Our Lady's Hospital

PurposeOral symptoms are common in patients with advanced cancer. The aim of this study was to translate the Oral Symptom Assessment Scale (OSAS) into Japanese and then validate the translated questionnaire.MethodsTranslation of the original (English version) OSAS into Japanese was performed following the Multinational Association of Supportive Care in Cancer (MASCC) Guideline Translation Policy. Participants with advanced cancer then completed the Japanese translated OSAS (OSAS-J), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Core30 (EORTC QLQ‐C30), and the associated oral health module (EORTC QLQ-OH15). Associations between the results from the Japanese OSAS and the EORTC QLQ-C30 / EORTC QLQ-OH15 were determined using Spearman’s rank correlation coefficients.ResultsOne hundred advanced cancer patients were recruited, and 97 completed all of the assessments. Ninety (92.9%) participants reported that one had at least one oral symptom on the OSAS-J. The median number of oral symptoms was 4 (range 0 to 18). Comparison between oral symptoms in the OSAS-J and the EORTC QLQ-OH15 revealed moderate and strong correlation.ConclusionThe OSAS was successfully translated into Japanese and validated in a study subjects of Japanese advanced cancer patients. The Japanese OSAS / OSAS-J should help clinicians better identify oral problems amongst their advanced cancer patients.Trial registrationThe study was registered on the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with reference number: UMIN000048749 on August 24, 2022.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10329-2.

BackgroundDespite advancements in diagnostics and treatment strategies, infective endocarditis continues to carry a substantial morbidity and mortality risk. In addition, the field of infective endocarditis contains many gaps in evidence, as international guidelines are predominantly based on low-level evidence. To improve infective endocarditis care and survival rates in the Netherlands, adequate evaluation of diagnostics, treatment strategies and outcomes is essential.MethodsTo address this need, a new infective endocarditis registry has been developed by the multidisciplinary ENDOCOR working group with the aim of facilitating nationwide quality control, improving infective endocarditis patient care, and contributing to the numerous gaps in evidence. To optimize data collection, facilitated by the Netherlands Heart Registration (NHR), a pilot project was launched in January 2023 across three selected hospitals.ResultsThe findings from the first 150 registered patients were presented to highlight the registry’s potential. Following the pilot, many more centres have initiated data collection, demonstrating national engagement and scalability of the initiative.ConclusionThis article outlines the purpose of ENDOCOR, presents initial pilot data and illustrates the potential of the new national infective endocarditis registry to enhance patient care and support future research.

SUMMARY Mirroring the general population, the number of medical students, doctors and, indeed, psychiatrists disclosing being neurodivergent is rising. These individuals commonly have a variety of strengths that can enhance their work, but these strengths may go unrecognised. All too often such individuals have been labelled ‘doctors in difficulty’. We begin this article with a review of contemporary thinking regarding neurodiversity, before considering specific issues facing neurodivergent doctors, specifically psychiatrists. We explore neurodivergent strengths and the evidence regarding career outcomes and mental health. We discuss the stigma that many neurodivergent psychiatrists face in the medical sphere and how difficulties may be reframed as unmet needs. We highlight initiatives that aim to change workplace culture, before discussing the concept of reasonable adjustments, alongside a wide range of practical suggestions of adjustments to consider, using the Autistic SPACE framework and the Royal College of Psychiatrists’ reasonable adjustments guidance. Finally, we consider how those in senior leadership roles can contribute to this field and provide role modelling and signposting to further information and support for neurodivergent doctors and their supervisors and line managers.

DXA technology is widely available today in many regions of the world. There is a growing realization of the value of DXA not only for osteoporosis management but also for sports medicine, sarcopenia, and the assessment of cardiovascular disease and mortality. Such features may be of particular interest for populations with a greater risk of these outcomes such as those with diabetes mellitus or rheumatoid arthritis. Recent systematic reviews and meta-analyses show DXA can robustly predict fractures, cardiovascular disease, dementia and mortality. Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting multiple organs including synovial joints, bone and other tissues. People suffering from RA have a greater propensity to osteoporotic fracture, cardiovascular disease, infection and premature death, which is well recognised. RA is the only unique disease included in some fracture risk algorithms such as FRAX, and so RA patients are often referred for a DXA scan to evaluate their risk of osteoporosis. We have previously shown vertebral fractures, aortic calcification and cardiovascular disease are prevalent in our RA population, with strong association. In this paper we performed a scoping review of published literature in Medline and Embase to better understand the current status of DXA and cardiovascular disease in RA populations. 822 papers were identified in an initial search of which 7 papers reflecting 2,038 RA patients from 7 different countries were included. Study design included 4 cross-sectional, 2 longitudinal and 1 case-control. All included associations with various cardiovascular measures, while only 1 included clinical events as an outcome. Our results suggest this is an area which remains relatively unexplored but has substantial important clinical potential.

The pathophysiology of perinatal asphyxia is remarkably complex, triggering a cascade of biochemical dysregulations across multiple systems. 1,2The distinctiveness of neonatal asphyxia lies in its timing, taking place during the vulnerable window of postnatal adaptation where changes in blood oxygen levels play a pivotal role in pulmonary and cardiovascular transition. 3t the histological level, including the myocardium, hypoxia initiates VEGF overexpression, which activates angiogenic remodeling leading to endothelial apoptosis and disseminated intravascular coagulation. 4These alterations impair the endothelial barrier, which might lead to multiple organ injury, such as coronary artery congestion and thrombosis. 5Consequently, early after asphyxia, the cardiovascular system demonstrates high pulmonary vascular resistance (PVR), reduced systemic vascular resistance (SVR), and abnormal ductus arteriosus shunting, further impairing coronary perfusion and exacerbating myocardial ischemic injury. 6he right ventricle (RV) appears particularly vulnerable under these conditions.As the dominant, metabolically active ventricle during fetal life, its crescentic, thin-walled structure makes it more sensitive to afterload changes compared to the ellipsoid, thickwalled left ventricle (LV). 7At a high RV pressure, right coronary perfusion shifts from taking place in both systole and diastole to become diastolic-dependent.This may be further compromised by increased end-diastolic pressures. 8Moreover, a hypoxicischaemic cardiomyopathy leads to impaired myocardial contractility which further compromises the coronary perfusion.This situation can additionally deteriorate during therapeutic hypothermia (TH), which may induce bradycardia and increase PVR. 9 Recent research has revealed intriguing aspects of cardiomyocyte remodeling in the neonatal period.Contrary to adult hearts, neonatal hearts demonstrate remarkable regenerative capacity in response to hypoxic-ischaemic injury.However, perinatal hypoxia may activate fetal programming through altered expression of cardioprotective genes, potentially increasing susceptibility to future ischemic injuries. 10Additionally, cardiac fibroblasts play a critical role in reprogramming RV myocytes, enabling the reactivation of a fetal-like phenotype over the long-term. 11While this initially supports adaptation to pressure overload, it may accelerate maladaptive responses over time.Enhanced cardiomyocyte proliferation has also been observed as a compensatory response to pressure overload. 12However, hypoxia-induced delays in sarcomeric assembly and isoform switching, combined

BackgroundOsteoporotic fractures are a major global public health issue, leading to patient suffering and death, and considerable healthcare costs. Bone mineral density (BMD) measurement is important to identify those with osteoporosis and assess their risk of fracture. Both the absolute BMD and the change in BMD over time contribute to fracture risk. Predicting future fracture in individual patients is challenging and impacts clinical decisions such as when to intervene or repeat BMD measurement. Although the importance of BMD change is recognised, an effective way to incorporate this marginal effect into clinical algorithms is lacking. MethodsWe compared two methods using longitudinal DXA data generated from subjects with two or more hip DXA scans on the same machine between 2000 and 2018. A simpler statistical method (ZBM) was used to predict an individual's future BMD based on the mean BMD and the standard deviation of the reference group and their BMD measured in the latest scan. A more complex deep learning (DL)-based method was developed to cope with multidimensional longitudinal data, variables extracted from patients' historical DXA scan(s), as well as features drawn from the ZBM method. Sensitivity analyses of several subgroups was conducted to evaluate the performance of the derived models. Results2948 white adults aged 40–90 years met our study inclusion: 2652 (90 %) females and 296 (10 %) males. Our DL-based models performed significantly better than the ZBM models in women, particularly our Hybrid-DL model. In contrast, the ZBM-based models performed as well or better than DL-based models in men. ConclusionsDeep learning-based and statistical models have potential to forecast future BMD using longitudinal clinical data. These methods have the potential to augment clinical decisions regarding when to repeat BMD testing in the assessment of osteoporosis.

Physical activity can assist people with life-limiting conditions to maintain their wellbeing and quality of life. To explore the views of clinical nurse specialists (CNS) working in community palliative care towards the role of physical activity for people with life-limiting conditions, and to explore the physical activity needs of patients with life-limiting conditions identified by CNSs. A purposive sample of CNSs working in community palliative care received an anonymous online survey via email. The response rate was 66% (n=20). Most respondents were practicing for over 20 years (60%, n=12). All respondents (100%, n=20) reported they would like further information on the role of exercise for palliative populations. The main perceived benefit of physical activity was to improve quality of life (95%, n=18). A lack of physical activity guidelines for people living with life-limiting conditions was the most commonly reported barrier to engaging in discussions around physical activity (74%, n=14). Further education opportunities on the role of physical activity for patients living with life-limiting conditions are needed.

Safeguarding adults at risk of abuse presents complex ethical challenges. By knowing what counts as adult abuse, recognising the signs of adult abuse and appropriately addressing suspected adult abuse, nurses contribute to protecting patients' safety, well-being, autonomy and dignity. This article discusses categories and indicators of adult abuse, relevant legislation and standards, the principles of adult safeguarding and the key elements of a nursing assessment of suspected adult abuse. The author highlights that nurses need to approach safeguarding concerns sensitively and strike a balance between acting to safeguard the person and preserving their right to autonomy. There is a need for ongoing education and training to enhance nurses' understanding of safeguarding practices, legislation, policies and standards.

Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.

People experience life and interact with others in many ways. The term ‘neurodivergence’ refers to variations from what is considered typical. Research and education into neurodivergent conditions in women and girls is essential to inform a timely reassessment of clinicians’ approaches to those who present with multiple symptoms. Neurodivergence may influence a person’s style of communication, learning, attitudes, and behaviour, and they may experience inequity and rejection. A formal diagnosis improves access to support services and helps them and their family better understand themselves and the challenges they face. Neurodivergent females are very prone to developing many physical and psychological health issues, and it is important that clinicians learn to recognise and respond to these. This narrative review highlights the huge burden of co-occurring conditions carried by neurodivergent women and girls and suggests how clinicians might increase their awareness of diagnosis and management of these to mutual benefit.