Homerton University Hospital NHS Foundation Trust

To explore missed opportunities for PrEP use among people with recently acquired HIV in the United Kingdom. Data were derived from CASCADE, an international, longitudinal, mixed-methods study of adults (≥16 years) with recently acquired HIV (≤12 months). Individuals were recruited from nine UK clinics (08/2022-09/2024) to self-complete a questionnaire; a subset participated in semi-structured interviews (SSIs). 46 questionnaires were completed (39 cisgender men and 7 women, including 2 transgender women) and 11 SSIs (1 cisgender woman). Among men, 22 perceived HIV risk before diagnosis; 21 had ≥5 sexual partners and 17 reported group sex in the 3 months before diagnosis. Thirty (29 men and 1 woman) reported sexualized drug use. Twenty men had ever used PrEP; seven of them had not used it in the 6 months prior to diagnosis. No women had ever used PrEP. Most gay, bisexual and other men who have sex with men (GBMSM) were aware of PrEP; however, risk perception, social meanings of PrEP and concerns about side effects hindered utilization. Among five men using event-based dosing (EBD), three described difficulty predicting sexual activity that led to missed or mistimed pre-/post-sex doses - while others were reluctant to take daily PrEP. For women, the biggest barrier was lack of awareness. PrEP barriers vary by population. For GBMSM, addressing barriers to uptake/adherence (e.g., EBD challenges) are key, highlighting the potential benefit of long-acting injectables. However, awareness of PrEP remains a key challenge for women to achieve equity in prevention.

<h3>Background</h3> Clinical outcomes for NTM-PD are often poor. The NTM Network UK Standards of Care were launched in 2024 to support consistent, high-quality practice including pharmacological and non-pharmacological treatment. We aimed to document NTM-PD management prior to this to identify opportunities to improve care. <h3>Methods</h3> Centres were invited via the NTM Network UK to complete an online retrospective survey. At each site, anonymised clinical data were recorded from three consecutive adults (≥18) newly diagnosed with NTM-PD from 1 January 2022. <h3>Results</h3> 48 centres participated (Northern England, n=12; Southern England, n=12; London, n=9; Wales, n=7; Midlands, n=6; Scotland, n=2) They reported having the following resources: physiotherapy for airway clearance (n=42/48, 88%), dietitian and pulmonary rehabilitation (each n=32, 67%), specialist nurse (n=30, 63%), and health psychology (n=9, 19%). Respondents contributed data on 137 patients. 72 (53%) were female and 115 (84%) identified as White-British. 45 (34%) were aged 61–70. 62 (45%) had COPD and 55 (40%) bronchiectasis. Common radiological findings were nodular-bronchiectatic change (n=62, 45%), fibro-cavitary disease (n=40, 29%), and emphysema (n=39, 28%). <i>Mycobacterium avium complex</i> (MAC) was identified in 106 (77%), <i>M. kansasii</i>(n=14, 10%) and <i>M. abscessus</i> (n=9, 7%). Eighty-one (59%) patients were discussed in an MDT. Treatment plans included involvement of specialist nurses (n=91, 66%), physiotherapists (n=52, 38%), dietitians (n=34, 25%), and pulmonary rehabilitation (n=16, 12%). Forty-two (31%) were advised on airway clearance using Active Cycle Breathing, 25 (18%) Positive Expiratory Pressure devices, 17 (12%) mucoactive drugs, and 12 (9%) hypertonic saline. Written resources were provided to 39 (28%) patients, 22 (16%) were directed to patient-focused websites, and 13 (10%) signposted to peer-support networks. During a median follow-up from diagnosis of 21 (IQR 14–29) months, 124 (91%) started antibiotics for NTM-PD. Forty-five (33%) remain on follow-up and using antibiotics, 53 (39%) are not on antibiotics, 26 (19%) were discharged, and 12 (9%) died. <h3>Conclusion</h3> This UK-wide assessment of NTM-PD management reveals significant variation in available services and care provided. Most patients started specific antimicrobials, though non-medical health care support and patient information provision were limited. We have identified important areas for re-audit against the 2024 Standards.

The literature on the exact incidence of equipment failure during urological surgery is rather heterogeneous. Although failure rates are unacceptably high in other surgical disciplines, more compelling evidence is needed in urology. The present study provides case examples to illustrate several instances of urological instrument malfunction encountered in daily surgical practice, from the field of endourology to the newer robotic systems. Five cases of endourological device failures involving a resectoscope, a semi-rigid ureteroscope and alligator forceps and one case involving monopolar scissors of the Hugo RAS robotic system are presented, without any resultant complications to patients. Urologists and surgical personnel need to become acquainted with various equipment utilised in their field. Initiatives aimed at improvement of handling, inspection and prompt replacement of defective devices, rigorous adherence to manufacturers' guidelines, implementation of evaluative checklists for quality control and the adoption of incident-specific reporting forms are commendable actions toward enhancing operational efficiency. In the context of robotic surgery, a team of technical experts possessing sufficient knowledge of the equipment should offer continuous assistance in accordance with troubleshooting protocols. By implementing a standardised problem-solving strategy, they could diagnose and rectify emerging errors promptly and efficiently. Overall, failure in the theatre demands collective understanding and prompt management. Urologists need to communicate such events and collaborate to improve overall surgical efficiency.

Human papillomavirus (HPV) is causally related to neoplasia in multiple anogenital zones including anal, vulval, vaginal, and cervical areas in women. Care for anogenital neoplasia involves multiple specialist fields. Women with a history of cervical neoplasia are at increased risk of multiple anogenital neoplasias and second cancers occur in the anogenital zones. Results of a survey on current management practices across Europe are presented. A questionnaire was developed by iterative process and circulated amongst specialists in all fields associated with anogenital neoplasia. Data was recorded and analysed using Microsoft Excel/Stata. 316/430 (73.5%) respondents collaborated with colleagues to provide care, but only 27.0% were engaged in full multidisciplinary team meetings (MDT).Second cancers were observed both in the same anatomical zone (56.5%) as well as in different anatomical zones (45.3%) by the respondents.The survey identifies significant variability in clinician workload, experience and screening practices.Low utilisation of high-resolution anoscopy (HRA) by specialists (14.9%) indicate lack of standardisation of practices, though some (12.7%) expressed interest in training in HRA. 24.4% did not offer treatment for anogenital neoplasia, while those who treated utilised multiple modes of treatment. Recognition of multizonal anogenital neoplasia and the risk of second cancers, and new data on successful treatment of anal neoplasia have led to the assessment of expertise amongst Europe's specialists. Enhanced HRA training, improved guidelines and robust follow-up protocols are essential to optimising care. A concerted effort is needed to align professional development, workload standards and clinical practices across Europe.

Kidney stone disease, or nephrolithiasis, is a prevalent urological condition with variable pathogenesis. Among various factors, urine pH is not only considered to be a more influential factor in stone formation and can aid in the early diagnosis and management of specific stone types such as uric acid, cystine, calcium phosphate and struvite stones, but the role of urine pH in calcium oxalate stones, which comprise most cases, is more complex. Hypocitraturia in routine evaluation is another recognizable factor in lithogenesis, and administration of citrate, a widely used agent in the conservative management of stones. corrects hypocitraturia. Citrate also alkalizes the urine and can therefore be used to dissolve and prevent uric acid stones. However, citrate can induce the formation of insoluble calcium phosphate salts, such as brushite and hydroxyapatite, which can lead to mixed stones and the development of nephrocalcinosis. To address this complexity, innovative treatments that focus on a broader inhibition of lithogenesis with pH-modifying strategies may allow for more comprehensive management. In addition, modern technological tools such as pH meters and pH-tracking mobile applications can offer personalized treatment plans, potentially improving patient outcomes. The current lack of consensus on the standard and optimal management of pH measurement and modification underscores the need for further research and greater collaboration among experts. The development of evidence-based strategies will be essential to improve prevention and nephrolithiasis.

The foot and ankle are frequently affected in rheumatic and musculoskeletal diseases (RMDs), yet there is a lack of high-quality evidence to determine the effectiveness of treatments. Outcomes in research are often inconsistently measured, impeding evidence synthesis. Additionally, clinical decisions are based on research outcomes, but these are not always regarded as important by people with RMDs. This study aimed to determine domains of importance to people with RMDs who have experienced foot and ankle disorders, and aid in developing a standardised core outcome set (COS) to address these issues. Participants from four continents (Europe, Africa, Australia, North America) were recruited to semi-structured interviews through clinical departments and electronic mailing lists. Analysis was conducted using a mixed deductive/inductive approach to the framework method. Patient research partners co-produced the interview schedule and recruitment materials, and co-interpreted results. Fifty-six participants (age range 27 to 76 years; 66 % female), with foot and ankle disorders in a variety of RMDs (including inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases), were interviewed. Sixteen domains were described by participants: pain, physical function, fatigue, deformity, skin and nail health, swelling, temperature, numbness, poor circulation, cramping, activities/participation, footwear impact, psychological impact, sleep, healthcare utilisation and personal expenses. Most domains were considered important to participants regardless of RMD or geographic location. Foot and ankle disorders have far-reaching consequences for people with RMDs. This large qualitative study provides a foundation for achieving international consensus on a core outcome set for foot and ankle disorders in RMDs, to improve the quality of evidence demonstrating effectiveness of treatments.

Current treatments for patients with Parkinson's disease (PwP) can fail to address gait disturbance and falls, which in turn affect quality of life (QoL). The CUE1 device delivers cueing with vibrotactile stimulation showing potential to alleviate motor symptoms and reduce falls based on preliminary user testing results. This study aimed to evaluate the feasibility, safety, and tolerability of CUE1 and its effect on motor and non-motor symptoms in PwP. PwP used the CUE1 for 9-weeks and were assessed at week 0, 3, 6, and 9 on MDS-UPDRS Part-III, Timed Up and Go (TUG), TUG with dual task (DT), and Functional Gait Assessment (FGA). Patients-reported outcomes were assessed through MDS-UPDRS Part-I, Part-II, and Part-IV. Ten PwP (5 females, age range: 46-80; disease duration: 3-9 years) completed the CUE1 intervention with 100% compliance and no adverse events. CUE1 comfort and usability were rated highly (80%). Immediate CUE1 effect was observed on MDS-UPDRS Part-III (45.40±12.22 vs 39.60±11.74, p=0.008), TUG (11.53±1.92 vs 11.08±1.94, p=0.022), TUG DT (18.57±5.75 vs 17.61±6.28, p=0.037) and FGA (16.40±3.86 vs 18.60±3.92, p=0.007). Cumulative effect was noted on MDS-UPDRS-III (45.40±12.22 vs 27.80±12.32, p=0.005), FGA (18.60±3.92 vs 23.10±2.85, p<0.001), TUG DT (18.57±5.75 vs 13.58±7.05, p=0.031), MDS-UPDRS Part-I (18.60±6.75 vs 12.20±3.68, p=0.011), MDS-UPDRS Part-II (17.30±7.29 vs 11.90±8.67, p=0.002), and MDS-UPDRS Part-IV(7.50±3.75 vs 3.40±2.95, p=0.003). In this unblinded, feasibility study, cueing with vibrotactile stimulation delivered via the CUE1 technology appeared to be a feasible, safe and well tolerated intervention for PwP improving motor and non-motor features.

BackgroundResearch indicates that treatment outcomes are poorer for people with long-term physical health conditions (LTCs) in Talking Therapies services (formerly known as Improving Access to Psychological Therapies). However, the impact of having an LTC on attendance at assessment and treatment appointments within Talking Therapies remains unclear. Internet-enabled therapies may be one way to overcome barriers to treatment engagement in Talking Therapies. However, their effect on engagement and the influence of LTC status on receipt of internet-enabled therapies is unknown.AimsTo explore the association between LTC status and assessment attendance, treatment engagement and internet-enabled therapy receipt within Talking Therapies services, and whether receipt of internet-enabled treatment bolsters engagement.MethodWe used anonymous patient-level data from two inner London Talking Therapies services during January to December 2022 (n = 17 095 referrals). Binary logistic regression models were constructed to compare differences between LTC and non-LTC groups on (a) assessment attendance, (b) engagement and (c) internet-enabled therapy receipt. In our regression models, we controlled for key clinical and demographic covariates.ResultsThere were no differences between patients with or without an LTC in assessment attendance or treatment engagement, after controlling for covariates. Across the whole sample, receiving internet-enabled treatment increased engagement. People with an LTC were less likely to receive an internet-enabled treatment.ConclusionsHaving an LTC does not negatively affect assessment attendance and engagement with talking therapies. However, receiving an internet-enabled treatment bolstered engagement in our regression models. People with an LTC were less likely to receive internet-enabled treatment.