Wye Valley NHS Trust

Introduction: This study analyses the applicability of validated work stress and resilience assessment tools to the Occupation Therapy (OT) workplace, and OT’s understanding and experiences of the meaning of work stress and resilience, to inform current OT leadership and management approaches to work stress and resilience. Method: The study utilises mixed quantitative and qualitative methods involving a self-completed online questionnaire ( n = 36), the completion of three standardised work stress assessment tools and further qualitative semi-structured interviews ( n = 15) with thematic analysis of the transcriptions. Findings: Findings from the mixed methods data indicated divergence between the results from the validated tools and the Occupational Therapist’s actual experiences of resilience. Quantitative data indicated participants as having a ‘normal’ level of self-efficacy and resilience in the workplace with many of the stressors being reflected as positive and motivational pressures rather than harmful stress. However, findings from the qualitative data related negative experiences that system constraints and demands are having on participants’ self-efficacy, professional identity, integrity and consequently resilience. Conclusion: The findings highlight three key interrelated issues which inform current OT leaders and managers’ use of validated work stress and resilience tools, towards the development of a service resilience framework to better meet the needs of the OT workforce.

Background: Cutaneous carcinosarcoma is an exceptionally rare biphasic malignancy characterised by both epithelial and mesenchymal malignant components. Because of its aggressive biological behaviour, accurate diagnosis is crucial. Case Presentation: We report the case of an 87-year-old man with a three-month history of a posterior scalp lesion that began as a keratotic area and evolved to ulceration with intermittent pain. Clinical examination revealed a 3.0 × 1.2 cm ulcerated lesion without regional lymphadenopathy. A clinical impression of squamous cell carcinoma prompted wide local excision. Histopathological assessment identified a tumour measuring 8.2 mm in thickness with deep invasion into the reticular dermis and focal extension into subcutaneous fat (pT3). Microscopy demonstrated two intimately admixed components: an infiltrative basal cell carcinoma and a high-grade pleomorphic spindle-cell sarcomatous component. Immunohistochemistry showed dual expression of epithelial markers together with S100, p63, CD68, and vimentin, supporting the diagnosis of cutaneous carcinosarcoma. The sarcomatous component accounted for the deepest invasion. Conclusion: This case underscores the need for heightened awareness of cutaneous carcinosarcoma, particularly when encountering sarcomatoid features in lesions arising from common skin cancers. Immunohistochemistry plays an essential role in delineating its biphasic nature and excluding mimics.

This study assesses incidence, and overall and net survival in patients with lentigo maligna (LM) in England. Data show excellent 5-year net survival for all ages (> 100%), but overall survival in those aged 80+ years is only 60.4%, reflecting the impact of comorbidities and limited life expectancy. These findings highlight the need for LM management guidelines to incorporate frailty assessment and support shared decision making in older adults, including consideration of nonsurgical approaches.

A male patient in the late teens presented with intermittent right iliac fossa pain associated with fever and raised inflammatory markers following a previous episode of conservatively managed appendiceal mass and was treated for recurrent acute appendicitis. The patient was managed with intravenous antibiotics and underwent an appendicectomy. The histology of the specimen reported an appendix with perforation at the tip and surrounding congestion with associated malignant tumour involving the entire length of the appendix, and further testing showed signs in keeping with a diagnosis of high-grade B-cell non-Hodgkin lymphoma. The patient was subsequently informed of the underlying diagnosis following his management for appendicitis and underwent chemotherapy.

<h3></h3> Non-invasive ventilation (NIV) has proven clinical benefits in treating acute type 2 respiratory failure (T2RF), but can contribute to distress in the acute setting (Demoule <i>et al.</i>, 2018). This anxiety can result in poor NIV compliance - impacting on clinical outcomes such as length of stay, mortality, and morbidity (Yıldız <i>et al.</i>, 2022). This study sought to identify the contributory factors to distress when acute NIV is initiated, thus illuminating key actions to alleviate anxiety and promote patient compliance. All patients who received acute NIV for T2RF within a three-month period were approached with written information to obtain study consent. A semi-structured standardised telephone interview was conducted two weeks post-discharge with participants to minimise recall bias. Interviews were audio recorded, transcribed, and analysed by trained members of the study team. Patients were given the option to opt out at any time. 42 patients were identified as eligible to participate. Amongst these, the study recruited 19 patients from 1 December 2024 to 1 March 2025. 4 patients consented were lost to follow up with 1 patient withdrawing initial consent. 8 patients declined to participate. A number of patients were deemed inappropriate due to frailty (n=4), being end of life (n=8) and lacking capacity (n=3). BTS NIV Audit was conducted parallel to assess confounding factors. Qualitative thematic analysis identified aspects of patient care pivotal to compliance and patient anxiety. Key themes included difficulties with mask fitting and claustrophobia, interrupted sleep for monitoring, and communication from clinical staff to reassure and convey important clinical information on progress (see figure 1). A targeted action plan to focus on mask fitting, seal, comfort and adjustment, and communication was implemented. Healthcare staff involved in NIV provision attended advanced communication and interdisciplinary simulation training. Twice daily prompts were included in the NIV care plan to support communication on weaning and clinical progress. Open dialogue from clinical staff to assess comfort and sleep quality and pressure sore areas were standardised. A variety of masks with adjustable straps and interfaces were introduced. A repeat analysis of patient satisfaction and anxiety/distress levels is planned to be conducted in the autumn.

The British Association of Dermatologists and British Geriatrics Society recommend routine screening for frailty for all patients aged ≥ 65 years being considered for management of skin cancer using a validated tool such as the Rockwood Clinical Frailty Scale.

Emerging evidence suggests that coronavirus disease 2019 (COVID-19) survivors face increased risks of cardiovascular complications, but the long-term risks, underlying mechanisms, and clinical implications remain incompletely characterized. This systematic review synthesizes current evidence on post-COVID-19 cardiovascular manifestations, evaluating their incidence, pathophysiology, and outcomes. A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Fifteen observational studies (cohort, case-control, cross-sectional) meeting predefined eligibility criteria, confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, cardiovascular outcomes assessed ≥4 weeks post-infection, sample sizes >10, and peer-reviewed publication, were included. The risk of bias was assessed using the Newcastle-Ottawa Scale. The multinational studies (United States, Europe, Asia, South America) involved diverse populations (n=80-8,126,462), with follow-up durations ranging from three to 24 months. Mechanisms such as endothelial dysfunction, myocardial inflammation, and autonomic dysregulation were consistently supported across studies via imaging (e.g., cardiac MRI) and biomarkers (e.g., troponin, C-reactive protein (CRP)). Persistent arrhythmias and subclinical myocardial injury were directly demonstrated in 40-60% of patients. Worse outcomes were associated with hospitalization during acute infection, preexisting cardiovascular disease, and metabolic syndrome. Heterogeneity in follow-up durations may limit the detection of very-late-onset complications, though risks remained elevated across all intervals. Individualized management strategies should include cardiovascular imaging (echocardiography, MRI), biomarker profiling, and tailored pharmacotherapy (anti-inflammatory agents, anticoagulants). The ethical rationale for randomized trials is now strengthened by the clear evidence of long-term risks; ongoing trials are testing targeted anti-inflammatory and anticoagulant regimens. These findings underscore the necessity of systematic cardiovascular surveillance and risk-stratified care for COVID-19 survivors. Future research should prioritize extended follow-up studies and randomized controlled trials (RCTs) to optimize interventions for this growing population.

SUMMARY BOX Health played a central role in the recent Conference of Parties 28 (COP28): witnessing the first official ‘Health Day’, the first COP climate-health ministerial, endorsements of a declaration on climate change and health by 149 countries, the highest number of climate and health-related side-events, and funding commitments of US$1 billion dedicated to climate and health. In this first-ever quantitative analysis of the health community’s attendance at UN climate conferences between 1995 and 2023, we show a steady increase in absolute attendance of health actors, with the highest attendance of health actors at COP28 (n=1612) compared with the lowest attendance at COP1 (n=17). Yet, the percentage of health delegates remained largely constant over time in relation to the overall number of attendees. Although a small number of Ministers of Health attended individual COPs between 1995 and 2022, COP28 was attended by approximately the same number of Health Ministers (n=52) as in all previous COPs combined (n=53). While parties and representatives of the UN and its Specialised Bodies increasingly embrace the health narrative, crucial climate change commitments continue to lag. Without fundamental social change, without phasing out fossil fuels, and without climate justice, the health narrative for climate change cannot bring what it promises: health for all.