Northampton General Hospital NHS Trust

Increases in the number of migrants (economic, educational, and involuntary) to Europe from countries with high incidence of communicable diseases [tuberculosis (TB), HIV, and hepatitis B (HBV) and C (HCV)]; has increased the need for cost-effective early disease diagnosis programmes to improve outcomes. We aimed to synthesize and evaluate current literature on community-based screening (CBS) initiatives in Europe, the diseases being screened for, and acceptance when offered. Database search (OVID Medicine, OBIFD EMCAre, and EMBRACE) of studies between January 2000 and January 2024 investigating CBS of newly arrived migrants for TB, HIV, HBV, and HCV in Europe (PROSPERO ID: 542289). Fifteen studies were included TB only (9/15, 60%), blood borne viruses (BBV) (2/15, 14%), and two or more diseases (4/15 26%). Ten (68%) studies were community-based, 3 (16%) in reception centres, 1 (8%) in primary care, and 1 (8%) mixed setting. Five (33%) studies included community leaders/members in recruitment and two (13%) performed follow-up on participants. Screening acceptance ranged from 41% to 100% (TB 41%-100%, BBV 78.5%-100%, TB/BBV 47.3%-100%) and disease prevalence ranged from 0.09% to 45.1% (TB 0.09%-45.1%, BBV 0.2%-8.7%, TB/BBV 3.2%-28.8%). There are few studies investigating CBS of TB or BBV in migrants in Europe, despite a rise in migration over the last decade. This review shows an urgent need for CBS of migrants for multiple infections that includes community members/leaders to improve acceptance rates and reduce disease mobility and mortality in a vulnerable population.

Introduction:Approximately 600,000 people die every year in the United Kingdom including 24,000 who die in the Emergency Department (ED). The National Audit of Care at the End of Life looks at the care of dying people during their last hospital admission. However, patients who die in the ED are excluded from this audit and therefore little is currently known about this population. Purpose:This service evaluation aimed to describe the population who died in a 12-month period in five NHS EDs, including whether palliative care teams were involved. Patients and methods:Records from all eligible patients in the 12 months from 1st June 2022 were reviewed. Anonymised data from each site was collated and compared. Results:There were 704,303 ED patient presentations across the 5 sites, and 852 deaths. The mean age of death was 74.04 with a slight male preponderance of 56.8%. Between sites there was a wide range (0.4%-25%) of involvement from palliative care with these patients whilst in ED. The overwhelming majority had a medical (rather than surgical or traumatic) cause of death. Conclusion:Research is needed in order to ascertain how care can be improved for this group of patients. More UK-centric work is required to understand the characteristics of patients who die in EDs including their cause of death and ethnicity, as well as an exploration of whether greater palliative care collaboration in ED improves patient, family and staff experience.

BACKGROUND:Retropharyngeal lymph node (RPN) involvement in oropharyngeal squamous cell carcinoma (OPSCC) may influence prognosis, staging, radiotherapy target volumes, and treatment strategy. However, its true prevalence and association with clinicopathological factors remain incompletely defined. METHODS:A systematic review and meta-analysis was performed in accordance with the PRISMA 2020 statement. MEDLINE, EMBASE, EMCARE, PubMed, Web of Science, Scopus, and the Cochrane Library were searched from database inception to 15 June 2026. Studies reporting radiological or pathological assessment of retropharyngeal lymph node (RPN) involvement in oropharyngeal squamous cell carcinoma (OPSCC) were included. Pooled prevalence estimates were calculated using a random-effects model, with subgroup analyses according to tumour stage, nodal status, HPV status, and primary tumour subsite. RESULTS:Fourteen studies comprising 8,887 patients were included. The pooled prevalence of RPN involvement was (95% CI 11-16%; 95% PI 6-24%), with substantial heterogeneity. HPV-negative tumours demonstrated higher prevalence than HPV-positive tumours (21% vs 11%). Prevalence increased with advancing T stage, from 2% in T1 to 18% in T4 disease, and was higher in node-positive than node-negative disease (16% vs 1%). Tonsillar primaries showed higher prevalence than base of tongue tumours (14% vs 8%). Among patients with RPN involvement, the pooled distant metastasis rate was 16%. CONCLUSION:RPN metastases were identified in approximately one in eight patients with OPSCC and were more frequent in HPV-negative disease, advanced stage, and tonsillar primaries. These findings support careful evaluation of the retropharyngeal space during staging and may assist risk stratification in selected higher-risk patients.

A man in his early 40s presented with a sudden-onset headache, slurred speech, drooling, and a transient left-sided facial droop, which resolved within a few hours. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare monogenic hereditary cerebrovascular disorder that can cause stroke in adults due to mutations in the NOTCH3 gene and is associated with characteristic white matter changes on imaging (the "NOTCH" part of the gene name is derived from the Drosophila melanogaster notched wing mutant, and "3" signifies that it is the third discovered human homologue). The presence of elevated blood pressure raised questions regarding an alternative etiology for stroke. Therefore, he was referred to the accident and emergency department for further evaluation, including an MRI of the brain, which showed an acute infarct with periventricular white matter changes involving the right internal capsule. This report highlights the importance of considering CADASIL as an underlying cause of stroke in patients with persistent symptoms and characteristic white matter changes.

This chapter establishes an evidence-informed framework for clinical competence in medical cannabis nursing, integrating assessment, dosing, monitoring, patient education, ethical reasoning, and professional identity formation. Drawing on the current research, regulatory guidance, and theoretical models such as the biopsychosocial approach and therapeutic stewardship, the chapter outlines the clinical and ethical complexities associated with cannabinoid-based care. It explores variability in product pharmacology, the need for structured risk stratification, the importance of shared decision-making, and the challenges posed by stigma, misinformation, and regulatory inconsistencies. By synthesising empirical findings, ethical principles, and professional standards, the chapter delineates the knowledge, skills, and reflective capabilities required to ensure safe, accountable, and context-sensitive nursing practice within an evolving therapeutic landscape.