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Emerging perspectives in quality of life after trabeculectomy surgery.
No full textBACKGROUND/OBJECTIVES: Trabeculectomy is the gold standard surgery in treatment of glaucoma but there is little reported on its early impact in health-related quality of life (HRQoL). Here we characterise HRQoL in the early post-operative period with two generic patient-reported outcome measures tools (PROMs), the EQ-5D and SF-6D, and compare them to visual-related and glaucoma-specific PROMs, the VF-25 and GUI. SUBJECTS/METHODS: We prospectively enrolled 168 patients with failed medical treatment undergoing trabeculectomy and assessed HRQoL at baseline and in the post-operative period using the PROMs above. Paired t-tests, ANOVA and linear regression tests were used to analyse outcomes. RESULTS: A significant drop in HRQoL was identified in the first month post-operatively with the SF-6D, the VF-25 and the GUI but not with the EQ-5D. This drop was reversed to pre-operative levels by month 3. Four dimensions of HRQoL, including physical functioning, social functioning and adaptation to physical and to emotional roles had the most impact on the generic HRQoL. Visual acuity dropped one line in the operated eye at month 1 and was the only measurable clinical factor contributing to HRQoL. CONCLUSIONS: The early post-operative period in trabeculectomy surgery is associated with a reversible loss of HRQoL, which is the result of transient worsening of vision but also physical, emotional and social restrictions caused by the busy medication regimen and drastic lifestyle changes. The SF-6D was better than the EQ-5D at picking up changes in HRQoL
Personalized Care in CKD: Moving Beyond Traditional Biomarkers.
No full textBACKGROUND: Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been central to chronic kidney disease (CKD) diagnosis and management, leading to a standardized CKD classification system. However, these biomarkers are non-specific and fail to capture the heterogeneity within CKD and the nuances of an individual's disease mechanism, limiting personalized treatment approaches. There is an increasing need for novel biomarkers that reflect the diverse pathophysiological processes underlying CKD progression, enabling more precise risk prediction and treatment strategies. SUMMARY: This review examines the limitations of current CKD biomarkers and classification systems, highlighting the need for a precision medicine approach. While traditional markers like eGFR and uACR are foundational, they inadequately capture CKD's complexity. Emerging biomarkers offer insights into specific disease processes, such as inflammation, oxidative stress, fibrosis, and tubular injury, which are crucial for personalized care. The article discusses the potential benefits of integrating these novel biomarkers into clinical practice, including more accurate risk prediction, tailored treatments, and personalized clinical trial designs, as well as the barriers to their implementation. Furthermore, advancements in multi-omics and high-throughput techniques offer opportunities to identify novel causative proteins with druggable targets, pushing CKD care towards greater precision. KEY MESSAGES: Current CKD classification systems, based on non-specific biomarkers, fail to capture CKD's heterogeneity. Incorporating biomarkers reflecting diverse pathophysiological mechanisms can enhance risk prediction, customized treatments, and personalized clinical trials. High-throughput multi-omic techniques present a promising path towards precision medicine in nephrology
Effectiveness of a community-based rehabilitation programme following hip fracture: results from the Fracture in the Elderly Multidisciplinary Rehabilitation phase III (FEMuR III) randomised controlled trial.
Get PDFOBJECTIVE: To determine whether an enhanced community rehabilitation intervention (the Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR) intervention) was more effective than usual National Health Service care, following surgical repair of hip fracture, in terms of the recovery of activities of daily living (ADLs). DESIGN: Definitive, pragmatic, multisite, parallel-group, two-armed, superiority randomised controlled trial with 1:1 allocation ratio. SETTING: Participant recruitment in 13 hospitals across England and Wales, with the FEMuR intervention delivered in the community. PARTICIPANTS: Patients aged over 60 years, with mental capacity, recovering from surgical treatment for hip fracture and living in their own home prior to fracture. INTERVENTIONS: Usual rehabilitation care (control) was compared with usual rehabilitation care plus the FEMuR intervention, which comprised a patient-held workbook and goal-setting diary to improve self-efficacy, and six additional therapy sessions delivered in-person in the community, or remotely during COVID-19 restrictions (intervention), to increase the practice of exercise and ADL. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the Nottingham Extended Activities of Daily Living (NEADL) scale at 12 months. Secondary outcomes included: Hospital Anxiety and Depression Scale, Falls Self-Efficacy-International scale, hip pain intensity, fear of falling, grip strength and Short Physical Performance Battery. Outcomes were collected by research assistants in participants' homes, whenever possible, but had to be collected remotely during COVID-19 restrictions. RESULTS: In total, 205 participants were randomised (n=104 experimental; n=101 control). Trial processes were adversely affected by the COVID-19 pandemic. There were 20 deaths, 34 withdrawals and three lost to follow-up. At 52 weeks, there was no significant difference in NEADL score between the FEMuR intervention and control groups. Joint modelling analysis testing for difference in longitudinal outcome adjusted for missing values also found no significant difference with a mean difference of 0.1 (95% CI -1.1, 1.3). There were no significant between-group differences in secondary outcomes. Sensitivity analyses, examining the impact of COVID-19 restrictions, produced similar results. A median of 4.5 extra rehabilitation sessions were delivered to the FEMuR intervention group, with a median of two sessions delivered in-person. Instrumental variable regression did not find any effect of the amount of rehabilitation on the main outcome. There were 53 unrelated serious adverse events (SAEs) including 11 deaths in the control group: 41 SAEs including nine deaths in the FEMuR intervention group. CONCLUSIONS: The FEMuR intervention was not more effective than usual rehabilitation care. The trial was severely impacted by COVID-19. Possible reasons for lack of effect included limited intervention fidelity (fewer sessions than planned and remote delivery), lack of usual levels of support from health professionals and families, and change in recovery beliefs and behaviours during the pandemic. TRIAL REGISTRATION NUMBER: ISRCTN28376407
Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit.
No full textBackground: Deceased donor kidney transplants often face delays, leading to prolonged cold ischemia time (CIT), yet data on post-allograft arrival delays are scarce. Objectives: This audit aims to identify and characterize the delays contributing to CIT prolongation after allograft arrival at the implanting center. Design: Data was collected prospectively from 14 UK centers between February and September 2022. Timelines from allograft arrival to the implanting center to implantation were recorded for adult deceased donor kidney-only transplants. Results: The median CIT for all 446 allografts [(donation after cardiac death (DCD), 48.2% and donation after brain death (DBD), 51.6%)] was 11:08 h (interquartile range (IQR): 08:15-15:12). A total of 42% of DCD and 15% of DBD allografts exceeded the national recommended duration of 12 and 18 h, respectively. CIT was prolonged in centers with dedicated transplant theaters, with a median CIT of 13:41 (IQR: 08:11-15:13) compared to a median CIT of 09:43 (IQR: 07:36-12:29) hours (p < 0.005, 95% CI: -4.40, -2.60) in centers without dedicated transplant theaters. Compared to full cross-match (FXM) results, a higher proportion of Virtual cross-match (VXM) results (75.2% vs. 89.4%, Odds Ratio (OR): 2.79, CI: 1.57-5.0, p < 0.005) were available before the allograft arrived at the implanting center. The proportion of crossmatch results available before the recipient's arrival at the implanting center was 31.7% (46.6% for VXM vs. 4.9% for FXM, OR: 16.76, CI: 7.50, 44.17, p < 0.005). However, no difference was found in CIT between the VXM (median: 11:06, IQR: 08:14-15:20) and FXM (median: 11:00, IQR: 08:34-14:56) groups (p = 0.75, CI: -0.75, 1.02). Qualitative analysis identified theater and staff unavailability as common reasons for delay. Conclusion: Internal center practices have a significant impact on CIT, necessitating intervention to optimize transplant outcomes.https://onlinelibrary.wiley.com/doi/10.1111/ctr.7022
The relationship between emotional impulsivity (Urgency), aggression, and symptom dimensions in patients with borderline personality disorder
Get PDF© The Author(s) 2025, corrected publication 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International
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mons.org/licenses/by/4.0/.BACKGROUND: A hallmark of borderline personality disorder (BPD) is a disposition to anger, irritability and aggression. High impulsivity, particularly high emotional impulsivity (urgency), has been associated with aggression in BPD patients. AIMS: This study aimed to explore, in a sample of patients with BPD, the subtleties of the relationship between borderline symptomatology, different facets of impulsivity, and an aggressive disposition. METHODS: Two hundred and twenty patients with a DSM-5 (Sect. 2) diagnosis of BPD were assessed on measures of impulsivity (UPPS model), aggression (Brief Aggression Questionnaire, BAQ-12) and borderline symptoms (Borderline Personality Questionnaire, BPQ). RESULTS: Results showed: (i) there was a close relationship between BPD symptomatology and an aggressive predisposition measured by BAQ-12; (ii) emptiness and intense anger were the BPD symptom dimensions most significantly associated with aggression (iii) both negative and positive urgency, and to a lesser extent lack of premeditation and sensation seeking, mediated the relationship between borderline symptom dimensions and aggression. DISCUSSION & CONCLUSION: Results suggest a close relationship between almost all dimensions of BPD, but especially anger, and impulsive aggression. They further suggest that urgency, particularly negative urgency, mediates this relationship. Future studies will need to parse aggression into motivationally distinct types.https://bpded.biomedcentral.com/articles/10.1186/s40479-025-00292-
Risk Factors for Wound Complications and Hernia Recurrence in Abdominal Wall Reconstruction: A Single-Institution Retrospective Study.
Get PDFINTRODUCTION: Incisional hernia (IH) remains a frequent and challenging postoperative complication, often requiring complex abdominal wall reconstruction (AWR). This study aimed to evaluate the outcomes of AWR and identify risk factors for wound complications and hernia recurrence at a district general hospital. METHODS: A retrospective cohort study was conducted at Queen's Hospital Burton, including 42 patients who underwent elective midline AWR between June 2017 and December 2023. Data on patient demographics, hernia characteristics, operative details, and postoperative outcomes were collected. Primary outcomes were hernia recurrence and wound complications. Secondary outcomes included hospital length of stay, postoperative ileus, fistula formation, and reoperation. Univariate statistical analysis was performed to identify predictors of wound complications; analysis for risk factors for recurrence was not feasible due to the low event rate. RESULTS: The mean patient age was 60.4 ± 12.5 years, with a mean BMI of 32.4 ± 5.0 kg/m². The most common repair technique was Rives-Stoppa, used in 28 (66%) patients. Hernia recurrence occurred in two (4.8%) patients, while wound complications were observed in 21 (50%) patients, predominantly seromas, which were noted in 12 (28.5%) patients. A BMI >35 kg/m² was significantly associated with wound complications (p=0.016). Other factors, including age, diabetes, smoking status, and hernia type, were not statistically significant predictors. The mean hospital stay was 5.4 ± 3.15 days, with a single postoperative mortality (2.4%). Conclusion: AWR using the Rives-Stoppa technique with retrorectus mesh placement resulted in low recurrence rates and acceptable morbidity, although postoperative wound complications occurred in half of the patients. High BMI was a significant predictor of wound complications. These findings underscore the importance of tailored surgical planning and preoperative optimization in high-risk patients undergoing complex ventral hernia repair
Factors influencing physical healthcare quality for people with intellectual disabilities : psychiatry multidisciplinary team perspective
Get PDF© The Author(s), 2025. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.BACKGROUND: There is a need for better collaborative care between services to improve healthcare provision for people with intellectual disabilities. In the UK, the learning disability psychiatry multidisciplinary team (MDT) is a specialist team responsible for providing and coordinating care for people with intellectual disabilities. AIMS: To document learning disability MDT perspectives on factors influencing healthcare quality for people with intellectual disabilities. METHOD: Healthcare professionals who were members of a learning disability MDT within a National Health Service Trust in the West Midlands were purposively sampled for interview (n = 11). Participants included psychiatrists, nurses, occupational therapists and speech and language therapists. Data were analysed thematically using Braun and Clarke's six-stage approach. RESULTS: Factors influencing the quality of healthcare provision included: the learning disability MDT working to overcome systemic barriers; the consequences of specific failures within mainstream healthcare services, such as diagnostic overshadowing; inadequate use of information collated in health passports; and inadequate capacity assessments of people with intellectual disabilities. Improvements in healthcare provision for people with intellectual disabilities require better accessibility to healthcare and better training for healthcare professionals so they can understand the health needs of people with intellectual disabilities. CONCLUSIONS: A rapid review of practices around health passports for people with intellectual disabilities should be conducted. Healthcare professionals working in mainstream healthcare services need an increased awareness of the harms of diagnostic overshadowing and inadequate capacity assessments. Conclusions are based on findings from MDTs within one health board; future work may focus on understanding perspectives from different teams.https://resolve.cambridge.org/core/journals/bjpsych-open/article/factors-influencing-physical-healthcare-quality-for-people-with-intellectual-disabilities-psychiatry-multidisciplinary-team-perspective/00622A38149ACD1CF2EFE1A00420C19
How to write an effective business case
No full textFinances in the NHS are severely stretched, so it is essential that requests for funding are for clinically valuable, evidence-based and cost-effective initiatives that aim to improve patient care. Developing a robust business case can support nurses to present a proposed initiative to fundholders in a structured way. This article describes how to write an effective business case that can help ensure fundholders will consider a proposed initiative to be viable. • Using a structured format can enable the nurse to demonstrate their proposal in a concise, business-like manner that all stakeholders can understand. • Historically, nurses have not been supported to obtain the skills needed to develop business acumen and produce robust business cases, but they can access support provided by charities that fund NHS posts. • Writing a business case may involve several reviews to ensure the content is robust and relevant to the needs of the service and/or organisation. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might help you to write a business case relevant to your practice area. • How you could use this information to support your colleagues to write an effective business case.https://journals.rcni.com/nursing-standard/how-to-series/how-to-write-an-effective-business-case-ns.2025.e12458/ab
Antecedents and outcomes of a late attention deficit hyperactivity disorder (ADHD) diagnosis in females [In Press]
No full textFemales receive an attention deficit hyperactivity disorder (ADHD) diagnosis at an older age than males. We examined the antecedents and outcomes of later (age 12+) diagnosis in females using data from a Welsh nation-wide electronic cohort of 13,593 individuals (N=2,680 (19.7%) females) with ADHD and 578,793 individuals (N=286,734 (49.5%) females) without ADHD. We compared females with later diagnoses (ages 12–25) to those with earlier, timely diagnoses (ages 5–11) and no diagnosis, in terms of childhood (ages 5–11) antecedents and adolescent/adult (ages 12–25) outcomes. We also tested for sex differences. Females with later diagnosed ADHD used more adolescent/adult healthcare services and had worse mental health, educational and socioeconomic outcomes than females diagnosed earlier. Health and educational difficulties were already evident in childhood in this group. Many outcomes were exacerbated in females compared to males. Timely childhood ADHD diagnosis is necessary to mitigate later risks, especially for females.https://www.medrxiv.org/content/10.1101/2025.07.07.25330613v
Patient ethnicity and staff use of restraints and restrictive practice in inpatient psychiatric services : a systematic review
No full textRestrictive practices such as restraints, seclusion, and forced medication are only intended to be used when the threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated with the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient’s ethnic identity was associated with staff use of restrictive practices in inpatient psychiatric services. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Four databases were searched (PsycINFO, Medline, Embase, and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Program Checklists. Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4), and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in studies having larger participant numbers, longer follow-up periods and less methodological bias. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity. Future research should explore beyond patient-level factors.https://journals.sagepub.com/doi/abs/10.1177/1524838025135589