Cognitive factors are associated with disability and pain, but not fatigue among physiotherapy attendees with persistent pain and fatigue.

Objectives: Most research exploring the relationship between cognitive factors and pain, disability and fatigue in patients with persistent pain/fatigue has been performed in multi disciplinary environments. It is unclear whether these associations are consistent in other contexts. This study therefore aimed to establish the relationships between these factors in patients with persistent pain/fatigue referred for physiotherapy treatment.

A case report of a ruptured subclavian artery aneurysm presenting to the emergency department.

Subclavian artery aneurysms are uncommon and present a diagnostic dilemma. Our patient attended with life-threatening rupture, requiring prompt management. However, lack of on-site facilities and specialist input posed a logistical challenge.

Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand.

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ.

Quality and Reliability of YouTube Videos as a Source of Patient Information on Rhinoplasty.

This study evaluates the quality and reliability of YouTube videos pertaining to rhinoplasty as a source of patient information.

Developing a video-based method to compare and adjust examiner effects in fully nested OSCEs.

Background: Although averaging across multiple examiners' judgements reduces unwanted overall score variability in objective structured clinical examinations (OSCE), designs involving several parallel circuits of the OSCE require that different examiner cohorts collectively judge performances to the same standard in order to avoid bias. Prior research suggests the potential for important examiner-cohort effects in distributed or national examinations that could compromise fairness or patient safety, but despite their importance, these effects are rarely investigated because fully nested assessment designs make them very difficult to study. We describe initial use of a new method to measure and adjust for examiner-cohort effects on students' scores.

Refining and testing the diagnostic accuracy of an assessment tool (PAT-POPS) to predict admission and discharge of children and young people who attend an emergency department: protocol for an observational study.

Background: Increasing attendances by children (aged 0-16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses. The Pennine Acute Hospitals NHS Trust Paediatric Observation Priority Score (PAT-POPS) was developed as an ED-specific tool for this purpose.

Encouraging Medium-term Results of Wallis Second Generation Dynamic Stabilisation Device.

Background: Aim of this prospective study was to evaluate safety and efficacy of second generation Wallis system for degenerative lumbar disc disease.

Material And Methods: 25 patients underwent discectomy and insertion of Wallis system. Outcome assessment was done using Modified Oswestry disability index (ODI) and visual analogue scale (VAS) for backache and leg pain.

Symptoms of chronic fatigue syndrome/myalgic encephalopathy are not determined by activity pacing when measured by the chronic pain coping inventory.

Objectives: Chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) is a chronic illness which can cause significant fatigue, pain and disability. Activity pacing is frequently advocated as a beneficial coping strategy, however, it is unclear whether pacing is significantly associated with symptoms in people with CFS/ME. The first aim of this study was therefore to explore the cross-sectional associations between pacing and levels of pain, disability and fatigue.

A case of multiple cardiac calcified amorphous tumours.

Cardiac calcified amorphous tumours of the heart are rare non-neoplastic cardiac masses that can present like a malignant mass or an intra-cardiac thrombus. We report an extremely unusual case of a 73year old man who presented to hospital with dyspnoea and subsequent investigations revealed multiple cardiac CATs.

Optimal timing for faecal tagging in same day CT colonography for patients with failed colonoscopy.

Aim: Same day CT colonography (CTC) for incomplete colonoscopy should be considered to avoid the need for further bowel preparation. Oral administration of contrast is essential for optimal colonic analysis of the CTC. Our aim was to determine the optimal time for giving contrast to people who underwent same day CTC after failed colonoscopy.

Role of IL-17 in plaque psoriasis: therapeutic potential of ixekizumab.

Developments in the understanding of the immunopathogenesis of psoriasis have identified interleukin (IL)-17 as the key proinflammatory cytokine in the pathogenesis of plaque psoriasis, with the consequent development of drugs that target this cytokine or associated receptors. Ixekizumab is a subcutaneously administered humanized monoclonal antibody, which acts to neutralize IL-17A. This article reviews the role of IL-17 in the pathogenesis of psoriasis, the biological and pharmacokinetics of ixekizumab and the safety profile and the clinical efficacy of ixekizumab in Phase III clinical trials.

Sternocleidomastoid pyomyositis.

Introduction: Pyogenic myositis (pyomyositis) represents a bacterial infection of striated muscle. Predominantly associated with tropical regions and commonly caused by Staphylococcus aureus, the incidence of cervical pyomyositis is rare. To our knowledge, we report the first case of group A streptococcal cervical pyomyositis in an immunocompetent British Caucasian patient.

Traumatic andropause after combat injury.

In association with lower extremity amputation, complex genitourinary injuries have emerged as a specific challenge in modern military trauma surgery. Testicular injury or loss has profound implications for the recovering serviceman, in terms of hormone production and future fertility. The initial focus of treatment for patients with traumatic testicular loss is haemostasis, resuscitation and management of concurrent life-threatening injuries.

The use of personal hearing protection in hostile territory and the effect of health promotion activity: advice falling upon deaf ears.

Introduction: Noise-induced hearing loss is a significant cause of morbidity among serving soldiers despite provision of a range of personal hearing protection (PHP) and education and training. It appears that soldiers are choosing to forego PHP. This audit aimed to evaluate the effect of health promotion activity on the use of hearing protection in hostile territory.

Cross-Atlantic modification and validation of the A Tool to Assess Quality of Life in Idiopathic Pulmonary Fibrosis (ATAQ-IPF-cA).

Rationale: The A Tool to Assess Quality of Life in Idiopathic Pulmonary Fibrosis (ATAQ-IPF) was developed in the USA to assess health-related quality of life in patients with IPF. It is likely that some of the original ATAQ-IPF items perform differently when applied in different countries. This paper reports results of a study conducted to identify the need to refine the content of the ATAQ-IPF to minimise cross-country bias between the USA and the UK.

Admission levels of serum amyloid a and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with C-reactive protein.

Background: Acute appendicitis is the commonest surgical emergency, but its diagnosis can be elusive with a negative appendicectomy rate of 20%. The aims of this study were to investigate the potential value of the markers of acute inflammation, serum amyloid A (SAA), and serum procalcitonin (ProCT), in the diagnosis of acute appendicitis in adults and to compare that with the commonly used serum C-reactive protein (CRP).

Methods: Adult patients presenting with acute right lower abdominal pain and a clinical suspicion of acute appendicitis were included.

Human factors perspective on the prescribing behavior of recent medical graduates: implications for educators.

Background: Junior doctors are at high risk of involvement in medication errors. Educational interventions to enhance human factors and specifically nontechnical skills in health care are increasingly reported, but there is no work in the context of prescribing improvement to guide such education. We set out to determine the elements that influence prescribing from a human factors perspective by recent medical graduates and use this to guide education in this area.

A painful thumb.

Isolated traumatic carpometacarpal (CMC) dislocation of the thumb is a rare injury. There are many different ways to manage a thumb CMC joint dislocation which ranges from closed reduction with or without Kirschner wires and casting to ligament reconstruction. However, it is still up for debate on the best management for this injury.

Specialist nurses improve outcomes in heart failure.

There are growing numbers of heart failure specialist nurses, who are well placed to act as a point of contact for patients with chronic heart failure in acute and primary care settings. Analysis of four studies shows that the work of these nurses improves quality of life and reduces hospital admissions. However, fewer than half of the patients who could benefit from referral to a heart failure nurse are actually referred, and there is a need for health professionals to be educated about their role.

A comparison of the diagnostic yield of rigid and semirigid thoracoscopes.

Medical thoracoscopy has an important place in the diagnosis and management of pleural disease. However, the application of this procedure is limited in the United Kingdom. This may be partly because respiratory physicians remain unfamiliar with standard rigid thoracoscopy instruments.