Andrew Rideout

BACKGROUND: Emerging evidence suggests that heart failure (HF) patients who have mild cognitive impairment (MCI) may experience greater difficulty with self-care. OBJECTIVE: This article reports a systematic review that addressed the objective "What is the evidence for an association between MCI and self-care, measured in 1 or more of the self-care domains related to HF, in adults who have a diagnosis of chronic HF?" METHOD: We adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the review and synthesis of quantitative research studies that formally measured both cognitive function and self-care in HF patients and sought to describe the relationship between these factors. RESULTS: Ninety-one potentially relevant studies were located; 10 studies (2006-2014) were included. Because of heterogeneity in the retrieved studies, meta-analysis was not possible. Narrative synthesis found growing evidence regarding the association between MCI and adverse effects on self-care in HF. Nine studies reported significant positive associations between MCI and self-care in HF, either specifically in relation to medication adherence or more generic measures of self-care activity. One study reported a significant, negative correlation between cognitive function and self-care, suggesting that worse cognitive function was associated with better self-care; however, this is partially explained by a small sample size and mixed methodology. CONCLUSIONS: These findings have implications for clinical practice. It is known that HF patients have difficulty with self-care, and the influence of cognitive function needs to be considered when providing professional support. Further research to determine the feasibility and acceptability of cognitive assessment in routine clinical care is recommended.

OBJECTIVE: This study examined whether involvement in a pre-surgical cardiac rehabilitation programme conferred a long-term survival benefit. DESIGN: Patients randomly allocated to a pre-surgical cardiac rehabilitation programme intervention or a control group were tracked through national databases at a point approximately 12 years later, and all causes of mortality were identified from death records. Kaplan-Meier survival analyses based on involvement in a cardiac rehabilitation programme and known pre-surgical risk factors were carried out. SETTING: Two health boards in the west of Scotland, referring to a single cardiothoracic tertiary centre. SUBJECTS: Patients admitted to the waiting list for coronary artery bypass surgery. INTERVENTIONS: Patients were randomly allocated to a control group ('usual' care) or an intervention group (nurse-led cardiac rehabilitation) in the pre-operative phase. They were followed up at 12 years post surgery. MAIN MEASURES: The only outcome measure used for analysis was survival. Measures of anxiety and depression, and physiological and lifestyle risk factors were included as independent variables in analysis of death. RESULTS: The initial study included 110 patients--none were lost to follow-up. Relative risk of death associated with inclusion in the cardiac rehabilitation programme was 0.814; risk of death increased with increasing pre-surgical depression (RR 1.07) and anxiety (RR 1.09). CONCLUSIONS: Undertaking pre-surgical cardiac rehabilitation confers a long-term survival advantage over patients not offered this service. Increased anxiety and depression in the pre-surgical phase are additional risk factors for increased mortality.

INTRODUCTION: Health locus of control is a measure of an individual's beliefs in factors that are thought to determine health experiences. Scores are generated and form a graduated linear scale from external to internal control, with respect to their views on health causality. Health locus of control has been considered to be a relatively stable entity. However, it is not clear if this status changes in the advent of serious health challenges, such as coronary artery bypass graft surgery. The aim of this study is to explore the variability of health locus of control and its association with postoperative health in this context. METHODS: In a longitudinal cohort study of patients undergoing coronary artery bypass graft surgery, a purposive sample ( n=215) were recruited from the waiting list and followed up postoperatively, at approximately one year and seven years later. RESULTS: Patients undergoing coronary artery bypass graft surgery demonstrated marked fluctuations in health locus of control in their peri-operative and rehabilitative phases. Mean health locus of control became more external (often associated with poorer outcomes) peri-operatively, and more internal (generally associated with better health outcomes) in the rehabilitative period. CONCLUSIONS: Health locus of control scores were shown to be changeable during a major health care intervention, with possible consequences for patient outcomes and care needs. The significant health belief upheaval demonstrated in this cohort should be considered in assessing patients preoperatively, and managed as part of the patients' clinical journey by both acute and rehabilitation staff. It is likely to have particular importance in individualised assessment and management of future prevention advice for patients.

BACKGROUND: There have been large regional differences in COVID-19 virus activity across the UK with many commentators suggesting that these are related to age, ethnicity and social class. There has also been a focus on cases, hospitalisations and deaths rather than on hospitalisation rates expressed per 100,000 population. The purpose of our study was to examine regional variation in COVID-19 positive hospitalisation rates in Scotland during the first wave of the pandemic and the possibility that these might be related to population density. METHODS AND FINDINGS: This was a repeated point prevalence study. The number of COVID-19 positive patients hospitalised in the eleven Scottish mainland health boards peaked at 1517 on 19th April, then fell to a low of 243 on 16th August before rising slightly to 262 on 15th September. In July, August and September only four boards had more than 5 hospitalised patients. There was a statistically significant relationship between hospitalisation rates and population density on 97.7% of individual days during the first wave of the pandemic (Pearson's r 0.62-0.93, with 123 of a possible 174 days having p values <0.001). Multiple linear regression analyses performed on data from the 11 mainland boards across six time points suggest that population density accounted for 70.2% of the variation in hospitalisation rate in April, 72.3% in May, 81.2% in June, 91.0% in July, 91.0% in August, and 88.1% in September. Neither population median age nor median social deprivation score at health board level were statistically significant in the final model for hospitalisation. CONCLUSION: There were large differences in crude COVID-19 hospitalisation rates across the 11 mainland Scottish health boards, that were significantly related to population density. Given that lockdown was originally introduced to prevent the NHS from being overwhelmed, we believe our results support a regional rather than a national approach to lifting or reimposing more restrictive measures, and that hospitalisation rates should be part of the decision making process.

Sesamoiditis is a common equine disease with varying severity, leading to increased injury risks and performance degradation in horses. Accurate grading of sesamoiditis is crucial for effective treatment. Although deep learning-based approaches for grading sesamoiditis show promise, they remain underexplored and often lack clinical interpretability. To address this issue, we propose a novel, clinically interpretable multi-task learning model that integrates clinical knowledge with machine learning. The proposed model employs a dual-branch decoder to simultaneously perform sesamoiditis grading and vascular channel segmentation. Feature fusion is utilized to transfer knowledge between these tasks, enabling the identification of subtle radiographic variations. Additionally, our model generates a diagnostic report that, along with the vascular channel mask, serves as an explanation of the model’s grading decisions, thereby increasing the transparency of the decision-making process. We validate our model on two datasets, demonstrating its superior performance compared to state-of-the-art models in terms of accuracy and generalization. This study provides a foundational framework for the interpretable grading of similar diseases. • Innovative multi-task learning model grades sesamoiditis in equine radiographs with clinical interpretability. • Dual-branch decoder and feature fusion improve grading accuracy by focusing on vascular channels. • Visual and quantitative explanations make model decisions intuitive to clinicians. • Superior performance validated on both development and independent datasets.