Background: This scoping review explores the impact of coaching on the professional identity formation (PIF) of postgraduate medical trainees. Although coaching is well-documented in undergraduate medical education, its role in postgraduate medical education (PME) remains underexplored. This review aims to identify enablers and barriers to coaching in PIF, examine modalities employed and assess coaching's contribution to developing well-rounded, resilient physicians.

Methods: Following Arksey and O'Malley's scoping review framework and reported in accordance with the PRISMA-ScR guidelines, the research question was formulated using the Joanna Briggs Institute's Population-Concept-Context (PCC) framework. A comprehensive, peer-reviewed search strategy was executed across PubMed, Embase, Web of Science and Google Scholar (first 20 pages). Grey literature was included, and no date limits were applied. Studies of any design focusing on coaching in PME were eligible. Titles and abstracts were screened using Rayyan, and full-text reviews were conducted independently by three reviewers using a negotiated consensual validation approach. An additional study was identified through snowballing. Data were extracted using a structured charting framework and analysed thematically.

Results: Of the 336 records identified through database searches, 20 studies met the inclusion criteria, including one added through snowballing. The literature highlighted diverse coaching modalities and their positive impact on PIF. Coaching supported trainees in professional development, identity evolution, career planning, resilience and well-being. It fostered psychologically safe environments for self-reflection, self-assessment and development of both technical and non-technical skills. However, qualitative and longitudinal research on coaching's effectiveness in PME remains limited.

Conclusions: This review emphasises coaching as a valuable tool in shaping postgraduate medical trainees' professional identity. A conceptual framework of coaching has been identified, and its integration into medical curricula may enhance reflective capacity, communication skills, resilience and overall well-being. Future research should prioritise the validation of this evidence-based coaching framework and its impact on fostering communities of practice to support identity formation, holistic physician development and car

Background: Cognitive impairment varies widely in bipolar disorder. Identifying cognitive subgroups and their biological correlates may improve understanding of the disorder. Brain-derived neurotrophic factor (BDNF) and C-reactive protein (CRP) are key candidates due to their roles in neuroplasticity and inflammation.

Aims: The aim was to investigate cognitive subgroups in patients with bipolar disorder and their association with serum levels of BDNF and CRP.

Method: A cross-sectional study was conducted on 149 bipolar disorder patients and 48 healthy controls. Cognitive performance was assessed using a comprehensive battery of neuropsychological tests. Cluster analysis was performed to identify cognitive subgroups, followed by discriminant function analysis to validate the classification. Serum levels of BDNF and CRP were measured and compared across cognitive subgroups.

Results: Cluster analysis identified three cognitive subgroups: intact cognition, selectively impaired cognition (SIC) and globally impaired cognition (GIC). SIC exhibited the highest BDNF levels, while GIC demonstrated the highest CRP levels. CRP levels were negatively associated with performance across all cognitive domains. BDNF showed a negative correlation with verbal fluency, short-term memory and working memory. CRP levels exceeding 4.3 mg/L predicted global cognitive impairment with a sensitivity of 72.41% and specificity of 73.63%.

Conclusion: Cognitive impairments in bipolar disorder patients can be classified into distinct subgroups, which are associated with serum levels of BDNF and CRP. These findings suggest that inflammation and neuroplasticity play key roles in the pathophysiology of cognitive decline in bipolar disorder, providing potential biomarkers for identifying patients at risk for severe cognitive impairments.

Immune checkpoint inhibitors (ICIs) are increasingly being used as part of cancer treatment. Whilst effective oncological therapies, these drugs are associated with a significant risk of immune-related adverse events (IrAEs). They can affect a variety of organ systems, including the lungs, heart, kidneys, and gastrointestinal tract, with liver damage being a relatively well-recognised complication. There have been multiple previous reports describing immune-related hepatitis; however, more recent studies are starting to describe inflammation within the extrahepatic and intrahepatic bile ducts, specifically discussing immune-related cholangitis. This can be in addition to or distinct from hepatitis. Immune-related cholangitis remains rare and less extensively studied than other complications; however, it represents a significant adverse event that may evolve into potentially severe complications such as liver failure and can be fatal. We present a case of a 50-year-old man with non-small cell lung carcinoma (NSCLC) with brain metastases, who developed immune-related cholangitis following 11 cycles of the immune checkpoint inhibitor pembrolizumab. The patient presented with severe abdominal pain and transaminitis. A comprehensive workup excluded bacterial, viral, autoimmune and other alternative aetiologies leading up to the diagnosis of ICI-induced cholangitis, based on magnetic resonance cholangiopancreatography (MRCP). The patient responded well to the combination of ursodeoxycholic acid (UDCA), corticosteroid therapy and mycophenolate mofetil (MMF), showing gradual improvement in liver enzyme levels and significant improvement in abdominal pain. At the time of writing this case report, subsequent slow steroid weaning has been successful, without clinical or biochemical flare. As the use of ICIs increases, this case highlights the importance of awareness of immune-related cholangitis as a rare but significant adverse event to enable a timely diagnosis and treatment. Immune-related cholangitis such as this is crucial to identify as distinct from infective cholangitis, as treatment is primarily immunosuppression. It adds to the growing body of evidence of immune-related cholangitis as a specific adverse reaction, encouraging and enabling more research into this to guide future clinical decision-making and the formation of treatment guidance and diagnostic criteria.

Background: People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding QoL in dementia.

Aims: To conduct the first comprehensive systematic review of all studies that investigated efficacy of any pharmacological or non-pharmacological intervention for improving QoL of PwD.

Method: Our review team identified eligible studies by comprehensively searching nine databases. We completed quality assessment, extracted relevant data and performed GRADE assessment of eligible studies. We conducted meta-analyses when three or more studies investigated an intervention for improving QoL of PwD.

Results: We screened 14 389 abstracts and included 324 eligible studies. Our meta-analysis confirmed level 1 evidence supporting the use of group cognitive stimulation therapy for improving QoL (standardised mean difference 0.25; P = 0.003) of PwD. Our narrative data synthesis revealed level 2 evidence supporting 42 non-pharmacological interventions, including those based on cognitive rehabilitation, reminiscence, occupational therapy, robots, exercise or music therapy. Current evidence supporting the use of any pharmacological intervention for improving QoL in dementia is limited.

Conclusions: Current evidence highlights the importance of non-pharmacological interventions and multidisciplinary care for supporting QoL of PwD. QoL should be prioritised when agreeing care plans. Further research focusing on QoL outcomes and investigating combined pharmacological and non-pharmacological interventions is urgently needed.

Ultrasound contrast agents (UCAs) are microbubbles comprising an inert gas core stabilized by an encapsulating shell, which serves to increase the signal-to-noise ratio of blood-to-tissue in diagnostic ultrasound imaging. More recently, research has investigated the use of UCAs to combine both diagnostics and therapeutic outcomes in an amalgamated approach, designated 'theranostics.' Two examples of theranostic based approaches include the use of super-resolution imaging with ultrasound localized microscopy (ULM) and ultrasound-mediated drug delivery (UMDD). Both ULM and UMDD have been shown to have the potential to improve both patient care and clinical outcomes. Currently, there are 4 commercially available global UCAs licensed for clinical use. The physico-chemical properties of each of these UCAs influence its potential theranostic efficacy. Because of differences in their composition and/or manufacturing processes, each UCA has different characteristics that contribute to different i n vivo resonance behavior, which in turn influences their effective clinical applications. This review highlights the key physico-chemical characteristic differences of the 4 commercially available contrast agents, with specific emphasis on their gaseous core, shell composition, and microbubble volume distribution, while providing novel insights into their benefits for supporting emerging clinical technologies, specifically ULM and UMDD.

Non-muscle-invasive bladder cancers (NMIBC) are a heterogeneous subclass of bladder cancers consisting of carcinoma in situ, stage Ta disease, and stage T1 disease. Despite treatment by tumor resection, they have a high rate of recurrence and progression, which present unique management challenges. This scoping review discusses the management of NMIBC, including risk stratification, intravesical therapy, surveillance protocols, and developing treatments. A systematic search in different databases (PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science) was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications in English, from January 2010 to April 2025, were included. The final search was conducted on May 5, 2025. A total of 16 studies that met our inclusion criteria were reviewed. Different themes emerged, which include risk stratification and diagnosis, tumor resection, intravesical therapy, surveillance and follow-up, patient factors, and novel therapies. Substantial differences were found in clinical practice. Immediate postoperative chemotherapy was not adequately used, and the schedules of surveillance varied. Newer therapies, such as immune checkpoint inhibitors and novel intravesical agents, are promising. The role of enhanced cystoscopy and urinary biomarkers is also increasing for non-invasive disease monitoring. Despite this advancement, therapy standardization or a patient-centered view is still lacking. This review highlights the need for harmonized guidelines, wider access to innovative therapies, and collaborative research to improve outcomes in patients living with NMIBC.

Introduction.
Gastrointestinal infections remain a leading cause of morbidity and mortality within the UK.Hypothesis. The Luminex® NxTAG® Gastrointestinal Pathogen Panel (NxTAG GPP) multiplex reverse transcriptase PCR assay performs equivalently to standard-of-care diagnostic approaches.

Aim.
To compare the analytical performance of the NxTAG GPP assay versus routine diagnostic testing methods in a district general hospital setting.

Methodology.
Gastrointestinal pathogens in 159 faecal specimens from hospital inpatients and outpatient clinics were comparatively analysed using the NxTAG GPP assay versus traditional culture, enzyme immunoassay and molecular methods.

Results.
Positive results were detected in 45 out of 159 specimens (28.3%) by NxTAG GPP, which was a higher positivity rate when compared with traditional diagnostic methods which detected 31 out of 159 (19.5%) positive infections (P=0.087 by Fisher's exact test). Infections were caused by a single organism in 40 out of 45 (88.9%) cases, but 5 out of 45 (11.1%) infections detected were due to coinfections. No coinfections were detected by traditional methods. Campylobacter Group was the most common enteropathogen detected with 15 out of 52 (28.9%) infections. Viruses caused 26.9% of infections, including 15.4% being norovirus. Overall sensitivity, specificity and accuracy for the NxTAG GPP assay were 97.6%, 99.7% and 99.5%, respectively, for enteropathogenic bacteria and viruses detected during this study. No parasites were detected during this study and were not included in comparisons.

Conclusions.
The NxTAG GPP assay demonstrated high sensitivity and specificity for identifying gastrointestinal pathogens, with comparable accuracy as more resource-intensive and time-consuming standard diagnostic approaches. The NxTAG GPP has the potential to enhance patient diagnosis, reduce turnaround time and improve clinical outcomes compared to routine diagnostic methods.

Introduction: Diabetic foot ulcers (DFU) are a major consequence of diabetes and a major cause of lower-extremity amputation. Effective management techniques are essential given this high burden, especially in Bangladesh. The purpose of this study was to compare the effectiveness of collagen and traditional dressings in the treatment of DFU patients.

Methods: An observational comparative cross-sectional study was conducted in the Department of Surgery, Dhaka Medical College Hospital, Bangladesh, over six months. A total of 100 patients with DFU were enrolled and equally divided into two groups: one treated with collagen dressing and the other with conventional dressing. Patients were recruited following inclusion and exclusion criteria, and informed consent was obtained. Data on socio-demographic characteristics, glycemic control, and treatment outcomes were collected. Outcome assessment focused on time to granulation and complete healing. Data were analyzed using Stata Statistical Software: Release 13 (StataCorp LLC, College Station, Texas, United States).

Results: The mean age of participants was 60.07±10.39 years (range: 34-78 years); 77% (n=77) were male. Mean HbA1c was comparable between groups (collagen: 8.12±1.14% vs. conventional: 8.05±0.74%). Granulation occurred significantly earlier in the collagen group (2.26±1.58 weeks) than in the conventional group (3.76±1.57 weeks; p<0.001). Similarly, mean healing time was shorter with collagen (4.90±2.54 weeks) compared to conventional dressing (6.24±3.76 weeks; p<0.05). Hazard ratio (HR) analysis showed granulation tissue appeared 1.96 times more likely with collagen dressing than conventional (HR: 1.96; 95%CI: 1.31-2.96; p<0.05).

Conclusion: DFUs, which involve prolonged healing and a high risk of infection, are a major cause of morbidity, mortality, and hospitalization in diabetic patients. This study found that collagen dressing outperforms conventional dressings, promoting faster healing and earlier granulation, with granulation tissue nearly twice as likely to appear early.

Background Copeland resurfacing hemiarthroplasty (CRHA) was developed as a bone-preserving alternative to stemmed hemiarthroplasty, offering advantages such as preservation of native anatomy and quicker recovery. However, there is limited evidence regarding its long-term survivorship. Objective The objective of this study is to determine the medium- to long-term survival outcomes and functional results of CRHA performed in a single-surgeon series. Methods A retrospective cohort study was conducted on patients who underwent CRHA between 2007 and 2013 at King's Mill Hospital, Mansfield, UK. There were no inclusion or exclusion criteria; all patients had significant morbidity and radiological evidence of glenoid arthropathy (Walch classification). The Oxford Shoulder Score (OSS) was collected pre- and postoperatively. Kaplan-Meier survival analysis was performed. Statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States), with significance set at p<0.05. Results Eighty CRHAs were performed in 72 patients (eight bilateral procedures). The mean follow-up was 79 ± 18 months (range 50-122), corresponding to approximately 6.5 years. The primary indication was osteoarthritis (76.3%), followed by cuff tear arthropathy (CTA) (16.3%), rheumatoid arthritis (RA) (5%), and post-trauma (1.3%). The mean preoperative OSS was 16 ± 5, which doubled postoperatively to 32 ± 8 (p<0.05). Fifteen patients (18.8%) underwent revision surgery, with a mean time to revision of 49 ± 11 months. Projected survival at five, seven, and 10 years was 83%, 81%, and 79%, respectively. Conclusion CRHA improved pain and function in the medium term but demonstrated a higher revision rate compared with other arthroplasty options, particularly in patients with CTA and RA. These findings should guide patient selection and shared decision-making.

Introduction: The National Audit of Breast Cancer in Older Patients (NABCOP) fitness assessment aims to standardise treatment for breast cancer patients over 70. However, studies have shown that compliance with NABCOP fitness assessment forms is variable. We sought to evaluate the form's usability, to improve compliance and ensure treatment decisions are based on overall patient performance rather than age alone.

Methods: We conducted two audit cycles involving patients over 70 diagnosed with breast cancer (metastatic or palliative presentations excluded). Cycle 1 (January-December 2021) included 108 patients, while Cycle 2 (January-December 2024) included 93 patients. Between cycles 1 and 2, modifications were made to the fitness assessment forms. These included making the Abbreviated Mental Test Score (AMTS) assessment optional based on clinician-identified cognitive concerns, incorporating Age Gap Decision Tool outcomes, and adding a tick-box for clinicians' overall judgement of "fitness for surgery".

Results: Form compliance improved from 37 % to 87 %. AMTS scores were documented in 11.9 % of cases in the first cycle, with no significant impact on surgical decision-making (p = 0.26), supporting reliance on clinical judgment for cognitive assessment. Across both cycles, the mean age for surgical patients was 77 years (SD ± 4.9), compared to 84 years (SD ± 6.2) for conservative management. Frailty scores were strongly associated with treatment decisions (p < 0.001), averaging 2.69 for surgical and 4.56 for non-surgical patients.

Conclusion: Modifications including simplified cognitive assessment and integration of the Age Gap Tool to the fitness assessment form improved compliance and streamlined decision-making. Frailty assessment remains pivotal in guiding treatment choices.

Background: Since the 1960s, beta blockers have been used to treat hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder causing abnormal heart muscle thickening. This systematic review evaluates their efficacy across clinical outcomes.

Methods: Registered on PROSPERO (CRD42022344255), searches were performed in June 2022 and updated in September 2025 across MEDLINE, Embase, CINAHL and PubMed. Two reviewers independently screened studies. Meta-analysis was undertaken when ≥3 comparable datasets were available; otherwise, narrative synthesis was used.

Results: 21 studies including 775 adults met inclusion criteria. Beta blockers significantly reduced left ventricular outflow tract (LVOT) gradient (Standardised mean difference (SMD) -1.57; 95% CI -2.07 to -1.07) and heart rate (SMD -1.19; 95% CI -2.24 to -0.14). Sensitivity analyses confirmed the robustness of the LVOT effect, while heart rate effects remained heterogeneous. Improvements in New York Heart Association class, exercise tolerance and symptom burden were consistently reported, although data were subjective and small in scale. Mortality evidence was limited to two retrospective cohorts with divergent findings.

Conclusions: Beta blockers provide consistent haemodynamic and symptomatic benefits in HOCM, but most evidence derives from small, older studies with high risk of bias and limited survival data. Contemporary, adequately powered randomised controlled trials are required to define optimal agent selection, dosing and long-term outcomes.

Background: Delayed or inconsistent administration of N-acetylcysteine (NAC) for paracetamol overdose in the emergency department (ED) poses a risk to patient safety, with current Royal College of Emergency Medicine (RCEM) standards often not being met. The traditional 21-hour NAC regimen is associated with adverse drug reactions, medication errors and prolonged admissions. The Scottish and Newcastle Acetylcysteine Protocol (SNAP) was introduced as a simpler alternative with comparable efficacy. This quality improvement project (QIP) aimed to improve compliance with RCEM standards by implementing targeted interventions while also reducing the length of inpatient stay and maintaining patient safety.

Method: This QIP was conducted at Royal Derby Hospital using a multidisciplinary, systematic approach based on Plan-Do-Study-Act cycles. Baseline data were collected from 100 randomly selected patients (November 2021-May 2022) and compared with outcomes during a 52-week intervention period (September 2023-August 2024). Interventions included educational sessions, quick reference materials and enhanced prescribing tools. Data were analysed for compliance with RCEM standards, adverse events (liver function derangement and anaphylactoid reactions) and system-level measures, such as length of inpatient stay and timing of paracetamol plasma levels.

Results: A total of 214 patients were included. Compliance with RCEM standard 1 improved from 36% to 43%. No change was noted for standards 2 and 3. Median inpatient stay decreased from 35 hours to 30.5 hours. No significant differences were found in adverse events. Special cause variation was identified in paracetamol plasma level timing, attributed to early sampling in some cases.

Conclusion: This QIP addressed problems of delayed or inconsistent NAC administration in the ED by improving compliance with RCEM standard 1 and reducing inpatient stay while maintaining patient safety. Although standards 2 and 3 did not improve, the interventions proved cost-effective, feasible and scalable. Future work should focus on sustaining improvements and exploring patient-centred outcomes across diverse healthcare settings.