• Proximal humerus fractures : a review of anatomy, classification, management strategies, and complications

  Younis, Zubair; Hamid, Muhammad A; Amin, Jebran; Khan, Muhammad Murtaza; Gurukiran, Gurukiran; Sapra, Rahul; Singh, Rohit; Wani, Kubra Farooq; Younus, Zuhaib; Sapra, Rahul; et al. (Springer, 2024-11-05)

  Proximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications. Several classification systems assist in guiding treatment for proximal humerus fractures, including Codman's, Neer's, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) system, and the Codman-Hertel system, which helps predict ischemia risk. Evaluation of proximal humerus fractures begins with Advanced Trauma Life Support (ATLS) protocols, emphasizing a thorough shoulder assessment, particularly focusing on skin integrity in elderly patients. Neurological and vascular examinations are essential due to the common occurrence of nerve injuries, especially involving the axillary nerve. Imaging typically includes multiple standard views, with advanced imaging reserved for complex cases and for assessing associated soft tissue injuries. Treatment options range from conservative management for stable fractures to surgical intervention for more complex cases. Surgical choices include techniques like fixation, nailing, and various arthroplasty options, with some procedures potentially offering advantages for older adults with bone quality or soft tissue challenges. Rehabilitation is a vital component of recovery, with emphasis on early mobility and gradual strengthening to restore function, especially in older patients. Complications following open reduction and internal fixation (ORIF) for proximal humerus fractures can include issues such as non-union, malunion, osteonecrosis, infection, joint stiffness, and fixation failure. In cases where non-union or fixation failure occurs, revision surgery or arthroplasty may be necessary. Joint stiffness may require further intervention if physical therapy is insufficient, while symptomatic osteonecrosis might also need surgical management. Malunion is generally better tolerated in older patients but may require correction in younger individuals. Other surgical options, such as hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA), share similar risks, including infection, fractures, complications at the tuberosity, stiffness, and instability. RSA may be favored when there are tuberosity or rotator cuff issues. Closed reduction with percutaneous pinning carries a high risk of pin migration and malunion, which can result in deformities, pain, and dysfunction. Proper anatomical knowledge is essential to avoid neurovascular injury and to manage common issues such as pin-site infections effectively.
• Left atrial appendage closure with catheter ablation vs. ablation alone on outcomes of atrial fibrillation in heart failure with reduced ejection fraction : a propensity score-matched analysis

  Uwumiro, Fidelis E; Oghotuoma, Oghenemaro O; Eyiah, Nathaniel; Ojukwu, Somto; Uwaoma, Gentle C; Okpujie, Victory; Daboner, Temabore V; Mgbecheta, Justice C; Ewelugo, Claire A; Agu, Ifeanyi; et al. (Springer, 2024-11-27)

  Background Combining left atrial appendage closure with catheter ablation (LAACCA) has been proposed as a potential approach to improving outcomes by simultaneously addressing arrhythmia and reducing stroke risk. This study compares the in-hospital outcomes of LAACCA vs. catheter ablation (CA) alone for atrial fibrillation (AFib) in patients with heart failure with reduced ejection fraction (HFrEF). Methods We analyzed adult hospitalizations with HFrEF and AFib who underwent LAACCA or CA alone from the 2016-2020 nationwide inpatient sample using validated ICD-10 codes. Propensity score matching, accounting for patient-, hospital-, and procedure-level covariates, illness severity, and baseline risk of mortality, was used to alleviate bias in nonrandomized treatment assignments. The primary endpoints included all-cause in-hospital mortality, hospital stay, and hospitalization costs. Secondary endpoints included postprocedural complication rates. Prolonged hospitalization was defined as hospital stay in the top decile of hospital stay in each cohort. All statistical analyses in the study were based on weighted hospital data. Results About 233,865 HFrEF patients were hospitalized for AFib. Approximately 27,945 (11.9%) underwent LAACCA, while 205,920 (88.1%) underwent CA only. The cohort comprised mostly males (151,077; 64.6%) (mean age: 67.4; SD: 4.3). The propensity score-matched cohort comprised 18,195 LAACCAs and 18,195 CAs; all covariate imbalances were alleviated. LAACCA was associated with a higher rate of prolonged hospital stay (7.6 vs 5.6 days; P<0.001), a higher mortality rate (209 (1.1%) vs. 160 (0.9%); P=0.011), and higher mean hospital costs ($289,960 vs. $183,932; P<0.001) compared with CA alone. LAACCA was associated with a higher incidence of acute myocardial ischemia (528 (2.9%) vs. 455 (2.5%); P=0.013), complete atrioventricular block (1,200 (6.6%) vs. 892 (4.9%); P=0.004), need for implantable device therapy (1,510 (8.3%) vs. 1,348 (7.4%); P=0.017), pneumothorax (328 (1.8%) vs. 91 (0.5%); P<0.0001), hemothorax (200 (1.1%) vs. 127 (0.7%); P<0.0001), pneumonia (983 (5.4%) vs. 546 (3.0%); P<0.0001), vascular access complications (346 (1.9%) vs. 255 (1.4%); P=0.046), and septicemia (309 (1.7%) vs. 182 (1.0%); P<0.001). CA was associated with a greater incidence of cardiac tamponade (237 (1.3%) vs. 382 (2.1%); P=0.010) and femoral artery pseudoaneurysm (364 (0.2%) vs. 91 (0.5%); P<0.001). Conclusion LAACCA was correlated with higher mortality odds compared to CA alone for atrial fibrillation in HFrEF.
• Evaluation of Patient-Initiated Follow-Up (PIFU) service in a Fracture clinic : a comprehensive service evaluation and patient satisfaction audit

  Younis, Zubair; Hamid, Muhammad A; Khan, Muhammad Murtaza; Sapra, Rahul; Gurukiran, Gurukiran; Singh, Rohit; Sapra, Rahul; Trauma and Orthopaedics; Medical and Dental; Shrewsbury and Telford Hospital NHS Trust; University Hospitals Birmingham NHS Foundation Trust; Walsall Healthcare NHS Trust (Springer, 2024-11-11)

  Background Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary. This study evaluates PIFU's efficacy in improving outpatient services and patient satisfaction by reducing routine appointments and prioritizing patient-driven follow-up. Methods This service evaluation and patient satisfaction audit was conducted at the fracture clinic of Royal Shrewsbury Hospital over three months (December 2023-March 2024). Out of 3828 patients seen, 203 were assigned to PIFU based on criteria indicating stable conditions with minimal follow-up requirements. The remaining patients were either scheduled for routine follow-ups or discharged. Data were collected retrospectively from clinic records, and a structured questionnaire assessed patient satisfaction with the PIFU service. Results Among the 203 patients assigned to PIFU, 183 (90.15%) patients received an informational leaflet, with all respondents finding it easy to understand. However, only 41 (20.2%) of patients utilized the PIFU service, primarily for concerns about pain, healing, or complications. Satisfaction among PIFU users was high, with 163 (80.3%) patients rating the service 5/5. Non-users mostly cited no perceived need for follow-up. Demographic analysis indicated that patients aged 40-60 were predominant (n=132; 65.02%) among the PIFU cohort. Conclusion The PIFU model demonstrated the potential to alleviate clinic workload by reducing routine follow-ups while maintaining high patient satisfaction. Although utilization rates were low, those who engaged found the service beneficial, suggesting PIFU's value for patients comfortable with self-management. Improved patient education may enhance engagement, supporting the broader implementation of PIFU in outpatient settings. Further research is warranted to explore barriers to patient-initiated follow-up and refine eligibility criteria for optimal outcomes.
• Efficacy and safety of sublingual buprenorphine in managing acute postoperative pain - a systematic review

  Nair, Abhijit S; Dudhedia, Ujjwalraj; Bodas, Prasad Vilas; Rangaiah, Manmohan; Borkar, Nitinkumar; Rangaiah, Manmohan; Anaesthetics; Medical and Dental; Ibra Hospital; Dr. L.H. Hiranandani Hospital; Krishna Institute of Medical Sciences; Walsall Healthcare NHS Trust; All India Institute of Medical Sciences (Medknow Publications, 2024-07-19)

  Sublingual (SL) buprenorphine has been used as a modality of managing acute postoperative pain in many studies. This systematic review aimed to investigate the safety and efficacy of SL buprenorphine as an analgesic for various surgeries. After registering the protocol with PROSPERO, we searched PubMed, Cochrane Library, and Ovid databases with relevant keywords. The primary outcomes were 24-hour pain scores, and the secondary outcomes were postoperative nausea and vomiting, sedation scores, pruritus, rescue analgesia, and urinary retention. The risk of bias scale was used to identify the quality of evidence. From the 103 articles identified, four randomized-controlled trials fulfilled the inclusion criteria for qualitative analysis. The overall risk of bias was low. Most of the studies showed that the use of SL buprenorphine led to either better or comparable pain scores when compared to a control group with lesser or tolerable adverse events. There was a lot of heterogeneity across the studies in this systematic review in terms of the type of surgery performed, the comparison groups, doses of buprenorphine, and the outcomes that were assessed. Therefore, a quantitative meta-analysis was not performed. The results of this systematic review should be interpreted with caution due to heterogeneity in the methodology. Adequately powered studies with robust methodology should investigate the safety and efficacy of SL buprenorphine when used for postoperative analgesia.
• Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery : a prospective cohort study

  Hamid, Mohammed; Zaman, Shafquat; Mostafa, Omar Ezzat Saber; Deutsch, Alex; Bird, Jonty; Kawesha, Anthony; Reay, Michael; Banga, Irmeet; Williams, Anna; Waterland, Peter; et al. (Springer, 2024-12-18)

  A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27 kg/m2 (24-32 kg/m2), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6 h (p < 0.001); reduced analgesic requirement (p ≤ 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381).
• Evolving trends and future demands in ENT procedures : a nationwide 10-year analysis

  Jangan, Akash; Minhas, Satvir; Diakos, Emmanuel; Simmons, Mark; Mughal, Zahir; Jangan, Akash; Minhas, Satvir; Diakos, Emmanuel; Simmons, Mark; Ear, Nose and Throat; et al. (MDPI, 2024-12-23)

  Objective: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and resource planning in ENT. Methods: Hospital Episode Statistics data were extracted between April 2012 and April 2023. A total of 121 otology, 114 rhinology, and 122 H&N procedure codes were included. Correlation and linear regression analyses were conducted to examine trends and produce a forecast model for the volume of operations. Results: A gradual upward trend in the volume of operations was observed in rhinology, with a positive correlation coefficient (R = 0.74). In contrast, otology (R = -0.67) and H&N (R= -0.75) showed negative trends, indicating a moderate decline in operational volumes over time. The COVID-19 pandemic significantly disrupted operating activity in rhinology and otology. To address the backlog and reach the pre-pandemic forecasted levels within the next five years, surgical capacity must increase by an additional 33,807 rhinology 25,486 otology, and 10,300 head procedures per year in England. Conclusions: This analysis highlights a need for prioritization and expansion of the ENT workforce and resources to manage the current backlog and anticipated increase in demand over the next five years.
• Unlocking the learning in formal complaints : the development of an end-of-life care complaint analysis tool

  Walker, Wendy; Dowling, Alison; Dowling, Alison; Palliative Care; Nursing and Midwifery Registered; The Royal Wolverhampton NHS Trust; Walsall Healthcare NHS Trust (MAG Online Library, 2024-10-07)

  Background/Aims End-of-life care is a targeted area of healthcare service reform. Complaints are increasingly recognised as a valuable source of evidence for evaluating practice and informing service improvement work. This project aimed to develop a tool to support the standardised coding, categorisation and organisational use of formal complaint data concerning end-of-life care for adults. Methods A service evaluation was conducted using existing data. Deductive analysis was conducted with 59 letters of formal complaint submitted to an NHS trust in the Midlands, UK. A published healthcare complaints analysis tool served as a thematic framework for use in conjunction with framework analysis. The project was carried out in two stages: the first comprised preliminary work to produce a template of end-of-life care concerns; the second involved pilot testing the face validity of the template when used as a coding and categorising scheme. Results An initial template of 20 subcategories of end-of-life care concerns were developed from the data during preliminary work. This template was deemed to enable the analyst to focus on predefined areas of interest, organise concerns into relevant themes, concisely present the data in a summarised form and provide meaningful objective conclusions. During pilot testing, 185 complainant concerns were coded and categorised, over half of which fell into the domain of ‘relationship problems’ (n=99; 53.5%). Within this domain, the most common problem categories were ‘communication’ (n=44) and ‘respect and rights’ (n=44). A total of five new subcategory concerns were also derived and added to the template. Collectively, the outcomes of complaint data analysis informed the structure of a dedicated end-of-life care complaint analysis tool comprising 25 subcategories of end-of-life care concerns and accompanying exemplar indicators, together with criteria that were meaningful to identifying the context of the care concerns. Conclusions A systematic approach to analysing and reporting complainants' experiences of end-of-life care has the potential to support organisational learning, quality monitoring and bespoke service improvements in response to collective complaints and concerns.
• The National Joint Registry Data Quality Audit of elbow arthroplasty

  Hamoodi, Zaid; Shapiro, Joanne; Sayers, Adrian; Whitehouse, Michael R; Watts, Adam C; Abbott, Jennifer; Abbott, Sarah; Adebayo, Oliver; Ahmad, Kashif; Ahrens, Philip; et al. (British Editorial Society of Bone and Joint Surgery, 2024-12-01)

  Aims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow. Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them. Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties. Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.
• Validation of minimally invasive articular cartilage sparing technique for olecranon osteotomy

  McClelland, Damian; Blackwell, John R; Dover, Caroline; Grocott, Natalie; Ogrodnik, Peter J; Mataliotakis, George I; Kim, Edward; Blackwell, John R; Trauma and Orthopaedics; Medical and Dental; et al. (Wiley, 2024-11-27)

  Background: The authors present a cadaveric validation of a minimally invasive articular cartilage preserving olecranon osteotomy technique for use in the operative management of distal humeral fractures. Methods: Twenty-four elbows in six male and six female formaldehyde embalmed cadavers were dissected. With the cadaver placed in a lateral decubitus position, a posterior sub-periosteal dissection was performed to the medial and lateral aspects of the olecranon at the level of the joint and Mini Hohmann retractors were inserted into each side of the ulnohumeral joint. The medial (M) and the lateral (L) points where the retractors touch the articular surface were marked with a fine marker pen (Crown point) and a line drawn between the two points. The midpoint formed the apex of the chevron osteotomy. An osteotomy was performed and analysis of the osteotomy relative to the ulnar bare area (UBA) was undertaken. Results: The distal boundary of the UBA can be reliably found at a distance of 4.8 ± 0.4 mm (females) and 5.4 ± 0.8 mm (males) distal to the Crown point using this technique. Conclusion: Identifying the Crown of the olecranon articular surface is a reliable and accurate technique which identifies the ulnar bare area reproducibly for the safe performance of a cartilage sparing, and minimally invasive, olecranon osteotomy for the surgical management of distal humeral fractures.
• Appropriateness of small molecule agents for patients with IBD of childbearing age - a RAND/UCLA appropriateness panel

  Selinger, Christian; Laube, Robyn; Limdi, Jimmy K; Headley, Kate; Kent, Alexandra; Kok, Klaartje; Fraser, Aileen; Newman, Victoria; Ludlow, Helen; Rees, Fiona; et al. (Sage Publications, 2024-11-13)

  Selinger C, Laube R, Limdi JK, Headley K, Kent A, Kok K, Fraser A, Newman V, Ludlow H, Rees F, Sagar N, Walker E. Appropriateness of small molecule agents for patients with IBD of childbearing age - a RAND/UCLA appropriateness panel. Therap Adv Gastroenterol. 2024 Nov 13;17:17562848241299737. doi: 10.1177/17562848241299737. PMID: 39539488; PMCID: PMC11558739.
• De Garengeot Hernia : a case report of an incidental finding

  Tiwana, Simrat; Kabir, Syed A; Tiwana, Simrat; Kabir, Syed A; General Surgery; Medical and Dental; Walsall Healthcare NHS Trust (Springer, 2024-11-16)

  De Garengeot hernia is a rare occurrence characterised by the presence of the appendix within a femoral hernia. This type of hernia is notable for its rare anatomical presentation. In rare instances, the appendix can present as inflamed or necrotic in which case it may present as an emergency. In many instances, De Garengeot hernia is discovered incidentally during surgical repair of a hernia. This incidental finding raises an important consideration for surgeons. This study reports a case of De Garengeot hernia identified as an incidental intraoperative finding. It aims to enhance awareness of the condition, ultimately improving patient outcomes and management.
• A review of consent policies in Dermatological Surgery in the United Kingdom and the impact of leaner pathways and teledermatology on consent

  Potluru, Aparna; Sokol, Daniel; Wernham, Aaron; Wernham, Aaron; Dermatology; Medical and Dental; Leicester Royal Infirmary; King's Bench Walk; Walsall Healthcare NHS Trust (Oxford University Press, 2024-11-21)

  Obtaining valid consent is an ethical and legal requirement in clinical practice, ensuring patients are adequately informed about their treatments. Recent updates in consent policies, including GMC guidance, the Patterson inquiry report, and key legal rulings like Montgomery, emphasise a shift towards patient-centred care and the importance of a comprehensive patient-clinician dialogue. Budget constraints and increasing NHS demand have led to the adoption of digital solutions and streamlined pathways, such as teledermatology and direct booking to surgery, potentially compromising the consent process. This review examines the current state of informed consent in UK dermatology, particularly in light of the Montgomery ruling, which requires clinicians to ensure patients are aware of all material risks and alternatives associated with their treatments. The two-stage consent process, involving consent at two distinct points, is advocated to allow patients adequate time for reflection and decision-making. However, challenges remain in pathways like one-stop clinics and direct booking for surgery, where limited face-to-face interaction and time constraints can undermine the quality of informed consent. To mitigate these issues, integrating multimedia tools and standardised procedure-specific consent forms can enhance patient comprehension and satisfaction. These tools ensure consistent and clear communication of risks, benefits, and alternatives, maintaining robust informed consent amidst evolving healthcare delivery models. Sustaining a thorough and individualised dialogue throughout the patient care journey is essential for upholding patient autonomy and shared decision-making in dermatological surgery.
• A case report of Peritoneal Mesothelioma as an Acute Abdomen Mimic : a rare presentation and diagnostic challenges

  Fadl, Lana; Fadl, Mohammed; Fadl, Ola; Thaplar G Gouda, Siddalingana Gouda; Mirza, Hibah; Fadl, Lana; Gouda, Thaplar; Mirza, Hibah; General Medicine; Medical and Dental; et al. (Springer, 2024-11-27)

  Malignant peritoneal mesothelioma (MPM) is a rare and aggressive cancer often linked to asbestos exposure. This case report presents a 60-year-old man with a history of asbestos exposure who developed MPM, initially presenting with acute abdominal pain, an uncommon mimic of the acute abdomen. Diagnosing MPM is challenging due to its vague symptoms, often leading to delayed diagnosis. Additionally, the patient developed internal jugular vein thrombosis, a rare complication associated with malignancies. This case highlights the rare presentation of peritoneal mesothelioma as an acute abdomen mimic, the diagnostic complexities associated with MPM, and the rare type of thromboembolic event in this case.
• National Dermatological Surgery Sustainability Survey : an evaluation of healthcare professional beliefs and practices

  Ali, Fatima; Jabouri, Hakam; Abbott, Rachel A; Wernham, Aaron; Wernham, Aaron; Dermatology; Medical and Dental; Guy's and St Thomas' NHS Foundation Trust; Dartford and Gravesham NHS Trust; Cardiff and Vale University Health Board; Walsall Healthcare NHS Trust (Oxford University Press, 2024-11-23)

  Background: Dermatological surgery contributes to the large environmental impact of healthcare, but to date there are no data on the current sustainability practices, attitudes, or behaviours of UK and Republic of Ireland health professionals involved in skin surgery. Objectives: We sought to evaluate this using a national sustainability questionnaire, organised by the British Society for Dermatological Surgery. Methods: Over 12-weeks, a 17-item online questionnaire was distributed nationally to healthcare professionals involved in skin surgery. Results: 115 UK healthcare professionals responded. 'See and Treat' provision for non-Mohs skin surgery was described by 32% of respondents. When compared to single-use equipment (Median=4), reusable equipment (Median=7) outperformed on perceived safety (p =.0056), quality (p =.00001), and patient outcomes (p =.0067), but no difference was found in usability (p =.68916). Perceived sustainability was greater in the reusable (Median=7) than single-use (Median=1)(p=.00001). Almost all (97%) respondents believe global climate change is happening, and the majority (74%) are concerned by dermatological surgery's impact. However, only 44% feel comfortable discussing health effects of climate change with patients. Whilst 75% turn off surgical lighting in between lists, often room lighting (31%), equipment (32%) or heating/air conditioning (22%) is forgotten. Conclusion: Whilst awareness of the impact of dermatological surgery on global climate change is common among healthcare professionals involved in skin surgery, there is room for improvement in translating this into local action, advocacy, and service improvement to standards dictated by national sustainability guidance.
• Comparison of one-year outcomes in sleeve gastrectomy vs. one anastomosis gastric bypass in a single bariatric unit

  Das, Kieran; Nadeem, Faisal; Kabir, Syed A; Das, Kieran; Nadeem, Faisal; Kabir, Syed A; General Surgery; Medical and Dental; Walsall Healthcare NHS Trust; Lancashire Teaching Hospital NHS Foundation Trust; Maroof International Hospital (Springer, 2024-11-30)

  Introduction Sleeve gastrectomy (SG) is the most popular bariatric procedure worldwide in terms of numbers performed. However, there has been a rise in the popularity of the one anastomosis (mini) gastric bypass (OAGB). There have been various studies comparing the outcomes of SG vs OAGB and this study aims to add our experience and compare one-year outcome data between SG and OAGB in a single UK bariatric centre. Methods A retrospective search of our database between June 2021 and August 2023 was performed to identify those patients undergoing either laparoscopic SG or OAGB. Initial and one-year follow-up data was collected including percentage total weight loss (%TWL), percentage excess body weight loss (%EBWL), incidence of post-operative reflux, remission of co-morbidities (diabetes), glycated haemoglobin (HbA1c) changes, operating time and post-operative complications. Results A total of 64 OAGB and 53 SG patients were identified in this time frame. Nineteen OAGB and 26 SG patients had one-year outcome data available and so were included in the final analysis. Pre-op BMI was significantly lower in the OAGB group (OAGB = 47.1, SG = 52.7, p<0.05). Initial age, rates of pre-operative gastro-oesophageal reflux symptoms and pre-operative diabetes were comparable. Regarding one-year outcomes, %EBWL was comparable, as was the length of stay, reduction in HbA1c and resolution of diabetes. Operating time was significantly shorter in the SG group (OAGB = 140 mins, SG = 111 mins, p<0.05). While the number of patients with post-operative complications was the same in both groups, two patients in the OAGB group suffered from ulcer disease with one requiring a return to theatre for this. No patients in the SG group suffered from ulcer disease. One OAGB patient required conversion to Roux-en-Y gastric bypass (RYGB) for reflux, while three SG patients required conversion to RYGB for resistant reflux. Conclusion Both OAGB and SG patients in our centre have comparable outcomes with regard to excess body weight loss and resolution of diabetes. SG was quicker to perform. OAGB may be associated with higher rates of ulceration while SG may be associated with higher rates of treatment-resistant reflux requiring conversion surgery. The literature has revealed greater weight loss and increased rates of diabetes resolution with OAGB. This along with our findings will be considered when counselling our patients on the bariatric procedures available to them.
• Assessment and management of allergic rhinitis : a review and evidence-informed approach for family medicine

  Jangan, Akash; Mughal, Zahir; Ahmad, Ahmar; Simmons, Mark; Sheikh, Aziz; Mughal, Faraz; Jangan, Akash; Mughal, Zahir; Ahmad, Ahmar; Simmons, Mark; et al. (Wiley, 2024-07-14)

  Allergic rhinitis is an inflammatory disorder affecting nasal mucosa in response to allergen exposure and is commonly assessed and managed in family medicine. In this article, we review new international guidelines on the diagnosis and management of allergic rhinitis and generate evidence-informed recommendations for family medicine doctors.
• Is there an association between daylight hours and serum testosterone levels in men?

  Livingston, Mark; Heald, Adrian H; Hackett, Geoffrey; Ramachandran, Harishnath; Ramachandran, Sudarshan; Livingston, Mark; Black Country Pathology Service; Medical and Dental; Black Country Pathology Services; The University of Wolverhampton; Manchester University; Salford Royal Hospital; Aston University; University of East Anglia; University Hospitals Birmingham NHS Foundation Trust; University Hospitals of North Midlands; Keele University; Staffordshire University; Brunel University London (Taylor and Francis Group, 2024-10-13)

  Median inter-sample interval was 63 days. No significant inter-sample differences were evident regarding serum TT levels and seasonality indices. No associations were noted between δTT and δ seasonality indices in the total cohort and subgroups stratified by age and TT. Interestingly, δ ambient temperature (p = 0.012) and daylight duration (p = 0.032) were inversely associated with δTT in the 126 men in the non-fasting group (dependent variable). Only a small degree of the variability in the δTT was accounted by the above-mentioned independent variables. The seasons did not appear to influence serum TT values.
• Disseminated tuberculosis in a patient on tumor necrosis factor (TNF)-α inhibitor treatment for ankylosing spondylitis : a case report

  Fadl, Lana; Abdelgadir, Arowa; Mirza, Hibah; Mahreen, Aqsa; Thaplar G Gouda, Siddalingana Gouda; Fadl, Lana; Mirza, Hibah; Mahreen, Aqsa; Gouda, Siddalingana Gouda Thaplar G; General medicine; et al. (Springer, 2024-10-31)

  Tumour necrosis factor-alpha (TNF-α) inhibitors are commonly used in the treatment of ankylosing spondylitis (AS) due to their effectiveness in reducing inflammation and slowing disease progression. However, their use is associated with an increased risk of opportunistic infections, particularly tuberculosis (TB). This case report presents a young male patient in the United Kingdom (UK) with AS, who had been on long-term biological therapy with adalimumab, a TNF-α inhibitor. The patient developed disseminated TB, which rapidly progressed and unfortunately resulted in the patient's death. This case underscores the importance of comprehensive screening for latent TB before initiating TNF-α inhibitor therapy, as well as ongoing monitoring throughout treatment. Given the multicultural nature of the UK, where individuals may be exposed to TB without traveling to endemic areas, careful attention to TB risk across all ethnicities is critical. This case highlights the need for heightened vigilance and tailored preventive strategies to mitigate the risks of TNF-α therapy.
• Standardising the biochemical confirmation of adult male hypogonadism : a joint position statement by the Society for Endocrinology and Association of Clinical Biochemistry and Laboratory Medicine

  Jayasena, Channa N; de Silva, Nipun L; O'Reilly, Michael W; MacKenzie, Finlay; Marrington, Rachel; Jones, Hugh; Livingston, Mark; Downie, Paul; Hackett, Geoff; Ramachandran, Sud; et al. (Wiley, 2023-07-01)

  Background: Inter-assay variation between different immunoassays and different mass spectrometry methods hampers the biochemical confirmation of male hypogonadism. Furthermore, some laboratories utilise assay manufacturer reference ranges that do not necessarily mirror assay performance characteristics, with the lower limit of normality ranging from 4.9 nmol/L to 11 nmol/L. The quality of the normative data underlying commercial immunoassay reference ranges is uncertain. Design: A working group reviewed published evidence and agreed upon standardised reporting guidance to augment total testosterone reports. Results: Evidence-based guidance on appropriate blood sampling, clinical action limits, and other major factors likely to affect the interpretation of results are provided. Conclusions: This article aims to improve the quality of the interpretation of testosterone results by non-specialist clinicians. It also discusses approaches for assay harmonisation which have been successful in some but not all healthcare systems.
• Environmental sustainability in dermatological surgery : part 1 : reducing carbon intensity

  Ali, Fatima; Wernham, Aaron; Abbott, Rachel; Wernham, Aaron; Dermatology; Medical and Dental; King's College London; Guy's and St Thomas' NHS Foundation Trust; Walsall Healthcare NHS Trust; Cardiff and Vale University Health Board (Oxford University Press, 2024-10-26)

  This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 1 focuses on strategies to reduce the carbon intensity of dermatological procedures by adopting low-carbon alternatives and optimising operational resource usage. Key strategies for a system-wide reduction in environmental impact include using leveraging local suppliers to reduce transport emissions, streamlining care models, promoting efficient waste management, and using mindful prescribing practices. Another aspect is integrating sustainability into dermatological education whilst minimising the carbon footprint of surgical education. Additionally, the review provides a comprehensive overview of optimising resource use in dermatological surgery, focusing on efficient management of consumables, equipment, and energy. This includes recycling, waste segregation, transitioning to reusable personal protective equipment and surgical instruments, and applying energy-saving and sustainable water use practices. By implementing these strategies, dermatological surgery can significantly reduce its environmental impact while upholding high standards of patient care.

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