Inverclyde Royal Hospital,NHS Greater Glasgow and Clyde

Urinary incontinence is a common but often underreported experience, largely because of feelings of embarrassment and stigma associated with the condition. Urinary incontinence can be highly debilitating and isolating, with a significant impact on psychological, physical and social wellbeing. Yet, feelings of shame or misconceptions that incontinence is a normal part of the ageing process mean that patients often do not seek medical advice until they have been experiencing symptoms for a long time. Therefore, holistic, patient-centred and compassionate assessment is vital. General practice nurses are often the first point of contact for the patient, and may already have a trusting relationships with them. They are thus well placed to identify, assess, educate and support patients experiencing urinary incontinence and to coordinate onward care or referrals. This article will explore some of the practical aspects of assessing patients, as well as holistic considerations. Challenges in management of urinary incontinence are also discussed, alongside the important role of primary care nurses.

Abstract Background/Aims Erythrocyte Sedimentation Rate (ESR) has traditionally been used to assess inflammation in rheumatological conditions. Despite the introduction of C-reactive protein (CRP) testing in the 1980s-90s, ESR remained widely used due to the initial cost and limited availability of CRP. Educational materials and clinical guidelines have historically emphasised ESR. However, simultaneous testing of ESR and CRP for monitoring inflammatory arthritis, giant cell arteritis (GCA), and polymyalgia rheumatica (PMR) is often unnecessary, as CRP alone is sufficient in many cases. CRP offers several advantages: it is less affected by non-inflammatory factors and is significantly more cost-effective (<£2 vs. £20.36 per test). Despite this, dual ordering remains common, partly due to legacy scoring tools such as DAS-28. ESR testing also has a greater environmental impact, requiring more materials, energy, and generating more waste. Methods This quality improvement project aimed to reduce unnecessary ESR testing when CRP was also ordered across Clyde rheumatology services (three hospital sites). Pre-intervention data were collected in November 2024; post-intervention data from March-June 2025. Interventions included: education at rheumatology MDT meetings; targeted reminders to medical day bed unit staff; monthly progress updates via email; removal of ESR from standard biologic screening panels; education to orthopaedics on CRP-only testing for swollen joints and rheumatology referrals. Results In November 2024, 626 ESR and CRP tests were ordered on the same day. By June 2025, this fell to 479—a 23.5% reduction. Orders from the rheumatology team decreased from 231 to 154, representing a 33.3% reduction. These results demonstrate the effectiveness of targeted interventions in reducing unnecessary test utilisation. Conclusion Simple, targeted behavioural interventions can significantly reduce unnecessary ESR testing, yielding substantial cost savings (>£3000/month) and environmental benefits. These changes support realistic medicine principles by avoiding unnecessary investigations. Future plans include updating TrakCare blood order sets and extending education to Primary Care on appropriate ESR use. Disclosure M. Jaffery: None. G. Roberts: None. S. Maunick: None.

Stone impaction is an obstacle to successful laparoscopic common bile duct exploration (LCBDE). This study aims to identify the incidence, operative difficulties and techniques used to disimpact and remove impacted stones during LCBDE. Prospectively collected data from a large series of LCBDE. Preoperative and operative findings in patients with impacted stones including the difficulty grading, impaction site, disimpaction methods, operative complications and postoperative outcomes were analysed. 136 of 1447 (9.4

Migraine is a complex neurological disorder marked by severe headache and associated with various systemic symptoms. Atrial septal defect (ASD) closure, a common cardiac procedure, has been linked to the onset of new migraine episodes. This systematic review explores the incidence and management of migraine following transcatheter ASD closure. A comprehensive literature search was conducted in PubMed, Scopus, and CINAHL Ultimate, covering studies from inception to August 2024. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024578609). Data extraction and risk of bias assessment were systematically performed by independent reviewers. A total of 831 studies were identified out of which 13 were included for the final analysis. The studies encompassed diverse populations globally, revealing varying onset times for migraine post-ASD closure, ranging from as early as 1 day to up to a year. Migraine incidence varied significantly, with several studies noting a higher prevalence in females and some cases showing a familial predisposition typically in the maternal side. The typical methods for ASD closure involved transcatheter approaches. Treatment modalities included non-steroidal anti-inflammatory drugs, calcium channel blockers, and anticoagulants, with some cases experiencing spontaneous resolution of symptoms. Modifications to anti-platelet therapy post-procedure, such as the introduction of clopidogrel along with aspirin, showed significant efficacy in treating and preventing migraine. This review highlights a significant correlation between ASD closure and the onset of migraine, underlining the need for further investigation into preventive strategies and management. These findings suggest a complex interaction between structural heart alterations and migraine pathophysiology.