North Middlesex University Hospital, known locally as North Mid, is a district general hospital in Edmonton in the London Borough of Enfield. The hospital is managed by North Middlesex University Hospital NHS Trust.
There are several pressing reasons to re-examine shingles and strategies for its prevention through vaccination. Firstly, the UK has recently recommended the introduction of a national childhood varicella vaccination programme, and this may impact the epidemiology of shingles. Secondly, treatments for immune-mediated inflammatory diseases are increasingly targeting immunological pathways essential for antiviral defence. Thirdly, we now have access to a highly efficacious shingles vaccine. This review article will explore each of these developments in a way that is globally relevant, incorporating international recommendations.
BACKGROUND:Catheter ablation for atrial fibrillation (AF) in left ventricular systolic dysfunction (LVSD) improves outcomes, yet left ventricular ejection fraction (LVEF) response is difficult to prospectively predict. OBJECTIVE:This study aimed to identify preprocedural predictors of LVEF response after AF ablation in patients with LVSD and develop a pragmatic score to stratify patients. METHODS:This multicenter cohort study included patients with AF and an LVEF of <50% undergoing index ablation. The primary endpoint was responder status defined as ≥10% increase in LVEF or improvement to ≥50% on follow-up echocardiography after the final ablation. Multivariable logistic regression modeling, stratified by follow-up rhythm, was used to identify predictors and derive a simplified scoring tool. RESULTS:Among 366 patients (aged 64.4 ± 10.6 years; 82% male), 70.8% were left ventricular responders at follow-up. Predictors of nonresponse in the sinus rhythm subgroup included heart failure etiology, QRS duration of >105 ms, paroxysmal AF, and type 2 diabetes. These were incorporated into the PACED score, which stratified response (score <2, 87% probability of response; score ≥3, 71% of nonresponse) with good discrimination (c-statistic 0.83; 95% confidence interval 0.77-0.89). In the largest contemporary multicenter cardiac magnetic resonance subcohort, late gadolinium enhancement was more frequent among nonresponders (84.6% vs 53.6%; P < .001). Guideline-directed medical therapy at baseline was not independently associated with recovery. CONCLUSION:LVEF response post-AF ablation in patients with LVSD can be accurately predicted precatheter ablation with a bedside score. Left ventricular response depends primarily on substrate and conduction characteristics rather than pharmacotherapy in a guideline-directed medical therapy-optimized cohort. Late gadolinium enhancement on cardiac magnetic resonance is associated with an increased chance of being a nonresponder to ablation.
Introducing a formal hospital-based peer mentorship programme for residents in training to improve preparation for specialty applications and career progression, especially in light of recent increases in competition ratios for training numbers. We recruited mentors (usually ST3 level or below) and mentees (focusing on F1/F2) from a range of specialties in a 400-bed size hospital. Mentors completed e-training on mentorship. Based on interests, we matched pairs and liaised to organise meetings. The programme spanned August 2023 to August 2024. A questionnaire was sent at the start and end of the year on looking at confidence in specialty applications, CV, preparation for interviews and post-graduate examinations.The Mann-Whitney U test was used for analysing statistical significance. Comparing 22 respondents at the start to 11 at the end, the average score from 1 to 5 (least confident to most confident)compared between before and after: How confident do you feel regarding the following: CV development (2.45 and 3.64, p-value .00108), application for future training (2.27 and 3.73, p-value .00072), acquisition for trainee competencies (2.86 and 4.09, p-value .00424), preparation for specialty interviews (1.91 and 3.09, p-value .00214), undertaking post graduate exams (2.41 and 3.45, p-value .01778). 100% of participants found the programme beneficial. The programme was beneficial for all and demonstrated statistically significant improvement in mentees’ confidence on training competencies, specialty applications, CV, preparation for interviews and post-graduate exams. We recommend implementing this programme across more trusts and looking at data of residents who successfully get training numbers after taking part.
