Leighton Hospital is a hospital located to the northwest of the town of Crewe in the county of Cheshire, England. It is managed by the Mid Cheshire Hospitals NHS Foundation Trust.
Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Beyond recurrent ischemic events, many patients experience a sustained and gradual reduction in physical activity and functional capacity after diagnosis, hospitalization, and treatment. Deconditioning is a complex process that encompasses physiological and behavioral decline driven by inactivity, symptoms, fear-avoidance behaviors, and treatment-related factors. It provides a unifying condition through which these deficits can be understood and targeted. Although exercise-based cardiac rehabilitation is a cornerstone of secondary prevention, deconditioning is rarely measured explicitly in clinical practice or treated as a reportable outcome in CAD studies and clinical pathways. In this narrative review, we aim to refine the contemporary definition of deconditioning as it applies to CAD, and we summarize drivers of deconditioning across the CAD continuum (stable angina, acute coronary syndromes, and postrevascularization care). Furthermore, we discuss clinical consequences, including impaired quality of life, hospital readmission risk, and reduced participation, in evidence-based therapies. Finally, this review proposes a pragmatic research and implementation agenda to incorporate objective activity/functional endpoints and early patient mobilization strategies into routine CAD care. Treating deconditioning as a modifiable, patient-oriented outcome may improve recovery after adverse coronary events and might offer a platform that aligns coronary revascularization and pharmacotherapy decisions with what matters to patients the most. This includes the absence of ischemic symptoms, recovery of functional capacity, and return to usual leisure and work activities.
Introduction Axillary ultrasonography (AUS) and US-guided needle core biopsy (NCB) are recommended for evaluating axillary nodal status in new breast cancer cases. Presence of axillary nodal metastasis significantly impacts five-year survival rates. This study evaluated the diagnostic accuracy of preoperative AUS and US‑guided NCB in patients with invasive breast cancer at Leighton Hospital, benchmarked against national NHS standards. The primary objective was to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and NCB in detecting nodal metastasis. Methodology This retrospective study was conducted at the Breast Unit of Leighton Hospital, part of the Mid Cheshire Hospital Trust. The study population included all patients diagnosed and treated for breast cancer from January 1, 2022, to December 31, 2022. Patients presenting with locally advanced, metastatic, or recurrent breast cancer were excluded from the study. Ultrasound evaluations were performed using a high-frequency linear-array transducer (7.5-17 MHz). Patients with in situ disease were not subject to axillary assessment/surgery. Lymph nodes with cortical thickness of 3 mm or more, irregular margins, and effacement of the fatty hilum were considered suspicious and were graded A3 and above. All these patients were subjected to US‑guided NCB. Patients graded A1/A2 and those with biopsy-proven benign nodes had sentinel node biopsy. Patients with positive biopsy for metastatic disease were subjected to axillary lymph node dissection (ALND). Results Axillary assessment for patients graded A3 and above (Group B) met or exceeded NHS standards for sensitivity (0.93), specificity (0.92), and PPV (0.92). NPV (0.92) was slightly below NHS standard. The lower performance metrics in Group B (A1-5) fell short of NHS guidelines in all four metrics, highlighting the need for potential improvements in the diagnostic process or the use of additional diagnostic tools to enhance accuracy. Conclusion Axillary assessment in A3 patients met or exceeded NHS standards, with sensitivity, specificity, and PPV at 0.92, though NPV was slightly lower. A1/A2 patients underperformed across all measures. The findings support AUS as a reliable tool for breast cancer staging and management.
