The Royal Hampshire County Hospital in Winchester is a District General Hospital serving much of central Hampshire. It is owned and run by the Hampshire Hospitals NHS Foundation Trust. It is commonly abbreviated to RHCH, or alternatively, Winchester Hospital as it is the only open NHS hospital in Winchester.
Background: Lymphoedema of the breast is a known side effect of breast conserving surgery (BCS) and adjuvant radiotherapy. There is significant variability in reported incidence of breast lymphoedema following breast cancer treatment and even less following the newly introduced 26Gy in 5# radiotherapy regimen following the FAST-Forward Study in 2020, however data from this indicates a possible, increase in clinician reported breast oedema and patient reported breast swelling, as well as increased breast lymphoedema specialist referrals from the shorter course of EBRT. At our district general hospital, we offer intra-operative radiotherapy (IORT) to a subsect of patients, which showed fewer side effected than external bean radiotherapy (ERBT) in TARGIT A trial.
Abstract Aim Congenital nasolacrimal duct obstruction (CNLDO) affects 5-20% of infants and usually resolves spontaneously by one year. Persistent cases may require probing to open a distal membrane at the valve of Hasner. Endoscopic assistance with ENT involvement is a relatively new adjunct, offering intranasal visualisation to identify and manage distal pathology, though its routine use is not yet standardised despite growing support in the literature. This study evaluates long-term outcomes of joint Ophthalmology-ENT endoscopically assisted probing in children. Method A retrospective review of all paediatric nasolacrimal probings from 2013-2025 was undertaken at a district general hospital. Procedures were classified by ENT involvement and endoscopic assistance. The primary outcome was need for repeat probing per surgery. Secondary data included detection of mucoceles, Crawford tube placement, and dacryocystorhinostomy (DCR) requirement. Results A total of 138 surgeries (130 patients; 197 eyes) were analysed, with 116 (84%) performed jointly with ENT using endoscopy. Repeat probing was required in 6/116 (5.2%) cases; one proceeded to DCR. All 11 Crawford tubes and 25 mucoceles (21.6%) were identified and managed within the ENT-assisted group. Conclusions Endoscopically assisted joint Ophthalmology-ENT probing achieved high primary success rates and enabled direct management of distal pathology such as mucoceles. These results add to emerging evidence supporting this collaborative approach. Publishing further outcome data from centres using this technique may help standardise treatment protocols for persistent CNLDO.
Abstract Background and aims The UK and ROI Acute Stroke Simulation Course (ASSC) launched in February 2024 enabling a nationwide standardised approach to stroke simulation-based education. Initial evaluations demonstrated a statistically significant increase in confidence immediately after the course, particularly in managing acute stroke and reperfusion therapies. However, the sustainability of these benefits over time required further assessment. Methods Candidates who attended the ASSC were invited to complete follow-up questionnaires at 3- and 6-months post-course. Questionnaires sought to capture quantitative and qualitative data, focusing on changes in clinical practice, application of course learning, and perceived impact on patient care at the specific time intervals. Thematic analysis was used to explore the free-text responses to identify recurring patterns and insights. Results 32 candidates responded at 3-months; 27 candidates at 6-months. The majority reported a positive and sustained impact on their clinical practice, including improved ability to apply new skills and knowledge gained during the course. Thematic analysis revealed three key themes: (1) sustained confidence in acute stroke management; (2) enhanced leadership, efficiency, and communication within multidisciplinary teams; and (3) improved recognition of stroke mimics and understanding of reperfusion therapies. Several respondents suggested that the course should be mandatory for all professionals involved in acute stroke care. Conclusions This evaluation demonstrates that simulation-based education in acute stroke management provides sustained benefit in acute stroke management. Ongoing expansion of the ASSC across the UK and ROI continues with plans to integrate enhanced online learning opportunities and further assess the programme’s impact on patient outcomes. Conflict of interest Ella Sherman: nothing to disclose. Zehra Mehdi: nothing to disclose. Louise Shaw: nothing to disclose.
Lipoprotein(a) (Lp(a)) is increasingly recognized as a significant contributor to the risk of atherosclerotic cardiovascular disease (ASCVD). We report the case of a 53-year-old woman who presented with chest pain and has notable family history of premature cardiovascular events. Investigation revealed a markedly elevated Lp(a) level of 492 nmol/L, alongside the presence of coronary artery disease necessitating stenting. Despite adherence to high-intensity statin therapy, her low-density lipoprotein (LDL) cholesterol levels remained suboptimal. Consequently, we initiated treatment with a PCSK9 inhibitor to achieve further reductions in LDL cholesterol. This case underscores the importance of routinely measuring Lp(a), as recommended by European guidelines, which advocate for its assessment at least once during adulthood for effective risk stratification. While lifestyle interventions play a critical role in cardiovascular health, targeted therapies such as PCSK9 inhibitors and emerging nucleic acid-based treatments, including Zerlasiran, offer promising options for significantly lowering Lp(a) levels. Recognizing and addressing elevated Lp(a) is vital for identifying patients at high cardiovascular risk and for informing tailored management strategies aimed at improving patient outcomes.
