Introduction: Renal stones develop when urinary solutes crystallize into solid deposits within the urinary tract. The 2019 National Institute for Health and Care Excellence (NICE) and British Association of Urological Surgeons (BAUS) guidelines recommend serum calcium and urate testing for all patients with renal or ureteric stones. This single-center audit aimed to assess compliance with these guidelines in a local urology department and implement quality improvement interventions to enhance adherence.

Methods: We conducted a retrospective two-cycle audit on patients admitted with renal stones by the urology team at Chesterfield Royal Hospital, United Kingdom. Patient information and admission investigations were reviewed using the hospital's electronic medical records. Data were obtained from electronic medical records and assessed for compliance with calcium and urate testing guidelines. Interventions included educational sessions for clinicians, reminder posters, and updates to admission documentation. Pre- and post-intervention results were compared using statistical analysis.

Results: A total of 70 patients were included (36 in the first cycle; 34 in the second). In the first cycle, urate testing was performed in 2 patients (5.6%), while calcium testing was performed in 31 (86.1%). Following the intervention, urate testing increased to 13 patients (38.2%; p = 0.00087) and calcium testing reached 100% compliance (p=0.0241).

Conclusion: This audit identified poor adherence to urate and calcium testing guidelines for patients with renal stones. Educational and process interventions significantly improved compliance, achieving 100% for calcium testing and a more than sixfold increase in urate testing. Sustained improvement will require continued quality improvement measures.

Locally advanced prostate cancers (LAPC) are a clinical dilemma due to their biological heterogeneity and multiple algorithmic treatment options. Recent years have seen a great deal of progress in management, both in established methods and new modalities. This had led to a necessity to systematically map out existing evidence. This scoping review intends to systematically integrate and summarize the zeitgeist research in the area of the care of LAPC to advance the available knowledge, discuss emergent management strategies, and identify evidence needs in different healthcare settings. A scoping review was undertaken following the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A primary study search was conducted on six electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL Plus, and Cochrane Library) and gray literature sources published between 2013 and April 2025. The Population-Concept-Context (PCC) framework guided the eligibility. Data were plotted and thematically synthesized into six key domains: hormonal therapy, radiotherapy innovations, surgical strategies, new systemic therapies, imaging improvements, and real-life evidence. Six studies were included, consisting of a randomized controlled trial, an observational study, and a diagnostic review. The main themes were the benefits of multimodal treatment, the impact of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging and genomic profiling, and the role of second-generation androgen receptor inhibitors and regional disparities in access to treatments. Combination therapies showed oncologic benefits, but raised concerns about patients' quality-of-life outcomes. The management of LAPC is moving to a related precision-based, multimodal paradigm. Although current knowledge supports more aggressive and individualized therapy, there are still data gaps in long-term outcomes, global uptake, and patient-reported measures. Future research needs to be based on inclusive longitudinal studies that span between clinical innovation and real-world application.

Acute gastrointestinal bleeding (GIB) is a major medical emergency with high morbidity and mortality. Endoscopy remains the first-line diagnostic and therapeutic approach, but radiological imaging has become increasingly important, particularly when endoscopy is inconclusive or unavailable. This review outlines the evolving role of radiological techniques, including computed tomography angiography (CTA), catheter-based angiography, radionuclide scintigraphy, magnetic resonance imaging (MRI), and ultrasound (US), in the detection, localization, and management of acute GIB. CTA is now the preferred imaging modality because of its speed, noninvasive nature, and superior anatomical detail. Catheter angiography not only enables precise diagnosis but also provides therapeutic options through embolization. Nuclear medicine techniques offer high sensitivity for intermittent or low-rate bleeding, while MRI and US contribute complementary insights in select patient groups. An integrated approach that combines radiological, endoscopic, and surgical strategies improves decision-making, shortens time to intervention, and enhances patient outcomes. Recent advances, including dual-energy CT, AI-assisted imaging, and novel embolic agents, are expected to further strengthen both diagnostic accuracy and therapeutic potential. Understanding the strengths, limitations, and sequencing of these modalities is key to optimizing care for patients with acute GIB.

No abstract available

Rationale: Literature shows that breast pain alone has no significant association with breast cancer. Currently, patients experiencing these symptoms are often referred to breast cancer diagnostic clinics (BCDCs), leading to an increase in unnecessary anxiety and overutilisation of already strained secondary care resources. The East Midlands Breast Pain Pathway (EMBPP) aims to establish a new pathway that improves patient care and eases pressure on BCDCs, as well as being cost-beneficial and providing a positive patient experience.

Aim and objectives: This study aims to evaluate the impact of the EMBPP on patient care, including safety, costs incurred by the health system and patient experience.

Methods: The EMBPP was analysed quantitatively and qualitatively using data extracted from the community breast pain clinics (CBPCs), BCDCs, patient-reported outcome measures, clinic costs, family history data and staff interviews.

Results: Breast cancer incidence within the cohort of patients with a full 12-month follow-up period was shown to be 3.7 per 1000 patients, below the population estimates in the literature. There was no delay to care for those who were diagnosed with breast cancer after attending a CBPC. The clinics were found to be cost-beneficial, with a cost-benefit ratio of 1.26 in year 1, 1.40 in year 2 and 1.56 in year 3. The pathway was positively received by patients, with 98.7% indicating that they would recommend the service.

Conclusion: Following on from previous audits and analysis of the EMBPP pathway, this national evaluation has shown that CBPCs are effective across multiple Cancer Alliances, National Health Service (NHS) Trusts and demographics. The CBPC offers a positive patient experience and is cost-beneficial and safe, with no evidence of a delay to care for the patients.

Climate change is now widely accepted as a real and serious anthropogenic threat to the future, driving a need to change our personal and professional behaviour in relation to environmental sustainability. This research aims to establish orthodontists’ knowledge, attitudes and current practice in relation to environmental sustainability in the clinical environment. A cross-sectional survey of orthodontists in the UK was carried out using a bespoke online questionnaire developed through literature review, consultation with experts and pre-testing. Information was collected about the perceived importance of environmental sustainability and strategies to improve practice, current practice and policies, and potential barriers and facilitators to change. Data were analysed descriptively to report sample characteristics and frequency of reported attitudes and practice. Free text answers provided additional context and detail. The questionnaire was completed by 146 BOS members (10%). Environmental sustainability was overwhelmingly scored as critical or important, with slightly higher ratings for the importance of environmental sustainability in general than in orthodontics. The environmental strategies rated as often as ‘critically important’ were: (1) reducing the use of plastics; (2) recycling consumables; (3) reducing the use of single use items; and (4) rethinking waste management processes. The main concerns associated with facilitating change related to attitudes, culture and the relative benefit and feasibility of making changes. Key perceived barriers to making changes were cost, regulations and organizational policies, largely reported by people working in hospitals. Orthodontists appear passionate about environmental sustainability, but a number of barriers limit their ability to make meaningful changes in practice. This study provides preliminary information about awareness, attitudes and behaviours of orthodontists, which is useful for generating questions for future research.

Despite widespread attempts from governments and leading health organisations worldwide to promote equity in healthy living medicine, the evidence suggests that attempts to curb worsening public health have been almost entirely ineffective. Despite significant advancements in knowledge, medicine, and technology, as well as the promotion of guidelines and the implementation of numerous global initiatives aimed at addressing health disparities and mitigating the progression of non-communicable diseases (NCDs) worldwide, substantial work remains to be undertaken particularly in addressing inequalities in physical activity. Achieving equitable access to health resources and parity in health outcomes remains a critical and unresolved challenge. Whilst it is recognized that the public health paradigm is broad and complex, with many intersecting and interacting parts, the actions and considerations required to address the urgent and escalating scale of the problem appear at a crossroads of now or never. Throughout this narrative review, we describe the effectiveness of landmark physical activity-related guidelines, policies and national interventions that have been implemented since the turn of the century to address physical activity behaviour in the context of health inequalities.

No abstract available

Introduction: Physiological age-related bone loss is common, with 50% of women aged ≥80 having osteoporosis. Bone loss is exacerbated in women receiving aromatase inhibitors (AIs) for early breast cancer (EBC), increasing fracture risk. This study explored the management of bone-health in older women (≥70 years) with EBC and factors influencing clinical decision-making.

Materials and methods: This was a sub-study of a larger United Kingdom multicentre observational study into practice variation and outcomes in older women (≥70) with EBC (Age Gap study). Participants were aged ≥70 years with EBC; data were collected on health status, treatments, and outcomes. This sub-study focused on patients recruited at five hospitals, where more detailed data on bone health and management were collected for women with ER + ve (oestrogen receptor positive) cancers who received adjuvant or primary endocrine therapy treatment. We aimed to determine factors influencing treatment selection and outcomes in this age group.

Results: The main Age Gap study recruited between 2013 and 2018. In this sub-study, 565 patients had ER + ve cancers, of whom 529 (93.6%) received AIs and 26 (4.6%) tamoxifen. The median age of participants was 77 years (70-98 years). A baseline dual energy x-ray absorptiometry (DEXA) scan was performed in only 354/529 (67%) of the AI group. Bisphosphonates were prescribed for 226/529 (43%). Baseline DEXA scans were more likely to be requested if patients were fit for surgery and were < 80 years old. Of those scanned (n = 354), 148 (42%) were osteopenic and 64 (18%) osteoporotic. Bisphosphonate prescription was associated with younger age (<80 years old) (p = 0.02). From recruitment to 2022, fractures were diagnosed in 23% of participants (122/529), of whom only 38% (46/122) had received prior bisphosphonates. Frailty or prefrailty (Rockwood scale) were present in 94% (431/461), but there was no correlation between frailty and baseline hip (r2 = 0.0098) or spine (r2 = 0.00007) T-scores. Rates of DEXA scanning varied between centres from 36% to 76% (p < 0.001) for unknown reasons.

Discussion: Age and general health influenced bone-health management decision-making, but there was considerable variation between centres, highlighting the need for standardised bone-health care for older women with EBC.

A 95-year-old female presented to the emergency department with chest pain and difficulty breathing. She had a left-sided tension hydropneumothorax secondary to a spontaneous rupture of a hiatus hernia close to the gastro-oesophageal junction. This has not previously been described in the literature and therefore, the purpose of this report is to pique clinicians' interest and highlight this rare phenomenon as a possible differential diagnosis in patients with a hiatus hernia who present with chest pain. It also demonstrates the importance of the use of oral contrast when using computerised tomography to investigate for oesophageal rupture.

Rationale: Research indicates that breast pain as the sole symptom has no association with breast cancer. However, patients with breast pain only are often referred onto urgent breast cancer diagnostic pathways, leading to unnecessary anxiety and overutilisation of secondary health care services. The novel community breast pain clinic (CBPC) service in the UK aims to improve patient care while providing system-wide improvements for patients with breast pain, patients who have 'red flag' symptoms, as well as being cost-effective.

Aim and objectives: This study seeks to evaluate and assess the impact of the CBPC on patient care, experience, and healthcare system improvements.

Methods: Quantitative and qualitative analysis of CBPC was undertaken using data from CBPC based on a core data set designed by the programme team, secondary care follow-up data, Patient Reported Outcomes Measure (PROMs) data and family history data.

Results: The CBPC was well-received by patients with 98.5% recommending the service. Additionally, health economic analysis indicated a cost benefit ratio of 1.23 in year 1, indicating a positive return on investment. Breast cancer incidence within the cohort was estimated at 3.2 per 1000, in line with population estimates in the literature. For those with a breast cancer diagnosis, there is no evidence of care delays or missed diagnoses via the service.

Conclusion: The CBPC offers significant benefits in patient experience and value for money, with no evidence of reducing patient safety. The impacts of the clinics appear to be reproducible across all five centres in the East Midlands (a population of 5.5 million). Recommendations on further assessment on optimal staff mix and clinic cost mechanisms should be considered to maximise benefits.

Introduction In the United Kingdom (UK), the General Medical Council (GMC), the regulatory authority for doctors, emphasizes teaching competence in its Good Medical Practice guidelines. Teaching experience is also a key criterion in core and specialty training applications. In response to these expectations, we established the Surgical trainee interest group (STIG), a collaborative platform for junior doctors focused on addressing training needs, particularly in teaching. Through STIG, we developed and implemented a peer-led education program aimed at enhancing teaching skills and supporting the development of individual teaching portfolios. The program included quarterly teaching sessions on surgical topics and preparatory courses for specialty applications, conducted over one year (2022-2023). Traditional teaching programs are often resource-intensive and challenging to organize. Media can help bridge this gap by enhancing teaching delivery, improving learner comprehension and retention, and fostering collaboration through broader access to educational opportunities. In our program, teaching sessions were delivered online using platforms such as Medall and Microsoft Teams. Recruitment and dissemination of activities were primarily conducted via social media. This study aimed to evaluate the effectiveness and challenges of integrating media into a surgical teaching program for resident doctors. Given the limited literature on media use in surgical education, our research provides valuable insights into the advantages and limitations of leveraging digital platforms for medical teaching. Methods Resident doctors who participated in the teaching program were asked to complete an online feedback form at the end of each session. The form included questions assessing the effectiveness of media integration within the teaching program. Only participants who provided consent and submitted the feedback form were included in the analysis; no exclusion criteria were applied. Quantitative feedback was collected using a 5-point Likert scale, and a comments section was provided for qualitative feedback. To explore perspectives on media usage, semi-structured interviews were conducted with the tutors. All data were subsequently collected and analyzed. Results Forty participants attended our teaching sessions on the Medall platform, while 12 attended via Microsoft Teams. The on-demand content from our sessions recorded a total watch time of 784 minutes. Respondents rated the use of media with an average score of 4.5 on a 5-point Likert scale. Many respondents agreed that the use of media was effective in supporting teaching delivery. Positively themed comments were noted, while challenges and areas for improvement were also identified. Tutors reported that media enhanced their ability to deliver effective teaching and supported the overall objectives of the program. Conclusion Our analysis highlights the role of media in medical education. We evaluated the effectiveness and challenges associated with media integration in a surgical teaching program. The study demonstrated that media, when integrated into surgical education, is effective in enhancing teaching delivery. While the pivotal role of media in instruction was evident, several challenges were identified that warrant further improvement.