Author: Jason Curtis

Time perception in shoulder dystocia management; a secondary analysis of the prospective cohort simulation SAFE study (2025)

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Type of publication:

Journal article

Author(s):

*Papoutsis D.; Klazoglou P.; Valasoulis G.; Tzavara C.;

Citation:

European Journal of Obstetrics and Gynecology and Reproductive Biology. 311 (no pagination), 2025. Article Number: 114016. Date of Publication: 01 Jul 2025.

Abstract:

Objective: The aim of this study was to explore and quantify the potential improvement and retention of time perception in a simulated childbirth complicated by shoulder dystocia with use of high-fidelity simulation. Method(s): This was a secondary analysis of the previously conducted prospective cohort SAFE study. Registered midwives and final year Midwifery students were invited to attend a one-day workshop in 6-monthly intervals at the University of Western Macedonia in Greece between October 2021-November 2022. There was a 30-minute initial assessment, a 30-minute theoretical and hands-on training, and a 30-minute post-training assessment on shoulder dystocia management. We identified the actual-time and the self-reported perceived-time of delivery at the start and end of each workshop and measured the difference between them to determine if there was any improvement and retention of time perception through consecutive workshops. Result(s): The baseline workshop recruited 101 participants with mean age of 26.7 +/- 9.8 years (range:20-59), of which 53 participated at the 6 month and 33 at the 12 month workshop. There was a significant improvement in time perception by approximately 34.8 % at the end of the baseline workshop, which was retained after 6 and 12 months. 80.2 % of participants experienced a 'time-distortion effect' towards the same direction and felt that the simulated delivery lasted longer than the actual time recorded by the birthing simulator. Those who were more competent at the start of the baseline workshop demonstrated a better time perception. Conclusion(s): The skill of time perception in shoulder dystocia can be improved and retained through simulation training.

DOI: 10.1016/j.ejogrb.2025.114016

Link to full-text [open access - no password required]

Is Hybrid Closed Loop Continuous Subcutaneous Insulin Infusion Beneficial in Adults with Type 1 Diabetes(T1D) on Continuous Glucose Monitoring: A Reallife District General Hospital Perspective (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A275-A276), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) and continuous glucose monitoring(CGM) have made significant improvements in management of T1D.We studied benefits of Hybrid closed loop(HCL) over non-closed loop(NCL) CSII in a cohort of adults with T1D. Method(s): We analysed a live database of patients managed in a single District General Hospital (DGH) service on CSII from 2011 onwards. %Time in range (TIR), %hypoglycaemia (%hypo) and HbA1c were analysed with independent samples T-Test (SPSS software). Result(s): 302 patients were included: mean age was 44 years (range 19-81), female:male 57:43, diabetes duration 25years (range 2-61), and mean pre-CSII HbA1c 63mmol/mol. 218 were on HCL, 21 partial closed loop(PCL) and 63 were NCL. All patients were either on real-time(rt)CGM or intermittently scanned( is)CGM. HCL users were on Medtronic 780G with Guardian G4 sensor or Tandem T-Slim with Dexcom G6 sensor and NCL patients mostly on Omnipod DASH with rtCGM or isCGM. For HCL vs NCL systems, mean HbA1c (52 vs 57mmol/mol, p < 0.005), TIR (71% vs 62%, p < 0.005) were significantly improved on HCL. There was a trend to reduced %hypo (1.64% vs 2.64%,p = 0.08) but not statistically significant. Conclusion(s): This analysis demonstrates significantly better glycaemic control, in both HbA1c and TIR parameters, in HCL CSII users compared to NCL CSII in T1D. Hypoglycaemia was reduced but did not achieve statistical significance, possibly due to overall low rate of hypoglycaemia in the entire cohort. We speculate patients would have been responding to CGM alarm warnings to abort actual hypoglycaemic events.

Is Continuous Glucose Monitoring (CGM) the Critical Technological Intervention in Adults with Type 1 Diabetes(T1D) on Continuous Subcutaneous Insulin Infusion (CSII) Therapy? (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Kumar A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A230), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: We assessed impact of CGM in existing CSII patients with T1D switching to hybrid closed loop (HCL), partial closed loop (PCL) or remaining on non-closed loop (NCL) CSII. Method(s): Outcomes of patients with T1D on CSII in an adult service from 2011 were reviewed. Analysis of %Time in range (%TIR), %hypoglycaemia (%hypo) and HbA1c was done with SPSS. Result(s): 302 patients were included. 183 were on Tandem T-Slim(T-Slim), 58 Omnipod Dash(DASH), 39 Medtronic780G(780G), 11 Medtronic670G(670G), and 7 Medtronic640G(640G). 218 were on HCL, 21 PCL and 63 NCL. All were on either real-time (rt)CGM (DexcomG6, GuardianG3 or GuardianG4) or intermittently scanned (is)CGM (Freestyle Libre2). T-Slim, DASH, 780G, 670G, 640G showed mean HbA1c of 53.8, 55.6, 53.0, 62, 52.8mmol/mol; %TIR of 70, 64, 72, 61, 56%; and %hypo of 1.7, 1.8, 2.0, 1.4, 4.0% respectively. Post-hoc analysis only showed statistically significant benefits with HbA1c for T-Slim over 670G, and 780G over 670G; %TIR for 780G over 640G and %hypo for T-Slim over 640G. Mean HbA1c and %TIR were significantly better on HCL vs NCL and PCL, but not %hypo. PCL did not show benefit over NCL in HbA1c, %TIR or %hypo. Conclusion(s): We propose CGM confers the most important interventional benefit in patients already on CSII. HCL provided additional benefits in improving glycaemia, both TIR and HbA1c, but not hypo in patients on CGM. PCL does not provide additional benefits over NCL in patients on CGM. QOL indices, however, may show additional benefits both in HCL and PCL.

Does Age Influence Clinical and Patient Satisfaction Outcomes in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (CSII) And Continuous Glucose Monitoring (CGM)? (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Kumar A.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A124), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: There is a possibility of subconscious bias towards using complex technology in young adults. Patient perceptions towards treatment may be influenced by age. We explored outcomes and patient experiences in various age groups with Type 1 Diabetes(T1D). Method(s): Database of patients within a single adult pump service was analysed for HbA1c, %time in range(%TIR), %hypoglycaemia(%hypo). Additionally, for Hybrid closed-loop patients Diabetes Treatment Satisfaction Questionnaire (DTSQ), Type 1 Diabetes Distress score(T1DDS), Hypoglycaemia fear survey(HypoFS) and Insulin dosing systems, perceptions, ideas, reflections, and expectations (INSPIRE)scores were analysed in different age groups. Result(s): 302 patients were included: mean age 44 years (range 19-81), 57% females, mean diabetes duration 25years (range 2- 61), and mean pre-CSII HbA1c 63mmol/mol. 218 users had hybrid closed-loop(HCL), 21 partial closed-loop and 63 non-closed-loop CSII. All were on CGM. Only 2 patients were aged above 75years and excluded from statistical analysis. Compared to the entire cohort, 19-25-year-olds had worse mean HbA1c(53.8vs58.8%), TIR(68.7vs59%) and %hypo(1.79vs2.33%), of which only %hypo was not statistically significant. Clinical outcomes were similar in all other groups. Positive Correlation(r) with age was noted with TIR(r = 0.263,p <0.001), DTSQ(r = 0.143, p = 0.03), and negative correlation with %hypo(r = -0.127, p = 0.028), HypoFS(r = -0.309, p <0.001), T1DDS(r = -0.244,p <0.001), and INSPIRE(r = – 0.146,p = 0.038). HypoFS were worse in younger individuals with progressive improvement with increasing age. Conclusion(s): Young adults (19-25 years) had worse clinical outcomes compared to other adults on CSII. Diabetes distress, fear of hypoglycaemia was higher in younger individuals. Use of complex technology including HCL was equally embraced across all age groups, though younger patients may have greater acceptance.

Hybrid-Closed Loop Pump in Type 1 Diabetes (T1D) Improves Clinical Outcome More Than Quality of Life (QoL) Compared to Nonclosed Loop Pumps Supported By CGM (2024)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A327), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) and continuous glucose monitoring(CGM) have made significant improvements in management of T1D. We studied benefits of Hybrid closed loop(HCL) over non-closed loop(NCL) CSII in a cohort of adults with T1D. Method(s): We analysed a live database of patients managed in a single centre on CSII. Clinical parameters assessed included %Time in range(TIR), %hypoglycaemia(%hypo) and HbA1c. QOL was assessed with Diabetes Treatment Satisfaction Questionnaire( DTSQ), Hypoglycaemia Fear Survey(HFS), Type 1 Diabetes Distress score(T1DDS). Data was analysed using the SPSS software. Result(s): Data on 281 patients were included, mean age was 44 years(range 19-81), 57% females. 218 were on HCL (Medtronic 780G with Guardian G4 sensor or Tandem T-Slim with Dexcom G6 sensor) and 63 (Omnipod DASH with Dexcom G6 or Freestyle Libre 2). For HCL vs NCL systems, clinical parameters improved with mean HbA1c (52 vs 57mmol/mol, p < 0.005), TIR (71% vs 62%, p < 0.005) and %hypo (1.64% vs 2.64%, p = 0.08). QOL improvement favoured HCL, but were non-significant with mean DTSQ (36.3 vs 35.5, p = 0.21), HFS (33.6vs34.9, p = 0.71) and T1DDS (47.2 vs 49.3, p = 0.40). There was no significant difference in clinical or QOL parameters between Medtronic 780G and Tandem T-Slim HCL systems. Conclusion(s): HCL systems studied had clear benefits in terms of clinical outcome parameters compared to NCL, but this was not reflected in improved patient perceptions on QOL. All patients on NCL being on CGM may be a possible explanation, with the reassurance of CGM making the biggest impact on patients perceived QOL.

Effect of Long Disease Duration on Clinical and Patient Perceived Satisfaction Outcomes in Patients with Type 1 Diabetes (T1DM) on CSII And CGM (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A326), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Patients with longstanding T1DM tend to have more glycaemic variability. Patient perceptions towards chronic disease change over time. We examined outcomes in patients on CSII with different DM durations. Method(s): A single adult service outcome database of T1DM patients was analysed for Hba1c, %Time in range(%TIR), %hypoglycaemia(%hypo). For Hybrid closed loop(HCL) patients, Diabetes Treatment satisfaction Questionnaire(DTSQ), Type 1 Diabetes Distress score(T1DDS), Hypoglycaemia fear survey(HypoFS) and Insulin dosing systems, perceptions, ideas, reflections and expectations(INSPIRE) scores were analysed. Results were compared across different disease duration groups. Result(s): A cohort of 302 patients with T1DM were studied. 218 were on HCL, 21 partial closed loop and 63 were nonclosed loop CSII. All were on CGM. Mean diabetes duration was 25 years (range 2-61), male:female 43:57. Mean Hba1c(53.8mmol/mol), %TIR(68.7%) and %hypo(1.79%) were similar except 21-30year duration group who had better Hba1c and TIR. Correlation(r) for Hba1c(r = -0.111,p = 0.055), TIR(r = 0.206, p < 0.001) and %hypo(r = -0.106, p = 0.067) suggest better outcomes with longer duration of diabetes. HypoFS(r = -0.169,p = 0.016) and T1DDS(r = -0.192,p = 0.006) scores correlated inversely, DTSQ(r = 0.148, p = 0.035) positively and INSPIRE(r = -0.127, p = 0.069) did not correlate with diabetes duration. Conclusion(s): CSII and CGM glycaemic outcomes were similar in patients with all diabetes durations, highest in the 20- 30 years duration group. Reasons for this remains uncertain. Longer duration correlated with better outcomes on Hba1c, TIR and satisfaction scores. Hypo fear and diabetes distress was greater with shorter duration though hypo frequency was not statistically correlated to diabetes duration. These may be due to human factors, better disease acceptance and perceptions with longer duration.

Clinical and Patient Satisfaction Outcomes in People with Type 1 Diabetes from Different Social Background Treated with CSII and CGM (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A326-A327), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: There may be a bias towards use of expensive technological innovations in people from higher socioeconomic classes. We explored patient experiences and outcomes in different socioeconomic backgrounds with T1diabetes( T1DM) treated with insulin pumps. Method(s): Index of Multiple Deprivation (IMD), an official statistic based on income, education, employment, health, housing, crime and living environment was used to stratify patients into quintiles based on socioeconomic status. HbA1c, time in range(%TIR), %hypoglycaemia(%hypo), Diabetes Treatment Satisfaction Questionnaire (DTSQ), Type 1 Diabetes Distress score (T1DDS), Hypoglycaemia fear survey (HypoFS) and Insulin dosing systems, perceptions, ideas, reflections and expectations (INSPIRE) scores in different IMD quintiles were analysed. Result(s): 302 patients were included: mean age 44 years (range 19-81), male:female 43:57 diabetes duration 25years (range 2- 61). 218 were on hybrid closed-loop, 21 partial closed-loop and 63 on non-closed-loop CSII. All were on CGM. Mean HbA1c (53.7vs52.6mmol/mol, correlation r = -0.059,p = 0.3), %TIR (67.7vs70.1%,r = -0.053,p = 0.36) and %hypo (2.29vs1.58%,r = -0.117,p = 0.043) had a trend to be worse in lower socioeconomic classes but correlation was not statistically significant apart from in %hypo. Mean DTSQ and INSPIRE scores were similar between social classes but mean T1DDS (52.8vs41.8,r = -0.189,p = 0.007) and HypoFS (41.7vs29.9,r = -0.145,p = 0.038) scores were worse in lowest compared to highest social quintile. Conclusion(s): Outcomes on CSII and CGM were broadly similar across all social backgrounds. There was statistically significant correlation, albeit low, between lower socioeconomic class and hypoglycaemia. This may explain the higher greater diabetes distress and hypoglycaemia fear in lower socioeconomic classes. Diabetes treatment satisfaction including with HCL were similar.

Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft (2025)

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Type of publication:

Journal article

Author(s):

*Carmont, Michael R; *Saha, Arunansu; *Rhind, John-Henry; Nilsson, Niklas; Karlsson, Jon; Nilsson-Helander, Katarina.

Citation:

Video Journal of Sports Medicine. 1(5):26350254211021859, 2021 Sep-Oct.

Abstract:

Background: Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function.

Indications: The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap.

Technique Description: The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion.

Discussion/Conclusion: Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.

Link to full-text [open acces - no password required]

Mercury exposure, pink disease and Young's syndrome: a forgotten public health disaster (2025)

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Type of publication:

Journal article

Author(s):

Brown, Megan; Hendley, Victoria; *Ahmad, Nawaid.

Citation:

BMJ Case Reports. 18(4), 2025 Apr 26.

Abstract:

Pink disease was once a widespread phenomenon, known to physicians throughout the Western world. Its prevalence declined massively once the source, mercury, was identified in several products. In modern medicine, pink disease rarely forms a differential and is known only to few physicians, despite the long-term effects of this illness. This report details a case of a man who suffered from pink disease as a child following his mother applying teething powder containing inorganic mercury to his gums for 12 weeks, from the age of 6 months. He received no treatment at the time. Throughout his lifetime, however, the man (in his 70s) has been diagnosed as infertile, and with bronchiectasis, despite a lack of convincing history to suggest an aetiology. The cause of these pathologies remains elusive, either organically occurring or components of Young's syndrome.

Link to full-text [NHS OpenAthens account required]

Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory (2025)

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Type of publication:

Journal article

Author(s):

Rai, Tanvi; Hinton, Lisa E; Mackay, Rosa; Black, Mairead; Sanders, Julia; Slade, Pauline; *Elsmore, Amy; Dhadda, Amrit; *Parry-Smith, William; Collis, Rachel; Petrou, Stavros; Stanworth, Simon; Pallman, Philip; Townson, Julia; Fye, Haddy; Geden, Ayse Gur; Collins, Peter; Bell, Sarah.

Citation:

PLoS ONE [Electronic Resource]. 20(4):e0320754, 2025.

Abstract:

BACKGROUND: Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being implemented across 36 sites in the rest of the UK through the OBS UK stepped-wedge cluster randomised controlled trial. We conducted a qualitative evaluation of the OBS care bundle five years after its adoption to inform plans for optimising its implementation across the UK.

METHODS: We conducted ethnographic observations, informal conversations and qualitative interviews with multidisciplinary teams (MDT) in four maternity units in Wales. Data were analysed thematically and usingNormalisation Process Theory.

RESULTS: The OBS Cymru protocol was used daily and MDT members believe it improves the quality and safety of PPH management. The paper proforma supporting OBS Cymru was the 'boundary object' that kept the care bundle in view while clarifying individualised roles across the MDT during a PPH and prompting improved and continuous communication as bleeding progressed. The standardisation of processes through the care bundle was seen as enabling all staff with an overall knowledge of PPH care, while situating the prominence of their particular roles within a greater whole. Enacting the bundle in practice varied slightly across different settings, according to staffing structures (e.g., in delivery rooms versus theatre births) and caseload, and some residual tensions remained regarding expectations from different staff members and levels of support provided regarding OBS Cymru.

CONCLUSIONS: Despite some small-scale variations, OBS care bundle has become normalised as standard PPH care in Wales. Insights from this evaluation, such as the centrality of the proforma in holding the bundle together, and need for greater clarity in staff role expectations, have informed implementation plans for the OBS UK trial.

Link to full-text [open access - no password required]