Montagu Hospital

Abstract Innovation policies in post-Soviet economies often prioritise technology-oriented R&D infrastructures while neglecting the production capabilities that sustain incremental learning and adaptation. Yet the mechanisms leading to this outcome are not theorised in the literature. This paper explains how such a selective focus becomes institutionalised through STI-centric policy myopia, a configuration that narrows policy attention to visible, codifiable, and globally recognisable indicators. Using Azerbaijan as an illustrative case, the study draws on policy documents, media and social-media narratives, and a structured survey of senior officials to trace three reinforcing processes: circumscribed policy discourse, which limits the vocabulary through which innovation can be imagined; indicator-driven tunnel vision, which prioritises metrics and global rankings over capability-deepening reforms; and accretive institutional layering, which adds STI-compatible instruments on top of unreformed organisational cores, gradually locking the system into symbolic, high-visibility pathways. Together, these processes stabilise a reform trajectory in which STI-compatible models appear self-evident, while doing–using–interacting (DUI) modes, despite their relevance in sectors such as agriculture, logistics, and processing, remain peripheral to policy design. Recognising this mechanism clarifies why capability-deepening trajectories fail to materialise even when DUI practices exist in the economy, and it sharpens analytical expectations about reform patterns in developing and post-Soviet systems. The paper therefore offers a conceptual lens for understanding the reproduction of STI-oriented policy agendas and for analysing when and how alternative innovation imaginaries might gain institutional traction.

Orthodontic training in the UK is evolving to address workforce shortages and meet increasing demand. A new curriculum, effective from September 2024 emphasizes evidence-based practice. Despite these advancements, challenges persist, including competitive recruitment, financial constraints and an uneven distribution of services. Possible areas for future development include the integration of primary care experience into training; and the revision of orthodontic commissioning in the NHS. Any measures introduced should aim to improve training pathways, ensure equitable service delivery, and maintain high standards of care. Addressing these issues is vital for developing a sustainable orthodontic workforce capable of meeting future healthcare needs. CPD/Clinical Relevance: This article reviews current developments in UK orthodontic training, assessment, workforce challenges, and NHS service provision, providing essential context for trainees, educators, and clinicians preparing for future practice.

The presence of the right atrial thrombus (RAT) is a life-threatening condition often associated with acute pulmonary embolism (PE). This case report details a 63-year-old male patient who presented with a serpiginous RAT and a massive PE. Despite the administration of both anticoagulation and fibrinolytic therapies, the patient unfortunately experienced sudden cardiac arrest and succumbed to the condition.

Kabuki syndrome (KS) is now listed in the Human Inborn Errors of Immunity (IEI) Classification. It is a rare disease caused by KMT2D and KDM6A variants, dominated by intellectual disability and characteristic facial features. Recurrently, pathogenic variants are identified in those genes in patients examined for autoimmune cytopenia (AIC), but interpretation remains challenging. This study aims to describe the genetic diagnosis and the clinical management of patients with paediatric-onset AIC and KS. Among 11 patients with AIC and KS, all had chronic immune thrombocytopenic purpura, and seven had Evans syndrome. All had other associated immunopathological manifestations, mainly symptomatic hypogammaglobinaemia. They had a median of 8 (5-10) KS-associated manifestations. Pathogenic variants were detected in KMT2D gene without clustering, during the immunological work-up of AIC in three cases, and the clinical strategy to validate them is emphasized. Eight patients received second-line treatments, mainly rituximab and mycophenolate mofetil. With a median follow-up of 17 (2-31) years, 8/10 alive patients still needed treatment for AIC. First-line paediatricians should be able to recognize and confirm KS in children with ITP or multiple AIC, to provide early appropriate clinical management and specific long-term follow-up. The epigenetic immune dysregulation in KS opens exciting new perspectives.

The role and recognition of advanced clinical practitioners (ACPs) have been subject to debate in various healthcare settings. Therefore, this review aims to critically analyze the role of ACPs in leading change within primary care services. By referring to current clinical research, the review aims to evaluate the efficacy of this role in creating a sustainable future for the National Health Service (NHS) by reducing the gap between primary and secondary care, as highlighted in the NHS Five Year Forward View. From the authors' perspective, the role of ACPs in leading change in primary care settings has never been more crucial than it is today. Understanding the changes that ACPs can introduce is essential to accelerate progress and achieve the most optimistic scenario for the future. However, the emergence of the ACP role faces three challenges: defining their domain, their training package, and determining the necessary adjustments in NHS organizations.

Dalbavancin is a long-lasting lipoglycopeptide active against Gram-positive bacteria, especially methicillin-resistant staphylococci. Few data are available on dalbavancin use for treatment of prosthetic joint infections (PJIs). We describe a cohort of patients treated for PJI with dalbavancin and review the literature regarding this condition. All adult patients with PJI from the French dalbavancin national cohort from 1 June 2017 to 1 January 2019 were included. We collected clinical and microbiological characteristics and outcome through a standardised questionnaire. Clinical cure was defined as absence of clinical signs of infection at last visit. Failure was a composite criterion defined by persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment and/or death from infection. The literature review was performed using PubMed. Seventeen patients were included. Bacteria were identified in 16 cases: Staphylococcus aureus (n=10), including methicillin-resistant S. aureus (n=1); and coagulase-negative staphylococci (n=10), including methicillin-resistant Staphylococcus epidermidis (n=4). Sixteen patients (94.1%) had received antibiotic therapy prior to dalbavancin use (mean of 2.2 ± 1.3 lines). Clinical cure was achieved in 8/17 patients after a median follow-up of 299.0 (IQR 97.0-476.0) days. We reviewed all cases of PJI treated with dalbavancin available in the literature and the overall clinical cure was estimated at 73.1%. Our study and literature data suggest that use of dalbavancin in PJI could be considered, even as salvage therapy. Dalbavancin appears to be a safe and easy treatment for patients with staphylococcal PJIs.

Severe COVID‐19 disease is a hyperinflammatory, pro‐thrombotic state. We undertook plasma exchange (PEX) to determine its effects on organ function and thrombo‐inflammatory markers.Seven critically ill adults with severe COVID‐19 respiratory failure (PaO2:FiO2 ratio < 200 mm Hg) requiring invasive or noninvasive ventilatory support and elevated thrombo‐inflammatory markers (LDH >800 IU/L and D‐dimer >1000 μg/L (or doubling from baseline) received PEX, daily, for a minimum of 5 days. No other immunomodulatory medications were initiated during this period. Seven patients matched for age and baseline biochemistry were a comparator group.Coagulation screening revealed no evidence of coagulopathy. However, von Willebrand Factor (VWF) activity, antigen and VWF antigen: ADAMTS13 ratio, Factor VIII and D‐dimers were all elevated. Following 5 days of PEX, plasma levels of all the above, and ferritin levels, were significantly reduced (P < .05) while lymphocyte counts normalized (P < .05). The PaO2:FiO2 ratio increased from a median interquartile range (IQR) of 11.6 (10.8‐19.7) kPa to 18.1 (16.0‐25.9) kPa (P < .05). Similar improvements were not observed in controls. Acute kidney injury (AKI) occurred among five patients in the control arm but not in patients receiving PEX.PEX improved oxygenation, decreased the incidence of AKI, normalized lymphocyte counts and reduced circulating thrombo‐inflammatory markers including D‐Dimer and VWF Ag:ADAMTS13 ratio.