Royal Cornwall Hospital

Abstract Granitic melts derived from anatexis of metasedimentary rocks, particularly biotite-dehydration reactions, are important lithium (Li) sources. Petrogenetic models depend on mineral-melt lithium partitioning, yet published partition coefficients ( $${D}_{{{{\rm{Li}}}}}^{{{{\rm{mineral/melt}}}}}$$ D Li mineral/melt ) vary by over an order of magnitude, and are commonly used as static values. Here we use thermodynamic modelling coupled with relevant published $${D}_{{{{\rm{Li}}}}}^{{{{\rm{mineral/melt}}}}}$$ D Li mineral/melt ranges, including a dynamic composition- and temperature-dependent $${D}_{{{{\rm{Li}}}}}^{{{{\rm{biotite/melt}}}}}$$ D Li biotite/melt , to quantify viable enrichment during partial melting and fractional crystallisation. Using the lithium-rich Cornubian granite batholith, we demonstrate the sensitivity of results to $${D}_{{{{\rm{Li}}}}}^{{{{\rm{mineral/melt}}}}}$$ D Li mineral/melt choices for modally-dominant lithium-poor phases (e.g. quartz), as well as phases traditionally thought to dominate lithium budgets (e.g. biotite). While economic lithium enrichment can result from extreme fractionation with selective $${D}_{{{{\rm{Li}}}}}^{{{{\rm{mineral/melt}}}}}$$ D Li mineral/melt , we suggest that dehydration melting of fluorinated biotite is the most viable petrogenetic model. The latter reconciles the common observations of fluorite in lithium-granites and their late-orogenic occurrence, and provides a mechanism for extensive fractionation.

BackgroundPenicillin allergy (penA) records are associated with negative patient and health-system outcomes, which makes removal of incorrect penA records (penicillin allergy de-labelling; PADL) an antimicrobial stewardship and patient safety priority. We set up a nurse-run, adult, low-risk PADL outpatient clinic, supervised by an antimicrobial pharmacist.MethodsAdult PADL guidelines were written and approved by the hospital, and PADL training was provided to nurses. Electronic adult referrals from hospital outpatient clinics and three GP surgeries in Cornwall were accepted. Patient telephone triage started from 6 January 2025, which included taking a penA-focused history, penA risk assessment and determination of PADL method. Eligible patients were invited for a direct oral penicillin challenge (DOC) test and were followed up via a telephone call 10 days after the test. The first outpatient PADL clinic was on 7 February 2025.ResultsThere were 404 referrals between 27 December 2024 and 16 September 2025, of which 326 were successfully contacted. Of these, 130/326 (39.9%) had a high-risk penicillin allergy history and 5/326 (1.5%) were excluded due to cognitive impairment. Of the 326 contacts, 191 (58.6%) were categorized as low risk. Of these, 22/191 (11.5%) were de-labelled on history alone, 54/191 (28.3%) were awaiting their outpatient DOC appointment or declined attending clinic, and 115/191 (60.2%) attended clinic for DOC. Of 115 patients, 110 (95.7%) patients were successfully de-labelled and 5 (4.3%) retained their allergy status due to side effects.ConclusionsPADL delivered by non-allergy nurses in the outpatient setting is safe and effective at removing low-risk penicillin allergy records.

Bisphosphonates have become a cornerstone in the management of osteoporosis and other bone-related conditions over the past few decades. While these medications have proven highly effective in reducing the risk of typical osteoporotic fractures, a concerning paradox has emerged: long-term use may be associated with a rare but serious complication known as atypical femoral fractures (AFFs). These unusual breaks occur in the shaft of the femur and differ significantly from common osteoporotic fractures in terms of location, appearance, and mechanism.This review explores the nature of these fractures by examining their characteristics, underlying mechanisms, risk factors, clinical presentation, diagnostic approaches, and management strategies. Understanding this complication is essential for clinicians who prescribe bisphosphonates and for patients who take them, as it highlights the importance of balancing the substantial benefits of these medications with their potential risks - particularly with prolonged use.

This project explores the feasibility of setting up a neuropsychiatric de-identified database (DiD) and a Research Register (RR) to collect, analyse, monitor and systematically report clinical data for people with intellectual disabilities (PwIDs) and epilepsy. A multicentre project designed to collect de-identified data from clinical records at three adult ID specialist services in England and Wales and to develop an RR of PwID and epilepsy. Patients added to the DiD will be identified from patient clinic lists, clinic letters, in-house databases and electronic systems. Patients to be added to the RR will also be identified through attendance for regular review at clinic appointments. The collected data will be entered into the Research Electronic Data Capture (REDCap) database. Personal details of PwID and their consultees will also be collected from participants who consent to be on the RR. Around 600 PwID and epilepsy (200 per site) will be added to the DiD at the three sites, while around 45-60 participants (15-20 per site) are anticipated to be added to the RR. Data analysis will involve using descriptive statistics to summarise feasibility outcomes, such as screening and recruitment rates, as well as the completeness of the collected data. The characteristics of the participants (demographic, ID classification, clinical, epilepsy history and antiseizure medication) will be summarised descriptively. Progression will be assessed using the Red/Amber/Green stop-go criteria to determine if a national register should be created. Ethical approval (24/NW/0210) has been obtained from the Northwest-Haydock Research Ethics Committee and the University of Plymouth Faculty Research Ethics and Integrity Committee (reference no. 5284). The project is funded by Jazz Pharmaceuticals as an independent investigator-initiated support grant and, as such, has received independent peer review. NCT06780501.

BackgroundRisk stratification is fundamental in guiding treatment decisions for mRCC patients. The Meet-URO score is a novel prognostic model (IMDC score + NLR + Bone metastases, PMID 36493602) developed in the immunotherapy era. This innovative score enhanced the prognostic discrimination compared with the IMDC score in patients receiving different therapeutic strategies in different settings.MethodsA previous external validation on a retrospective real-world cohort of 1174 mRCC patients receiving first-line immune-combinations from 27 centers showed the higher prognostic accuracy of the Meet-URO score compared with the IMDC score ( n. IUC20761-50). Here, we report the updated OS assessment with an exploratory analysis for PFS and ORR.Results: A total of1,418 patients from 31 cancer centers were assessed: 54% of patients received IO-IO (Nivolumab + Ipilimumab), 46% IO-TKI, mainly Avelumab + Axitinib (24%); 52.5% of patients had NLR ≥ 3.2, and 32% had bone metastases. After an mFU of 16.5 months, the overall mOS was 34.7 months and resulted in more distinction within the Meet-URO score groups (Table 1), confirming its better prognostic accuracy compared with the IMDC score (c-index: 0.68 vs 0.64), especially for intermediate- and poor-risk patients, while for favorable patients, more FU is needed. Although the Meet-URO score was developed as an OS model, it showed better performance also in terms of PFS (c-index: 0.60 vs 0.58) and ORR (c-index: 0.57 vs 0.54).ConclusionsThe Meet-URO score demonstrated robust and better performance compared with the IMDC score in a large-scale UK mRCC cohort receiving first-line immune-combinations, not only in terms of OS but also in terms of PFS and ORR. The adoption of the Meet-URO score in clinical practice and as a stratification factor of clinical trials could support more individualized patient management.ScoreGroup distributionHR (95% CI)P valuemOS(mo)3y-OSMeet-URO 113%1.00 (ref)45.866% 227%1.23 (0.88-1.72).2351.462% 322%1.74 (1.24-2.44).00137.653% 430%3.31 (2.42-4.51)<.00119.732% 58%4.82 (3.35-6.94)<.00111.526%IMDC Favorable19%1.00 (ref)45.861% Intermediate53%1.40 (1.09-1.79).00737.654% Poor28%3.23 (2.51-4.16)<.00114.930%

The purpose of this literature review is to highlight information on the use of traditional eye medicine (TEM) within Malawi. The papers included in the review were sourced from PubMed, African journals online (AJOL) and African Index Medicus (AIM). The search terms 'Traditional healers in Malawi' 'Traditional Eye care in Malawi' and 'Traditional medicine in Malawi' were used and studies were selected from 1990 through to August 2023. There is a need to strengthen blindness prevention in Malawi. Due to the already well-established use of traditional healers in the rural regions, it has been suggested that collaborating with them rather than working independently of them will be a better approach to tackling vision impairment. There are multifactorial apprehensions on the part of biomedical practitioners to work with traditional healers which range from a genuine concern that healers practice in a way that may be harmful to patients, to a lack of knowledge of the actual practices of traditional healers. More research needs to be done on how to bridge the gap between the two groups to tackle vision impairment in Malawi.

This study aimed to explore the barriers and facilitators of implementing rehabilitation interventions for visual field loss due to stroke. The study was a qualitative exploration using one-to-one interviews coded using template analysis and the COM-B a-priori framework. Participants were five occupational therapists from hospital (n=4) and community (n=1) National Health Service (NHS) stroke care settings in England. The intervention experienced by the participant was a standardized goal-based visual scanning and search training for stroke survivors with visual field loss, delivered by occupational therapists (OTs), supported by information sheets and a dedicated website (HABIT). HABIT provides a structured approach for delivering scanning and visual search training. HABIT resources aided participants' understanding and self-management. HABIT was considered similar to current practice as practiced by study participants and of most value to trainees and newly qualified therapists. However, resources had limited accessibility due to a lack of computer access and difficulty in reading text; modifications were required to make training activity examples more suitable for ward settings. Within ward settings, the delivery of HABIT was highly limited by time constraints; therapists ranked activities linked to safety and early discharge as higher priority. Clinicians noted that stroke survivors' lack of awareness of their visual loss and its impact limited their engagement with the HABIT, making delivery difficult. Prioritization of vision rehabilitation in highly pressurized acute settings is a key factor in implementing HABIT. The findings will enable further refinement of HABIT content and delivery to address the barriers identified and improve its suitability in acute hospital settings.

Skin cancer superclinics have been proposed as an innovative solution to current capacity shortfalls. The aim of this study was to investigate whether this model was associated with decision fatigue. Consecutive patients with suspected skin cancer who attended a superclinic in 2022 were compared with patients seen by the same clinician in standard clinics. Proxy markers of decision fatigue were cancer pickup rates and the proportion of patients discharged without histology following their initial clinic visit. Of 345 patients seen in superclinics, 100 (29.0%) had an ultimate diagnosis of skin malignancy vs. 161 of 588 patients (27.4%) seen in standard clinics (P = 0.598). Among the superclinic patients, 47.0% (n = 162/345) were discharged without intervention vs. 50.0% (n = 294/588) of patients in the standard clinic group (P = 0.369). The superclinic model did not appear to be associated with decision fatigue in the one clinician studied and proved a safe and effective means of providing clinical care, improving capacity and delivering training.