How do patients determine when their inhaler is empty? Insights from an analysis of returned inhalers and a patient survey.

Background: Inhalers are widely used for the management of asthma and chronic obstructive pulmonary disease. However, there is little knowledge about the extent to which an inhaler is used and when it is disposed of, despite the implications for an individual's health (when used beyond the recommended number of doses (overused)), and medicine wastage, healthcare costs and the environment (when discarded with remaining doses (underused)). To explore inhaler use, we assessed the number of doses remaining in pressurised metered-dose inhalers (pMDIs) returned via a Chiesi Inhaler Recycling scheme.

Assessing disability progression using the WHODAS 2.0 in multiple sclerosis: Investigating clinical and socio-demographic factors in a large longitudinal cohort study (TONiC-MS).

Background: Identifying influences on disability accumulation in multiple sclerosis (MS), including modifiable factors other than the core features of disease itself, is vital for clinical care, but has often relied on instruments with acknowledged psychometric shortcomings. We model MS disability using the WHO Disability Assessment Schedule (WHODAS) 2.0, a validated measure based on the WHO's biopsychosocial model and sensitive to the breadth of disability-related domains important to people, to investigate the factors associated with its trajectory after diagnosis.

The Impact of Age and Sex on Fasting Plasma Glucose and Glycated Haemoglobin (HbA1c) in the Non-diabetes Population.

Introduction: We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50 years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels.

Methods: We extracted data on same-day, paired HbA1c and FPG levels from clinical biochemistry laboratory databases from Mersey and West Lancashire Teaching Hospitals NHS Trust (n = 10,153) and Cambridge University Hospitals NHS Foundation Trust (n = 10,022) between Jan 2019 and Dec 2023.

Lower limb necrotising fasciitis descending from malignant colonic perforation: a rare pattern.

Necrotising fasciitis (NF) is a rare surgical emergency characterised by soft tissue necrosis and systemic compromise. Typically it originates following adjacent skin and soft tissue insult; however, our unusual case required a high index of clinical suspicion to avert potential mortality. A man in his 60s with diabetes mellitus presented with 2 weeks of knee pain, swelling and necrotic skin on the posterior calf.

The UK consensus supporting effective introduction of novel treatments for multiple myeloma in the National Health Service.

Introduction: Multiple myeloma (MM) is a relapsing, debilitating blood cancer which remains incurable despite advances in treatments. Patients typically receive multiple lines of treatment, to which they become refractory, thereby limiting treatment options. B-cell maturation antigen (BCMA) bispecific antibodies (BsAbs) represent a novel modality of treatment that has significant efficacy for relapsed or refractory patients.

Advancing kidney transplantation in black patients: a genetics-based and personalized approach under NICE, KDIGO, and ERBP guidelines.

Induction therapy is a critical component of renal transplantation, aimed at reducing delayed graft function (DGF) and improving graft survival. This review assesses the impact of leading large national and international guidelines: National Institute for Health and Care Excellence (NICE), Kidney Disease: Improving Global Outcomes (KDIGO), and European Renal Best Practice (ERBP) propositions, focusing on their applicability to high-risk groups, specifically, on Black patients and those with donor-specific antibodies (DSAs). While NICE guidelines provide a standardized approach favoring basiliximab, concerns arise regarding their suitability for high-risk patients, who may benefit more from potent lymphocyte-depleting agents.

Women's experiences and needs in the use of digital technologies for the management of gestational diabetes: An integrative systematic review.

Introduction: Gestational diabetes mellitus (GDM) represents a widespread complication occurring during pregnancy, posing potential risks to both expectant mothers and their babies. Evidence shows that digital technologies provide comparable levels of care to conventional methods for GDM self-management, which help to improve maternal and neonatal outcomes. This systematic review aimed to explore women's experiences in using digital technologies, inform future technology design for gestational diabetes and potentially help improve usability.

Prevalence and Outcomes of Chronic Kidney Disease-Associated Pruritus: International Results from Peritoneal Dialysis Outcomes and Practice Patterns Study.

Key Points: CKD-associated pruritus is highly prevalent among peritoneal dialysis patients. Pruritus is associated with reduced health-related quality of life, and the composite of mortality and transfer to hemodialysis for peritoneal dialysis patients. Efforts to better identify and manage pruritus in this population are needed.

A Review of Photon-Counting Computed Tomography (PCCT) in the Diagnosis of Cardiovascular Diseases.

Photon-counting computed tomography (PCCT) is an innovative mechanism used for imaging and provides higher spatial resolution and contrast sensitivity in comparison with the orthodox energy-integrating detectors (EIDs). Unlike EID-based CT systems, which indirectly convert X-ray photons to electrical signals, PCCT directly counts and quantifies each photon's energy, enhancing image quality and material separation. With all of these features, PCCT is especially useful for cardiovascular imaging, where it is essential to precisely observe cardiac tissues, vascular structures, and coronary arteries.

Pre-analytical stability of haematinics, lactate dehydrogenase and phosphate in whole blood at room temperature up to 24 h, and refrigerated serum stability of lactate dehydrogenase, folate and vitamin B12 up to 72 h using the CRESS checklist.

Objectives: There is a lack of analyte stability data in whole blood (WB). The aim of this study was to determine the allowable delay in WB processing for lactate dehydrogenase (LDH), folate, vitamin B12, iron and phosphate measurement. The stability of LDH, folate and vitamin B12 was also assessed in stored serum at clinically relevant time points.

Fragment-Specific Fixation for Trimalleolar Fractures: Functional and Radiological Outcomes.

Introduction A trimalleolar fracture is a complex unstable fracture that usually occurs as the result of rotational injuries of the ankle. Management and understanding of these fractures have evolved greatly over the last decade. Our study aimed to assess the postoperative outcomes following the fixation of these fractures using fragment-specific low profile anatomical fixation implants.

Meta-analysis of routine abdominal drainage versus no drainage following distal pancreatectomy: Does the best available evidence overcome "HPB surgeon's paranoia"?

Aims: To evaluate comparative outcomes of routine abdominal drainage versus no drainage after distal pancreatectomy (DP).

Methods: A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted (last search: 20th April 2024). All comparative studies reporting outcomes of DP with routine abdominal drainage and no drainage were included and their risk of bias were assessed.

Characteristics and outcomes of patients with acute coronary syndrome who present with atypical symptoms: a systematic review, pooled analysis and meta-analysis.

How frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical. We determined the proportion of patients with atypical or no chest pain and used meta-analysis to evaluate predictors of atypical presentation and mortality associated with atypical presentation.

Development and Preliminary Testing of the Staffordshire Questionnaire for Adolescent Idiopathic Scoliosis (SQ-AIS): Content and Face Validity.

Introduction: Adolescent Idiopathic Scoliosis (AIS) is a structural spinal deformity with implications for health-related quality of life (HR-QoL). The Scoliosis Research Society-22 revised (SRS-22r) questionnaire is the standard for HR-QoL assessment. However, studies have identified limitations with the SRS-22r, including content and face validity issues, reliability concerns, and language appropriateness.

Statin-treated RBC dynamics in a microfluidic porous-like network.

The impact of therapeutic interventions on red blood cell (RBC) deformability and microscale transport is investigated, using statins as an exemplar. Human RBCs were treated in vitro with two commonly prescribed statins, atorvastatin and rosuvastatin, at clinically relevant concentrations. Changes in RBC deformability were quantified using a microfluidic-based ektacytometer and expressed in terms of the elongation index.

The Role of Telemedicine in Improving Hypertension Management Outcomes: A Systematic Review.

Telehealth has been proven to be effective in a variety of healthcare settings and has enhanced patient utilization of healthcare services. Little is known about the use of telehealth in the treatment of hypertension. This study aimed to categorize and identify data related to various telehealth technologies and intervention types used in the management of hypertension.

Straight-to-Test Pathway in Faecal Immunochemical Testing (FIT)-Negative Patients: A Cost-Effective Approach.

Introduction: Colorectal cancer (CRC) is the fourth most common malignancy in the UK and represents a high-volume diagnostic and clinical burden on the National Health Service (NHS). To maximise the use of limited diagnostic resources and increase efficiency, the colorectal services at University Hospitals North Midlands Trust (UHNM) developed the triage-to-test (TTT) service with risk stratification for diagnostic testing in patients with suspected colorectal cancer using faecal immunochemical testing (FIT) result. Our retrospective cohort study looked at the pick-up rate of colorectal cancer (CRC) and non-colorectal cancer (non-CRC) in FIT-negative patients.

A framework for developing Generic Implant Safety Procedures (GISPs) for scanning patients with medical implants and devices in MRI.

UK guidelines for MR safety recommend that MRI departments refer to the implant manufacturer for advice regarding the MRI safety of scanning patients with an implantable medical device prior to scanning [1]. This process of assuring safety can be time consuming, leading to delays and potential cancellations of a patient's MRI. Furthermore, at times the implant cannot be identified, or the implant manufacturers cannot provide up to date MRI safety information.