The Belfast Health and Social Care Trust (BHSCT) is a health organisation covering Belfast, Northern Ireland. The trust is one of five new trusts which were created on 1 April 2007 by the then Department of Health, Social Services and Public Safety (DHSSPS). The Belfast Trust employs 22,000 staff. It has responsibility for services to over 340,000 patients, provided at various hospitals including Belfast City Hospital, the Royal Victoria Hospital, the Mater Hospital and Musgrave Park Hospital.
Mental health problems among healthcare staff have been well documented within the literature. Due to the COVID-19 pandemic and subsequent redeployment of many healthcare workers to frontline settings such as COVID intensive care units (ICUs), their mental health has been further adversely affected. To address this, a pilot service was developed that offered rapid assessment and trauma-focused cognitive behavior therapy (TF-CBT) to staff redeployed to COVID ICUs during the pandemic. Aims included reducing mental health symptoms associated with psychological trauma in this cohort and sustaining the workforce by promoting a successful return to work. Outcome measures indicated that the TF-CBT intervention led to significant improvements, with scores of many participants who completed measures moving from moderate or severe clinical categories to mild across anxiety (48%), depression (62%), and posttraumatic stress disorder (75%). These results generally held when accounting for reliable change. Additionally, 97% of staff returned to work following intervention. The average number of sessions provided was 4, with higher baseline anxiety being the only significant predictor of session duration. These results indicate that substantial therapeutic and functional gains can be achieved by offering staff experiencing trauma-related mental health symptoms a rapid access TF-CBT intervention within a limited time frame. Limitations and next steps are discussed.
Primary endometrial carcinomas with somatically derived yolk sac tumor (YST) components are rare. We analyzed 23 such cases using detailed clinicopathologic, immunohistochemical, and molecular methods. The median patient age was 68 years. Elevated serum alpha-fetoprotein (AFP) was detected in 76.9% (10/13) of tested cases. International Federation of Gynecology and Obstetrics (FIGO) 2009 stages were I (n = 12, 55%), II (n = 1, 5%), III (n = 5, 23%), IV (n = 4, 18%), and unknown in one. Histologic YST patterns included glandular (87%), papillary (52%), solid (48%), endodermal sinus (17%), hepatoid (17%), and reticular (13%) architectures. The associated Müllerian-type neoplasms were endometrioid carcinoma (n = 17), carcinosarcoma (n = 3), serous carcinoma (n = 2), and clear cell carcinoma (n = 1). Immunohistochemically, 17 cases (74%) exhibited mutation-type p53 staining, and 2 (9%) were mismatch repair-deficient (MMRd). YST components uniformly expressed glypican-3 and spalt-like transcription factor 4 (SALL4), whereas 17 (74%) also expressed AFP. HER2 positivity was seen in 13 of 21 tested (62%; four 3+, three 2+, and six 1+). Molecular analysis revealed TP53 variants in 16 of 22 cases (73%) without POLE hotspot mutations. According to The Cancer Genome Atlas molecular classification, 17 tumors were p53-abnormal (74%), 2 (9%) MMRd, 4 (17%) were no specific molecular profile, and none was POLE-ultramutated. Recurrent copy number gains involved CCNE1 (9/22, 41%), 1q44 (12/14, 86%), and 3q26.32 (8/14, 57%). Features reminiscent of germ cell tumors included amplifications at 7p21.2 (8/14, 57%) and 9p21.3 (11/14, 79%), polysomy or amplification of chromosome 12p (6/22, 27%), deletion at 11q24.3 (8/14, 57%), and a high frequency of T>C nucleotide substitutions. Follow-up showed 15 patients (75%) had died of disease or were alive with disease; 12 of these 15 cases were p53-abnormal. Overall survival was significantly poorer than in other molecular subtypes of endometrial carcinoma. These tumors should therefore be regarded as high grade (grade 3) by definition. In summary, endometrial carcinomas with a somatically derived YST component are highly aggressive, predominantly p53-abnormal, with smaller subsets classified as MMRd or no specific molecular profile. Recognition of the YST component is crucial, and biomarker profiling may reveal therapeutic targets.
BACKGROUND:Education is considered a foundational component of chronic pain treatment. In response to challenges relating to accessibility and scalability, health services have increasingly adopted online formats for delivering pain education programmes. However, little is known about how patients experience these digital interventions, particularly in relation to engagement, meaning-making, and perceived impact. This study aimed to explore participant experiences of completing an online education programme for chronic pain. METHODS:The study adopted an Interpretative Phenomenological Analysis (IPA) methodological framework, which informed the development of the interview schedule, the sampling strategy, and the analytic process. Semi-structured interviews were conducted with 10 adults who completed a 6-week programme, Pain Retrained, which delivered education on chronic pain in a group setting via Microsoft Teams. The intervention was provided by an interdisciplinary team with 2 h of clinician contact per week. RESULTS:Analyses identified two principal themes, "It was a stretch" and "And now I can move on". Participants expanded their understanding of chronic pain from a biomedical model to a more integrated biopsychosocial perspective, which supported a constructive shift toward engaging with evidence-based care and self-management. CONCLUSION:This study offers novel insights into participants' experiences of an online pain education programme. The online format enhanced accessibility and made a longer-duration intervention more feasible for individuals. This structure allowed relational and temporal processes to support reconceptualization and importantly, reorientation to evidence-based care. Findings highlight the value of participatory, interdisciplinary education delivered in a format that accommodates the realities of living with chronic pain. SIGNIFICANCE STATEMENT:This research advances understanding of how education can lay the foundation for recovery in chronic pain. A pivotal contribution is the identification of reorientation to evidence-based treatments as a core process within pain education. These findings extend current models of pain education by highlighting experiential elements critical to change. The insights offer actionable direction for clinicians and service leadership seeking to develop, implement or refine accessible pain education interventions.
OBJECTIVE:Mesonephric-like adenocarcinoma (MLA) of the endometrium and ovary is a rare and aggressive malignancy with limited treatment options. Antibody-drug conjugates (ADCs) targeting cell-surface proteins such as TROP2, CLDN6, B7-H3, and DLL3 are emerging therapies in gynecologic cancers; however, their expression has never been systematically investigated in MLA. This study aimed to characterize the expression of these potential therapeutic targets in MLA. METHODS:Immunohistochemical staining for TROP2, CLDN6, B7-H3, and DLL3 was performed in a cohort of 22 MLAs (11 endometrial and 11 ovarian). H-scores (range 0-300) were calculated to quantify expression levels for each biomarker. RESULTS:B7-H3 was universally expressed in all 22 cases (100%), often at high levels, with a median H-score of 140 (range: 20-245). TROP2 was also expressed in all cases (22/22; 100%) but with lower overall scores (median H-score 95, range: 37.5-210). CLDN6 expression was observed in most tumors (21/22; 95.5%) with variable intensity (median H-score 66.3, range 0-175). In contrast, DLL3 was largely negative, with minimal staining in a small subset of cases (3/12, 25%; median H-score of 0 (range: 0-17)). CONCLUSIONS:MLAs consistently express B7-H3, TROP2, and CLDN6, identifying them as highly promising therapeutic targets for ADC-based therapies, but this may require biomarker informed eligibility screening. DLL3 is unlikely to be a useful therapeutic target in this aggressive histotype. These findings expand the biomarker landscape in MLA and provide a rationale for clinical investigation of ADCs in this setting.
BACKGROUND:Dedicated randomised studies on intravascular imaging guidance in unprotected left main coronary artery (LMCA) disease are lacking. AIMS:We aimed to investigate the clinical feasibility of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) of true LMCA bifurcation lesions and to evaluate its prognostic impact compared with angiographic guidance. METHODS:Patients with true LMCA bifurcation lesions who were randomised to either OCT or angiographic guidance in the OCTOBER Trial were included. The feasibility of OCT guidance was assessed as the proportion of patients with successful and analysable OCT pullbacks before, during, and after stenting. Clinical outcomes between the two groups were compared based on the incidence of a composite of major adverse cardiac events (MACE), comprising cardiac death, any myocardial infarction, or target lesion revascularisation. RESULTS:In total, 227 patients were included (OCT: 111, angiography: 116). OCT guidance was successful, with 98% of cases having a pre-stenting pullback performed and 96% a final pullback, as per protocol. The proximal LMCA stent edge was analysable in 43% of patients, and in the remaining 57%, only 5% were limited by insufficient image quality. No statistically significant difference in MACE was observed between the two groups (OCT: 14.4% vs angiography: 18.4%, hazard ratio 0.78, 95% confidence interval: 0.39-1.51). CONCLUSIONS:OCT-guided PCI in true LMCA bifurcation lesions was clinically feasible, but visibility of the LMCA ostium was limited by short pullbacks, insufficient clearance, or guide catheter shadowing. OCT guidance was associated with a non-significant reduction in MACE, consistent with the effect estimate in the main trial.
