Royal United Hospital

CT-P13 SC, a new subcutaneous (SC) formulation of biosimilar infliximab (IFX), was approved by the European Medicines Agency in 2020 for the treatment of radiographic axial spondyloarthritis (axSpA) in adult patients. The present study aimed to assess the real-world outcomes of CT-P13 SC (SC IFX) as a treatment for both radiographic and non-radiographic axSpA. Data were drawn from the Adelphi Real World axSpA Disease Specific Programme™, a cross-sectional survey with retrospective data collection in France, Germany, Italy, Spain, and the UK between June 2023 and June 2024. Rheumatologists and their patients with axSpA completed questionnaires on patient demographics, clinical characteristics, and treatment satisfaction. Outcomes for patients on SC IFX were analyzed, with additional evaluations based on baseline characteristics and treatment patterns. Such outcomes were also compared with patients receiving other advanced therapies, including biologics and Janus kinase inhibitors. In total, 191 patients were evaluated. The mean patient age was 44.5 years, and most were male (117 [61.3%]). Baseline characteristics were similar between radiographic and non-radiographic axSpA patients, with a higher proportion of patients in the radiographic group (116 [60.7%] vs. 75 [39.3%]). Significant improvements in disease severity were observed with SC IFX from treatment initiation to data collection (severe disease: 37.4% to 3.2%), along with significantly lower levels of pain and fatigue, and fewer tender entheseal points and affected joints (all p < 0.0001). SC IFX treatment was also associated with improvements in musculoskeletal, extra-articular, systemic, and functional symptoms, and inflammatory imaging features. Subgroup analysis showed that SC IFX was effective across various patient populations with differing characteristics such as age, prior experience with advanced therapies, or coexisting conditions. SC IFX showed high treatment satisfaction for both physicians and patients. No new safety signals were reported. In this real-world study, SC IFX demonstrated clinical effectiveness in both radiographic and non-radiographic axSpA, with consistent results across diverse patient characteristics. Both physicians and patients reported high satisfaction with no new safety concerns. This analysis suggests that SC IFX can be an effective, convenient, and well-tolerated treatment option for diverse axSpA patient populations.

The aims of this study were to gain an understanding of the relative incidences of bone and joint injuries around each finger joint after a fall on the outstretched hand. Injuries at a single hospital over 1 year were recorded and validated by a Delphi review. The Delphi study assessed the perception of consultant hand surgeons about the frequency of peri-articular injuries. There were 97 injuries in 95 adults with a mean age of 42 (range 18-91) years. There were 52 men and 43 women. There were 28 injuries around the distal interphalangeal joint, 54 injuries around the proximal interphalangeal joint and 15 injuries around the metacarpophalangeal joint. The commonest injuries were bony mallet injuries, palmar plate injuries and dislocations of the proximal interphalangeal joint and transverse fractures of the base of the proximal phalanx. Seventeen consultant hand surgeons completed the Delphi study. Their responses matched the findings of the 1 year review of the injuries except that they expected many more tendinous mallet injuries. The patterns of peri-articular finger injuries differ greatly between the three finger joints. This is explained by the mechanism of falling and the local biomechanical forces. IV.

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations (CoSTR) pubished by the International Liaison Committee on Resuscitation (ILCOR). The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation. The post-resuscitation care of children is described in the ERC guidelines 2025 Paediatric Life Support.

BackgroundStress echocardiography is a key imaging modality for assessing coronary artery disease in the UK. Traditionally, stress echo services were led by consultant cardiologists, but evolving workforce models have increased the involvement of cardiac physiologists and scientists. This study, as part of the National Review of Stress Echocardiography Practice (BSE N-STEP), aimed to evaluate current stress echo workforce structures and test outcomes across a group of UK hospitals to inform future workforce planning.ResultsData were analysed from 8506 stress echocardiograms, conducted between September 2020 and June 2023 across 34 UK hospitals. Based on the supervising workforce, stress echocardiograms were allocated into either a doctor-led (DL) or cardiac physiologist/scientist and nurse-led (CNL) model. 56.9% of stress echocardiograms were DL, while 42.7% were conducted under a CNL model. Physiologists/scientists were the most frequently involved staff (81.9%). The primary indication for stress echocardiography was ischaemia evaluation (89.4%). Dobutamine stress echocardiography was more common in DL services (63.0 vs. 56.3%, p < 0.001), while CNL services performed more exercise stress echocardiography (42.8 vs. 36.4%, p < 0.001). Test positivity rates were similar between DL and CNL models (17.1 vs. 17.7%, p = ns), though the CNL group had a lower complication rate (2.2 vs. 5.3%, p < 0.001). Reporting of stress echocardiograms remained consultant-led in 82% of cases, but physiologist/scientist-led reporting showed an increase over time. Training was primarily provided to registrars/fellows (60.2%), with physiologist/scientist trainees accounting for 32.4%. ConclusionsThis study provides a contemporary overview of stress echocardiography workforce models in the UK, highlighting the increasing role of cardiac physiologists and scientists in supervising and reporting stress echocardiography. Despite these shifts, consultant cardiologists remain central to stress echo reporting. The findings support the integration of multidisciplinary workforce models to enhance service efficiency. These insights will aid in future workforce planning and training strategies to optimise stress echocardiography service provision across the NHS. Supplementary InformationThe online version contains supplementary material available at 10.1186/s44156-025-00088-x.

Ventilator-associated pneumonia (VAP) is the most prevalent nosocomial infection in the intensive care unit (ICU), accounting for more than 30% of the overall costs for all healthcare-associated infections. VAP leads to poor outcomes, such as increased duration of mechanical ventilation, prolonged length of ICU stay and increased mortality rates for up to five years after discharge. The pathophysiology of VAP is complex, attributable to the colonisation of abnormal microbiota and micro-aspiration risks associated with mechanical ventilation and critical illness, and thus its prevention and treatment is complex. With the rising prevalence of multidrug resistance infections and antibiotic prescription pressures, the management of VAP is becoming increasingly challenging. The traditional treatment of VAP with intravenous or oral antibiotics is effective; yet inhaled antibiotics may offer a targeted, synergistic and effective alternative. Empirical therapy with broad-spectrum antibiotics are associated with systemic complications and increased pathogenic strains, whilst inhaled antibiotics reduce bystander antimicrobial resistance with fewer systemic side effects. However, large-scale clinical trials have failed to cosnsitently demonstrate the clinical benefits of inhaled antibiotics and thus translation into practice remains controversial. In this review, we summarise the pathophysiology and diagnosis of VAP, underpin the mechanisms of currently available therapies and discuss the potential role of inhaled antibiotics for the prevention and treatment of VAP, with critical discussion of the available evidence.

To explore modifications of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guideline algorithm for neuroprognostication after cardiac arrest to improve its prognostic accuracy. Post-hoc analysis of four prospective multicentre studies (TTM, TTM2, KORHN and ProNeCA). We raised the Glasgow Coma Scale motor (GCS-M) inclusion threshold at 72h after cardiac arrest from the current GCS-M<4 to GCS-M<6 (all unconscious patients). Secondly, we included good outcome predictors (GCS-M 4-5, neuron-specific enolase<17µg/L, benign electroencephalography patterns≤72h post-arrest and normal magnetic resonance imaging at 72-168h post-arrest) in the algorithm. Functional outcome was assessed dichotomously at six months, including modified Rankin Scale 0-3, Cerebral Performance Category 1-2 or Glasgow Outcome Scale 4-5 (no symptoms to moderate disability) as good outcome. We analysed 3,388 patients, of whom 2,079 had GCS-M<4 at≥72h. Of the 874 patients identified by the 2021 ERC/ESICM poor outcome criteria, 870 had poor functional outcome (specificity: 99.6% [95%CI 99.0-99.9]). Using the GCS-M<6 threshold, 366 more patients entered the algorithm (N=2,445). Seven more patients with poor outcomes were identified, with close to identical specificity. Good outcome predictors thereafter identified 673 patients with potential recovery, of whom 411 (61%) had a good functional outcome at six months. With the updated algorithm, the number of prognosticated patients with an indeterminate prognosis decreased from 1,205/2,079 (58%) to 891/2,445 (36%). Raising the GCS-M inclusion threshold and adding favourable predictors to the 2021 ERC/ESICM prognostication algorithm reduced prognostic uncertainty without increasing falsely pessimistic predictions.

Abstract Aim As healthcare professionals we are exposed to emotionally and psychologically challenging cases. The nature of our work, combined with increasing system stressors contribute to a worrying national trend. Rates of burnout are rising, trainee wellbeing scores are the worst reported since the survey began, and retention is low. National provision of trauma support is variable, with little training around psychological safety and coping strategies. Method Over the last year, following agreement with the Southwest surgical training committee, ‘Dealing with difficult cases’ sessions have been delivered at surgical training events. These included sharing stories and experiences of Post Traumatic Stress Disorder, burnout, performance anxiety, the value of regular coaching and finding joy at work, all through a trauma-informed lens. Facilitated discussions explored the emotions, triggers and fears around our personal responses and signposting to support resources. Results All sessions received overwhelmingly positive feedback. Trainees and Consultants attending the session found it invaluable and relevant to their everyday practice. Four trainees have since been signposted to support services following the opportunity to share their experiences for the first time. Conclusions These sessions have identified an important gap in surgical training, which is vital for ensuring surgeons are capable not only of recognising the impact of trauma on themselves, but delivering trauma informed care to their patients, and supporting junior colleagues. It aligns with the general competencies’ framework and the new surgical curriculum. This is the first step in a necessary culture change within surgery and we are working to expand this training regionally.

Abstract Background/Aims Eosinophilic fasciitis (EF) is a rare disorder characterised by inflammation in the fascia that results in non-pitting oedema, followed by collagenous thickening. However, the pathogenesis is poorly understood and the condition is heterogeneous in both its symptoms and severity. Despite the name of the condition, it is important to understand that peripheral eosinophilia and the presence of eosinophils in the skin biopsy are not essential in making a diagnosis of EF. Methods A 58-year-old black woman, with hypertension, diabetes, alopecia and dilated cardiomyopathy, presented with a six-month history of bilateral progressive swelling in her forearms and calves, with skin tightening and significant weight loss, but no history of Raynaud’s. On examination, she had tender, symmetrical, thickened skin in the forearms and calves, which was shiny and indurated, with elbow and knee contractures to 120 degrees and a positive groove sign. She had no sclerodactyly, nailfold changes, calcinosis, telangiectasias or synovitis. She had preserved power throughout all limbs with normal sensation. Cardiovascular and respiratory examinations were unremarkable. Results Bloods showed ESR 34mm/h and CRP 27mg/L, with negative rheumatoid factor, anti-CCP antibodies, ANA, myositis antibody panel and ANCA. IgG was elevated (25.6g/L), with no paraprotein. She had mild leucocytosis (11.4x109/L) with neutrophilia (8.2x109/L), but normal eosinophils (0.3x109/L). CT chest/abdomen/pelvis showed no malignancy but small volume right axillary and pelvic lymph nodes. MRI forearm showed intermuscular fascial thickening and oedema, with subcutaneous oedema consistent with EF. Deep skin biopsy showed thickening of the fascia with lymphoplasmacytic inflammatory infiltrate but no eosinophils, but in keeping with EF. She was treated with prednisolone 40mg once daily, but lack of progress led to escalation of therapy with intravenous methylprednisolone 500mg for three days, followed by prednisolone 0.5mg/kg and a slow wean. Methotrexate 20mg once weekly was added, alongside hydroxychloroquine 200mg once daily. Her inflammatory markers improved with treatment (ESR 28mm/h, CRP 5mg/L) yet there was no significant change in her contractures, swelling and pain. Conclusion EF is a rare disease and it is important to have a high index of suspicion in a patient who presents with scleroderma-like skin with no history of Raynaud’s. A dual approach of MRI and deep skin biopsy helps support the diagnosis, especially in the absence of significant peripheral eosinophilia. Peripheral eosinophilia and histopathological infiltration of eosinophils in the fascia are effective, but not essential, for a diagnosis of EF. Furthermore, there is no standardised treatment pathway for EF, but whilst steroids are often effective at inducing remission, in this case steroids had a limited impact. It raises the question of whether this is secondary to the lack of peripheral eosinophilia and eosinophils on the biopsy. This may represent a subset of EF patients with poor response to standard therapy. Disclosure D. Srikantharajah: None. J. Kimpton: None. Y. Man: None.