Gloucestershire Hospitals NHS Foundation Trust runs Gloucestershire Royal Hospital, an NHS district general hospital in Great Western Road, Gloucester, England. It serves western and southern Gloucestershire and parts of Herefordshire. It also runs Cheltenham General Hospital. The trust is currently under the leadership of chair Peter Lachecki and chief executive Deborah Lee.The trust's vision is "Best Care for Everyone" and this is underpinned by their values of "Caring, Listening and Excelling".
Invasive acral Lentiginous Melanoma (ALM) is a distinct subtype of melanoma, primarily affecting non-sun-exposed extremities such as the palms, soles, and nail beds. First described by Reed in 1976. ALM is characterised by lentiginous proliferation of atypical melanocytes along the basal layer of glabrous skin. While “acral melanoma” refers broadly to melanomas arising on acral sites, “acral lentiginous melanoma” specifically denotes this lentiginous subtype. ALM is disproportionately represented among individuals with richly pigmented skin, including Black, Hispanic and Asian populations, in whom it accounts for a higher proportion of melanoma cases than in White populations. Although it represents only 2–3% of all melanomas, ALM carries a poorer prognosis, with five-year melanoma-specific survival rates averaging 80.6%. The pathogenesis of ALM remains incompletely understood. It is not primarily UV-induced but often associated with mechanical stress on weight-bearing or high-friction areas. Recurrent mutations in KIT, NF1, TERT and TP53 are frequently observed, particularly in older and Asian patients, underscoring its distinct molecular profile. Diagnosis is often delayed due to its subtle presentation as irregularly pigmented macules or patches. Histologically, ALM demonstrates lentiginous basal proliferation with dermal invasion. Management typically involves wide local excision, though advanced disease may require lymph node surgery, radiotherapy or systemic therapy. Prognosis is influenced by tumour thickness, ulceration, and sentinel lymph node involvement. Persistent disparities in outcomes highlight the need for improved awareness, earlier diagnosis, and targeted management strategies to address the biological and sociodemographic complexities of ALM.
AIM:This national survey aimed to evaluate the adoption and implementation of delivery room cuddles (DRC) for preterm infants (<32 weeks' gestation) in neonatal units across the UK. We sought to determine the extent of the practice, and understand the consistency and challenges associated with DRC, with the goal of enhancing care for preterm infants. METHODS:Between January and March 2024, all UK level 2 and 3 neonatal units were invited to complete a structured survey on DRC practices. We collected data on the existence, frequency and facilitation of DRC, as well as any institutional guidelines and barriers for its practice. RESULTS:We received complete responses from all 131 centres invited (100% response rate). Among these, 60 centres (45.8%) reported routinely practising DRC, 66 (50.4%) did so occasionally and 5 (3.8%) reported not practising DRC at all. Notably, 81 centres (61.8%) practised DRC without formal institutional guidelines. Main barriers to practice included equipment limitations, varying staff attitudes, and concerns about the clinical condition of preterm infants. CONCLUSION:This survey demonstrates an encouraging high uptake of DRC in recent years, typically offered after initial stabilisation (within 30-60 min post-birth). Despite the recognised benefits of DRC to parents and in enhancing neonatal outcomes, considerable variability remains in its implementation underscoring the need for comprehensive guidelines and professional training. These could standardise DRC practices across the UK, promoting more consistent and effective care for preterm infants.
Background: Sub-Saharan Africa (SSA) faces the world’s highest age-standardised prevalence of blindness (0.99%), nearly double the global average. The leading causes—cataract, glaucoma, and diabetic retinopathy—may require surgical interventions. Yet SSA suffers from a significant shortage of ophthalmologists (2.7 per million population) and a lack of access to quality surgical training. Simulated Ophthalmic Surgery (SOS) training provides a promising, safe, and scalable method for early-stage surgeons and trainers to develop critical surgical skills outside live theatre settings. Methods: A cross-sectional, anonymous electronic survey was distributed to 201 trainees and 22 trainers who attended UCT SOS training between 2017 and 2024, exploring demographics, training experiences, perceived impacts, and systemic barriers. Results: The survey received responses from 100 trainees (49.7%) and 18 trainers (81.8%). Trainee worked in 20 SSA countries, with 93% reporting improved confidence, 78% noting fewer complications, and 76% observing better postoperative outcomes. Trainers also benefited: 78% felt more confident in teaching, and 75% observed fewer complications among trainee they later supervised. 65% of trainee and 70% of SSA-based trainers reported inadequate resources for continued simulation practice. Only 50% of trainee could apply their training within one month. Conclusion UCT’s SOS courses significantly enhance surgical and teaching confidence. Institutional barriers such as delayed application, inadequate infrastructure, and limited training time threaten the long-term impact. Simulation-based surgical training shows strong potential for building SSA’s ophthalmic workforce and reducing avoidable blindness. Sustained investment in simulation training infrastructure, policy integration, and structured mentorship attachments is essential to unlock this potential.
Arthroscopic shoulder stabilisation surgery (ASSS) is a common procedure for treating anterior shoulder instability. Postoperative rehabilitation remains a crucial, but under-researched, aspect of patient recovery. Despite its importance, no comprehensive rehabilitation guideline based on robust clinical trials has emerged, leaving a gap in evidence-based practice.To address this, the British Elbow & Shoulder Society appointed the Allied Health Professional Clinical Guideline Group to review current practices and establish clinical guidance on rehabilitation. This evidence synthesis aims to provide a critical synthesis and discussion on rehabilitation following ASSS. The intended outcome is to highlight areas of uncertainty and make recommendations for clinical practice and further research.The development of this evidence synthesis followed a rigorous five-stage process: (1) systematic literature review, (2) UK national practice survey, (3) expert consensus (Delphi) study, (4) updated literature search and review and (5) synthesis of the previous four stages. Stages 1-3 have been published previously. This evidence synthesis comprised stages 4 and 5.10 key domains for postoperative rehabilitation from immediate postsurgery to return to normal function, including sports, were identified. This paper synthesises current knowledge and provides a platform for recommendations in clinical practice and future research. In particular, early shoulder movement was recommended during the 'immobilisation period', but confined to shoulder elevation up to 90°, anterior to the scapular plane, with neutral external rotation. Further high-quality primary research is needed to address uncertainties and expand the evidence base, thereby informing and challenging clinical practice.
