We present a rare case of allergic bronchopulmonary aspergillosis (ABPA) with endobronchial aspergilloma in a 70-year-old man who presented with acute total collapse of the left lung. Initial imaging raised concern for malignancy, but bronchoscopy revealed a fungal ball obstructing the left main bronchus. Serological markers confirmed ABPA. Treatment with bronchoscopy-guided clearance, oral corticosteroids, and voriconazole led to complete clinical and radiological recovery. This case highlights the importance of considering fungal aetiologies in atypical presentations of lung collapse

Objective:
We conducted a systematic review and meta-analysis to assess the effectiveness of Intensive Community Care and Services (ICCS) compared with treatment as usual (TAU), including inpatient care, and to synthesize common psychosocial interventions used within ICCS.

Method:
We searched 14 databases from Jan 1, 1999, to May 30, 2025, for quantitative studies of ICCS for adolescents predominantly (aged 12-18 years) with mental health problems. We used a random-effects meta-analysis of randomized controlled trials (RCTs) comparing ICCS versus TAU (and inpatient care only), on psychosocial functioning, mental health and cost-effectiveness outcomes. We used a narrative synthesis with an adapted Delphi approach to identify common psychosocial interventions and theoretical mechanisms. The protocol was registered in PROSPERO.

Results:
We included 48 publications on 35 unique ICCS evaluations (N=6917 adolescents; median age 14.5 years) involving admission avoidance/home treatment, assertive outreach and family preservation models. Meta-analysis of 11 unique RCTs (range: 297-1176 participants per outcome) showed that, compared with TAU, ICCS yielded statistically significant improvements in psychosocial functioning (Hedges' g= 0.15, 95% CI=0.04, 0.26; 9 RCTs), reductions in inpatient admission days (-0.48 -0.82, -0.15; 4 RCTs), total emotional and behavioral problems (-0.15, -0.30, -0.01; 5 RCTs), and externalizing symptoms (-0.18, -0.30,-0.06; 6 RCTs) post-treatment. The effect for psychosocial functioning increased and remained significant when comparing ICCS with inpatient care only (0.25, 0.04, 0.46; 5 RCTs). No significant differences were found for internalizing symptoms, family functioning, or total costs. The narrative synthesis showed that psychosocial interventions consistently included enhanced engagement strategies, cognitive behavioral therapy, family systems approaches, and dialectical behavior therapy skills.

Conclusion:
For adolescents with severe mental health problems, ICCS yielded small but significant improvements in psychosocial functioning, reductions in inpatient days and emotional and behavioral symptoms, while achieving comparable effects for other outcomes. Findings support the expansion of ICCS as a viable alternative to inpatient care. Future research should prioritize multisite RCTs and developing and evaluating standardized psychosocial intervention guidelines to enhance treatment fidelity and outcomes

Purpose of review:
Point-of-care ultrasound (POCUS) has transformed emergency medicine by providing a noninvasive, accessible, repeatable, efficient, and cost-effective imaging tool to the bedside. This article is a narrative review of the most impactful POCUS literature over the past 18 months, identifying and highlighting the most common emerging themes.

Recent findings:
We identified five main themes in the recent POCUS literature: ultrasound-guided regional anesthesia, POCUS in resuscitation, diagnostic POCUS, technology and artificial intelligence, and POCUS governance and administration.

Summary:
The recent body of literature strengthens the utility of POCUS in emergency medicine, demonstrating its efficacy, safety, and efficiency across multiple clinical scenarios. The literature continues to expand the scope of POCUS by covering new diagnostic applications and integrating emerging technologies, while continuing to build a robust governance framework. Future research should focus on patient-oriented outcomes, implications of POCUS protocolization and clinical application, and the impact of POCUS at hospital and healthcare systems levels.

No Abstract Available

Objectives: Self-compassion is a positive psychological factor linked to improved physical and psychological outcomes across different chronic illness populations. However, the extent to which self-compassion contributes to reduced distress across different conditions or as a function of participant factors is not clear. The current meta-analysis aimed to quantify the association between self-compassion and psychological distress in different chronic illness populations and evaluate the factors that moderate this association.

Methods: A systematic search of three electronic databases identified research reporting associations between self-compassion and psychological distress in chronic illness. A random effects meta-analysis was conducted to evaluate the association between self-compassion and psychological distress. Moderator analyses were conducted for sample characteristics and distress types. A bespoke tool evaluated study quality.

Results: Searches yielded 51 eligible studies with 57 effect sizes. Meta-analysis revealed that self-compassion was negatively associated with psychological distress (r = -.516; 95% CIs [-.55, -.48]; p = .000). Moderator analyses were significant for distress type and chronic illness group, with effects being largest for stress and neurological conditions. Effects did not vary by sex, age or illness duration.

Conclusions: Findings from this first comprehensive investigation of the link between self-compassion and distress in chronic illness highlight the protective role of self-compassion for chronic illness populations. These results lay the foundation for further research into understanding the processes that link self-compassion to lower psychological distress, and that examine the effectiveness of self-compassion interventions in chronic illness populations, to further advance knowledge and inform practice in this area.

Fractured and missing teeth within the aesthetic zone have always posed a clinical challenge for the dental team. Management and treatment requires the input from a number of dental specialists to guarantee a high quality result. A case report is presented to demonstrate an effective combined orthodontic/restorative approach that fully restored aesthetics and function. The report is of a 14-year-old girl who traumatized her maxillary central incisors, in a dentition that was already compromised as she had congenital absence of her maxillary left lateral incisor.

Using fixed orthodontic appliances, the fractured teeth were extruded to bring the fracture line above the level of the alveolar bone. This movement allowed an immediate aesthetic improvement, using stainless steel prefabricated posts and composite resin buildups, which also facilitated further orthodontic tooth movement. Teeth, that would otherwise have been extracted, were salvaged and, utilizing a multidisciplinary team approach, a reasonable long-term prognosis has resulted.

CPD/Clinical Relevance: This case report aims to demonstrate how a multidisciplinary team approach in Orthodontics can be utilized for management of severely handicapped dentitions that have sustained dental injury. It is not the aim of this case report to discuss the treatment of dental injuries but to demonstrate and provide an overview of the possible treatment modalities that can be effective in restoring function and aesthetics, with special consideration given to missing teeth and subgingival crown fractures within the aesthetic zone.

BACKGROUND: Cancer of unknown primary is the fourth most common cause of cancer death in the United Kingdom. National guidance in 2010 recommended the establishment of a dedicated unknown primary team to facilitate targeted investigation and symptom control. A service development project was undertaken to identify those affected by malignancy of unknown origin and institute a pathway for coordinating their care led by a palliative physician.
METHOD: In order to describe the patient population and illness trajectory and to assess the effect of the new pathway on the clinical outcomes we used a retrospective and prospective comparative case notes survey to identify the pre- and post-pathway population. This took place in secondary care. Inclusion criteria were patients with metastatic disease with no known primary; exclusion criteria were where the site of metastasis was so suggestive of a primary that it would be managed as per that disease process. 88 patients were included.
RESULTS: Mean age was 72.5 years. The mean survival time from presentation was 81.8 days. There was no difference pre or during pathway implementation in age, performance status or survival time. There was no reduction in the numbers referred for tumour directed therapy. There was a non-statistically significant reduction in the number who died in hospital during the pathway implementation.
CONCLUSIONS: This study suggests having a metastatic malignancy of unknown primary origin service led by a palliative physician does not reduce the number referred for tumour directed therapy. It also adds evidence of the poor prognosis and thus the need for early palliative care input.

Environments that support pre- and post-registration students' and staff learning are vital to ensure the delivery of high quality patient care by knowledgeable and competent healthcare practitioners. A project was undertaken at Chesterfield Royal Hospital NHS Foundation Trust to modernise and enhance preceptorship against a background of national and local drivers. This article describes the development, piloting and evaluation of a new role designed to support and enhance practice learning environments for newly qualified nurses, preceptors, pre-registration nursing students and mentors. The article identifies the factors that affect clinical learning environments and discusses some practical solutions to the challenges associated with learning in practice. Finally, the article offers some recommendations and implications for practice in relation to the pilot outcomes.

Purpose: To describe a hitherto unreported late ocular surface complication of retinal detachment surgery around a radial segment explant.

Methods: A single case report of a 72-year-old white man, with a previous history of right scleral buckling surgery for retinal detachment surgery 25 years ago, presented with right-sided ptosis of 6 months duration.

Results: Ocular surface examination showed a prominent right supero-nasal quadrant radial segment explant, around which there was bulky pink conjunctival mass, extending from the supero-medial fornix down to the medial canthal area and inferior medial fornix with similar changes seen on the upper medial tarsal conjunctiva. The clinical differential diagnosis was either inflammation from an exposed radial explant or lymphoma. Biopsies of the conjunctival mass showed perivascular and interstitial solid eosinophilic deposits of amyloid, with scattered giant cells; the amyloid was of AL type. There was no morphological or immunohistochemical evidence of lymphoma or a plasma cell neoplasm in the specimen.

Conclusion: This is the first report of localized conjunctival amyloid deposition, secondary to a retinal detachment radial explant. It is proposed that the localized amyloid deposit arose from the ocular surface irritative effects of the radial explant.

Esophageal varices are dilated submucosal esophageal veins that connect the portal and systemic circulations. Bleeding esophageal varices is a well-recognized complication of liver cirrhosis.It is known that in active variceal bleeding, treatment needs to be started promptly. Treatments comprise band ligation, sclerotherapy, removable stent placement, balloon tamponade, and transjugular intrahepatic portosystemic shunt (TIPS).We report a case in which hemodynamic stability can be maintained with the use of Purastat to control bleeding

Lifelong learning refers to the systematic acquisition, renewal, updating and completion of knowledge. It is synonymous with the term 'self-directed learning'. This is a new educational strategy meant to consolidate knowledge in a fashion that is reproducible for a lifetime with successful application to both known and unknown clinical exercises. The development of lifelong learning is based on the principles of andragogy (autonomy and independence in one's learning activities), reflection and learning from experience. This paper deals with the development of these theories culminating in the advent of self-directed learning. Evidence to support experiential, reflective and self-directed learning is provided, including the use of rating scales. An example from obstetrics is used to highlight the application of these principles. There are barriers to adopting a new educational paradigm, however, lifelong learning remains an excellent tool for continuous professional development.

Introduction Seroma formation is the most common complication after modified radical mastectomy (MRM). It leads to increased pain and discomfort, potentially prolonging morbidity and treatment. Various treatment modalities are being used to decrease the incidence of seroma formation. The objective of this study was to compare intravenous hydrocortisone injection versus placebo in patients undergoing MRM in terms of frequency of post-operative seroma formation. Methods This randomized, double-blinded, placebo-controlled study was conducted at Surgical Unit-I, Holy Family Hospital, Rawalpindi, Pakistan from January 2021 to December 2021. A total of 152 female patients were randomly assigned to each of the study and placebo groups. Group I patients received 100 mg of hydrocortisone intravenously while group II patients received one ml of 0.9% normal saline intravenously prior to induction of general anesthesia for MRM. The incidence of seroma formation after 10 days of MRM and total drain volume till their removal was measured in all patients. Results The mean age was 48.42±10.15 in Group I, while it was 47.67±10.75 in Group II. Mean drain output till removal was 99.14±31.01 ml in the hydrocortisone group and 177.57±63.37 ml in the placebo group. Forty-eight patients developed seroma (31.58%), of whom nine received intravenous hydrocortisone and 39 received normal saline (P=0.000). Conclusion Intravenous hydrocortisone is effective in terms of frequency of post-operative seroma formation as compared to placebo in patients undergoing MRM.

This article aims to outline the role and training of orthodontic auxiliaries in the UK, including the development of orthodontic therapists (OTs). The limitations and findings from a survey taken to understand the training and scope of orthodontic auxiliaries across Europe are provided and we reflect on the desirability and feasibility of standardized training for OTs, particularly in light of Brexit.

CPD/Clinical Relevance: Orthodontic auxiliaries are important members of the dental team. It is important that the training, role and scope of practice of all team members are understood to allow safe delegation and supervision.

This article describes the problem of disorientation in students as they become doctors. Disorientation arises because students have a poor or inaccurate understanding of what they are training to become. If they do not know what they are becoming it is hard for them to prioritise and contextualise their learning, to make sense of information about where they are now (assessment and feedback) or to determine the steps they need to take to develop (formative feedback and "feedforward"). It is also a barrier to the early development of professional identity. Using the analogy of a map, the paper describes the idea of a curriculum that is articulated as a developmental journey--a "roadmap curriculum". This is not incompatible with a competency-based curriculum, and certainly requires the same integration of knowledge, skills and attitudes. However, the semantic essence of a roadmap curriculum is fundamentally different; it must describe the pathway or pathways of development toward being a doctor in ways that are both authentic to qualified doctors and meaningful to learners. Examples from within and outside medicine are cited. Potential advantages and implications of this kind of curricular reform are discussed.

No abstract available

INTRODUCTION: "Be Clear on Cancer" (BCOC) was a national campaign to raise awareness of breast cancer in women over seventy years old. Cancer Research UK conducted this campaign from 03 February 2014 to 15 March 2014. This study assesses its impact on breast care services.

METHODS: BCOC campaign guidelines for hospital trusts were used as standard comparator for this retrospective case-control study. All new patients referred to breast clinic over four months from February 2014 were included, and compared to the same period in 2013. Information was recorded for referrals, biopsy rates and pathological diagnoses. Intra & inter-group comparisons were performed.

RESULTS: 1646 patients were included. An increase of 25.2%(n = 184) was observed in referrals in 2014(n = 915) compared to 2013(n = 731). Cancer detection rates went down significantly (P = 0.002,Chi-square) in 2014 (5.1%,n = 47) compared to 2013 (9.0%,n = 66) due to the increase in number of referrals. In the over 70s group, a higher than predicted increase of 64.2%(n = 52) in all referrals, and 8%(n = 44) in two-week wait referrals was observed. The number of biopsies and cancers detected remained stable although the proportions undergoing biopsies (2014-29.3%,n = 39/133 versus 2013-38.3%,n = 31/81) or being diagnosed with cancer (2014-19.5%,n = 26/133 versus 2013-30.9%,n = 25/81) declined significantly (P = 0.001,McNemar) during the campaign due to an inflation in the number of referrals. Despite the overall reduction, cancer detection rate for biopsies performed remained significantly high in the over 70s (66.7%,n = 26/39) when compared with the under 70s (23.9%,n = 21/88) during the campaign.

CONCLUSIONS: Although "Be Clear on Cancer" campaign resulted in a significant increase in breast cancer referrals, it did not translate into an increase in biopsy rates or cancer detection rates. The amount of work generated for the hospital because of this campaign was far greater than the predicted increase from campaign pilots. Therefore, the overall effectiveness of this campaign is questionable.

We previously reported modest clinical 3-year benefit for topical imiquimod compared with surgery for superficial or nodular basal cell carcinoma at low-risk sites in our noninferiority randomized controlled SINS trial. Here we report 5-year data. Participants were randomized to imiquimod 5% cream once daily (superficial basal cell carcinoma, 6 weeks; nodular basal cell carcinoma, 12 weeks) or excisional surgery (4-mm margin). The primary outcome was clinical absence of initial failure or signs of recurrence at the 3-year dermatology review. Five-year success was defined as 3-year success plus absence of recurrences identified through hospital, histopathology, and general practitioner records. Of 501 participants randomized, 401 contributed to the modified intention-to-treat analyses at year 3 (primary outcome), 383 (96%) of whom had data at year 5. Five-year success rates for imiquimod were 82.5% (170/206) compared with 97.7% (173/177) for surgery (relative risk of imiquimod success = 0.84, 95% confidence interval = 0.77-0.91, P < 0.001). These were comparable to year 3 success rates of 83.6% (178/213) and 98.4% (185/188) for imiquimod and surgery, respectively. Most imiquimod treatment failures occurred in year 1. Although surgery is clearly superior to imiquimod, this study shows sustained benefit for lesions that respond early to topical imiquimod.

No abstract available

Records were reviewed (n=1052) for patients admitted to a large general intensive care unit (GICU) and examined for HIV testing criteria published in UK national testing guidelines (UKNG). All actual tests sent from GICU were also examined for comparison. Strict application of the UKNG revealed 30% of patients met criteria for HIV testing on admission to GICU. With pragmatic application, 18% of admissions met criteria for testing. Less than 5% of admissions were actually tested when no testing guideline was adopted.
DISCUSSION: The UKNG can be adopted in a representative GICU to increase HIV testing rate by 4-6-fold.

BACKGROUND: The TheraMon microsensor is the most recent device developed to measure the wear-time of removable appliances. The accuracy has not been validated intraorally.

OBJECTIVES: To determine 1) if the TheraMon microsensor accurately records time when fixed intraorally, and 2) the effect of the intraoral location on the recorded time.

METHODS: A prospective pilot study, using a convenience sample, was carried out in a UK hospital orthodontic department. Five non-patient volunteers wore microsensors positioned palatal to an upper molar, and buccal to a lower molar for 7 days. Differences between actual amount of wear and the wear recorded by each device were calculated. Differences between sites were also examined.

RESULTS: The mean daily wear-time recorded by the upper and lower microsensors combined was 23 hours (95% CI 22.6-23.4), which is a mean under-recording of 4% (CI 2.5-5.8%). The maximum daily under-reporting of wear times was 5.5 hours. Microsensors in the lower buccal sulcus recorded wear-times that were closer to actual wear-times.

CONCLUSIONS: Assumptions made by the TheraMon microsensors software lead to under-reporting of intraoral wear-time, particularly when placed palatally. These discrepancies could be significant in both clinical practice and research. Adjustment of the microsensor software parameters would improve accuracy, irrespective of the intraoral location.