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Multidisciplinary high-fidelity simulation training for the management of laryngospasm following general and local anesthetic procedures
No full textIntroduction: Laryngospasm is a potentially life-threatening airway emergency characterized by sudden, involuntary contraction of the laryngeal muscles, leading to partial or complete airway obstruction. Effective management of laryngospasm hinges on prompt recognition and appropriate intervention. The increase in laryngeal procedures performed under local anesthesia in outpatient settings necessitates that all involved multidisciplinary healthcare professionals be proficient in recognizing and managing laryngospasm promptly. Methods: A simulation-based training day was designed to provide a structured, multidisciplinary approach to the recognition and management of laryngospasm through both theoretical learning and hands-on practical experience during two high-fidelity simulation scenarios, using advanced manikins and a realistic clinical environment to replicate real patient responses and team dynamics (local anesthetic and general anesthetic). Each scenario was followed by a structured debriefing session where participants received immediate feedback from faculty members. Pre- and post-course feedback forms were collected to assess changes in knowledge, confidence, and perceived competence, each considered a primary outcome representing complementary aspects of learning targeted by the training. Results: Around 19 pre- and post-questionnaires were evaluated. Roles varied from resident doctors, ENT consultants, healthcare assistants, nurses, CNS, and speech and language therapists. All participants completed both simulation scenarios, and feedback was collected after the full training day. Overall, there was a statistically significant improvement (p<0.05) in participants' confidence and perceived competence in recognizing and managing laryngospasm. Conclusions: This study suggests that a multidisciplinary high-fidelity simulation workshop can enhance confidence and perceived competence in managing laryngospasm across both local and general anesthetic scenarios. Although knowledge gains were not statistically significant, the training's greatest value lies in fostering non-technical skills such as communication, leadership, and teamwork, which underpin effective airway crisis management and patient safety. Future sessions incorporating larger cohorts, objective assessments, and anesthetist participation may further strengthen the educational and clinical impact of this multidisciplinary approach.https://www.cureus.com/articles/408938-multidisciplinary-high-fidelity-simulation-training-for-the-management-of-laryngospasm-following-general-and-local-anesthetic-procedures#!
Comparing foundation doctors' confidence and dermatologists' expectations in inpatient referrals: a multi-site survey
No full textBackground: Inpatient dermatology referrals rely on non-dermatologist doctors to recognise and communicate skin problems effectively. Limited dermatology training during medical school may leave newly qualified doctors underprepared for this responsibility. Objectives: This study aimed to evaluate foundation doctors' confidence in core dermatological skills and knowledge and to compare these with dermatologists' expectations based on observed inpatient referral quality across two UK hospital sites. Methods: A cross-sectional survey was conducted at Basildon University Hospital and Northampton General Hospital in England. Foundation year doctors (n = 87) completed questionnaires assessing confidence (on Likert scales 1-5) in describing skin lesions, identifying urgent dermatological conditions, knowing what information to include in referrals, and using common treatments. Dermatologists (n = 8) were surveyed on expected referral information, common deficiencies, and examples of inappropriate referrals. Descriptive statistics were used to compare responses. Results: Across both sites, most foundation doctors reported low confidence in describing skin lesions and identifying serious dermatoses: only 8-29% rated themselves "confident" or "extremely confident." Over 65% were not confident in using different emollients (only 2-10% felt confident). Only ~30% of foundation doctors were aware of the British Association of Dermatologists (BAD) handbook. Dermatologists consistently expected detailed clinical information in referrals but noted that many lacked these elements. Common conditions like eczema, psoriasis, scabies, and drug eruptions were cited as being referred inappropriately. Conclusions: Foundation doctors reported limited confidence in fundamental dermatological assessment and management skills, reflecting inadequate undergraduate dermatology training. Dermatologists observed corresponding deficiencies in referral quality. This mismatch may lead to suboptimal patient management and unnecessary specialist referrals. Improving dermatology education for medical students and resident doctors is recommended, alongside clearer referral guidelines and continued dermatologist feedback.https://www.cureus.com/articles/408872-comparing-foundation-doctors-confidence-and-dermatologists-expectations-in-inpatient-referrals-a-multi-site-survey#!
Navigating NHS commissioning for digital mental health : a perspective on learning through collaboration
Get PDF© 2025 Hall, Prentice, Hastings, Babbage, Hall,
Bolton, Bouttell, Gibbons, Patel, Watts, Davies,
Groom and Hollis. This is an open-access
article distributed under the terms of the
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BY). The use, distribution or reproduction in
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in this journal is cited, in accordance with
accepted academic practice. No use,
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which does not comply with these terms.Digital mental health interventions (DMHIs) offer promising solutions to address unmet mental health needs among children and young people, yet how to get DMHIs commissioned into the NHS can seem mystifying for innovators. This perspective paper draws on insights from a collaborative commissioning event focused on the Online Remote Behavioural Intervention for Tics (ORBIT) intervention, a digital behavioural therapy for young people with tic disorders, to explore the barriers and enablers to commissioning DMHIs in England. Key challenges identified include unclear commissioning pathways, limited clinical expertise, integration hurdles, and short-term funding models. Enablers included clinical advocacy, robust research evidence, and alignment with national frameworks. These insights highlight the importance of early collaboration between academics, developers, and policymakers in the product development cycle seeking to bridge the gap between innovation and implementation in digital mental health care.https://www.frontiersin.org/journals/health-services/articles/10.3389/frhs.2025.170746
The cognitive and neuroimaging for neurodegenerative disorders study (CogNID) : design and initial findings from real-world clinical practice
Get PDF© 2025 Hosseini, Shao, Lee, Dhillon, Junaid, Gran, Sellars, Sargisson, Jung and Mukaetova-Ladinska. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Introduction: Dementia presents with significant heterogeneity across age groups, particularly in early-onset cognitive decline (EOCD), which poses diagnostic and management challenges. The Cognitive and Neuroimaging for Neurodegenerative Disorders (CogNID) study aims to characterise clinical, cognitive, neuroimaging, and biomarker features across a diverse cohort of individuals with cognitive impairment, with a focus on diagnostic complexity, biomarker utility, and mortality.MethodsOut of 680 study participants within this prospective cohort enrolled from the real-world clinics within the National Health Service, who consented to take part in the study, we analysed data from 429. Individuals were recruited between December 2018 and November 2024 from the Memory Clinics, including the early-onset dementia service and associated services. Participants underwent structured cognitive assessments, neuroimaging (MRI/CT), and Cerebrospinal fluid (CSF) biomarker evaluation, where available. Diagnoses were made by multidisciplinary consensus. Group comparisons were conducted between early-onset (EOCD, <65 years) and late-onset cognitive decline (LOCD, ≥65 years).ResultsOf the 429 participants, 349 (81.4%) had EOCD and 80 (18.6%) had LOCD. The mean age was 60.05 years, with no significant difference in sex or ethnicity across groups. Depression and anxiety were common (29.6%), as were cardiovascular risk factors. Lumbar punctures were more frequently performed in EOCD (p = 0.03), with 36.4% of tested participants demonstrating biomarker profiles consistent with Alzheimer’s disease (A+T+). Functional cognitive disorder (FCD) was more common in EOCD (22.3% vs. 5.0%, p < 0.001). Subgroup analysis revealed significantly lower ACE-III scores and higher pathological CSF findings in Alzheimer’s disease versus FCD. Mortality was higher in the LOCD group (11.3% vs. 4.6%, p = 0.03).ConclusionThe CogNID study highlights the clinical and diagnostic heterogeneity of individuals with cognitive impairment, particularly in younger adults. Incorporating neuroimaging and CSF biomarkers into routine clinical pathways enhances diagnostic precision and reveals distinct phenotypic profiles between EOCD and LOCD. These findings underscore the need for harmonised diagnostic protocols, broader biomarker accessibility, and inclusive recruitment strategies in dementia research and clinical services.https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.163008
Role of vitamin D supplementation in modifying outcomes after surgery: a systematic review of randomised controlled trials
No full textBackground: There is increasing evidence to suggest vitamin D plays a role in immune and vascular function; hence, it may be of biological and clinical relevance for patients undergoing major surgery. With a greater number of randomised studies being conducted evaluating the impact of vitamin D supplementation on surgical patients, it is an opportune time to conduct further analysis of the impact of vitamin D on surgical outcomes. Methods: MEDLINE, EMBASE and the Cochrane Trials Register were interrogated up to December 2023 to identify randomised controlled trials of vitamin D supplementation in surgery. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool. A narrative synthesis was conducted for all studies. The primary outcome assessed was overall postoperative survival. Results: We screened 4883 unique studies, assessed 236 full-text articles and included 14 articles in the qualitative synthesis, comprising 1982 patients. The included studies were highly heterogeneous with respect to patient conditions, ranging from open heart surgery to cancer operations to orthopaedic conditions, and also with respect to the timing and equivalent daily dose of vitamin D supplementation (range: 0.5-7500 mcg; 20-300 000 IU). No studies reported significant differences in overall survival or postoperative mortality with vitamin D supplementation. There was also no clear evidence of benefit with respect to overall or intensive care unit length of stay. Discussion: Numerous studies have reported the benefits of vitamin D supplementation in different surgical settings without any consistency. However, this systematic review found no clear evidence of benefit, which warrants the supposition that a single biological effect of vitamin D supplementation does not exist. The observed improvement in outcomes in low vitamin D groups has not been convincingly proven beyond chance findings. Trial registration number: CRD42021232067.https://bmjopen.bmj.com/content/14/1/e073431.lon
Evidence for molecular subtyping in pancreatic ductal adenocarcinoma: a systematic review
No full textBackground: Pancreatic Ductal Adenocarcinoma (PDAC) patients exhibit varied responses to multimodal therapy. RNA gene sequencing has unravelled distinct tumour biology subtypes, forming the focus of this review exploring its impact on survival outcomes. Methods: A systematic search across PubMed, Medline, Embase, and CINAHL databases targeted studies assessing long-term overall and disease-free survival in PDAC patients with molecular subtyping. Results: Fifteen studies including 2731 patients were identified. Molecular subtyping was performed by RNA sequencing and Immunohistochemistry in 14 studies and by Mass Spectrometry in 1 study. Two main tumour subtypes were identified (classical and basal-like or squamous) with basal like associated with poorer outcomes. Further subtypes were identified in individual studies. Superior survival was seen with classical subtype in all other analyses that compared the classical and basal subtypes. High risk stromal subtypes were identified on further analysis of the stroma and were associated with a worse survival independent of the tumour subtype. Conclusion: Molecular subtyping of PDAC specimens can identify patients with high-risk tumour biology and poor survival outcomes. Routine subtyping is limited by the cost of RNA sequencing and the volume of raw data generated which has made its translation into routine clinical practice difficult.https://www.hpbonline.org/article/S1365-182X(24)00020-0/abstrac
Patients’ and staff’s experiences of Well-Track physical activity and sleep quality intervention in an Early Intervention in Psychosis (EIP) service
No full textObjective Individuals, who experience psychosis are found to have worse fitness levels, are less likely to be physically active, and experience greater sleep problems than the general population. The aim of this research was to examine the Well-Track psychical activity and sleep quality intervention which addresses these issues; it comprises using a Fitbit, motivational interviewing, goal identification and setting, exercise and sleep hygiene advice and feedback sessions with staff working in an Early Intervention in Psychosis (EIP) service. Method This qualitative study examined patients’ and staff’s experiences of Well-Track. Semi-structured interviews with thirteen patients and five staff were analysed using thematic analysis based on a structure-process-outcome framework. Results Key elements of the structure comprise supportive staff and the use of a wearable device (Fitbit). Process themes included the implementation of a multifaceted framework, setting realistic goals and a personal recovery process. Outcomes identified were knowledge (about exercise and sleep), implementation of action-orientated behaviours and improvements in well-being. Discussion Effective sleep and engagement with physical activity and exercise are important for the well-being and mental and physical health of EIP service patients and facilitating this can be achieved through Well-Track which comprises evidenced components to promote behaviour change. EIP services can implement Well-Track to meet service goals related to reducing weight gain, improving well-being, improving physical activity and enabling better self-management and healthier lifestyles.https://www.tandfonline.com/doi/abs/10.1080/18387357.2024.230211
Influence of cardiometabolic medications on abdominal aortic aneurysm growth in the UK Aneurysm Growth Study: metformin and angiotensin-converting enzyme inhibitors associated with slower aneurysm growth
No full textBackground: There is a clinical need for treatments that can slow or prevent the growth of an abdominal aortic aneurysm, not only to reduce the need for surgery, but to provide a means to treat those who cannot undergo surgery. Methods: Analysis of the UK Aneurysm Growth Study (UKAGS) prospective cohort was conducted to test for an association between cardiometabolic medications and the growth of an abdominal aortic aneurysm above 30 mm in diameter, using linear mixed-effect models. Results: A total of 3670 male participants with data available on abdominal aortic aneurysm growth, smoking status, co-morbidities, and medication history were included. The mean age at recruitment was 69.5 years, the median number of surveillance scans was 6, and the mean(s.e.) unadjusted abdominal aortic aneurysm growth rate was 1.75(0.03) mm/year. In a multivariate linear mixed-effect model, smoking (mean(s.e.) +0.305(0.07) mm/year, P = 0.00003) and antiplatelet use (mean(s.e.) +0.235(0.06) mm/year, P = 0.00018) were found to be associated with more rapid abdominal aortic aneurysm growth, whilst metformin was strongly associated with slower abdominal aortic aneurysm growth (mean(s.e.) -0.38(0.1) mm/year, P = 0.00019), as were angiotensin-converting enzyme inhibitors (mean(s.e.) -0.243(0.07) mm/year, P = 0.0004), angiotensin II receptor antagonists (mean(s.e.) -0.253(0.08) mm/year, P = 0.00255), and thiazides/related diuretics (mean(s.e.) -0.307(0.09) mm/year, P = 0.00078). Conclusion: The strong association of metformin with slower abdominal aortic aneurysm growth highlights the importance of the ongoing clinical trials assessing the effectiveness of metformin with regard to the prevention of abdominal aortic aneurysm growth and/or rupture. The association of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and diuretics with slower abdominal aortic aneurysm growth points to the possibility that optimization of cardiovascular risk management as part of abdominal aortic aneurysm surveillance may have the secondary benefit of also reducing abdominal aortic aneurysm growth rates.https://academic.oup.com/bjs/article/111/1/znad375/745956
Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: Longitudinal findings from the IDEAL programme
Get PDF© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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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 Creative Commons Public Domain Dedication waiver (http://creativecom mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.BACKGROUND: Most people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being. METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used. RESULTS: On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer's and vascular) dementia had more health conditions than those with Alzheimer's disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time. CONCLUSIONS: People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04601-
Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications
No full textThree commonly used approaches to the forearm in orthopedic surgery are Henry's, Thompson's, and the ulnar approach, each of which has the potential to cause injury to nerves around the wrist. Preserving these nerves is important to prevent complications such as neuroma formation and motor and sensory changes to the hand. We conducted a review of the literature to assess the nerves at risk and whether ‘safe zones’ exist to avoid these nerves. An independent reviewer conducted searches in Embase and MEDLINE of the literature from 2010 to 2020. A total of 68 papers were identified, with 18 articles being included in the review. Multiple nerves were identified as being at risk for each of the approaches described. In the anterior approach, the palmar cutaneous branch of the median nerve (PCBMN) is most at risk of injury. An incision immediately radial to the flexor carpi radialis (FCR) or directly over the FCR is most likely to avoid injury to both superficial branch of the radial nerve (SBRN) and PCBMN. With Thompson's approach, the safest zone for an incision is directly over or slightly radial to Lister's tubercle to avoid injury to SBRN and lateral cutaneous nerve of the forearm. For the ulnar approach, a safe zone was shown to be on the ulnar side of the wrist around the ulnar styloid (US) when the forearm was in supination or a neutral position to avoid injury to the dorsal branch of the ulna nerve (DBUN). Care must be taken around the US due to the density of nerves and the proximity of the last motor branch of the posterior interosseous nerve to the ulnar head. This review highlighted the proximity of nerves to the three most common surgical incisions used to access the forearm. In addition, anatomical variations may exist, and each of the nerves identified as being at risk has multiple branches. Both factors increase the potential of intraoperative damage if the anatomy is not properly understood. The surgeon must adhere carefully to the established approaches to the wrist and distal forearm to minimize damage to nerves and optimize surgical outcomes for the patient