University Hospitals Sussex NHS Foundation Trust

To describe the outcomes of a protocol using ultrasound-guided pericardiocentesis with pericardial drain placement as definitive treatment for penetrating cardiac injury with tamponade in a resource-limited war zone setting, where emergency thoracotomy is often unavailable. Single-center prospective case series. Nasser Medical Complex, a major tertiary trauma center in southern Gaza, over a period of 24 months during active conflict. 25 patients (21 male, 4 female), aged 4-65 years, not in cardiac arrest, with traumatic pericardial effusions and hematoma caused by penetrating injury presenting within approximately 3 hours. Ultrasound-guided pericardiocentesis via a large-bore 16 gauge dialysis catheter, aggressive aspiration of fresh blood, instilling 1 gram of intrapericardial tranexamic acid (TXA) and pericardial drain placement for 48 hours with serial echocardiographic monitoring. Survival to hospital discharge, need for subsequent thoracotomy and complications. This study demonstrated a high survival rate of 96%, with 24 out of 25 patients surviving to hospital discharge (the sole non-survivor died from other injuries). The protocol successfully prevented the need for thoracotomy in 100% of cases, establishing it as a definitive treatment. A recurrence rate of 8% was observed, requiring repeat drainage in two patients, while follow-up was maintained for 83% of survivors. In a warzone setting, a protocol of pericardiocentesis with pericardial drain placement and intrapericardial TXA served as definitive management for selected patients with penetrating cardiac tamponade, resulting in high survival and avoiding the need for thoracotomy. This approach challenges current practice and offers a life-saving alternative in resource-constrained environments.

Focused abbreviated survey technique (FAST) brain magnetic resonance imaging (MRI) (i.e., sedation-free abbreviated MRI) is progressively being implemented in the daily clinical practice of multiple pediatric institutions for neuroimaging assessment of children presenting with neurological disorders. To survey current awareness, imaging practices, and perception of members of the European Society of Pediatric Radiology (ESPR) regarding pediatric FAST brain MRI. A survey consisting of seven questions related to FAST brain MRI was distributed electronically to all ESPR members. A total of 64 responses from 27 different countries (17 of which were European) were received, corresponding to a 4% response rate. Among responders, 68% were full-time pediatric radiologists and the great majority (94%) were aware of current clinical use of FAST brain MRI in the pediatric setting. Moreover, 83% already apply this imaging approach in daily work activity, more commonly for a few years (85%). The most cited advantage for adopting this imaging approach was radiation risk reduction (95%). Major reported obstacles to routine implementation were technical/human resource limitations (63%), potential medicolegal implications (55%), and lower image quality reducing diagnostic accuracy (53%). Diverse protocols are used, including utilization of inhouse/custom developed solutions (68%) or one of multiple commercially available/published protocols (17%), or both (15%). Near all participants (97%) expressed desire for formal consensus recommendations from the ESPR on the topic. Despite widespread knowledge and high clinical adoption rate of pediatric FAST brain MRI among participants, clinical indications/protocols remain variable and some barriers persist in the daily practice, highlighting the need for evidence-based consensus-driven guidelines.

Cardiovascular disease prevention is a key focus of current guidelines, emphasising medication adherence, lifestyle modification, and patient education. Nurses play a central role in delivering these interventions across the care pathway). This selection of recent studies highlights evidence on nurse-led, educational, dietary, and digital approaches to cardiovascular disease prevention, demonstrating both their potential benefits and the need for targeted, personalised strategies in clinical practice.

Neurobiomarkers measured in peripheral blood can supplement management strategies following traumatic brain injury (TBI). Dual-assay of glial fibrillary acid protein (GFAP) and ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1) is FDA-approved to inform a decision threshold approach (GFAP > 30µg.L- 1 and/or UCHL1 > 360µg.L- 1) for post-TBI neuroimaging. As physical activity and thermal strain often accompany TBI-prone activities, we investigated whether each molecule's quantification - and, by extension, clinical decisions - could be influenced by exercise-heat stress. In healthy volunteers monitored continuously for body core temperature (Tc), we used the i-STAT Alinity to assess plasma GFAP and UCHL1 responses to exercise in the laboratory (four female, eighteen male trained participants, cycling for 45min in 32°C) and field (three female and 22 male recreational marathon runners, finishing time 231 ± 34min, peak ambient temperature 11°C). Respective ΔTc overall were 1.42 ± 0.37°C and 1.87 [1.53, 2.31] °C. With laboratory exercise, GFAP and UCHL1 did not exceed the manufacturer's decision threshold. Across the marathon, GFAP was stable, whereas UCH-L1 more than doubled (200 [200, 200] vs. 462 [310, 782] µg.L-1, P < 0.0001), breaching the decision threshold for neuroimaging in 18/25 runners. Confounding from more severe exercise-heat stress should be considered when interpreting near-care assay of UCHL1 for TBI management.

Objective: Women aged 40–65 years, who undergo predictable and important physiological transitions, feel that access in England to Women’s Health and Wellbeing Services (WHWS) is poor and inequitable. The barriers and enablers to WHWS, focusing on sexual health and sexual wellbeing services, for women aged 40–65 years, and feasible suggestions for development, were explored from the perspective of 11 providers of health and social care. Design: A qualitative study, using semi-structured interviews, was conducted with providers of WHWS. Framework Analysis, applying the Socio-ecological Model (SEM), through an intersectionality lens, was employed to analyse the findings. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Setting and Participants: Eleven providers of care were recruited by convenience sampling from health and wellbeing settings serving the most under-resourced areas in South-East England. Results: The intersectional disadvantage of belonging to underserved groups overlapped across the constructs of the SEM. The main themes that emerged were the lack of prioritisation of midlife women within society, and the inadequate knowledge about the health and well-being requirements, including the sexual health and sexual well-being requirements, of midlife women. Conclusion: Amongst policy makers, the sensitive, complex, and interlinked nature of health and wellbeing, including sexual health and sexual wellbeing, of midlife women must be recognised. Investment in public and Health Care Professionals’ education, together with a life-course approach to health research and policy, is required to destigmatise and improve access to WHWS for midlife women.