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IntroductionTo describe ANP role within current CTCA service, including administering beta-blockade, and future progression to ANP-led CTCA listsMethodsOur CTCA service started in 2015 with a Cardiologist/Radiologist, 2 radiographers and 1 ANP per list, and expanded with updated stable chest pain NICE guideline (CG95) 2016. At CTCA the ANP administers rate control up to a total of 50mg IV Metoprolol and GTN. We formally agreed a betablockade protocol and referrals detail drug suitability. The ANP has access to patient notes and collaborative decision-making support within the team. The ANP must have Advanced Life Support Provider qualification to support lists. The ANP role also includes history taking, diagnosis and treatment of patients with potential cardiac disease including patients with chest pain. ANPs request investigations and prescribe pre-procedural rate control medication. ANPs interpret reported findings and commence appropriate treatment. Satisfaction questionnaires were obtained from patients alongside regular audit of CTCA service. Standardisation of the service was met with clear pharmaceutical protocols and referral guidelines.ResultsData from local audit has highlighted positive CTCA outcomes and high level of patient satisfaction. This supported expansion of the service, including team, lists and advancing technologies. The ANP-led service has freed up consultant time for reporting.ConclusionANP-led patient care and drug administration at CTCA improves continuity of care for patients, provides efficient team structure for supporting cardiac imaging and facilitates consultant reporting time. Fully ANP-led lists with our new scanners in 2024 should reduce ongoing service costs and further increase consultant reporting time.

Regarding the game - it shows we can't afford to switch off. Understandably Rafa was furious as we never looked like losing.

This book provides a new perspective on joblessness among men. During the last twenty years vast numbers of men of working age have moved completely out of the labour market into 'early retirement' or 'long-term sickness' and to take on new roles in the household. These trends stand in stark contrast to rising labour market participation among women. Based on an unprecedented range of new research on the detached male workforce in the UK, and located within an international context, the book offers a detailed exploration of the varied financial, family and health circumstances 'detached men' are living in. It also challenges conventional assumptions about the boundaries between unemployment, sickness and retirement and the true health of the labour market. Work to Welfare represents an important contribution to debates about the labour market and benefit systems and will be of interest to readers and practitioners in social policy, economics and geography.

IntroductionSevere traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI.Methods and analysisThe Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients.Ethics and disseminationThis study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study.Trial registration number NCT04318665