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Management trends and practices in ischial tuberosity avulsion fractures: a cross-sectional study among hip surgeons in the UK, surgical technique and literature review
No full textBackground: Ischial tuberosity avulsion fracture (ITAF) is a rare injury affecting predominantly adolescent athletes yet lacks standardised management protocols. This study aims to investigate the diverse management preferences among hip surgeons regarding ITAF and share our preferred surgical technique and management. Methods: In a cross-sectional study, 237 British Hip Society members were surveyed regarding various aspects of ITAF management, including preferences for operative versus non-operative approaches, surgical techniques and postoperative rehabilitation regimens. Sixty-two surgeons responded, yielding a 26% response rate. Results: Thirty-six surgeons (58.1%) favoured conservative treatment, while 26 (41.9%) preferred surgery based on the degree of displacement. Among those advocating for surgery, 16 (61.5%) deemed displacement ≥20mm as significant, with 5 (19.2%) considering ≥15mm significant and another 19.2% regarding any displacement as significant. Prone theatre positioning was overwhelmingly preferred by 96.2%, with a majority (65.4%) favouring the transverse gluteal crease approach. Postoperatively, 11.5% preferred immediate full weight bearing, while 88.5% opted for six weeks of non-weight-bearing following surgery. Among conservative management advocates, 29% allowed unrestricted weight-bearing post-injury, 11.3% preferred weight-bearing until further review and 59.7% opted for partial weight-bearing for at least six weeks. Conclusions: This study highlights the absence of a consensus on ITAF management. We present our preferred approach through a case analysis involving an ITAF patient treated at our department to enhance understanding of this rare injury and potentially improve management strategies.https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2025.000
Primary Hypercortisolism
No full textPrimary hypercortisolism, commonly known as Cushing's syndrome, is an endocrine disorder characterized by excessive cortisol production by the adrenal glands, independent of adrenocorticotropic hormone stimulation. This disorder presents with a wide range of clinical manifestations, including metabolic, cardiovascular, and psychological disturbances, making its diagnosis and management complex. This document aims to provide a detailed review of primary hypercortisolism, including its pathophysiology, clinical presentation, diagnostic approaches, and treatment modalities. Special attention is given to the molecular mechanisms underlying cortisol overproduction, differential diagnosis from other forms of Cushing's syndrome, and the challenges posed by this condition in clinical practice.https://www.sciencedirect.com/science/article/abs/pii/S0094014325000023?via%3Dihu
Reconstruction of large glenoid bone defects with graft and extended caged base plate yields positive mid-term results.
No full textBackground This retrospective study assessed postoperative functional outcomes and radiographic graft integration following reverse total shoulder arthroplasty (rTSA) and glenoid reconstruction using computed navigation. Methods A case series of 14 patients underwent rTSA with an augmented glenoid baseplate using autograft or allograft. All patients had preoperative computed tomography scanning to assess glenoid defects and repeat scans at a minimum of 12 months to assess graft integration. Outcome measures were collected, consisting of the Oxford Shoulder Score (OSS), visual analogue pain scale (VAS), and range of motion figures at a minimum 12-month follow-up. Results This study included 14 patients (13 females, 1 male) with a median age of 74 (range: 58-86) years, a median body mass index of 29 (range: 18-35), and a median American Society of Anesthesiologists physical status classification system of 2 (range: 1-3). Ten were primary replacements, and 4 were revisions. Humeral head autograft was used for 6 patients, and femoral head allograft in 8 patients. All patients demonstrated graft integration on computed tomography at a median of 15 months (range: 11-42 months). The outcome measures (OSS, VAS, and range of motion) revealed overall improvement in functional outcomes. Median OSS improved from 21 (range: 7-34) preoperatively to 45 (range: 12-49), median VAS improved from 8 (range: 5-10) to 0 (range: 0-8), median lateral abduction improved from 60 to 90°, and median forward flexion 80 to 140°. These improvements were significant. Glenoid version correction, although not significant, improved from a median of 24° retroversion to 9° retroversion. Navigation was performed in all patients except 2, one by choice in a primary rTSA and the other due to intraoperative coracoid fracture during a revision case. Conclusion This study demonstrated an effective solution for managing complex glenoid defects in rTSA with excellent radiographic and functional outcomes.https://www.sciencedirect.com/science/article/abs/pii/S104545272500093
A health digital twin framework for discrete event simulation based optimised critical care workflows
No full textDigital twins have been used in industries and is now gaining traction in healthcare, particularly in precision medicine. Discrete Event Simulation is a modelling methodology for simulating processes and workflows in healthcare. This paper presents a methodology that integrates these technologies to optimise critical care workflows based on real-time state changes, emphasising patient safety, operational efficiency, and sustainability. This study proposes a novel dual-layer architecture to monitor physical and conceptual entities in the Critical Care Unit. In the current scope, this study aims to establish a methodology using Azure cloud to track treatment workflows in real-time. The results indicated that by reviewing observation forms alone successfully tracked 72% of staff-performed tasks in real-time. This study underscores the potential of digital twins to transform precision care in critical care delivery by bridging the gap between actual and ideal clinical practices.https://www.nature.com/articles/s41746-025-01738-
Asking pre-operative patients to opt out of referral to Stop Smoking Services via Short Message Service: A controlled interrupted time series analysis.
Full text linkBackground and aims: Smoking tobacco increases the risk of intra- and post-operative complications. Abstinence before surgery reduces these risks and costs to healthcare services. This study measured smoking abstinence among elective pre-operative patients who smoked following a modified clinical pathway. Design: An observational, follow-up study of patients who received the changed pre-operative pathway, supplemented by a controlled interrupted time series analysis (ITSA) of hospital patients referred to the community Stop Smoking Service (SSS) between April 2020 and August 2024. Patients referred to the SSS by primary care clinicians acted as a negative control to assess whether any observed changes reflected general time trends rather than the intervention effect. Setting: A district general hospital in Nottinghamshire, United Kingdom, during January 2024. Participants: 476 pre-operative patients recorded as smokers in primary care electronic health records (52% female; mean age 52 years) awaiting elective procedures taking place in more than 6 weeks were included. Intervention: Patients who had completed the routine pre-operative care pathway were invited via Short Message Service message (SMS) to opt out of SSS referral. Those who did not respond within 14 days were referred. The SSS provided usual care consisting of face-to-face or virtual counselling and an offer of nicotine replacement therapy. The intervention was low-cost and used existing pre-operative services. Measurements: The primary outcome was patient-reported smoking abstinence 28 days after an agreed quit date. This is a routinely collected SSS outcome. Controlled ITSA compared weekly counts of first SSS appointments between secondary care and primary care referrals among patients who subsequently achieved abstinence, before and after the intervention was implemented. Findings: 10.5% (50/476) of patients reported 28-day abstinence. 25.4% (121/476) booked an SSS appointment and 16% (77/476) opted out of SSS referral. 63.9% (304/476) were contactable by the SSS and 54.2% (258/476) confirmed smoking. 19.4% (50/258) of patients who were contactable and confirmed smoking stopped. ITSA indicated an immediate increase in weekly hospital patients referred who reported abstinence was not due to any general time trends (5.83, 95% confidence interval = 2.50-9.16, P < 0.001), consistent with a pulsed intervention of limited duration. Conclusions: Inviting elective surgical patients to opt out of Stop Smoking Service referral via Short Message Service message appears to increase 28-day smoking abstinence.https://onlinelibrary.wiley.com/doi/10.1111/add.7020
Efficacy of Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.
Full text linkThe study was conducted to evaluate the safety and effectiveness of platelet-rich plasma (PRP) injections for knee osteoarthritis. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Database for studies published between January 2015 and June 2025. Only randomized controlled trials (RCTs) published in the English language were included, while reviews, case reports, and non-randomized studies were excluded. Six high-quality RCTs were identified, including a total of 1,162 patients with mild-to-moderate knee osteoarthritis. PRP injections were compared with hyaluronic acid, corticosteroid injections, or placebo. Pain and function were assessed using standardized tools such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score, and the Visual Analog Scale. Significant improvements with PRP were observed at 6 and 12 months. The WOMAC pain score was reduced by an average of -8.5 points, and the IKDC score increased by +6.2 points. Both results were statistically significant. Moderate variability was found between studies, but sensitivity analyses confirmed stability of the results. Subgroup analysis did not show consistent differences between leukocyte-rich PRP and leukocyte-poor PRP. Reported side effects were minor and self-limiting. Overall, PRP demonstrated significant improvements at 6 and 12 months. Pooled analysis indicated moderate pain reduction (standardized mean difference (SMD) = -0.32, 95% confidence interval (CI) = -0.48 to -0.15; I² = 46%) and functional improvement (SMD = -0.28, 95% CI = -0.44 to -0.12; I² = 52%) compared with control groups. However, long-term structural improvement was not demonstrated. Larger trials are still needed to confirm benefits, optimize preparation methods, and assess cost-effectiveness.https://www.cureus.com
Intracerebral haemorrhage during a caesarean section: a report of a rare case
No full textWe report a rare case of intracerebral haemorrhage (ICH) in a pregnant patient intraoperatively during caesarean section, without a history of hypertension antenatally or an identifiable aetiology on subsequent evaluation. This case underscores the importance of considering atypical causes of stroke in pregnancy and highlights possible predisposing factors for haemorrhagic events in patients without a history of pregnancy-induced hypertension or preeclampsia. We also discuss management of stroke in pregnancy for optimal outcome with a multidisciplinary approach.https://www.cureus.com/articles/430850-intracerebral-haemorrhage-during-a-caesarean-section-a-report-of-a-rare-case#!
Characteristics of women admitted to medium secure care : a comparison of patients admitted to specialised single-sex and mixed-sex services in an English forensic psychiatric hospital
Full text link© 2025 McCarthy, Westhead, Gibbon, Hatcher
and Clarke. This is an open-access article
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Commons Attribution License (CC BY). The
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which does not comply with these terms.BackgroundForensic mental health care has evolved from mixed-sex provision to specialised sex-specific services. It is important to understand how the characteristics of women admitted to medium secure care have changed over time and how this may impact on their outcomes after discharge.ObjectiveThe study aims to describe and compare admission and discharge characteristics of two consecutive cohorts; women admitted between 1983 and 2001 to a mixed-sex medium secure care (‘Mixed’ cohort) and women admitted between 2005 and 2013 to single-sex medium secure care (‘Specialised’ cohort).MethodsData came from a 30-year study of outcomes for first admissions to an NHS medium secure hospital (the ALACRITy study). Follow-up data were available up to a census date of June 30th 2013.Results93 women comprised the Mixed cohort (mean age 29.3 years; 81% White ethnicity; 49% personality disorder diagnosis) and 45 women comprised the Specialised cohort (mean age 32.4 years; 76% White ethnicity; 49% personality disorder diagnosis). The Specialised cohort were more likely than the Mixed cohort to be admitted from high security, or under a forensic section of the Mental Health Act. The Specialised cohort were more likely than the Mixed cohort to have previous convictions, or to have committed a ‘grave’ index offence warranting a life sentence. Over 95% of all women had received previous inpatient psychiatric care. The Specialised cohort had greater prevalence of alcohol use, self-harm and childhood adversity than the Mixed cohort. At the census, 99% of the Mixed cohort and 42% of the Specialised cohort had been discharged. Women in the Specialised cohort had a longer median length of stay than the Mixed cohort; 859 days and 229 days respectively. Over 80% of patients in the Mixed cohort were readmitted during the follow-up period.ConclusionThe study provides empirical data for two consecutive cohorts of women admitted to one medium secure hospital over the course of thirty years. Women admitted to single-sex services had more criminological and adverse trauma histories than women admitted to the earlier mixed-sex service. Further research is required to establish the long-term outcomes of women admitted to specialised single-sex medium secure care.https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.171285
Clinical effectiveness of music interventions for dementia and depression in older people (MIDDEL) : a multinational, cluster-randomised controlled trial
Full text link© 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Background: Dementia and depression are among the leading causes of global disease burden. Effective and scalable interventions are needed to address the effect of these conditions, and music interventions are a promising non-pharmacological approach. The aim of this study was to determine the effectiveness of music interventions on depressive symptoms among care home residents with dementia in Australia, Germany, the Netherlands, Norway, Türkiye, and the UK.https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(25)00102-3/fulltex
‘From band 2 to enhanced clinical practitioner apprentice’
Full text linkGav Oxby reflects on his decade-long career journey in the NHS, going from a band 2 to become an enhanced clinical practitioner apprentice.https://www.nursingtimes.net/careers/from-band-2-to-enhanced-clinical-practitioner-apprentice-23-12-2025