• Promoting equitable genetic testing in ovarian cancer : the demonstration of improvement for molecular ovarian cancer testing (DEMO) project

  Leung, Elaine Yl; Funingana, Ionut Gabriel; Bird, Lisa; Alcaraz, Marie-Lyne; Evans, Anuji; Considine, Anna; Freeman, Susan; Jimenez-Linan, Mercedes; Spencer, Catherine; Phanasan, Kiran; et al. (BMJ Publishing Group, 2025-02-25)

  Parallel genetic testing (testing for both tumour and germline gene changes) after the diagnosis of ovarian cancer should be considered the standard of care and is crucial to support treatment decisions. The demonstration of improvement for molecular ovarian cancer testing (DEMO) project aimed to develop patient-focused tools to promote equitable genetic care in diverse communities with high proportions of patients with limited English proficiency and biopsy guidelines to address the variations in specimen quality in different geographical regions in the UK. Our three work packages (WP) aimed to promote awareness by addressing the information gaps in different community groups (WP1), develop infrastructure to evaluate the different tissue collection pathways in different regions (WP2) and support continuing professional development (CPD) to encourage best practices with the involvement of patients (WP3). Our output included a multimedia multilanguage information package with paired National Health Service-branded written materials to support genetic testing after ovarian cancer diagnosis (https://ovarian.org.uk/demo-uk/), a scalable database to enable a multisite audit of parallel genetic testing pathways and a collection of CPD events that had patient involvement as an essential component. In addition, we have collaborated with patient and community groups to contribute to a national consensus guidance on genetic testing in ovarian cancer. Our co-production work has been recognised by local and regional awards as an exemplar for patient and public involvement (PPI). This has supported the start of a legacy co-production group in gynaeoncology (https://www.dhlnetwork.com/gohildas) to address the critical unmet need for sustainable and equity-oriented PPI to advocate for underserved communities. The DEMO project has contributed to raising awareness of the importance of equitable genetic care in ovarian cancer. We will continue to build on this groundwork to support future quality improvement projects and research, with the ultimate goal of improving the outcomes of patients with ovarian cancer.
• Percutaneous coronary intervention in the UK : recommendations of the British Cardiovascular Intervention Society

  Curzen, Nick; Routledge, Helen; McGrath, Samuel; Abouelasaad, Mohamed; Mamas, Mamas; Kinnaird, Tim; Al-Lamee, Rasha; O'Kane, Peter; Clesham, Gerald; McKenzie, Dan; et al. (Radcliffe Cardiology, 2025-01-23)

  Percutaneous techniques to treat obstructive coronary artery disease continue to evolve and the evidence base informing our practice is shared and summarised in international guidelines. In the UK, the British Cardiovascular Intervention Society represents and supports interventional cardiologists undertaking both coronary and structural interventions. Procedural data are collected in a national registry and these inform our understanding of UK practice and outcomes. These recommendations, pertaining to coronary intervention alone, are an update of those published in 2015 and describe the provision of percutaneous coronary intervention in the UK intended to provide optimal patient care.
• Laser hair depilation therapy for pilonidal sinus disease : a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023

  Andrew, Kashini; Dyson, Maya; Lee, Pui Chi; Sonigra, Pooja; Applewaite, Rona; Li, Danning; Thomson, Michelle; Nevill, Alan; Andrew, Kashini; Dyson, Maya; et al. (Oxford University Press, 2025-01-16)

  Background: Pilonidal sinus disease (PSD) is a chronic debilitating condition predominantly affecting young men. Laser hair depilation is an established adjunct to surgical treatment for PSD and can lead to reduced rates of recurrence, and post-surgical interventions.This study aimed to assess the outcome of laser hair depilation therapy on disease progression in pilonidal sinus disease patients at the Birmingham Skin Regional Laser Centre. Methods: Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention, and treatment outcomes were extracted from electronic medical records of patients (n=97) referred for laser hair depilation between 2017 and 2023. Statistics were performed using Microsoft Excel and R. Treatment outcomes were categorised as improvement (healed, improved) or no improvement of underlying PSG. Disease severity was classified using Guner et al.'s method. Results: Most patients affected were males (77.3%). Median age was 22 (IQR, 20 - 28). Median LHR sessions were 8 (IGR, 5.5, 10). The number of LHR sessions provided was the only predictive factor for symptom resolution (p = 1.28e-06). Neither undergoing surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) performed showed a significant association with improvement in PSD (p = 0.474, p = 0.6504). In the subgroup of patients who did not undertake surgery (n = 32, 33.0%), 25 (79.1%) patients had improvement or healing in their PSD. There was no statistically significant association between age, type of laser, disease severity, and benefit from LHR. No complications were reported and there was only one case of recurrence. Conclusion: Laser hair depilation is a safe and effective post-operative adjunct treatment for treating sacrococcygeal PSD. For early stage disease it may offer curative treatment.
• Evaluating the role of simple assistive devices in promoting motivation and self-care in chronic disease management

  Kulkarni, Sanat; Chockalingam, Nachiappan; Chambers, Ruth; Poulose, Pegin; Suresh, Shamita; Thileepan, Laxmi; Nachiappan, Nitish; Nachiappan, Nitish; Medicine; Medical and Dental; et al. (Elsevier, 2025-03-01)

  Objective: This study evaluates the development and distribution of simple assistive devices designed to support individuals in managing their health conditions at home. The focus is on older adults from lower socio-economic groups in Stoke-on-Trent and Newcastle-under-Lyme, UK. Methods: Assistive kits were distributed to participants between December 2021 and April 2022, addressing weight management, diabetic foot care, mental wellbeing, and daily living independence. Each kit contained affordable and accessible assistive devices, including portion plates, exercise bands, and remote-operated plugs, alongside educational materials to promote self-care. Feedback was collected between March and June 2022 to assess user satisfaction and engagement. A qualitative analysis, informed by self-determination theory, explored how these kits supported autonomy, competence, and relatedness in self-management. Results: Over 90 % of recipients reported using the kits more than once weekly and an increased confidence in managing their health conditions independently. Qualitative analysis indicated that the kits facilitated motivation towards self-management by enhancing users' autonomy, competence, and social connectedness. However, barriers such as cost, availability, and lack of support were identified as limiting factors for broader adoption. Conclusions: This study highlights the potential of affordable, simple assistive devices to empower individuals in managing their health and wellbeing. The initiative demonstrates a promising approach to addressing health management challenges in lower socio-economic groups. Further research is needed to expand access and refine interventions to maximise impact and improve quality of life.
• Key clinical findings from the IMPROVE-UK quality improvement projects : an overview

  Phillips, Andrew James; Bowen, Rebecca; Wells, Mary; McNeish, Iain; Sundar, Sudha; Sundar, Sudha; Gynaecological Oncology; Medical and Dental; University Hospitals of Derby and Burton NHS Foundation Trust; Royal United Hospital Bath NHS Trust; Imperial College Healthcare NHS Trust; Sandwell and West Birmingham NHS Trust; et al. (BMJ Publishing Group, 2025-02-25)

  Introduction: Survival from ovarian cancer in the UK is poor compared with international comparators. The Ovarian Cancer Audit Feasibility Pilot demonstrated variation in 1-year and 5-year survival across the UK as well as significant variation in treatment rates. In 2020, IMPROVE-UK was established as the first major programme to address inequalities in ovarian cancer management and survival across the UK, to develop a legacy of best practice sharing across the country and to establish and evaluate quality improvement projects that could drive care at scale. Methods: Following a competitive process, seven quality improvement projects were funded to address inequalities in care and identify strategies to improve and equalise survival rates for all women with ovarian cancer in the UK, to address health inequalities from geography, age or ethnicity. Results: Projects addressed the secondary care diagnostic pathway, genomic testing, prehabilitation and improving treatment-related decision-making, particularly decisions for surgery. All seven projects at least partial achieved their aims with numerous areas across all projects identified where processes could be refined and incorporated into standard care to improve outcomes of women diagnosed with ovarian cancer. Dissemination of information regarding best practice has been undertaken. Conclusion: IMPROVE-UK was the first programme of its kind addressing significant inequalities of care in women with ovarian cancer. We demonstrate systematic quality improvement projects in ovarian cancer targeting various aspects of the treatment journey. Scaling up the results of the improve UK pilots is likely to improve survival in the UK and potentially internationally.
• Meeting report : The Systemic Lupus International Collaborating Clinics (SLICC) world Lupus seminar on Africa

  Legge, Alexandra; Reynolds, John; Ugarte-Gil, Manuel Francisco; Adelowo, Olufemi; Blazer, Ashira; Dey, Dzifa; Omondi, Eunice; Oyoo, Omondi; Ramsey-Goldman, Rosalind; Reynolds, John A.; et al. (BMJ Publishing Group, 2025-03-03)

  The Systemic Lupus International Collaborating Clinics (SLICC) is an international research group dedicated to promoting collaboration among scientific investigators in the study of systemic lupus erythematosus (SLE). Currently, most SLICC members are based in North America and Europe, with limited representation from other regions. SLICC recognises the importance of expanding its global collaborations and representation to ensure that its research accurately reflects the global burden of SLE and provides equal benefit to all patients with SLE worldwide. Given that SLICC currently lacks representation from the African continent, an opportunity was identified to convene a meeting bringing together lupus physicians with experience providing clinical care and conducting lupus research in Africa, along with members of the SLICC group. The purpose of the meeting was to share information regarding SLE in Africa, to discuss recent innovations and current challenges in the region and to explore future collaborations between SLICC members and colleagues in Africa in the areas of SLE clinical care, research and education. This meeting report highlights information presented during the seminar as well as a discussion of next steps moving forward.
• Long-term effectiveness of intra-articular injectables in patients with knee osteoarthritis : a systematic review and Bayesian network meta-analysis

  Gupta, Nikhil; Khatri, Kavin; Lakhani, Amit; Dahuja, Anshul; Randhawa, Amandeep; Bansal, Vivek; Bansal, Kapil; Randhawa, Amandeep; Trauma and Orthopaedics; Medical and Dental; et al. (BMC, 2025-03-03)

  Background: Intra-articular injectables are proposed as a solution for pain relief and functional improvement in knee osteoarthritis (OA), however most studies involving intra-articular knee injectables are focused on short-term relief, leaving the recommendations regarding long-term management unclear. This network meta-analysis aimed to evaluate the mid- to long-term effectiveness of intra-articular knee injection of platelet-rich plasma (PRP), hyaluronic acid (HA), corticosteroids (CS), and their combinations for management of knee OA. Methods: Relevant studies were searched through PubMed, EMBASE, Scopus, and Cochrane Register of Trials databases from inception to 20th October, 2024 for randomized controlled trials (RCTs) of knee OA patients who had taken intra-articular injectable treatment with a follow-up duration of at least one year. The study included 37 RCTs involving 5089 patients. The outcomes assessed were pain relief and functional improvement of knee joint. The random effects Bayesian model was carried out for network meta-analysis. The surface under the cumulative ranking (SUCRA) curve demonstrated the rank probability of each injectable therapy for different outcomes. Results: Analysis revealed that, in terms of both knee pain relief and improvement of functional outcomes, the combined intra-articular injection of PRP and HA was ranked ahead of the isolated administration of PRP, followed by combination of HA with CS, HA alone, placebo, and CS at the end of one year. Conclusion: These findings emphasize the sustained efficacy of PRP, particularly when combined with HA, in providing superior long-term pain relief and functional improvement in knee OA compared to other intra-articular injectables, highlighting its potential as a preferred treatment modality.
• Exploring barriers and facilitators to self-management for patients with persistent musculoskeletal conditions following NHS-led hydrotherapy : a service evaluation

  Pathak, Natasha; Newham, Roger; Smith, Neil; Burgess, Roanna; Pathak, Natasha; Smith, Neil; Burgess, Roanna; Musculoskeletal Service; Allied Health Professional; Sandwell and West Birmingham NHS Trust; University of Birmingham (Wiley, 2025-03)

  Introduction: Persistent musculoskeletal (MSK) disorders are one of the leading reasons for years lived with disability within the UK. Guidelines encourage integrating self-management support. Hydrotherapy supports patients with persistent MSK conditions; however, self-management following NHS-led hydrotherapy has been inconsistent. Aim: To identify outcomes of hydrotherapy alongside the barriers, facilitators, and contributory factors affecting self-management in the local persistent MSK pain population. Methods: Between April 2023 and May 2023, a service evaluation was undertaken exploring factors affecting self-management in the local persistent MSK pain population following NHS-led hydrotherapy. Demographics, clinical factors, functional status (MSK-HQ) and patient-reported experiences, including barriers and facilitators to self-management, were recorded. Data was analysed using descriptive statistics alongside exploration of themes. Results: Ninety patients completed hydrotherapy. White British (n = 24) and Indian British (n = 23) were the most common groups to attend. Multiple joint (n = 27) and spinal conditions (n = 26) were the most common MSK conditions. Mean pre- and post-MSK-HQ scores were 20.8 and 26.1, respectively. Among the contactable patients (n = 69), 49 patients did not maintain independent water-based self-management reporting barriers such as ongoing support, access and financial concerns. Patients supported the establishment of a support group (n = 56) to help maintain water-based exercises. Conclusions: The local persistent MSK pain population lacks self-efficacy for independent water-based self-management. A supportive and collaborative approach is proposed to address this via a patient-led hydrotherapy support group.
• Explained deep learning framework for COVID-19 detection in volumetric CT images aligned with the British Society of Thoracic Imaging reporting guidance : a pilot study

  Fouad, Shereen; Usman, Muhammad; Kabir, Ra'eesa; Rajasekaran, Arvind; Morlese, John; Nagori, Pankaj; Bhatia, Bahadar; Rajasekaran, Arvind; Morlese, John; Nagori, Pankaj; et al. (Springer, 2025-02-26)

  In March 2020, the British Society of Thoracic Imaging (BSTI) introduced a reporting guidance for COVID-19 detection to streamline standardised reporting and enhance agreement between radiologists. However, most current DL methods do not conform to this guidance. This study introduces a multi-class deep learning (DL) model to identify BSTI COVID-19 categories within CT volumes, classified as 'Classic', 'Probable', 'Indeterminate', or 'Non-COVID'. A total of 56 CT pseudoanonymised images were collected from patients with suspected COVID-19 and annotated by an experienced chest subspecialty radiologist following the BSTI guidance. We evaluated the performance of multiple DL-based models, including three-dimensional (3D) ResNet architectures, pre-trained on the Kinetics-700 video dataset. For better interpretability of the results, our approach incorporates a post-hoc visual explainability feature to highlight the areas of the image most indicative of the COVID-19 category. Our four-class classification DL framework achieves an overall accuracy of 75%. However, the model struggled to detect the 'Indeterminate' COVID-19 group, whose removal significantly improved the model's accuracy to 90%. The proposed explainable multi-classification DL model yields accurate detection of 'Classic', 'Probable', and 'Non-COVID' categories with poor detection ability for 'Indeterminate' COVID-19 cases. These findings are consistent with clinical studies that aimed at validating the BSTI reporting manually amongst consultant radiologists.
• A review on the epidemiology of rheumatoid arthritis : an update and trends from current literature

  Uke, Perpetual; Maharaj, Ajesh; Adebajo, Adewale; Uke, Perpetual; Rheumatology; Medical and Dental; Sandwell and West Birmingham NHS Trust; Walter Sisulu University; University of Sheffield (Elsevier, 2025-02-11)

  Rheumatoid arthritis (RA) is a systemic, chronic autoimmune disease affecting mainly the joints, often with extra articular manifestations. This review provides an update on RA epidemiological trends and management. PubMed and EMBASE were searched from 2014 to 2024 using rheumatoid arthritis as keyword, combined with incidence, prevalence, diagnosis, classification, and management. Emphasis was on papers published in the past 5 years. Globally, the age-standardised prevalence and incidence rate (ASPR and ASIR) of RA increased with varying figures. The ASPR increased by 0.37%, 14.1%, and 6.4% from 1990 to 2019, 2020 and 2017 respectively; and 9% from 1980 to 2019. The ASIR increased by 0.3% and 8.2% from 1990 to 2019 and 2017 respectively; the disability-adjusted life years (DALY) figures increased 0.12% and decreased 0.36% in the same period from different authors. Reduction in ASIR were reported while ASPR varies. Disease modifying anti-rheumatic drugs (DMARDs) remain the cornerstone of treatment.
• Reconstruction of a large lateral upper and lower eyelid defect using a Mitek screw, Fricke flap and skin grafts from the eyelid

  Kadaba, Varsha; Ghosh, Yajati; Kadaba, Varsha; Ghosh, Yajati; Ophthalmology; Medical and Dental; Sandwell and West Birmingham NHS Trust (BMJ Publishing Group, 2024-12-22)

  Periocular basal cell carcinomas (BCC) are commonly excised and reconstructed by oculoplastic surgeons. We describe, with the aid of pictures and diagrams, a multimodal reconstruction of a large defect involving the lateral canthal angle, one-third of the upper eyelid and half of the lower eyelid with loss of lateral orbital periosteum. The eyelids were anchored with the novel use of a Prolene suture tethered to a titanium screw at the lateral orbital rim, providing structural stability. A Fricke flap was mobilised to reform the anterior lamella of the upper and lower eyelids, with the addition of an upper eyelid advancement flap and a small skin graft. The patient has had an excellent result at 15-month follow-up.
• Long-term improvements in glycemia and user-reported outcomes associated with open-source automated insulin delivery systems in adults with type 1 Diabetes in the United Kingdom : a real-world observational study

  Liarakos, Alexandros L; Crabtree, Thomas S J; Hussain, Sufyan; Patel, Rachel; Gazis, Anastasios; Mendis, Buddhike; Herring, Roselle; Kennedy, Adele; Black, Neil; Ryder, Robert; et al. (Mary Ann Liebert, 2025-01-27)

  Objective: To evaluate real-world outcomes in adults with type 1 diabetes initiating open-source automated insulin delivery systems (OS-AID). Methods: Adults with type 1 diabetes who commenced OS-AID, between May 2016 and April 2021, across 12 centers in the United Kingdom were included. Anonymized clinical data, collected during routine clinical care between December 2019 and November 2023, were submitted to a secure web-based tool within the National Health Service network. Outcomes included change in hemoglobin A1c (HbA1c), sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), user opinion of OS-AID, and event rates (hospital admissions, paramedic callouts, severe hypoglycemia, and adverse events) between baseline and follow-up. Results: In total, 81 OS-AID users were included (51.9% male; 90.1% White British; mean age 41.4 years; median diabetes duration 25 years [IQR 17-32]). Over a mean follow-up of 1.7 years, HbA1c reduced by 0.8% (9 mmol/mol) (7.3 ± 1.1% vs. 6.5 ± 0.7%; P < 0.001), and the percentage of individuals achieving HbA1c ≤ 7.0% (53 mmol/mol) increased from 48.6% to 75.7% (P < 0.001). Diabetes-related distress score reduced by 0.9 (95% confidence interval [CI] -0.3, -1.5; P = 0.006), and Gold score reduced by 0.7 (95% CI -0.1, -1.3; P = 0.022). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) reduced (27.8% at baseline vs. 8.3% at follow-up; P = 0.039). Of those asked, all participants stated that OS-AID had a positive impact on quality of life. The number of hospital admissions was low. Conclusions: The use of OS-AID is associated with long-term improvements in HbA1c, hypoglycemia awareness, and diabetes-related distress in type 1 diabetes. These benefits were achieved without increased rates of hospital admissions, diabetic ketoacidosis, or severe hypoglycemia.
• The debate rages on : physician-assisted suicide in an ethical light. Response to Br J Anaesth 2024; 133: 1352-3

  Shenouda, John; Blaber, Michael; George, Robert; Haslam, James; Blaber, Michael; Connected Palliative Care; Medical and Dental; Central London School of Anaesthesia; Sandwell and West Birmingham NHS Trust; King's College London; Salisbury NHS Foundation Trust (Elsevier, 2025-01-27)

  No abstract available.
• A case series of ibogaine toxicity reported to the United Kingdom National Poisons Information Service (NPIS) over a 10-year period

  Edwards, Ella P; Gray, Laurence A; Elamin, Muhammad; Veiraiah, Aravindan; Thanacoody, Ruben H K; Coulson, James M; Elamin, Muhammad EMO; National Poisons Information Service; Medical and Dental; University Hospital Llandough; Sandwell and West Birmingham NHS Trust; Royal Infirmary of Edinburgh; Newcastle-upon-Tyne Hospitals (Taylor and Francis Group, 2025-01-30)

  Introduction: Ibogaine is a psychoactive alkaloid derived from the root bark of the West African shrub Tabernanthe iboga. It is not licensed in the United Kingdom but is used by individuals to alleviate drug or alcohol use. Methods: A retrospective analysis of telephone enquiries involving ibogaine between 1 January 2012 and 31 December 2022 to the United Kingdom National Poisons Information Service was performed. Case series: Eleven enquiries relating to seven patients were made to the United Kingdom National Poisons Information Service in this period. Five of these patients were male (71%) with the majority in the age category 31-40 years (57%). All patients presented symptomatically. The circumstances for all seven cases were recorded as "recreational abuse." The exact indication was not specified in three cases but in two cases it was being used to alleviate diacetylmorphine (heroin) use and in another two cases it was being used for relief from insomnia. Three sources of ibogaine were reported - in one case it was bought online, in one case by a dealer and in two cases it was bought from a shaman. When reported, the dose ingested ranged from 5g to 34g. Two patients took it in tablet form and four patients ingested the root bark. The time since exposure, when reported, ranged from 16 h to 1 month. Seven patients experienced neurological symptoms and six displayed features of cardiotoxicity. The most frequently reported features included cardiac arrest, hypoxia, torsade de pointes, QT interval prolongation, coma, convulsions, stupor, bradycardia, vomiting and anxiety. Conclusions: Individuals using ibogaine in variable doses to self-treat for drug use are at risk of developing severe cardiotoxicity and neurological symptoms. Further studies to quantify dose-response relationship and to further improve knowledge of its pharmacokinetics are required.
• Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services

  Crosby, Ben Thomas; Munglani, Laura; Wright, Karen; Charles, Kay; Evans, Wendy; Mathias, Megan; Davies, Stevie; Abdalla, Badr; Turner, Jeff; Crosby, Tom; et al. (BMJ Publishing Group, 2025-01-30)

  Introduction: Demand for endoscopic services is outstripping capacity in the UK. Transnasal endoscopy (TNE) utilises a narrow calibre endoscope to pass through the nasal passages, thereby reducing retching and discomfort. It is better tolerated compared with standard transoral endoscopy (TOE) but is still rarely used as a diagnostic modality. There is still uncertainty about how well it performs against TOE in diagnostic ability, cost and efficiency. Methods: We explored utilising TNE to deal with the growing demand for endoscopy. We compared findings to TOE procedures undertaken during the same time period. We evaluated cost differences, duration/time in the department for procedures as well as quality of procedures (both in terms of performance indicators as well as image quality using the validated POLPREP score). Results: A total of 241 upper gastrointestinal endoscopy procedures were evaluated (100 TNE and 141 matched TOE) between December 2021 and February 2022. TNE outperformed TOE in obtaining >95% success rate in nationally approved key performance indicators (retroflexion and duodenal intubation, both p=0.026). It also was associated with better image quality in the oesophagus with a POLPREP A3 Score (excellent image quality) in 36/98 available images compared with 26/136 TOE (p=0.028) and was equivalent to TOE in the stomach and duodenum. TNE was identified as having a key role in facilitating complex cases, previously failed via the TOE route with a success rate in 11/12 (91.7%) of such cases. TNE also shows promise in correcting misdiagnoses of short-segment Barrett's oesophagus (39%) compared with TOE (14.8%) (p=0.087). Conclusion: TNE is an emerging endoscopic modality, which shows great promise in replacing TOE in most diagnostic circumstances. In a modern healthcare service, TNE is cheaper, better tolerated and outperforms TOE in multiple domains.
• Outcomes of cataract surgery training among ophthalmology trainees in the independent sector and within the NHS

  Chen, Yunzi; Crothers, Oonagh; Ting, Darren Shu Jeng; Severn, Philip; Mansoor, Qasim; Ting, Darren SJ; Ophthalmology; Medical and Dental; James Cook University Hospital; University of Birmingham; Sandwell and West Birmingham NHS Trust; University of Nottingham; et al. (BMJ Publishing Group, 2025-02-04)

  Objective: The surge in National Health Service (NHS) cataract procedures in the independent sector (IS) has reduced opportunities for cataract surgical training among ophthalmology trainees. This study aims to analyse IS cataract surgery training outcomes and explore its potential as a supplement to NHS-based training by comparing IS outcomes with NHS and National Ophthalmology Database (NOD) standards. Methods and analysis: Two trainees (ST5 and ST3) trained in IS high volume and standard NHS lists. A comprehensive IS training programme included modular cataract training, structured feedback framework and non-technical skills development. Prospective data concerning case numbers, complexity, take-over, outcomes and complication rates were collected and compared. Results: In total, 161 IS and 62 NHS cases were analysed. On average, trainees did 6 cases/12 patient lists in IS versus 3 cases/6 patient lists in NHS. IS cases had similar complexity to NHS cases (43% IS vs 35% in NHS, p=0.32, adjusted p=1). Intraoperative complications (3% IS vs 5% NHS, p=0.53, adjusted p=1) and posterior capsule ruptures (1% IS vs 0% NHS, p=0.38, adjusted p=1) were similar, aligning with NOD standards. Based on cases without any ocular comorbidity, the proportion of eyes achieving a good visual outcome (≥6/12 Snellen vision) was similar between IS (100%) and NHS (96%) (p=0.12, adjusted p=1). Surgical efficiency was maintained with all lists completed within 4 hours. Conclusion: A structured training programme on high-volume lists within IS setting provided two trainees with valuable exposure to diverse cataract cases while ensuring safety and efficiency, producing training outcomes comparable to the NHS and NOD standards. This is a pilot study, and a much larger multicentre study will be required before the widespread introduction of training in cataract surgery in the IS can be recommended.
• EXamining the feasibility of exerCisE to manage symptoms of Lupus (EXCEL) : a protocol for a randomised controlled pilot study

  Quickfall, Megan; Green, Scott; Hesketh, Katie; Veldhuijzen Van Zanten, Jet; Cocks, Matthew; Reynolds, John; Wadley, Alex J; Reynolds, John; Rheumatology; Medical and Dental; et al. (BMJ Publishing Group, 2025-01-16)

  Introduction: SLE is a chronic autoimmune disease that results in sustained hyperactivation of innate and adaptive immune cells and widespread inflammatory damage. Regular exercise reduces SLE symptoms including fatigue and joint pain and improves patient quality of life. However, most individuals with SLE are not sufficiently active to achieve these benefits, and guidance on the optimal approach to exercise is limited. EXCEL will examine the feasibility of conducting a large-scale randomised controlled trial comparing the effects of a remotely monitored, home-based, exercise programme with standard of care for individuals with SLE. Methods and analysis: 30 females with SLE will be recruited, and those randomised into Exercise (SLE-Ex) will codesign a progressive training plan with support from the research team. The aim of each 12-week plan will be to complete 150 min of moderate (60-70% heart rate max, HRmax) or 90 min of vigorous exercise (>70% HRmax) per week. SLE-Ex will be encouraged to exercise independently (without support) from weeks 13-18. Participants with SLE that are randomised into Control (SLE-Con) will maintain habitual activity without support for 18 weeks. Measures of feasibility and acceptability will be reported, and peripheral blood will be collected at weeks 0, 12 and 18 to explore whether the frequency, phenotype and metabolic profile of lymphocyte subsets has changed. Biomarkers of SLE activity, and self-reported measures of fatigue, sleep quality and health-related quality of life will also be monitored at these timepoints. Blood and self-reported measures will be compared with a healthy control (HC) group (n=15, age and body mass index matched) at baseline only. Ethics and dissemination: A favourable ethical opinion was given by South East Scotland Research Ethics Committee (22/SS/0082). Findings will be disseminated at conferences and published in peer-reviewed journals.
• Time below range and its influence on hypoglycemia awareness and severe hypoglycemia : insights from the Association of British Clinical Diabetologists study

  Deshmukh, Harshal; Wilmot, Emma G; Choudhary, Pratik; Ssemmondo, Emmanuel; Barnes, Dennis; Walker, Neil; Walton, Chris; Ryder, Robert; Sathyapalan, Thozhukat; Ryder, Robert; et al. (American Diabetes Association, 2025-01-02)

  Objective: This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH). Research design and methods: This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH. Results: The study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2-6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P < 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively. Conclusions: Our findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.
• Avoiding never events in orthopaedics theatres : a quality improvement project

  Bhavanasi, Bhaskar Amarnath; Kulkarni, Shrikant; Bhavanasi, Bhaskar Amarnath; Kulkarni, Shrikant; Trauma and Orthopaedics; Medical and Dental; Sandwell and West Birmingham NHS Trust (BMJ Publishing Group, 2025-01-27)

  Never events in the operating room are a surgeon's nightmare, with an incidence rate of 54%. These events are highly stressful for theatre staff and significantly compromise patient safety. The aim of this project is to avoid never events in trauma and orthopaedic theatres by ensuring that theatre staff adhere to the surgical pause and imaging pause protocols through regular audits.This prospective study was conducted in both trauma and elective orthopaedic theatres. It involved theatre staff members who were not part of the surgical team. The study was designed to take place on random days across different theatres, with the operating team unaware of the audit to ensure genuine behaviour and compliance.The audits focused on observing whether the surgical and imaging pause protocols were followed correctly. These protocols are critical for verifying patient identity, the surgical site, and the specific procedure and confirming the correct imaging is available and reviewed before proceeding. Data collected and corrective actions were implemented when non-compliance was observed, and data on compliance rates were systematically collected and analysed.Preliminary results indicate a substantial increase in compliance with both the surgical and imaging pause protocols, corresponding with a reduction in the occurrence of never events. Theatre staff reported improved understanding and confidence in performing these safety checks The use of external auditors who were not part of the surgical team provided an unbiased assessment of compliance, enhancing the reliability of the findings.In conclusion, the project demonstrates that regular audits, and data collected by non-surgical team staff, significantly improve adherence to surgical and imaging pause protocols, thereby reducing the incidence of never events in trauma and orthopaedic theatres. This approach highlights the importance of continuous monitoring and education in fostering a culture of safety and precision in surgical practice.
• Corpus Spongiosum Abscess in a patient undergoing intermittent self-dilatation : a rare case report

  Vinoo, Akshay; Ali, Meyada; Sivakumar, Naveen; Krishan, Anil; Sultana, Abida; Urology; Medical and Dental; Worcestershire Acute Hospitals NHS Trust; Sandwell and West Birmingham NHS Trust; University Hospitals Birmingham; Charing Cross Hospital (Springer, 2024-09-14)

  Penile abscesses of the corpus spongiosum are rare in urology, with few documented cases. These abscesses may occur spontaneously or due to risk factors such as diabetes mellitus, intracavernosal injection therapy, tuberculosis, trauma, and perianal or intra-abdominal abscesses. This report discusses a 76-year-old man who developed a penile abscess involving the corpus spongiosum following intermittent self-dilatation. This required open drainage together with antibiotic cover to clear the infection, and follow-up in an andrology clinic found no remnant abscess. This case highlights the importance of early diagnosis and intervention in penile abscesses, typically managed with imaging, drainage, and culture-directed antibiotics. The drainage options may include open or an ultrasound-guided approach, depending on the size and location. A multidisciplinary approach is crucial, with careful follow-up to manage potential complications such as penile deviation and erectile dysfunction. Pre-procedural counseling is essential, particularly in cases involving urethral instrumentation.

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