Wrexham Maelor Hospital

Diabetic foot disease is a common life altering complication of diabetes mellitus that results from a combination of neuropathy, angiopathy, and structural deformities. Minimally invasive orthopaedic surgeries (MIOS) are known to shorten recovery time, reduced length of stay in hospital, reduce wound complications, all of which would benefit diabetic patients. Current evidence-based guidance on the use of minimally invasive orthopaedic surgeries (MIOS) in managing diabetic foot disease is limited.

To systematically review all studies on the use of MIOS in managing diabetic foot disease affecting various anatomical locations, and to compile data on ulcer healing, recurrence, complication rates.

A systematic literature search of Medline (PubMed), Embase, Scopus and Cochrane Library from inception until 31st October 2024, using the keywords 'diabetes', 'diabetic foot', 'minimally invasive surgery', 'minimally invasive procedure'. Articles were reviewed for demographic details and surgical outcomes. PRISMA guidelines were adhered to and reported.

Twenty-nine studies were included in the review: 13 reported on forefoot interventions, 4 on midfoot interventions, 3 on hindfoot interventions, and 9 on lower limb interventions. Forefoot MIOS, such as distal metatarsal osteotomies, phalangeal osteotomies and flexor tenotomies, showed significant improvements in ulcer healing times (mean 1.5-3.7 weeks) and reduced recurrence rates (0-21 %). Midfoot MIOS included Taylor Spatial Frame external fixator with percutaneous arthrodesis, solid bolt fixation and metatarsal ray resection. These interventions demonstrated promising outcomes with minimal complications, particularly in managing Charcot neuroarthropathy. MIOS techniques in hindfoot explored were tibio-talo-calcaneal arthrodesis, vertical contour calcanectomy and combination of subtalar arthroereisis with Achilles tendon lengthening. They showed favourable results in lowering post-operative infections (0-3 %) and raising functional scores (improved American Orthopaedic Foot & Ankle Society scores of 44.8). Lower leg MIOS, including percutaneous Achilles tendon lengthening, showed improved plantar forefoot ulcers healing (30-57.5 days) and lower recurrence rates (0-38 %) compared to total contact cast.

MIOS exhibits a promising role in the management of diabetic foot disease and ulcers, especially when paired with rigorous patient selection criteria and preoperative patient optimisation through a multidisciplinary team approach.

Background Infective endocarditis (IE) is a life-threatening infection of the endocardial surface, most commonly affecting native or prosthetic valves and intracardiac devices. Despite advancements in diagnosis and treatment, IE continues to carry a high mortality risk. Blood cultures remain a cornerstone of diagnosis, typically yielding positive results and enabling identification of the causative organisms. Staphylococcus aureus is now recognised as the most prevalent pathogen, particularly in healthcare-associated and intravenous drug use-related cases, and is associated with worse outcomes. Other commonly implicated organisms include streptococci and enterococci. This study aimed to investigate the distribution of causative pathogens and their associated mortality risk in patients diagnosed with IE at the Wrexham Maelor Hospital, North Wales, United Kingdom. Method A retrospective cohort study was conducted using patient data from the Welsh Clinical Portal at the Wrexham Maelor Hospital, covering the period from June 2022 to May 2025. Patients were eligible for inclusion if they had a confirmed diagnosis of IE based on the modified Duke criteria. Statistical analysis was performed using Chi-squared or Fisher's exact test to evaluate associations between pathogen type and mortality. Results A total of 50 patients with positive blood cultures were included. Staphylococcus aureus was the most frequently isolated organism (n=19; 38%), followed by polymicrobial infections (n=7; 14%), Staphylococcus epidermidis (n=4; 8%), and Enterococcus faecalis (n=3; 6%). Streptococcus sanguinis, Escherichia coli, and Haemophilus parainfluenzae each accounted for 4% (n=2), with the remaining 2% (n=1) comprising less common pathogens. Twenty-three deaths were recorded, with the highest mortality observed in the culture-negative group (n=6). No statistically significant correlation was found between the pathogen type and mortality. Conclusion While Staphylococcus aureus was the most frequently isolated pathogen, the highest mortality occurred in patients with culture-negative IE. This may reflect the diagnostic and therapeutic challenges posed by the absence of microbiological confirmation, potentially delaying appropriate, targeted antimicrobial therapy. These findings highlight the importance of early diagnosis, empiric antimicrobial coverage, and timely treatment adjustments to improve outcomes in IE, particularly in culture-negative presentations.

To examine how neonatal staff perceive the clinical impact of noise, including its influence on their performance and its potential contribution to neonatal morbidity.

A 56-item survey was developed, piloted and disseminated across all nine neonatal units in Wales, UK. Distribution was supported by unit-based study champions and weekly response monitoring. Responses were analysed using descriptive and inferential statistics, as well as inductive thematic analysis.

A total of 405 valid responses were received from clinical staff, including 260 nurses, 126 doctors and 19 allied health professionals, representing 49.6% of all neonatal nurses and doctors in Wales. Respondents spanned all levels of seniority and unit types.

Primary outcomes were the proportion of staff who perceived noise as having (1) a direct negative impact on neonatal health and (2) an indirect impact via impaired staff performance. Secondary outcomes included specific perceived clinical consequences (e.g., sepsis, intraventricular haemorrhage, necrotising enterocolitis) and the prevalence of noise-mitigation strategies in practice.

92% of staff reported that noise directly affects neonatal health; 76% believed that it indirectly contributes to harm through its impact on staff functioning. Nearly half of doctors and over one-third of nurses linked this to serious complications. Free-text responses revealed themes of concern over clinical harm, impaired communication and lack of effective institutional response.

Neonatal professionals view noise as a clinically significant risk factor. These findings support the need for system-level noise-reduction strategies and further evaluation through multicentre interventional studies aimed at reducing neonatal morbidity.