The Royal Cornwall Hospital, formerly and still commonly known as the Treliske Hospital, is a medium-sized teaching hospital in Treliske, on the outskirts of Truro, Cornwall, England. The hospital provides training services for the University of Exeter Medical School. It is managed by the Royal Cornwall Hospitals NHS Trust.
Background/Objectives: The role of the endometrial microbiome in reproductive failure remains incompletely understood. This study aimed to describe the composition of the endometrial microbiome in women evaluated for infertility or recurrent miscarriage. Methods: In this single-center descriptive study, endometrial samples were collected from women evaluated for infertility or recurrent miscarriage. Microbiome profiling was performed using 16S rRNA gene next-generation sequencing. Samples were classified as Lactobacillus-dominant when Lactobacillus spp. accounted for ≥90% of the total bacterial community. Alpha diversity was assessed using the Shannon and Simpson indices, while beta diversity was evaluated using Bray-Curtis dissimilarity, principal coordinates analysis (PCoA), PERMANOVA, and PERMDISP. Results: Of the 60 samples, 20 (33.3%) were Lactobacillus-dominant and 40 (66.7%) were non-Lactobacillus-dominant. Across all samples, Firmicutes was the predominant phylum (76.6%). Non-Lactobacillus-dominant samples showed significantly higher alpha diversity than Lactobacillus-dominant samples for both the Shannon and Simpson indices (p = 1.19 × 10-6 and p = 1.51 × 10-6, respectively), as well as higher observed taxa richness (p = 0.000017). PCoA based on Bray-Curtis dissimilarity demonstrated clear separation between microbiome profiles, supported by PERMANOVA (pseudo-F = 13.87, R2 = 0.193, p = 0.001). PERMDISP showed significantly greater dispersion among non-Lactobacillus-dominant samples (F = 566.94, p < 0.001). Non-Lactobacillus-dominant samples showed greater representation of Enterococcus and Prevotella. Conclusions: In this cohort non-Lactobacillus-dominant communities were more frequent with greater diversity, richness, and compositional heterogeneity than Lactobacillus-dominant communities. These findings highlight the need for larger, standardized studies with appropriate control populations to clarify their clinical significance.
Abstract Teledermatology for inflammatory dermatoses is well established, predominantly via Advice and Guidance. We introduced a novel direct-to-patient teledermatology (DTPT) service for adults referred with an inflammatory dermatosis and awaiting their first appointment in 2024. Our results demonstrated that > 25% could be managed without requiring face-to-face consultation. One potential criticism was the lack of data regarding re-referral rates. The aim of this study was to establish the rate of re-referral within 1 year. Records for patients involved in the DTPT pilot, conducted during May to October 2024, were reviewed retrospectively in December 2025. Primary measures were whether there was re-referral within 12 months, and if so, the indication and outcome. Overall, 128 of 528 patients using DTPT (24%) were discharged following virtual review. The most common diagnoses were cutaneous infection (n = 26, 20%), psoriasis (n = 18, 14%), eczema (n = 13, 10%), hidradenitis suppurativa (n = 8, 6%) and rosacea (n = 6, 5%). Management recommendations included topical steroid (n = 30, 23%), calcipotriol/betamethasone (n = 10, 8%) and other topical preparations (n = 17, 13%). Oral antimicrobials were recommended for 26 patients (20%). Specific management recommendations were not given in 10 patients (8%). After 1 year, 12.5% (n = 16) had been re-referred. Ten (8%) were for the same indication, while six were referred with new, unrelated issues, primarily skin lesions. The outcomes of the 16 re-referrals were nine to await outpatient review, two listed for surgery, two listed for phototherapy and three discharged with further treatment. These long-term follow-up data confirm the effectiveness of DTPT, with only 8% of patients initially discharged with advice being re-referred for the same condition within 12 months. This reflects an overall 20% reduction in outpatient appointments in this cohort. DTPT reduces demand on outpatient clinics, administrative burden on general practitioners, and unnecessary patient travel, while affording dermatologists flexible and remote work. As the demand on primary care and dermatology increases, DTPT could become a highly effective way to streamline patient pathways.
Background:Penicillin allergy (penA) records are associated with negative patient and health-system outcomes, which makes removal of incorrect penA records (penicillin allergy de-labelling; PADL) an antimicrobial stewardship and patient safety priority. We set up a nurse-run, adult, low-risk PADL outpatient clinic, supervised by an antimicrobial pharmacist. Methods:Adult PADL guidelines were written and approved by the hospital, and PADL training was provided to nurses. Electronic adult referrals from hospital outpatient clinics and three GP surgeries in Cornwall were accepted. Patient telephone triage started from 6 January 2025, which included taking a penA-focused history, penA risk assessment and determination of PADL method. Eligible patients were invited for a direct oral penicillin challenge (DOC) test and were followed up via a telephone call 10 days after the test. The first outpatient PADL clinic was on 7 February 2025. Results:There were 404 referrals between 27 December 2024 and 16 September 2025, of which 326 were successfully contacted. Of these, 130/326 (39.9%) had a high-risk penicillin allergy history and 5/326 (1.5%) were excluded due to cognitive impairment. Of the 326 contacts, 191 (58.6%) were categorized as low risk. Of these, 22/191 (11.5%) were de-labelled on history alone, 54/191 (28.3%) were awaiting their outpatient DOC appointment or declined attending clinic, and 115/191 (60.2%) attended clinic for DOC. Of 115 patients, 110 (95.7%) patients were successfully de-labelled and 5 (4.3%) retained their allergy status due to side effects. Conclusions:PADL delivered by non-allergy nurses in the outpatient setting is safe and effective at removing low-risk penicillin allergy records.
A quality improvement project that focused on the health outcomes of a local population of unaccompanied asylum-seeking children (UASC) in Cornwall, with a specific emphasis on immunisation.Aim To increase immunisation uptake among UASC within four months of their entering local authority care or by the time they turn 18.Background Although a successful public health intervention, global immunisation coverage remains a concern. Declining uptake of routine immunisations is associated with increased childhood infections. Poor local UASC vaccination rates reflect the broader immunisation inequalities strategy.Design A small test of change was introduced to a clinic for UASC, led by a trainee Advanced Nurse Practitioner. The clinic offered UASC the three-dose vaccination 'catch-up' schedule within statutory health assessment appointments, extending the already established 'one-shop' model.Methods The Model for Improvement was applied for this quality improvement project. The vaccines administered were quantified, and post-vaccination surveys were conducted to capture the experiences of clinic users.Outcomes UASC vaccination uptake increased significantly during the project, and UASC reported positive experiences at their clinic appointments.Conclusion This project demonstrates that offering vaccinations to UASC within a specialist provision improves vaccine uptake, enabling an equitable and inclusive service. The benefits of applying a child-centred and trauma-informed model were evidenced in the positive feedback and improved immunisation outcomes for UASC.
