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Magnetic resonance imaging of inner ear and internal auditory canal structures in the presence of a cochlear implant
Get PDFOBJECTIVE: To determine whether the internal auditory canal (IAC) can be visualized using magnetic resonance imaging (MRI) in users of a cochlear implant (CI) model that can safely undergo MRI at 3 T. PATIENTS: Four normally hearing controls and three individuals unilaterally implanted with a HiRes Ultra 3D (Advanced Bionics LLC, California, USA). INTERVENTIONS: Participants underwent 3 T MRI using sequences appropriate for the postoperative surveillance of the IAC. Images in normally hearing individuals were acquired after placing a fully functional, unpowered, CI underneath a swimming cap at each of eight candidate scalp positions, four on each side of the head. Images were compared to a control condition without a CI present. and CI users were imaged with similar sequences. MAIN OUTCOME MEASURES: In normally hearing controls, the likely impact of the artifact on detection of pathology for multiple neuroradiological locations as rated by two independent radiologists. In CI users, a qualitative assessment of the diagnostic usability of images. RESULT(S): Visibility of the ipsilateral IAC and cochlea varied among the three CI users, with images from one participant deemed largely usable, while those from the other two participants exhibited less diagnostic certainty, likely due to differences in implant locations and cranial/neuroanatomical variations. Ratings of images in normally hearing participants showed that more middle-to-anterior CI locations were associated with reduced likelihood of overlooking gross abnormalities. CONCLUSION(S): Through meticulous surgical placement, bilateral IAC visualization may be achievable for monitoring chronic health conditions such as tumor surveillance in high-risk patients, and as a safety monitoring outcome measure in clinical trials.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.https://doi.org/10.1097/mao.000000000000444
Anticoagulation and atrial fibrillation in prognostic models for type B aortic dissection.
Get PDFNo Abstracthttps://www.sciencedirect.com/science/article/pii/S127977072500137X?via%3Dihu
Barriers and facilitators to using standardised diagnostic assessments in child and adolescent mental health services : a qualitative process evaluation of the STADIA trial
No full text© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The STADIA trial aimed to assess the effectiveness of a standardised diagnostic assessment tool (Development and Wellbeing Assessment, DAWBA) in aiding clinician-made diagnosis decisions in Child and Adolescent Mental Health Services (CAMHS). This study reports the qualitative process evaluation of the STADIA trial, which aimed to identify barriers and facilitators to using the online-completed DAWBA in CAMHS. Qualitative data were collected through 109 semi-structured interviews with young people, parents/carers, healthcare professionals and service commissioners/funders in 8 CAMHS sites across England. Deductive thematic analysis was guided by the domains of the Consolidated Framework for Implementation Research. Young people and parents/carers showed high levels of engagement with the DAWBA. They perceived a validation of symptoms from the generated DAWBA report, which they actively used as 'evidence' when seeking help from other services. Clinicians involved in determining referral acceptance/rejection decisions were positive about its use and saw benefits in aiding decision-making. In contrast, however, barriers to clinicians engaging with the DAWBA report during the assessment stage arose from limited awareness and accessibility to the report, a context of high workload and pressure, and general concerns about the value of a diagnosis. The DAWBA was not widely used by clinicians in the expected way to aid diagnostic decision-making. However, it may offer children and young people much-needed engagement during long waiting times for initial assessment in CAMHS. The DAWBA may be more acceptable to clinical teams in triaging referrals to help with timely decisions about the most suitable services.Trial registration ISRCTN15748675 (29/05/2019).https://link.springer.com/article/10.1007/s00787-025-02678-w#citea
Intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion in patients with atrial fibrillation: A systematic review and meta-analysis
Get PDFBackground: Intracardiac echocardiography (ICE) is an innovative technique that has emerged as an alternative to transesophageal echocardiography (TEE) to guide the implantation of a left atrial appendage occlusion (LAAO) device in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate anticoagulants. Purpose: We aim to review the clinical efficacy and safety of ICE compared to TEE to guide the implantation of LAAO devices in patients with AF. Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and EMBASE until March 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024542537. Results: We included 19 studies involving 44,706 patients. ICE was associated with a statistically significant high procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006, 1.0104], p = 0.01), but there was no difference in procedure duration (MD: 3.07 with 95% CI [-4.67, 10.80], p = 0.44) between the two groups. However, compared to the ICE group, patients undergoing LAAO under TEE guidance required more than one device more often (RR: 1.39 with 95% CI [1.23, 1.57], p < 0.01). The TEE group also reported a reduced incidence of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI [0.50, 0.85], p < 0.01). Conclusion: Our meta-analysis concluded that ICE can be a viable alternative to TEE for guiding LAAO, particularly in patients unsuitable for general anesthesia. It can also reduce the need for GA and adverse effects and resources associated with it, require fewer devices, and demonstrate comparable safety and efficacy outcomes, though it may increase the risk of pericardial effusion. Further prospective trials are warranted.https://onlinelibrary.wiley.com/doi/10.1002/joa3.7011
The weight of existence : suicide, self-harm and health inequalities in transgender populations
No full textThis series of articles will examine the issues of suicide, self-harm and the health disparities that disproportionately affect the trans population. It will also discuss how these issues are routinely under-addressed, under-researched, and portrayed negatively within the government, media and the NHS. This article, the first in the series, will provide a background of the risk factors, statistics relating to self-harm in the trans community, and a brief history of discrimination experienced by its members.https://www.magonlinelibrary.com/doi/abs/10.12968/bjha.2025.19.7.16
Psychosocial problems caused by abdominal aortic aneurysm surveillance: A cross-sectional survey.
Get PDFObjectivePeople with abdominal aortic aneurysms (AAA) are at risk of aneurysm rupture, which is immediately life-threatening. People diagnosed with AAA that are a sub-threshold size for intervention undergo regular ultrasound surveillance in England. However, surveillance may cause psychosocial problems such as anxiety. We aimed to use an AAA-specific measure of quality of life to identify the characteristics of people in surveillance with AAA-related psychosocial problems.SettingIn the National Health Service (NHS) in England, all men are screened for AAA aged 65. They undergo annual surveillance if a small AAA is detected (3-4.4 cm) and three-monthly surveillance if a medium AAA is detected (4.5-5.4 cm). Men with larger AAAs are referred to vascular services.MethodsA postal survey of men in AAA surveillance from five regional screening centres was conducted using the e-PAQ-AAA quality of life measure which included the Psychological Consequences of Screening Questionnaire.ResultsThe response rate was 64% (734/1156). The majority of men reported no AAA-related anxiety or impact on daily living, and no screening-related psychological consequences. However, 11% (29/257) of men in three-monthly surveillance reported having AAA-related anxiety most or all of the time. Men with higher levels of anxiety and physical, emotional or social consequences of surveillance tended to be younger, from more socially deprived communities, have poorer physical health, and have relatively larger and faster-growing AAAs.ConclusionsPsychosocial problems related to AAA surveillance were not common but did affect a minority of men significantly. An intervention would be beneficial in helping men in AAA surveillance to manage such problems
Impact of young people's admissions to adult mental health wards in England : national qualitative study
Get PDF© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. 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: National policy in England recommends that young people be admitted to mental health wards that are age-appropriate. Despite this, young people continue to be admitted to adult wards. AIMS: To explore the impact of young people's admissions to adult wards, from the perspectives of young people, parents/carers and mental health professionals working in adult services. METHOD: Semi-structured interviews were conducted with 29 participants to explore experiences of receiving and delivering care in adult mental health wards. Participants were four young people (aged 16-17 years), four parents/carers and 21 mental health professionals from adult mental health services in England. Data were analysed using framework analysis. RESULTS: Young people's admissions to adult wards tend to occur out of hours, at a time of crisis and when no suitable adolescent bed is available. Admissions were conceptualised as a short-term safety measure rather than for any therapeutic input. Concerns were raised about safeguarding, limited treatment options and a lack of education provision for young people on adult wards. However, exceptionally, for older adolescents, an adult ward might be clinically or socially appropriate. Recommendations to reduce adult ward admissions included better integration of adolescent and adult services, having more flexible policies and increasing community provision. CONCLUSIONS: Our findings emphasise the importance of young people being admitted to age-appropriate in-patient facilities. Earlier intervention and increased provision of specialist care in the community could prevent young people's admissions to adult wards.https://www.cambridge.org/core/journals/bjpsych-open/article/impact-of-young-peoples-admissions-to-adult-mental-health-wards-in-england-national-qualitative-study/2A43DAAC3D7D1872F2EE301C666994B
Prospective Observational Cohort Study of the Effect of Topical Levobupivacaine on Post-Operative Outcomes for Paediatric Patients Undergoing Tonsillectomy.
No full textThe efficacy of topical anaesthetic in children undergoing tonsillectomy is controversial. It can block sensory signals along C-fibres. Observational study of pain after cold-steel tonsillectomy. Two cohorts; one with topical levobupivacaine soaked swab in the tonsil bed and a second without. FACES® scale and visual analogue score were used. Other parameters were oral intake, hospital stays and use of oral morphine. 74-enrolled patients whose parents completed feedback telephone reviews. 37-patients had topical levobupivacaine. There was no difference in pain and analgesic needs between both cohorts on the first two days. Local anaesthesia induced a significant rebound pain on the fifth day. Early use of oral morphine and female gender showed a significant correlation with rebound pain. Topical levobupivacaine showed limited control of early postoperative tonsillectomy pain with rebound pain on the fifth day. Female gender and early opioid use postoperatively increased the risk of rebound pain
Avelumab-Induced Ocular Myasthenia Gravis: A Case Report.
Get PDFAvelumab, a programmed death-ligand 1 (PD-L1) inhibitor, has shown efficacy in renal cell carcinoma (RCC) but is associated with immune-related adverse events (irAEs), including rare neurological complications such as myasthenia gravis (MG). We report a case of a 75-year-old male patient with metastatic RCC receiving avelumab and axitinib who developed bilateral ptosis and ophthalmoplegia. Notably, there were no swallowing difficulties, limb weakness, or sensory deficits. The patient was treated with pyridostigmine and a weaning course of steroids per neurology input. Avelumab was eventually stopped due to the recurrence of symptoms. This case highlights the importance of early recognition and management of immune checkpoint inhibitor-induced MG to balance oncologic benefits with potential toxicities while also underlining the value of a multidisciplinary team (MDT) approach
Post-intervention neuroimaging effects of psychosocial interventions aimed at promoting resilience in children and adolescents under psychological stress : a systematic review
Get PDF© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Childhood and adolescence are neurodevelopmentally critical periods, during which psychological adversity can increase the risk of subsequent mental health difficulties. However, the increased neuroplasticity during this window also confers potential for developing resilience, which is now seen as a dynamic process of adapting to adversity. This pre-registered systematic review (PROSPERO-CRD42024537715) summarises the post-intervention neuroimaging outcomes of non-invasive, non-pharmacological interventions aimed at promoting resilience in samples with a mean age of < 25 years exposed to any explicit psychological stress. Studies involving traumatic or focal brain lesions were excluded. MEDLINE, PsycINFO and CENTRAL databases were searched from inception to 14/7/2024. Magnetic Resonance Imaging (MRI) outcomes were the primary focus. Risk of bias was assessed against adapted Joanna Briggs Institute checklist items. A narrative synthesis was conducted due to study heterogeneity. We identified 13 eligible studies: 1 reporting structural and diffusion-weighted MRI (performed after 2 years of intervention), 1 resting-state fMRI (14 years after end of intervention) and 11 task-based fMRI metrics (ranging from immediately post-intervention to 8 years after end of intervention). Resilience interventions reduce limbic activity (thalamus, amygdala and right anterior insula) in task-based fMRI. In older adolescents, social, mindfulness, and exercise interventions strengthen Prefrontal Cortex(PFC)-limbic connectivity, decreasing limbic activity. Evidence in younger adolescents is sparse, showing mixed effects on PFC-limbic connectivity. Five studies were at high risk of bias; the most common limitation was no pre-intervention MRI scans. Overall, this study summarises promising mechanisms, as demonstrated on neuroimaging, through which resilience can be enhanced in stressed youth through psychosocial interventions.https://www.sciencedirect.com/science/article/pii/S014976342500196