Western Health and Social Care Trust

Vitamin D is a key regulator of musculoskeletal growth, immune regulation, and cognitive function in children. As children in the United Kingdom (UK) and Ireland are at risk of vitamin D deficiency due to the northern latitude, supplementation is recommended. To our knowledge, the effect of supplementation on status and related health outcomes has not been investigated in children residing in the UK/Ireland. To examine the effect of vitamin D3 supplementation on vitamin D status and related health outcomes in children. The D vitamin in children study was a double-blind, randomized, placebo-controlled trial, conducted among healthy children (aged 4-11 y). Children received 12 wk of either 10 μg/d vitamin D3 or a placebo devoid of vitamin D (control) in the form of an oral spray. The primary outcome, plasma 25-hydroxyvitamin D, and secondary outcomes, including grip strength, balance, cognitive function, winter status, immune markers, and bone turnover markers, were assessed pre- and postintervention. One hundred eighteen participants completed the study (mean age 8.1 ± 1.8 y; 51% girls). Supplementation significantly increased 25-hydroxyvitamin D concentration (from 66.31 ± 17.26 nmol/L to 69.04 ± 16.93 nmol/L) compared to a decline in the placebo group (63.67 ± 19.48 nmol/L to 56.29 ± 18.58 nmol/L; P < 0.001) and prevented deficiency during the extended winter months. No effects were observed on muscle function, cognitive function, immune function, or bone turnover markers. Vitamin D insufficiency is prevalent in UK/Irish children, and supplementation in the form of an oral spray is effective in achieving/maintaining an adequate status in most children. Further research is warranted to elucidate mechanisms underpinning nonresponse to supplementation and to further investigate the potential beneficial effects of supplementation on cognitive function. This trial was registered at clinicaltrials.gov as NCT05018988.

Abstract Aim This study evaluates Key Performance Indicators (KPIs) in cholecystectomy at our Trust, assessing adherence to the British Benign Upper Gastrointestinal Society (BBUGSS) standards. Objectives included monitoring procedural volume, day-case rates, readmissions, index laparoscopic cholecystectomy rates for acute cholecystitis and Gallstone pancreatitis, conversion rates, complications, and mortality in alignment with national benchmarks. Method A retrospective cohort analysis included 599 patients randomised from 983 elective and emergency cholecystectomies performed trust-wide between April 2023 to April 2025. Data were obtained from electronic health records and theatre logs. Assessed KPIs included day-case rates, 30-day readmissions, index laparoscopic cholecystectomy for acute cholecystitis and gallstone pancreatitis, conversion rates, morbidity, bile leak, retained common bile duct (CBD) stones, major bile duct injury, and mortality. Descriptive statistics and chi-square tests were used for analysis. Results No mortality (0%) or major bile duct injuries (0%) were recorded. proportion of index or within two weeks laparoscopic cholecystectomy for gallstone pancreatitis was performed on 16.7% of cases and in 7.5% of those with cholecystitis. The 30-day readmission rate was 6.3%. Retained CBD stones were reported in 0.7%, and bile leaks in 1.5%. Overall morbidity was 11.7%. Subtotal cholecystectomy was performed in 2.3% and conversion to open surgery in 0.2%. Conclusions Outcomes largely align with national KPIs, with no mortality or bile duct injury and low rates of bile leak, retained stones, and conversion. However, the readmission and morbidity rates slightly exceed benchmarks in addition to lower proportion of index operations for cholecystitis and gallstone pancreatitis, indicating potential areas for improvement.

Patients with ankylosing spondylitis (AS) are vulnerable to cervical spinal fractures despite minute trauma. As there is a lack of consensus on which surgical approach is the most efficacious in treating cervical spinal fractures in AS patients, we sought to compare the posterior-only and combined (anterior-posterior) approach regarding intraoperative and postoperative complications. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (ID: CRD42024284877). Studies published up to May 20, 2025, were searched in PubMed, MEDLINE, and CENTRAL (Cochrane Central Register of Controlled Trials) with predetermined terms. Studies reporting outcomes, including intraoperative and postoperative complications and mortality rate, were evaluated. Included studies underwent a risk of bias assessment. Seventeen studies (one prospective, 16 retrospective) involving 858 patients (with AS and cervical spine fractures) with an average age of 59.9 years were included. The most common mechanism of injury was minor trauma (173, 66%), and C6-7 was the most common level injured (185, 50.6%). Although the posterior-only approach yielded fewer intraoperative complications (4 (4.8%) vs. 2 (15%); p>0.05), postoperative complications (17 (7.5%) vs. 16 (22.6%); p>0.05), and instrument-related complications (1 (2.8%) vs. 3 (12.5%); p>0.05) compared to the combined approach, the difference was not statistically significant. However, the combined approach recorded a significantly lower mortality rate (3 (9.2%) vs. 13 (24.5%); p>0.05) when compared with the posterior-only approach. The results of this systematic review suggest that both the combined and posterior-only approaches have advantages and disadvantages and approach selection should be done on a case-by-case basis. Future randomized controlled trials directly evaluating the efficacy of surgical approaches in such patients are needed to form a consensus.

Chronic pain and post-traumatic stress disorder (PTSD) are frequently comorbid and are associated with more significant pain-related disruption than chronic pain alone. It is not clear if these disruptions are due to traumatic experience or specific symptoms related to PTSD. This issue was evaluated in a large sample (N = 1367) of individuals with chronic pain presenting for treatment at an interdisciplinary pain rehabilitation service. As a secondary objective, the comorbidity of chronic pain and PTSD in Northern Ireland (NI) was also examined given high regional prevalence rates. Participants completed a PTSD screening measure, along with measures of pain interference, social functioning, pain anxiety, pain self-efficacy, pain intensity and depression. Screening indicated that 46.4% had never experienced a traumatic event, 22.5% had experienced a traumatic event but screened negative for PTSD and 31.1% screened positive for PTSD. Following identification of covariates, a Multivariate Analysis of Covariance examined differences in dependent measures by PTSD category, which yielded a similar pattern of results across measures. The group that screened positive for PTSD reported worse functioning and more disruptions in comparison to the other two PTSD groups, with the latter groups not differing on any measure. These analyses indicate that poorer functioning was not associated with trauma exposure alone; rather, it was experienced in association with PTSD symptoms. Further, comorbidity rates of PTSD and chronic pain in this NI dwelling sample were at the high end of the range in relation to previous work and exceeded past year regional prevalence estimates. PTSD assessment in those with chronic pain may be best served by evaluating the impact of these experiences on function, rather than focusing on the traumatic experiences in isolation. Further, there is scope to develop integrated chronic pain and PTSD treatments.

Alcohol and drug dependent individuals have consistently exhibited elevated impulsivity and some studies have indicated that impulsivity recorded in young adults predicts future alcohol abuse. Research also indicates that depressed individuals with higher impulsivity are more likely to report suicidal ideation even when they are less depressed, which may indicate that impulsivity could more strongly predict suicidality than severity of depressive symptoms. The aim of this study was to investigate the mediating role of impulsivity on suicidal behaviour and self-harm among students with depression, alcohol and substance abuse disorders. Participants were first-year undergraduate students (n=1829) across Ulster University (NI) and Letterkenny Institute of Technology - now known as Atlantic Technological University Donegal (ROI), who were recruited as part of the World Mental Health International College Student Initiative. Participants completed an online survey utilising the WMH-Composite International Diagnostic Interview Screening Scales (CIDI-SC). Mediation analyses were conducted in three different stages. A high prevalence of depression and substance use disorders, suicidal ideation, plans, attempts and self-harm were observed. Impulsivity was found to partially mediate the association between depression and suicidal behaviours and substance use disorders and suicidal behaviours. Impulsivity was significantly associated with suicide ideation, attempts and self-harm, but not suicide plans. Males were more likely to be impulsive, and higher levels of depression and substance use disorders were related to higher impulsivity. The main findings of this study reinforce the role of impulsivity in mediating the relationship between depression and suicidality and substance use and suicidality. College wellbeing services may consider whether screening for impulsivity, rather than for example substance abuse, could be more beneficial and less prone to under-reporting, when assessing for suicide risk among vulnerable students.

Sexually transmitted Chlamydia trachomatis infections remain common globally and most frequently are asymptomatic. The 2025 European C. trachomatis guideline provides up-to-date guidance regarding indications for testing and treatment of C. trachomatis infections. It includes advice on urogenital and extragenital C. trachomatis testing including the use of self-collected specimens; recommendation to use only validated NAATs for diagnosis; and recommendation to treat all C. trachomatis infections with doxycycline as first line in preference to single-dose azithromycin regimens. The absence of evidence and limited value of broad screening in asymptomatic populations for C. trachomatis infections is also discussed.

Since the publication of The Cancer Genome Atlas (TCGA) molecular Classification of endometrial carcinomas in 2013, multiple studies have demonstrated the prognostic and therapeutic importance of this. However, there is great variability on whether and how this is undertaken in different institutions, and this is often dependent on resources and availability of molecular testing. Points of controversy include whether molecular classification is needed on all endometrial carcinomas and whether pure molecular testing is undertaken or a surrogate such as the ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) Classifier. Herein we report our experience instigating molecular classification of endometrial carcinomas in Northern Ireland. From 1st March 2023, all endometrial carcinomas diagnosed on biopsy in the four pathology laboratories in Northern Ireland were referred to the central molecular pathology laboratory for genomic analysis using a custom next-generation sequencing (NGS) panel; the NGS panel included the entire coding regions of polymerase epsilon (POLE) and TP53 genes, as well as microsatellite instability (MSI) analysis. All cases also underwent immunohistochemical staining with oestrogen receptor (ER), p53, and the mismatch repair (MMR) proteins MLH1, PMS2, MSH2, and MSH6. The molecular results were available by the time of surgery (if a hysterectomy was performed) allowing integration into the final pathology report where a TCGA molecular type was assigned. Two hundred and sixty-seven endometrial carcinomas underwent molecular testing; in five cases, there was insufficient material for testing, leaving 262 cases. The TCGA groups were POLEmut (19; 7.3%), MMRd (63; 24%), p53abn (62; 23.7%), and no specific molecular profile (NSMP) 118 (45%). Seventeen tumours (6.5%) were "multiple-classifiers": five POLEmut-p53abn, two POLEmut-MMRd, one POLE-MMRd-p53abn (all included in the POLEmut TCGA group), and nine MMRd-p53abn (included in the MMRd group). This represents one of the first population-based studies investigating the prevalence of the different TCGA molecular groups of endometrial carcinomas in an unselected population. Performing molecular testing on biopsies enables management to be tailored to the molecular group and allows integration of the TCGA group into the report of the final resection specimen. We hope our experience will facilitate other laboratories in undertaking TCGA molecular classification.