PurposeTo describe the common risk factors, complications, and management options for anterior migration of Ozurdex implant.MethodsA comprehensive review of the literature was performed.ResultsAmongst the most common risk factors predisposing to implant anterior migration we found a history of pseudophakia or aphakia or previous vitrectomy. The most common complication is that of corneal edema.ConclusionsA variety of management options to treat migration of the dexamethasone implant are utilized by different specialists around the world. These depend on the doctor’s preference, presence of corneal damage and history of previous migrations after repositioning the implant. The most common approaches are operative or non-operative implant repositioning and surgical implant removal.

IntroductionUrinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in older women during hospital admission. UI during hospital admissions, within this group, has also been under-researched in terms of its relationship to specific clinical conditions and mortality rates. Given that UI has serious implications for both patient care and women’s general health and well-being on discharge, this protocol describes a planned research project which aims to determine mortality, morbidity, prevalence and incidence of UI in older women (≥55 years) during hospital admission to inform nursing practice. Additionally, it aims to explore the experience of nurses who deliver women’s care.Methods and analysisThis is an explanatory mixed-methods study consisting of two phases: (1) retrospecitive analysis of electronic patient care records (EPCR) to determine prevalence/incidence of UI, clinical conditions most likely associated with UI and any associations between UI and death, (2) nurse interviews to explore views, knowledge and perceptions of performing the nursing assessment and providing care for older women (≥55 years) with UI during admission. EPCR will be gained from a National Health Service (NHS) teaching hospital. Nurse interviews will be conducted with nurses from an alternative but similar-sized NHS hospital.Ethics and disseminationEthical approval is provided by the University of Salford Ethics Committee and regulatory approval by the NHS Health Research Authority (Integrated Research Application System project ID: 303118). Local NHS trust approval to access electronic care records for the purposes of analysis of anonymised data has been provided by one of the two collaborating NHS hospitals. Findings will be disseminated through open-access geriatric or urogynaecology journals and presented to relevant stakeholders at local, national and international meetings including scientific meetings such as the UK Continence Society and International Continence Society.

ObjectiveShape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views.MethodThe British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform.Results40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments.Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a ‘bleed rota’, this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents.ConclusionRespondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.

Rachel Mayall, Lead Lymphoedema Practitioner, Rochdale Care Organisation, Northern Care Alliance (Rachel.Mayall@nca.nhs.uk), winner of a Bronze Award in the Chronic Oedema Nurse of the Year category of the BJN Awards 2023.

BackgroundUK local authorities that experienced sustained high levels of COVID-19 between 1st March 2020 and 28th February 2021 were described by the UK Scientific Advisory Group for Emergencies as areas of enduring prevalence. This research was carried out in order to examine the views of local authority Directors of Public Health, who played a crucial role in the local response to COVID-19, on reasons for sustained high levels of prevalence in some areas, alongside an investigation of the mitigation strategies that they implemented during the course of the pandemic.MethodsInterviews were conducted with Directors of Public Health in 19 local authority areas across England, between July and November 2021. This included nine areas identified as areas of enduring prevalence and ten ‘comparison’ areas.ResultsThe outcomes of this study suggests that the geographical differences in prevalence rates are strongly influenced by health inequalities. Structural factors including deprivation, employment, and housing, due to their disproportionate impact on specific groups, converged with demographic factors, including ethnicity and age, and vaccination rates, and were identified as the main drivers of enduring prevalence. There are key differences in these drivers both within and, to a lesser extent, between local authorities. Other than these structural barriers, no major differences in facilitators or barriers to COVID-19 mitigation were identified between areas of varying prevalence. The main features of successful mitigation strategies were a locally tailored approach and partnership working involving local authority departments working with local health, community, voluntary and business organisations.ConclusionsThis study is the first to add the voices of Directors of Public Health, who played a crucial role in the local COVID-19 response. Areas of enduring prevalence existed during the pandemic which were caused by a complex mix of structural factors related to inequalities. Participants advised that more research is needed on the effectiveness of mitigation strategies and other measures to reduce the impact of structural inequalities, to better understand the factors that drive prevalence. This would include an assessment of how these factors combine to predict transmission and how this varies between different areas.

IntroductionIn November 2021, HCRG Care Group introduced a Onestop LARC service (consultation and LARC fit within the same consultation) across Bury, Rochdale and Oldham sexual health services to reduce patient waiting times for coil and implant procedures. This audit was done to assess outcome of intrauterine LARC offer following implementation.MethodsA data collection toolkit was created and disseminated across all 3 sites. LARC fitters filled in an audit sheet per patient, with data collected over 3 months from 1st November 2021 to 31st January 2022. 10 patients were randomly selected per month per site, aiming for 90 patients over the 3 month period. Implants were excluded from the audit.Results80 patients were included, with 25 from Bury, 30 from Rochdale and 25 from Oldham. Age ranges from 20 to 54. 48/80 were from White British ethnicity, followed by 22/80 from Asian ethnicity. 47/80 were currently on contraception, with condoms (17/47), IUS (11/47) and IUD (10/47) reported. 7 patients required emergency contraception, with the emergency IUD fitted in 4 of these patients. Of the 80 patients, 73 had same day LARC counselling and 7 were previously counselled via telephone or face to face appointments. Of the 73 patients, 17 were fitted with an IUS and 32 fitted with an IUD. No coils were fitted in 24 patients. 56/80 (70%) patients received a coil on the day of appointment.DiscussionThe Onestop LARC service has reduced patient waiting times, and 70% of patients who attended were fitted with a LARC on the same day. However, 24 patients did not receive a LARC for several reasons, and this number can be reduced with appropriate counselling. The Onestop clinics are high in demand, and in view of long LARC waiting lists nationally, emphasis should be placed on reducing wastage of LARC appointments.

Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.

We must temper our enthusiasm for the plethora of health and wellness apps to also consider some of the limitations associated with them. These limitations can be grouped around limitations related to the apps themselves, restrictions placed on them by the hardware on which they are used, and the wider cultural and sociological environments in which they operate. The apps themselves can have issues with their efficacy and the evidence-base on which they are built including issues of bias and prohibitive cost. The smartphones and tablets that mHealth apps run on introduce their own limitations in terms of inputs and outputs. Finally, digital health inequalities that limit an app’s efficacy and usability often mirror deeply entrenched social inequalities with social class, deprivation, caste, age, race, disability, gender, sexuality, and geography all impacting an app user’s ability to benefit from their use.

Health apps have undergone a dramatic and almost unrecognizable evolution since the birth of smartphones and app stores. Beginning as simple ways of communicating medical information in digital forms, apps have evolved into highly sophisticated and intelligent pieces of software which utilize the whole gamut of smartphone features in order to investigate, diagnose, and even treat hundreds of conditions across multiple physiological systems. For example, some health apps are capable of diagnosing skin cancers, predicting personalized risk of asthma exacerbations, “crowdsourcing” sight for people with visual impairment, and even treating type 1 diabetes with an “artificial pancreas system.” Typically, health apps are designed around a specific medical problem such as diabetes or depression with many modern apps focusing on delivering multiple components of care in digital forms. With over 350,00 health apps across the top 2 mobile app libraries (The Google Play Store on Android and Apple App Store on iOS) and a vast number of medical problems that health apps are designed around, we have organized this chapter according to the functions that apps have evolved to serve—from simple information provision through to treatment of specific conditions. Broadly, apps are considered as information apps; communication apps; diagnosis, self-management and monitoring apps; and treatment apps.