Staff Publication

Improving patients’ understanding about pleural effusion management options (2025)

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Type of publication:

Conference abstract

Author(s):

*Maimuna Adamu, *Greenway Tammy, *Jennifer Nixon

Citation:

Future Healthcare Journal. 2025 Volume 12, Issue 2, Supplement, June 2025. Abstracts from Medicine 2025: The future of medicine. RCP annual conference.

Abstract:

Introduction and objective
Various treatment options are available for managing recurrent pleural effusions, each with its merits. These include: (1) symptomatic control with medication; (2) ambulatory repeated pleural aspiration; (3) inpatient chest drain and talc pleurodesis; and (4) home-based indwelling pleural catheters. British Thoracic Society (BTS) guidelines recommend that, in the context of malignant pleural effusion (MPE), ‘decisions on the best treatment modality should be based on patient choice’.1 There are different factors to consider in choosing a treatment option, such as symptoms, availability of resources, need for hospitalisation and risk of requiring further pleural interventions. In our Trust, this information was given to patients in an unstructured verbal context, with variation between each practitioner. The objective of our project was to provide information on the different pleural effusion management options in a standardised written format as a tool to help patients reach an informed decision about their preferred option.

Methods
This quality improvement project was conducted in two cycles using the plan–do–study–act (PDSA) methodology. The patient population included were those attending our weekly outpatient pleural list within a 3-month period, who already had a diagnosis of MPE or if the clinical details (history, examination or imaging) were highly suggestive of MPE. The first cycle involved assessing our current practice against the BTS guidelines for pleural disease. A telephone-based questionnaire was administered, assessing how much patients understood and retained about the different methods of pleural effusion management after attending the pleural list. Our intervention involved designing and producing a pleural effusion management options patient information leaflet (Fig 1). The leaflet included information about pleural effusions and each of the management options listed above, with illustrative diagrams. We received input from our Trust’s health literacy team to ensure that the information was written in a way patients could understand. The leaflet was then given to clinically appropriate patients attending the pleural list. The same questionnaire was repeated after the leaflet had been in use for 4 months, and pre and post-intervention results were compared.

Results
Fig 2 summarises the findings. At baseline (n=21), only 48% of patients felt they had enough information to choose their preferred management option if their pleural effusion recurred. None knew about the option of symptomatic management with medication. After the intervention (n=20), there was a significant improvement in understanding of the pleural effusion management options, with 95% of patients now satisfied that they had enough information to choose their preferred management option.

Conclusion
This project demonstrates the benefits of providing structured, written information to patients with recurrent pleural effusion. This intervention enhanced patient understanding and helped patients to make informed choices about their treatment options, in alignment with the BTS guidelines

DOI: 10.1016/j.fhj.2025.100412

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Exploring the Association Between Myocardial Infarction and Cognitive Decline: A Narrative Review (2025)

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Type of publication:

Journal article

Author(s):

Issimdar, Iqrah A; Mudegowdar, Rohit; *Gupta, Anchal R; Patel, Keval B; Elshoura, Anas; Bhanushali, Vidhi Mahendra; Joseph, Joshua R; Meiyalagan Varalakshmi, Aishwarrya; Sahotra, Monika; Kashif, Mazin; Binny, Vivasvat; Pathan, Nahila A; Siddiqui, Humza F.

Citation:

Cureus. 17(5):e84957, 2025 May.

Abstract:

The association between cognitive impairment (CI) and myocardial infarction (MI) has been highlighted in recent years. Several studies have reported an increased incidence of cognitive decline (CD) following MI, emphasizing the need for early identification and intervention in such patients. Previous research findings have been inconsistent due to the presence of various unaccounted factors potentially contributing to CD and disparities in the methods utilized to assess cognition such as the Mini-Mental State Examination, Mini-Cog and self-evaluation questionnaires. This emphasizes the potential for a more standardized tool of assessment to investigate the onset of CD amongst MI patients in a reliable manner. This literature review delineates the correlation between MI and CI, exploring the pathogenesis, risk factors, management and preventive strategies. Cerebral hypoperfusion, underlying atherosclerosis and neuroinflammation are crucial in the development of CD after MI. Hence, it is important to consider the 'heart-brain axis' for targeted therapy of CD in MI patients. Old age is a common risk factor for CD and MI. However, the impact of variables including gender and comorbidities is underreported, which can potentially alter the relationship between cognitive outcomes and MI. The implementation of multidisciplinary-oriented cardiac rehabilitation programs and a universal screening tool to follow up on patients with established CI post-MI has shown favorable outcomes and has reduced the risk of adverse health consequences. Optimizing medical management and regular monitoring of serum brain natriuretic peptide (BNP) and hemoglobin levels are essential in preventing CD after MI. Psychological evaluation and counselling also help attenuate CD. Additionally, preventive strategies addressing modifiable risk factors and implementing anti-inflammatory diets have proven beneficial. Ongoing research is focused on the study of novel interventions targeting the neuroinflammatory process. Recently a new member of the C-reactive protein family, pentraxin 3, has been identified as a specific vascular inflammatory biomarker produced by cells in atherosclerotic lesions that can potentially aid in recognizing CD. It is imperative to establish uniform guidelines to recognize and manage CI among patients following MI to improve quality of life among the elderly population.

DOI: 10.7759/cureus.84957

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A systematic review and network meta-analysis of interventions to preserve insulin-secreting beta cell function in people newly diagnosed with type 1 diabetes: results from randomised controlled trials of immunomodulatory therapies (2025)

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Type of publication:

Systematic Review

Author(s):

Beese, Sophie E; Price, Malcolm J; Tomlinson, Claire; Sharma, Pawana; Harris, Isobel M; Adriano, Ada; Quinn, Lauren M; Gada, Ritu; *Horgan, Thomas J; Maggs, Fiona; Burrows, Martin; Nirantharakumar, Krishnarajah; Thomas, G Neil; Andrews, Robert C; Moore, David J; Narendran, Parth.

Citation:

BMC Medicine. 23(1):351, 2025 Jul 01.

Abstract:

BACKGROUND: Type 1 diabetes is characterised by the immune-mediated destruction of pancreatic beta cells. We aimed to determine the effectiveness of immunotherapies for preserving residual beta cell function in newly diagnosed (stage 3) type 1 diabetes.

METHODS: Searches were carried out in MEDLINE, Embase, Cochrane CENTRAL and trial registries until 31st Jul 2024. RCTs of immunotherapies to preserve beta cells in newly diagnosed type 1 diabetes were included. Data were extracted using a bespoke, piloted extraction sheet. Risk of bias was assessed using Cochrane Risk of Bias Tool 1. A random effects network meta-analysis was undertaken in R. The primary outcome was C-peptide. Interventions were analysed by class.

RESULTS: Sixty trials were included (4597 patients, 32 intervention classes). Forty-one trials of 42 interventions were eligible for network meta-analysis. Eleven interventions demonstrated statistically significantly higher levels of C-peptide than placebo at 12 months, mesenchymal stem cells (autologous and Wharton's jelly-derived cells), azathioprine, interferon-alpha (5000 IU), autologous dendritic cells, anti-TNF golimumab, low-dose ATG, 3 mg 1-course anti-CD3 teplizumab, baricitinib, cyclosporin and 9/11 mg 2-course anti-CD3 teplizumab but with substantial heterogeneity present (I2 = 66%). Azathioprine ranked highest (median ranking 3rd); however, rankings demonstrated relatively wide confidence intervals and thus uncertainty in exact rank order of near adjacent therapies. Risk of bias assessment identified poor reporting, particularly in older trials, but few studies demonstrated high risk overall.

CONCLUSIONS: Eleven of 42 interventions demonstrated statistically significantly higher C-peptide levels than placebo at 12 months in the network meta-analysis. These results have identified the 11 most promising therapies trialled and help to direct future head-to-head clinical trials to support approvals for interventions to treat those newly diagnosed with type 1 diabetes. However, data for some interventions originated from small studies (mesenchymal stem cell therapies, azathioprine, autologous dendritic cells) and findings should be considered as hypothesis generating and interpreted with caution due to evidence heterogeneity.

SYSTEMATIC REVIEW REGISTRATION: The protocol for the systematic review was registered on PROSPERO, the international database of prospectively registered systematic reviews (registration: CRD42018107904).

DOI: 10.1186/s12916-025-04201-z

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Complicated Pyelonephritis Leading to Vertebral Osteomyelitis: Diagnostic and Therapeutic Considerations (2025)

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Type of publication:

Journal article

Author(s):

*Ibraheem, Mustafa; *Al-Rubaye, Rafal; *Tanswell, Ian

Citation:

Cureus. 17(5):e84838, 2025 May.

Abstract:

This case illustrates the significant progression of pyelonephritis to vertebral osteomyelitis secondary to Escherichia coli bacteraemia, highlighting the potential for hematogenous dissemination from urinary
tract infections to the spine. A female patient in her 60s initially presented with fever, nausea, and diarrhoea, subsequently diagnosed with E. coli bacteraemia from pyelonephritis. Despite initial clinical
improvement with intravenous and oral antibiotics, her condition deteriorated over three hospital admissions, progressing to L1/L2 vertebral osteomyelitis complicated by bilateral psoas and epidural
abscesses. Her functional status markedly declined from independent ambulation to requiring assistance for mobilization. This case emphasizes critical lessons regarding the complexity of determining optimal
antibiotic therapy duration, especially when complicated by abscess formation and recurrent bacteraemia. It further underscores limitations associated with early transitions from intravenous to oral antibiotics in
complicated vertebral infections, advocating heightened clinical vigilance and a multidisciplinary approach to prevent diagnostic delays and severe functional impairment.

DOI: 10.7759/cureus.84838

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Patient reported voice outcomes following multi-disciplinary approach to botulism toxin for spasmodic dysphonia (2025)

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Type of publication:

Journal article

Author(s):

Kakar, Sahil; Gupta, Keshav Kumar; *Richards, Emma; Shirley, Colin; Bradley, Paige; Sonsale, Anita.

Citation:

Acta Otorrinolaringologica Espanola. 512261, 2025 Jun 19. [epub ahead of print]

Abstract:

PURPOSE: Spasmodic dysphonia (SD) is a debilitating disorder primarily affecting voice production. Current treatment includes repeat botulinum toxin (botox) injections for symptomatic management. The aim of this study is to review the impact of botox injections on patient reported outcome measures (PROM), using a novel and unique quality of life, proforma, and side effects in patients treated at our centre.

METHODS: This retrospective case series evaluated all patients who were treated in our specialised voice clinic, at a single tertiary referral centre between May 2019 and April 2024 with botox for SD. The primary outcome measure was PROM of voice quality weekly post-injection as per a unique proforma. Variables extracted included patient demographics, treatment specifics and complications.

RESULTS: Fifty-two patients were included representing 21 (40.4%) males. Forty-two (80.8%) suffered from adductor spasmodic dysphonia with 8 (15.4%) having abductor dysphonia and 1 (1.92%) with mixed dysphonia. Patients with abductor dysphonia had a statistical improvement in voice following dose 2, (1.8-3.0, p=0.03) and dose 3 (1.4-3.2, p = <0.001). Patients with adductor dysphonia had significant improvements in voice following all doses (2.1-2.9, p=0.01), (1.9-3.0, p = <0.01) and (2.1-3.0, p = <0.01). The most common complication was a 'breathy voice', ranging from 31.4% to 51.0% but all patients reported this as transient.

CONCLUSION: Patient reported quality of voice is improved following botox injections for spasmodic dysphonia, and most patients do not suffer from long-term complications.

DOI: 10.1016/j.otoeng.2025.512261

The description, measurement with inter- and intra-observer reliability of calcaneal tunnel placement for tendon transfer in Achilles tendon reconstruction (2025)

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Type of publication:

Journal article

Author(s):

*Carmont, Michael R; Andresen, Tor Kristian; *Morgan, Fraser; Nilsson-Helander, Katarina; Husebye, Elisabeth Ellingsen.

Citation:

Journal of Experimental Orthopaedics. 12(2):e70223, 2025 Apr.

Abstract:

Purpose: A tendon transfer is a common method of treating ankle plantar flexion weakness and tendon end non-union following chronic Achilles tendon rupture and delayed representation following Achilles tendon re-rupture. Commonly, the transferred tendon is fixed into a bone tunnel on the postero-superior surface of the calcaneum close to the distal Achilles tendon insertion. To date, there is no standardised description or measurement of calcaneal tunnel position. The aim of this study is to describe the anatomic location for calcaneal tunnel placement and to determine the reliability of a method of measuring tunnel position and direction within the calcaneum.

Methods: The routine post-operative lateral ankle radiographs from 40 patients (40 ft) following Achilles tendon reconstruction using tendon transfer into the calcaneum: calcaneal tunnel zone (CTZ), calcaneal tunnel ratio (CTR) and calcaneal tunnel angle (CTA) were tested for reliability using test-retest between three observers. Additionally, CTR and CTA were compared in cases where a calcaneoplasty was performed or not.

Results: The intraclass correlation coefficient (ICC) of the CTR and CTA was found to be 0.86-0.95 (95% confidence interval [CI]: 0.75-0.98) and 0.95-0.99 (95% CI: 0.92-0.99), respectively, indicating good and excellent reliability. Patients who received a calcaneoplasty had a significantly greater CTR of 0.74 (0.1) and a lower CTA of 76.1degree (10.8) compared to those who did not have a CTR of 0.61 (0.1) and 100.9 (12.4), Diff 95% CI: 0.13 (0.08-0.18) and -25 (-32 to -17), respectively, both p < 0.001.

Conclusions: The CTR and CTA were reliable measures for the calcaneal tunnel following Achilles tendon reconstruction using tendon transfer within the limitations of the sagittal radiographic view. When a
calcaneoplasty was performed, it resulted in a significantly greater CTR. These measurements should be used to describe calcaneal tunnels rather than a description of tunnel placement to optimise predictive factors following Achilles tendon reconstruction.

Level of Evidence: Level III.

DOI: 10.1002/jeo2.70223

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Magnet ingestion in children in the United Kingdom: a national prospective observational surveillance study (2025)

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Type of publication:

Journal article

Author(s):

Neville J.J.; Lyttle M.D.; Messahel S.; Parkar S.; Mytton J.; Hall N.J.; Brooker H.; Varnam R.; Putt-Willis D.; Smith M.; Smith L.; Yusuf I.; Dean N.; Patel D.; Rahman M.; Vooght E.; Parveen R.; Shirley-Mansell L.; Cresner R.; Cromarty T.; Broomfield R.; Bayreuther J.; Bethell G.; Major C.; Barling J.; Wilson V.; Maney J.; Wilson K.; Ratnaraj D.; Divakaran D.; Hickey J.; Ranasinghe D.; Foster A.; Martin B.; Walker R.; Jones C.; Soans E.; Monk A.; Rahman A.; Tambudze K.; Hopgood D.; Downes A.; Nasreen T.; Preskey S.; Long J.; Adamson J.; Henderson R.; Andreassen H.; Chadwick H.L.; Towart G.; Abdelhafiz K.; O'Connor E.; Carlyle D.; Tubman L.; Wallace K.; Mohamed A.; Siner S.; Fissler S.; Mcleish S.; Tolhurst-Cleaver M.; Fletcher S.; Russell M.; Winrow K.; Taylor J.; Armitage A.; Geoghegan K.; Buckle R.; Wood S.; Tremarco L.; Collins V.; Egginton D.; Simpson G.; Dowsett S.; Djendow F.; Jarman H.; Edyta K.; Dotchin M.; Potter S.; Kamaraj K.; Fagelnor A.; Dadnam C.; Shafiq A.; Lewis S.; Zarifa I.; Craigie R.; Aldridge P.; Veeraragavan N.; Haslam Z.; Carney A.; Rimmer G.; Jones S.; Richardson S.; Riddick L.; McCourt E.; Azad-Karim A.; Quigley K.; Yassin S.; Merrick V.; Salter R.; Yoshida R.; Bass J.; Vincent E.; Healy C.; Jones E.; Ball E.; Azam A.; Ryan E.; Bedoya S.; Keers S.; Blaney E.; Peacock P.; Hartshorn S.; Cash V.; Snelson E.; Coles V.; Stacey A.; Zuhairy S.; Chandler L.; Pinedo J.; Bradley A.; Gate V.; *Sanlon N.; *Juttiga U.; *Marsh A.; *Okeke C.; *Ali N.; Ramlakhan S.; Subramanian T.; Haffenden V.; Obire J.; Hartin D.; Darlow N.; Beeby D.; Francis R.; Basu S.; Saxena A.; Jeropoulos R.; Hegan A.; Browning J.; Craven E.; Foster S.;

Citation:

Archives of Disease in Childhood. (no pagination), 2025. Article Number: archdischild-2024-328195. Date of Publication: 2025. [epub ahead of print]

Abstract:

Objective: Magnet ingestion in children and young people (CYP) is associated with significant harm. We aimed to describe the incidence, circumstances and outcomes of magnet ingestion in CYP in the United Kingdom (UK). Design(s): Prospective multicentre observational surveillance study. <br/>Setting(s): UK secondary and tertiary level hospitals in urban and rural settings. Patient(s): CYP <=16 years of age who ingested >=1 magnet. Intervention(s): Data were collected regarding demographics, circumstances surrounding ingestion, clinical features and management. The primary outcome was the incidence of magnet ingestion in the UK. Result(s): Between 1 May 2022 and 30 April 2023, 366 cases of magnet ingestion were recorded, of which 314 met eligibility (median age 8.7 years (IQR 5.1-12.0)). The incidence of magnet ingestion in the UK was at least 2.4/100 000 (95% CI 2.2 to 2.7) CYP per year. CYP sourced magnets from toys (38%), and magnet products were predominantly purchased by parents or caregivers (19%). Magnet-related injuries occurred in 23 (7%) cases, and surgery was undertaken in 32 (10%). Single magnet ingestions did not cause magnet-related injury. Swallowing greater numbers of magnets associated with an increased risk of injury (OR 1.1 (95% CI 1.0 to 1.2), p=0.002). CYP were asymptomatic in 75% of cases, but clinical features on presentation were associated with an increased risk of injury (OR 3.8 (95% CI 1.4 to 10.3), p=0.008). Conclusion(s): While magnet ingestion in children is uncommon, ingestion of multiple magnets can cause injuries requiring surgery. Greater public and clinician awareness of the associated risks is warranted. This study can inform public health interventions and evidence-based guidelines.

DOI: 10.1136/archdischild-2024-328195

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Iliopsoas Impingement After Total Hip Arthroplasty: A Review of Diagnosis and Management (2025)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Ravi, Balu; *Abdullah, Faliq; Al-Naseri, Ahmed; Bitar, Khaldoun.

Citation:

Cureus. 17(5):e83391, 2025 May.

Abstract:

Iliopsoas impingement is a growingly acknowledged yet frequently overlooked cause of persistent groin pain after total hip arthroplasty (THA), occurring in a small percentage of patients undergoing the
procedure. It typically results from mechanical irritation of the iliopsoas tendon by anterior acetabular component overhang, retained cement, long screws, or other prosthetic hardware. Clinically, patients
report pain that worsens with active hip flexion, stair climbing, and transitioning from sitting to standing. Diagnosis involves a combination of clinical assessment, imaging techniques such as radiographs, CT scans, or ultrasound, and confirmatory image-guided diagnostic injections. Conservative management, including physiotherapy and corticosteroid injections, may offer temporary relief but is often insufficient for long-term resolution. Surgical options, particularly iliopsoas tenotomy or acetabular component revision, are indicated in refractory cases and have demonstrated high success rates with improved functional outcomes. Early recognition and appropriate intervention are critical for optimizing
postoperative recovery and improving the quality of life in affected patients.

DOI: 10.7759/cureus.83391

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The efficacy of indocyanine green fluorescence in facilitating thoracic duct visualisation and mitigating injury in cervicothoracic surgery: a systematic review and meta-analysis (2025)

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Type of publication:

Systematic Review

Author(s):

Evans, Martin J; Bunola-Hadfield, Elena E; Sowkoor, Jeevith Shetty; Malik, Tahira Y; Master, Hussain; *Sultana, Emiko; Mohamed, Abdiqadir O; Alqaseer, Abdullah M; Ismail, Ahmed T; Mafi, Pouya; Rahman, Shafiq.

Citation:

British Journal of Oral & Maxillofacial Surgery. 63(5):349-356, 2025 Jun.

Abstract:

Chyle leak following injury to the thoracic duct (TD) is an uncommon but serious complication of cervicothoracic procedures, including neck dissection and oesophagectomy, and has significant morbidity and mortality. We aimed to investigate the efficacy of indocyanine green (ICG) fluorescence in facilitating intraoperative TD visualisation and preventing chyle leaks. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards for studies that assessed ICG for TD visualisation in cervicothoracic procedures. The primary outcome measure was TD visualisation using ICG. Secondary outcomes included rates of chyle leak detection, visualisation rate in white light, and time from injection to visualisation. Twelve studies enrolling 475 subjects met the inclusion criteria. The TD visualisation rate with ICG was 93.3% (SE 0.013, p < 0.001) compared with 54.3% (SE 0.065, p < 0.001) in white light. Detection rates for intraoperative chyle leak were higher using ICG compared with no ICG use: 74% (SE 0.047, p < 0.001) vs 17.5% (SE 0.086, p = 0.043), respectively. ICG reduced rates of postoperative chyle leak from 10.1% (untransformed proportion metric: 0.101 (0.045, 0.157), p < 0.001) to 3.9% (SE 0.021, p = 0.061). Mean time from ICG injection to TD visualisation was 83.94 minutes (p < 0.001). ICG offers an effective method of TD visualisation in cervicothoracic surgery. It can reduce rates of chyle leak and mitigate adverse sequelae from inadvertent duct injury. High-quality randomised controlled trials are required to improve the evidence base.

DOI: 10.1016/j.bjoms.2025.03.013

Risk of infection in patients with early inflammatory arthritis: results from a large UK prospective observational cohort study (2025)

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Type of publication:

Journal article

Author(s):

Adas, Maryam A; Bechman, Katie; Russell, Mark D; Allen, Victoria; Patel, Samir; Gibson, Mark; Karafotias, Ioasaf; Biddle, Kathryn; Zuckerman, Benjamin; Song, Kaiyang; Nagra, Deepak; Alveyn, Edward; Mahendrakar, Suma; Nursoy, Meryem; Atzeni, Fabiola; Gallagher, Sarah; Price, Elizabeth; *Garton, Mark; Rutherford, Andrew; Cope, Andrew P; Norton, Sam; Galloway, James B.

Citation:

Rheumatology. 2025 Jun 05. [epub ahead of print]

Abstract:

OBJECTIVE: To identify risk of serious infections-(SI) according to initial conventional synthetic disease modifying anti-rheumatic drugs-(csDMARD) and corticosteroids, in patients recruited to the National Early Inflammatory Arthritis Audit.

METHODS: An observational cohort study was used, including adults in England and Wales with new diagnoses of rheumatoid arthritis-(RA) between 2018-2023. Main outcome was SI-events, defined as infections requiring hospitalisation/or resulting in death. Secondary analyses evaluated SI-related mortality alone. Hazard ratios-(HR) were calculated using cox proportional hazards models. Primary predictor was initial treatment strategy, with confounder adjustments.

RESULTS: 17 472 patients were included, of whom 10 997 on methotrexate-based strategies; 4,540 on other csDMARDs; 13 680 received corticosteroids. There were 1307 SI-events, corresponding to incidence
rates per 100 person-years of 3.02 (95% CI: 2.86-3.19) and 311 SI-related mortality (IR 0.69, 95% CI: 0.61-0.77). Methotrexate-based strategies were associated with reduced risk of SI-events compared with other csDMARDs (adjusted HR 0.72, 95% CI: 0.63-0.82). In unadjusted models, corticosteroid was associated with higher risk of SI-events, but in adjusted models this association was no longer significant (adjusted HR 0.99, 95% CI: 0.87-1.12). Increasing age, being a current/or ex-smoker (relative to non-smoker), having a comorbidity, being seropositive, and having high DAS28 all associated with increased incidence of SI. One unit increase in baseline DAS28 increases the risk of SI-event by 10%.

CONCLUSION: Methotrexate-based regimens associated with a reduced risk of SI compared with other strategies. Patient-level and disease-related factors at diagnosis are important predictors of SI in individuals with new RA.

DOI: 10.1093/rheumatology/keaf312

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