2025

Improvement to Stoma Care (2025)

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Type of publication:

Service improvement case study

Author(s):

*Paula Hilditch, *Rebekah Tudor

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

To improve the quality of stoma care given to patients on surgical wards as measured by pre and post teaching questionnaire and audit of stoma care practice by December 2025.

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Creatine Use and Thromboembolism Risk in Athletes: A Case Report (2025)

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Type of publication:

Journal article

Author(s):

*Abdalla, Osama S; *Mudassir, Haseeb; *Green, Hazel; *Katarki, Praveenkumar.

Citation:

Cureus. 17(12):e99242, 2025 Dec.

Abstract:

Creatine monohydrate (Cr) is a widely used supplement in the sports and fitness industry, with its popularity continuing to rise. It is well known for its ability to maintain high-energy phosphate levels during intense physical activity, thereby enhancing performance. Documented benefits of creatine supplementation include enhanced muscular development, neuroprotective effects in certain neurodegenerative conditions, and potential cardiovascular advantages. Nonetheless, a growing body of reports has raised concerns regarding possible adverse vascular effects, particularly an increased risk of thrombosis. This case underscores the potential thrombotic risks associated with creatine use and highlights the need to re-evaluate its safety profile. In addition, we provide an updated review of the literature regarding this potentially serious adverse effect.

DOI: 10.7759/cureus.99242

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Chronic Infective Endocarditis Linked to Staphylococcus epidermidis Infection of a Pacemaker Lead: A Case Report (2025)

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Type of publication:

Journal article

Author(s):

*Abdalla, Osama S; *Idris, Ghada; *Ekanayake, Darshani; *Khallaf, Laila; *Adjepon, Charlotte.

Citation:

Cureus. 17(12):e99028, 2025 Dec.

Abstract:

The diagnosis and management of pacemaker-related infective endocarditis present significant challenges, with limited available data. Accurately attributing a systemic infection to pacemaker endocarditis can be difficult, particularly in identifying vegetations and obtaining positive blood cultures from patients who have undergone non-specific antibiotic therapy. Moreover, such infections may manifest long after pacemaker implantation. Herein, we present a male patient in his 70s, with a history of pacemaker placement, who was admitted with a three-month history of fever and chills, having already completed two courses of empirical antibiotics prior to admission. Upon hospital admission, he was treated for an infection of unknown origin with intravenous antibiotics. Initial laboratory evaluations indicated leucocytosis and elevated C-reactive protein levels; however, blood cultures and infectious serologies returned normal results. A CT scan of the abdomen and pelvis was deemed unremarkable, and transthoracic echocardiography (TTE) also yielded normal findings. The empirical antibiotic regimen was discontinued, leading to three sets of blood cultures being subsequently positive for coagulase-negative Staphylococcus epidermidis. A transoesophageal echocardiography (TOE) was performed, revealing vegetation on the pacemaker lead. The patient received a triple antibiotic therapy and underwent device removal; subsequent blood cultures were negative following a four-week antibiotic course. A new pacemaker was implanted, and the patient has since remained asymptomatic. This case illustrates that coagulase-negative Staphylococcus epidermidis can infect pacemaker leads even long after installation, potentially leading to an indolent course of infective endocarditis that is difficult to diagnose and manage. Consequently, clinicians should maintain a high index of suspicion for pacemaker infective endocarditis in patients presenting with prolonged fever.

DOI: 10.7759/cureus.99028

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Autonomic Nervous System Dysregulation in Metabolic Syndrome: An Association With Hypertension and Cardiovascular Risk (2025)

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Type of publication:

Systematic Review

Author(s):

Soomra, Hoor; Mukhtar, Asad; *Asif, Fatima; Khalid, Ayesha; Noureen, Sadia; Qamar, Zeeshan; Haider, Usman.

Citation:

Cureus. 17(12):e98932, 2025 Dec.

Abstract:

Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities, including abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure, that increases the risk of type 2 diabetes and cardiovascular disease (CVD). Autonomic imbalance, characterized by increased sympathetic activity and reduced parasympathetic tone, is proposed to play an important role in the development of hypertension and adverse cardiovascular outcomes in individuals with MetS. This systematic review evaluates the association between autonomic nervous system (ANS) dysregulation and MetS. A systematic search was conducted in PubMed, Embase, Scopus, and Cochrane Library for studies published from January 2015 to September 2025. Eligible studies included human research that examined measures of autonomic function such as heart rate variability (HRV), baroreflex sensitivity, muscle sympathetic nerve activity, and plasma catecholamine levels at rest in individuals with MetS. Observational and interventional studies were included. Data were extracted and synthesized narratively. A total of 16 studies met the inclusion criteria. Most included studies reported reduced HRV, impaired baroreflex sensitivity, increased resting sympathetic nerve activity, and elevated plasma catecholamines in participants with MetS, suggesting a consistent association between ANS dysregulation and blood pressure elevation. However, causality could not be established due to the predominantly observational study designs. Current evidence indicates a significant association between autonomic dysfunction and MetS, particularly in relation to hypertension and increased cardiovascular risk. ANS biomarkers may support refined cardiometabolic risk stratification, although further prospective and mechanistic studies are needed to clarify causal pathways.

DOI: 10.7759/cureus.98932

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Checkpoint Inhibitors and Beyond: A Systematic Review of Immunotherapy in Cutaneous Malignancies (2025)

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Type of publication:

Systematic Review

Author(s):

Rashid, Yasir; Devi S, Kartika; Gonzalez-Espinosa, Tomas Faustino; Jain, Juhi; Dalain, Mujahed; Baig, Rayyan; D'Amico, Giuseppe Antonio; Mowo-Wale, Adetola G; Khomchenko, Mariia; Baby, Nima; *Yateem, Dana; Duhamel, Axel; Ali, Ramsha.

Citation:

Cureus. 17(12):e98959, 2025 Dec.

Abstract:

Skin cancers represent a major health concern, and there is a need for more effective treatment approaches, among which immune checkpoint inhibitors have become a particularly important recent development. This study aimed to explore the efficacy and tolerability of immune checkpoint inhibitors, intratumoral immunotherapies, targeted agents, and their combinations in advanced cutaneous malignancies. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-conform review of PubMed (2012-2024) identified 26 studies, including randomized trials, observational cohorts, network meta-analyses, and systematic reviews, evaluating checkpoint inhibitors, anti-PD-1/PD-L1and anti-CTLA-4. Outcomes included progression-free survival (PFS), objective response rate (ORR), overall survival (OS), biomarkers, and treatment-related adverse events. This meta-analysis of 26 studies (2012-2024) evaluated treatments for cutaneous malignancies, including melanoma, basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC), covering systemic immunotherapies (PD-1, CTLA-4), combination checkpoint inhibitors, and novel approaches like IL-12 electroporation. Melanoma: PD-1 therapies showed durable benefits; ipilimumab retreatment yielded 42% two-year survival. MCC: Avelumab achieved a median OS of 12.9 months. cSCC: Nivolumab PFS 8.2 months; cemiplimab 12-month PFS >53%. Targeted therapy: BRAF/MEK inhibitors reached OS ~33 months. Emerging strategies: TIL-based and neoadjuvant immunotherapy showed high pathological and durable responses. Overall, combination therapies consistently outperformed monotherapies in survival and response. Adverse events were common, especially with combination therapy, with severe immune-related toxicities reported in 30-59% of cases, while monotherapies were generally safer. Overall, immunotherapy offers substantial, often long-lasting benefits, though careful patient selection and monitoring are essential to balance efficacy and toxicity. Combination immunotherapies and targeted regimens are more effective for advanced melanoma, although they have increased toxicity.

DOI: 10.7759/cureus.98959

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Big tooth, Big problems? (2025)

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Type of publication:

Conference abstract

Author(s):

*Shargill I.

Citation:

Journal of the World Federation of Orthodontists. Conference: 10th International Orthodontic Congress. Rio de Janeiro Brazil. 14(6) (pp 479), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background Patients that present with a macrodont can require complicated treatment. Case summary: A 14 year old patient presented with Class II division 1 incisors on class I skeletal pattern with normal FMPA complicated by a macrodont lower incisor and impacted lower second premolar teeth. Management of macrodontic teeth can be very difficult to manage as they can be unsightly and dealing with space can be difficult to manage whether this is restorative or space closure. Conclusion(s): This case report illustrates that in the patients presenting with macrodontic teeth they can be treated with orthodontics without the complications of long-term restorative implications.

DOI: 10.1016/j.ejwf.2025.07.243

Standardising Acute Coronary Syndrome Management: The Impact of Electronic Order Sets on Prescribing Compliance in a Tertiary Cardiology Centre. (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Fan L.

Citation:

Heart. Conference: BACPR Annual Conference 2025. Glasgow United Kingdom. 111(Supplement 5) (pp A9), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background Acute Coronary Syndrome (ACS) management relies on timely and accurate prescribing of evidence-based pharmacological therapies as per NICE NG185 guidelines. However, inconsistencies in prescribing practices, especially between cardiology-trained and non-cardiology clinicians, can lead to delays in optimal treatment, inconsistencies in care, and suboptimal discharge planning. Aim To evaluate whether implementing a standardised electronic prescribing order set improves compliance with NICE NG185 recommendations in ACS patients admitted to a tertiary cardiology centre. Method A retrospective review was conducted using EPMA (Electronic Prescribing and Medicines Administration) preintervention (June-October 2022, n=221) and post intervention (February-March 2023, n=76). Patients admitted with STEMI or NSTEMI were assessed within 1-3 days of admission for prescribing compliance with five core ACS medications: aspirin, beta-blockers, statins, proton pump inhibitors (Table present) (PPIs) and ACE inhibitors (ACEi). Following governance approval, a standardised electronic NICE-aligned order set was implemented on the EPMA system. Prescribing compliance pre and post intervention were compared and analysed for significance. Results Pre-intervention (NSTEMI=104, STEMI=117) revealed universal aspirin prescribing (100%), but notable omissions in other therapies: beta-blockers (70.6%), PPIs (72.9%), ACEi (71.5%) and statins (91.4%) [table 1]. Post-intervention (NSTEMI=28, STEMI=48) showed significant prescribing improvements: beta-blockers: +20.2% (p=0.0007), PPIs: +15.3% (p=0.0102), and ACEi: +10.1% (p=0.1143). Statin prescribing showed smaller changes (+3.3%) [table 1]. Conclusion Introducing standardised electronic order sets significantly improved prescribing compliance for ACS medications, particularly beta-blockers and PPIs. This intervention promoted adherence to NICE NG185 guidelines, reduced prescribing variability, streamlined medication reconciliation and improved discharge readiness. Embedding digital decision-support tools into EPMA can enhance early initiation of secondary prevention and facilitate a smoother transition to cardiovascular rehabilitation to optimise ACS care. Future directions will focus on sustainability and scalability across additional clinical settings and specialties to standardise ACS care.

DOI: 10.1136/heartjnl-2025-BACPR.15

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Multidisciplinary team stakeholder event driving development of a novel Haemolytic Disease of the Fetus and Newborn (HDFN) national database for improving clinical outcomes of pregnancy affected by alloimmunisation (2024)

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Type of publication:

Conference abstract

Author(s):

Wilkes N.; Jeffs B.; Morton S.; Rogers L.; *Shields J.; Graham S.; Young B.; Asquith B.; O'Shea M.; McBride C.; Wilkes C.; Hazell M.

Citation:

Transfusion Medicine. Conference: 41st Annual Scientific Meeting of the British Blood Transfusion Society. Glasgow United Kingdom. 34(Supplement) (pp 37-38), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Introduction: HDFN is caused by incompatibility between maternal and fetal red cells, stimulating maternal antibody formation and attacking antigen positive fetal red cells, causing haemolysis (Poole and Daniels, 2007). Severity ranges from mild symptoms of jaundice & anaemia to fatal haemolysis (RCOG, 2014). Scientific advances including anti-D prophylaxis and fetal genotyping have improved clinical care and reduced the occurrence of HDFN (BSH, 2016). Guidelines recommend regularly monitoring maternal blood samples during pregnancy to determine antibody formation and titration, identifying any potential risk to the fetus, thus informing clinical decisions and intervention (BSH, 2016). Reviewing guidelines through evidence base analysis is best for patients, ensuring appropriate management plans. NHSBT historically collected data on outcomes of pregnancies with clinically significant alloantibodies. This project aims to launch a novel data collection platform populating a national pregnancy outcomes database ensuring best practice, prevention and treatment in HDFN. Stakeholder engagement and collaboration is essential, here we present the insights gained and the next steps. Method(s): Stakeholders were surveyed prior to the event to inform current practice and guide the face-to-face event agenda. Continuous improvement tools (including Kano analysis) were employed to facilitate guided evaluation and re-design of the current questionnaire & novel digital platform needs. Stakeholders were split into groups with various professional backgrounds allowing different perspectives to be sought. Following the event attendees had access to the collaborative whiteboard tool, Miro, to further understand challenges and requirements. Results and Discussion: Stakeholder output was key to redesigning a user-friendly questionnaire and drive development of a novel digital platform to promote national uptake. Multidisciplinary team collaboration of clinical, laboratory and operational colleagues across organisations gained helpful intel enabling patient focussed outcomes. This approach enabled open discussions capturing ideas to frame service development. Utilisation of the Kano model was an insightful way of understanding user requirements. Conclusion(s): The expanding dataset will be used to inform future guidelines by questioning which pregnancies are at higher risk of HDFN. Increased information aids in providing optimal care to mothers and their babies. Usage of large datasets to benefit patient outcomes are key strategic priorities within Transfusion 2024 (Stanworth et al, 2023).

DOI: 10.1111/tme.13084

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