The Southern Health and Social Care Trust (Irish: Iontaobhas Sláinte agus Cúraim Shóisialaigh an Deiscirt) provides health and social care services in Northern Ireland. It runs Craigavon Area Hospital, Daisy Hill Hospital in Newry, Lurgan Hospital and South Tyrone Hospital as well as Armagh Community Hospital and St Luke's Hospital in Armagh. St Luke's provides mental health services. Daisy Hill Hospital emergency department is under threat because of difficulty in retaining staff. The trust serves an estimated population of 380,312 (June 2017 estimates).
Purpose of Review:As the life expectancy of people with multiple sclerosis (PwMS) increases, the importance of recognizing and addressing specific needs and challenges faced by those undergoing age-related sex hormone changes and hypogonadism is becoming increasingly evident. We present expert-led, practical recommendations from a consensus program that address gaps in age-related sex hormone changes and hypogonadism in PwMS not sufficiently addressed in current literature and guidelines. A multidisciplinary steering committee (SC) of 15 international experts identified 18 key clinical questions across 6 themes: climacteric symptoms in women with MS; impact of MS on the climacteric stage; impact of menopause on MS disease activity and progression; treatment and management of climacteric symptoms in women with MS; late-onset hypogonadism (LOH) in men with MS; and patient-centered care. After thorough review of the evidence from a systematic literature review, the SC formulated 18 clinical recommendations to address the questions. These recommendations were voted on by the SC and an extended faculty of 23 health care professionals from 16 countries, including 2 nurses and 1 patient association representative. Recent Findings:Consensus was reached when ≥75% of respondents expressed agreement, with a score of 7-9 on a 9-point scale. After a single voting round, all 18 recommendations reached consensus (14 reaching consensus at 90%-100% and 4 at 80%-90%). The clinical recommendations addressed the following: the potential overlap and exacerbation of MS symptoms during the climacteric stage; the need for preventive care and screening during the menopausal transition; the potential for, and a paucity of data on, differential efficacy and tolerability of MS medications in menopausal/postmenopausal women; the complex causal interplay between hormonal and/or immunologic changes and natural aging in PwMS switching to a more progressive phase of disease; consideration of behavioral/lifestyle interventions alongside pharmacologic treatments; effects of hormonal treatments on MS symptoms; and management of LOH in men with MS. Summary:These recommendations were based on a robust modified Delphi consensus approach and present a valuable framework for improved patient care. These results emphasize the need to address critical gaps in our understanding and management of PwMS undergoing age-related sex hormone changes and hypogonadism.
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.
Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. Care pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.
BACKGROUND:Nonlinear analyses show promise for determining antibiotic use thresholds linked to antimicrobial resistance (AMR). An approach that allows aggregation of results from multiple models to capture context-specific AMR dynamics is needed to improve predictive accuracy and define realistic antibiotic use thresholds to reduce AMR. METHODS:We conducted TARGET-A, a retrospective multicentre ecological modeling study in four UK hospitals (2020-2024), applying a threshold-logistic ensemble consensus modeling approach to identify hospital-level antibiotic use thresholds and risk scores associated with increasing hospital-onset, healthcare-associated Clostridioides difficile infection (HOHA-CDI) incidence. RESULTS:Analysis set the cutoffs for critically high HOHA-CDI incidence at: Antrim Area Hospital (AAH), 75th percentile; Craigavon Area Hospital (CAH), 80th percentile; Pinderfields General Hospital (PGH), 82.5th percentile; St James's University Hospital (SJUH), 77.5th percentile. Antibiotic use thresholds (defined daily doses (DDD)/1000 occupied bed-days (OBD)) were identified: AAH- fluoroquinolones 62.3, macrolides 254.6; CAH- co-amoxiclav 75.8, carbapenems 16.1; PGH- co-amoxiclav 251.3, macrolides 129.2; SJUH- clindamycin 14.2, fluoroquinolones 128.3. Risk scores for exceeding high HOHA-CDI incidence were determined, supporting early warning alerts. A consensus approach was developed to establish attainable antibiotic use thresholds. CONCLUSIONS:This approach provides a framework to define hospital-level quantitative antibiotic use targets to control HOHA-CDI incidence. Further validation is needed in prospective interventional studies.
