Aneurin Bevan University Health Board

Abstract Background Cauda Equina Syndrome (CES) is a neurosurgical emergency requiring urgent intervention; diagnostic delay can have severe consequences. This study audited the CES pathway across South Wales hospitals. The primary aim was to quantify the number of competent healthcare professionals (HCPs) reviewing patients prior to MRI. The secondary aim was to assess the patient journey and identify deviations from the South Wales Spinal Network pathway. Methods A retrospective review was performed using South Wales Spinal Network data. Patients >16 years presenting with suspected CES from any referral source were included. Exclusions were isolated radicular pain without bladder/bowel disturbance and metastatic spinal cord compression. Data collected included time from symptom onset to presentation, number of HCPs seen pre-MRI, and MRI timing. Results A total of 157 patients were included. A proportion presented >14 days after symptom onset. Most first attended GPs or Emergency Departments. Median time from first contact to MRI varied: ABUHB 10.15h, CTMUHB 15.5h, SBUHB 8.6h, C&VUHB 5.3h. Multiple HCPs assessed 60.9% of patients pre-MRI, potentially delaying diagnosis. Mean HCPs per trust were: ABUHB 2.0, CTMUHB 1.6, SBUHB 2.4, C&VUHB 1.3. CES was radiologically confirmed in 9.6%. Pathway compliance varied: two trusts were 0% compliant, others 3.57% and 52%, with individual step compliance ranging 0–89.3%. Conclusions Delays in CES diagnosis persist, particularly regarding MRI access. Variation in pre-imaging reviews suggests inefficiencies. Improved MRI availability, streamlined referral pathways, and consistent regional standards are required to optimise outcomes.

Abstract Introduction Osteoporosis affects approximately 3.5 million individuals in the UK, resulting in over 500,000 fragility fractures annually. An initial fracture significantly increases the risk of subsequent fractures, particularly in very high-risk patients. Current clinical guidelines advocate a ‘treat-to-target’ strategy, recommending anabolic treatment for individuals at very high risk of fracture. The objective of this study was to evaluate biochemical safety, service delivery efficiency, and imminent fracture risk among osteoporosis patients receiving anabolic agents. Methods We conducted a retrospective review of Aneurin Bevan Fracture Liaison Service (AB-FLS) between August 2023 and June 2025. Of the initial 71 patients identified, 62 patients who received Romosozumab were included in the final analysis. Three Romosozumab patients were excluded due to disengagement from follow-up or declining treatment. Patients treated with Teriparatide (n = 5) and Abaloparatide (n = 1) were excluded due to small sample sizes. Data collected included patient demographics, fracture types, T-scores at the spine and femoral neck, biochemical markers (serum calcium, alkaline phosphatase (ALP), 25-hydroxyvitamin D [Vit D]), service metrics (waiting times from initial consultation to treatment initiation), incidence of hypocalcaemia (calcium <2.20 mmol/L), ALP elevation (>25% from baseline), vitamin D deficiency (<50 nmol/L), re-fracture incidence, and mortality. Results Mean age for all women (n = 62) was 72 years (range 40–83), 58% were vertebral, 24% were wrist/arm. Mean T-score at spine and femoral neck were − 3.20 (range − 5.39 to −0.70) and − 2.65 (range − 4.40 to −0.90) respectively. Median treatment initiation time post-initial consultation was 42 days (interquartile range 35–78 days). Biochemically, hypocalcaemia occurred in only 1 patient (1.6%) at the 4-month follow-up. Significant ALP elevations (>25%) were most common at 2 months (45%, 28/62) and gradually declined over subsequent follow-ups. Pre-treatment vitamin D deficiency was present in nine patients, all of whom received supplementation. Four patients (6.5%) experienced re-fracture between 84 to 275 days (mean 167 days). No mortality was recorded post initiation of anabolic. Conclusion Romosozumab treatment demonstrated good biochemical safety profiles and a low incidence of hypocalcaemia. We observed delays of nearly 6 weeks in treatment initiation for very high-risk patients. Given the observed imminent fracture risk of 6.5% whilst on treatment, efforts to reduce treatment delays by introducing stronger partnerships working with a dedicated FLS Pharmacists could be tested.

Coroners' Prevention of Future Death reports (PFDRs, also known as Regulation 28 reports) provide an opportunity to understand factors contributing to mental health-related deaths. To examine available mental health-related PFDRs, addressing three core questions: (a) What is the overall profile of these reports? (b) What relational patterns emerge from these reports? and (c) What concerns and preventive actions do coroners highlight in these reports, and how they evolved over time? We collected all mental-health related public PFDRs available up to June 2025 (N = 586). Data extraction combined automated web scraping, optical character reading and large language model (LLM)-assisted (GPT-4o) parsing to capture demographics, settings, coroner areas, co-occurring categories, concerns and recommended actions. Descriptive statistics, category and recipient co-occurrence network analysis and thematic analysis were used to provide a comprehensive landscape of these reports. Report numbers increased steadily from 2013, peaking in 2021 and then declined. Some jurisdictions, including Manchester South, East Sussex and East London, consistently had more PFDRs issued. The deceased were typically young, male and had died mainly outwith hospital, most often at home; 78.0% of reports included at least one formal response from recipients, whereas 22.0% had no corresponding response available. The network analyses suggested that PFDRs seldom identified isolated issues. Coroners' concerns changed over time, from service access and resources to inter-agency coordination and then, more recently, to risk assessment and management. Mental health-related deaths examined by coroners arise within complex, evolving multi-sector contexts and do not frequently identify single errors. Minimising such deaths may require coordinated strategies across healthcare, social care and justice systems. Analysis of PFDRs allows identification of patterns that may inform such actions. PFDRs should be analysed routinely and patterns followed over time.

We present the case of a 54-year-old woman with a clinically suspected malignant melanoma. Histology, however, revealed the unexpected diagnosis of large cell acanthoma. This is a benign epidermal neoplasm that is poorly understood and underreported in the literature. The clinical and dermoscopic appearance in our patient differs from previously reported cases. We draw attention to this heterogeneous lesion and encourage further investigation into its classification and distinguishing features, which may ultimately inform optimal management for patients.

The face-to-face traditional fracture clinic (TFC) model for managing acute musculoskeletal trauma in the UK has faced increasing criticism for being inefficient, costly, and often failing to meet timely specialist review standards. In response, the virtual fracture clinic (VFC) model was introduced, replacing automatic physical appointments with a consultant-led virtual review of clinical notes and radiographs to appropriately triage patients. This narrative review examines the current evidence on the safety, efficacy, and cost-effectiveness of this virtual approach. Evidence strongly supports the VFC model's safety, with systematic reviews covering over 63,000 patients reporting low re-attendance rates (under 5%) and minimal missed diagnoses, comparable to or better than TFCs. The VFC structure enhances clinical governance, routinely achieving compliance rates above 83% for the national standard of specialist review within 72 hours, a significant improvement over the performance of many traditional clinics. Furthermore, the economic case is robust, with VFCs consistently demonstrating substantial cost savings for healthcare systems by reducing unnecessary appointments and optimizing consultant time. Patient satisfaction is generally high, primarily due to convenience, though ensuring high-quality, structured communication and robust safety-netting is essential to mitigate concerns related to the lack of physical examination. Overall, VFCs provide a safe, efficient, and cost-effective method for managing selected injuries, serving as a critical complementary tool that reserves physical clinic capacity for patients with complex needs.

Introduction: Acute hand infections are a frequent cause of emergency surgical admission and can lead to significant morbidity. C‑reactive protein (CRP) and white blood cell (WBC) count are commonly used biomarkers, yet their comparative value for monitoring treatment response remains unclear.Methods: We conducted a retrospective cohort study of 69 consecutive patients with culture‑positive acute hand infections admitted between January and May 2024 at a single tertiary centre. Demographics, comorbidities, infection type, microbiology, management strategy, and outcomes were collected. CRP and WBC were recorded at admission and serially throughout treatment. Trends were analysed in relation to infection type and clinical response.Results: The cohort was predominantly male, with 51 patients (73.9%), and diabetes mellitus was the most common comorbidity, being present in 22 patients (31.9%). Staphylococcus aureus was the leading pathogen. Elevated CRP (>10 mg/L) was present in 62 patients (89.86%) on admission, while leukocytosis was observed in 16 patients (23.2%). Mean CRP declined significantly from 72.4 mg/L at admission to 18.6 mg/L by discharge (p<0.001), whereas WBC changes were not statistically significant (p=0.184). Deep infections demonstrated significantly higher admission CRP levels than superficial infections (112.3 mg/L vs. 38.7 mg/L; p=0.002).Conclusions: Serial CRP measurement is a more sensitive marker of treatment response in acute hand infections than WBC. Higher admission CRP correlates with deeper infections and longer hospital stay. Incorporating serial CRP monitoring into routine care may support antibiotic stewardship, discharge planning, and resource utilisation.

Microfluidic encapsulation enables the isolation of particles or cells within picolitre-sized droplets, forming the foundation for a wide range of applications in biology, medicine, and materials science. From droplet-based single-cell ribonucleic acid (RNA) sequencing to long-term three-dimensional cell culture in microgels, the ability to efficiently encapsulate one or more objects per droplet is essential for throughput and downstream analysis. However, random encapsulation governed by Poisson statistics results in high fractions of empty droplets and undesired multiple occupancy, limiting the efficiency of current workflows between 20% and 36%, depending on the initial loading. Viscoelastic encapsulation provides a passive and scalable alternative to active sorting or inertial ordering approaches. By exploiting elastic and shear-thinning effects, objects self-organize into equally spaced trains along the channel centerline, enabling frequency-matched droplet formation. Despite its promise, only two studies have explored this phenomenon, with limitations including large droplet sizes, filament formation, and confinement constraints that restrict applicability to small biological objects. In this work, we introduce improved microfluidic platforms for viscoelastic-controlled encapsulation and co-encapsulation, demonstrating single-encapsulation efficiency up to 74% and co-encapsulation efficiency up to 46%. We design new device geometries, develop optimized hyaluronic acid formulations, and demonstrate high-efficiency encapsulation of both rigid particles and live Tetraselmis suecica algae. Our platform achieves encapsulation efficiencies well above Poisson statistics, reduced multi-occupancy, and droplet generation frequencies up to 2 kHz. These results establish viscoelastic encapsulation as a practical solution for high-throughput single-cell workflows, offering a robust path forward for droplet-based diagnostics and analytical platforms.

<h3>Background</h3> Ambulatory clinics are essential in effectively managing chronic conditions like heart failure. They bridge the gap between hospital care and home management, ensuring patients receive continuous support and care. <h3>Aim</h3> Setting up a new ambulatory heart failure clinic aiming to provide specialised care for patients in out-patient setting and avoid heart failure in-patient admission hence reducing overall hospital admission under cardiology. <h3>Methods - Logic Model</h3> <h3>Inputs (Resources Required)</h3> A structured approach was implemented through process mapping, SOPs, and clinical protocols. Inclusion/exclusion criteria guided patient selection, and a multidisciplinary team was recruited. Essential equipment and medication inventory were secured. Operational planning supported scheduling, documentation, and feedback collection. <h3>Activities (Implementation Steps)</h3> Activities included workflow development, patient enrolment, staff training, infrastructure setup, equipment testing, and launching twice-weekly sessions. <h3>Outputs &amp; Outcomes</h3> Immediate outcomes were an operational clinic, trained staff, patient engagement, and efficient resource use. The unit improved access to care, enhanced patient confidence, and reduced admissions. Long-term, the model offers scalable, cost-effective heart failure management and strengthened multidisciplinary collaboration across healthcare settings. <h3>Results</h3> The ambulatory heart failure unit managed patients with fluid overload needing IV diuretics and iron, while supporting urgent investigations to optimize therapy and reduce delays. It now includes patients undergoing antiarrhythmic and anticoagulation therapy before cardioversion. Only three patients required hospital admission during their care (figure 1). <h3>Conclusion</h3> The ambulatory unit reduced admissions and boosted patient confidence through timely, expert care. It improved efficiency by minimizing delays. Future plans include more sessions, advanced therapies, telehealth, remote monitoring, and stronger collaboration to support sustainable, comprehensive care.