From Dry Cavities to Healing Pathways: Innovations in Managing Empty Nose Syndrome.

Background: Empty nose syndrome remains one of the rare and least touched topics worldwide. It needs to be dealt with in detail to understand its cause, pathophysiology, types and treatment options that are available at present. Still today management plans related to pathogenesis have not yet reached common consensus.

Opportunities for optimising care transitions of adults with multiple long-term conditions: a qualitative interview study.

Background: The number of adults with multiple long-term conditions (MLTC) who experience frequent care transitions is rising. Improving care transitions for adults MLTC is important because transitions between and within care settings commonly lead to preventable adverse events. We explored multidisciplinary professional perspectives and experiences of managing care transitions for patients with MLTC to identify opportunities for improvement.

Measuring frailty: a comparison of the cumulative deficit model of frailty in survey and routine data.

Purpose: Frailty, a state of increased vulnerability to adverse health outcomes, impacts individuals and healthcare systems. The cumulative deficit model provides a flexible frailty measure but its application across diverse data remains underexplored. This study compares frailty indices derived from survey and routine data.

Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions.

Introduction: Overall dementia diagnosis rates are substantially below true rates. Hospital admissions of older people involve cognitive and functional assessments relevant to dementia diagnosis. These assessments could be harnessed to contribute to identifying patients for further assessment.

Tailoring cardiovascular risk prediction to females.

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of morbidity and mortality in females worldwide. In this review, we provide insights into how sex differences may affect traditional risk factors associated with ASCVD, and give an overview of non-traditional risk factors that have the potential to enhance cardiovascular risk prediction in females. We review clinically applied cardiovascular risk estimation systems, discussing the integration of promising risk factors within these systems.

Multiomic profiling of glioblastoma metabolic lesions reveals complex intratumoral genomic evolution and dipeptidase-1-driven vascular proliferation.

Background: Glioblastoma undergoes a complex and dynamic evolution involving genetic and epigenetic changes. Understanding the mechanisms underlying this evolution is vital for the development of efficient therapeutic strategies. Although treatment resistance is associated with intratumoral heterogeneity in glioblastoma, it remains uncertain whether hypometabolic and hypermetabolic lesions observed through clinical positron emission tomography (PET) imaging are influenced by spatial intratumoral genomic evolution.

Targeting Investigation and Treatment in Type 2 Myocardial Infarction: A Pilot Randomized Controlled Trial.

Background: Type 2 myocardial infarction occurs in the absence of atherothrombosis, due to myocardial oxygen supply or demand imbalance, often during another acute illness. It is common and associated with poor clinical outcomes. No randomized controlled trials are available to guide investigation or treatment.

Delirium on presentation with a hip fracture is associated with adverse outcomes : a multicentre observational study of 18,040 patients using national clinical registry data.

Aims: Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.

Methods: This study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021.

Understanding hospital activity and outcomes for people with multimorbidity using electronic health records.

As the prevalence of multimorbidity grows, provision of effective healthcare is more challenging. Both multimorbidity and complexity in healthcare delivery may be associated with worse outcomes. We studied consecutive, unique emergency non-surgical hospitalisations for patients over 50 years old to three hospitals in Scotland, UK between 2016 and 2024 using linked primary care and hospital records to define multimorbidity (2 + long-term conditions), and timestamped hospital electronic health record (EHR) contacts with nursing and rehabilitation providers to describe intensity of inpatient care.

Atypical Head and Neck Cysticercosis: Diagnostic Pitfalls and Clinical Insights from a Case Series and Literature Review.

Head and neck swellings encompass a broad range of differential diagnoses, often necessitating comprehensive clinical and diagnostic evaluations to reach an accurate diagnosis. Cysticercosis, a parasitic infection caused by the larval form of Taenia solium, typically affects neural and extraneural regions. Although neural manifestations are well-documented, extraneural cysticercosis in the head and neck is rare and can mimic neoplastic and inflammatory conditions, posing diagnostic challenges.

Angioinvasive Mucormycosis and Internal Carotid Artery Thrombosis: A Case Series.

Rhinocerebral mucormycosis is an acute, rapidly progressing, and life-threatening condition that predominantly affects individuals with uncontrolled diabetes and those who are immunocompromised. One critical complication of this disease is the thrombosis of orbital vessels, which can be indicative of angioinvasiveness and predict the subsequent development of cerebral infarctions. In this context, we present a case series of patients with rhino-orbital mucormycosis who experienced complications due to internal carotid artery thrombosis.

Comparing Care Pathways Between COVID-19 Pandemic Waves Using Electronic Health Records: A Process Mining Case Study.

Unlabelled: The COVID-19 pandemic caused rapid shifts in the workflow of many health services, but evidence of how this affected multidisciplinary care settings is limited. In this data study, we propose a process mining approach that utilises timestamped data from electronic health records to compare care provider patterns across pandemic waves. To investigate healthcare patterns during the pandemic, we collected routine events from Scottish hospital episodes in adults with COVID-19 status, generating treatment logs based on care provider input.

Predicting incident dementia in community-dwelling older adults using primary and secondary care data from electronic health records.

Predicting risk of future dementia is essential for primary prevention strategies, particularly in the era of novel immunotherapies. However, few studies have developed population-level prediction models using existing routine healthcare data. In this longitudinal retrospective cohort study, we predicted incident dementia using primary and secondary care health records at 5, 10 and 13 years in 144 113 Scottish older adults who were dementia-free prior to 1st April 2009.

An Expert Consensus Statement on Biomarkers of Aging for Use in Intervention Studies.

Biomarkers of aging serve as important outcome measures in longevity-promoting interventions. However, there is limited consensus on which specific biomarkers are most appropriate for human intervention studies. This work aimed to address this need by establishing an expert consensus on biomarkers of aging for use in intervention studies via the Delphi method.

High-sensitivity cardiac troponin I and risk of dementia: 25-year longitudinal study in the Whitehall II cohort.

Objective: We hypothesise that subclinical myocardial injury during midlife, indexed by increases in cardiac troponin I, is associated with accelerated cognitive decline, smaller structural brain volume, and higher risk of dementia.

Design: Longitudinal cohort study.

Setting: Civil service departments in London (Whitehall II study).

New horizons in systems engineering and thinking to improve health and social care for older people.

Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management.

Understanding hospital rehabilitation using electronic health records in patients with and without COVID-19.

Background: Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19.

Methods: We performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland.

Multimorbidity and adverse outcomes following emergency department attendance: population based cohort study.

Objectives: To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department.

Design: Population based cohort study.

Setting: Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019.

Frailty or frailties: exploring frailty index subdimensions in the English Longitudinal Study of Ageing.

Background: Frailty, a state of increased vulnerability to adverse health outcomes, has garnered significant attention in research and clinical practice. Existing constructs aggregate clinical features or health deficits into a single score. While simple and interpretable, this approach may overlook the complexity of frailty and not capture the full range of variation between individuals.

The electronic frailty index and outcomes in patients with myocardial infarction.

Background: Frailty is increasingly present in patients with acute myocardial infarction. The electronic Frailty Index (eFI) is a validated method of identifying vulnerable older patients in the community from routine primary care data. Our aim was to assess the relationship between the eFI and outcomes in older patients hospitalised with acute myocardial infarction.

Predicting short- to medium-term care home admission risk in older adults: a systematic review of externally validated models.

Introduction: Predicting risk of care home admission could identify older adults for early intervention to support independent living but require external validation in a different dataset before clinical use. We systematically reviewed external validations of care home admission risk prediction models in older adults.

Methods: We searched Medline, Embase and Cochrane Library until 14 August 2023 for external validations of prediction models for care home admission risk in adults aged ≥65 years with up to 3 years of follow-up.