Glangwili General Hospital

Introduction:Fast-setting high viscosity cement was introduced in the last decade, offering arthroplasty surgeons the benefit of shortened setting time. This could reduce the operating time, which may reduce the risk of infection and improve theatre efficiency. PALACOS® Fast R+G high viscosity cement has an average setting time of less than 6 minutes (30% faster than regular PALACOS® R+G) due to the lack of a waiting phase. The aim of this study was to investigate the safety of total knee arthroplasty performed using this fast-setting, high viscosity cement and short-term radiological outcomes.Material and Methods:This single surgeon case series looked at 344 primary TKAs performed using PALACOS® fast R+G cement from January 2016 to March 2020. Data were collected on patient demographics, perioperative events, and complications. Radiographs taken immediately post-operatively and at the one-year follow-up were analysed using the Knee Society Roentgenographic Evaluation and Scoring System (KSRESS).Results:This case series included 313 consecutive patients (31 bilateral) with a mean age of 70 years (range 44-93). A total of 237 patients (76%, 262 TKA patients) had a minimum one-year follow-up. No adverse events were noted perioperatively; ten patients had superficial wound issues and were managed successfully with wound care and/or oral antibiotics. Six (1.7%) patients underwent re-operation in the study period. These included one DAIR, one staged revision for deep infection, two revisions for instability, one manipulation under anaesthetic for stiffness, and one patella internal fixation for fracture. The mean combined valgus angle for the prosthesis was 183.1° (range 177.7° to 187.8°), indicating adequate alignment. At one-year follow-up, no radiographs demonstrated any new loosening or worsening of any previously noted radiolucent lines.Conclusion:This study reports the largest case series that looks at the use of fast-setting bone cement in primary TKA. It demonstrates good safety, as evidenced by a low re-operation rate, deep infection rate, and no adverse events during implantation. Fast-setting cement offers the promise of improving theatre efficiency and decreasing total running costs. Further studies are needed to provide data on improved theatre efficiency, cost savings and the longevity of implanted knees utilising this cement.

Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS). Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS. Design Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales. Exposure PHECG administration. Outcomes Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion. Results Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment. Conclusions Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.

ABSTRACTAimThis study explores the initial impact of the 2021 Military coup on Myanmar's nursing profession, clinical practice and clinical education.BackgroundMyanmar is a country historically riven by conflict; however, between 2010 and 2021, there was democratic reform and partial peace, prompting improvements in nursing practice and health outcomes. This study examines the impact of the 2021 coup, which effectively halted this progress, on Myanmar's nursing. It contributes to the limited literature exploring the effects of civil unrest and governmental coups on nursing, particularly in closed societies such as Myanmar.MethodsWe present a qualitative synthesis of semi‐structured interviews, undertaken with seventeen nurses in Myanmar via secure video link.ResultsNurses describe the challenges to nursing practice before the coup, the relative progress that Myanmar's nurses made in the short years of quasi‐civilian government and, following the coup, the significant deterioration in working locations, conditions and personal safety for nurses who refused to work in Junta‐controlled hospitals.DiscussionThe coup has damaged all aspects of nursing in Myanmar. These results document a rapid unravelling of progress, accentuated by long‐standing underlying weaknesses in systems and leadership, with additional threats to personal safety. This trend has been previously reported in other conflicts but rarely directly from nurses and never from Myanmar.Implications for nursingThe coup has been catastrophic for nursing in Myanmar. Participants describe widespread health system collapse, deliberate targeting by the junta and a need for international support.

We hypothesised that there is substantial variation in acute myocardial infarction (AMI) treatment across English hospitals, particularly for people hospitalised for non-ST-elevation myocardial infarction (NSTEMI) and with reduced kidney function. This study aimed to describe this variation at the hospital and the individual level to understand treatment variation and potential disparities in AMI management among people with reduced kidney function. Cross-sectional study. Secondary care in England. People hospitalised for AMI (ST-elevation myocardial infarction (STEMI) or NSTEMI) in English hospitals and captured in the Myocardial Ischaemia National Audit Project, 2014 to 2019. Kidney function was defined using estimated glomerular filtration rate (eGFR) derived from the serum creatinine recorded within 24 hours of AMI admission. The primary outcome was recorded invasive cardiac intervention (at least one of angiography, percutaneous coronary intervention and coronary artery bypass graft) compared with conservative management. We included 361 259 people with a first hospitalisation for AMI (STEMI or NSTEMI) at 209 hospitals for hospital-level analyses and 292 572 people with complete covariable data at 207 hospitals for individual-level analyses. We found substantial variation in the mean proportion of people with NSTEMI managed invasively across hospitals in England. At the individual level, using multivariable logistic regression to derive adjusted predicted probabilities to describe the association between kidney function and AMI management (invasive vs conservative management), we found that people had a lower adjusted predicted probability of being treated with invasive cardiac management with worsening eGFR range, particularly for NSTEMI cases (eGFR range 2: 76.6% (95% CI 76.3 to 76.8) vs eGFR range 5: 44.5% (95% CI 41.2 to 47.5)). There is substantial AMI treatment variation across hospitals in England, particularly among people hospitalised for NSTEMI with reduced kidney function. Further research is needed to evaluate the comparative effectiveness of NSTEMI management strategies for complex patients.

Background: Despite global progress in immunization, Nigeria continues to face challenges in achieving adequate vaccination coverage. This study examined the knowledge and practices of primary healthcare workers regarding routine childhood immunization in Osun State, where coverage exceeds national averages but remains below global targets. Methods: A descriptive cross-sectional study was conducted among 273 primary healthcare workers across 48 primary health centers in Osun State. Results: There was a significant disparity between the knowledge (86.5%) and practice of routine childhood immunization (40.6%). Key gaps included inadequate vaccine storage (with 59% failing to maintain temperature records) and inconsistent caregiver communication (only 53.7% consistently obtained consent). Training deficiencies were evident, with 12.3% of staff lacking pre-service immunization training and 60% not having received refresher training within the previous six months. Conclusions: These findings suggest that achieving better immunization outcomes requires more than just knowledge transfer. Health system strengthening should focus on improving cold chain infrastructure, implementing regular competency-based training, and strengthening supervision mechanisms. The study emphasizes the importance of ongoing support for healthcare workers to bridge the gap between knowledge and practice in routine immunization services.

Prostate cancer (PC) is considered the second most diagnosed cancer in men worldwide. It remains a leading cause of cancer-related death. Recently, many modalities have been discovered and used in the diagnosis and management of PC, with the incorporation of many treatment options such as hormonal therapy, chemotherapy, targeted therapies, immunotherapy, and precision medicine. Robotics and artificial intelligence (AI) have further modified the diagnosis and management of PCs, improving the diagnosis accuracy and disease progression. This comprehensive review offers an in-depth exploration of the historical modalities of treatments, an evaluation of current therapeutic techniques, a discussion of the use of robotic surgery and AI, and an examination of ongoing clinical trials and emerging procedures. Additionally, this review also covers the challenges. By inspecting these aspects, the review may provide valuable information regarding future research and clinical practice directions in PC treatment, contributing to a thorough understanding of the complex and emerging context of PC management.