UNASSIGNED: Despite the availability of effective antidepressant strategies, numerous people with depressive disorders remain untreated. The Covid-19 pandemic has affected healthcare services, especially the mental health sector. This study aims to explore the coverage of depression treatments in the general Spanish population and the impact of the Covid-19 pandemic.
UNASSIGNED: We used longitudinal data (2018 and 2022) from the general Spanish population: pre-pandemic n = 1512; mean age = 65.43 years ± 14.90; 56 % females; post-pandemic n = 909; mean age = 68.00 years ± 14.24; 54 % women. The International Classification of Disease 10th edition was used to diagnose lifetime depressive episodes and severity. We explored psychological and pharmacological treatment coverage via multiple logistic regressions adjusted for 4 covariates (sex assigned at birth, education level, age, Covid-19 pandemic) for participants with a diagnosis of depression.
UNASSIGNED: Treatment coverage for depression in the pre-pandemic and post-pandemic samples was, respectively, 53.3 % and 51.9 %. We observed an association between severe depression and treatment coverage (OR = 2.77, 95%CI 1.05 to 7.75). We found no association between the COVID-19 pandemic and treatment coverage.
UNASSIGNED: The pharmacological treatment coverage was associated with severe types of depression. The prevalence rates of treatment coverage were similar in the pre- and post-COVID-19 pandemic attesting to the resilience of the mental health system in Spain.

Introduction Lower gastrointestinal bleeds (LGIB) are defined by having a bleeding point in the gastrointestinal tract beyond the ligament of Treitz. The most common causes include diverticular bleeds, tumours, and colitis. There are no National Institute for Health and Care Excellence (NICE) guidelines regarding safe discharge of patients with LGIB. The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology (BSG) guidelines, in patients presenting with LGIB at William Harvey Hospital. Methods Patients with LGIB who presented to Accident & Emergency or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patients\' Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients\' admission, discharges, and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. Patients with no adverse outcomes were deemed to have had a safe discharge. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome (and therefore safe discharge) were calculated. Results A total of 123 patients were included. These led to a total of 144 LGIB presentations to the hospital. Twenty-nine patients had an Oakland score of ≤8; 21 (72.4%) cases were initially discharged with four representations (19.0%) and eight (27.6%) were admitted although none of these suffered from any adverse outcomes. For those who scored ≤8, 25 (86.2%) were therefore deemed to have had a safe discharge. A total of 115 had a score >8; 43 (37.4%) were initially discharged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome including 16 (13.9%) representations, 21 (18.3%) blood transfusions, three (2.6%) surgical interventions and one (0.9%) endoscopic haemostasis. Out of the 115 cases which scored >8, 74 (64.3%) were deemed to have had a safe discharge. The AUROC for safe discharge was 0.84. Conclusion The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score of >8 could be used as many patients with a higher score did not experience adverse outcomes.

Background Glial tumours are the most common central nervous system (CNS) neoplastic lesions. They occur in 7 per 100,000 individuals in the United Kingdom (UK) and are categorized into astrocytomas, oligodendrogliomas, and glioblastomas in the adult population. The World Health Organization (WHO) has created a classification system in order to better categorise these lesions, placing them in a range from grade I to grade IV. The higher the grade, the poorer the prognosis. The National Institute of Health and Care Excellence (NICE) in the United Kingdom recommends that all surgical resections of glial brain tumours are followed by a postoperative magnetic resonance imaging (MRI) scan within a 72-hour to establish a baseline for further management. Objective We present a retrospective analysis that assessed the compliance rate with NICE guidelines among patients who underwent surgical resection of glial lesions at the Department of Neurosurgery, Queens Hospital Romford, between January 2022 and September 2023. Materials and methods A retrospective analysis was conducted on 136 glial tumour resections that were performed during the period between January 2022 and September 2023. The total time between the end of the operation and the MRI scan was calculated in hours for each procedure. This was analyzed into two groups with respect to compliance with the NICE guidelines, which are within 72 hours and after 72 hours. The non-compliant group was then further investigated regarding the reason for the delay. The cost related to delays was also determined by discussion with the hospital\'s finance department. Results All of the procedures were followed by a post-operative MRI scan but only 88% were within the timeframe recommended by NICE guidelines. The amount of delay was calculated in hours and the reasons for these delays were identified. We created two categories for delay: requesting delays and radiology department-related delays with an almost equivalent number of delays resulting from each category. This delay has resulted in approximately £19,845 of extra costs for inpatient stays. Conclusion A retrospective analysis at Queens Hospital, Romford, found good compliance with NICE guidelines for post-operative MRI scans in glial lesion resections from January 2022 to September 2023. Eighty-eight per cent of patients received scans within 72 hours, crucial for baseline assessment. A 12% non-compliance rate revealed areas for improvement, causing £19,845 in extra costs due to longer inpatient stays. Expediting scans to 36 hours could save around £30,876 annually and reduce complications like infections and thromboembolism. Proposed strategies include dedicated MRI slots and policy adjustments for MRI requests.

BACKGROUND: Cardiovascular disease (CVD) is an important cause of morbidity and mortality in diabetic patients. As such, risk stratification is essential to identify the risk factors of CVD and provide early intervention. The QRISK®3 tool, recommended by the National Institute for Health and Care Excellence (NICE) guidelines, has the option to choose the patient\'s ethnicity, which is not available in other tools. However, there is a paucity of data regarding the use of this tool in the Indian population. Therefore, this study was planned to predict 10-year CVD risk using the QRISK®3 tool and to determine statin eligibility in diabetic patients.
METHODS: We enrolled diabetic patients visiting our general medicine outpatient department and diabetic clinic in the study. We collected data from clinical and prescription records, as well as through patient interviews. We analyzed the data to determine the 10-year CVD risk using the QRISK®3 risk tool, which is available online. A cut-off QRISK score of 10%, as recommended by the NICE guidelines (2014), was used to stratify patients as \"over-users\" and \"under-users.\" We also analyzed the data to determine any correlation between other risk factors and QRISK scores.
RESULTS: Of the 134 diabetic patients recruited in this study, 43 (32.09%) had a CVD risk score of <10%, of which 16 (37.21%) were categorized as \"over-users.\" Of the patients, 91 had a CVD risk score of ≥10%, of which 17 (18.68%) were categorized as \"under-users.\" Risk factors showing a positive correlation with QRISK score included duration of diabetes, age, blood pressure treatment, waist circumference, and non-high-density lipoprotein cholesterol level.
CONCLUSIONS: QRISK score can be useful to predict 10-year CVD risk in the Indian population and to stratify patients as statin over-users and under-users. This tool can be used in the Indian set-up to identify potential candidates for statin initiation.

Type 2 diabetes (T2DM) and obesity represent major global health burdens and economic costs to healthcare systems. T2DM management is challenging due to multiple comorbidities and limited drug efficacy. Bariatric surgery has emerged as an effective treatment approach. A 65-year-old man with refractory obesity (BMI > 35 kg/m2) and poorly controlled T2DM underwent gastric bypass surgery in 2018. Prior to surgery, medication noncompliance and dietary measures failed to achieve adequate glycemic control or weight loss. Postoperatively, the patient lost 20 kg and achieved improved T2DM control (HbA1C reduction), allowing complete cessation of diabetic medications. The patient\'s case demonstrates bariatric surgery\'s potential to significantly alter the clinical course of obesity and T2DM versus standard care. National guidelines outline eligibility criteria for bariatric referral; however, utilization rates remain low (<1%) despite over two million eligible individuals in the United Kingdom. Improved access could reduce disease burden and healthcare costs from diabetes complications over the long term. This case report provides a real-world example supporting bariatric surgery as an effective intervention for appropriately selected patients with obesity and uncontrolled T2DM, with the potential to improve clinical outcomes and lower costs associated with diabetes management.

BACKGROUND: The National Institute for Health and Care Excellence (NICE) updated the 2011 hip fracture management guidelines on January 6, 2023, suggesting that clinicians offer sliding hip screws in preference to intramedullary nails for trochanteric fractures above and including the lesser trochanter except reverse oblique fractures. This study aims to assess the compliance of our hospital with the updated guidelines while comparing the results with our performance prior to the update together with the national average.
METHODS: A retrospective observational study was done to analyse if trochanteric fractures managed surgically were compliant with NICE guidelines. Pathological fractures secondary to tumours and AO/OTA 31A1.1 fractures were excluded. Fractures were classified using the 2018 AO/OTA classification system independently by two authors, with a review from a senior consultant if there was interobserver variation. Group A (n=60) included trochanteric fractures managed surgically three months prior to the update, while Group B (n=46) included patients managed operatively three months following the update.
RESULTS: The compliance rates for Group A and Group B were similar at 88.33% and 89.13%, respectively, while the national average was about 67% over the course of six months.
CONCLUSIONS: 31A2 fractures showed higher rates of non-compliance in both groups. Non-compliance was thought to be multifactorial: surgeon bias, inaccurate classification of fractures and a lack of awareness of guidelines.
CONCLUSIONS: While there is scope for improvement, district general hospitals can achieve high rates of compliance. Educating and training doctors could help improve compliance.

Objectives Preoperative fasting plays a pivotal role in adequately preparing patients for anaesthesia and surgical procedures. However, it is imperative to consider not only the medical aspects but also patients\' overall comfort, as this can significantly contribute to improved surgical outcome. The primary objective of this quality improvement project (QIP) is to provide healthcare professionals, including anaesthetists, surgeons, nurses, and stakeholders with information regarding insights required to embrace the concept of preoperative snack prescription as a strategy for enhancing patient-centred care. Methods This QIP was conducted in the vascular surgery department of a district general hospital in Wales, United Kingdom. A prospective analysis was conducted in two cycles, i.e., the pre-intervention group (PrIG) and post-intervention group (PoIG), with preoperative snacks such as biscuits, chips, or cakes, being prescribed to the PoIG. A total of 40 patients who met the inclusion criteria were enrolled in this study, with 20 patients participating in each cycle. The timing of preoperative meals, i.e., the closest preoperative breakfast, lunch, or dinner, preoperative snacks (for the PoIG), anaesthesia commencement, and surgical commencement were collected. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), in conjunction with Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results In our QIP, the PrIG and PoIG comprised 40% (8 out of 20) and 35% (7 out of 20) female patients, respectively, with mean ages of 74 years (range, 61-86 years) and 61.3 years (range, 36-81 years). Within the PrIG, the mean duration from the preoperative meal to anaesthesia and surgery commencement was 17.8 hours (range, 14.6-22.5 hours) and 18.5 hours (range, 16.0-23.3 hours), respectively. In the PoIG, following the initiation of preoperative snack prescription, the mean time intervals between preoperative snack prescription and anaesthesia and surgery commencement were 10.9 hours (range, 6.5-16.0 hours) and 12.0 hours (range, 7.5-16.5 hours), respectively. Conclusions In summary, our QIP has successfully integrated preoperative snack prescription into the local hospital\'s preoperative care policy, prioritising the balance between patient safety and comfort. Based on our single-centre experience, we observed a significant reduction in the time interval between preoperative fasting and the initiation of anaesthesia, decreasing from 18.3 hours to 10.9 hours post-implementation of preoperative snacks. This QIP holds relevance for healthcare professionals as it underscores the benefits of shorter fasting periods, which contribute to heightened patient satisfaction and comfort.

Introduction Breast cancer is the most common type of cancer worldwide, and even with all the screening and education, great numbers of diagnoses are made in advanced stages. Additionally, patients in remission always remain at risk of relapse and metastasis. Pakistan has the highest incidence of breast cancer among Asian countries. The purpose of this clinical audit was to compare data from the largest cancer hospital in Pakistan with international standards to provide room for quality improvement. Methods A retrospective review of patients with advanced breast carcinoma over a period of six months was done. Permission was obtained from the Quality Assurance and Patent Safety Department before the commencement of the audit. Standards Data obtained were audited against nine standards of four different categories from the National Institute for Health and Care Excellence (NICE) guidelines on advanced breast carcinoma. Results For the diagnosis and assessment category, for which a target of 100% was set, 99.66% was achieved; for disease monitoring, for which a target of 100% was set, 91.8% was achieved; for systemic disease-modifying therapy, for which the majority was the target, only 1% was achieved; for managing complications, for which a target of 100% was set, 71.8% was achieved. Conclusion Continuous research and breakthrough advancements have made health care an ever-evolving field. Clinical audits like these that compare international standards with local data are beneficial and lead to quality improvement. They highlight issues that may be overlooked otherwise, raise questions that may never be asked, and may inspire prospective research studies. Limitations of the audit were that this clinical audit was conducted outside of the NHS where NICE guidelines are not followed and local guidelines differ from NICE guidelines.

BACKGROUND: Pediatric distal radius buckle fractures are commonly encountered in the emergency department (ED) and are considered non-complex and stable injuries. The National Institute for Health and Care Excellence (NICE) guidelines recommend managing these fractures with a soft cast and discharging patients directly from the ED. However, prevailing practices often involve rigid casts and follow-up clinic visits, leading to unnecessary congestion, prolonged waiting times, excessive radiographic examinations, and frequent cast changes, resulting in additional financial burdens on hospitals.
METHODS: We conducted an initial audit over a 6-month period at Hull University and Teaching Hospitals, reviewing 184 pediatric distal radius fractures, of which 84 were buckle fractures in children under 12 years old. Data on demographics, subsequent clinic visits, treating doctor\'s grade, additional radiographs, initial and final treatment approaches, and cast change frequency were collected. After the initial audit, NICE guideline compliance was promoted through the education of parents and healthcare providers. A second audit was performed on patients within the following 6-month period.
RESULTS: This study assessed the management of pediatric distal radius buckle fractures in a cohort of 84 patients. 39/84 (46.4%) of patients sought medical attention within one week of sustaining the injury, with 33/84 individuals being discharged during their first visit, either by consultants or registrars. Most patients (69/84) required only a single X-ray examination in the ED, while some needed two or three X-rays during their evaluation. However, after implementing NICE guidelines, in the second audit cycle, 62 out of 64 were discharged directly from the ED, with 42 receiving focal rigidity casts (FRCs) removed at home and 10 discharged with simple crepe bandages.  Conclusions: This closed-loop audit effectively showcased that adherence to NICE guidelines yielded better patient management by avoiding unnecessary visits, radiographs, and platers. The adoption of the guidelines leads to the conservation of time and resources.

OBJECTIVE: To report the predictive performance for preterm birth (PTB) of the Fetal Medicine Foundation (FMF) triple test and National Institute for health and Care Excellence (NICE) guidelines used to screen for pre-eclampsia and examine the impact of aspirin in the prevention of PTB.
METHODS: Secondary analysis of data from the SPREE study and the ASPRE trial.
METHODS: Multicentre studies.
METHODS: In SPREE, women with singleton pregnancies had screening for preterm pre-eclampsia at 11-13 weeks of gestation by the FMF method and NICE guidelines. There were 16 451 pregnancies that resulted in delivery at ≥24 weeks of gestation and these data were used to derive the predictive performance for PTB of the two methods of screening. The results from the ASPRE trial were used to examine the effect of aspirin in the prevention of PTB in the population from SPREE.
METHODS: Comparison of performance of FMF method and NICE guidelines for pre-eclampsia in the prediction of PTB and use of aspirin in prevention of PTB.
METHODS: Spontaneous PTB (sPTB), iatrogenic PTB for pre-eclampsia (iPTB-PE) and iatrogenic PTB for reasons other than pre-eclampsia (iPTB-noPE).
RESULTS: Estimated incidence rates of sPTB, iPTB-PE and iPTB-noPE were 3.4%, 0.8% and 1.6%, respectively. The corresponding detection rates were 17%, 82% and 25% for the triple test and 12%, 39% and 19% for NICE guidelines, using the same overall screen positive rate of 10.2%. The estimated proportions prevented by aspirin were 14%, 65% and 0%, respectively.
CONCLUSIONS: Prediction of sPTB and iPTB-noPE by the triple test was poor and poorer by the NICE guidelines. Neither sPTB nor iPTB-noPE was reduced substantially by aspirin.