University Hospital of North Tees

To evaluate whether QR (Quick Response) code-linked digital patient information leaflets (PILs) improve documentation of shared decision making (SDM) and patient experience in elective hip and knee replacement clinics. A two-cycle quality improvement project (completed audit loop) comparing preintervention and postintervention outcomes. Elective orthopaedic clinics in a UK district general hospital (secondary care). Patients listed for elective hip or knee replacement during two 6-week periods (25 in cycle 1; 43 in cycle 2). Patients with incomplete records or not assessed face-to-face were excluded. Introduction of QR code-linked digital PILs between audit cycles, provided at clinic appointments. The resource included procedure information, anaesthetic options, recovery expectations and links to translation services. Primary outcomes were documentation rates of PIL provision and key SDM domains in line with NICE NG157 (National Institute for Health and Care Excellence Guidance) and GIRFT (Getting it Right First Time) standards. Secondary outcomes were patient-reported measures of clarity, usability, accessibility and preference, obtained through an anonymous Likert-scale survey. Documentation that a PIL had been offered increased from 7% (hip) and 9% (knee) in cycle 1 to 24% and 36% in cycle 2. Documentation of patient understanding rose from 79% to 90%, and recovery expectations from ≤9% to 36%. Survey results showed 100% of respondents found the digital information clear, 86% preferred it over paper and 71% reported greater engagement with the digital format. QR code-linked digital PILs improved documentation, engagement and accessibility in elective orthopaedic clinics. This low-cost, scalable intervention supports national guidance on SDM, aligns with NHS (National Health Service) Green Plan sustainability goals and has potential for spread to other surgical pathways.

We present the case of a 44-year-old male patient with a known history of pyloric stricture secondary to peptic ulcer disease who was admitted with quadriparesis, vomiting, and chest pain. He had a background of multiple endoscopic dilatations for gastric outlet obstruction and was severely malnourished at presentation. Clinical findings included markedly low serum potassium, phosphate, and magnesium, elevated creatine kinase, and ECG changes suggestive of myocardial strain. High-sensitivity troponin was also elevated, prompting evaluation for acute coronary syndrome and aortic dissection. Imaging ruled out structural cardiovascular pathology, and a diagnosis of type 2 myocardial infarction was made, likely secondary to electrolyte imbalance and volume depletion.Despite correction of electrolyte abnormalities, the patient’s neuromuscular weakness persisted, prompting neurologic evaluation and spinal imaging to exclude Guillain-Barré Syndrome and compressive pathology. MRI spine was unremarkable. Over the course of his intensive care admission, the patient received central electrolyte replacement, cautious nutritional rehabilitation, and multidisciplinary input from neurology, cardiology, gastroenterology, and dietetics. As electrolyte levels improved, so did his neurological function, and he regained significant muscle strength.He was subsequently transferred to the gastroenterology ward, where further endoscopic assessment confirmed ongoing pyloric narrowing. Given his history of multiple unsuccessful dilatations and persistent symptoms, he was referred to surgical services for consideration of a definitive gastrojejunostomy.This case highlights the importance of considering gastrointestinal causes of profound electrolyte disturbances and the potential for these metabolic abnormalities to mimic primary neuromuscular or cardiac pathologies. It also underscores the critical role of multidisciplinary collaboration in managing complex cases involving metabolic, nutritional, and functional decline. Early recognition and a systematic approach to diagnosis and treatment can prevent complications, improve outcomes, and avoid unnecessary interventions.

Gallstone ileus is a rare complication, typically resulting from a cholecystoenteric fistula. Its occurrence following endoscopic retrograde cholangiopancreatography (ERCP), particularly without evidence of fistula formation, is exceedingly uncommon. We present the case of a 69‑year‑old man with choledocholithiasis who developed gallstone ileus 48 hours after successful ERCP and stone extraction. The risk of gallstone ileus was anticipated during the procedure due to the large size of the bile duct stones. The patient subsequently developed symptoms of small bowel obstruction and underwent surgical intervention with enterolithotomy. Recognition of this potential complication, even in the absence of a fistula, is critical for timely diagnosis and management. This case emphasizes the need for careful procedural planning, documentation, and post‑procedural vigilance in patients with large biliary stones.

Presacral cystic lesions are rare and diagnostically challenging due to their nonspecific symptoms and deep anatomical location. We report a case of a youngwoman with apre-coccygeal cyst, first identified following an emergency Caesarean section in 2020. Over the next five years, the lesion increased in size, likely exacerbated by hormonal changes during successive pregnancies, resulting in chronic pelvic pain, neurological symptoms, and cutaneous fistulisation. Imaging via MRI and CT demonstrated a complex, encapsulated lesion with peripheral enhancement and restricted diffusion. Multidisciplinary evaluation suggested a congenital epidermoid or duplication cyst. Given the absence of malignancy and surgical complexity, a conservative management strategy was adopted. This case underscores the importance of including longstanding presacral cysts in differential diagnoses and highlights the value of multidisciplinary input and long-term surveillance in guiding management.

There is an increasing need to engage with evidence-based practice (EBP) and continuing professional development (CPD) to effectively respond to the current healthcare demands and challenges. This review highlights barriers to applying EBP and CPD, and synthesises the economic, ethical and legal implications of EBP and CPD in radiography. Inconsistent application of EBP and engagement in CPD may not only result in compromised professional development and gaps in knowledge in practice, but also affect patients, healthcare services and health organisations unfavourably from an economic, ethical and legal perspective. Leaders such as managers in radiology departments may play a key role in fostering an evidence-based culture. Consistent application of EBP and CPD in daily practice is beneficial to patients, professionals and healthcare organisations from an economic, legal and intellectual perspectives. Morally and ethically, although it has some conflicting views to EBP, applying an evidence-based approach may be considered a professional's responsibility to ensure the provision of prime quality care and treatment. The delay in translation of evidence-based interventions into everyday practice has several consequences and leads to possible missed opportunities including failure to provide best available care, reduction of unnecessary imaging procedures and cost. Hence, it is crucial for radiographers to regularly engage in EBP and CPD, and for healthcare organisations and radiology managers to educate themselves on EBP and CPD, and act as knowledgeable leaders for developing, enhancing, and sustaining EBP and CPD as the norm, create an environment that facilitates and empowers staff, and support staff to appreciate the rationale for any organisational changes associated with EBP.