St. Johns Hospital

<h3>Background and Importance</h3> Anticholinergic burden (ACB) is associated with several adverse outcomes, including cognitive decline, falls, and prolonged hospital stays. Despite the known harms, there remains a high prevalence of patients with a problematic ACB from their medications. As such, it is unclear how aware healthcare professionals (HCPs) are of ACB and HCPs’ abilities to identify and manage ACB-related issues in practice. <h3>Aim and Objectives</h3> To explore the views and knowledge of HCPs regarding ACB. <h3>Material and Methods</h3> An anonymous online survey was piloted with various HCP types and then distributed to HCPs via email and social media between March and August 2025. Descriptive statistics were performed on all survey questions, which included multiple choice and Likert scale questions. <h3>Results</h3> A total of 250 valid responses were received, from pharmacists (81.6%), nurses (7.2%), doctors (4.4%), and other HCPs (6.8%). Most respondents agreed that identifying anticholinergic medications is important for patient safety (97.6%), and that they can play a role in identifying anticholinergic medications (97.6%) and managing ACB (90.7%). However, a large proportion were <i>‘slightly’</i> or ‘<i>not at all’</i> confident in their ACB knowledge (40%), identifying strong anticholinergic medications (32%), and calculating an ACB score (50.4%). While nearly two-thirds indicated that identifying potential anticholinergic side effects is a priority in their day-to-day roles (65.9%), over one third were <i>‘slightly’</i> or <i>‘not at all’</i> confident in their ability to recognise adverse anticholinergic effects (36.1%). Nearly all reported that being informed of an ACB score would impact their approach to care (98%), but only half were aware of ACB scoring systems (50.8%); among these, 48% reported seldom use, 6.3% reported once-off use, and 20.5% reported never using them in practice. While nearly two-thirds were aware of steps that can be taken to reduce ACB (64.7%), 92% indicated they would like additional training to identify anticholinergic side effects and ACB in their patients. <h3>Conclusion and Relevance</h3> This study has uniquely highlighted deficiencies in HCPs’ knowledge and abilities to manage ACB. The findings demonstrate a need for further ACB education and training, particularly enhanced awareness regarding ACB scoring systems, which should aid HCPs in identifying patients with problematic ACB and ultimately help reduce patient harm. <h3>Conflict of Interest</h3> No conflict of interest

This survey study describes the top 5 standards for psychosocial care identified by clinicians and caregivers of pediatric patients with cancer.

End-of-life (EoL) continuous glass fibre-reinforced polyamide 6 composites (cGF/PA6) are commonly recycled by shredding and milling, followed by injection moulding, often resulting in lower mechanical properties of second-generation products, primarily due to fibre length reduction. This study investigates the thermomechanical reprocessing of cGF/PA6 laminates via compression moulding, aiming to retain maximum mechanical performance by preserving the fibre length. Two types of 2/2 twill glass fibre-reinforced anionically polymerised polyamide 6 laminates (cGF/APA6), with either a reactive sizing agent (RS) or a non-reactive sizing agent (nRS), were reprocessed at two different temperatures, i.e., at 180 °C (between the glass transition temperature (Tg) and the melting temperature (Tm) of PA6) and 230 °C (above the melting temperature (Tm) of PA6). The influence of reprocessing on matrix crystallinity, thermomechanical properties, microstructure, and flexural performance was investigated. The results revealed that reprocessing at both temperatures led to an improvement in matrix crystallinity, retention of the desirable α-crystalline phases, and an elevated Tg (glass transition temperature) in both reprocessed laminates. Additionally, reprocessing at 180 °C maintained the flexural performance in both, whereas reprocessing at 230 °C led to nearly 20% improvement in flexural strength for the RS laminate. The microstructural analysis of the failed flexural specimens showed matrix-coated fibre surfaces, highlighting retained fibre-matrix adhesion. Overall, the results offer insights into the potential of compression moulding as a viable alternative for recycling cGF/APA6 laminates.

Abstract Surrogacy intersects with ethical, social, and legal dilemmas, making it an invaluable case study for bioethics education. This paper posits that surrogacy can serve as an effective teaching tool, engaging students with complex issues that mirror broader societal concerns. By integrating systems thinking methodology into Moral Case Deliberation (MCD), educators can enhance students' understanding of these multifaceted dilemmas. Systems thinking allows for a holistic analysis of the interconnected factors and stakeholders involved in surrogacy, leading to more comprehensive and pragmatic solutions. The phenomenon of cross-border surrogacy, with its intricate layers involving surrogates, medical professionals, legal systems, and socio-economic factors, exemplifies a real-time bioethical issue. This approach encourages students to develop critical thinking, moral evaluation, and socio-cultural awareness. Adopting systems thinking in MCD enables bioethics education to address the complexities of modern reproductive technologies and their ethical implications more effectively.

Abstract Introduction Venous thromboembolism (VTE) prophylaxis is commonly administered to patients across many hospital settings; however, it can be more challenging to address in frailty patients. These patients are more likely to have contraindications to anticoagulation and be ‘delayed discharges’ (medically fit for discharge and at baseline mobility), at which point VTE prophylaxis may not be indicated. Method This quality improvement project was carried out in the acute geriatric ward at St John’s Hospital. With the aim to improve VTE prophylaxis (appropriately prescribed and deprescribed when delayed discharge) in frailty inpatients by December 2024, through education of medical staff and by creating a Trak proforma. Teaching was provided to ward medical staff and a new delayed discharge Trak proforma was created. This prompted a review of VTE prophylaxis deprescribing when patients were medically fit for discharge. A simultaneous QI project created an admissions proforma which prompted a review of VTE prophylaxis prescribing when a patient was first admitted to the ward. Results Before the intervention, only 58% of patients in Ward 8 had VTE prophylaxis correctly prescribed on admission. Many patients (40%) remained on VTE prophylaxis despite being delayed discharges. A staff survey revealed a higher confidence level around prescribing VTE prophylaxis than deprescribing. Only 44% of staff regularly considered stopping VTE prophylaxis once a patient was a delayed discharge. After the intervention, an increased number of patients (74%) had correct VTE prescriptions on Ward 8 admission (28% improvement). Only 16% of delayed discharge patients remained on VTE prophylaxis (60% improvement). Conclusion This project improved rates of VTE prescribing in patients admitted to an acute frailty ward and deprescription rates in patients where VTE prophylaxis was no longer indicated by prompting regular reviews of these prescriptions. This intervention could be utilised in other departments.

Characterization and prediction of the interactions between engineered nanoparticles (ENPs), proteins, and biological membranes is critical for advancing applications to nanomedicine and nanomanufacturing while mitigating nanotoxicological risks. In this work, we employ a coarse-grained dissipative particle dynamics (DPD) simulation to investigate the interactions among cytochrome c (CytC), lipid bilayers, and citrate-coated gold nanoparticles (AuNPs). We updated the DPD potential to accurately represent binding potentials between molecules, and validated the model relative to an all-atom representation. The DPD simulations successfully replicate experimental observations: CytC facilitates the binding of citrate-coated AuNPs to lipid bilayers composed of 90% dioleoylphosphatidylcholine (DOPC) mixed with 10\% stearoylphosphatidylinositol (SAPI) or 10% tetraoleoyl cardiolipin (TOCL)but not to pure 100% DOPC bilayers. In addition, the simulations reveal nuanced differences in binding preferences between CytC, the lipid bilayers, and the ENP, at a scale that is not presently directly observable in experiments. Specifically, we found that the surface coating of the nanoparticles---%viz variations in the CytC surface density---%affects the protein-mediated binding with the bilayers.Such a molecular-sensitive result underscores the utility of DPD simulations in simulating complex biological systems.

The global market for natural drugs has witnessed an upsurge in demand due to the increasing preference for traditional and herbal remedies. However, the surge in popularity has also led to a rise in adulteration practices, jeopardizing the safety and efficacy of these medicinal substances. This study addresses the critical issue of adulteration in crude drugs of natural origin and proposes a systematic evaluation approach through advanced analytical methods. The chapter focuses on developing and employing sophisticated analytical techniques, such as chromatography, spectroscopy, and microscopy, to identify and quantify adulterants in various natural drugs. By harnessing the power of these methods, we aim to establish a robust framework for the authentication and quality assessment of crude drugs. This involves the creation of reference standards and databases to facilitate the comparison and verification of botanical profiles, ensuring the integrity of natural drugs in the supply chain. Furthermore, the study delves into the development of novel methodologies for the detection of subtle adulteration, including the exploration of molecular markers and fingerprinting techniques. The proposed analytical methods are not only sensitive but also time-efficient, making them practical for routine quality control (QC) in the pharmaceutical and herbal industries. The outcomes of this chapter contribute to the establishment of stringent QC measures for crude drugs of natural origin, safeguarding consumer health, and preserving the efficacy of traditional medicines. By enhancing our understanding of adulteration patterns and providing reliable analytical tools, this study offers a comprehensive strategy to combat the escalating challenges posed by the adulteration of natural drugs, thereby fostering confidence in the utilization of these invaluable resources for therapeutic purposes.

As an equine registered veterinary nurse (RVN), it is essential to understand the fundamental welfare, health, and husbandry requirements for equine patients. This chapter includes information on welfare legislation, housing, nutrition, exercise, grooming, dental care, vaccinations, parasite control, breeds and markings, passports requirements and exports, handling and restraint, transport techniques, and equine behaviour,. The information in this chapter is an important foundation to developing and delivering a high standard of individualised nursing care to equine patients.

Aim: Informed consent for paediatric facial reanimation requires effective patient/parent education and involvement in a shared decision-making (SDM) process to help set their expectations and understanding from the outset. No article in the current literature has systematically reviewed the available tools for facilitating effective patient/parent education and the validity of informed consent in the context of paediatric facial reanimation. Methods: A systematic literature review was undertaken, following the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. MEDLINE via PubMed, Embase and Cochrane Library were searched and the results screened and reviewed in accordance with pre-defined inclusion and exclusion criteria. Results: The initial search yielded 478 articles, of which only 4 fulfilled the study’s inclusion criteria. One cohort study evaluated qualitative feedback from patients and their relatives participating in a family education and support day for paediatric facial palsy, while another article from the same group reviewed the readability of online education resources. The remaining two articles represented educational reviews focusing on treatment and patient education based on expert opinion without providing original outcome data. Conclusion: There is a paucity of evidence regarding patient/parent education to support the informed consent process for children undergoing paediatric facial reanimation. There remains a need for further resources and platforms to be developed that may support children and their parents in engaging in a SDM process, setting appropriate expectations, and providing valid informed consent for their surgery.