St Pancras Hospital is part of the Camden and Islington NHS Foundation Trust in St Pancras area of Central London, near Camden Town. The hospital specialises in geriatric and psychiatric medicine.
This review evaluates evidence linking both GLP-1 and GIP/GLP-1RAs’ exposure to a range of neuropsychiatric outcomes using the Bradford Hill criteria for causal inference. Glucagon-like peptide-1 (GLP-1) and the dual glucose-dependent insulinotropic polypeptide-GIP/GLP-1 receptor agonists (RAs) are incretin-based medications widely prescribed for type 2 diabetes mellitus and obesity, with demonstrated cardiometabolic benefit and rapidly expanding population exposure. In parallel, post-marketing surveillance and emerging translational research have raised questions regarding potential central nervous system effects, including neuropsychiatric adverse events and psychopharmacological properties. Integrating data from receptor pharmacology, preclinical neuroscience, randomized controlled trials, and observational and pharmacovigilance studies, the strength, consistency, biological plausibility, and experimental support for reported associations with depression, anxiety, suicidality, reward-related behaviour, cognitive effects and retinal/ocular related disturbances were here assessed. Implications for clinical risk–benefit assessment were discussed as well. Current evidence supports potential biological plausibility of a relationship between GLP-1 RAs and a range of psychopathological disorders but remains insufficient to establish causality for most neuropsychiatric outcomes, suggesting the need for prospective, mechanism-informed clinical studies.
Influenza has long been a well-documented contributor to cardiovascular morbidity and mortality, particularly among high-risk groups. COVID-19 has notably altered the seasonality and natural history of pandemic influenza, with broad implications for related cardiac complications. This review examines the interaction between influenza and cardiovascular illness, especially myocardial infarction, congestive heart failure, stroke, and other acute cardiac events. We review the impact of the COVID-19 pandemic on influenza transmission dynamics, public health policy, and the evolving burden of cardiovascular complications. New evidence indicates that both diseases exacerbate endothelial dysfunction, systemic inflammation, and prothrombotic states, thereby increasing cardiovascular risk. A comparative analysis of pre- and post-COVID-19 influenza-related cardiac complications clarifies evolving trends and guides future preventive strategies. In light of the recent resurgence of influenza following the relaxation of COVID-19 mitigation measures, maximizing vaccine coverage and collaborating to manage viral infections in patients with cardiovascular disease are critical. This review focuses on key research needs to understand long-term cardiac consequences and the urgent requirement for targeted public health strategies to counter viral-mediated cardiovascular threats. In the post-COVID era, integrating influenza and COVID-19 vaccination strategies into cardiovascular risk management may represent a critical opportunity to reduce virus-triggered cardiovascular morbidity and mortality.
Abstract Background Patients from the lesbian, gay, bisexual, transgender, queer plus (LGBTQ +) community face various health inequalities and report poor healthcare experiences. Little is known about how knowledgeable and confident UK doctors are around LGBTQ + health, and previous research demonstrates that UK medical schools rarely deliver teaching in this area. This research evaluated the level of knowledge, awareness and confidence of LGBTQ + health among Internal Medical Trainees (IMTs) in London. Methods London IMTs were invited to complete an online questionnaire evaluating knowledge, awareness and confidence in LGBTQ + health. Stratified analysis of results by demographics was performed. Results Three hundred and fifteen surveys were analysed from 796 eligible trainees (40%). Confidence in caring for LGBTQ + patients was variable. Confidence in discussing gender identity was lower than for sexual orientation. Knowledge of health issues affecting LGBTQ + patients varied. Most participants had never received training on LGBTQ + health at undergraduate (n = 201, 64%) or postgraduate level (n = 252, 80%), but the majority of participants felt that training would be useful (n = 233, 74%). Stratified analysis revealed that IMTs who received previous LGBTQ + teaching at undergraduate or postgraduate level were considerably more confident discussing sexual orientation with patients, compared to those who received no previous teaching. Conclusions There is a clear need for education on LGBTQ + health, given the varied levels of knowledge and confidence identified. A significant majority of IMTs in London have never received teaching on LGBTQ + health, although there exists a strong desire for this. LGBTQ + health topics should be integrated into undergraduate and postgraduate training and examinations for IMTs. This would support IMTs in delivering high quality and inclusive care for all patients, particularly those of sexual orientation and gender identity minorities. There are relatively few published studies exploring competency in LGBTQ + health among doctors, and this is the first among UK Internal Medicine Trainees.
In this study, the interrater reliability of the Clinical Frailty Scale (CFS) ratings comparing assessments by both experienced and unexperienced staff (ED clinicians and a study team (ST) using a smartphone application to support CFS scoring) was evaluated. The feasibility of the CFS assignment at ED triage, defined as a majority of patients aged 65 or older assigned a CFS level at triage, was also investigated. In this cross-sectional study of 1349 consecutive ED patients aged 65 years and older, the interrater reliability for CFS ratings was good for three different dyads assessed, whether used as an ordinal scale or as frailty categories (CFS 1–4 = non-frail to vulnerable; CFS 5–6 = mild to moderate frailty; CFS 7–9 = severe frailty to terminally ill). More than two-thirds (70.2
