Danetre Hospital

Introduction: Many transgender and gender diverse (TGD) people experience high levels of mental health difficulties. Different gender-affirmative interventions exist which aim to alleviate gender dysphoria, with the hope that this in turn will improve the mental health and quality of life of TGD people. Objective: This systematic review aims to examine the effectiveness of affirmative dysphoria-focused interventions for adults in improving mental health outcomes. Methods: Inclusion criteria were published, prospective design studies with pre and post-test intervention mental health outcomes, following a gender affirmative intervention. Single-person case studies and measures of sexual distress and body image were excluded. Database searches were conducted with additional hand-searching (database inception to August 2023). Study quality was double-rated using a validated tool. Results: Twenty-nine studies (2789 total participants) were identified that quantitatively assessed mental health outcomes (including depression, anxiety and self-esteem) following hormone, surgical and/or psychotherapeutic interventions. No eligible qualitative research or studies of voice and communication therapy or hair removal/electrolysis were found. The majority of studies of hormone treatments found that mental health, and in particular depression outcomes, significantly improved post-intervention and at follow-up. Improvements following surgical interventions were reported at follow-up time points beyond 6 months after the end of intervention. The majority of surgical intervention studies at post-intervention to 6-month follow-up showed no significant anxiety change, with mixed results for other mental health conditions. The majority of psychological interventions reported improvements in various mental health outcomes. The majority of included studies were assessed as being 'medium' or 'weak' quality. Conclusion: This review indicates that interventions for gender dysphoria, especially hormone and psychological treatments, may have mental health benefits for TGD people. Further research is required to examine the relationship between mental health post-intervention and minority stressors, visual congruity and intersectional factors.

ABSTRACT This article argues that elder abuse in institutional as opposed to domestic settings remains invisible because institutions for elders are mainly all-female spaces where ageism and sexism converge and clients and workers are economically and socially disadvantaged. A general culture of violence that increasingly legitimates the everydayness of abuse and that conforms to dominant gender stereotypes refuses to investigate abuse of women by women. Research is needed into the different kinds of abuse committed in institutional settings by women. Staff and clients need to be enabled to report abuse and effective measures for combating it put in place.

PURPOSE: To determine the prevalence of unilateral absence of vas deferens (UAVD) in men with both testes seeking vasectomy. MATERIALS AND METHODS: Computerized charts of 23.013 patients encountered between January 1994 and December 2013 in one university hospital and two community clinics of Quebec City, Canada, were searched. Pre-vasectomy consultation, operative reports and semen analysis results were reviewed to identify cases of UAVD. Cases were categorized as confirmed (unilateral vasectomy and success confirmed by semen analysis) or possible congenital UAVD further sub-categorized according to whether or not a scrotal anomaly was present. RESULTS: Among 159 men identified as potentially having UAVD, chart review revealed that 47 had only one testicle, 26 had bilateral vasa, and four were misdiagnosed (post-vasectomy semen analysis [PVSA] showing motile sperm after unilateral vasectomy) leaving 82 men deemed cases of UAVD (0.36%, 95% confidence interval 0.28% to 0.43%). These were classified as confirmed (n=48, 0.21%) and possible (n=34, 0.15%; 22 without and 12 with scrotal anomalies) congenital UAVD. The misdiagnosis ratio of UAVD was low when scrotal content was otherwise normal (1:48), but higher if anomalies were present (3:12). CONCLUSIONS: Most surgeons who perform vasectomy will encounter cases of UAVD. In most suspected cases, it is safe and effective to proceed with unilateral vasectomy under local anesthesia while stressing the need for PVSA. Further studies or scrotal exploration may be considered in patient with prior scrotal surgery.

Objectives: Transgender and gender non-conforming people may face elevated rates of shame and self-criticism in light of minority stress. Compassion-focused therapy has a growing evidence base in addressing trans-diagnostic processes in mental health difficulties, including shame and self-criticism. The objective of the present study was to explore the experience of an initial pilot compassion-focused therapy group delivered online in a Gender Service during the COVID-19 pandemic. Methods: Six transgender people completed a semi-structured interview after attending an 8-week compassion-focused therapy group in a national Gender Service. Inductive thematic analysis was used to identify themes in the data. Results: Participants reported that the compassion-focused framework was an appropriate and helpful way of understanding their experiences of stigma and that both the content and process of the group had benefitted them. Being with other transgender people raised some anxieties, such as comparisons or fear of offending, but also enabled seeing the self in more positive and accepting ways. While online delivery had some challenges, participants largely felt it was an effective mode of delivery, aided by the experiential nature of the group. Conclusions: Compassion-focused therapy seems to be a feasible and acceptable approach for transgender and gender non-conforming people. Group processes may be helpful in increasing self-acceptance. Further quantitative exploration of therapy process and outcomes is warranted.

Plantar plate positioning has been demonstrated as biomechanically superior. However, some operators remain resentful about the morbidity of the surgical approach. To provide improved plate fixation for first tarsometatarsal joint arthrodesis with respect to the tibialis anterior tendon, a medio-plantar plate was developed. The purpose of this biomechanical study was to compare its construct stability to that of a plantar plate construct. Twelve pairs of fresh frozen human specimens were used in a matched pair test. Each pair was fixed with a 4 mm compression screw and either a plantar locking plate or a medio-plantar locking plate. A cantilever beam test was performed in dorsiflexion. Before and after cyclic loading (5000 cycles; 40 N), bending stiffness and relative movements at the joint space were monitored in a quasi-static test including optical motion tracking. Maximum load and bending moment to failure were investigated in a load-to-failure ramp test. The bending stiffness of both groups did not significantly differ before (plantar 49.9 N/mm ± 19.2; medio-plantar 53.9 N/mm ± 25.4, p = 0.43) or after (plantar 24.4 N/mm ± 9.7; medio-plantar 35.3 N/mm ± 22.0, p = 0.08) cyclic loading but decreased significantly in both groups (p < 0.01) after cyclic loading. Relative movement increased significantly during cyclic testing in both groups (p < 0.01) but did not differ significantly between the groups before (p = 0.29) or after (p = 0.16) cyclic loading. Neither load nor bending moment to failure were significantly different (plantar 225 N ± 78, 10.8 Nm; medio-plantar 210 N ± 86, 10.1 Nm, p = 0.61). Both plate constructs provided equivalent construct stability, both being well suited for Lapidus arthrodesis.

Abstract Background Osteomyelitis of the foot is a major complication of diabetes that can be limb and life threatening. Systemic antibiotic pharmacotherapy is often used first line to eradicate infection and allow restoration of devitalised bone. The aim is to conduct a systematic review of the effectiveness of systemic antibiotics on osteomyelitis of the foot in adults with diabetes mellitus. Methods A systematic review of all interventional studies treating osteomyelitis with systemic antibiotics in participants with diabetes mellitus and an ulcer of the foot below the malleoli will be conducted. Studies not available in English and in people below the age of 18 will be excluded. Study selection will follow the Patient Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA‐P guidelines). The quality of the studies will be assessed using the Cochrane risk‐of‐bias tool (RoB 2) for all randomised controlled trials and the Newcastle–Ottawa Scale (NOS) will be used for non‐randomised controlled trials. Electronic databases will be searched with no timeline restrictions. Data Extraction All identified references will be imported to the Rayyan Application. Studies for eligibility will be screened by two reviewers. One reviewer will perform the data extraction and quality appraisal will be conducted by two authors. If sufficient data is available, the quality will be analysed and a meta‐analysis will be performed. Data synthesis will be conducted, and meta‐analysis undertaken using RevMan 5.4.1 Meta‐analysis software. Non‐parametric data may be compared between selective intervention and outcomes. Discussion The results of this systematic review will identify the effectiveness of systemic antibiotic therapy on osteomyelitis of the foot in people with diabetes based on the set outcome measure criteria. The findings will establish if there are existing consistent standards or variation in practice when treating diabetic foot osteomyelitis (DFO). The study may establish if guidelines are required to standardise practice when treating DFO with systemic antibiotic therapy. This systematic review protocol will synthesise the existing evidence on the effectiveness of systemic antibiotic therapy for treating DFO. Trial registration International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021245424 .

Background: The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods: Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results: 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions: The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.

BackgroundInjectable glucocorticoids are widely used in the management of foot pathology, in particular for the treatment of osteoarthritis of the great toe - hallux limitus/rigidus. Injections can be performed using anatomical (blind) guided methods or performed with needle placement aided by the use diagnostic imaging with ultrasound or fluoroscopy, with or without the use of contrast media.AimPalpation and image guided injection techniques have been studied in other joints of the body but less so for the first metatarsophalangeal joint of the foot, where palpation guidance is commonly performed. The aim of this study was to investigate the injection accuracy of palpation guided injections of the first metatarsophalangeal joint in six cadaveric feet using radio-opaque contrast media.MethodsThe injection equipment consisted of a 2.5 ml Luer lock syringe and a 23-gauge needle used to inject iohexol (Omnipaque 300) into the first metatarsophalangeal joint in six cadaveric specimens. The needle was placed into the joint space by a single practitioner using palpation guidance. The contrast media was injected under live (cine) view without further movement or ingress of the needle. The injectate was considered accurate if the media coated the inside of the synovial membrane and/or outlined the joint shape.FindingsFailure of technique was seen in one of six feet, and extravasation of contrast media beyond the joint margins noted in three out of six feet.ConclusionsFurther study on a large sample of live subjects using a variance of technique is required to expand the confidence of these findings but the high failure rate calls into question the confidence of palpation guided techniques for injection of the first metatarsophalangeal joint.

If crime is a social problem, then ways of preventing it must be sought. Punishment has been the traditional approach to preventing crime, either as a deterrent, or as a means of reforming the offender. Neither of these approaches is wholly acceptable. Even if deterrence punishment, as grounded in utilitarianism, effectively prevents crime, there may be other methods which produce better results. Reform fails to justify any form of punishment since not only does punishment not reform, but it interferes with the reformative process. Reform is limited in scope to those people who commit crimes and are caught. If crime is to be prevented, then it is necessary to go beyond the crime and the criminal and consider the social contexts in which people act, and the ways in which they learn to react to them. By shaping both the environment and people's responses to it, society can solve the problem of preventing crime, without the need for punishment.

Nail surgery for the permanent removal of all or part of the nail unit can be performed via incisional or physically ablative techniques for conditions such as ingrown, mycotic, or dystrophic toenails. In the United Kingdom podiatric community, where phenol techniques are the standard of care for ablation of the matrix, there remains confusion about the management of patients undergoing nail surgery who are concurrently taking antithrombotic medication(s). The aim of this paper was to review the literature describing treatment strategies for antithrombosed patients undergoing nail surgery. However, having found limited evidence, the authors considered relevant and associated literature in the field of cutaneous/dermatological surgery and extrapolated those findings for patients undergoing nail avulsion surgery. A case-by-case risk assessment is warranted in all patients but as a general rule, the podiatrist can perform nail surgery without the patientceasing their antithrombotic medication.

<ns3:p> <ns3:bold>Background: </ns3:bold> The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment education. </ns3:p> <ns3:p> <ns3:bold>Methods: </ns3:bold> Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment education. </ns3:p> <ns3:p> <ns3:bold>Results: </ns3:bold> 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, ‘being the way I want to be’ in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. </ns3:p> <ns3:p> <ns3:bold>Conclusions: </ns3:bold> The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants’ experience of transformation may also guard against professional burnout. </ns3:p>

The use of Integrated Learning Systems (ILS) was introduced at Danetre School with a small pilot study four years ago and has continued to evolve. Currently up to 200 students (mainly at KS3), some with special educational needs, extend their skills through its use in daily literacy or numeracy sessions. Improvement is not only evident in their learning but also in their attitude and increased self‐esteem. Some teachers, in a range of schools, are still unclear of what is involved in ILS and have difficulties in responding to its principles. In this article Alison Williams provides a clear view of ILS and suggests its value in supporting students with special educational needs in a comprehensive school.

A ward sister discusses why communication and coordination of care are so important

Aim: To analyse the anatomical knowledge, understanding of pathology and clinical practice perception of Plantar Fasciitis amongst Clinicians, Podiatrists and Allied Health Professionals. Materials and Methods: An online cross-sectional survey consisting of nine multiple choice questions was compiled and distributed amongst orthopaedic surgeons, radiologists, podiatrists, physiotherapists and other allied health professionals throughout the UK to ascertain the following: a) Anatomical knowledge, b) Practice setting, c) Clinical management strategies Results: There were 76 responses from Orthopaedic surgeons (28.9%), Radiologists (34.2%), Podiatrists (17.1%), Physiotherapists (14.5%), and other Allied Health Professionals (5.3%) from different settings across the UK. 56.6% chose the central band as the most affected in Plantar Fasciitis, while 43.4% picked the medial band. In the practice setting, 46.1% answered that their site of injection is central, with 47.4% injecting the medial site. Corticosteroids are the most common treatment modality for injection with 64.5% answers, while 26.3% do not use injection as a treatment. Conclusion:There is a wide variation between health professionals regarding the pathoanatomy of Plantar Fasciitis. Plantar heel pain (PHP) is a very common musculoskeletal problem with a high rate of prevalence in the community and contributes to long-term morbidity and poor quality of life. An approach involving the education and enhanced circulation of the characteristic pathoanatomic knowledge of PHP will lead to a better understanding and management of this common condition.

. Gender identity transition and detransition is a varied experience and people have multiple needs.

EDITOR, - I was surprised to read Michael J Noble's letter and to see his figures on home visits in general practice.1 The age distribution of patients receiving out of hours home visits in his practice differs from that in mine, although I also practice in a semirural area. I take part in an on call rota with my four partners and two other, smaller practices; the total population at risk at nights and weekends is some 17 …

Ingrown toenails are a commonly occurring foot complaint. The condition occurs when the nail plate pierces the sulcus, giving rise to pain, inflammation and infection. As the skin attempts to heal itself, hypergranulation tissue may form. This is a case report of phenolic nail surgery treatment for a bilateral presentation with sharp resection of hypergranulation tissue performed in only one (the lateral) of the two affected sulci. Sharp resection of the residual medial hypergranulation tissue was performed two months after the index procedure when this had not settled. The case highlights the potential role of sharp resection in the overall improvement of treatment outcomes.

I am a medical secretary on a band 4 pay scale. This morning I have checked my consultant’s data quality performance reports; reviewed the waiting list; booked …