Ealing Hospital is a district general NHS hospital, part of London North West University Healthcare NHS Trust, located in the Southall district of the London Borough of Ealing, West London, England. It lies on the south side of the Uxbridge Road 8.5 miles west of central London. It sits between Southall town centre to the west and Hanwell to the east. It is built on land that was once part of St. Bernard's Hospital which is run by West London Mental Health (NHS) Trust. The Ealing Hospital Interchange bus station is adjacent to the hospital.
Training in quality improvement (QI) and patient safety remains highly variable despite regulatory mandates. We describe a novel, intensive 5-day experiential QI education programme for postgraduate trainees that integrates real-world observation, brief didactic sessions and workshop-based improvement work, supplemented by creative storytelling and team-based development of campaign media products. First-year anaesthesia residents conducted over 100 structured operating room observations and interviews, collected quantitative and qualitative data on distractions and presented improvement proposals that they developed to institutional stakeholders along with narrative campaign videos. Postcourse evaluations demonstrated a significant increase in trainee confidence in QI methodology and presentation, with participants valuing the experiential and creative elements over traditional didactic instruction. This model demonstrates the feasibility, reproducibility and educational value of immersive, short-duration QI training in authentic clinical settings and suggests a promising alternative to longer, resource-intensive curricula.
We present a case of a woman in her 20s with right iliac fossa pain. Initial investigations showed mildly elevated inflammatory markers and serum beta human chorionic gonadotrophin (hCG) <1 mIU/mL. She was taken to theatres as a presumed early appendicitis but found to have haemoperitoneum with a free-floating cystic structure in the pouch of Douglas with intact pelvic organs. This was subsequently confirmed histologically as a gestational sac which had likely been expelled via the abdominal ostia into the peritoneal cavity (a so-called complete tubal abortion). She made a good postoperative recovery and was discharged with no complications. This case highlights the rare but important potential for ectopic pregnancy and its complications to be present despite a negative serum beta-hCG.
Gastric amyloidosis is a rare condition characterized by localized amyloid deposition in the stomach, often mimicking more common gastrointestinal disorders and presenting diagnostic challenges due to nonspecific symptoms and endoscopic findings. A 62-year-old man with six months of dyspepsia unresponsive to proton pump inhibitors underwent endoscopy, which revealed nodular mucosal changes and erosions in the gastric antrum. Biopsy confirmed amyloid deposits with Congo red staining, and systemic involvement was excluded through comprehensive evaluation. The patient improved with symptomatic management. This case underscores the importance of considering isolated gastric amyloidosis in patients with refractory dyspepsia and atypical gastric lesions, with early biopsy and Congo red staining being essential for accurate diagnosis and appropriate care.
BACKGROUND:Diabetic foot ulcers are a major complication of diabetes, with resulting soft tissue defects increasing the risk of limb amputation and mortality. Reconstruction of defects may be in the form of local, pedicled, or free tissue transfer. This systematic review aims to confirm the role and benefit of free tissue transfer in this patient cohort. METHOD:This review is registered on PROSPERO (ID: 617657). A literature search was performed using the online databases EMBASE, MEDLINE, and Web of Science to identify literature reporting use of free flaps in the management of diabetic lower limb ulcers. Mesh terms used included "diabetes," "lower limb," "ulcer," and "free tissue transfer." A random-effect meta-analysis was implemented to assess the efficacy of free flaps as a treatment based on complication and limb salvage rates. RESULTS:Twenty-five studies were included in this systematic review, amounting to 547 free flaps. The total complication rate was 26% (95% CI = 21%-32%, I2 = 27%, p = 0.11). Partial flap loss was noted in 6% of cases (95% CI = 3%-11%, I2 = 0%, p = 0.96) while complete loss occurred in 4% of cases (95% CI = 2%-7%, I2 = 0%, p = 1.0). The most performed flap was the anterolateral thigh (ALT) flap. Revascularization was performed prior to free flap reconstruction in 15% of cases. The amputation-free rate was 95% at the latest follow-up point of each study. CONCLUSION:Free tissue transfer is a viable treatment option for patients with diabetic foot ulcers. The low complication including amputation rate supports its implementation in practice provided a myriad of factors and careful patient selection is maintained.
Background: Oesophageal varices is one of the most common complications in liver cirrhosis and can be seen in almost 50% of patients, with an annual bleeding risk of 10–15% and a 6-week mortality rate of up to 25%.1 Endoscopy is the gold standard test for early detection and prevention of complications.2 However, adherence to guidelines is not systematically evaluated. This study assessed adherence to endoscopic guidelines, barriers to adherence and their association between progression of disease and mortality. Methods: This was a retrospective study that examined alcoholic liver cirrhosis patients who underwent an endoscopy study at Ealing Hospital. Data collection for this study was performed following registration with Clinical Audit and Governance team at London North West University Healthcare NHS Trust with Registration No: St.M.EH.24.200.This study was performed to assess adherence to endoscopic surveillance guidelines, in particular Baveno VI3 and VII,4 to determine whether patients had endoscopic evaluations at recommended timelines: every 2–3 years in patients with compensated cirrhosis and every 1–4 weeks until eradication, followed by scheduled follow-up in decompensated cirrhosis.To explore the impact of adherence on disease progression and mortality, statistical analyses, including Chi-square tests and binary logistic regression, were performed, thus allowing vigorous testing of relationship between compliance, clinical outcomes and potential barriers to adherence to surveillance. Results: The total number of patients included was 177; 77% men (n=137) and 22.6% women (n=22.6%). In terms of age groups, 51–60 years (29.9%) and 61–70 years (27.1%) collectively accounted for more than half the study population. In general, 57.6% of patients adhered to recommended endoscopic surveillance guidelines, while 42.4% did not. The major reasons behind non-compliance were missed appointments (26.7%), mental health problems (16.7%), mortality(15.6%) and split care between centres (15.6%) (Fig 1).Chi-square test (p=0.007) showed significant association between surveillance guidelines and progression of disease. Among the patients who followed recommended guidelines, 66% had stable disease and 55% showed clinical improvement. By contrast, disease progression was seen in 59% of patients who did not adhere to the recommended guidelines (Table 1).In addition, binary logistic regression showed that disease progression (B=–2.636, p=0.005, OR=0.072) and disease severity (B=0.786, p=0.006, OR=2.195) were significant predictors of mortality. Although adherence to surveillance guidelines plays a major role in stability of disease, it was not statistically associated with mortality (p=0.183). Thus, overall survival is directly influenced by disease severity and progression rather than by adherence to guidelines alone. Conclusion: This study suggests adherence to endoscopic surveillance leads to stable disease and lower progression rates. Disease burden and severity remain central in predicting mortality. Essentially, non-compliance was primarily attributed to missed appointments, mental health issues and split care. Addressing these barriers could enhance adherence, reducing disease progression, and improved long-term outcomes. Recommendations: Improved compliance requires streamlined referrals, automated remainders and proper patient education. In addition, multidisciplinary collaboration, enhanced community outreach and digital tracking improve patient outcomes in the long-term.
