Wythenshawe Hospital is an acute general hospital in Wythenshawe, South Manchester. It is managed by the Manchester University NHS Foundation Trust.
BACKGROUND:Dedicated randomised studies on intravascular imaging guidance in unprotected left main coronary artery (LMCA) disease are lacking. AIMS:We aimed to investigate the clinical feasibility of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) of true LMCA bifurcation lesions and to evaluate its prognostic impact compared with angiographic guidance. METHODS:Patients with true LMCA bifurcation lesions who were randomised to either OCT or angiographic guidance in the OCTOBER Trial were included. The feasibility of OCT guidance was assessed as the proportion of patients with successful and analysable OCT pullbacks before, during, and after stenting. Clinical outcomes between the two groups were compared based on the incidence of a composite of major adverse cardiac events (MACE), comprising cardiac death, any myocardial infarction, or target lesion revascularisation. RESULTS:In total, 227 patients were included (OCT: 111, angiography: 116). OCT guidance was successful, with 98% of cases having a pre-stenting pullback performed and 96% a final pullback, as per protocol. The proximal LMCA stent edge was analysable in 43% of patients, and in the remaining 57%, only 5% were limited by insufficient image quality. No statistically significant difference in MACE was observed between the two groups (OCT: 14.4% vs angiography: 18.4%, hazard ratio 0.78, 95% confidence interval: 0.39-1.51). CONCLUSIONS:OCT-guided PCI in true LMCA bifurcation lesions was clinically feasible, but visibility of the LMCA ostium was limited by short pullbacks, insufficient clearance, or guide catheter shadowing. OCT guidance was associated with a non-significant reduction in MACE, consistent with the effect estimate in the main trial.
Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with significant morbidity, delayed diagnosis and health inequalities. Patients frequently rely on publicly available information to guide self-management; however, the quality, safety and inclusivity of information resources for patients with HS are poorly defined. Inadequate guidance may contribute to anxiety, inappropriate management and delayed escalation of care. Our aim was to assess the quality, accuracy and inclusivity of publicly available information leaflets for patients with HS, and to improve identified deficiencies through a structured two-cycle quality improvement project. This was a trainee-led quality improvement project. In cycle one, 12 publicly available information resources for patients with HS, including national dermatology and healthcare organization materials, were audited using a novel 10-domain assessment tool derived from international HS guidelines. The domains assessed were diagnostic clarity, disease explanation, first-line management, escalation pathways, safety netting and red-flag symptoms, procedural advice, lifestyle guidance, psychosocial support, representation of skin of colour, and signposting to specialist care and support services. Following baseline assessment, an evidence-based leaflet for patients with HS was redesigned to address identified omissions and inconsistencies. Cycle two reassessed the redesigned leaflet against the same standards. Cycle one demonstrated widespread deficiencies across existing resources, with no audited leaflet meeting all 10 quality domains. Red-flag symptoms and escalation guidance were inconsistently addressed across resources, including those produced by national dermatology organizations. Considerations specific to skin of colour were minimal or absent in all audited materials. The redesigned leaflet achieved full compliance across all 10 domains in cycle two, with marked improvements in safety netting, escalation advice, clarity of management pathways and inclusivity. This project identifies critical safety and equity gaps in publicly available information for patients with HS, including the absence of red-flag guidance in national resources. A structured, guideline-aligned redesign produced measurable improvement across two plan–do–study–act cycles. Standardizing patient education may improve safety, reduce health inequalities and support earlier escalation of care in HS.
