Princess Alexandra Hospital NHS Trust

<p><strong>Background: </strong></p> <p>Antimicrobial resistance (AMR) is a growing global health crisis driven by inappropriate antibiotic use, prolonged treatment, and inadequate documentation of prescribing rationale. Optimizing antimicrobial use through hospital-based stewardship interventions is a clinical priority to improve outcomes and curb resistance. This audit evaluated whether structured pharmacist–microbiologist interventions could enhance compliance with local antimicrobial-prescribing standards on a busy medical ward in a United Kingdom district general hospital.</p> <p><strong>Aim:</strong> To measure compliance with Trust antimicrobial-prescribing standards and assess the effect of pharmacist–microbiologist interventions on prescribing quality.</p> <p><strong>Methods:</strong> Two nine-week audit cycles were undertaken on medical ward. Each cycle included a four-week baseline review, a four-week stewardship intervention, and a one-week post-intervention re-audit. Data were extracted from the electronic prescribing system.</p> <p><strong>Results:</strong> In Cycle 1, baseline compliance was 63 % (guideline), 79 % (indication), and 83 % (duration), rising post-intervention to 83 %, 92 %, and 94 %. In Cycle 2, baseline rates were 63 %, 25 %, and 90 %, improving to 85 %, 69 %, and 92 % after intervention.</p> <p><strong>Action Plan</strong>: Daily pharmacist–microbiologist antimicrobial-stewardship ward rounds and integrated electronic prescribing prompts have been embedded into routine clinical practice. Regular re-audits and targeted induction training for new prescribers will help sustain ≥ 90 % compliance with guideline standards and support ongoing patient-safety improvement.</p> <p> </p> <p> </p>

Abstract Background: Lifestyle interventions are known to impact physical activity, mental wellbeing, and cancer recovery outcomes. This project evaluated the effectiveness of a lifestyle medicine coaching program over 12 weeks for overweight and obese breast cancer survivors on follow up across three domains: physical activity (Exercise Vital Sign - EVS), mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale - WEMWBS), and cancer wellbeing (FACT-G7 scores). Methods: Fifteen participants were assessed pre- and post lifestyle medicine program of education and patient led goal-based coaching for healthy behaviour change led by a lifestyle medicine physician, nutritionist, cancer exercise specialist and yoga teacher. Exercise minutes per week, mental wellbeing scores, and cancer wellbeing scores were collected and analysed using paired t-tests and Wilcoxon Signed-Rank Tests. Results: Significant improvements were observed across all three outcome areas. Weekly exercise minutes increased from a mean of 75.2 to 201.0 (t (14) = -5.81, p < .001, Cohen’s d = 1.5). Mental wellbeing scores improved from a mean of 45.0 to 53.0 (p < .05), with 86% of participants showing a meaningful positive change. Cancer-related wellbeing scores improved from 14.3 to 20.5 (t (14) = -3.266, p = .006). The proportion of participants with low mental wellbeing reduced from 43% to 11% post-intervention, while those reporting high wellbeing increased from 7% to 16%. Conclusion: The lifestyle coaching program produced statistically significant and clinically meaningful improvements in physical activity, mental wellbeing, and cancer-related health outcomes. These findings support the integration of holistic, behaviour-based coaching interventions into health promotion and cancer survivorship care pathways. Citation Format: Z. Wasim, N. Goyal, A. Konstantis, S. Patel. Impact of lifestyle coaching on physical activity, mental wellbeing, and cancer wellbeing scores [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-04-22.

Meropenem is a broad-spectrum carbapenem antibiotic commonly used in hospitals to treat moderate-to-severe infections. Although rare, meropenem can cause drug-induced liver disease, including mild transaminase elevation, cholestasis, or hepatic failure. This report presents an 80-year-old woman admitted after a mechanical fall and diagnosed with a catheter-associated urinary tract infection. Intravenous meropenem was initiated following urine culture confirmation of Citrobacter koseri in the context of worsening confusion and elevated inflammatory markers. Six days after starting meropenem, the patient developed generalised weakness and mild pruritus. Liver function tests showed significant abnormalities: alkaline phosphatase (ALP) 1450 U/L and alanine transaminase (ALT) 415 U/L. Liver function improved after meropenem was discontinued. The pattern of injury was consistent with cholestatic drug-induced liver injury (DILI) (R-value = 1), and an updated Roussel Uclaf Causality Assessment Method (RUCAM) score of 8 indicated a probable causal relationship with meropenem. This case highlights the importance of considering DILI, even with short-term antibiotic use, especially in elderly patients. Routine monitoring of liver function is recommended for those receiving meropenem. Early recognition and prompt withdrawal of the offending agent are essential for clinical improvement and prevention of complications.

This is the first study to propose a combined approach for predicting NB in ICU patients with suspected AMI. When AMI is highly suspected, surgical exploration should be considered in patients presenting with signs of gastrointestinal injury in a context of fluid removal or renal replacement therapy, as these findings are strongly suggestive of necrotic bowel.

This narrative review summarises key developments presented at the American Thoracic Society (ATS) 2025 International Conference and examines their relevance to lung cancer care in the United Kingdom, with particular emphasis on transatlantic differences between US and UK practice. Drawing on selected high‑impact plenary sessions, thematic symposia, expert panel discussions, and late‑breaking abstracts covering screening, diagnosis, staging, treatment, and survivorship, the review highlights advances in lung cancer screening eligibility, emerging artificial intelligence (AI) and radiomic tools for diagnostic support, updates to Tumour-Node-Metastasis (TNM) staging, and evolving approaches to quality‑of‑life assessment. UK‑specific perspectives are incorporated, including experience from a single National Health Service (NHS) tertiary centre involving patients diagnosed with lung cancer on clinico‑radiological grounds without tissue confirmation. Differences in diagnostic strategies, healthcare system design, and resource availability between the United States and the United Kingdom are explored to identify opportunities for shared learning and adaptation within NHS lung cancer pathways. This review aims to inform UK clinicians, multidisciplinary teams, and policymakers about international developments and their potential translation into contemporary UK clinical practice.

<h3>Introduction</h3> Coronary artery calcification (CAC) is associated with poor outcomes in patients undergoing percutaneous coronary intervention (PCI).¹Rotational atherectomy (RA) and orbital atherectomy (OA) are two ways to manage CAC.² <h3>Methods</h3> A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed was searched from January 2000 to July 2025. Eligible studies reported comparisons between OA and RA in the management of patients with severe CAC. Data was synthesised quantitatively and narratively. The Newcastle-Ottawa scale was used to assess risk of bias in observational studies, and the Cochrane Risk of Bias Tool was used for randomised controlled trials. <h3>Results</h3> No significant differences were found in short-term major adverse cardiovascular events (MACE), cardiac mortality, long-term non-fatal myocardial infarction (MI), or short-term target vessel revascularisation (TVR). RA was associated with higher long-term MACE (OR: 1.52, 95% CI: 1.02–2.27), long-term TVR (OR: 2.55, 95% CI: 1.14–5.71), short-term non-fatal MI (OR: 1.75, 95% CI: 1.05–2.92), and short- and long-term all-cause mortality (OR: 1.61 and 3.98, respectively). However, RA showed lower rates of coronary dissection (OR: 0.36, 95% CI: 0.29–0.45) and cardiac tamponade (OR: 0.34, 95% CI: 0.25–0.46). No differences were found in slow-flow/no-reflow, device-induced perforation, fluoroscopy time, or contrast volume. <h3>Conclusion</h3> OA is associated with superior long-term outcomes, while RA demonstrated fewer procedural complications, highlighting the need for individualised device selection based on patient and lesion characteristics. <h3>References</h3> Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. <i>J Am Coll Cardiol.</i> 2006;<b>47</b>(8 Suppl):C13-C18. Khan MH, Ahmed Z, Fatima B, <i>et al</i>. Rotational versus orbital atherectomy for treating heavily calcified coronary lesions: a meta-analysis. <i>Catheter Cardiovasc Interv.</i> 2020;<b>96</b>(6):1242–1249.

Tirzepatide (Mounjaro), a novel, dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, is increasingly prescribed for type 2 diabetes and off-label weight loss. While gastrointestinal adverse effects are common, hyponatremia induced by tirzepatide is rarely reported. We report a 63-year-old woman with no significant past medical history who developed tonic-clonic seizures 4 days after starting tirzepatide for weight loss. Laboratory evaluation revealed severe hyponatremia (serum sodium 122 mmol/L), low serum osmolality, and high urine osmolality and urine sodium consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). No other causes were identified. Discontinuation of tirzepatide and fluid restriction led to gradual normalization of sodium levels and full clinical recovery. This case highlights tirzepatide as a potential cause of SIADH and severe hyponatremia leading to seizures, even in low-risk individuals. Clinicians should monitor electrolytes when initiating GLP-1 receptor agonists, especially off-label.

The pleural clinic at Princess Alexandra Hospital in Harlow was established in 2023 following identification of a service need to streamline the managements of patients with pleural diseases. Since its development, over a 12 month period between January 2023 until December 2023, we have seen 79 patients, 56 (70.9%) of which are new referrals. The mean age of patients seen was 69.9years with 50% males. The major bulk of patients were reviewed for pleural effusions with only 3 (3.7%) being pneumothoraces. 32.1% of the referrals originated from wards, 12.5% came from Emergency Department/Same Day Emergency Care and oncology referrals made up 17.9% of referrals. Only 10% had transudative effusions. 6F Rocket drain was the most common procedure performed at 58.7%, 5 indwelling pleural catheters were inserted in this clinic and 4 were removed. Only 1 patient needed admission from clinic due to significant pain leading to vasovagal syncope. 15.2% of patients were referred to the thoracic surgeon for VATS. Of the 56 new patients seen, 5.2% were admitted to hospital within a week and there were 28.5% deaths within a 12 month period - 75% of the deceased patients had pleural fluid showing malignancy. The development of this service has really been a valuable addition to our district general hospital with positive patient feedback and has reduced follow up time and allows a more robust follow up pathway of patients with pleural diseases. We intend to continue to monitor and audit our performance over the past year.

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.