Barnet Hospital

To assess the long-term anatomical and visual outcomes of primary scleral buckle (SB) surgery for rhegmatogenous retinal detachment (RRD) and identify predictors of surgical and functional success. All primary SB procedures performed at Manchester Royal Eye Hospital between January 2008 and December 2023 were reviewed retrospectively. Preoperative, intraoperative and postoperative data were extracted from electronic records. Primary end-points were single-surgery anatomical success (SSAS) and final best-corrected visual acuity (BCVA); univariate and multivariate regression analyses examined predictive variables and complications. 608 eyes were included. SSAS was achieved in 515 eyes (85%) and final anatomical success in 602 eyes (99%). Mean BCVA improved from 0.62±0.85 to 0.32±0.49 logarithm of the minimum angle of resolution (logMAR) (p<0.01). On multivariate analysis, age >40 years (OR 0.55, 95% CI 0.37 to 0.83; p=0.004), macula-off status (OR 0.65, 95% CI 0.44 to 0.97; p=0.034) and ocular trauma (OR 0.40, 95% CI 0.19 to 0.82; p=0.012) independently reduced SSAS. For visual outcomes, macula-off detachment (β=+0.36; p<0.001) and ocular trauma (β=+0.42; p<0.001) were independent predictors of worse postoperative BCVA. The most common complications were subretinal haemorrhage (4.6%), inadvertent deep sutures (3.9%) and postoperative ocular hypertension (7.4%). Primary SB provided high anatomical success, significant visual improvement and a favourable safety profile in this large single-centre study. Age above 40 years, macula-off status and ocular trauma predicted poorer SSAS; trauma and macula-off status were also associated with worse postoperative BCVA on multivariate logistic regression.

This study aimed to describe and compare postoperative pain patterns associated with two commonly used pre-incisional analgesic practices: intravenous paracetamol and port-site infiltration of 0.5% ropivacaine in patients undergoing laparoscopic cholecystectomy. This observational study included 68 adult patients undergoing elective laparoscopic cholecystectomy under general anesthesia between December 2019 and April 2021. Ethical approval was obtained, and informed consent was secured from all participants. According to routine anesthetic practice, patients received either pre-incisional intravenous paracetamol (Group P, n = 34 (50%)) or port-site infiltration with 0.5% ropivacaine (Group R, n = 34 (50%)). Postoperative pain was assessed using the visual analog scale (VAS) at defined postoperative time points, and the need for rescue analgesia and the incidence of postoperative nausea and vomiting (PONV) were recorded. A total of 68 patients were analyzed, with comparable baseline characteristics between the intravenous paracetamol and port-site ropivacaine groups (mean age 42.5 ± 12.2 years; females 64.7%). Postoperative pain was observed in 48 (70.6%) patients, with a similar distribution between the two groups. Mean VAS scores declined from 7.55 ± 0.75 at 0 hour to 3.15 ± 1.4 at 24 hours in both groups. Rescue analgesia within 24 hours was required in 30 (44.1%) patients, more frequently in the intravenous paracetamol group (58.8%) than the port-site ropivacaine group (29.4%). Logistic regression showed higher, but non-significant, odds of rescue analgesia with intravenous paracetamol (OR 2.25; 95% CI 0.92-5.50). Pre-incisional intravenous paracetamol combined with port-site infiltration of ropivacaine produces a predictable postoperative pain trajectory following laparoscopic cholecystectomy. Although the specific effect of port-site ropivacaine on local incision pain could not be isolated, the intervention contributes to overall pain control. No clear predictors of rescue analgesia were identified. These findings highlight the importance of incorporating site-specific analgesia into a broader multimodal pain management strategy to optimize postoperative comfort.

Background: Helicobacter pylori (H. pylori) infection is a leading cause of peptic ulcer disease (PUD), with eradication complicated by increasing antibiotic resistance.Objective: To prospectively evaluate and compare the efficacy of various first-line H. pylori eradication regimens in treatment-naïve patients diagnosed with PUD.Methodology: A prospective observational study was conducted from October 2023 to September 2024 at the Department of Gastroenterology, Azad Jammu and Kashmir Medical College and Abbas Institute of Medical Sciences, Muzaffarabad. A total of 252 endoscopically confirmed, treatment-naïve PUD patients were enrolled and assigned to one of the three regimens using a rotational system. Eradication success was evaluated at 6 weeks post-treatment via urea breath or stool antigen test. Antibiotic resistance was assessed using culture and sensitivity testing from gastric biopsies. Logistic regression was used to identify predictors of eradication success.Results: Among 252 patients, 84 (33.33%) received standard triple therapy, 83 (32.94%) received bismuth-based quadruple therapy, and 85 (33.73%) received concomitant therapy. Overall, H. pylori eradication was achieved in 208 patients (82.54%), including 61 (72.62%) in the triple therapy group, 71 (85.54%) in the quadruple group, and 76 (89.41%) in the concomitant group (p=0.01). Resistance to metronidazole (n=131; 52.78%), clarithromycin (n=92; 36.51%), and amoxicillin (n=17; 6.75%) was associated with significantly reduced eradication rates, particularly in dual- and triple-resistant strains. Multivariate analysis confirmed that concomitant therapy (aOR: 2.72, p=0.007) and bismuth-based quadruple therapy (aOR: 2.11, p=0.033) were significantly more effective than standard triple therapy.Conclusion: Concomitant and bismuth-based quadruple therapies are superior to standard triple therapy in H. pylori eradication, particularly in areas with high antibiotic resistance.

The Art of Child and Adolescent Psychiatry is an engaging and authoritative account of the essential skills required to practice child and adolescent psychiatry for all those working in children's mental health, from trainees to experienced professionals in paediatrics, psychiatry, psychology, and psychotherapy. The practical tasks of meeting the child and family, planning treatments, and working with colleagues are all covered, building on existing texts that mainly focus on diagnostic criteria, protocols, and laws. This book respects the evidence base, while also pointing out its limitations, and suggests ways in which to deal with these. Psychiatry is placed within broader frameworks including strategy, learning, management, philosophy, ethics, and interpersonal relations. With over 200 educational vignettes of the authors' vast experience in the field, the book is also highly illustrated. The Art of Child and Adolescent Psychiatry is an indispensable guide to thoughtful practice in children's mental health.

Abstract Background In early 2024, 25 research-ready nurses specialising in IBD joined the United Kingdom IBD Nurse Research Network (UK IBD NRN). This network is dedicated to collaborating on national service evaluation and research initiatives, aiming to enhance service delivery and improve patient experiences within IBD care. Each year, the network will undertake one project, with a ballot for ideas held towards the end of the project. The first initiative focuses on monitoring advanced therapies (AT-IBD) used in the UK for treating IBD. Current recommendations for monitoring advanced therapies in IBD remain ambiguous, and the efficacy of proactive therapeutic drug monitoring (TDM) is still uncertain. To address this, we sought to explore the variations in monitoring practices across IBD services in the UK, focusing on key areas such as access to medication, adherence to monitoring protocols, and the effectiveness of therapeutic drug monitoring. Methods Data collection instruments using REDCap were created and launched in November 2024. Data includes site demographics, a minimum of ten and a maximum of 25 reactively and proactively monitored cases. The case data is collected from retrospective monitoring events and anonymised. Descriptive statistics are used to report results. Results Seventeen unique users are entering data from 15 sites. The survey is open to all four nations of the UK. Responses have been received in England and Wales. Of the 17 users (15;82.4%) reported having had training to interpret blood results. IBD patient population was reported by seven out of eleven sites, with a total of 39,843 reported. Two sites shared the entire local population, and three were reported as unknown. The seven sites that reported the IBD patient population used an electronic health record. There is variance in the pre-screening undertaken (Figure 1); access to advanced therapies appears different, with some sites not having access to newer small-molecule medications (Figure 2). There is wide variation in routine and TDM frequency across all therapies. Conclusion The AT-IBD project is ongoing, with full results anticipated to provide insights into current practices for monitoring advanced therapies in the UK. The collected data may offer valuable insights regarding adherence and the effectiveness of advanced therapy monitoring, particularly concerning patient safety and outcomes. The UK IBD NRN remains committed to providing opportunities for training, collaboration, and research for IBD nurses across the UK.

Despite the proven superiority of various luteal phase support protocols (LPS) over placebo in view of improved pregnancy rates in fresh cycles of IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) cycles, there is ongoing controversy over specific LPS protocol selection, dosage, and duration. The aim of the present study was to identify the optimal LPS under six core aspects of ART success, clinical pregnancy, live birth as primary outcomes and biochemical pregnancy, miscarriage, multiple pregnancy, ovarian hyperstimulation syndrome (OHSS) events as secondary outcomes. Twelve databases, namely Embase (OVID), MEDLINE (R) (OVID), GlobalHealth (Archive), GlobalHealth, Health and Psychosocial Instruments, Maternity & Infant Care Database (MIDIRS), APA PsycTests, ClinicalTrials.gov, HMIC Health Management Information Consortium, CENTRAL, Web of Science, Scopus and two prospective registers, MedRxiv, Research Square were searched from inception to Aug.1st, 2023, (PROSPERO Registration: CRD42022358986). Only Randomised Controlled Trials (RCTs) were included. Bayesian network meta-analysis (NMA) model was employed for outcome analysis, presenting fixed effects, odds ratios (ORs) with 95% credibility intervals (CrIs). Vaginal Progesterone (VP) was considered the reference LPS given its’ clinical relevance. Seventy-six RCTs, comparing 22 interventions, and including 26,536 participants were included in the present NMA. Overall CiNeMa risk of bias was deemed moderate, and network inconsistency per outcome was deemed low (Multiple pregnancy χ2: 0.11, OHSS χ2: 0.26), moderate (Clinical Pregnancy: χ2: 7.02, Live birth χ2: 10.95, Biochemical pregnancy: χ2: 6.60, Miscarriage: χ2: 11.305). Combinatorial regimens, with subcutaneous GnRH-a (SCGnRH-a) on a vaginal progesterone base and oral oestrogen (OE) appeared to overall improve clinical pregnancy events; VP + OE + SCGnRH-a [OR 1.57 (95% CrI 1.11 to 2.22)], VP + SCGnRH-a [OR 1.28 (95% CrI 1.05 to 1.55)] as well as live pregnancy events, VP + OE + SCGnRH-a [OR 8.81 (95% CrI 2.35 to 39.1)], VP + SCGnRH-a [OR 1.76 (95% CrI 1.45 to 2.15)]. Equally, the progesterone free LPS, intramuscular human chorionic gonadotrophin, [OR 9.67 (95% CrI 2.34, 73.2)] was also found to increase live birth events, however was also associated with an increased probability of ovarian hyperstimulation, [OR 1.64 (95% CrI 0.75, 3.71)]. The combination of intramuscular and vaginal progesterone was associated with higher multiple pregnancy events, [OR 7.09 (95% CrI 2.49, 31.)]. Of all LPS protocols, VP + SC GnRH-a was found to significantly reduce miscarriage events, OR 0.54 (95% CrI 0.37 to 0.80). Subgroup analysis according to ovarian stimulation (OS) protocol revealed that the optimal LPS across both long and short OS, taking into account increase in live birth and reduction in miscarriage as well as OHSS events, was VP + SCGnRH-a, with an OR 2.89 [95% CrI 1.08, 2.96] and OR 2.84 [95% CrI 1.35, 6.26] respectively. Overall, NMA data suggest that combinatorial treatments, with the addition of SCGnRH-a on a VP base result in improved clinical pregnancy and live birth events in both GnRH-agonist and antagonist ovarian stimulation protocols.

IntroductionBiologic therapies are widely used in the management of inflammatory bowel disease. There is a paucity of data on outcomes and relapse rates after stopping vedolizumab (VDZ). This real-world study aimed to explore relapse rates after VDZ discontinuation, and the response on re-initiating VDZ in a single centre.MethodsA pharmacy database of all patients on VDZ at Barnet Hospital from January 2016 – July 2023 was reviewed. Data retrieved included baseline demographics, prior biologic use and immunomodulator medication history, duration of initial treatment with VDZ and markers of remission (clinical, biochemical and histological). Patients who had transferred their care, were lost to follow-up or died were excluded.ResultsWe identified 74 patients (female = 40, male = 34; ulcerative colitis = 58, crohn’s disease = 16; median age = 47 years; age range 21–92 years).VDZ was used as a first line biologic in 16 patients (21.6%), second line in 49 patients (66.2%), third line in 8 patients (10.8%) and on one occasion (1.4%), it was the fourth line treatment.VDZ has been discontinued in 47 patients for the following reasons: non response with escalation to different agents or surgery in 25 patients (53.2%), adverse reactions in 2 patients (4.3%), or steroid-free remission in 20 patients (42.6%).Of those 20 patients who achieved remission, 15 patients (75.0%) remained in steroid-free remission at week 52 post VDZ, including 9 patients (45.0%) who remained in steroid-free remission at week 104.Nine patients (45.0%) who were VDZ responders had to be restarted on VDZ due to relapse off treatment. Of those restarted, five patients (55.5%) remain on a standard 8-weekly schedule and four patients (44.5%) were escalated to 4-weekly dosing. The mean durability of response time prior to restarting was 48 weeks (range 27 – 68 weeks).ConclusionIn our unit, VDZ has achieved steroid-free remission in 47 patients, in keeping with clinical trial response rates. The durability of response lasted one year in 75.0% of patients and two years in 45.0% in VDZ responders off treatment. When VDZ is reintroduced for relapse, the majority of patients respond to reintroduction of VDZ. This should give clinicians and patients confidence to utilise VDZ a second time if necessary before switching drug class.