Luton and Dunstable University Hospital is an acute hospital in Luton, Bedfordshire, England, run by Bedfordshire Hospitals NHS Foundation Trust. It provides medical and surgical services for over 350,000 people in southern Bedfordshire, the north of Hertfordshire and parts of Buckinghamshire. The hospital is often abbreviated to the 'L&D', and employs 3,400 staff.
This systematic review synthesizes evidence on biomechanical fracture thresholds of the tibia and fibula under axial and multi-axial loading. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library identified six studies, including experimental cadaveric, computational, and material testing investigations, comprising 72 postmortem specimens and validated finite element models. Outcomes assessed included axial force, bending moments, failure load, stress distribution, and fracture patterns. Results indicate that tibial fracture thresholds range from ~7.5 kN in female specimens to 11.3 kN under combined axial and bending loads, with fibula contribution increasing axial tolerance by ~10%. Variance and confidence interval measures were not reported in the included biomechanical studies; therefore, findings are presented descriptively. Multi-axial loading consistently reduced fracture tolerance compared with isolated axial loading, and fracture resistance was influenced by specimen gender, load duration, and biomechanical methodology. Risk of bias ranged from low to moderate across studies. These findings provide clinically relevant benchmarks for injury prediction, preclinical testing, and orthopedic device design, emphasizing the importance of multi-axial assessment in understanding lower-limb fracture mechanics.
Aims Cauda equina syndrome (CES) is a rare neurosurgical emergency where diagnosis and treatment by emergency spinal decompression is time critical. A national CES pathway from Getting It Right First Time (GIRFT) suggested development of 24/7 MRI services at district general hospitals (DGHs). It gave a national target of time to scan time between MRI scan request and actual scan of less than four hours. The Luton CES pathway was introduced in 2021 at Luton and Dunstable University Hospital, UK, to improve the time (in hours) to a MRI service, as well as to streamline patient care for suspected CES. It aimed to improve time to scan and reduce need of out-of-hours transfer to tertiary centre for urgent MRI scan. Methods A retrospective review of patients who presented with suspected CES before (2018) and after (2024) the introduction of the pathway in Luton and Dunstable University Hospital. The time to scan was the primary outcome measure. Secondary outcome measures were number of patients scanned, scan positive rate (patients with actual CES who underwent emergency spinal decompression), patients meeting the national target of time to scan, and the number of patients needing out-of-hours transfer to tertiary centre for urgent MRI scan. Results The median time to scan improved from 8 hours 48 minutes to 34 minutes (p < 0.001). The number of patients scanned increased more than two-fold from 280 to 688. Patients meeting the national target increased from 66% to 90%. The number of patients also needing out-of-hours transfer reduced more than 50% from 17 to six. Conclusion A local dedicated pathway can achieve national targets, and reduce need for out-of-hours transfer to a tertiary centre for urgent MRI scan. This is achieved by efficient use of an existing in-hours MRI service, already available in every DGH of UK. This can be the pragmatic way forward for most DGHs until they establish a 24/7 MRI service.
Background Concealment of a body in a suitcase presents unique forensic challenges. PMCT can non-invasively demonstrate concealed injuries and provide compelling evidence for court. Methods We present a homicide case in which the deceased was discovered inside a suitcase. PMCT was performed prior to autopsy. Results PMCT demonstrated:Multiple facial fractures with clear visualisation on 3D reconstruction.Soft tissue swelling and haemorrhage correlating with blunt force trauma.Body position within the suitcase, confirming concealment mechanics.The imaging findings directed forensic pathologists to key injury sites and later formed a central exhibit in court proceedings. Conclusions This case demonstrates the pivotal role of PMCT in homicide investigation where concealment complicates assessment. Beyond COD determination, PMCT provided a visually compelling reconstruction that helped clinch the forensic narrative for both pathologists and the court.
Abstract Aim Bariatric surgery remains one of the most effective interventions for severe obesity, but significant micronutrient disturbances, particularly iron deficiency, continue to affect long-term postoperative health. As iron absorption relies on intact gastric physiology, patients are routinely advised to take lifelong supplements. However, real-world experiences suggest that postoperative behaviours around supplementation vary widely. This study sought to examine how often iron deficiency develops after surgery and to explore the patterns of supplement use that may influence this risk. Method A literature search was performed across PubMed, EBSCO and Cochrane Library for publications from 2010 - 2025 reporting both postoperative iron deficiency and patient-reported supplement use in adult bariatric cohorts. Studies without quantifiable haematological outcomes or descriptions of supplement-taking behaviour were excluded. Data extracted included iron deficiency prevalence, supplement initiation and continuation patterns and patient-reported challenges. Results Nine studies met the criteria. Iron deficiency remained a prominent postoperative issue, though frequency varied substantially between centres and procedure types. Adherence differed markedly across populations. In one study (n=340) 37.6% took iron supplements as recommended, while 23.6% did not take them at all.Patients frequently cited medication fatigue, gastrointestinal discomfort and the diminishing perception of postoperative risk as reasons influencing their routines. Conclusions The development of iron deficiency after bariatric surgery is tied not only to altered physiology, but to the everyday patterns through which patients engage with supplementation. Addressing postoperative iron deficiency will depend on interventions that recognise and support these behavioural patterns rather than relying solely on prescribing standard supplement regimens.
Purpose: This study aimed to assess occupational stress and its relationship with psychological well-being among physicians working in the emergency departments of tertiary hospitals in Dhaka, Bangladesh, and to determine key occupational factors that may affect stress levels and mental health outcomes. Research Methodology: This study was conducted on 110 emergency physicians in Dhaka, using the Health Professionals Inventory Scale (HPIS) to measure occupational stress and the WHO-5 Well-Being Index to assess psychological well-being. The survey also collected demographic information and data on job satisfaction and employment types. Results: The study findings revealed that 57.3% of respondents experienced very high occupational stress, and 41.8% reported good psychological well-being. A significant inverse relationship between stress levels and well-being was observed, indicating that higher occupational stress was associated with poorer psychological health. Employment type and job satisfaction were identified as critical factors influencing stress and well-being. Conclusions: Occupational stress represents a significant challenge for emergency physicians and requires organizational interventions, including workload management, psychological support, and improved workplace conditions. Limitations: The cross-sectional design, self-reported measures, limited sample size, and concentration of participants in tertiary hospitals in Dhaka restrict the generalizability and causal interpretation of the findings. Contributions: This study provides empirical evidence for healthcare administrators and policymakers to develop targeted strategies for reducing occupational stress and strengthening psychological well-being among emergency physicians.
