St Bernard''s Hospital,Gibraltar Health Authority

ABSTRACT Approximately 80% of individuals in secure mental health units are overweight or obese, yet nurses often lack practical guidance on how to initiate and sustain weight‐related conversations in these complex settings. This study aimed to co‐design an evidence‐based, nurse‐led weight talk tool with service users and nursing staff, and to evaluate its acceptability and usability in low‐ and medium‐secure inpatient care. A multi‐stage, iterative design was undertaken. Initial evidence informed development, followed by a person‐centred co‐design process involving service users and staff through workshops, structured discussions and repeated feedback. The tool was subsequently evaluated using a think‐aloud approach with 19 nurse–service user pairs, enabling real‐time exploration of usability, understanding, and emotional responses. Co‐design produced a structured, visually engaging tool tailored to the sensitivities and constraints of secure mental health settings. Service users and staff shaped key refinements, including simplified language, removal of potentially stigmatising elements, enhanced visual design, and the inclusion of structured opening and closing components to support psychologically safe conversations. Evaluation findings demonstrated high acceptability and usability. Service users valued the respectful, collaborative approach, while nurses reported increased confidence in addressing weight‐related issues. These findings highlight the value of co‐design as a method for developing acceptable, contextually relevant interventions for sensitive clinical topics. Embedding collaborative approaches within mental health nursing practice may strengthen therapeutic engagement and support more effective, person‐centred care across diverse international settings.

BACKGROUND:Despite an aging multiple sclerosis (MS) population, clinical outcomes and long-termeffects of disease-modifying therapies in patients aged ≥50 years remain under-studied. OBJECTIVE:To compare the efficacy and safety of cladribine in relapsing-remitting MS (RRMS) patients aged <50 versus ≥50 years. METHODS:In this retrospective, observational multicenter study, 366 RRMS patients treated with cladribine (cumulative dose 3.5 mg/kg) were included. Patients were stratified by age at treatment initiation (<50 years, n = 317; ≥50 years, n = 49). Outcomes included annualized relapse rate (ARR), MRI activity, percentage of patients without EDSS progression, and no evidence of disease activity (NEDA-3) at 12 and 24 months. Safety endpoints encompassed lymphocyte nadirs, infection, and malignancy rates. RESULTS:At baseline, the ≥50-year cohort had longer disease duration (9.8 ± 7.9 vs. 6.6 ± 5.3 years; p < 0.001) and higher EDSS (2.6 ± 1.6 vs. 1.7 ± 1.6; p = 0.001). Eighteen patients aged <50 years (5.7 %) discontinued cladribine before the second course due to breakthrough clinical or radiological activity; all patients ≥50 years completed both courses. After treatment, ARR was lower in the older cohort (0.02 vs. 0.11; p = 0.001). Percentage of patients free of EDSS progression was similar in both groups (97.3 ± 16.2 in <50 years versus 95.9 ± 20 in ≥50 years p = 0.6). NEDA-3 rates at 12 months were 73.2 % (<50 years) versus 77.6 % (≥50 years; p = 0.53) and at 24 months were 90.5 % versus 98.0 % (p = 0.31). Treatment failure occurred in 8.1 % of patients aged <50 years versus 3.0 % of those aged ≥50 years (p = 0.47). Lymphocyte nadirs were similar in both groups. Only one <50 year patient developed grade 4 lymphopenia. Infection (8.1 % vs. 2.3 %; p = 0.21) and malignancy rates (2.0 % vs. 0.6 %; p = 0.86) were similar between groups. CONCLUSIONS:Cladribine demonstrated sustained efficacy and a favorable safety profile in RRMS patients across age groups. The ≥50-year cohort showed a significantly lower ARR and no early treatment discontinuations due to clinical or radiological activity. These findings support its utility in the management of older patients with RRMS.

BACKGROUND:Chronic ataxias, a complex group of over 300 diseases, pose significant diagnostic challenges because of their clinical and genetic heterogeneity. Here, we propose that artificial intelligence (AI) can aid in the identification and understanding of these disorders through the utilization of a smart virtual assistant. OBJECTIVES:The aim is to develop and validate an AI-powered virtual assistant for diagnosing chronic ataxias. METHODS:A non-commercial virtual assistant was developed using advanced algorithms, decision trees, and large language models. In the validation process, 453 clinical cases from the literature were selected from 151 causes of chronic ataxia. The diagnostic accuracy was compared with that of 21 neurologists specializing in movement disorders and GPT-4. Usability regarding time and number of questions needed were also evaluated. RESULTS:The virtual assistant accuracy was 90.9%, higher than neurologists (18.3%), and GPT-4 (19.4%). It also significantly outperformed in causes of ataxia distributed by age, inheritance, frequency, associated clinical manifestations, and treatment availability. Neurologists and GPT-4 mentioned 110 incorrect diagnoses, 83.6% of which were made by GPT-4, which also generated seven data hallucinations. The virtual assistant required an average of 14 questions and 1.5 minutes to generate a list of differential diagnoses, significantly faster than the neurologists (mean, 19.4 minutes). CONCLUSIONS:The virtual assistant proved to be accurate and easy fast-use for the diagnosis of chronic ataxias, potentially serving as a support tool in neurological consultation. This diagnostic approach could also be expanded to other neurological and non-neurological diseases. © 2025 International Parkinson and Movement Disorder Society.

Left atrial appendage occlusion is a treatment for patients with atrial fibrillation who have a high risk of bleeding and are unable to take oral anticoagulants. The Watchman device is an option and has been shown to be safe and effective in reducing embolic stroke risk. Rare but serious and potentially life-threatening complications, such as dislodgment, can occur. Though there is a designated apparatus available for delivery and implantation of these devices, there are no predefined instructions or required equipment available for extraction of dislodged device. This multicenter study aimed to describe the Watchman extraction procedure and to assess the success rates and potential complications associated with the procedure. In this observational study, we analyzed prospectively collected data from 9 patients that underwent percutaneous Watchman extraction with an endoscopic gasping tool (Raptor) at two high volume centers for Watchman implant in United States between 2019 and 2023. Procedural success was described as complete extraction of Watchman without procedural complication. The Watchman was removed due to dislodgement, a potential risk factor for device embolization. The maximum and the minimum size of the extracted Watchman were 24 and 31 respectively. Mean dwell time was 34±8 days. In all the first attempt of retrieval the watchman was done with only one transeptal access with one bioptome (Raptor) to stabilize the watchman and trying to pull inside a 16 mm sheath. In 7 case a second transeptal was required to use another bioptome to allow entry into the sheath. Thus, in these cases sheath bigger than 16 mm was required to extract the Watchman (Fig.1-2). The device was replaced with a bigger watchman in 6 cases, with an amulet in 1 case and in 2 cases, it was not replaced but oral anticoagulation therapy was continued. Procedural success was obtained in 8 (73%) patients. In one case, the use of a single bioptome during extraction led to the embolization of the Watchman device into the ascending aorta, causing a dissection and the patient's subsequent death within the initial week. Watchman extraction is a valuable option when complication, such as dislodgment, occur and should be done using two transeptal access with two bioptomes to improve safety and effectiveness.