Mersey Care NHS Trust

Prominent ear is a common auricular malformation that can have long-term psychosocial consequences on affected individuals. Otoplasty remains the standard surgical corrective treatment; however, the optimal technique has long been debated, with >200 methods described in the literature. This systematic review, conducted in accordance with PRISMA guidelines, aimed to evaluate the available evidence on the most effective otoplasty approach. The outcomes assessed across different techniques (exclusive suture, exclusive cartilage-scoring, incisionless, suture + flap, suture + cartilage-scoring, and cartilage-scoring + flap hybrids) included: a) number of patients suffering a complication, b) recurrence, c) reoperation, d) infection, e) keloid or hypertrophic scar formation, and f) haematoma. A search of PubMed and MEDLINE identified 412 papers. Following PICOT framework-guided screening, application of inclusion and exclusion criteria, and quality assessment, 22 studies were included: 19 retrospective and three prospective cohort studies. Current medical literature suggests that suture + cartilage-scoring and cartilage-scoring + flap hybrid methods, may be associated with lower rates of recurrence, and reoperation when compared to single-technique or suture + flap approaches. However, high-quality, long-term randomised control trials are required to determine the superior technique for otoplasty.

ABSTRACT Placement breakdown is a common cause of avoidable admissions to intellectual disability inpatient services among people with intellectual disability. The Dynamic Support Register with intensive support function was introduced to help minimise these admissions. This study explored the perceptions of service users, carers and professionals of the extent to which the Dynamic Support Register identifies early risk of placement breakdown and reduces admissions. Semi‐structured interviews were conducted with four service users, five community learning disability team professionals and five carers (paid and unpaid). Interviews were audio‐recorded and transcribed verbatim and analysed using the constructs of Normalisation Process Theory. Key factors influencing the placement breakdown were identified. There was consensus that increasing understanding and awareness of the Dynamic Support Register with intensive support among health and social care professionals, service users and families would improve the provision of timely and appropriate support. The intensive support function provided by the community learning disability team for people on the Dynamic Support Register was viewed to have reduced avoidable inpatient admissions. The Dynamic Support Register identifies early risk of placement breakdown and, with intensive support from the community learning disability team, could minimise avoidable inpatient admissions. However, limited awareness among primary care, health and social care professionals highlights the need for increased training to optimise its impact.

Superior mesenteric artery (SMA) syndrome is an uncommon yet clinically important cause of upper intestinal obstruction, occurring when the third segment of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta, typically due to loss of the mesenteric fat pad that narrows the aorto-mesenteric angle and decreases the distance, most commonly following substantial weight loss. We present the case of a 52-year-old woman who developed persistent vomiting, diarrhoea, abdominal pain, and significant unintentional weight loss. Initial blood tests, stool studies, and endoscopic evaluation did not reveal any abnormalities. However, contrast-enhanced CT of the abdomen revealed significant narrowing of the space between the aorta and the superior mesenteric artery, along with a decreased vascular angle consistent with the diagnosis of SMA syndrome. She was managed conservatively with nutritional support, dietary modification, and postural therapy, resulting in gradual symptomatic improvement. This case highlights the diagnostic challenge of SMA syndrome and the importance of considering it in patients with unexplained weight loss and gastrointestinal obstruction symptoms, particularly when endoscopy is normal. Early recognition and radiological confirmation are crucial to guide appropriate management. Conservative treatment remains first-line, with surgery reserved for refractory cases. Maintaining a high index of suspicion for SMA syndrome is essential when evaluating patients with unexplained weight loss and persistent gastrointestinal symptoms.

Background: Sarcopenia, defined as progressive loss of skeletal muscle strength and function, is a frequent but underrecognized complication of liver cirrhosis. It has been associated with increased morbidity and mortality, yet its prevalence and correlation with prognostic scores remain incompletely studied in the Indian population. The study aimed to determine the prevalence of sarcopenia in cirrhotic patients using handgrip strength and to evaluate the correlation between sarcopenia and liver disease severity, Child-Turcotte-Pugh (CTP) score, and Model for End-Stage Liver Disease (MELD) score.Methods: A cross-sectional study was conducted among 75 adult cirrhotic patients. Handgrip strength was measured using a handheld dynamometer, and sarcopenia was defined as <27 kg in men and <16 kg in women (European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria). Disease severity was assessed using CTP and MELD scores. Statistical analysis included Pearson correlation, with p<0.05 considered significant.Results: The mean age of patients was 55.43 ± 11.54 years, with a male predominance of 54 (72%). Alcoholism was the leading etiology (n=45, 60%), followed by nonalcoholic steatohepatitis (NASH), hepatitis B virus (HBV), and hepatitis C virus (HCV). Mean MELD and CTP scores were 15.42 ± 6.32 and 8.42 ± 2.65, respectively, with most patients in CTP class B (60%). The overall mean handgrip strength was 26.69 ± 4.76 kg, higher in male patients than in female patients. The prevalence of sarcopenia was 42.7%. Handgrip strength declined across CTP classes (28.45 ± 5.65 kg in A, 26.87 ± 3.89 kg in B, and 21.65 ± 2.42 kg in C; p=0.001). Significant negative correlations were observed between handgrip strength and MELD (r = -0.412, p<0.001) as well as CTP (r = -0.358, p=0.01).Conclusion: Sarcopenia is highly prevalent in cirrhosis, particularly in patients with alcohol-related disease and advanced CTP class. Handgrip strength correlates strongly with MELD and CTP scores, making it a simple and effective prognostic tool in routine practice.

People with intellectual disabilities (ID) and forensic histories face significant health inequalities, including reduced quality of life and prolonged stays in mental health hospitals. This is a global health issue, and there is an urgent need for evidence-based specific forensic interventions, models of care and service models to allow for effective discharge in the community, improve long-term outcomes and reduce healthcare costs. This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We have adapted Morrisey's framework to report outcomes of clinical models of care to include (i) effectiveness of treatment; (ii) patient safety; (iii) patient and family experience of care; and (iv) staff outcomes, skills and attributes. Fifty-six studies were included in this review, reporting on 49 interventions, models of care and service models (referred to as 'models'). Four forensic models of care were identified as best practice: the Discharge Pathway Protocol, the Care Pathway-Based Approach, the Psychological Treatment Pathway and the Forensic Intellectual Disability Secure Services (FIDSS) Model of Care. The first three have demonstrated effectiveness in reducing length of stay, facilitating timely discharges and improving patient outcomes for individuals with ID, while the FIDSS Model of Care represents a holistic and culturally sensitive approach emphasising person-centred care, rehabilitation and quality of life. The findings underscore the need for larger studies to explore predictors of successful discharge and long-term outcomes. This is the first review to bring together 'clinical effectiveness' studies and those reporting on patient and family experience, as well as staff's needs, attributes and experiences. Policymakers and practitioners should consider the models identified here as frameworks for developing effective, person-centred care pathways, ensuring appropriate staff training and support, meaningful communication and work with the patient and their family/peers/support network and integrating community services to address the complex needs of this vulnerable population.

Cardiovascular diseases are among the most prevalent and deadly diseases affecting humans. The most widely used diagnostic tool to interrogate cardiovascular physiology and function is an electrocardiogram (ECG). Despite its widespread availability and use, the ECG is subject to interobserver variability and suboptimal sensitivity for asymptomatic or early-stage disease. Artificial intelligence (AI), particularly deep learning (DL) approaches, has provided a suite of methods to improve both the diagnostic and prognostic utility of the ECG in multiple cardiovascular domains. AI-enabled automated ECG interpretation (most commonly using convolutional neural networks (CNNs)) has reached and even surpassed expert-level performance for arrhythmia detection and classification. Additional data-driven approaches to ECG analysis have identified paroxysmal atrial fibrillation from a record of sinus rhythm ECGs, identified left ventricular systolic dysfunction, and predicted cardiac structure and ischemic burden (e.g., acute coronary syndromes). Pragmatic implementation has demonstrated higher diagnostic yield for asymptomatic left ventricular dysfunction in the primary care setting (EAGLE). Other emerging indications include expanded data-derived outputs, such as electrolyte disturbances, biological age, and cardiovascular risk prediction. Despite a growing list of promising applications, numerous translational hurdles remain before routine implementation. Generalizability is limited due to differences in training and target populations. Bias related to sex, race, and comorbidities is an important limiting factor to fair and equitable implementation. Other considerations include “black box” concerns with DL, clinical interpretability and adoption, medicolegal liability, and integration with clinical workflows and infrastructure. Related to these factors, data privacy, algorithmic fairness, accountability, and transparency are important to consider as AI-ECG continues to undergo regulatory scrutiny and outcomes-based validation. In conclusion, AI and ECG represent a major shift towards precision cardiology by improving prediction, screening, and early detection of cardiovascular disease. We anticipate continued improvements with prospective outcome studies, transparent and explainable approaches, and careful regulatory review to ensure safe and effective implementation in the clinic.