Clinical Practice Research Articles

How Can Surgeons Balance Clinical Practice and Research?

Background: Virtual clinical learning variedly impacted newly registered nurses’ confidence. For some, it led to a lack of confidence in performing specific procedures, while for others, effective virtual learning fostered a high confidence level. This dynamic is likely to be even more complex when newly qualified nurses transition from education to practice, as healthcare facilities have high expectations, anticipating a certain level of knowledge and competence despite the challenges posed by coronavirus disease 2019 (COVID-19). Aim: The study explored newly registered nurses’ virtual experiences of learning clinical skills during COVID-19 and its impact on their transition into professional practice in the Tshwane District of Gauteng province in South Africa. Setting: The study was conducted in two selected hospitals in the Tshwane District of Gauteng province. Methods: Using unstructured interviews, a qualitative exploratory, descriptive and contextual design was executed to collect data. Purposive and snowballing sampling were utilised to reach to the sample of 12 registered nurses. Results: Three themes emerged in this study, namely: (1) Impact of virtual learning on confidence in clinical practice, (2) Challenges of transitioning from virtual learning to practical application and (3) Recommendations for enhancing virtual learning in nursing education. Conclusion: The study revealed both potential benefits and drawbacks of virtual clinical teaching on registered nurses’ transition into professional practice. Contribution: The findings may guide strategies to help nursing education institutions design virtual learning that ensures competent, practice ready nurses.

Introduction: Student radiographers must be proficient in appraising diagnostic images for clinical manifestations and taking appropriate action [1]. Chest X-rays (CXR’s) are the most frequently performed imaging examinations in the UK [2]. presenting complex anatomy and numerous pathologies that challenge students. Simulation-based education, particularly gamification, has shown promise in enhancing engagement and achieving learning outcomes [3]. This study evaluates the effectiveness of a co-produced, creatively designed simulation in improving CXR proficiency among third-year radiography students. Methods: Ethical approval was obtained from the university’s Faculty of Medicine and Health Sciences ethical committee. This study involved the development and implementation of CXR RadPath, co-produced and led by a student radiographer, academic supervisor, and the faculty simulation team. The tool was designed to enhance CXR interpretation through gamification. Encompassing the use of QR codes to access and explore various radiographic images, six key categories related to CXR interpretation which would be a skill required in clinical practice, and an element of competition. The game pro-actively promoted students to work collaboratively and learn together. Participants completed pre- and post-simulation assessments to measure improvements in proficiency and confidence. Quantitative data were collated and evaluated using descriptive statistics to assess changes in image analysis competence. Qualitative data were thematically analysed to evaluate students’ perceptions of gamification and its effectiveness in supporting radiographic education. Results: Students demonstrated significant improvement in CXR interpretation proficiency after using the gamified version of reporting images in clinical practice. Significant changes were noted following its use with 83% of students progressing from “Moderately Confident” to “Very Confident” in their ability to interpret CXR’s. A further 67% of students improved in identifying abnormalities on CXR’s with a mean score improvement of 31%. Qualitative themes found the simulation to be engaging, effective, and beneficial for enhancing systematic radiographic analysis skills, fostering creativity, and promoting a culture of collaborative learning. Discussion: The use of a co-produced and creatively designed gamified version of reporting chest X-rays significantly improves students’ confidence and accuracy in CXR interpretation. Co-production allowed the simulation design pedagogy to be taught while aligned to student motivations. This collaborative approach ensured that the educational strategies were not only pedagogically sound but also engaging and relevant to the students, thereby enhancing their learning experience and outcomes. These significant outcomes have led to further development of this student-led project, expanding into other areas of image interpretation (axial and appendicular skeleton) and being implemented with other cohorts. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Point-of-care ultrasound (POCUS) is increasingly becoming an integral component of healthcare due to its capability for swift diagnosis, aiding management plans and improving accuracy and decreasing complications of bedside procedures. POCUS training has advanced over recent years with many centres now offering accredited courses and implementing structured training to improve clinician’s ultrasound skills. According to the literature, frequent barriers to accreditation include lack of supervisors and lack of time to complete supervised scans [1], by running a “Introduction to POCUS” course it was our aim to reduce these barriers. Methods: We organised a monthly “Introduction to POCUS” session for resident doctors to teach how to use ultrasound using simulation via Bodyworks Eve and SonoSim. Residents were taught how to use an ultrasound probe, perform ultrasound guided cannulation and were shown different pathologies involving heart, lung, and abdomen. Results: Several sessions were held between 2022 and 2024 for interested resident doctors. In total 45 participants attended. The majority were FY1 and FY2 doctors (97%), with most having no previous ultrasound experience (67%). Participants were asked to rate their confidence in carrying out bladder scanning, ultrasound guided cannulation, and diagnosing DVTs and lung/abdomen pathology. 33 doctors completed both the survey before and after the session, with all showing statistically significant improvements (p < 0.01) in all measured parameters using the paired t-test. Interestingly, doctors cited access to probes, supervision, and their lack of practical knowledge were the main barriers to being able to use or learn ultrasound. Discussion: Our study has shown that early exposure to ultrasound may be beneficial for doctors in improving their clinical practice and development of new skills. All participants that participated believed they were more likely to use ultrasound in their clinical practice going forward. The use of ultrasound guided cannulation may also reduce the burden on departments such as vascular access or the anaesthetics, that may be asked to assist during difficult cannulation. We are hoping to reduce the barriers to accessing ultrasound and practising the skills residents have learned over the next coming months by implementing more informal monthly sessions where doctors will be given access to use the simulation equipment. Lastly, we will arrange future accreditation courses in focussed acute medical ultrasound, to allow them to take the first steps to becoming accredited. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Strategies for optimal rehabilitation after anterior cruciate ligament (ACL) reconstruction (ACLR) continue to evolve, as the incidence of contralateral ACL injuries and ACL failures varies widely in the literature, highlighting the need for optimising rehabilitation protocols. Early and intermediate rehabilitation build the crucial foundation on which later stages of rehabilitation can successfully be based, ideally leading to satisfactory outcomes and return to preinjury sports performance. However, guidelines for optimal pre- and postoperative rehabilitation management following ACLR remain conflicting, complicating evidence-based decision-making for rehabilitation following ACLR in clinical practice. Furthermore, a standardised rehabilitation protocol, adopted across different institutions, could enable more reliable comparisons of outcomes across studies focusing on surgical aspects, such as graft selection and fixation methods. An international, multidisciplinary group of experts was convened at the 2024 Freddie Fu Panther Sports Medicine Symposium to discuss and debate recent advances and future directions of rehabilitation and return to sport following ACLR. While this part of the series explores the preoperative and early to intermediate phases of rehabilitation, Part 2 highlights the complexity of return to sport and adjunct technologies after ACLR. Early recovery of knee extension, quadriceps function and early focus on movement quality are key components for achieving satisfactory outcomes after ACLR. This summary of key concepts aims to give an overview of recent evidence and current concepts of early and intermediate rehabilitation after ACLR from a multidisciplinary expert perspective and how it needs to be tailored to the individual based on graft type and patient demographics in clinical practice. LEVEL OF EVIDENCE: Level IV, expert opinion.

Introduction: Individuals with ASC experience poorer health outcomes globally, yet healthcare professionals often lack adequate ASC knowledge [1]. Simulation-based learning enhances recall and practice [2], though resource limitations often restrict its use. Mental health nursing simulations are less developed compared to other fields, leaving a gap in training. Our co-created 360-degree video aims to address this by providing realistic scenarios that enhance students’ empathy and confidence in working with ASC patients. Methods: This research aimed to co-create real-time scenarios filmed in 360-degree video to help students understand how a person with ASC experiences hospital admission or clinical procedures. Working with qualified nurses and individuals with lived experience, we developed a 360-degree video of an ASC patient being assessed in a hospital setting. The video was embedded in a Complex Health Care teaching unit and viewed by third-year nursing students using Oculus Quest™ devices. Data were collected via an online survey and focus group discussions (with students and staff) and thematically analysed [3]. Ethical clearance was obtained from our university’s ethics committee. Results: Eighty students responded to our survey (32% response rate), with 65% reporting no prior ASC training. Seventy-four per cent found the VR resource useful, and 66% felt it would benefit their clinical practice. The small sample size is a limitation, and responses may not be fully representative of the broader student population. Ongoing focus group analysis suggests that the VR exercise helps increase students’ confidence, knowledge, and empathy, as evidenced by comments like: “This was excellent as it put you in the shoes of someone with ASC.” Staff facilitators provided insights into running VR sessions with large cohorts, including the need for preparatory and debriefing sessions, managing background noise, appropriate staff-to-student ratios, and addressing students entering the session late. Discussion: This study highlights a significant educational gap, with many students lacking prior ASC training. The positive response to the VR experience suggests it can improve understanding, empathy, and confidence, which may translate to better clinical interactions with ASC patients. Facilitators also identified key considerations for optimizing VR sessions, such as session preparation, managing group dynamics, and debriefing for knowledge consolidation and reflective practice. These findings have implications for nursing education policies, emphasizing the need for structured VR training in mental health curricula. Future research should explore the long-term impact of VR training on knowledge retention and clinical practice, as well as best practices for large-group VR training. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

Introduction: The UK Foundation Programme Curriculum [1] requires understanding of patient safety and incident management. While the NHS Patient Safety Incident Response Framework [2] advocates a systems-based approach, training often emphasises non-technical skills without deeper exploration of system-wide factors. To address this gap, the Simulation Team at University Hospitals of North Midlands (UHNM) integrated human factors teaching into one of the three simulation sessions they provide for Foundation doctors. The goal was to equip trainees with the tools to analyse incidents and appreciate how changes to the wider work system can affect patient safety. Methods: We created a course to enhance Foundation doctors’ understanding of human factors, with a focus on the SEIPS (Systems Engineering Initiative for Patient Safety) model [3] and Safety-II thinking. A mix of twelve Foundation year one and two doctors participated in each session, which included two interactive workshops and five simulation scenarios. -Workshops: The first introduces systems engineering and Safety-II principles; the second focuses on the practical application of the SEIPS model. -Scenarios: These span various clinical situations-from discharge errors to never events-each is designed with a specific human factor learning outcome. Debriefs emphasise how work systems might be improved rather than focusing on individual performance, differentiating this session from other sessions that consider clinical management. Results: To date, 107 of 160 Foundation doctors have participated, with full attendance by July. Preliminary feedback from those that have attended shows: 100% of participants reported understanding how to apply a systems-based approach to incident investigations. 100% felt confident using the SEIPS model to evaluate system changes. 100% stated the session would influence their clinical practice. Qualitative feedback indicated increased awareness of human factors and their influence on patient safety. The session received an average rating of 4.92 out of 5. 100% of participants reported understanding how to apply a systems-based approach to incident investigations. 100% felt confident using the SEIPS model to evaluate system changes. 100% stated the session would influence their clinical practice. Qualitative feedback indicated increased awareness of human factors and their influence on patient safety. The session received an average rating of 4.92 out of 5. Detailed analysis will be conducted upon course completion. Discussion: This simulation-based approach centred around patient safety scenarios has enabled trainees to analyse errors through the lens of system design rather than individual fault. It has fostered reflective dialogue on patient safety issues and how work systems can be improved. It has highlighted the need for a stronger training of human factors amongst Foundation trainees. A follow-up of the longer-term impacts is planned for the current Foundation Year 1 doctors when they return for simulations in Foundation Year 2. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: The Nursing & Midwifery Council (NMC) now mandates nursing students to replace 600 clinical hours with simulated practice learning (SPL) [1]. While Higher Education Institutions (HEIs) are incorporating this shift into curricula, aligning simulation with clinical competencies remains a challenge. Traditional skills training is often hands-on but lacks realism and practical transferability [2]. To bridge the gap between theoretical knowledge and clinical application, we developed a procedural simulation model that embeds clinical skills training within structured simulation scenarios. This model aligns with NMC standards and best practice guidelines, supporting the development of core nursing competencies in realistic settings that are replicable in practice. This study evaluates the model’s effectiveness in enhancing students’ clinical competence, knowledge, and skills while meeting SPL requirements. Methods: The procedural simulation model was embedded within the curriculum to align with NMC proficiencies for each academic year [1]. Procedural Simulation (Pro Sim) sessions included hands-on practice with equipment and high-fidelity mannequins, scenario-based learning, and structured debriefing with facilitators [2]. Pro Sim was delivered during the first two days of each SPL week, with students grouped by field of practice. To accommodate individual learning styles, students participated in small-group simulations reflecting real-life clinical scenarios [2]. Each three-hour session included a theoretical overview, tutor-led demonstrations, supervised hands-on practice, and debriefing to support reflective learning and knowledge retention. Results: Informal feedback from students highlighted significant improvements in clinical skills competence and confidence as independent practitioners following Pro Sim sessions. Evaluation data also indicated enhanced communication skills, stronger teamwork abilities, and improved responses to real-life clinical situations, with a noticeable reduction in anxiety about clinical placements. For example, feedback on the Medication Management Pro Sim reflected these overall positive outcomes (Figure 1). Additionally, the Pro Sim model fostered a supportive, culturally competent, and inclusive learning environment. Discussion: The Pro Sim model integrates simulation into traditional instructional methods, strengthening existing simulation-based education by allowing students to practice, evaluate, and refine their clinical competencies [1]. A comprehensive plan is in place to collect both qualitative and quantitative data to evaluate the model’s sustained impact on students’ clinical practice. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

FLASH radiotherapy (FLASH-RT) is an emerging technique that delivers radiation at ultra-high dose rates, offering the potential to achieve equal or superior tumour control compared to conventional radiotherapy, while significantly reducing toxicity to surrounding healthy tissues. Experimental studies have consistently demonstrated tissue-sparing effects, and early clinical experiences suggest potential benefits in sensitive patient groups, such as children or those requiring re-irradiation. Although the precise biological mechanisms are not yet fully understood, the observed protective effects suggest a complex interplay of physicochemical and cellular processes. The translation of FLASH-RT into clinical practice was still limited by significant technological challenges, particularly in dosimetry, beam generation, and treatment delivery. Nevertheless, the rapid pace of research and the promising balance between safety and efficacy highlight FLASH-RT as a potential breakthrough in the future of cancer therapy.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, contributing to substantial morbidity and mortality. Thus, there is an urgent need to understand the molecular contributions to AF susceptibility. We identified a novel missense mutation (M527L) in the cardiac transcription factor NFATC1 in a multigenerational family with autosomal dominant young onset atrial fibrillation (AF). Germline deletion of nfatc1 in zebrafish (KO) causes atrial tachyarrhythmia and sudden death in the juvenile stage. Objective: To define the electrophysiological and molecular phenotype of NFATC1 deletion in human induced pluripotent stem cell derived cardiomyocytes (iPSC-CMs). Methods: Using CRISPR/Cas9, we targeted NFATC1 exon 4 and generated a compound heterozygous iPSC line harboring 16 bp and 14 bp deletions in trans ( NFATC1 KO), confirmed to lack detectable NFATC1 protein. Spontaneous optical action potentials (AP) were measured in 30-day post-differentiation WT and NFATC1 KO iPSC-CMs, using di-4-ANBDQBS. Single-cell RNA-seq was performed using the Chromium GEM-X Single Cell 3' kit and an Element Bioscience AVITI sequencer, with a 30,000 reads/cell depth. DeSeq differential gene analysis was performed, followed by Enrichr pathway analysis. Results: APs in WT iPSC-CMs were mostly regular, with no delayed afterdepolarizations (DADs) observed. By contrast, APs in KO iPSC-CMs were mostly irregular, with DADs observed in 28% of records (p=6.52E-4, Table 1). Increased spontaneous beat rate and a wider beat to beat interval range were noted in KO cells (55±3 bpm WT [n=43] vs 73±7 bpm KO [n=33], p=0.015; and 128±21 ms WT [n=39] vs 345±70 ms KO [n=30], p=0.015). Analysis of differentially expressed genes identified perturbations in known AF pathways, including calcium, GPCR, cAMP, cGMP-PKG and MAPK signaling (Table 2). Conclusions: Loss of NFATC1 in iPSC-CMs leads to spontaneous electrical instability (evidenced by increased spontaneous beating rate, beat-to-beat variability, and DADs), supporting its essential role in maintaining normal cardiac excitability. Differential gene expression analysis highlighted perturbations in key AF-related signaling cascades, illustrating how NFATC1 deficiency disrupts cardiomyocyte homeostatic networks. Taken together, these data establish NFATC1 as a key transcriptional regulator of cardiac excitability and that loss of NFATC1 is pro-arrhythmogenic.

Introduction: Aortic aneurysm and dissection are rare but life-threatening conditions, with an incidence of 5–30 cases per million annually. The introduction of endovascular aneurysm repair (EVAR) has markedly improved outcomes. This study analyzes 25-year U.S. mortality trends (1999–2023) and forecasts rates through 2030. Methodology: We analyzed national mortality data from the CDC WONDER database (1999–2023) using ICD-10 codes I71.0–I71.9 to identify deaths due to aortic aneurysm and dissection. Age-adjusted mortality rates (AAMRs) were stratified by demographics and geography, based on NCHS urban–rural and U.S. Census regional classifications. Trends were assessed using Joinpoint regression to estimate Annual and Average Annual Percentage Changes (APC/AAPC) with 95% confidence intervals. ARIMA models with Box-Cox transformation were fitted after ADF/KPSS tests Results: From 1999 to 2023, the age-adjusted mortality rate (AAMR) for aortic aneurysm and dissection in the U.S. declined markedly from 15.88 to 6.6 per 100,000. ARIMA modeling forecasted an AAMR of 6.32 (95% CI: 5.90–6.79) in 2025 and 5.48 (95% CI: 4.92–6.19) in 2030, with good model fit (RMSE = 0.450; Ljung-Box p = 0.242). Joinpoint regression identified the most rapid decline between 2006 and 2009 (Annual Percent Change [APC] = –10.78), coinciding with the widespread adoption of endovascular aneurysm repair (EVAR), despite its initially delayed adoption into clinical practice. Urban–rural disparities were evident, with the most significant decline observed in large central metro areas (AAMR: 14.52 to 5.16) compared to non-core rural areas (18.25 to 7.38). Regionally, the Midwest had the highest mortality in 1999 and experienced the steepest decline over time. Racial disparities persisted, with White individuals accounting for the highest number of deaths but also demonstrating the most pronounced decline (AAMR: 16.5 to 6.12; APC = –5.35). Non-Hispanic males had the highest mortality rates overall (AAMR: 24.55 to 8.39; AAPC = –4.61), while Hispanic females consistently had the lowest. Conclusions: From 1999 to 2023, mortality from aortic aneurysm and dissection declined significantly, driven by advances such as endovascular aneurysm repair (EVAR) and improved clinical care. However, notable disparities by race, sex, and region remain despite these advances, highlighting the need for patient-centered selection, ongoing outcome reevaluation, and an equitable approach to care delivery.

Background: Due to the availability of effective lipid-lowering therapies, familial hypercholesterolemia (FH) case finding is adopted by many healthcare systems. In parallel, polygenic risk scores (PRS) have emerged as a powerful tool for capturing the effect of common genetic variants associated with CAD. Research Question: What proportion of individuals at high PRS for CAD exhibit equivalent risk compared to FH variant carriers, and what are the potential clinical benefits of treating these individuals with statins. Methods: We analyzed data from the UK Biobank, identifying FH carriers via whole-exome sequencing and defining polygenic risk using a CAD PRS. Incident CAD events in statin-naive individuals were compared between FH carriers and individuals with high PRS. Number-needed-to-treat (NNT) with statins and number needed to screen (NNS) were calculated to assess therapeutic impact in high PRS individuals. Results: The top 8% of the PRS distribution exhibited comparable or higher CAD risk than FH carriers. This high-PRS group accounted for between 18 and 29 times more CAD events than FH carriers, depending on age. In the untreated high PRS group the rate of CAD events was 10.28 per 1000 person years (9.01 - 11.67) compared to 6.78 per 1000 person years (5.39 - 8.42) in the treated high PRS group, representing a relative risk reduction (RRR) of 0.34 (0.15 - 0.49). In the median PRS group, the rate of CAD events was 5.28 per 1000 persons (4.67 - 5.94) compared to 3.93 per 1000 person years (3.21 - 4.75) in the treated group, representing a RRR of 0.26 (0.07 - 0.41). The NNT in the high PRS group was 286 compared to 741 in the median PRS group, indicating that statins were roughly 2.6 fold more effective, after matching on clinical risk factors. The NNT (286) for statins in the high PRS group is similar to literature based estimates for statin treatment in FH (222) but the number needed to screen is approximately 21 fold higher for FH than for high PRS. Conclusion: In the population, screening for high CAD PRS individuals will prevent more CAD cases than screening for FH. This is because high PRS individuals are much more prevalent than FH individuals and have enhanced therapeutic benefit from statin treatment (compared to those without high PRS). The polygenic component of CAD is a major, treatable risk factor that is not routinely evaluated in prevention programs, despite a growing body of evidence that this can be implemented easily into clinical practice.

Background: The prevalence of peripheral arterial disease, including chronic limb-threatening ischemia (CLTI), is globally increasing due to the aging society and the pandemics of diabetes mellitus. Although managing elderly CLTI patients with non-ambulatory status is substantially common in clinical practice, determination of treatment planning remains clinically challenging. This study aimed to evaluate the mortality and prognostic factors in elderly CLTI patients with non-ambulatory. Methods: This was a multicenter retrospective observational study enrolling 2309 CLTI patients (age: 75.5 ± 10.2 years, male: 60.5%, diabetes mellitus: 61.9%, dialysis: 46.9%) who underwent endovascular therapy (EVT) between April 2010 and March 2024. Patients aged over 80 years old with non-ambulatory status including wheelchair or bedridden were defined as the vulnerable CLTI group. The primary outcome measure was all-cause mortality, and were analyzed by multivariate analysis. Results: A total of 443 patients (19.2%) were classified as vulnerable CLTI. The 5-year all-cause mortality rate was 76.4% in the vulnerable CLTI group and 49.9% in the non-vulnerable CLTI group (p<0.001). The multivariate analysis revealed hemodialysis (hazard ratio [HR]: 1.83, p < 0.001), wound, ischemia, and foot infection (WIfI) stage 4 (HR: 1.71, p = 0.002), left ventricular ejection fraction < 50% (HR: 1.52, p = 0.04), and serum albumin level < 3 g/dL (HR: 1.55, p = 0.009) were positively associated with mortality in vulnerable CLTI group, with no significant interactions. 12-month mortality rate was 71.6% in patients with three or more of these risk factors. Conclusions: The current study revealed that hemodialysis, wound severity, malnutrition, and cardiac dysfunction were significantly associated with mortality in vulnerable CLTI patients. Risk stratification based on these predictors allows estimation of prognosis in vulnerable CLTI patients, and would be clinically useful for determination of treatment planning including palliative care.

Introduction: Final-year medical students often report feeling unprepared for managing the responsibilities of on-call shifts as foundation doctors, particularly in prioritisation, escalation, communication, and prescribing tasks [1]. Responding to bleeps has been identified as a particularly anxiety-inducing element of starting clinical practice [2]. Addressing this gap in preparedness is crucial for ensuring a safer transition to postgraduate training. The Virtual On-Call (VOC) simulation was developed to provide a realistic, low-fidelity, psychologically safe environment for final-year students to practice core on-call competencies. We aimed to evaluate whether participation in VOC improved students’ self-reported confidence across key clinical domains and to explore student perceptions of the simulation’s realism and educational value. Methods: We implemented a low-fidelity simulation across two hospital sites (Maidstone and Tunbridge Wells) between early 2024 and 2025. Groups of 3–4 students carried simulated bleeps and responded to a series of ward-based on-call tasks, such as fluid prescribing, patient reviews, and escalating deteriorations using SBAR. Tasks were accessed from designated ward envelopes, with no live patient interaction. Each session lasted one hour, followed by structured group debriefs. Six sessions were delivered. Students completed pre- and post-session surveys measuring confidence across six domains (prioritisation, prescribing, answering bleeps, note-taking, handover, and escalation) on a 5-point Likert scale. Free-text responses were collected to explore qualitative experiences. Descriptive analysis was performed. Results: Of the 27 students completing pre-session surveys, 20 completed post-session surveys (completion rate: 74%). Confidence improved across all domains. The greatest improvement was seen in answering bleeps, with the mean confidence score increasing from 1.8 to 3.8. Initially, 85% of students rated their confidence as low (scores 1–2), compared to 75% rating it as moderate-to-high (scores 3–4) post-session. Qualitative analysis identified themes of increased confidence, appreciation of the session’s realism, and the importance of practicing teamwork and escalation pathways. Discussion: Participation in the VOC simulation significantly improved final-year students’ self-reported confidence, especially in managing bleeps and prioritising tasks. Students valued the realism, safe environment, and practical application of multiple skills simultaneously. Our findings suggest that low-fidelity, accessible simulations can effectively enhance undergraduate preparedness for clinical practice, supporting previous literature on simulation-based learning [3]. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: This teaching simulation aims to improve the team working and leadership skills of different members of the medical team in an acute scenario and allows them to understand the direct roles of each individual team member. Objectives: To assess the effectiveness and value of multi-professional simulation in increasing the awareness of roles within an interprofessional setting. To assess if multi-professional simulation increases confidence levels when managing emergency scenarios in a team-based setting. Methods: The simulation consisted of six varied emergency scenarios common to the Accident and Emergency department, where the scenario would involve care of Addisonian Crises, Euglycaemic Diabetic Ketoacidosis, ACS leading into Heart Block etc. The participants were all at varying levels of training and roles from Advanced Practitioners, Nurses, Senior and Junior Clinical Fellows. Nursing teams would be asked to do an initial assessment of a high-fidelity manikin, refer to their seniors and slowly the full medical team would be involved in handling the patient’s care. Once all scenarios were completed, we collected one minute feedback forms from all participants which investigated how our simulation differed from traditional simulation provided in their training, what they learnt for their own clinical practice and the roles of other professions. Results: Out of the ten candidates, only two of them had previous simulation experience. They reported that the simulation blended acute scenarios well with hospital pathways and therefore felt realistic to their practice. Other comments praised the interactive elements and covering different hospital protocols. Candidates received specific personal learning objectives tied to individual learning, but a highlight was that eight out of ten (80%) candidates felt that this learning improved their teamworking and leadership skills in emergency situations, with emphasis on communication between members of the team, their expertise and limitations. Discussion: High-fidelity multi-professional simulation enhanced awareness of team members’ roles and collaborative dynamics. Participants reported improvements in communication and confidence in emergency care delivery. Broader implementation and further evaluation are needed to assess its impact across different healthcare settings. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Nursing and Midwifery Council (NMC) approved institutions can deliver up to 600 hours of Simulated Practice Learning (SPL) within the 2,300 practice hours, pre-registration nursing students are required to register [1]. Many approved Higher Education Institutions (HEIs) are using immersive technology-enhanced learning as part of a blended approach in their SPL delivery. Virtual Reality (VR) is commonly used to simulate immersive environments where learners can practise decision-making skills within different clinical contexts. Alongside this, there is a need for 3rd year nursing students to develop peer supervision and coaching skills in preparation for registration [2]. The purpose of this work is to report on an evaluation of a teaching intervention, utilising both VR and peer-to-peer learning. Methods: A peer-to-peer VR learning experience was delivered to 22, 3rd year children’s nurses using Oxford Medical Simulation (OMS) software. Students were paired, with one undertaking a simulation scenario using a VR Oculus headset, which was streamed to a computer screen. The second student observed this stream and made notes on their peers’ performance for feedback. The pair then had an unstructured debrief to explore ways to improve their performance. The roles were then reversed with the observing student completing the same scenario. Following this activity, the wider group came together for a facilitated debrief using the diamond debrief model [3]. Data collection included quantitative and qualitative student feedback gathered via a scannable QR code and quantitative data from the OMS platform’s feedback scoring system. Results: Qualitative findings brought up two main themes: translating theory to practice & and peer-to-peer support. Limitations of using immersive technology were also highlighted. Quantitative results showed an overall improvement in clinical practice between the peer attempts. These results are seen in Table 1. Out of the 11 pairs of participants, 7 scored, on average, 18.12% better than their peers. Of the 3 pairs of participants that scored lower, they were 4.64% lower than their peers. Discussion: Repeated peer-supported VR scenarios have the potential to improve knowledge and enhance peer supervision. Importantly, the post-scenario debrief was positively received by the majority of learners to consolidate their in-scenario peer learning. We suggest that the value of using this approach within SPL may be an effective way for 3rd year student nurses to acquire knowledge and develop peer supervision skills. Challenges arose surrounding the use of a VR headset and limitations in using a virtual platform. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Background: The fourth trimester—the postpartum year—is a critical window for maternal health, particularly among populations facing psychosocial stressors. While adverse SDOH are known contributors to disparities in maternal outcomes, the specific influence of psychosocial domains on long-term cardiovascular and multisystem risks remains underexplored. Methods: Using data from the TriNetX US Collaborative Network (64 healthcare organizations), we conducted a retrospective cohort analysis of 66,320 postpartum women (15–60 years) with psychosocial SDOH exposures between 2008 and 2023, compared to 1,876,884 postpartum women without documented SDOH exposures. After 1:1 propensity score matching, 42,256 patients per group were included. Outcomes—such as all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), heart failure subtypes, thromboembolic events, and end-organ dysfunction—were assessed over a 5-year follow-up using risk and survival analyses. Results: Women with psychosocial stressors had significantly elevated risks of all-cause mortality (Risk Ratio [RR] = 2.08, p < 0.001), acute myocardial infarction (RR = 1.69, p = 0.003), 3-point and 4-point MACCE (RR = 1.69 for both, p < 0.001), and liver failure (RR = 2.24, p = 0.002). Increased risk was also observed for acute kidney injury (RR = 1.22, p = 0.013). Conversely, postpartum preeclampsia was less common in the SDOH group (RR = 0.78, p < 0.001), a trend warranting deeper investigation. Kaplan-Meier analysis demonstrated significantly lower survival probabilities among the psychosocial SDOH cohort across multiple outcomes. Conclusions: Psychosocial stressors are associated with heightened maternal morbidity and mortality in the postpartum period, particularly regarding cardiovascular and systemic complications. These findings emphasize the urgent need for integrated psychosocial screening and intervention strategies in postpartum care, with implications for both clinical practice and policy to address maternal health inequities.

Introduction: Genetic testing for cardiomyopathies has become routine in clinical practice, yet current testing strategies primarily determine the presence of a probable pathogenic variant but relatively little information regarding prognosis, severity, or potential treatment. This limitation is primarily due to insufficient knowledge of the physiological and clinical impact of cardiomyopathy variants. Methods: We developed a high-throughput, multi-parameter platform for assessing variants in the important cardiomyopathy gene TNNI3. This platform combined both high-throughput measurement of contractility and calcium handling in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) expressing variants in TNNI3, as well as single-cell RNA sequencing-based assessment of gene expression signatures. We applied our platform to a library of variants found in cardiomyopathy patients. We then tested whether our in vitro measurements were able to predict clinical outcomes in cardiomyopathy patients. Results: Physiologic measurement of the relationship between calcium and contractility in hiPSC-CMs was able to accurately separate pathogenic variants from synonymous and benign variants. Unbiased clustering of variants by both functional measurements and single-cell gene expression analysis revealed multiple subgroups that correlated physiological function with structural properties of TNNI3. Finally, comparison with patient outcomes revealed that diastolic tension measured in vitro could predict age of onset (R^2 = 0.5) and pulmonary capillary wedge pressures (R^2 = 0.72), providing an in vitro prediction of disease severity. Conclusions: Multiparameter assessment of cardiomyopathy variants using our scalable platform provides a powerful approach for predicting pathogenicity and severity of disease in patients. Future work on the subgroups identified by physiology and gene expression has the potential to reveal variant-specific targets for personalized management of genetic cardiomyopathies.

Background: Pulse pressure (PP), the difference between systolic and diastolic blood pressure, reflects arterial stiffness and vascular aging. Its role in predicting gastrointestinal (GI) bleeding risk among anticoagulated atrial fibrillation (AF) patients remains poorly defined. Objective: To assess whether elevated pulse pressure independently predicts GI bleeding in anticoagulated patients with atrial fibrillation. Methods: This retrospective cohort study used the REACHnet database. Adult patients diagnosed with AF and receiving blood thinners were included. PP was derived from outpatient systolic and diastolic measurements and categorized into tertiles: T1 (<46 mmHg), T2 (46–62 mmHg), and T3 (>62 mmHg). The primary outcome was GI bleeding requiring hospitalization. Demographic and clinical variables were compared across tertiles using Wilcoxon tests, t-tests, and Chi-square tests as needed. Kaplan-Meier analysis assessed time to GI bleeding. Cox proportional hazards models were adjusted for confounders, including systolic blood pressure (SBP). Results: Among 3,142 patients (mean age 74 ± 8.9 years; 47% female), 9.9% experienced GI bleeding over a median follow-up of 4.1 years. Patients in the highest PP tertile (T3) had significantly greater prevalence of hypertension, diabetes, peripheral artery disease, history of stroke, and anticoagulant use (all p<0.01) (Table 1). Despite this higher burden of comorbidity, elevated PP remained an independent predictor of GI bleeding. Adjusted analysis showed that patients in T3 had a 48% increased risk of GI bleeding compared to T1 (HR: 1.48; 95% CI: 1.19–1.84; p<0.001), independent of SBP and other clinical factors. Kaplan-Meier curves demonstrated significantly lower bleeding-free survival in T3 (log-rank p=0.003) (Figure 1). Conclusion: High pulse pressure, especially >62 mmHg, is independently associated with GI bleeding in anticoagulated AF patients. This association persists after adjustment for SBP and other comorbidities. PP should be considered in bleeding risk assessment models in clinical practice.

Background: The assessment of left ventricular (LV) mechanical synchrony using phase analysis (PA) provides incremental diagnostic value over conventional indicators and is widely used in clinical practice. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has emerged as an imaging technique to visualize blood flow dynamics. Intra-LV kinetic energy (KE) obtained from 4D-CMR is a novel parameter refers to the quantification of the energy associated with the motion of blood within LV. This study aimed to simultaneously investigate the relationship between LV mechanical synchrony and intra-LV blood flow energy in patients with ischemic heart disease (IHD), using hybrid PET/MR system. Methods: Sixty-six patients (mean age 67 years, male 54) who underwent rest-pharmacological stress 13 N ammonia PET and 4D flow CMR at our hospital between January 2022 and February 2024 were included. Left ventricular ejection fraction (LVEF), PA parameters including histogram bandwidth (BW), phase standard deviation (PSD), and entropy were obtained from rest and stress gated PET. Perfusion defect was assessed as summed defect score from rest and stress static PET images. Intra-LV 4D flow MR acquisition was simultaneously performed for rest and stress. Intra-LV blood flow KE indexed with end-diastolic volume (KEi mJ/mL) was obtained from dynamic 4D flow curve. Results: BW[KF1] was 24.6 ± 17.9 and 24.4 ± 15.4%, PSD was 6.2 ± 3.7 and 6.2 ± 3.5, entropy was 61.6 ± 7.9 and 60.3 ± 9.3 for rest and stress, respectively. Summed defect score was 6.1 ± 7.1 and 11.2 ± 9.4 for rest and stress. KEi[KF2] was 0.018 ± 0.01, and 0.019 ± 0.01 (mJ/mL) for rest and stress. A significant positive correlation was observed between LVEF and KEi at both rest (R=0.30, P=0.014) and stress (R=0.42, P<0.001). Summed defect score was not significantly correlated with KEi at either rest or stress. All PA parameters demonstrated a weak inverse correlation with KEi at rest (BW: R= –0.29, P=0.019; PSD R = –0.27, P=0.026; entropy R = –0.27, P=0.031) and stress (BW: R= –0.28, P=0.023; PSD R = –0.36, P=0.003; entropy R = –0.31, P=0.010). Conclusions: PET-derived PA parameters were significantly associated with intra-LV blood flow KE, suggesting impaired LV mechanical synchrony is linked to intra-LV blood flow energy insufficiency.