The British Orthopaedic Oncology Management (BOOM) audit.

Aims: Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in the UK.

Methods: A prospective, multicentre, national collaborative audit was designed and delivered by a trainee-led collaborative group.

Venous blood point-of-care testing (POCT) for paramedics in urgent and emergency care: protocol for a single-site feasibility study (POCTPara).

The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase 'see and treat' opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making.

Periprosthetic joint infection: what next?

Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there are still many unanswered questions. We now have a workable definition that everyone should align to, but we need to continue to focus on identifying the organisms involved.

Compliance with the Updated BASHH Recurrent Vulvovaginal Candidiasis Guidelines Improves Patient Outcomes.

Recurrent vulvovaginal candidiasis (RVVC) is a debilitating, chronic condition that affects over 138 million (6%) women of reproductive age annually. We performed a retrospective audit of RVVC referrals to our tertiary care clinic to evaluate the impact of the significantly updated British Association of Sexual Health and HIV (BASHH) 2019 vulvovaginal candidiasis guidelines on patient outcomes, the principles of which were implemented at our centre at the onset of the guideline revision process in 2017. A total of 78 women referred with suspected RVVC in 2017-2020 were included.

Patient expectations of cosmetic appearance after complex facial surgery in a low-income country.

Managing aesthetic expectations for patients post facial operations can be challenging in the high-income countries, yet alone in low-income countries. This cohort study involved patients undergoing facial operations during the October 2018 Facing Africa charitable surgical trip at the Nordic Medical Centre in Addis Ababa, Ethiopia. Twenty-one patients were shown pre and postoperative photographs of patients who had operations for similar facial pathologies on a prior surgical mission.

Histamine-2 (H ) antagonists can be safely removed from standard paclitaxel premedication regimens.

Aims: The aim of this study is to investigate the rates of hypersensitivity reactions (HSRs) in patients receiving paclitaxel chemotherapy, with and without a histamine-2 (H ) antagonists.

Method: This prospective, multi-centre, cohort study compared patients receiving paclitaxel treated with premedication regimens containing chlorphenamine, dexamethasone and an H antagonist vs patients treated without an H antagonist. Rates of HSRs were described and logistic multivariable regression was used to investigate any associations with H antagonist treatment, adjusting for confounding variables.

Markers of tumor inflammation as prognostic factors for overall survival in patients with advanced pancreatic cancer receiving first-line FOLFIRINOX chemotherapy.

Background: Identifying pretreatment blood markers that distinguish prognostic groups of patients with advanced pancreatic ductal adenocarcinoma (PDAC) under first-line FOLFIRINOX chemotherapy has the potential to improve management of this condition. Aim of this study was to determine the prognostic utility of a range of pretreatment, inflammation-related, blood cell markers in this group of patients.

Material And Methods: Data from a training cohort were analyzed to identify potential pretreatment blood markers correlating to survival outcomes.

Radiographers' self-perceived competencies after attending postgraduate courses in CT and MRI.

Introduction: Postgraduate education in computed tomography (CT) and magnetic resonance imaging (MRI) varies globally. Multiple factors affect the development of associated core skills and competencies for these specialist roles. Previous research has highlighted that different teaching standards and methods may influence radiographers' confidence and competencies.

Paediatric Dentistry and Orthodontics interface: When should we consider balancing and compensating extractions?

The guidelines regarding balancing and compensating extractions, published by the Royal College of Surgeons of England, are based on relatively low-level evidence and it is highlighted in the guidance that further research into these areas is required. This paper aims to appraise the current evidence base regarding balancing and compensating extractions, to aid general dental practitioners in their decision making. General and clinical factors that should be considered in the treatment planning process are discussed throughout.

An outbreak of livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) clonal complex 398 in a regional burns centre.

Background: Meticillin-resistant Staphylococcus aureus (MRSA) outbreaks have been reported previously in burns centres with resulting mortality and morbidity. This article describes the first human-associated outbreak in the UK caused by a strain of mupirocin-resistant (MuR) livestock-associated MRSA clonal complex 398 (LA-MRSA CC398) in an adult burns centre. The centre historically had a very low prevalence of MRSA infections.

Improving accessibility to outpatient clinics for adults with suspected seizures from the emergency department: A quality improvement project.

Introduction: Seizure-related presentations or suspected seizures, (i.e. epileptic seizures, PNES, cardiogenic and acute symptomatic seizures) comprise 1.

Social media: medical education's double-edged sword.

Social media (SoMe) are platforms that enable users to create and share content, or participate in social networking. Medical education is rapidly moving into a post-COVID world, with the use of SoMe becoming ever more prominent. We explore the risks and benefits of using this technology to assist learning and examine these in light of relevant educational theory.

What can we learn from supermarkets? An application of the Poisson distribution (order-up-to) model to improve blood culture bottle supplies.

Background: The order-up-to inventory model is a method for identifying and maintaining the optimal product level for items that that hold value over time and have recurring demand. Typically, supermarkets utilise it to manage stock-levels of non-perishable goods.

Local Problem: This project aimed to improve blood culture bottle supplies following reports by junior doctors of shortages when dealing with septic/unwell patients.

Aflibercept in clinical practice; visual acuity, injection numbers and adherence to treatment, for diabetic macular oedema in 21 UK hospitals over 3 years.

Introduction: Randomised controlled trials provide evidence that a treatment works. Real world evidence is required to assess if proven treatments are effective in practice.

Method: Retrospective data collection on patients given aflibercept for diabetic macular oedema over 3 years from 21 UK hospitals: visual acuity (VA); Index of multiple deprivation score (IMD); injection numbers; protocols used, compared as a cohort and between sites.

Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study.

Aims: Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography.

Running a one-stop clinic for patients with inflammatory bowel disease.

, Clinical Nurse Specialist, IBD, The Mid Yorkshire Hospitals NHS Trust (julie.carriss-wright@nhs.net), runner-up in the Awards 2020 Gastrointestinal/IBD Nurse of the Year category.

Double trouble - thyro-pericarditis: rare presentation of Graves' disease as pericarditis-a case report.

Background: Acute pericarditis is frequently encountered in clinical practice; however, pericarditis as the first presentation of Graves' disease is rare and mainly limited to case reports in the literature. We hereby report a case in which a young patient presented with pericarditis as the first manifestation of Graves' disease.

Case Summary: A 24-year-old male was admitted to hospital with presenting complaint of left-sided chest pain, gradual in onset, 6/10 in intensity, sharp in character, increased by deep breathing and improved by leaning forward.

Real-world experience with caplacizumab in the management of acute TTP.

The cornerstone of life-saving therapy in immune-mediated thrombotic thrombocytopenic purpura (iTTP) has been plasma exchange (PEX) combined with immunomodulatory strategies. Caplacizumab, a novel anti-von Willebrand factor nanobody trialed in 2 multicenter randomized controlled trials (RCTs) leading to European Union and US Food and Drug Administration approval, has been available in the United Kingdom (UK) through a patient access scheme. Data were collected retrospectively from 2018 to 2020 for 85 patients (4 children) receiving caplacizumab from 22 UK hospitals.