Betsi Cadwaladr University Health Board (BCUHB) (Welsh: Bwrdd Iechyd Prifysgol Betsi Cadwaladr) is the local health board of NHS Wales for the north of Wales. It is the largest health organisation in Wales, providing a full range of primary, community, mental health, and acute hospital services for a population of around 694,000 people across the six principal areas of north Wales (Anglesey, Conwy, Denbighshire, Flintshire, Gwynedd and Wrexham) as well as some parts of Mid Wales, Cheshire and Shropshire. Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr Local Health Board.The Board is responsible for the operation of three district general hospitals, 22 other acute and community hospitals, and a network of over 90 health centres, clinics, community health team bases, and mental health units. It coordinates the work of 121 GP practices and NHS services provided by North Wales dentists, opticians and pharmacies.The Board is named after Betsi Cadwaladr, a Welsh nurse born in Bala, Gwynedd in 1789. Towards the end of her life – in her mid-60s – she worked alongside Florence Nightingale, nursing casualties of the Crimean war.
Our society has entered the era of artificial intelligence, bringing significant changes to the field of medical education and the way medicine is practiced. With the advances in technology, it is essential to assess the effect of these on all aspects of medical education and research. In this short commentary we briefl y discuss the merits and demerits of artificial intelligence in medical education and research.
BACKGROUND:Psychotherapy's integration into Southeast Asia (SEA) clinical practice is limited despite its recognized effectiveness. This study examined psychiatrists' and psychiatry trainees' perspectives on barriers to accessing psychotherapy, expectations for its future delivery, and attitudes toward digital mental health. METHODS:A cross-national survey was conducted between March and August 2024 among 253 psychiatrists and psychiatry trainees from Indonesia (n = 121), Malaysia (n = 39), Singapore (n = 6), Thailand (n = 74), and Vietnam (n = 13). The questionnaire explored perspectives on delivering psychotherapy including barriers, provider roles, therapy formats, and digital delivery. Data were analyzed descriptively and comparatively. RESULTS:Key barriers to delivering psychotherapy included time constraints, cost concerns, systemic limitations, and insufficient psychotherapy skills, respectively. Regarding preferences for psychotherapy providers, trainees rated psychiatrists as most suitable, while psychiatrists preferred psychologists. Crisis intervention and individual therapy were the top priorities for training. Although videoconferencing and mobile apps were favored for future delivery, concerns about clinical effectiveness and system-level limitations hindered wider acceptance of digital psychotherapy. CONCLUSION:A major barrier was that psychotherapy is too time-consuming, and a lack of skills was a significant challenge for healthcare professionals. Both psychiatrists and trainees agreed that training should prioritize crisis intervention and individual therapy. For internet-based psychotherapy, the primary challenge was concern over its low clinical effectiveness, as many felt face-to-face interaction was necessary. The findings highlight the need for enhanced psychotherapy training, systemic support, and digital infrastructure to improve psychotherapy accessibility in SEA. These insights can inform the development of targeted interventions and policies to promote the effective integration of psychotherapy into mental health services in the region.
Introduction Surgery in patients with diabetes mellitus is associated with increased morbidity and mortality compared with those who do not have diabetes mellitus. This is likely multifactorial and could be attributed to organisational issues; dysglycaemia; hospital-acquired diabetic ketoacidosis; errors with insulin prescribing and administration; issues with fluids and electrolytes; and systemic and surgical site infections. There was a need to update guidance for the peri-operative management of diabetes mellitus given improvements in our understanding, introduction of novel drugs and development of wearable technologies. Methods This was a multidisciplinary consensus statement with a diverse authorship group, including diabetologists; anaesthetists; surgeons; pharmacists; surgical diabetes inpatient specialist nurses; and patients with lived experience. We undertook a directed literature search and a three-round Delphi process to develop, refine and agree recommendations. Results Following three rounds, 38 recommendations were included, spanning all phases of the peri-operative pathway. Recommendations were made for organisations and general principles for the management of patients with diabetes, aiming to improve pathways, implement protocols and support training. We prioritise individualised care plans, encourage clinical judgement regarding proceeding with surgery with out-of-range HbA1c concentrations and recommend ensuring appropriate insulin regimens are prescribed and administered. We also provide guidance for capillary blood glucose and ketone monitoring and management; safe handovers of care; and multidisciplinary care plans for the peri-operative use of wearables. Discussion This consensus statement provides principles to be applied throughout the entire peri-operative pathway by healthcare professionals, institutions and patients. It is hoped that the implementation of these key recommendations will improve experience and outcomes for patients with diabetes mellitus having surgery.
INTRODUCTION:Recurrent acute otitis media (RAOM) is a common condition most frequently affecting children under two years of age. The main causative agent is Streptococcus pneumoniae. Pneumococcal vaccination has been shown to be an effective method of RAOM prophylaxis. Currently, pneumococcal antibody testing can be performed to assess immunity levels, followed by booster vaccination if protection is suboptimal. We aimed to explore the role of antibody testing and vaccination in the context of managing paediatric RAOM. METHOD:A retrospective study was performed between January and December 2023. A total of 1,004 paediatric referrals (age: ≤ 16 years) to our trust were reviewed. Patients with RAOM who underwent pneumococcal antibody testing were identified. Suboptimal antibody levels were defined as ≥ 6 low serotypes out of 13. This study took place at Royal Preston Hospital, United Kingdom. RESULTS:Our cohort includes 169 children with RAOM, of which 42 underwent pneumococcal antibody testing with available results. Of these patients, 19 (45.2%) had suboptimal pneumococcal antibody levels; 13 (68.4%) patients received a booster vaccine. A reduction in RAOM episodes was reported in 92.3% (12/13) of vaccinated children at follow-up (≥ 3 months), with improvement in symptoms, including otalgia, fever, and hearing loss. Adequate Haemophilus influenzae antibody levels were found in every tested child with RAOM (n=43). CONCLUSION:These findings indicate that approximately half of children with RAOM have suboptimal pneumococcal antibody levels, which can be successfully addressed with booster vaccination. Re-testing pneumococcal antibody levels after booster vaccination and performing H. influenzae antibody levels are not required. Further work is required to identify if booster vaccinations reduce the frequency or severity of RAOM presentations.
