Author: Jason Curtis

Improving compliance to follow-up alerts in chest X-rays with consolidation through clinician education (2025)

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Type of publication:

Conference abstract

Author(s):

*Adeniran-Babatunde S.F.; *Gbede O.; *Oguntoye O.; *Alkhouly M.

Citation:

Clinical Radiology. Conference: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 83(Supplement 1) (no pagination), 2025. Article Number: 106889. Date of Publication: 01 May 2025.

Abstract:

Category: Chest Background to the audit: Timely follow-up of abnormal chest X-rays (CXRs) showing consolidation as recommended by the radiologist can aid prompt diagnosis and treatment of other serious conditions with subsequent good outcomes. Research has shown that significant morbidity can occur from delay and lack of follow-up in patients with consolidation or other abnormalities on initial CXR, which is why the British Thoracic Society (BTS) recommends follow-up CXRs at around six weeks after completing treatment for all patients with consolidation on CXR to ensure resolution. This formed the premise for our audit looking into how to improve compliance to this protocol in our trust and thereby improve patient safety. Standard: BTS recommendation. Indicator: We assessed source of referral. We assessed if repeat CXR has been performed as suggested by the radiologist. We assessed the time frame suggested for the repeat CXR. We compared the actual time frame of the repeat imaging with the time frame suggested. Target: 100% compliance to follow-up alert. 100% compliance to recommended time frame. Methodology: In the first round, retrospective review of random 100 CXRs done in the trust with follow-up alert. Data collected include patient's referral source, date of the initial image, recommended time frame for repeat image and date of the follow-up CXR. The data were analysed and presented in percentages. The exact similar process was repeated for the second round three months after the intervention. Results of first audit round: 43% of the patients were referred from emergency department (ED), 39% from GP and 18% from the wards. 79% of the patients had repeat CXRs, 14% did not and 7% had died. Of those that had repeat CXRs, 46% had it done at the recommended time, 43% were done at a later date and 11% were done earlier. First action plan: Audit was presented at clinical meetings to educate clinicians on the need to request follow-up CXRs to ensure patient safety. Results of second audit round: 54% were from ED, 31% from GP and 15% from the wards. 95% had repeat CXRs while the remaining 5% had died. 78% had repeat CXRs within the recommended time, 14% were done later and 8% were done earlier. Second action plan: Presentation and teaching at clinical meetings to further reinforce and improve on follow-up compliance.

Image-guided brachytherapy for locally advanced cervical cancer: audit of practice at UHNM 2023 and re-audit 2024 (2025)

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Type of publication:

Conference abstract

Author(s):

Perera J.; Bhana R.; *Choudhury Y.; Devleena D.; Seedhouse I.; Tsui S.M.

Citation:

Clinical Oncology. Conference: SUPP: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 40(Supplement 1) (no pagination), 2025. Article Number: 103820. Date of Publication: 01 May 2025.

Abstract:

Category: Gynaecology Background to the audit: Standard treatment for locally advanced cervix cancer consists of chemoradiotherapy followed by brachytherapy. Trial data show shortening overall treatment time and escalation of doses to the high-risk clinical target volume (HR-CTV) to be associated with better local control. Image-guided brachytherapy (IGBT) enables greater dose conformity and local control.<sup>1-6</sup>UHNM commenced a magnetic resonance-based IGBT service for cervical cancer in 2016. Standard: BGCS/ESGO/ESTRO/ESP/ASTRO guidelines on management of cervical cancer.<sup>7-9</sup>1. Overall treatment time should not exceed 49-56 days. 2. Total equivalent dose in 2 Gy fractions (EQD2) to 90% of the HR-CTV (D90) to be >=85 Gy. Indicator: Percentage of patients meeting each standard. Target: 100% having overall treatment less than 56 days. 90% achieving the dose to HR-CTV targets keeping organs at risk(OAR) within tolerence. Methodology: Retrospective analysis of data on IGBT for radical cervical cancer treatments from 1 January 2021 to end of March 2023 done and reviewed at May 2023 UHNM brachytherapy meeting. Initial time span selected to minimise impact of COVID. Action plan implemented and patient data for April 2023 to April 2024 re-audited. Results of first audit round: 43 UHNM and Shrewsbury patients treated. Overall treatment time data available only for 20 UHNM patients. 1 (5%) had exceeded 56 days and 7 (35%) had taken 50-56 days to complete. 37/43 (86.1%) had received a D90 HR-CTV of >85 Gy. A linear relationship between external beam radiation therapy (EBRT) completion to brachytherapy start with total treatment duration identified. First action plan: Pathway changes made to commence chemoradiotherapy on Monday/Tuesday and to schedule the whole course of chemoradiotherapy and brachytherapy at the time of referral. Ring and tandem commissioned as a priority to allow more applicator options. Results of second audit round: All 26 (100%) UHNM and Shrewsbury patients had completed treatments within 56 days. 73.1% within 49 days. 1 outside patient's chemoradiotherapy data incomplete. HR-CTV D90 >85 Gy in 85.2%. 8 patients treated with ring and tandem with 60% more needle use compared with ovoids. No patient exceeded mandatory OAR tolerences. Second action plan: Proactively scheduling brachytherapy, liaising with the regional network monthly to optimise timing and resources usage. To continue with dosimetric data collection to optimise needle placement and to review impact of needles on OAR doses and clinical outcomes in the next audit.

Hyponatraemia Induced by Terlipressin in Patients Diagnosed with Decompensated Liver Cirrhosis and Acute Variceal Bleeding (2025)

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Type of publication:

Journal article

Author(s):

*Elshehawy, Mahmoud; *Panicker, Richel Merin; Abdelgawad, Alaa Amr; Ball, Patrick Anthony; Morrissey, Hana.

Citation:

Medicines. 12(2), 2025 Mar 28.

Abstract:

Background: Hyponatraemia is a rare but potentially life-threatening complication of terlipressin therapy. Case history: In the current case, a 39-year-old female with decompensated liver cirrhosis (Child-Pugh C) and acute variceal bleeding experienced a precipitous decline in serum sodium-from 136 mmol/L to 115 mmol/L-within 48 h of initiating terlipressin therapy. This was accompanied by marked fluid retention, reduced urine output, and symptoms of confusion and agitation. Laboratory tests confirmed dilutional hyponatraemia, characterized by urinary sodium <20 mmol/L and urine osmolality <100 mOsm/kg, indicating excessive free water reabsorption. Outcomes: The prompt discontinuation of terlipressin, fluid restriction and the cautious administration of hypertonic sodium chloride solution (2.7% NaCl) achieved a gradual normalization of sodium levels and resolution of symptoms. Fluid balance monitoring revealed a marked diuretic response following terlipressin cessation. This case aligns with existing reports, emphasizing the dual vasopressin receptor activity of terlipressin and its capacity to induce hyponatraemia, particularly in cirrhotic patients with preserved renal function and higher baseline sodium levels. Conclusions: This case and a literature review underscored the critical need for early fluid balance monitoring to detect retention. This case highlights the importance of individualized risk assessment, multidisciplinary management, and vigilant sodium correction to avoid complications. Practical recommendations are outlined to aid clinicians in the recognition and management of terlipressin-induced hyponatraemia.

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A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin (2025)

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Type of publication:

Journal article

Author(s):

Brar, Gurjasan; Dhaliwal, Anoop; Brar, Anupjot S; Sreedevi, Manasa; *Ahmadi, Yasmin; Irfan, *Muhammad; Golbari, Rebecca; Zumarraga, Daniela; *Yateem, Dana; Lysak, Yuliya; Abarca-Pineda, Yozahandy A.

Citation:

Cureus. 17(3):e81109, 2025 Mar.

Abstract:

Ultraviolet (UV) radiation significantly contributes to photoaging, with its effects varying among different Fitzpatrick skin types. Light skin (Types I-III) has a natural sun protection factor (SPF) of only 3.3, making it particularly vulnerable to DNA damage, collagen degradation, and skin cancer. Darker skin (Types IV-VI) has a natural SPF of 13.4, providing greater photoprotection while elevating the risk of post-inflammatory hyperpigmentation and delaying skin cancer diagnosis. UVA penetrates deep into the dermis, promoting collagen degradation, whereas UVB causes DNA mutations, increasing the risk of cancer. Eumelanin in darker skin mitigates oxidative stress, while pheomelanin in lighter skin functions as a pro-oxidant, increasing vulnerability to photoaging. Although incidence rates are lower, melanoma is identified at more advanced stages in those with darker skin, resulting in poorer outcomes. Protective measures, such as broad-spectrum sunscreens, antioxidants, and hydration, are crucial for all skin types but necessitate customized strategies. Individuals with lighter skin benefit from SPF 50+ and DNA-repairing compounds, whereas those with darker complexion necessitate SPF 30-50 and pigmentation-focused skincare. Comprehending the biological mechanisms and variations in UV damage facilitates the creation of customized photoprotection solutions, enhancing skin health and mitigating long-term UV-related issues for all skin types.

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Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair (2025)

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Type of publication:

Journal article

Author(s):

Lopes, Ronny; Freiha, Kinan; *Carmont, Michael R; Valentin, Eugenie; Alvino, Kylian; Mousa, Mohamed; Rauline, Gauthier; Fourchet, Francois; Picot, Brice; Hardy, Alexandre.

Citation:

American Journal of Sports Medicine. 2025 Apr 22.[epub ahead of print]

Abstract:

BACKGROUND: The Ankle-GO is a composite outcome score based on 4 functional tests and 2 patient-reported outcome measures. It was initially described and validated for its ability to predict return to sports (RTS) at the same level of play after lateral ankle sprains.

PURPOSE/HYPOTHESIS: The main aim of this study was to assess the psychometric properties of the Ankle-GO in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict RTS at the same level of play. It was hypothesized that this composite outcome score is a valid and reliable tool that is able to discriminate and predict the level of RTS at 9 months after Achilles tendon repair.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: This was a prospective multicenter study. Patients who were active in sports and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 participants with no history of lower limb injuries was also evaluated. After standard rehabilitation for the first 2 months, the Ankle-GO was administered at 6 and 9 months after repair by the same experienced physical therapist. During testing, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between control participants and patients at 9 months after surgery was performed.

RESULTS: A total of 50 patients (24 women and 26 men), with a mean age of 38.3 +/- 10.1 years, were included. No patients were lost to follow-up at 9 months. The Ankle-GO score at 6 months was 10.7 +/- 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum score achieved was 3 points (n = 5 [10%]). Only 1 patient (2%) obtained the maximum score (25 points). There was a significant difference in the Ankle-GO score between patients at 6 and 9 months and between control participants and patients at 9 months after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to their preinjury level of sport at 9 months. The ability of the Ankle-GO score at 6 months to predict RTS at the preinjury level at 9 months was good (area under the curve = 0.71 [95% CI, 0.56-0.85]; P < .01). A Youden index of 0.42 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.

CONCLUSION: The Ankle-GO is a valid tool to evaluate and discriminate patients during the RTS continuum after Achilles tendon repair and to predict RTS at the same level at 9 months after surgery. This composite outcome score assesses ankle function and the patient's psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of a recurrence.

Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England (2025)

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Type of publication:

Journal article

Author(s):

Dawes, Mindy; Packman, Zoe; McDonald, Ruth A; *Cheetham, Mark J; Gallagher-Ball, Nannette M T; Warwick, Eleanor; Oyston, Maria; McCone, Emma; Snowden, Chris; Swart, Michael; Briggs, Tim W R; Gray, William K.

Citation:

British Journal of Anaesthesia. 2025 Apr 22.

Abstract:

BACKGROUND: Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

METHODS: This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >=17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

RESULTS: Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.

CONCLUSIONS: We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

Exploring the prevalence and risk factors of adolescent mental health issues in the COVID and post-COVID era in the U.K.: a systematic review (2025)

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Type of publication:

Systematic Review

Author(s):

Nwabueze K.K.; Akubue N.; Onakoya A.; Okolieze S.C.; Otaniyen-Igbinoba I.J.; Chukwunonye C.; *Okengwu C.G.; Ige T.; Alao O.J.; Adindu K.N.;

Citation:

EXCLI Journal. 24 (pp 508-523), 2025. Date of Publication: 03 Jan 2025.

Abstract:

Adolescence is a developmental phase largely characterized by rapid biological and non-biological transfor-mations, with a heightened susceptibility to social and environmental influences. Hence, adolescents are particularly vulnerable to external stressors, underscoring the need to safeguard their well-being and prioritize mental health interventions. The coronavirus disease (COVID-19) pandemic caused a global crisis with profound societal disruptions, and led to lasting impact on global public health, disproportionately affecting vulnerable populations, including adolescents. In view of the unique developmental challenges faced by adolescents, it is imperative to assess the growing burden of mental health issues exacerbated by the pandemic. This review synthesizes existing evidence on the emerging mental health challenges faced by adolescents in the United Kingdom (UK) as exacerbated by the COVID-19 pandemic. A systematic literature search was conducted using PubMed, ScienceDirect, MEDLINE, and SpringerNature databases, resulting in the selection of ten high-quality studies. A thematic analysis of the collected data revealed that depression and anxiety were the most frequently reported mental health conditions among adolescents. These conditions were particularly prevalent among adolescents who were from low-income households, those with pre-existing mental health disorders, adolescents experiencing household con-flicts, females, and those who provided self-reported data. Several key risk factors were identified, including family and peer relationships, academic pressures such as examinations and grades, financial constraints within house-holds, and the corruptive influence of social media. The findings underscore the urgency of targeted mental health interventions tailored to the specific needs of adolescents in the U.K. By addressing the identified risk factors, mental health professionals, policymakers, and educators can develop more effective strategies to mitigate the psychological impact of the pandemic on this vulnerable population. This study contributes to the evolving body of literature and emphasizes the need for evidence-based policies to foster overall well-being and resilience in adolescents navigating post-pandemic challenges.

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Rising incidence of necrotising fasciitis: a gynaecological perspective (2025)

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Type of publication:

Journal article

Author(s):

*Kaur, Harpreet; *Adekunle, Adeoye; *Ritchie, Joanne; *Rachaneni, Suneetha.

Citation:

BMJ Case Reports. 18(4), 2025 Apr 08.

Abstract:

Necrotising fasciitis is an uncommon and rapidly progressive surgical emergency. A high index of clinical suspicion, prompt administration of broad-spectrum antibiotics and emergency surgery to debride affected tissues are key to improving survival. With our review of three cases, we aim to raise awareness of this condition among gynaecologists, who have limited familiarity with it. Two of our patients presented to emergency with vulval necrotising fasciitis while the third developed it as a complication of postoperative wound infection. All patients underwent extensive surgical debridement and required a multidisciplinary approach from gynaecologists, surgeons, the intensive care team and the tissue viability team.

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