Unravelling Kikuchi-Fujimoto Disease: A Unique Presentation of Recurrent Aseptic Meningitis in a District Hospital Setting.

Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting, and ultimately benign condition characterised by localised lymphadenopathy. The association of KFD with aseptic meningitis is even more uncommon. We report a case of KFD accompanied by aseptic meningitis in a 31-year-old male who initially presented with lethargy, night sweats, axillary lymphadenopathy, and oral ulcers.

Depression and cardiovascular reactions to acute psychological stress: Is anhedonia the driver?

Blunted cardiovascular reactions in response to acute psychological stress are predictive of future health risk. A large body of research has identified depression as an influential factor associated with blunted cardiovascular reactivity. Separately, there has been a resurgence in focus on anhedonia as a key feature of depression, responsible for poor treatment responses to non-improvement in cardiac event-free survival.

An Early Supported Discharge (ESD) Model of Care for Older Adults Admitted to Hospital: A Descriptive Cohort Study.

Background: Early supported discharge (ESD) facilitates early discharge from acute hospitals with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Emerging evidence suggests it can have a positive impact on the care of older adults on discharge from the acute hospital setting to home. This study aims to characterize an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 and 180 days.

A Systematic Review of the Learning Curves of Novices and Trainees to Achieve Proficiency in Laparoscopic Skills: Virtual Reality Simulator Versus Box Trainer.

Laparoscopic surgery, established in the 1980s, has become a primary treatment method across various surgical specialities due to its advantages over open surgery, including shorter recovery times and fewer complications. Mastery of laparoscopic skills is essential for novice and junior trainees, who must develop hand-eye coordination, depth perception, and instrument handling. This systematic review examines the learning curves of novices using box trainers compared to those using virtual reality (VR) simulators to attain proficiency in laparoscopic skills.

Are trauma and orthopaedic consultant posts decreasing in frequency and increasing in subspecialisation?

Background: The needs of the population and changes to the configuration of the NHS affect the role of the Trauma & Orthopaedic (T&O) surgeon. This impacts training and the number of consultant posts available at Certificate of Completion of Training. Aim of this study was to review advertised T&O Consultant posts and determine the trends in frequency and sub-specialisation requirements between 2011 and 2020 to assess the perceived reduction in advertised posts and increasing subspecialisation, also looking at the impact to the NHS.

What impact does widening participation to medicine have on the medical workforce in the UK: a scoping review.

Purpose: Widening participation in medicine refers to the recruitment policy of encouraging those who are traditionally under-represented in medical school. Whilst research in the UK has investigated the processes around improving participation through recruitment and selection to medical schools, there is less focus around the period after medical school and how students from widening participation backgrounds fare in the workforce.

Methods: This study employed scoping review methodology to collate, map and summarise research in the field.

Placental mesenchymal dysplasia: a rare case associated with second trimester fetal growth restriction.

Background: Placental mesenchymal dysplasia (PMD) is a rare, benign, placental disorder characterised macroscopically by an enlarged multi-cystic placenta. It is a condition associated with a range of reported clinical outcomes and can be misdiagnosed as a molar or partial molar pregnancy given the similarities in clinical presentation. We present an unusual case of PMD complicated by fetal growth restriction and oligohydramnios in the second trimester.

An Algorithmic Approach to use Extended Spreader Grafts in Deviated Noses.

Background: Restoration of a straight and adequately wide nasal dorsum is challenging in patients with deviated noses. Supporting a reformed septum with an extended spreader graft (ESG) is important for maintaining position.

Objective: The study aimed to describe different types of ESG and propose a comprehensive algorithm for using specific types of ESGs in rhinoplasty according to the particular type of deviated nose.

Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model.

Background: Diastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.

Frailty screening with comprehensive geriatrician-led multidisciplinary assessment for older adults during emergency hospital attendance in Ireland (SOLAR): a randomised controlled trial.

Background: Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty.

Methods: In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland).

Challenging anticoagulation decisions in atrial fibrillation: a narrative review.

Atrial fibrillation (AF) is common and warrants consideration of oral anticoagulant (OAC) medication. Usually, the decision is straightforward, following the pathway outlined in the European Society of Cardiology's guideline; however, certain situations fall outside of this evidence base - such as a diagnosis of subclinical AF made via implanted devices or wearable electrocardiogram monitors, or alternatively diagnosis of 'secondary AF' following a major stressor. Subclinical AF is associated with stroke, though not to the extent of clinical AF, and the benefits of anticoagulation appear to be lower.

Critical care unit bed availability and postoperative outcomes: a multinational cohort study.

Background: Critical care beds are a limited resource, yet research indicates that recommendations for postoperative critical care admission based on patient-level risk stratification are not followed. It is unclear how prioritisation decisions are made in real-world settings and the effect of this prioritisation on outcomes.

Methods: This was a prespecified analysis of an observational cohort study of adult patients undergoing inpatient surgery, conducted in 274 hospitals across the UK and Australasia during 2017.

A frailty census of older adults in the emergency department and acute inpatient settings of a model 4 hospital in the Mid-West of Ireland.

Background: Frailty is a risk factor for presentation to the ED, in-hospital mortality, prolonged hospital stays and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty. The aim of this cross-sectional study was to establish the prevalence of frailty and co-morbidities among older adults in an acute hospital setting.

Occupational Therapy for Adults With Acute Hand Conditions: A Mixed-Methods Feasibility Study.

Hand injuries account for up to one third of acute hospital presentations. Current guidelines and standards of care recommend patients with hand trauma are seen by hand therapists, typically occupational therapists. This study explored the feasibility of implementing an occupational therapy-led hand therapy service for adults presenting acutely with a hand condition, using the RE-AIM framework.

Outcomes with single-agent gilteritinib for relapsed or refractory FLT3-mutant AML after contemporary induction therapy.

Gilteritinib is the current standard of care for relapsed or refractory fms related receptor tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia in many countries, however outcomes for patients relapsing after contemporary first-line therapies (intensive chemotherapy with midostaurin, or nonintensive chemotherapy with venetoclax) are uncertain. Moreover, reported data on toxicity and health care resource use is limited. Here, we describe a large real-world cohort of 152 patients receiving single-agent gilteritinib in 38 UK hospitals.

Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database.

Introduction: Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.