Weston General Hospital

The co-existence of an ostium secundum atrial septal defect (OS-ASD) and an anomalous circumflex (LCX) artery is rare, with limited literature addressing the device closure in such cases. A middle-aged woman presented to us with dyspnoea on effort which had progressively worsened from New York Heart Association (NYHA) class I to II over 2 years and evaluation revealed a 16 mm OS-ASD along with an anomalous LCX arising from the right coronary sinus with a retro-aortic course. We report this rare case of atrial septal defect (ASD) device closure in a patient with anatomical combination of ASD and an anomalous LCX, suggesting the combination is not always a contraindication for transcatheter device closure.

Acute coronary syndrome, especially STEMI, is a major cause of mortality in Indonesia. Fibrinolytic reperfusion remains an important revascularization strategy, particularly in resource-limited settings. A 58-year-old male presented to the emergency department with severe chest pain radiating to the left arm and jaw for seven hours, unrelieved by rest. He also experienced diaphoresis and nausea. His history included 18 years of smoking and untreated hypertension. On examination, blood pressure was 176/111 mmHg with otherwise normal vital signs and no abnormal heart sounds. ECG revealed ST elevation in leads II, III, aVF, V5, and V6. The patient was diagnosed with inferior-apical STEMI, with possible posterior involvement, Killip I. Fibrinolytic therapy was administered with maximum dosage and duration. The key goal in STEMI management is achieving early and complete microvascular reperfusion. Fibrinolysis remains a practical alternative that reduces mortality when timely performed. Accurate diagnosis, appropriate therapy, and efficient referral systems are essential to improve outcomes, especially in archipelago regions with limited access to primary PCI.

Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in adults. National guidelines by the British Thoracic Society (BTS) and the National Institute for Health and Care Excellence (NICE) recommend follow-up chest imaging within six weeks for adults diagnosed with CAP to exclude underlying malignancy. Timely follow-up of radiological abnormalities in CAP is crucial, as infectious infiltrates can obscure early signs of malignancy. At our institution, follow-up imaging was often delayed or missed entirely, risking delayed cancer diagnosis. This quality improvement project (QIP) sought to quantify adherence to national guidelines and to assess whether low-cost interventions could improve compliance. The implementation of targeted, low-resource interventions significantly improved compliance with national guidelines. Ongoing efforts are necessary to sustain improvement and optimise patient outcomes.

Applications of multifunctional magnetic nanoparticles (MMNPs) are numerous and include environmental and analytical domains. Because of their distinct magnetic characteristics and surface functions, MMNPs are useful instruments for magnetic separation, biosensing, and imaging methods. Their efficacy, surface treatments, and current trends are examined in this chapter. With their great sensitivity and selectivity, MMNPs are excellent in analytical methods like magnetic separation, biosensing, and magnetic resonance imaging (MRI). MMNPs help solve urgent environmental issues by facilitating pollution identification, water purification, and soil remediation in environmental applications. Innovative synthesis techniques, including green synthesis and microfluidic-assisted fabrication, are the focus of current trends and offer scalable and sustainable MMNP manufacturing. Furthermore, several issues related to cost-effectiveness, repeatability, and scalability still exist and will require further study, as has been mentioned. This chapter emphasizes how important MMNPs are to the advancement of analytical and environmental sciences and calls for more research and development in this area.

Abstract Introduction Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outcomes can be repeated in other urological centres. Method We piloted a Geriatric Perioperative Care service delivering CGA to older emergency urology patients admitted to within a tertiary centre. The aim of the service was to reduce length of hospital stay (LOS). We evaluated it using quality improvement methodology. Patients for review were identified using age ≥ 65 and the Clinical Frailty Scale. Patients that were transferred to another hospital team prior to discharge were excluded. Results 101 patients were included: 35 in the pre-intervention group and 66 in the post-intervention group. Mean LOS in the pre-intervention group was 7 days. In the post-intervention group, mean LOS was reduced to 3.5 days, 6 days and 5.5 days in the first, second and third months respectively. Conclusion We found that perioperative geriatric care was associated with reduced length of stay in older urology patients. These data would support the need for larger and/or multicentre studies to evaluate the relationship between geriatric intervention in urological inpatients and length of hospital stay.

Previous studies have demonstrated that female patients with coronavirus disease 2019 (COVID-19) demonstrate more favorable prognosis relative to male patients. In this article, we elaborate the possible role of estrogen in the modulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection severity. The potential interplay between several factors, including inherently lower estradiol (E2) and slightly higher estrogen receptor β (ERβ) levels in males, with inflammatory mediators are described. Altogether, there seems to be a sexually dimorphic response towards SARS-CoV-2 infection, and a possibility that COVID-19 severity is dependent on both E2 levels and ERα:ERβ expression ratio in lymphoid and lung cells.

Dyslexia impacts upon reading and writing, but not upon intelligence. Little research has explored dyslexia in medicine. An online questionnaire was emailed to all medical students within a single medical school, inviting them to participate. Results were analysed using descriptive statistics. Statistical significance was calculated for any differences between gender, age group, or year-group cohorts. 123 individuals responded. Most reported a good understanding of dyslexia, and feelings that their peers with it should be supported. However, a minority reported feelings of jealously, and dissatisfactionfeeling that students with dyslexia should not be supported, as this gives them an unfair advantage. In some, this seemed to stem from a belief that dyslexia were not real, or that their peers were "faking it".

<h3></h3> It is established that using Palliative Outcome Measures (POMs) leads to an improvement in health related quality of life. The hospital and hospice palliative care teams identified that different assessment tools were being used across both settings and recognised this was a barrier to communication. Working together using the same assessment tools would improve communication, ensure consistency and promote patient centred care. Our aim was to implement POMs (Phase of Illness, Australia-modified Karnofsky Performance Status (AKPS) and Integrated Palliative Outcome Scale (IPOS) across both settings in order to provide a consistent approach. Using the POMs we wanted to capture changes in health status, promote improved communication between professionals, aid decision making, ensure patient driven assessment and planning and monitor if IPOS scores show an improvement in patient symptoms, wellbeing and quality of life. Joint meetings and training have already taken place with the plan to use quality improvement methodology to show whether: POMs are being used between settings and effectively improve communication. The level of patient compliance and whether it is user friendly Early recognition of patient symptoms and wellbeing leads to prompt interventions If patients admitted to hospital, hospice named nurse informs palliative care team of Phase of Illness and AKPS score. On hospital discharge letter to hospice/GPs/District Nurses the Phase of Illness and AKPS score is recorded. An IPOS form is given to all known and new hospice patients on discharge from WGH. Hospice to use PCOMs at MDT, and IPU meeting and record on handover sheets and electronic patient system. Using the QI methodology the first three PDSA cycles were formulated, Cycle 1&amp; 2 being joint meetings and training and a Go Live date was set. Cycle 3 plans to undertake the first review and audit after three months, when further cycles will be planned.