London North West University Healthcare NHS Trust is an NHS trust based in London, United Kingdom. The trust was formed by the merger of North West London Hospitals NHS Trust and Ealing Hospital NHS Trusts in October 2014. The trust runs Northwick Park Hospital and St Mark's Hospital in Harrow, Central Middlesex Hospital in Park Royal, and Ealing Hospital in Southall. It also runs 4 community hospitals in addition to providing community services in Brent, Ealing and Harrow. The trust employs 8,590 staff across all its sites, and in 2016/17 had 141,355 attendances to its Emergency Department, and 80,756 elective inpatient and day case admissions.In 2018 the trust decided not to submit a bid for a 10-year contract to provide most “out of hospital services” to Ealing Clinical Commissioning Group – services which they had been providing. The chief executive told staff that it was not possible to provide a quality service for the money on offer, despite the sum being offered being higher than the sum the Trust was already receiving for delivering the services. Ultimately three bidders participated in the procurement and the services were awarded to a consortium led by West London Mental Health NHS Trust.In 2019 it set up a service combining vascular surgery, endovascular surgery and interventional radiology at Northwick Park Hospital, challenging the dominance of the London teaching hospitals in specialist services.
Phlegmasia cerulea dolens (PCD) is a rare, life-threatening venous thrombosis with high morbidity and mortality. Management requires careful balance between conservative anticoagulation and timely surgical intervention. We report a 79-year-old male with PCD presenting with distal foot sparing and thigh swelling. Close monitoring of symptoms, clinical examination, and biochemical markers guided the decision for urgent fasciotomy. Early recognition and individualized management allowed limb salvage and full functional recovery. This case highlights the key clinical and biochemical indicators for intervention and underscores the need for further research on optimal timing for surgical intervention.
Background Fatigue, impaired sleep quality and daytime sleepiness, common in neurodegenerative and immune-mediated diseases, are debilitating and have serious societal and economic implications. Currently, measurement of these symptoms largely relies on self-reported questionnaires, which are burdensome for patients and lack sensitivity, granularity and reliability. Methods Building on a preceding feasibility study and qualification advice of the European Medicines Agency, the Clinical Observational Study of the European project Identifying Digital Endpoints to Assess FAtigue, Sleep and acTivities of daily living in Neurodegenerative disorders and Immune-mediated inflammatory diseases (IDEA-FAST) investigates the relationship between digital and clinical parameters of the target concepts of fatigue, reduced sleep quality and daytime sleepiness. Results Between 2022 and 2025, 2000 people are being recruited at 24 European sites – 500 with Parkinson's disease, 500 with inflammatory bowel disease, 200 with each of the following diseases: Huntington's disease, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and 200 healthy volunteers. Participants are followed over a 24-week period with four visits, each including a 1-week assessment phase at home using CE-certified digital health (including active and passive) technologies. The latter collect information on physical activity, physiology, cognition as well as social interaction and behaviour as core dimensions of the target concepts. Conclusion This study will help to develop reliable, valid and efficient digital endpoints of fatigue, impaired sleep quality and daytime sleepiness for use in future clinical studies and trials.
Spontaneous coronary artery dissection (SCAD) is a cause of acute myocardial infarction predominantly affecting adult women. A proportion of SCAD cases are associated with rare heritable connective tissue disorders. Vascular EDS (vEDS), due to deleterious variants in COL3A1, is one of the most common of these. Our aim was to identify specific features of SCAD in vEDS which may aid patient selection for genetic testing. A systematic review of published cases of individuals with SCAD and vEDS was conducted. Additionally, patients with SCAD and genetically confirmed vEDS (SCAD-vEDS) were identified through the UK national EDS service and UK SCAD registry. Data were collected on presentation, management and extra-cardiac findings. Angiography was compared with an age and sex-matched, exome sequenced, control cohort with SCAD but without vEDS (SCAD-nonvEDS). Data from ten SCAD-vEDS patients were identified. There was a lower average age of SCAD and higher proportion of males in individuals with SCAD-vEDS, however differences should be interpreted carefully given cohort size. Fifty-six cases of SCAD-vEDS were identified through systematic review. Systemic features were present in most but not all cases. This report presents a new, angiographically characterised case-control cohort along with a systematic review of the current literature. Whilst clinical differences appear between the SCAD-vEDS and SCAD-nonvEDS groups, these are insufficient to accurately distinguish SCAD-vEDS from the general SCAD population. All individuals with SCAD should be evaluated for underlying vEDS but clinical assessment will miss some cases. Wider genetic testing in some SCAD patients may be merited to enable appropriate management. Systematic review registration: https://www.crd.york.ac.uk/prospero/536751 Identifier: 536751.
INTRODUCTION:Emergency general surgery (EGS) is an essential part of general surgery. However, the service configuration for EGS in the United Kingdom (UK) and Ireland varies significantly. This study aims to clarify current and desired future roles of EGS surgeons in the UK and Ireland, particularly regarding operative procedures. METHODS:An e-survey, designed by the Association of Surgeons of Great Britain and Ireland (ASGBI) Moynihan Academy, was distributed to ASGBI members at two national conferences in 2023. Data collection included the operative roles of EGS surgeons and factors influencing the appeal of a dedicated EGS career. The study was conducted and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS:There were 132 of 347 (response rate 38.0%) complete responses analysed. Respondents identified a core set of procedures that could be safely performed by EGS surgeons, regardless of dedicated EGS service configuration. A minority of respondents stated that EGS surgeons - rather than a surgeon with a specialist interest - should operate on specific conditions: emergency colonic resection for cancer (65 of 132 [49.2%]) or for inflammatory bowel disease (49 of 132 [37.1%]), laparoscopic cholecystectomy plus intraoperative cholangiogram with or without common bile duct exploration (45 of 132 [34.1%]), operations for gastric volvulus (45 of 132 [34.1%), operations for Boerhaave's (37 of 132 [28.0%]) and operations for bariatric complications (34 of 132 [25.8%]). Factors that might improve future EGS careers included pragmatic job planning, minimally invasive elective surgical opportunities and dedicated continuing professional development. CONCLUSIONS:This study outlines the operative role of EGS surgeons within the broader general surgical profession and highlights controversies regarding whether EGS surgeons should perform specific complex operations.
