The William Harvey Hospital is a hospital in Willesborough, Ashford, Kent, England. It is one of the three main hospitals in the East Kent Hospitals University NHS Foundation Trust area and is named after William Harvey (1578–1657), the Folkestone-born doctor who discovered the blood circulatory system.
Consultant Nurse (CN) roles were introduced in the United Kingdom (UK) in 1999 to enhance clinical leadership and patient care by keeping senior nurses focused on clinical practice. Defined by the Royal College of Emergency Medicine (RCEM) and Royal College of Nursing (RCN) [1], CNs are clinical experts in emergency nursing who lead on policy, research, education, and advancing practice. UK workforce standards mandate that every Emergency Department (ED) employs at least one CN at a senior pay, with additional roles in sub-specialties like paediatric emergency care. In practice these roles are undertaken by both nurses and allied health professionals. While the roles share the core functions of clinical practice, leadership, education, and research, their implementation varies. Policy initiatives such as workforce plans and a consultant-level practice capability framework have aimed to standardise and expand these roles. However, role configuration, pay, and qualifications continue to vary. Despite some evidence of positive impacts on clinical outcomes, the evidence base is limited, and inconsistent role definitions and integration into workforce planning have hindered implementation. Aim/Methods This study aimed to identify consultant nurse/practitioners in United Kingdom emergency care and describe their roles in EDs. A cross-sectional survey was developed, peer-reviewed, and distributed via professional networks, snowball sampling, and social media. Survey was administered via REDCap and was open June-August 2024. Results Thirty-seven survey responses were analysed, gathering data on demographics, confidence levels, and time spent in each domain. Consultant nurses/practitioners spent most time in expert clinical practice and least in research and innovation, reflecting lower confidence in research and fewer grant applications or publications. Respondents collectively had 299 years of experience, indicating a highly skilled workforce. Conclusion This study offers the first updated demographic review of consultant nurse and practitioner roles in UK emergency care since 2005, revealing workforce shortfalls and role variation. Despite a skilled workforce, reasons for under-recruitment remain unclear. The findings highlight the need for further research to guide workforce planning and optimise consultant-level practice in emergency care.
Abstract Background The Green Theatre Checklist (GTC) promotes environmentally sustainable surgical practice within the NHS. This audit assessed baseline awareness and knowledge of the GTC and sustainable surgical practices in a tertiary care NHS trust and evaluated the impact of targeted educational interventions. Methods A two-cycle audit was conducted using a structured questionnaire distributed to theatre-based surgical staff, including consultants, trainees, nurses, operating department practitioners, and anaesthetic staff. Cycle one assessed awareness of the GTC and knowledge of measures to reduce the environmental impact of anaesthesia, surgery, intra-operative, and post-operative practice. Results were presented at a clinical governance meeting, followed by a brief educational session. Interventions included posters and QR codes placed in theatre areas and hospital notice boards, alongside dissemination via mobile communication platforms. The same questionnaire was used for cycle two, and results were again presented at clinical governance. Results Awareness of the GTC increased from 37.5% to 64.5%. Knowledge of methods to reduce the environmental impact of anaesthesia improved from 57.5% to 77.4%, and awareness of sustainable surgical practices increased from 67.5% to 93.5%. Recognition of intra-operative measures rose from 40% to 93.5%, while awareness of post-operative sustainability measures increased from 22.5% to 87.9%. Knowledge of theatre waste management and the principles of the ‘R’s’ of sustainability also improved. Conclusion This closed-loop audit demonstrates that governance-led education significantly improves awareness and knowledge of the Green Theatre Checklist. This work is now progressing towards implementation of GTC learning into routine theatre practice.
Introduction Many adult hand and wrist procedures are performed with the patient awake under local or regional anaesthesia, including wide-awake techniques, a setting in which perioperative anxiety is a salient patient-experience outcome and discomfort may persist despite adequate anaesthesia. Virtual reality has been proposed as a non-pharmacological comfort adjunct, but its effects are procedure-dependent and existing trials come largely from other settings; the high volume of awake hand and wrist surgery, where patients are conscious during anaesthetic administration and manipulation, makes procedure-specific evidence necessary, and none has been synthesised. Methods MEDLINE (Ovid), Embase and CENTRAL were searched from inception to 19 December 2025 for randomised controlled trials of perioperative virtual reality in adult hand and wrist surgery (PROSPERO CRD420251269092). Selection and extraction were performed in duplicate. Risk of bias was assessed with Cochrane Risk of Bias 2 and certainty with GRADE. Heterogeneity precluded meta-analysis; findings were synthesised narratively. Results Seven trials (n = 543; 2019–2025) met inclusion criteria. Virtual reality did not consistently reduce perioperative pain. Of six trials assessing anxiety, three reported significant reductions in intraoperative anxiety during awake procedures; instruments and time points were heterogeneous, and the wide-awake local anaesthesia no tourniquet trial using a validated multi-item questionnaire showed no significant difference. Two trials reported lower intraoperative sedative requirements in pathways including sedation. Virtual reality was well tolerated, with no serious adverse events and minor self-limiting effects in a minority of participants. Certainty of evidence was low for both primary outcomes. Conclusion Virtual reality may reduce intraoperative anxiety in selected patients undergoing awake hand and wrist procedures, but evidence for analgesic benefit is inconsistent. Larger trials using validated anxiety instruments, stratified by baseline anxiety, are needed before routine use can be recommended.
Actinomycosis is a rare chronic bacterial infection, with pelvic involvement accounting for ~5% of cases. Surgery may be required if there is intestinal obstruction, abscess formation, severe infection, or if malignancy cannot be excluded. We report a 46-year-old woman with a 12-year history of an intrauterine device, presenting with abdominal pain, vomiting, constipation, lethargy, and malaise. Examination revealed abdominal distension, tenderness, and a left iliac fossa mass. Computed tomography imaging showed a complex, infiltrative pelvic mass involving the sigmoid colon and adjacent structures, including the small bowel, causing a closed-loop small bowel obstruction and raising suspicion of malignancy. She underwent emergency laparotomy with small bowel resection and anastomosis, Hartmann’s procedure, and bilateral ureteric stent insertion. Histology confirmed actinomycosis. She recovered well and commenced a 1-year antibiotic course. Pelvic actinomycosis demands a multidisciplinary approach with combined surgical and medical management due to its complex presentation and tendency to mimic other conditions.
