home oxygen; training in pulse oximetry (71%). CONCLUSION: This data has important implications for the validity of the quality indicators (QOF) under the new GMS contract. Our respondents identified areas where the new GMS contract QOF could be improved, as well as providing useful suggestions for service development. Respondents recognised that not all clinical services can be effectively delivered by general practice with data supporting the development of intermediate care services for people with COPD.

Journal Article THE NATURE OF THE ACT: A Neglected Dimension in the Classification of Sex Offenders Get access KATHARINE J. MAIR KATHARINE J. MAIR *Consultant Clinical PsychologistHM Prison, Peterhead AB42 6YY Search for other works by this author on: Oxford Academic Google Scholar The British Journal of Criminology, Volume 33, Issue 2, Spring 1993, Pages 267–275, https://doi.org/10.1093/oxfordjournals.bjc.a048301 Published: 01 March 1993

BACKGROUND: There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed. OBJECTIVE: The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community. CONCEPT OF SUPPORT: For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'. INCLUSION CRITERIA: The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus. SEARCH STRATEGY: The search set out to find published studies in English from 1990-2010. METHODOLOGICAL QUALITY: The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria. DATA SYNTHESIS: Findings from included papers were aggregated, categorised and synthesised. RESULTS: If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

A 30 year old man with asthma, previously well controlled with inhaled beclometasone 100 μg (two puffs twice daily) and salbutamol (as required), presented to his general practitioner with a three month history of increasing breathlessness and wheeze, primarily overnight and in the mornings. He was a non-smoker with no obvious trigger factors. He reported using his inhaler as prescribed, and his technique was satisfactory. He had no other medical history and no symptoms of allergic rhinitis. His general practitioner suggested a further inhaler containing a long acting β2 agonist (LABA), but the patient expressed concerns as he had read that these inhalers were linked to an increased risk of fatal asthma. LABAs have become an increasingly popular treatment over the past two decades as a supplement to inhaled corticosteroids in the management of persistent asthma.1 They have a bronchodilator effect when bronchomotor tone (the state of airway smooth muscle contraction or relaxation regulating airway calibre) is low, and a protective (or “airway stabilising”) effect with increased bronchomotor tone.2 Salmeterol and formoterol (the two LABAs in widespread clinical use) are lipophilic, bind to airway smooth muscle β2 adrenoceptors and exert effects for approximately 12 hours. Salmeterol has a slower onset of action (10-30 minutes) than formoterol (1-3 minutes). Both drugs can be prescribed in single inhaler devices, but they are commonly given with different inhaled corticosteroids with varying doses in combination inhaler devices (table 1⇓, fig 1⇓). Fig 1  Examples of different types of inhaler device used to deliver long acting β2 agonists (LABAs) to the airways: (a) Symbicort Turbohaler, (b) Seretide Accuhaler, (c) Seretide metered dose inhaler, (d) Fostair metered dose inhaler, (e) Flutiform metered dose inhaler View this table: Table 1  Combination inhaled corticosteroid and long acting β2 agonist (LABA) preparations licensed for …

Evidence-based practice (EBP) is a requirement of nurses through the generation of evidence to implementing it, in a bid to to improve clinical practice. However, EBP is difficult to achieve. This paper highlights an approach to generating evidence for enhancing community nursing services for patients with chronic obstructive pulmonary disease (COPD) through a collaborative partnership. A district nurse and two nursing lecturers formed a partnership to devise a systematic review protocol and perform a systematic review to enhance COPD practice. This paper illustrates the Joanna Briggs Institute (JBI) systematic review process, the review outcomes and the practitioner learning. Collaborative partnerships between academics, researchers and clinicians are a potentially useful model to facilitate enhanced outcomes in evidence-based practice and evidence application.

Introduction: The Fostair® 100/6 (BDP/FF) pressurized metered-dose inhaler, delivering an extrafine formulation, is licensed for asthma and COPD in the UK. However, its real-life effectiveness for COPD has not been evaluated. This study compared the clinical effectiveness of BDP/FF against other licensed ICS/LABA combination inhalers: the Seretide® Accuhaler® (FP/SAL) and the Symbicort® Turbohaler® (BUD/FF). Methods: A matched historical cohort study was conducted using records of patients with diagnostic codes for COPD from the Optimum Patient Care Research Database (OPCRD). Patients who had received BDP/FF as their first ICS/LABA were matched 1:1 with patients who had received FP/SAL or BUD/FF, resulting in two matched comparisons. Additional analysis was conducted on patients who had never had diagnostic codes for asthma. Noninferiority in terms of the proportion of patients with moderate/severe COPD exacerbations on the different inhalers in the following year was assessed. Noninferiority was achieved if the upper CI limit were ≤1.2. Results: This study included 537 and 540 patient pairs in the BDP/FF vs FP/SAL cohort and the BDP/FF vs BUD/FF cohort, respectively. The proportion of patients with COPD exacerbations in the BDP/FF group was not significantly different from either the FP/SAL (68.7% vs 70.2%, AOR 0.89, 95% CI 0.67-1.19) or BUD/FF group (68.5% vs 69.4%, AOR 0.79, 95% CI 0.58-1.08). Noninferiority of BDP/FF in preventing COPD exacerbations was fulfilled in both comparisons. In patients without asthma, BDP/FF was also noninferior to BUD/FF (proportion with COPD exacerbations, 67.8% vs 64.7%, AOR 0.79, 95% CI 0.51-1.1997). Additionally, a significantly lower proportion of patients prescribed BDP/FF had COPD exacerbations than FP/SAL (64.8% vs 73.7%, AOR 0.64 95% CI 0.43-0.96). Conclusion: Initiating ICS/LABA treatment of COPD with extrafine-formulation BDP/FF was noninferior in preventing moderate/severe exacerbations compared to FP/SAL and BUD/FF.

Despite national and international guidelines, asthma is frequently misdiagnosed, control is poor and unnecessary deaths are far too common. Large scale asthma management programme such as that undertaken in Finland, can improve asthma outcomes. A primary care asthma management quality improvement programme was developed with the support of the British Lung Foundation (now Asthma + Lung UK) and Optimum Patient Care (OPC) Limited. It was delivered and cascaded to all relevant staff at participating practices in three Clinical Commissioning Groups. The programme focussed on improving diagnostic accuracy, management of risk and control, patient self-management and overall asthma control. Patient data were extracted by OPC for the 12 months before (baseline) and after (outcome) the intervention. In the three CCGs, 68 GP practices participated in the programme. Uptake from practices was higher in the CCG that included asthma in its incentivised quality improvement programme. Asthma outcome data were successfully extracted from 64 practices caring for 673,593 patients. Primary outcome (Royal College of Physicians Three Questions [RCP3Q]) data were available in both the baseline and outcome periods for 10,328 patients in whom good asthma control (RCP3Q = 0) increased from 36.0% to 39.2% (p < 0.001) after the intervention. The odds ratio of reporting good asthma control following the intervention was 1.15 (95% CI 1.09-1.22), p < 0.0001. This asthma management programme produced modest but highly statistically significant improvements in asthma outcomes. Key lessons learnt from this small-scale implementation will enable the methodology to be improved to maximise benefit in a larger scale role out.

Accurate record keeping is important for many reasons, including demonstrating and recording activity and enabling safe transfer of care between professionals. An audit of child health records in Aberdeen and Aberdeenshire showed much good practice, but also areas for improvement.