University Hospital Monklands is a district general hospital in Airdrie, North Lanarkshire, Scotland. It serves a population of approximately 260,000 people of North and South Lanarkshire council areas and is managed by NHS Lanarkshire.
Ewing sarcoma is a malignant small round blue cell tumour most commonly found in the bones of children and adolescents. An 89-year-old woman presented with a progressively enlarging mass on her right hip, confirmed histologically and with immunohistochemistry as Ewing sarcoma. Owing to her staging, she was treated with radiotherapy alone and had a partial but good response. This case is quite rare, not only because of the tumour size and location but also because of the age of the patient.
Tinea barbae is a rare zoophilic dermatophyte infection of the beard area, commonly mimicking other dermatological or infectious conditions. We report a young man with progressive erythematous, nodular neck and wrist lesions, unresponsive to antimicrobials. Extensive investigation, including fungal PCR, identified Trichophyton species, leading to successful treatment with systemic antifungals. This case highlights the importance of considering atypical tinea barbae in patients with occupational animal exposure and persistent cutaneous lesions unresponsive to standard antibacterial treatments
Background Individuals with claudication have significantly reduced capacity for walking, which leads to worsening prognosis and decline in overall health status. Basic walking advice is usually provided to individuals with claudication during their routine clinic visits, which has very limited efficacy, resulting in little or no change in physical activity behaviour. Objective This study explored barriers and facilitators to physical activity (PA) in individuals with claudication, using the Behaviour Change Wheel (BCW) and the Socioecological Model (SEM) for behavioural diagnosis. Methods The study used a phenomenological design. A purposive sampling was used, and five individuals with claudication and three healthcare professionals participated in the study, out of a target sample size of 18 individuals. An online focus group/workshop was conducted, recorded, and transcribed verbatim. Data were coded in NVivo 12 and analyzed thematically. A deductive approach was used to map themes to BCW and SEM frameworks. Results Intrapersonal barriers included comorbidities, walking-related pain, and psychological challenges; facilitators were motivation and goal setting. At the interpersonal level, lack of social support was a barrier, while peer support and social connection were facilitators. Organizational-level barriers included lack of guidance, limited access to supervised exercise programmes (SEPs), poor communication, financial challenges, and variability in healthcare access; facilitators included alternative exercise options and access to resources and education. Recommended interventions include enablement, environmental restructuring, persuasion, education, training, and modelling. Conclusions Barriers to PA in claudication are complex and multi-level. Addressing them requires system-wide strategies, including patient education, peer-supported and personalized programmes, standardized national guidance, expanded SEP access, and reducing geographic disparities in service provision. Social media abstract Barriers to physical activity in individuals with claudication are complex and multi-level. Addressing them requires system-wide strategies @GCU @UoS
Background:Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority. Objectives:To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs. Design:Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19. Setting:Contributed data were collected in clinical, community and research settings. Interventions:Interventions from original studies were included as covariates in models. Data sources:MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers. Methods:Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I2. Outcome measures:Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life. Results:PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality. Limitations:Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system. Conclusions:PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities. Future work:Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes. Study registration:This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578). Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132895) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 29. See the NIHR Funding and Awards website for further award information.
