Peterborough City Hospital is an acute teaching hospital on the Edith Cavell Healthcare Campus serving the city of Peterborough, north Cambridgeshire, areas of east Northamptonshire and Rutland. It is managed by North West Anglia NHS Foundation Trust.
Background: Achieving breast symmetry is an important aesthetic goal following reconstruction post-mastectomy; however, little is known about women's awareness, attitudes, and barriers regarding Contralateral Breast Symmetry Procedures (CBSP) in Jordan. Objectives: To assess awareness, perceptions, and barriers toward contralateral breast symmetry procedures among breast cancer survivors who underwent reconstruction at King Hussein Cancer Center. Methods: A cross-sectional study was conducted from July to Oct 2025 at KHCC, among 314 women diagnosed with breast cancer who had post-breast reconstruction. Data were collected using a structured Arabic questionnaire, which was developed based on existing literature, validated by an expert panel, and piloted on 10 women for clarity and reliability. The final tool demonstrated acceptable internal-consistency (Cronbach's α = 0.712). The questionnaire captured sociodemographic and clinical data and detailed knowledge, attitudes, and barriers related to CBSP. Descriptive statistics summarized the data. Results: Participants' mean age was 45.8 years; the majority were married (83.8%) and held university degrees (65.6%). Most reconstructions used silicone implants (94.6%). Only 6.4% had undergone CBSP, primarily delayed breast augmentation or mastopexy, with 75% reporting satisfaction. Awareness of CBSP was limited (37.9%), and less than one-third had discussed CBSP options with their surgeon or knew about insurance coverage. While 82.5% valued symmetry for body image, 31.5% viewed it as unnecessary after cancer recovery. Main barriers included satisfaction with current appearance (48.1%), fear of additional surgery (32.2%), financial constraints (37.3%), and lack of physician counseling (27.1%). Trust in medical team recommendations was high (89.2%). Conclusions: Contralateral breast symmetry procedures are under-recognized and infrequently pursued, primarily due to limited awareness, financial concerns, and insufficient counseling. Focused education and enhanced surgeon-patient communication are essential to support women's aesthetic and psychological needs after reconstruction in Jordan.
Background Peripheral neuropathy is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Objective To evaluate the relationship between plasma homocysteine levels and the severity of peripheral neuropathy in patients with T2DM. Methods A cross-sectional study was conducted at Sahiwal Teaching Hospital, Sahiwal, from November 2024 to July 2025, involving 325 patients with T2DM. Plasma homocysteine levels were measured, and peripheral neuropathy severity was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and nerve conduction studies (NCS). Results Elevated plasma homocysteine levels (>15 μmol/L) were found in 34.5% of patients. The prevalence of neuropathy increased with higher homocysteine levels, with 44.5% of patients with normal homocysteine levels exhibiting neuropathy, compared to 66.7% in those with mild elevation and 85.7% in those with severe elevation. A positive correlation was observed between homocysteine levels and neuropathy severity (r = 0.42, p <0.001). Multivariate regression analysis identified homocysteine as an independent predictor of neuropathy severity (β = 0.38, p<0.001), along with diabetes duration and glycated hemoglobin (HbA1c). Conclusion Elevated plasma homocysteine levels are associated with increased severity of peripheral neuropathy in T2DM patients. These findings suggest that homocysteine may serve as a biomarker for identifying T2DM patients at risk for severe neuropathy, with potential implications for early diagnosis and therapeutic interventions.
Background Decompensated cirrhosis carries a high symptom burden, frequent hospitalizations, and unpredictable disease progression [1,2]. While inpatient palliative care (PC) provides symptom relief and facilitates care alignment, its effect on readmissions at the population level remains underexplored. This study evaluates the association between inpatient PC encounters and 30- and 90-day unplanned readmissions in decompensated cirrhosis. Methods Using the 2017–2021 Nationwide Readmissions Database (NRD), adults hospitalized with decompensated cirrhosis who survived to discharge were identified. Separate weighted cohorts were analyzed for 30- and 90-day outcomes, consistent with the NRD’s design. Multivariate survey-weighted logistic regression assessed the association between inpatient PC and 30- or 90-day readmissions, adjusting for demographics, comorbidities, and hospital characteristics. Results Among 202,903 weighted hospitalizations, 5.14% included an inpatient PC encounter. Thirty-day readmission occurred in 23.46% of patients, with an in-hospital mortality rate of 8.46%. PC was associated with reduced odds of 30-day readmission (adjusted odds ratio [aOR] 0.50, 95% confidence interval [CI] 0.47–0.54, p< 0.01).In a separate 152,059 weighted hospitalizations, 5.1% received PC. Ninety-day readmission occurred in 35.94% of patients, with an in-hospital mortality rate of 8.0%. PC was associated with reduced odds of 90-day readmission (aOR 0.42, 95% CI 0.39–0.45, p< 0.01).PC recipients were older (by ∼5 years, p< 0.01), more frequently Medicare-insured (p< 0.01), of lower income (p< 0.01), and more often treated at large teaching hospitals (p< 0.01).Leading causes of readmission included alcoholic cirrhosis with ascites, sepsis, and hepatic failure. Conclusion Inpatient palliative care was consistently associated with lower 30- and 90-day readmissions in patients with decompensated cirrhosis, independent of patient and hospital factors. These findings highlight the potential of palliative care as a critical adjunct in cirrhosis management, improving care quality while reducing avoidable hospital utilization.
Background:Spinal manipulation is widely used in clinical practice, yet how contact site selection influences mechanical transmission through spinal structures remains poorly understood. This exploratory study characterizes the biomechanical transmission of impulsive spinal manipulative thrust (SMT) forces through the in vivo human lumbar spine, examining how contact site and vertebral level alter the mechanical and neuromuscular response. Methods:Four patients undergoing elective lumbar surgery were instrumented with triaxial accelerometers on intraosseous Steinmann pins at L2 and L4, and bilateral needle electromyographic (nEMG) electrodes. An Impulse iQ adjusting instrument delivered impulsive SMTs to six contact points in randomized order: L3 spinous process, L5 spinous process, and bilateral L2 and L4 facet joints totaling 1,549 usable for force-dependent analyses after excluding one patient with an instrument force malfunction. Patient-level aggregation (n = 3-4) served as the primary statistical approach. Results:Two patterns of mechanical transmission were observed. Spinous process contacts produced larger posterior-anterior vertebral acceleration at L2 in all patients (14.95 ± 10.97 vs. 6.75 ± 4.62 g, patient-level P = 0.066), while facet contacts produced larger cranial-caudal acceleration at L4 (2.50 ± 2.27 vs. 0.94 ± 0.59 g). L3 spinous contacts produced substantially greater L2 posteroanterior acceleration than L5 contacts (21.3 ± 10.9 vs. 8.2 ± 5.8 g, patient-level P = 0.021), with proximity-dependent inter-vertebral attenuation reflected by transfer ratios of 0.094 (L3) versus 0.619 (L5). Facet contacts showed no significant bilateral asymmetry at the patient level. Conclusion:These exploratory findings suggest that contact site selection influences the transmission pathway architecture and directional character of the vertebral mechanical response during impulsive SMTs. These biomechanical observations may help generate hypotheses for future clinical studies examining the relationship between contact site selection and therapeutic outcomes.
