Milton Keynes Hospital

Martial arts involve cutting, jumping and landing movements known to increase injury risk. Martial artists frequently sustain injuries. Recreational martial arts have yet to implement an evidence-informed prehabilitation programme to prevent these injuries. Here, we evaluate the Martial Arts Striking Sports prehabilitation programme (MASS-12) in a recreational setting. Three traditional martial arts warm-ups and two MASS-12 warm-ups were delivered over 2 weeks as a recreational Jiu Jitsu club hall. A coach and seven athletes (five male, two female), ranging in experience from white belt to brown belt, participated. Main Outcome Measures were the Frontal plane projection angle (FPPA), a measure of dynamic knee valgus and Single leg vertical hops (SLVH), a measure of performance. Over half of recreational athletes reported previous, serious lower limb injuries. Athlete FFPA and SLVH significantly improved (−11.9° to −1.93°, 25.2 vs 27.5 cm, respectively) after the MASS-12. Athletes appreciated the increased feedback and sense of preparedness. The coach found it easy to teach and perceived improvements in performance. The MASS-12 is easy for coaches to implement; improves lower limb alignment; and is accepted by athletes. A significant improvement on current practices, the MASS-12 should be widely implemented in recreational martial arts.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1525:"<h3>Background</h3> Acromegaly is a rare condition caused by excess production of pituitary growth hormone (GH) with incidence 6-8/million/year(1). Diagnosis is often delayed due to slow progression of physical changes resulting from excess insulin like growth factor (IGF-1), by 5-10 years(2). Headaches are usually due to space occupying adenomas; we present a case caused by alternative craniofacial manifestations: sinus soft tissue enlargement. <h3>Case</h3> A 57-year-old man presented to neurology clinic with 3-month history of headache over the frontal region radiating to the maxilla and temples, lasting 30 minutes in the morning, with no associated sensory sensitivity, visual obscurations, jaw claudication or cranial autonomic symptoms other than a “stuffy nose” for several months. Examination showed prominent supraorbital ridges, hearing loss, normal optic discs and visual fields, neurological examination was otherwise normal. BP on ramipril 157/89. ESR&amp;CRP normal, IGF-1 40(9-31.7), GH 2.56(0-2.8), not suppressed by oral glucose tolerance testing. MRI revealed sinus soft tissue enlargement &amp; pituitary studies demonstrated a right sided focal subtle bulge. <h3>Discussion</h3> Soft tissue enlargement and sinus soft tissue enlargement are recognised in acromegaly, and high incidence of mucosal hypertrophy and polyposis have been described(3). Clinical examination is vital in the recognition of treatable unusual causes of headache. carolynnedoherty{at}doctors.org.uk ";}

BackgroundProximal humeral fractures (PHFs) are common injuries, but their management has remained controversial. Recent high-level evidence from randomized clinical trials has shown that for many PHFs, surgical treatment is not superior to non-surgical treatment. Our primary aim was to conduct a multi-nation assessment of temporal trends and changes in surgical treatment of isolated PHF in Denmark, England, and Sweden. A secondary aim was to estimate the incidence of serious adverse events (SAEs) within 30 days (and death within 90 days) of primary surgery.MethodsThis population-based cohort study presents routinely collected data from Danish, English, and Swedish patient registries and electronic health records from 1998 to 2018. All adult patients with isolated PHFs combined with predefined surgical procedure codes were included. Age- and sex-specific incidence rates (IRs) of surgery and each surgical procedure per calendar year were calculated. Kaplan–Meier plots displayed patient survival for the study period. Incidence proportions of SAEs within 30 days (and death within 90 days) of surgery were computed.ResultsA total of 54,077 primary surgical procedures, performed in 53,852 patients with isolated PHF, were included. Denmark and Sweden had the highest IR of surgery, with Denmark peaking at 17.4/100,000 person-years in 2011 and Sweden peaking at 18/100,000 person-years in 2013, while England peaked at 5/100,000 person-years in 2010. From 2004, plate fixation was the leading surgical procedure in Denmark and Sweden, while arthroplasty was the most frequent in England. The IR of surgery in Denmark and Sweden was 8–10 times higher for women aged 80 years than that observed in England. The 30-day incidence of SAEs varied between countries, ranging from 0.03% to 3.51%.ConclusionsVariations in surgical practice for isolated PHF exist between Denmark, England, and Sweden, with differences in overall IRs of surgery and preferred procedures. A complex interplay between hospitals, surgeons, healthcare systems, and evidence-based factors is likely to explain such variations. However, in all three countries, the IR of surgery, particularly for the use of locking plates, demonstrated a decline from 2013, coinciding with high-quality trials and meta-analyses suggesting that evidence-based factors are becoming more prominent in orthopaedic treatment decisions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04414-2.

The Flock Health Checklist online survey was designed to gather information directly from UK sheep farmers to identify key challenges. The survey received 966 responses from individual sheep farmers. Data were analysed to identify common behaviours across a range of farming practices. For example, 37% of farmers did not have a flock health plan, 42% did not know their lamb loss rate and 31% did not know their ewe barren rate. The findings can be used to identify areas requiring improvement within the sheep farming sector and to inform recommendations such as promoting systematic record-keeping, encouraging the adoption of best practices and leveraging government support through initiatives such as the Animal Health and Welfare Pathway and the Food Animal Initiative Farms Five Point Plan for lameness, to improve overall flock health and productivity.

Abstract Background The AI-based CariHeart Risk calculator has been developed using cardiac CT angiography (CCTA) assessment of the peri-coronary artery inflammation (FAI) and conventional cardiovascular risk factors to predict 8 years fatal and non-fatal cardiovascular events. As one of the 5 chosen Hospitals in the United Kingdom we have performed and interim analysis to assess the impact of the proposed new chest pain pathway on the risk stratification of patients referred for suspected angina to the Rapid Access Chest Pain Clinic (RACPC). Objective We set out to investigate the interaction (risk stratification predictive power) between the degree of coronary artery disease (CAD), the FAI risk score and the AI-based CariHeart Risk score. Methods 135 consecutive patients referred to the RACPC are part of this analysis. 2 patients had no contrast CCTA images at patient request and were excluded. Risk stratification was defined as no or mild CAD (&amp;lt;50% stenosis), moderate, (50-69% stenosis), severe (&amp;gt;70% stenosis) based on the degree or coronary artery luminal stenosis, low FAI score defined less then 50 percentile for any coronary artery, intermediate FAI score defined 50-75 percentile for LAD/RCA or 50-90 percentile for LCX, and high FAI score defined &amp;gt;75 percentile for LAD/RCA and &amp;gt;90 percentile for LCX. Low AI- CariHeart risk score was defined &amp;lt;1% 8 years CV mortality, intermediate risk 1-5% CV mortality, and high risk if &amp;gt;5% CV mortality. Results We found that patients with No or mild atherosclerotic CAD had a low FAI score in 4/114 (3.5%), intermediate score in 16/114 (14%), and high score in 94/114 (82%), (p&amp;lt;0.00001). Low CariHeart risk score was found in 4 (3.6%), intermediate risk score in 47 (41%), and high-risk score in 63 (55%) (p&amp;lt;0.0001). In No-or mild CAD patients the FAI score identified larger number of patients then CariHeart risk score as high risk 82% vs 55%, p&amp;lt;0.0001. However, merging the intermediate and high FAI score patients and compare it with the merged intermediate and high CariHeart risk score patients the two scores identified the same proportion of patients 97%. The 13 patients with moderate CAD on CCTA, low FAI score was found in none, intermediate score in 38%, and high score in 62%, (p=0.025). Low CariHeart risk score was found in none, intermediate risk score in 8%, and high-risk score in 92%, (p&amp;lt;0.007). High FAI score was found in all 3 cases whereas high CariHeart score in 2 cases and intermediate in 1 with severe CAD on CCTA. Conclusion The AI-based new chest pain pathway utilising CCTA images has identified higher proportion of at-risk patients particularly those with non-obstructive CAD. FAI score and CariHeart risk score seems to perform similarly in the aggregate intermediate and high-risk groups. To assess the value of the NP on real world outcome and the effect of new and conventional cardiovascular preventative therapy is warranted.

This studyinvestigated the safety, tolerability, and preliminary efficacy of Sirona, a novel gastro-retentive, dual-network polymer for weight management. This pilot trial comprised a randomized, parallel-group, double-blind, placebo-controlled (3:1 ratio), 12-week period, with a 12-week open-label extension (OLE), in participants with BMI of 30-40 kg/m2. Primary endpoints were feasibility, tolerability, and safety; secondary endpoints included weight loss and dietary intake, tested using Hedge's g [95% CI] as a measure of effect size. Participants received Sirona (n = 29/38) or Placebo (n = 9/38) (mean [SD] age = 40.9 [8.4]; weight = 101.7 [12.9] kg; BMI = 35.6 [3.0]; 29/38 female and 23/38 White British). Dosing was well tolerated (RCT Sirona: 95.2 [11.0]%; RCT Placebo: 97.8 [3.5]%; RCT + OLE Sirona: 93.1 [13.0]%). No serious adverse events occurred. Of the adverse events, nausea was most prominent (74.8%), mostly graded mild (79.3%) and requiring no intervention (84.4%). Percentage total body weight loss was greater for Sirona compared to Placebo after 12 weeks (3.9 [3.0]% versus 1.0 [2.1]%, g = 0.96 [-1.81, -0.10]). Weight loss continued in the OLE (change from baseline = 4.4 [3.8]%). Dietary intake reduced from baseline after 12 weeks of treatment (-382.5 [519.3] kcal; Placebo = 93.5 [670.3] kcal, g = -0.8 [-1.7, 0.0]) and after 24 weeks (-338.2 [486.7] kcal, g = 0.7 [0.2, 1.1]). Sirona was well tolerated, with mild, primarily gastrointestinal side effects. Reduced weight and dietary intake suggest Sirona is suitable as a nonpharmacological treatment for weight management. ISRCTN14083641 (https://doi.org/10.1186/ISRCTN14083641).

Guidelines recommend patients on long-term oxygen therapy (LTOT), who are mobile outdoors, should only be offered AOT if this allows them to achieve 15 hours/day compliance with LTOT and/ or improve capacity to undertake outdoor activities. For those who desaturate on exercise significantly AOT should only be offered if it improves exercise capacity / QoL (Suntharalingam 2017). The service audited 162 patients using LTOT and AOT or AOT alone 6-month period and additionally used a questionnaire via telephone call with 152 respondents. <bold>Aims:</bold> The aims were to: · Check AOT prescribed as per BTS standards · Check concordance · Ask about use of AOT and if not using why not · Distance able to walk with AOT All of these 162 patients were contacted and asked to complete a standardised questionnaire with 152 respondents · Only 34% used AOT outside of the home although most used wheelchairs or scooters. 90% of patients questioned did not walk further than 50m · Only 10% of those questioned used AOT as per national guidelines. · Concordance was poor with under-use significantly higher than over-use · 120 (74%) of patients had not ordered new cylinders during a 6-month period <bold>Conclusion:</bold> Use of ambulatory oxygen as per BTS (2017) guidelines poor, with only 34% using as prescribed and less than 40% going out very often. Most stated they didn’t use because felt no need/benefit with the next most common reason for not using was weight of equipment. No one had been assessed with second 6MWT on oxygen. The service delivery is being reviewed.

<bold>Background:</bold> Although the service manages adults, young people do transition into adult care without any real handover. The service noticed that some young people who were transitioning from paediatric to adult care, managed on home oxygen had not had oxygen assessment for some time. As it was already reviewing other aspects of oxygen management through audit it decided to run an audit with support from the area supplier, Vivisol. <bold>Aims:</bold> · Identify how many children and young people were managed on oxygen. · Identify any children approaching age for transition to adult care to enable smooth transfer · Check when was HOOF last updated? · Check concordance. <bold>Results:</bold> Only 45% had up to date oxygen prescriptions, 55% were out of date and 1 young person who transitioned during this period had not had the prescription for over 10 years with normal oxygen saturations, blood gases and oxygen no longer indicated. Concordance was also variable with only 1 child using oxygen as prescribed, with underuse varying between -2.87 hours and -24 hours. Following on from the audit: • Improved communication and networking • Oxygen often prescribed for acute episodes such as RTIs/post seizures hence why oxygen underused • All prescriptions now up to date • Better links to improve transition to adult services • Oxygen removed from 6 patients (20%) as not indicated or used <bold>Conclusion:</bold> The audit has led to improved communication and transition between both services, HOOFs are now up to date, and oxygen is removed or reviewed as indicated considering patient safety and cost-effectiveness.