Ysbyty Gwynedd

Objective To carry out a qualitative evaluation of personalised, multimodal prehabilitation for patients with advanced ovarian cancer in the UK, to inform the design and implementation of future programmes worldwide.Methods A multicentre, qualitative exploration of patients with advanced (stage III–IV) ovarian cancer with a surgical intent to treatment, who had been referred to a UK National Health Service prehabilitation programme. Using a purposive, maximum variation sampling approach, patients were invited to complete a semi-structured interview about their views and experiences of multimodal prehabilitation (exercise, nutritional, psychological and medical optimisation interventions). The interview focused on acceptability, perceived usefulness of the service and barriers and facilitators to engagement and adherence. Interviews were conducted virtually. Audio recordings of interviews were transcribed verbatim. Data were analysed thematically.Results Interviews were completed with 21 patients, with a median age of 56.5 years (range 37–89 years). Four main themes were identified with associated subthemes as follows: (1) introduction to the programme (timing, volume and content of information), (2) perceived need (support system and mindset, psychological and physical health), (3) delivery of the programme (convenience of appointments, accessibility of staff, family involvement, individual components of the intervention; ie, physical, psychological, nutritional interventions and group work) and (4) future engagement (addressing postsurgical gynaecological health and closure).Conclusion Overall, prehabilitation was acceptable to patients with advanced ovarian cancer who had been referred to a multimodal prehabilitation programme. Perceived accessibility of staff and inclusion of patients’ social network facilitated engagement. Lack of perceived need for prehabilitation was a barrier to participation, particularly for those with a strong support system or self-confessed strong physical and psychological baseline fitness. Effective patient-centred communication about prehabilitation could support patients with making informed choices about engagement in prehabilitation as part of their care plan.

Introduction Ambulatory trauma pathways manage a substantial proportion of operative orthopedic trauma, yet patient experience across these pathways is poorly characterized. This study aimed to describe patient-reported experience across two preoperative pathway domains, the ED attendance and the home-waiting interval, and to identify operational factors associated with poor experience. Methods This prospective survey included 65 consecutive adult ambulatory trauma patients at a UK district general hospital (October to December 2023). Patients rated their ED and home-waiting experience on a five-point Likert scale before planned surgery. Operational pathway metrics were captured prospectively via a digital handover platform and linked to experience scores. Low (≤3/5) and high (>3/5) experience groups were compared using the Mann-Whitney U test. Factors associated with low home-waiting experience were examined by logistic regression. All analyses were exploratory. Results Sixty-five patients were included (median age, 50 years; 60 (92%) self-presented; 50 (77%) were first assessed by an emergency nurse practitioner). Patients rating their ED experience as low (≤3/5; n = 22) had waited longer for first clinician review than those rating it as high (n = 43): median 91 vs. 31 minutes (p < 0.001) and had a longer total ED stay (5.4 vs. 4.0 hours, p = 0.027), whereas time to triage did not differ (p = 0.97). Patients reporting low home-waiting experience (27/65, 42%) had a longer ED-to-surgery interval (median 7 vs. 3 days, p = 0.018) and more operative cancellations (p < 0.001); 21 (32%) experienced at least one cancellation, with dissatisfaction rising from 27% among those never canceled to 75% among those canceled twice or more. On multivariable analysis, both a longer interval (adjusted OR, 3.31) and operative cancellation (adjusted OR, 4.91) were independently associated with low home-waiting experience. Forty-seven patients (72%) were uncertain about surgery timing, 13 (20%) received no red-flag advice, and only 17 (26%) had attempted to contact the trauma team during the home-waiting interval, with no dedicated contact route available; patients who had made contact reported a better home-waiting experience (p = 0.024). Conclusions Patient experience across the preoperative ambulatory trauma pathway was associated with time to first clinician review, total ED time, the ED-to-surgery interval, and operative cancellation, but not with triage speed or clinician grade. Uncertainty about surgery timing was the most prevalent problem. A structured preoperative communication package, including a dedicated point of contact, is a low-cost intervention that directly addresses the failures patients described.

OBJECTIVE:Impulsivity is a transdiagnostic risk factor for numerous health morbidities and is strongly associated with early relapse and poor treatment outcomes in addictions and mood-disorders. Lithium carbonate can be helpful in moderating the impulsive behaviors associated with mania, possibly mediated by reduced myo-inositol activity following inhibition of the enzyme inositol monophosphatase (IMPase). We tested the hypothesis that impulsivity-as motor disinhibition, decisions without adequate information, and stronger preferences for small immediate rewards over larger later rewards-can be moderated by the IMPase inhibitor ebselen in healthy adult volunteers. METHODS:One hundred and thirty healthy adults completed a between-subjects, double-blind, placebo-controlled protocol. Over 2 days, participants received a previously validated dose of 1800 mg of ebselen or placebo before completing tests of impulsivity and decision-making. RESULTS:There were no substantive changes in any measure of impulsivity following treatment with ebselen compared with placebo. Neither was there any convincing evidence of stronger treatment effects in high-trait impulsive participants compared with low-trait participants. CONCLUSION:These results fail to replicate findings that ebselen administration moderates validated measures of impulsivity in healthy adults, at least at doses shown to reduce myo-inositol within the medial prefrontal cortex and produce changes in emotional processing and reward-based learning.

Abstract Aim To evaluate the diagnostic performance of the Miami criterion for intraoperative parathyroid hormone (IOPTH) monitoring in patients undergoing parathyroidectomy for primary hyperparathyroidism. Method A single-center retrospective observational study was conducted involving 23 consecutive patients who underwent parathyroidectomy with IOPTH monitoring between January 2023 and June 2025. The Miami criterion which states ≥50% parathyroid hormone (PTH) reduction from baseline at 10 minutes was applied. Operative success, defined as normocalcemia at three months, served as the gold standard. Diagnostic performance was assessed by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results At three months, 19 of 23 patients (82.6%) achieved normocalcemia. The Miami criterion demonstrated high sensitivity (89.5%) and accuracy (78.3%). Miami criteria showed high PPV of 85.0%. Conclusions Miami IOPTH criteria reliably predicted postoperative normocalcemia. Operative failures were related to disease complexity rather than biochemical criteria. Advanced localization strategies and metabolic optimization should be integrated into perioperative planning to improve outcomes.

Patient education programmes prior to hip and knee arthroplasty reduce anxiety and create realistic expectations. While traditionally delivered in-person, the Covid-19 pandemic has necessitated change to remote delivery. We describe a ‘Virtual Joint School’ (VJS) model introduced at Ysbyty Gwynedd, and present patient feedback to it. Eligible patients first viewed online educational videos created by our Multi-Disciplinary Team (MDT); and then attended an interactive virtual session where knowledge was reinforced. Each session was attended by 8–10 patients along with a relative/friend; and was hosted by the MDT consisting of nurses, physiotherapists, occupational therapists, and a former patient who provided personal insight. Feedback on the VJS was obtained prospectively using an electronic questionnaire. From July 2022 to February 2023, 267 patients attended the VJS; of which 117 (44%) responded to the questionnaire. Among them, 87% found the pre-learning videos helpful and comprehensible, 92% felt their concerns were adequately addressed, 96% felt they had sufficient opportunity to ask questions and 96% were happy with the level of confidentiality involved. While 83% felt they received sufficient support from the health board to access the virtual session, 63% also took support from family/friends to attend it. Only 15% felt that they would have preferred a face-to-face format. Finally, by having ‘virtual’ sessions, each patient saved, on average, 38 miles and 62 minutes travel (10,070 miles and 274 hours saved for 267 patients). Based on the overwhelmingly positive feedback, we recommend implementation of such ‘Virtual Joint Schools’ at other arthroplasty centres as well.