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Assessing Disparities in Long Term Outcomes in Non-ST Elevation Myocardial Infarction According to Presence of Obstructive Airways Disease
No full textAcute myocardial infarction is a major cause of mortality in individuals with obstructive airway disease. The impact of inpatient care quality following non-ST elevation myocardial infarction (NSTEMI) on long-term mortality among those with chronic obstructive pulmonary disease (COPD) and asthma remains poorly understood. We analysed 499 318 adults with NSTEMI from the Myocardial Ischaemia National Audit Project registry between 2005 and 2019, linked with Hospital Episode Statistics for airway disease diagnosis and Office for National Statistics data for mortality outcomes. Inpatient care quality was measured using the opportunity-based quality-indicator (OBQI) score. Long-term outcomes were evaluated using multivariable Cox regression and Kaplan-Meier analyses. Individuals with COPD and asthma received lower quality of care (OBQI score: no airways disease: 83.5 vs COPD: 78.1, asthma: 80.8, P < .001). Percutaneous coronary intervention was less frequent in COPD patients (22%) than in those without airway disease (30%) or with asthma (31%), P < .001. COPD was associated with higher 10-year mortality (hazard ratio [HR]: 1.58, 95% CI 1.56-1.60), whereas those with asthma had lower risk (HR: 0.97, 95% CI 0.95-0.98). COPD was associated with increased adjusted cardiovascular mortality (sub-distribution HR: 1.89, 95% CI 1.84-1.95). Individuals with COPD received lower-quality inpatient care and fewer coronary interventions, which was associated with higher long-term mortality
A sense of direction
Full text linkMigratory moths use both magnetic and visual cues for navigation when travelling long distances in the dark
Strength and Vulnerability: A Qualitative Study of Mental Health and Unmitigated Communion Among Female Migrants in Southeast England
Full text linkUnmitigated communion (UC), the prioritisation of others’ needs over one’s own well-being, is a critical lens for understanding the mental health of female migrants. This qualitative study explores how UC intersects with constructions of strength and vulnerability within this population, particularly amid challenges such as adaptation, discrimination, and gendered roles. Using a feminist participatory methodology, the study was co-produced with 10 migrant women and three professionals. Semi-structured interviews were conducted with 18 female migrants from 13 countries, representing diverse languages, cultures, and lengths of stay in the UK. Data were thematically analysed using the Engaging Marginalised Communities by Building Relationships and Knowledge (EMBaRK) framework, which centres lived experience and equitable collaboration. Through this analytic process, three key themes were generated: (1) perceived strength and resilience shaped by societal pressures and internalised self-reliance; (2) gender roles and self-sacrifice, including traditional caregiving expectations and neglect of personal health; and (3) isolation and reluctance to seek support, marked by concealed mental health struggles and stigma. Participants’ narratives revealed shared tensions between resilience and vulnerability. The findings highlight the central role of unmitigated communion in shaping migrant women’s mental health and underscore the need for gender responsive, culturally informed interventions that support women to balance caregiving with self-car
Co‐Creating Publicly Available Resources to Increase Awareness of and Support for Long Covid Among Ethnic Minority Communities
No full textIntroduction: Stigma and discrimination make healthcare challenging for people living with Long Covid, especially those from ethnic minority groups. Since their experiences are under‐researched and may differ from other groups, it is crucial that healthcare guidance is informed by the lived experiences of diverse groups. Methods: Findings from underpinning research (hearing from the unheard: Impact of Long Covid in Black and minority ethnic groups in the UK: HI‐COVE – 31 interviews with ethnic minority individuals living with Long Covid) informed the development of two resources aimed at raising awareness of the challenges faced by ethnic minority groups and offer ways to best support these groups. People living with Long Covid (N = 4) provided feedback on the two resources. Feedback was guided by a topic guide. Minimal changes were made following feedback. Results: Resource 1: Four participants who took part in the underpinning research, worked with an Artist (AW) to curate artwork. The artwork created was a video called ‘Still Looking for Answers’ https://www.youtube.com/watch?v=GDt‐Ro1Cql8&t=1s. It comprises anonymised patient narratives and imagery (performed by actors) and a soundscape to convey ethnic minority lived experiences of Long Covid. Resource 2: an online learning tool called ‘Health and Social Care PROfessional‐Long Covid’: H‐Pro‐LC tool: https://clineduniverse.org/hicove/story_html5.html shares challenges people from ethnic minority groups face when accessing healthcare for Long Covid. The resource includes guidance on supporting people, particularly people from ethnic minority backgrounds, presenting to primary care with (probable) symptoms of Long Covid. Conclusions: These publicly available resources aim to raise awareness of Long Covid: they encourage viewers to emotionally connect with experiences of Long Covid as well as offer ways to support people living with the condition, particularly among people from ethnic minority groups. Patient and Public Involvement and Engagement: The underpinning research of these resources were extensively informed by both patient (N = 7) and expert advisory groups (N = 6). Co‐creation approaches (through workshops, meetings and written feedback) from people living with Long Covid, carers, stakeholders and members of the public informed the design, development, innovation and impact of resources developed. People with lived experience of Long Covid provided feedback on the resources developed in this study
Estimation of V̇O2peak and lactate threshold in recreationally active persons through new equations for a modified Åstrand’s maximal incremental treadmill test
No full textBackground The accurate and safe assessment of physiological parameters, such as the highest oxygen consumption (V̇O2peak) and the lactate threshold (LT), plays a crucial role in optimizing training intensity and monitoring long-term progress, ensuring the safety of the trainees. Sources of data Data were obtained during tests performed by 28 recreationally active young adults with varying levels and types of training. These individuals underwent a modified incremental Åstrand protocol for a treadmill test to exhaustion, during which their V̇O2peak and lactate threshold (Onset of Blood Lactate Accumulation method) were directly assessed. Areas of agreement Tests to exhaustion are considered valid methods for directly measuring V̇O2peak and determining LT. However, the direct assessment of V̇O2peak and LT requires specific equipment and raises various practical issues. Areas of controversy Indirect methods for estimating of V̇O2peak and lactate threshold are simpler to use, but these methods are often difficult to generalize or have a high margin of error from the many variables that can affect a subject’s V̇O2peak and lactate threshold. Growing points These results enable estimation of V̇O2peak and LT in apparently healthy young adults engaged in regular physical activity, regardless of their specific training backgrounds. Areas timely for developing research Future research should focus on developing more precise field-based methods for estimating V̇O2peak and lactate threshold, with lactate threshold presenting particular challenges due to the need for blood sampling equipment
Exploring the student experience of integrating blended learning to crime scene teaching using eXtended reality to complement in situ practical learning
No full textForensic Science teaching in higher education requires hands-on investigative field and laboratory skills, especially when aiming to meet accreditation standards. In situ teaching with large cohorts can prove challenging and time intensive. The implementation of virtual learning resources has seen an increase since the Covid-19 pandemic when remote learning was essential. This project aims to explore the application of complementary eXtended reality crime scenes for forensic science programmes as a means of supporting in situ investigative skills through insight into student’s experience of a blended learning approach. Research undertaken was divided into two cycles. The first collected and evaluated staff and student experiences of teaching and learning during the enforced lockdowns due to the pandemic. The second created an eXtended reality reconstruction of an in situ practical crime scene examination to support a blended learning approach. Opinions from both staff and students were sought via a focus group and survey questionnaire. Project findings evidenced the virtual crime scene was positively received, offered flexibility to accommodate a variety of learning styles and catered to individual student needs. Discussion key points centred around authentic learning and student engagement, with caution raised that online resources should not replace the crucial practical skills gained from in situ teaching. Further research into student engagement is needed to explore complexities within this topic. Whilst the survey response rate was low (n = 14; 13.5%), there was still evidence to suggest the virtual scene was enjoyable, easy to navigate and assisted with related coursework assessment. Ultimately, this research provides support for utilising virtual reconstructions in crime scene teaching when complementary to in situ teaching and further offers a model for other researchers to follow
Are the ARC-HBR criteria associated with major bleeding and ischaemic events in an all-comer AMI population? Insights from the MINAP and SWEDEHEART registries
Full text linkA significant proportion of acute myocardial infarction (AMI) patients have characteristics of high-bleeding -risk (HBR). Their influence on ischaemic and bleeding-events in AMI all-comers is not well described. AMI Patients in England and Wales (E&W), and Sweden between 2005 and 2019 were included from MINAP and SWEDEHEART national registries. Patients were categorised according to the Academic Research Consortium for HBR criteria (ARC-HBR). Primary outcomes were adjusted risk of major adverse cardiovascular events (MACE; admission with reinfarction and cardiovascular death) and major-bleeding events (death or readmission with bleeding), secondary outcomes were all-cause and cardiovascular mortality, up-to five-years, with Cox-regression models, adjusted for baseline demographics. Secondary analyses evaluated medically and invasively-managed patients. 563,251 AMI patients from E&W (39% HBR, median follow-up 1901 days) and 189,102 from Sweden (39% HBR, 2084 days) were included. Risk of MACE (E&W: adjusted Hazard ratio (aHR) 2.99, 95% CI [2.95-3.02], Sweden: 2.68[2.64-2.73]) and major- bleeding events (E&W: 2.28[2.21-2.35], Sweden: 2.71[2.58-2.85]) was higher in HBR-patients (all P<0.001). MACE was more likely in medically-managed (E&W: 3.24[3.19-3.29], Sweden: 2.31 [2.26-2.37]) and invasively-managed (E&W: 2.94[2.88-3.00], Sweden: 1.98[1.92-2.04]) HBR-patients (both P<0.001), as were major-bleeding events; medical (E&W: 2.28[2.19-2.37], Sweden: 1.35[1.25-1.45]) (both P<0.001); invasive groups (E&W: 2.25[2.15-2.35], P<0.001), Sweden: 1.41[1.29-1.54], P=0.024). In an all-comer AMI population, 1 in 3 meet HBR criteria. HBR patients had significantly higher rates of MACE and major bleeding, persisting whether managed invasively or medically. We show that the ARC-HBR criteria are associated with increased bleeding and MACE risk in all-comer AMI patients. [Abstract copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
Proxy consent to clinical research participation: how should it be justified?
Full text linkIn situations where first-hand, contemporaneous consent cannot be obtained from potential research participants—such as from those who lack competence—consent may be sought from a proxy, such as a family member. Such proxy consent must be shown to have a sound moral justification if it is to be an acceptable alternative to first-hand consent. Two standards traditionally proposed for this purpose are those of substituted judgment and best interests. We describe and discuss the limitations of these two approaches, with particular reference to ways in which the context of research differs from that of clinical practice, where proxy consent has been more widely utilized. Other approaches that expand upon or depart from these traditional justifications are then discussed, namely the authentic life, endorsed life, and substituted interests models, as well as one that grounds proxy consent in a putative obligation to participate in research. Whilst these models obviate some of the limitations of the substituted judgment and best interests approaches, they have shortcomings of their own, and do not take full account of all of the relevant values and motivations that obtain in the context of clinical research. We propose an alternative and, in our view, more fruitful approach to justifying proxy consent to research participation—based on W D Ross’s moral intuitionism—that does not rest upon a single moral principle but can accommodate a range of both deontological and consequentialist prima facie values
Variation in the Feasibility and Acceptability of Electronic Patient-Reported Outcome Measures in Patients with Inflammatory Arthritis
No full textObjectives Whilst electronic patient-reported outcome measures (ePROMs) can facilitate innovative, holistic care for patients with inflammatory arthritis (IA), their implementation could inadvertently worsen health inequalities. This mixed-methods study aimed to evaluate their feasibility and acceptability in routine care, and how this varied by factors potentially impacting digital inclusion. Methods Patients with IA were invited to complete ePROMs before/at their appointment on an NHS digital platform (“Haywood Arthritis Portal”). A cross-sectional survey and semi-structured interviews were conducted in consenting patients and healthcare professionals (HCPs). Acceptability was evaluated using the Theoretical Framework of Acceptability. Survey responses were summarised descriptively. Statistical tests assessed global acceptability responses in relation to factors associated with digital inclusivity. Interviews were analysed using the Rigorous and Accelerated Data Reduction technique. Quantitative and qualitative findings were triangulated. Results 336 patients/11 HCPs were surveyed; 12 patients/5 HCPs were interviewed. Patient surveys/interviews demonstrated high ePROMs acceptability (89% found ePROMs completely acceptable/acceptable; 89% felt they benefitted care). Acceptability was lower in those that were older (p < 0.001), lacked internet access (p = 0.009), and had low general/e-health literacy/digital skills (p < 0.001). Largest differences were in those with vs without essential digital skills (93.0% vs 42.9% rating ePROMs acceptable/completely acceptable). Patient/HCP interviews also demonstrated inclusivity concerns. All HCPs considered ePROMs acceptable. Conclusions Whilst using ePROMs is feasible and highly acceptable to patients with IA and HCPs, as acceptability is lower in patients that are older, less health literate, and with lower digital skills/access, these factors require careful consideration in ePROMs implementation to avoid worsening health inequalities
Bacteriophages in Hip and Knee Periprosthetic Joint Infections: A Promising Tool in the Era of Antibiotic Resistance
No full textBackground: Periprosthetic joint infections (PJIs) of the hip and knee are one of the most severe complications in arthroplasty, often requiring prolonged antibiotic therapy and multiple revision surgeries. The increasing prevalence of multidrug-resistant organisms and biofilm-associated PJIs has renewed interest in bacteriophage therapy as a targeted, adjunctive treatment option in refractory cases. This investigation systematically reviews and discusses the current evidence regarding the application, outcomes, and safety profile of bacteriophage therapy in the management of PJIs. Methods: This systematic review was conducted in accordance with the 2020 PRISMA statement. PubMed, Google Scholar, EMBASE, and Web of Science were accessed in August 2025. No time constraints were used for the search. All clinical studies investigating bacteriophage therapy for bacterial PJIs were considered for eligibility. Results: A total of 18 clinical studies, comprising 53 patients treated with bacteriophage therapy for PJI, were included. The mean follow-up was approximately 13.6 months. Staphylococcus aureus was the most frequent pathogen (18 cases); phage cocktails were used in 33 patients and monophage preparations in 9, all combined with suppressive antibiotic therapy. Persistent or resistant joint pain was reported in only two patients (3.8%), while signs of ongoing infection despite phage therapy were observed in four patients (7.5%). Adverse events following BT were inconsistently reported. Conclusions: Bacteriophage therapy shows promise as an adjunctive treatment for hip and knee PJIs, especially in refractory or multidrug-resistant cases. Current evidence is limited and methodologically weak, underscoring the need for well-designed clinical trials to clarify efficacy, safety, and optimal integration into existing orthopaedic infection protocols