Background: Early diagnosis of metastases is crucial but routine staging with contrast-enhanced multidetector computed tomography (ceMDCT) is suboptimal. A total of 20% will have indeterminate or too small to characterize (TSTC) liver lesions on CT, requiring formal characterization by magnetic resonance imaging (MRI). This UK cross-sectional study reports our experience undertaking routine abbreviated liver MRI (MRI).

Patients and methods: A total of 99 patients with rectal cancer had ceMDCT, abbreviated liver MRI, and rectal MRI at diagnosis. Liver imaging was scored for liver metastases, benign or indeterminate/TSTC lesions on a per patient basis. Primary rectal cancer was risk scored on MRI.

Results: A total of 42/99 (42%) had liver lesion(s) on ceMDCT versus 55/99 (56%) by MRI, and 46/99 (46%) had high-risk rectal cancer. ceMDCT showed 5 patients with liver metastases, 14 with benign lesions, and 23 with indeterminate/TSTC lesions. MRI showed 6 with liver metastases, 45 with benign lesions, and 4 with indeterminate/TSTC lesions. All liver metastases were in high-risk rectal cancer, OR 17.18 (p = 0.06), with 12.5% conversion rate of TSTC lesions to metastases in high-risk rectal cancer and 0% in low-risk rectal cancer. Diagnostic certainty of the liver findings was achieved in 93% of patients by MRI compared with 45% by ceMDCT (p < 0.0001).

Discussion: Abbreviated liver MRI diagnosed fewer indeterminate/TSTC lesions and provided greater diagnostic certainty than ceMDCT, p < 0.0001. High-risk rectal cancer is associated with a higher conversation rate of TSTC lesions to metastases than low-risk rectal cancers. Risk stratified; routine abbreviated liver MRI sequences should be investigated as part of the patient pathway for high-risk rectal cancer.

Background: Stroke is a major cause of mortality and permanent disability worldwide. Precise prediction of post-stroke mortality is essential for guiding treatment decisions and rehabilitation planning. The ability of Machine learning models to process large amounts of data, offer a promising alternative for improving mortality prediction in stroke patients. In this review, we aim to evaluate the risk of bias in different machine learning models used for predicting post-stroke mortality.

Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Relevant articles were retrieved from Cochrane Library, Scopus, PubMed, and Web of Science databases.

Results: A total of 9 studies were included, with an aggregate patient population of 669,424. Six studies used publicly available datasets, and four used hospital data with a follow up duration ranging from 7 days to 18 months. The range of area under the curve (AUC) for mortality prediction across the studies ranged from 0.81 to 0.95. All studies were determined to have a high overall risk of bias.

Conclusion: Machine learning models demonstrated great potential in predicting post-stroke mortality. However, implementation of these models in clinical practice is limited by high risk of bias. Future studies should focus on reducing this bias and enhancing the applicability of these models to improve the reliability of stroke mortality predictions.

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.

Newborn babies are examined at around 6 to 72 hours after their birth to rule out major congenital abnormalities and reassure the parents that their baby is healthy. This practical text is a step-by-step guide for all practitioners who undertake this clinical examination. It is particularly valuable for midwives and nurses undertaking Examination of the Newborn modules as well as a useful reference work for those already performing this role. It provides midwives and other practitioners involved in neonatal examination with a comprehensive guide to the holistic examination of the newborn infant.

Examination of the Newborn encourages the reader to view each mother and baby as unique, taking into account their experiences preconceptually, antenatally and through childbirth. The text covers:

• the role of the first examination as a screening tool;

• normal fetal development;

• parents’ concerns and how to respond to them;

• the impact of antenatal diagnostic screening;

• the events of labour and birth;

• the clinical examination of the neonate;

• the identification and management of congenital abnormalities;

• accountability and legal issues.

This new edition is thoroughly revised throughout to meet current Nursing and Midwifery Council (NMC), General Medical Council (GMC) and National Screening Committee standards. It reflects the new standards and key performance indicators (KPIs) from Public Health England (2016b). Case scenarios, model answers, questions and further reading help the reader to apply the content to their own practice.

Statement of problem: Manually sculpting a wax pattern of a facial prosthesis is a time-, skill-, and resource-intensive process. Computer-aided design (CAD) methods have been proposed as a substitute for manual sculpting, but these techniques can still require high technical or artistic abilities. Three-dimensional morphable models (3DMMs) could semi-automate facial prosthesis CAD. Systematic comparisons of different design approaches are needed.

Purpose: The purpose of this study was to compare the trueness and repeatability of replacing facial features with 3 methods of facial prosthesis design involving 3DMM, traditional CAD, and conventional manual sculpting techniques.

Material and methods: Fifteen participants without facial defects were scanned with a structured light scanner. The facial meshes were manipulated to generate artificial orbital, nasal, or combined defects. Three methods of facial prosthesis design were compared for the 15 participants and repeated to produce 5 of each design for 2 participants. For the 3DMM approach, the Leeds face model informed the designs in a statistically meaningful way. For the traditional CAD methods, designs were created by using mirroring techniques or from a nose model database. For the conventional manual sculpting techniques, wax patterns were manually created on 3D printed full face baseplates. For analysis, the unedited facial feature was the standard. The unsigned distance was calculated from each of the several thousand vertices on the unedited facial feature to the closest point on the external surface of the prosthesis prototype. The mean absolute error was calculated, and a Friedman test was performed (α=.05).

Results: The median mean absolute error was 1.13 mm for the 3DMM group, 1.54 mm for the traditional CAD group, and 1.49 mm for the manual sculpting group, with no statistically significant differences among groups (P=.549). Boxplots showed substantial differences in the distribution of mean absolute error among groups, with the 3DMM group showing the greatest consistency. The 3DMM approach produced repeat designs with the lowest coefficient of variation.

Conclusions: The 3DMM approach shows potential as a semi-automated method of CAD. Further clinical research is planned to explore the 3DMM approach in a feasibility trial.

The ageing global population is posing a significant challenge to healthcare systems worldwide. Healthcare needs have become more complex and the demand for services is ever increasing. Identification of frailty at the front door of hospitals can prompt comprehensive geriatric assessment and streamline patients to the most suitable clinical area. The United Kingdom has set a priority to develop front door services given the pressure on the National Health Service. A British Geriatrics Society survey has demonstrated that the majority of frailty assessments occur in the emergency department using the Clinical Frailty Scale. This survey prompted the creation of the setting up services guide and its key principles using a collaboration of experience from across the country. Understanding the systems that already exist and creating a network to enable a flow of care towards community teams is crucial to the successful provision of modern frailty attuned care.

Traditional approaches to health promotion involve clinicians imparting knowledge to patients and 'telling' patients what changes they should make to benefit their health. This so-called 'fixing reflex' can be counterproductive and ineffective, creating unhelpful discord between clinicians and patients. There is little evidence that this approach is wholly effective in bringing about healthier patient behaviours. In contrast, motivational interviewing (MI) is a patient-centred consultation style aimed at developing patient motivation and commitment for a range of health-related behaviours. It focuses on discovering the values, beliefs and goals of patients and encourages clinicians and patients to work together collaboratively, to bring about change and growth. It is an effective, evidence-based approach, even when used as a 'brief intervention' for a few minutes only. This paper discusses how MI can be applied in dental healthcare settings to enhance general and oral health. The evidence available for its use in dentistry is discussed, along with opportunities for training of the dental team in this skill.

No abstract available

Hepatocellular carcinoma (HCC) is the most common form of hepatic malignancy, with high mortality rates recorded globally. Early detection through clinical biomarkers, medical imaging and histological assessment followed by rapid intervention are integral for positive patient outcomes. Although contrast-enhanced computed tomography scans and magnetic resonance imaging are recognised as the reference standard for the diagnosis and staging of HCC in international guidelines, ultrasound (US) examination is recommended as a screening tool for patients at risk. Contrast-enhanced US (CEUS) elevates the standard of an US examination using US contrast agents (UCAs), capable of diagnosing focal liver lesions with high efficacy. Most UCAs are purely intravascular, offering clinicians a dynamic representation of a lesions' arterial phase vascular kinetics, which is seldom seen in such detail during computed tomography or magnetic resonance imaging assessments. Despite its benefits, there is incongruity between international societies on the role of CEUS in the HCC clinical pathway. The transient nature of pure blood-pool agents is suggested to be insufficient to justify CEUS as a primary modality due to the inability to consistently perform whole liver imaging, alongside disputes regarding its capabilities to differentiate HCC from intrahepatic cholangiocarcinoma. A sinusoidal phase UCA affords clinicians the opportunity to perform whole liver imaging through Kupffer cell uptake in addition to visualising lesion vascular kinetics in the arterial and portal venous phases. Therefore, the purpose of this review was to examine the role of CEUS in the HCC clinical pathway in its current practice and observe how a Kupffer cell sinusoidal phase UCA may supplement contemporary diagnostic techniques through a multi-modality, multi-agent approach.

Background and aim Non-contrast computed tomography of kidneys, ureters, and bladder (CT KUB) is the gold standard radiological imaging for nephrolithiasis. It significantly contributes to the total radiation exposure of a population. This is well known to be linked to increased cancer risk over time and as such should be minimized in line with Ionising Radiation (Medical Exposure) Regulations (IR{ME}R). Previous works have explored a number of avenues to reduce the total radiation exposure such as the cranial extent of the scan; however, at present, there are no formalized guidelines. This study aimed to compare the cranial extent of local CT KUB imaging with previously established thresholds and assess whether total radiation can be reduced through local intervention. Results In the first cycle, a total of 102 non-contrast CT KUB scans were included. Of these, 51% (n=52) commenced from the superior border of the T10-T12 vertebral levels, 48% (n=49) commenced above the T10 vertebral level, and only 1% (n=1) started below the T12 vertebral level. In the second cycle, a total of 105 non-contrast CT KUB scans were assessed. Of these, 21.9% (n=23) commenced above the T10 vertebral level, and 75.2% (n=79) commenced from the superior border of T10-T12 vertebrae. A further 2.9% (n=3) commenced below T12 vertebral level. The findings of this study demonstrate that starting the upper extent of the CT KUB at the T10 vertebral level showed a reduction in radiation dose in millisievert (mSv) delivered to patients while maintaining adequate diagnostic utility. Conclusion Limiting the cranial extent of CT KUB imaging to T10 has consistently captured the upper pole of both kidneys across different patient cohorts, including ours, thus making it an effective way of limiting radiation exposure without sacrificing diagnostic accuracy. In order to achieve robust evidence-based guidelines, further studies would be beneficial.

No abstract available

Pain is frequently encountered in dermatology practice, which impairs the activities of daily living, adds to psychological morbidity, and therefore compromises the quality of life. It ranges from mild to severe in intensity across various dermatoses and requires prompt addressal and treatment. Diseases such as extensive pemphigus vulgaris and Stevens-Johnson syndrome are especially painful and require a multidisciplinary approach with the involvement of a pain specialist in their management. The main pathogenic types of pain include visceral nociceptive, somatic nociceptive, and neuropathic types, the latter two being most relevant in dermatological disorders. Somatic nociceptive pain is often seen in patients of Stevens-Johnson syndrome/ Toxic epidermal necrolysis, epidermolysis bullosa, pemphigus vulgaris, erythema nodosum, and hidradenitis suppurativa, while neuropathic pain is part of the disease process in dermatoses like leprosy, herpes zoster, and dysesthesia syndromes. Therapeutic approaches to pain management include the use of non-opioids (acetaminophen, non-steroidal anti-inflammatory agents), opioids, and non-pharmacological therapies, along with appropriate management of the underlying dermatosis. World Health Organisation (WHO) analgesic ladder remains the most commonly employed guideline for the management of pain, although treatment needs individualisation depending on the nature and severity of pain (acute/chronic), type of dermatosis, and patient factors. There is a paucity of literature pertaining to pain management in dermatology and this topic is often neglected due to a lack of awareness and knowledge of the topic. The present review aims to discuss the pain pathway, various painful conditions in the setting of medical dermatology practice, and their management along with relevant pharmacology of the commonly used analgesics.