Cwm Taf Morgannwg University Health Board

Renin–angiotensin–aldosterone system inhibitor (RAASi) therapies are a cornerstone of guideline-directed medical therapy in the management of cardiorenal disease, including chronic kidney disease and heart failure. Management guidelines state that these therapies should be prescribed at the maximum licensed or tolerated dose in order to prevent disease progression and adverse events. However, both cardiorenal disease and RAASi therapies increase the risk of hyperkalaemia. When hyperkalaemia occurs, clinicians often down-titrate or discontinue these important RAASi therapies, leaving patients at risk of adverse cardiorenal outcomes. Eleven cardiorenal experts considered how hyperkalaemia can act as a barrier to optimised RAASi therapy in patients with cardiorenal disease and how these issues could be mitigated. Four key areas of suboptimal and variable clinical practice were identified: optimisation of RAASi therapy; definition and management of acute hyperkalaemia; secondary to primary care communications; and patient education. In this podcast article, two of the experts discuss the clinical challenges and principles of optimal care for each of the four areas identified. The experts agreed that hyperkalaemia should be considered a predictable and manageable condition, requiring a pre-emptive and long-term approach. When hyperkalaemia occurs, down-titrating or discontinuing RAASi therapy should be a last resort, after all other management approaches have been employed. Healthcare professionals in secondary and primary care must communicate and collaborate to ensure effective, consistent management of patients with cardiorenal disease. Finally, patients should be educated to understand their cardiorenal disease and its management and the importance of optimal RAASi therapy.

Using visualisation to conceptualise a chronic condition can encourage accurate illness beliefs and support treatment adherence. Hi-BP is a digital visual intervention to support adherence to antihypertensive medication, co-produced with patients. The aim of this study was to investigate the feasibility and acceptability of Hi-BP and explore the preliminary direction of effects on illness and treatment beliefs, medication adherence and blood pressure (BP). A two-phased mixed-methods non-randomised feasibility study was conducted from April 2021 to March 2022 in eight community pharmacies across one Health Board in South-East Wales, UK. Hi-BP was delivered as a single researcher-led consultation to 69 patients in Phase 1 and by pharmacists to three patients in Phase 2. Feasibility was determined using predefined criteria, with acceptability explored qualitatively using semi-structured interviews. Quantitative outcome measures (illness perceptions, medication beliefs, medication-adherence, prescription dispensing and collection data, BP) were recorded at baseline and immediately post-intervention.Follow-up outcome measures were collected at two-weeks (medication-adherence) and three-months (all baseline measures). Hi-BP met feasibility criteria for pharmacist recruitment in both phases, and patient recruitment in Phase 1, but not Phase 2. Hi-BP was acceptable to the sub-sample of 15 patient participants interviewed in Phase 1; insufficient data were available to determine patient acceptability at Phase 2. Hi-BP was acceptable to pharmacists in Phase 1 and partially acceptable at Phase 2, due to competing demands on time for intervention delivery. All outcome measures were considered feasible for use, though a ceiling effect was noted for medication adherence. A potentially positive directional effect was found for illness perceptions (X2(2)=10.83,n=54,p=0.004), medication beliefs (BMQ-Necessity (X2(2)=11.71,n=54,p=0.003) and BP (Systolic BP Z=-3.91,n=51,p=<0.001) but not for medication adherence (MARS-5 X2(2)= 2.4,n=45,p=0.299). In the Community Pharmacy setting, Hi-BP was well-accepted and has the potential for significant reductions in BP; however, further research is needed to explore pharmacist capacity to support implementation.

Background The quality of healthcare delivery relies heavily on building strong relationships between healthcare providers (HCPs) and clients. This study presents the results of a process evaluation for a Randomised Controlled Trial (RCT) examining the effectiveness of Intensive Community Care Service (ICCS) vs Treatment as Usual (TAU; inpatient or core community CAMHS). Methods Thirty-four semi-structured interviews were conducted with staff across various services, including 20 from ICCS and 14 other TAU services. A thematic decomposition analysis was conducted on the data, and specific themes relevant to staff experiences of young people’s engagement with services and overall recovery. Results Three main themes were observed in the HCP data (1. Relational Ecologies: barriers and enablers to engagement, 2. flexibility of approach amidst systemic pressures and 3. the web of trust in the relationship-building process). HCPs highlighted the necessity of developing trust and rapport through non-clinical engagement strategies, such as informal visits and personalised interactions. HCPs emphasised that without trust, treatment effectiveness diminishes, necessitating a tailored approach rather than a one-size-fits-all model. The flexibility in duration of treatment and methods of engagement was noted as crucial in accommodating individual client needs and fostering an open, trusting environment necessary for long-term recovery. Conclusion The findings highlight the vital importance of relational care models, especially ICCS, in addressing the complex needs of Children and Young People (CYP). Flexible, family-centred approaches improve trust, engagement, and long-term recovery outcomes. Recommendations include tackling systemic barriers and expanding relational care models within CAMHS to meet increasing mental health demands effectively. Further research should investigate scalable strategies for integrating these insights into wider mental health service frameworks.

Blunt splenic trauma is the most common solid organ injury in abdominal trauma, with high-grade (American Association for the Surgery of Trauma (AAST) III-V) injuries carrying increased risk of hemorrhage and failure of non-operative management (NOM). Splenic artery embolization (SAE) has emerged as a key adjunct for hemodynamically stable patients, aiming to achieve hemostasis while preserving splenic function. This systematic review evaluated SAE outcomes in high-grade blunt splenic trauma, focusing on technical success, splenic salvage, re-bleeding, complications, delayed splenectomy, and mortality. Five retrospective cohort studies, including 600 adults, were analyzed. SAE demonstrated high technical success (92-100%) and splenic salvage rates (>90%). Proximal and distal embolization achieved comparable salvage rates; distal embolization was associated with longer fluoroscopy times and occasional re-bleeding, while combined techniques showed higher abscess formation. Overall mortality was low, and SAE facilitated preservation of splenic function, reducing the need for delayed splenectomy. Limitations include retrospective design, moderate-to-serious risk of bias, and limited long-term immunologic data. SAE is a safe and effective adjunct to NOM in high-grade blunt splenic trauma, with technique selection influencing complication profiles. Prospective studies are needed to optimize embolization strategies and evaluate long-term outcomes.