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Aims: To estimate the rate at which people with diabetes and a low risk of foot ulceration change diabetic foot ulceration risk status over time, and to estimate the rate of ulceration, amputation and death among this population. Methods: We conducted an observational study of 10 421 people with diabetes attending foot screening in an outpatient setting in NHS Fife, UK, using routinely collected data from a national diabetes register, NHS SCI Diabetes. We estimated the proportion of people who changed risk status and the cumulative incidence of ulceration, amputation and death, respectively, among people with diabetes at low risk of diabetic foot ulceration at 2‐year follow‐up. Results: At 2‐year follow‐up, 5.1% (95% CI 4.7, 5.6) of people with diabetes classified as low risk at their first visit had progressed to moderate risk. The cumulative incidence of ulceration, amputation and death was 0.4% (95% CI 0.3, 0.6), 0.1% (95% CI 0.1, 0.2) and 3.4% (95% CI 3.1, 3.8), respectively. Conclusions: At 2‐year follow‐up, 5% of people at low risk of diabetic foot ulceration changed clinical risk status and <1% of people experienced foot ulceration or amputation. These findings provide information which will help to inform the current debate regarding optimal foot screening intervals. What's new?: People with diabetes are at increased risk of foot ulceration. However, there is no evidence regarding the rate at which people at low risk of diabetic foot ulceration change risk status over time.This study found that people with diabetes who are at a low risk of foot ulceration do not readily change ulceration risk status over time (5% at 2 years). The cumulative incidence of ulceration and amputation, respectively, at 2 years was <1%.This has implications for current guidelines on the frequency of foot screening in the UK. [ABSTRACT FROM AUTHOR]

A cross-sectional survey of Black Asian and minority ethnic (BAME) health care workers evaluating their perception and belief on increased Coronavirus disease-19 (COVID-19) death among BAME health care workers was conducted in Leicester. They found that 72% of respondents had some form of impact on their mental health but the majority were satisfied with the overall support they received from local health care providers. In conclusion, adequate culturally competent mental health support is necessary as the BAME workforce is routinely involved in frontline work. [ABSTRACT FROM AUTHOR]

Aim St Mark's Bowel Cancer Screening Centre commenced screening in October 2006 as a contributor to the national programme. The first 35 months' experience is reported. Method Individuals with a positive faecal occult blood test (FOBT) were offered colonoscopy or alternatives if they had significant comorbidity. All screening data were collected prospectively. Results Of the 98 815 FOBT kits issued, 42 523 were returned (43% uptake; 20.79% men). In total, 1339/1488 (90%) FOBT-positive participants attended the nurse clinic (57% men). Of these, 1057 had an index colonoscopy, 115 had a computed tomography colonoscopy (CTC) and eight had a flexible sigmoidoscopy. Five hundred and seventeen (44%) procedures were 'normal' (no polyps/cancers). Eighty (6%) individuals had colorectal cancer. The polyp detection rate in index procedures, including colonoscopy, CTC and flexible sigmoidoscopy, was 50%. The adenoma detection rate of all colonoscopies was 62.8%. The median polyp size was 5 (1-80) mm. In total, 1200 colonoscopies were performed by five accredited colonoscopists (96% completion rate). There were 13 (1%) adverse events with < 1 in 500 patients undergoing polypectomy requiring a transfusion. There was one 30-day postsurgical mortality, one perforation and no colonoscopy-related mortality. Almost all 39/40 (97%) patients in the BCS programme felt that the findings were adequately explained compared with 21/32 (64%) elective patients ( P < 0.001) within the same unit. Conclusions At this bowel cancer screening single centre, colonoscopy completion rates were high (unadjusted caecal intubation rate of 96%) and complication rates were low. In contrast to other published data, the uptake and cancer-detection rates were lower. [ABSTRACT FROM AUTHOR]

Re-evaluation of adult obesity thresholds in some ethnic groups has led to the questioning of childhood obesity thresholds. An expert group was convened to examine the representativeness of childhood obesity definitions, evidence for ethnic differences in body composition in UK children and the extent of misclassification of adiposity by current body mass index (BMI) thresholds in south Asian and black groups. The group concluded that the current International Obesity Task Force (IOTF) definitions remained the most appropriate for use in the United Kingdom, but further research was needed on the relationship of body shape, fat mass, metabolic markers and ethnicity in children and adolescents. [ABSTRACT FROM AUTHOR]

This articel focuses on a study that explores the impact of copying clinic letters to patients. The Great Britain National Health Service plan requires that, from April 2004, patients will hove the right to receive copies of au correspondence about them that is exchanged between healthcare professionals. researchers in the study demonstrates that the majority of patients appreciate receiving copies of their clinic letters and feel more informed as a result. There was also found no significant increase in workload for the clinic staff.

Abstract: Purpose: Touch imprint cytology (TIC) facilitates rapid diagnosis of breast diseases in women attending triple assessment clinics. Some pathologists, in our centre, feel that pathological interpretation of TIC slides is contentious when the lesions are radiologically indeterminate (R3), as these can lead to potentially higher false positive or false negative cytology results. We hypothesised that: ‘(R3) lesions are more likely to have higher false positive or false negative TIC and/or be inadequate for TIC assessment’. In other words, ‘imaging influences cytological classification especially when indeterminate’. Methods: Review of the data collected in our centre between December 2003 and July 2005. All patients who attended the one stop symptomatic breast clinic and had a TIC performed following an ultrasound (US) guided core biopsy (CB) were included. Demographic, radiological, cytological and core biopsy grading data were collected. Cytology grading was correlated with radiology classification to assess our hypothesis. Results: A total of 248 patients underwent 254 CB/TIC. The average patient''s age of the group was 54 years (range of 29–95). On TIC, 186 (73%) were deemed malignant, 23(9%) benign while 33(13%) were inadequate for assessment. There was no false positive or false negative TIC. There was good correlation between TIC and CB results (p <0.0001). Thirty-three cases were inadequate (C1) for cytology assessment, of these16 (48.5%) were indeterminate on imaging. R3 lesions were 6 times more prone to have C1 cytology (p <0.0001). Conclusion: Touch imprint cytology is a reliable and efficient method in running a one stop breast clinic, with the backup of full tissue diagnosis. Careful selection of cases that would benefit from this technique is highly recommended as a significant number of radiologically indeterminate lesions are likely to be insufficient for cytological assessment. Further prospective trials are required to assess this further. Until then the diagnosis in this sub-group should depend on core biopsy. [Copyright &y& Elsevier]

Introduction: Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline., Methods: Data were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre-operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed < 5 mg oral prednisolone equivalents., Results: Operations for 21,731 patients were audited: 277 (1.3%) patients were taking therapeutic corticosteroids. Detailed peri-operative data were collected for all patients receiving therapeutic corticosteroids: 201/277 (73%) were ASA physical status ≥ 3; 184/277 (66%) underwent elective procedures; and 252/277 (91%) were prescribed prednisolone pre-operatively, of whom 219/277 (79%) were prescribed ≥ 5 mg oral prednisolone equivalents. In the patients who were prescribed ≥ 5 mg oral prednisolone equivalents, 186/219 (85%) received pre-operative glucocorticoid supplementation and 97/219 (42%) received it postoperatively; however, only 67/219 (31%) and 43/219 (20%) respectively received glucocorticoid supplementation according to the guidelines. Overall, peri-operative prescribing was compliant in 19/219 (9%) patients. A similar proportion, 30/219 (14%), received no supplementation. In the patients taking < 5 mg oral prednisolone equivalents pre-operatively, 28/58 (48%) received inappropriate supplementation., Conclusions: Despite 125/277 (45%) of anaesthetists reporting Association of Anaesthetists' guidelines use, compliance remained low, with adherence in only 27/125 (22%) patients. Further research is required to identify the correct peri-operative strategy for patients taking therapeutic corticosteroids., (© 2024 Association of Anaesthetists.)

Background and Importance: Suboptimal acute pain care has been previously reported to be associated with demographic characteristics., Objectives: The aim of this study was to assess a healthcare system's multi-facility database of emergency attendances for abdominal pain, to assess for an association between demographics (age, sex, and ethnicity) and two endpoints: time delay to initial analgesia (primary endpoint) and selection of an opioid as the initial analgesic (secondary endpoint)., Design, Setting, and Participants: This retrospective observational study assessed four consecutive months' visits by adults (≥18 years) with a chief complaint of abdominal pain, in a UK National Health Service Trust's emergency department (ED). Data collected included demographics, pain scores, and analgesia variables., Outcome Measures and Analysis: Categorical data were described with proportions and binomial exact 95% confidence intervals (CIs). Continuous data were described using median (with 95% CIs) and interquartile range (IQR). Multivariable associations between demographics and endpoints were executed with quantile median regression (National Health Service primary endpoint) and logistic regression (secondary endpoint)., Main Results: In 4231 patients, 1457 (34.4%) receiving analgesia had a median time to initial analgesia of 110 min (95% CI, 104-120, IQR, 55-229). The univariate assessment identified only one demographic variable, age decade ( P = 0.0001), associated with the time to initial analgesia. Association between age and time to initial analgesia persisted in multivariable analysis adjusting for initial pain score, facility type, and time of presentation; for each decade increase the time to initial analgesia was linearly prolonged by 6.9 min (95% CI, 1.9-11.9; P = 0.007). In univariable assessment, time to initial analgesia was not associated with either detailed ethnicity (14 categories, P = 0.109) or four-category ethnicity ( P = 0.138); in multivariable analysis ethnicity remained non-significant as either 14-category (all ethnicities' P ≥ 0.085) or four-category (all P ≥ 0.138). No demographic or operational variables were associated with the secondary endpoint; opioid initial choice was associated only with pain score ( P = 0.003)., Conclusion: In a consecutive series of patients with abdominal pain, advancing age was the only demographic variable associated with prolonged time to initial analgesia. Older patients were found to have a linearly increasing, age-dependent risk for prolonged wait for pain care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To undertake a United Kingdom national medical student survey investigating undergraduate plastic surgery exposure and specialty perceptions., Background: Plastic surgery incorporates all anatomical regions, age groups and tissue types; clinical challenges vary from trauma and burns to congenital defects and cancer and although around 50% of the workload is trauma, it is often misperceived to revolve around cosmetic surgery., Method: Following ethical approval, a national survey was conducted across 27 included UK medical schools (31/03/23-07/07/23). Trends were analysed, with comparisons made between surgical and non-surgical aspirants., Results: Data were included from 2513 students; 29.2% had surgical career aspirations. Students perceived plastic surgery as challenging, competitive, and impacting quality of life; however, most had no formal teaching (56.3%); merely 6.2% had clinical exposure and 30.4% had an undergraduate plastic surgery placement available. Breast reconstruction was the most frequently correctly identified surgery (91.8%), with head and neck cancer surgery the least (35.9%). Surgical aspirants were less likely to overestimate private practice (p < 0.001) but demonstrated greater self-confidence in plastic surgery understanding (p < 0.001) and their future ability to make plastic surgery referrals (p < 0.001), being more likely to pursue it (p < 0.001). Surgical aspirants were 17.3% more likely to obtain non-curricular plastic surgery experience (p < 0.001), and 5.6% more self-confident dressing basic wounds (p < 0.001)., Conclusion: A greater need for undergraduate plastic surgery teaching was determined. Significant heterogeneity across medical schools was identified. Formation of a national undergraduate plastic surgery curriculum, led by professional bodies, may tackle disparities among medical schools, improve accessibility and facilitate knowledge acquisition., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Treatment options for pre-treated patients with metastatic triple-negative breast cancer (mTNBC) remain limited. This is the first study to assess the real-world safety and efficacy of sacituzumab govitecan (SG) in the UK., Methods: Data was retrospectively collected from 16 tertiary UK cancer centres. Pts had a diagnosis of mTNBC, received at least two prior lines of treatment (with at least one being in the metastatic setting) and received at least one dose of SG., Results: 132 pts were included. Median age was 56 years (28-91). All patients were ECOG performance status (PS) 0-3 (PS0; 39, PS1; 76, PS2; 16, PS3;1). 75% (99/132) of pts had visceral metastases including 18% (24/132) of pts with CNS disease. Median PFS (mPFS) was 5.2 months (95% CI 4.5-6.6) with a median OS (mOS) of 8.7 months (95% CI 6.8-NA). The most common adverse events (AEs) were fatigue (all grade; 82%, G3/4; 14%), neutropenia (all grade; 55%, G3/4; 29%), diarrhoea (all grade; 58%, G3/4, 15%), and nausea (all grade; 38%, G3/4; 3%). SG dose reduction was required in 54% of pts., Conclusion: This study supports significant anti-tumour activity in heavily pre-treated pts with mTNBC. Toxicity data aligns with clinical trial experience., (© 2024. The Author(s).)

Background: Despite MN being one of the most common causes of nephrotic syndrome worldwide, its biological and environmental determinants are poorly understood in large-part due to it being a rare disease. Making use of the UK Biobank, a unique resource holding a clinical dataset and stored DNA, serum and urine for ~500,000 participants, this study aims to address this gap in understanding., Methods: The primary outcome was putative MN as defined by ICD-10 codes occurring in the UK Biobank. Univariate relative risk regression modelling was used to assess the associations between the incidence of MN and related phenotypes with sociodemographic, environmental exposures, and previously described increased-risk SNPs., Results: 502,507 patients were included in the study of whom 100 were found to have a putative diagnosis of MN; 36 at baseline and 64 during the follow-up. Prevalence at baseline and last follow-up were 72 and 199 cases/million respectively. At baseline, as expected, the majority of those previously diagnosed with MN had proteinuria, and there was already evidence of proteinuria in patients diagnosed within the first 5 years of follow-up. The highest incidence rate for MN in patients was seen in those homozygous for the high-risk alleles (9.9/100,000 person-years)., Conclusion: It is feasible to putatively identify patients with MN in the UK Biobank and cases are still accumulating. This study shows the chronicity of disease with proteinuria present years before diagnosis. Genetics plays an important role in disease pathogenesis, with the at-risk group providing a potential population for recall., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2023 Hamilton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Heavy metal pollution can enhance the level of antibiotic resistance, posing concerns to ecosystem and public health. Here, we investigated heavy metal concentrations, heavy metal resistant bacteria and antibiotic resistant bacteria and their corresponding resistant genes, and integrons in four different river environments, i.e., low heavy metals and low wastewater, high heavy metals and low wastewater, low heavy metals and high wastewater, and high heavy metals and high wastewater levels. Heavy metals were found to show positive and significant correlations with heavy metal resistance and antibiotic resistance and integrons (r > 0.60, p < 0.05), indicating that heavy metal selective pressure can cause heavy metal and antibiotic resistance to be transmitted simultaneously via integrons, which can result in the development of multi-resistant bacteria in the heavy metal-polluted environments. Moreover, there were significant associations between heavy metal resistance and antibiotic resistance (r > 0.60, p < 0.05), demonstrating heavy metal and antibiotic resistance are connected via a same or related mechanism. Class 1 integrons were found to have strong correlations with heavy metals and heavy metal resistance and antibiotic resistance (r > 0.60, p < 0.05), indicating a higher occurrence of antibiotic resistance co-selection in the heavy metal-polluted environments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Heavy metal pollution and the potential for co-selection of resistance to antibiotics in the environment is growing concern. However, clear associations between heavy metals and antibiotic resistance in river systems have not been developed. Here we investigated relationships between total and bioavailable heavy metals concentrations; metal resistance gene (MRG) and antibiotic resistance gene (ARG) abundances; mobile genetic elements; and the composition of local bacterial communities in low and high metal polluted rivers in UK and India. The results indicated that MRGs conferring resistance to cobalt (Co) and nickel (Ni) (rcnA), and Co, zinc (Zn), and cadmium (Cd) (czcA), and ARGs conferring resistance to carbapenem and erythromycin were the dominating resistant genes across the samples. The relative MRGs, ARGs, and integrons abundances tended to increase at high metal polluted environments, suggesting high metals concentrations have a strong potential to promote metal and antibiotic resistance by horizontal gene transmission and affecting bacterial communities, leading to the development of multi-metal and multi-antibiotic resistance. Network analysis demonstrated the positive and significant relationships between MRGs and ARGs as well as the potential for integrons playing a role in the co-transmission of MRGs and ARGs (r > 0.80, p < 0.05). Additionally, the major host bacteria of various MRGs and ARGs that could be accountable for greater MRGs and ARGs levels at high metal polluted environments were also identified by network analysis. Spearman's rank-order correlations and RDA analysis further confirm relationships between total and bioavailable heavy metals concentrations and the relative MRG, ARG, and integron abundances, as well as the composition of related bacterial communities (r > 0.80 (or < -0.80), p < 0.05). These findings are critical for assessing the possible human health concerns associated with metal-driven antibiotic resistance and highlight the need of considering metal pollution for developing appropriate measures to control ARG transmission., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation., Objectives: Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis., Design: We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis., Interventions: The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated., Main Outcome Measure: The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a 'treat-all' strategy., Data Sources: Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule., Review Methods: We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid ® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019., Results: The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk., Limitations: The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates., Conclusions: There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable., Future Work Recommendations: Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus., Study Registration: This study is registered as PROSPERO CRD42016052324., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.

Objectives: To assess the safety and efficacy in routine clinical practice of balloon dilatation procedures in the treatment of paediatric airway stenosis., Design: Observational data collection in prospective online research database., Setting: Acute NHS Trusts with ENT department undertaking complex paediatric airway work., Participants: Children (<18) undergoing balloon dilatation treatment for airway stenosis., Main Outcome Measures: Airway diameter, complications, hospital resource usage., Results: Fifty-nine patients had 133 balloon procedures during 128 visits to 10 hospitals. Sixty-nine (52%) of balloon procedures were conducted with a tracheostomy. Intra-operative Cotton-Myer grade decreased in 43 (57%). The mean pre-balloon subglottic diameter was 4.2 [95% CI: 3.8 to 4.5] mm, and its rate of increase was 0.8 [0.5 to 1.2] mm per year modelled on 30 patients' long-term data. As the primary treatment of stenosis, the procedural success rate of balloon dilatation (n = 52) was 65% (22% with tracheostomy, 88% without tracheostomy), and 71% as an adjunct to open reconstructive surgery (n = 7). In the 64 hospital visits where a balloon procedure was conducted with a tracheostomy in place, only one in-hospital complication (lower respiratory tract infection) occurred. For those without a tracheostomy in place, in-hospital complications occurred in seven of 64 balloon hospital visits, all related to ongoing or worsening stenosis. Six out-of-hospital complications were deemed related to ongoing or worsening stenosis following the procedure, and two complications were a combination of lower respiratory infection and ongoing or worsening stenosis., Conclusions: Balloon dilation increases the size of the airway intraoperatively and is associated with long-term increase in airway diameter. Safety outcomes mostly relate to ongoing or worsening stenosis and are more common in patients without a tracheostomy., (© 2019 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.)

Background: Pain medicine practices vary across different regions within a country and between countries., Objectives: The objective of the survey was to study the variation in interventional pain medicine practices in the United Kingdom (UK) and the United States (US)., Methods: A survey was designed in 2019 on Survey Monkey®. Pain physicians from the UK and the US were invited to respond., Results: A total of 120 responses were received from pain physicians in the UK and 122 from the US. Twenty-six percent and 90% of pain physicians in the UK and US, respectively, are in full-time pain medicine practice. There was marked variation in the utilization of diagnostic medial branch blocks before performing radiofrequency denervation (RFD) between the UK and the US. In the UK, 42% of pain physicians, and 50% in the US, use a 20-gauge or a 22-gauge radiofrequency needle for lumbar RFD. Around 30% to 50% of pain physicians, both in the UK and the US, discontinued antithrombotic agents before medial branch blocks at all the spinal levels. Around 50% of pain physicians in the UK and US are stopping anticoagulants before lumbar and cervical RFD. Over 95% of UK and US respondents stopped antithrombotic agents for interlaminar and transforaminal epidural injections along the spine. At the lumbar level, 51% of pain physicians in the UK and 47% in the US use a particulate steroid for the initial lumbar transforaminal epidural injection (TFESI); and 4% and 14% in the UK and US, respectively, use a particulate steroid for initial cervical TFESI. Eight percent of pain physicians in the UK and 20% from the US would switch to a particulate steroid if the initial TFESI with a nonparticulate steroid did not provide satisfactory pain relief. Ten percent of pain physicians from the United Kingdom and 20% from the US believed that this switch provides better pain relief., Limitations: Interventional pain physicians from the UK and the US were invited to respond. This may not reflect global practice., Conclusions: Our survey has highlighted the wide variation in interventional pain medicine practices both in the UK and the US. The relevant governing bodies in the UK and in the US should encourage clinicians to use at least an 18-gauge radiofrequency needle for RFD at the lumbar level. Discontinuing antithrombotic agents for the lumbar medial branch block is not justifiable. Pain physicians must discuss the advantages and disadvantages of using a nonparticulate over a particulate steroid preparation with the patient before performing TFESI as a standard procedure during the consenting process., Key Words: Antithrombotic agents, epidural steroid, medial branch blocks, pain practice variations, particulate and nonparticulate steroids, radiofrequency denervation, spinal interventions.

Background: Surgical trainers consider laparoscopic videos as a useful teaching aid to maximize trainees' learning and skill development given the backdrop of time constraints and productivity demands. Aim of this study is to assess the current use of laparoscopic videos amongst surgical trainees in the United Kingdom., Methods: A steering committee of 15 experienced laparoscopic trainers from 8 countries developed a survey on the use of laparoscopic videos by surgical trainees. The survey items were finalized by discussion through e-mails, teleconferences, and face-to-face meetings and a finalised questionnaire was distributed amongst surgical trainees in the United Kingdom., Results: 92 trainees were invited and 75 returned the questionnaire (81.5%). 86.7% of the trainees routinely watched online surgical videos and the more frequently used websites were Youtube.com and Websurg.com. Trainees require laparoscopic videos to have supplementary educational content such as English commentary (90.7%) and use of snapshots (93.3%) and diagrams (86.7%). Position of the patient and trocars, indication for surgery, preoperative data and postoperative outcomes are required characteristics of laparoscopic videos. 29 trainees (38.7%) do not record the laparoscopic procedures they perform, despite the majority of them recognising the usefulness of routine video-recording for training purposes (78.7%)., Conclusions: Surgical trainees consider videos a useful adjunct in laparoscopic surgery training, with preference for open access sources. Trainees value highly informative videos with supplementary educational content., (Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: The disease burden of atopic dermatitis (AD) in European populations is not well known., Objective: To establish the disease burden in European adult patients with AD., Methods: Data were from the 2016 National Health and Wellness Survey conducted in France, Germany, Italy, Spain, and the United Kingdom. Bivariate analyses were conducted on outcomes between controls without AD matched to patients with self-reported AD (both n = 1860)., Results: Patients with AD and a subset of patients with inadequately controlled AD (IC-AD) versus controls without AD, respectively, reported significantly higher (P < .001) 36-Item Short Form Health Survey Physical and Mental Component Summaries (PCS, MCS), and anxiety (31.9% and 51.7% vs 14.4%), depression (25.8% and 36.2% vs 12.9%), and sleep disorder (22.7% and 39.7% vs 12.6%) prevalences. Patients with IC-AD versus controls without AD reported significantly greater (P < .001) overall work (57.1% vs 23.7%) and activity impairment (51.7% vs 26.5%). In addition, 21.6% of patients with AD and 37.9% of patients with IC-AD reported ≥1 emergency department visit in the previous 6 months versus 16.5% of controls without AD, and 93.1% of patients with AD versus 84.2% of those without AD had ≥1 clinician visit (both P < .001). Of these, patients with IC-AD showed greater burden on most outcomes than patients with controlled AD., Limitations: Low response rate, possible selection bias due to survey technology availability, and patient-reported data susceptible to recall bias., Conclusion: Patients with AD reported significant burden on health, health-related quality of life, productivity, activities, and health care., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Aim: The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB), which was developed and validated in the USA. We assessed the BLEED criteria in a UK population and aimed to elucidate factors that can be implemented for early risk stratification., Method: Patients were identified from a prospectively maintained surgical admission database at a central London teaching hospital. Data were collected on 26 clinical factors available on initial presentation. The primary-outcome end-points included severe bleeding (persistent bleeding within the first 24 h, blood transfusion, a decrease in haematocrit of ≥ 20% or recurrent bleeding after ≥ 24 hours of stability) and adverse outcome (emergency surgery to control bleeding, intensive care unit [ITU] admission or death)., Results: One hundred and eighty-four clinical episodes were identified, representing 3% of all surgical referrals. Twelve patients with upper gastrointestinal bleeding were excluded. Severe bleeding occurred in 110 (64%) patients. An adverse outcome was recorded in 20 (11.6%) patients, and 10 (5.4%) patients died during admission. The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine > 150 μm (P = 0.002); age > 60 years (P = 0.001); abnormal haemodynamic parameters on presentation (P = 0.05); persistent bleeding within the first 24 h (P = 0.05); and area under the receiver-operating characteristics curve (AUC) = 0.79. The BLEED criteria were shown to be nonpredictive (AUC = 0.60)., Conclusion: The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors that could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate the early identification of patients requiring more aggressive resuscitation, admission to a monitored bed and consideration for early radiological or surgical intervention., (© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.)

Background: Rates of coronary heart disease (CHD) mortality are 40% higher amongst South Asian men and women living in the UK compared with the general UK population. Despite an established excess CHD risk, little is known of the efficacy and safety of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) amongst South Asian migrants., Methods and Results: Hyperlipidemic South Asian patients (raised or uncontrolled low-density lipoprotein cholesterol [LDL-C]) were recruited from two UK centers (n = 33). After a five-week period, which included dietary advice, patients received atorvastatin 10 mg/d for five weeks to achieve a target LDL-C goal of < 3.0 mmol/L, titrated to 20 mg, 40 mg, or 80 mg for a further 12 weeks as required. Significant reductions in LDL-C levels from baseline were observed after 4 weeks' and 17 weeks' treatment with atorvastatin (> or = 33.6%; 26.0, 41.2). Overall, 81% (95% confidence interval [CI]: 62.5, 92.6%) achieved the target LDL-C after 4 weeks' treatment with 10 mg atorvastatin. Titration to a dose of more than 20 mg was required in only one patient (40 mg) at any point during the study. Nineteen patients reported at least one adverse event during the study; the majority were mild in severity and considered unrelated to atorvastatin., Conclusions: Atorvastatin was effective in achieving target lipid levels and was well tolerated. Statin therapy for high-risk South Asian individuals is likely to benefit CHD outcomes, although further and larger prospective trials are required.