Warrington and Halton Teaching Hospitals NHS Foundation Trust

BackgroundMedical school curricula in the United Kingdom (UK) have been reported to inadequately prepare newly qualified doctors to manage medical emergencies. Near-peer practice has been proposed to enhance emergency medical training. This study describes the development of a training session to improve the knowledge and confidence of newly qualified doctors to manage medical emergencies.MethodsA near-peer, interactive training session was developed to support newly qualified doctors in managing medical emergency scenarios. The Surgical and Medical Acute Response Training (SMART) session was delivered to newly qualified doctors in the induction week prior to their first clinical placements, which included medicine, surgery, psychiatry, and paediatrics. Pre-session and post-session questionnaires were used to assess the self-reported preparedness of newly qualified doctors to manage medical emergencies. Rank biserial correlation was used to estimate effect sizes. The Wilcoxon signed-rank test was used to identify statistically significant differences in ordinal data between the pre-session and post-session questionnaire responses.ResultsForty newly qualified doctors attended the SMART session, all of whom completed the pre-session questionnaire (response rate = 100%). Thirty-four participants (85%) completed the post-session questionnaire. Thirty participants (75%) reported exposure to simulation training during their undergraduate training. Seven (17.5%) reported that they considered their undergraduate medical training had prepared them to lead medical emergencies. In the pre-session questionnaire, participants indicated the highest confidence in completing airway, breathing, circulation, disability, and exposure (A-E) assessments and situation, background, assessment, and recommendation (SBAR) handovers. The lowest confidence was reported for determining treatment escalation plans. In the post-session questionnaire, a significant and large positive effect was observed in multiple items relating to awareness of medical emergency teams (METs) and roles of allied health professionals, confidence in leading METs, and clinical management of acute scenarios. No statistically significant effect on confidence in completing an A-E assessment was identified.ConclusionsThis study revealed that newly qualified doctors report reduced confidence across several aspects of managing medical emergencies. Participants reported an increase in confidence in managing acute medical emergencies after participating in the near-peer interactive training session. Clinical educators may consider implementing the SMART session to support newly qualified doctors at the beginning of their post-graduate careers.

Neurofibromatosis type 1 (NF1), a rare genetic disorder characterised by neurofibroma growth, affects approximately 25 000 individuals in the UK. Its wide range of clinical manifestations presents significant challenges in providing comprehensive care for patients. In agreement with National Health Service England's Commissioners, Childhood Tumour Trust initiated a patient-led service evaluation to understand existing care pathways and identify factors influencing patient satisfaction. The study was coproduced with patient charities, clinicians and the Patient Led Research Hub. Online surveys were composed for patients, families, carers (PFCs) and healthcare professionals (HCPs) and disseminated through charity and healthcare networks. Structured features were analysed using descriptive statistics to review pathways and examine correlations with care satisfaction. Free-text responses were coded and analysed thematically to explore PFCs' and HPCs' experiences. A total of 1083 PFC and 94 HCP responses were received from across the UK (783 and 49 were complete, respectively). Overall, 54% PFCs expressed dissatisfaction with NF1 care. While London had a significantly higher satisfaction rate (64%; p=0.01) than the national average, Scotland (30%, p=0.01) and Northern Ireland (16%, p=0.01) had significantly lower rates. Influencing factors included poor care coordination, long specialist wait times and insufficient signposting to charities. Regarding diagnosis and management, 46 HCP roles, 35 referral routes and 16 sources of management guidelines were identified, indicating a lack of clear pathways and care standardisation. Free-text data revealed additional challenges, including limited education and information for families, low NF1 awareness among professionals, inequitable access to specialists and a desire for holistic care. This evaluation revealed UK-wide dissatisfaction with NF1 care and a pressing need for system-level changes to improve regional disparities and care coordination, enhance patient education and HCP training and establish standardised pathways with a holistic model to enable high-quality equitable care for all NF1 patients.

Background: Bell's palsy is becoming more common in women and is frequently associated with pregnancy. Charles Bell was the first to define it in the 19th century as facial muscular paralysis brought on by an unidentified cause which predisposes people to physical, social, and psychological distress, with varying degrees of severity. Effective management, including medical, surgical, and physiotherapy approach, is made possible by early diagnosis and a thorough understanding of the course and risk factors. Aims: to enhance the current understanding of appropriate evidence-based physiotherapy practices for the management of Bell's palsy and to comprehend the role that pregnancy plays as a risk factor for the condition. Case: Right Facioparesis secondary to Bell’s Palsy in a Pregnant woman with Pre-eclampsia. Case Management: Comprehensive assessment was done on the 2024-05-23 and patient was discharged on 2024-7-12. Nine physiotherapy sessions was administered which included Kabat technique and electrical stimulation amongst treatment means. Conclusion: Using the House-Brackmann (HB) grading scale outcome measure to monitor progress of treatment significant recovery was attained from grade iv (moderately severe dysfunction) to grade i (normal facial function).

Bilateral successive anterior ischaemic optic neuropathy (AION) episodes are uncommon occurrences with a short list of differential diagnoses. We present the case of a 75-year-old male who developed bilateral consecutive non-arteritic AION after commencing 5-fluorouracil (5-FU) chemotherapy. The case report describes a temporal sequence of events with a halt in the progression of signs and symptoms upon cessation of treatment with this agent. Our patient demonstrated preexisting cardiovascular risk factors that were medically well controlled, as evidenced by laboratory results and blood pressure measurements. We reaffirm the current evidence that postulates an association between 5-FU use and arterial vasospasm in blood vessels predisposed to narrowing resulting in prolonged ischaemia to the optic nerve head.

Background Parkinson's disease (PD) is a chronic neurodegenerative disorder that significantly impacts patients' quality of life (QoL). Depression is a common comorbidity in patients with PD, potentially exacerbating QoL deterioration. This study aimed to assess the influence of depression on QoL in patients with PD at Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Nigeria. Methodology A cross-sectional, descriptive study design was utilized. The study included 420 patients with PD attending the Neurology Clinic at LAUTECH. A purposive sampling technique was employed to select participants. Data collection instruments included the Unified Parkinson's Disease Rating Scale (UPDRS) for PD assessment, the Hoehn and Yahr scale for PD staging, the Patient Health Questionnaire-9 (PHQ-9) for depression evaluation, and the Parkinson's Disease Questionnaire-39 (PDQ-39) for QoL assessment. Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY), with descriptive and inferential statistics (Chi-square test) to determine associations, considering a P-value < 0.05 as significant. Results Among the participants, the prevalence of moderate to severe depression was 245, representing 58.81%. QoL assessment revealed that 297 (70.71%) patients with PD reported poor to very poor overall QoL. A significant association was found between the degree of depression and overall QoL (P = 0.000). Patients with severe depression reported the poorest QoL, while those with minimal to no depression reported the highest QoL scores. Conclusions Depression significantly impacts the QoL in patients with PD at LAUTECH in southwestNigeria. Addressing depression in PD management is crucial to improve patient outcomes.

Non-surgical, conservative approaches to foot and ankle conditionsare of important consideration. Orthotics play a significant role in treating these conditions, preventing progression, and alleviating pressure on affected areas, thereby promoting normal gait. This article aims to assess the utility and effectiveness of various orthotic treatments in different clinical scenarios. We reviewed 27 peer-reviewed articles using electronic databases, employing keywords such as "orthoses," "orthotic treatment," "arthritis," "neuropathy," and "foot and ankle trauma."Studies conducted in recent decades have explored the effectiveness of orthoses in various conditions, including connective tissue disorders, tendon and ligament injuries, foot arthritis, neuropathic and inflammatory wounds, and sports-related recurrent injuries. Orthotic management has proven effective across diverse foot and ankle conditions. Integrating orthotic treatment with systemic approaches benefits patients with foot and ankle disorders.We believe this review can be utilised by clinicians in the management of foot and ankle disorders.

Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades. The primary outcome was the echocardiographic change in LV ejection fraction (LVEF). Six RCTs (randomizing 161 patients) and 47 observational studies (2644 patients) assessing the efficacy of upgrade to biventricular pacing were eligible for analysis. Eight observational studies recruiting 217 patients of CSP upgrade were also eligible. Fourteen additional studies contributed data on complications (25 412 patients). Randomized controlled trials of biventricular pacing upgrade showed LVEF improvement of +8.4% from 35.5% and observational studies: +8.4% from 25.7%. Observational studies of left bundle branch area pacing upgrade showed +11.1% improvement from 39.0% and observational studies of His bundle pacing upgrade showed +12.7% improvement from 36.0%. New York Heart Association class decreased by −0.4, −0.8, −1.0, and −1.2, respectively. Randomized controlled trials of biventricular upgrade found improvement in Minnesota Heart Failure Score (−6.9 points) and peak oxygen uptake (+1.1 mL/kg/min). This was also seen in observational studies of biventricular upgrades (−19.67 points and +2.63 mL/kg/min, respectively). In studies of the biventricular upgrade, complication rates averaged 2% for pneumothorax, 1.4% for tamponade, and 3.7% for infection over 24 months of mean follow-up. Lead-related complications occurred in 3.3% of biventricular upgrades and 1.8% of CSP upgrades. Randomized controlled trials show significant physiological and symptomatic benefits of upgrading pacemakers to biventricular pacing. Observational studies show similar effects between biventricular pacing upgrade and CSP upgrade.

Background Reports of high rates of non-union with poor functional outcomes following non-operative management of clavicle fractures have resulted in a shift of opinion towards the promising outcomes of surgical fixation. Varied implant choices with varying reports of successand associated complications have resulted in no definitive consensus on the choice of the ideal implant. Materials and Methods This is a retrospective study of clavicle shaft fractures stabilized using a Superior Clavicle Locking plate with lateral extensionin 40 active adult patients, predominantly male, with an average age of 36.7 years. Results Post-operatively, early mobilization was initiatedand on final discharge, there were no complaints of pain. All patients returned to their pre-injury levels of activity by four months, with all having achieved, essentially, a full range of movement by eight weeks post-operatively. Radiological union was observed in all patients by 5 months, except one. The QuickDASH scores of all the patients were less than 25 on discharge. Conclusion When surgical stabilization is considered in the management of active adults with clavicle shaft fractures, the superior clavicle locking plate with lateral extension appears to be a suitable implant by providing stable fixation lateral to the fracture, which is difficult with a regular locking plate.