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292 Prospective, randomised, multicentre trial of first line systemic treatment and radiotherapy in stage IV nonsmall cell lung cancer: PRINCE a Candidate-Specific Trial within the TOURIST Platform (TRIAL IN PROGRESS)
No full textIntroduction
Over the past 30 years, management of advanced lung cancer has changed profoundly, leading to variation in strategies for the use and timing of radiotherapy. Palliative radiotherapy is commonly offered to patients with stage IV non-small cell lung cancer (NSCLC). Dose fractionation trials from the 1990s demonstrated effectiveness in symptom control and suggested benefits in local disease management and survival among patients with good performance status. Current practice, however, continues to rely on dated evidence, and no recent trials have assessed radiotherapy in combination with contemporary systemic treatments.
Aims
PRINCE is a candidate-specific trial within the TOURIST platform. It aims to determine whether the addition of early highdose palliative thoracic radiotherapy to patients receiving first-line systemic treatment improves quality of life (QoL), overall survival (OS), progression-free survival (PFS), lung cancer symptoms, and toxicity.
Methods
Participants are randomised (1:1) to the control arm or to early high-dose palliative thoracic radiotherapy, with both groups receiving systemic therapy. Economic and process evaluations will also be undertaken, involving interviews with patients, carers, and healthcare professionals, alongside patient diaries.
Trial Progress We have 29 sites open to recruitment across England, Wales, Scotland and Northern Ireland, with the Republic of Ireland currently in set-up. Sites may open under the standard noncommercial agreement (mNCA) or a Hub and Spoke agreement. Patient Identification Centres are being introduced to support recruitment. 64 patients have been recruited to date. PRINCE is strongly represented with Patient and Public Involvement and Engagement (PPIE), which has been integral to the design of the trial, ensuring relevance to patient experience. The 12 month NIHR internal pilot has been completed, and recruitment will continue until 31 January 2028.
Disclosure
No significant relationship
A systematic review and meta analysis comparing clinical and functional outcomes of Mako-assisted versus conventional total knee replacement (PROSPERO ID: CRD420251115864)
No full textAim: To systematically evaluate the clinical effectiveness of Mako total knee arthroplasty compared with conventional jig-based TKA, focusing on functional outcomes, implant positioning, complications, length of stay (LOS), postoperative pain, and recovery time.
Method: A systematic review and meta-analysis was conducted following PRISMA guidelines. Prospective, retrospective, and registry-based comparative studies were included. Data were extracted for validated functional scores (OKS, KOOS-JR, VR-12), alignment parameters (hip–knee–ankle angle, outlier rates), perioperative complications, LOS, and VAS pain at multiple timepoints. Random-effects models were used for quantitative synthesis; heterogeneous outcomes (time to recovery milestones, gait analysis) were synthesised narratively. Certainty of evidence was assessed using GRADE.
Results: Twenty-one studies (n = 51,226) were included. At 12 months, robotic patients demonstrated modest improvements in functional outcomes (OKS pooled MD +2.5, 95% CI +1.0 to+3.9), approaching the minimal clinically important difference. Robotic TKA reduced alignment outliers. There was no consistent difference in periprosthetic joint infection or early revision rates. LOS was ∼0.5 days shorter with robotic, an effect confined to non-ERAS pathways. Pain outcomes showed no acute benefit, but a 6-month meta-analysis (Yang 2024, Masilamani 2025; n = 286) demonstrated lower pain with robotic (MD −0.43, 95% CI −0.57 to −0.28). Narrative synthesis indicated faster inpatient recovery milestones in conventional care but no advantage under ERAS protocols.
Conclusions: Robotic TKA confers small but consistent benefits in functional outcomes, alignment precision, LOS, and mid-term pain, without clear reductions in major complications. These advantages are context-dependent, most evident outside ERAS pathways. Higher-quality RCTs are required to confirm long-term clinical relevance
To assess efficacy of educational outreach programme in improving health literacy, awareness, and engagement with cervical cancer screening among women experiencing homelessness in lancashire, U.K.
No full textIntroduction/Background People experiencing homelessness remains a major public health challenge in Lancashire, experiencing disproportionately poorer health outcomes, with low health literacy being a contributing factor. This reduces engagement in preventive health behaviours, particularly cancer screening, with approximately 54% of homeless individuals reported having a cervical screening in the past three years, compared with approximately 70% in the general population. There exists limited research on how health literacy affects cervical screening uptake among homeless individuals in the UK, therefore presenting an opportunity to improve screening engagement in this underserved group.
Methodology This mixed-methods study employed an educational outreach initiative delivered through several sessions to women at homeless shelters in Lancashire. Cervical screening teaching involved illustrated leaflets, a PowerPoint presentation, and a speculum to visually represent the procedure and enhance understanding. After obtaining consent, participants completed a survey based on the Health Belief Model that consisted of 18 items. This served as a framework to guide 25-40 minutes semi-structured interviews, which aimed to confirm participant understanding and explore confidence, barriers, and perceptions.
Results Thirty participants attended cervical cancer education sessions focused on screening and speculum use. All participants identified barriers related to limited health awareness, fear, and/or embarrassment when engaging with clinicians, and difficulties accessing healthcare services. Following the education sessions, all participants reported feeling empowered, informed and valued accessibility of the services located near shelters. The socioecological framework was used to map the facilitators to overcome these barriers, highlighting development needs at the individual, organisational, and policy levels.
Conclusion Raising awareness through targeted education enhanced understanding on screening uptake and identified persistent health disparities within women experiencing homelessness
Beyond the interval: does maximal effort cytoreductive surgery after 6-cycles of chemotherapy play a role in the management of advanced ovarian cancer?
No full textIntroduction/Background: Complete resection of all visible disease remains the gold standard in the surgical management of advanced ovarian cancer. If this is not deemed possible in the upfront setting, then interval cytoreductive surgery (IDS) should be undertaken after 3-4-cycles of neoadjuvant chemotherapy (NACT). Some patients undergo delayed surgery after 6-cycles of NACT (DDS) due to persistence of unresectable disease on interval scanning or factors associated with patient fitness. Current evidence regarding the outcomes of DDS is limited and conflicting. This study aimed to review the short-term outcomes for patients undergoing DDS compared with IDS at a single UK Centre.
Methodology: A retrospective cohort study was conducted including patients with FIGO stage III–IV epithelial ovarian cancer treated between June 2023 and January 2025. Patients who received primary debulking were excluded. Data were extracted from electronic patient records. Primary outcome was the rate of complete cytoreduction. Secondary outcomes included surgical complexity, duration of surgery, and perioperative complications.
Results: Forty-two patients met inclusion criteria: 28 (66.7%) underwent IDS and 14 (33.3%) underwent DDS. Median age was 65 years, and 95% presented with FIGO stage IIIC–IV disease. There were 4 ‘open and close’ laparotomies in the DDS cohort, and 6 in the IDS cohort. Where cytoreductive surgery was attempted, complete cytoreduction was achieved in 100% in the DDS cohort compared with 86% in the IDS cohort. DDS was associated with longer mean operating time (313 vs. 267 minutes) and higher rates of bowel resection (28.6% vs. 3.6%). Despite greater mean surgical complexity in the DDS group (5.1 vs. 3.5), overall complication rates were low and comparable between cohorts. All patients received postoperative chemotherapy.
Conclusion: DDS may facilitate higher rates of complete cytoreduction without increasing perioperative morbidity. These findings suggest a potential role for DDS in selected patients with advanced disease; however, further studies are needed to determine whether DDS achieves comparable progression-free and overall survival outcomes to IDS
I feel your pain: individual differences in welfare indicators after castration in horses.
No full textPersonality affects both experience and expression of pain and the welfare impact of castration on horses is poorly understood. Therefore, the current study observed 19 horses to determine: the welfare impact of standard castration on horses; whether individuals consistently vary in their behavioural and emotional responses to pain; the influence of personality on behavioural and physiological responses to pain; whether Horse Grimace Scale (HGS) indicates how individuals feel about painful experiences. Eye temperature (IRT), salivary cortisol, HGS and a pain ethogram were measured at intervals before, throughout and during recovery from castration. IRT (p<0.005), Cortisol (p<0.024), HGS (p<0.03) and Maintenance behaviour (p<0.004) significant changed from baseline. Physiological and behavioural responses to castration were varied but not consistent within individuals. Veterinarian influenced responses, presumably reflecting the importance of clinician’s skill. Personality explained differences in cortisol responses with Neuroticism negatively (estimate=-0.275; p=0.035), and Extroversion positively (estimate=0.406; p=0.001) associated with the magnitude of response to castration. HGS was not confounded by personality suggesting that this pain indicator may be resilient to individual differences in pain expression and appears to reflect underlying affective pain states as it was associated with cortisol (r=0.568, p=0.027). Therefore, it is potentially an important tool in recognition of pain at an individual level. Further research should be done utilising a larger sample with greater standardisation of castration method to determine both the effect of baseline welfare on pain resilience and the sensitivity of Grimace Scales as an indicator of suffering during painful experiences
Does the Dynamic Support Register Identify the Risk of Early Placement Breakdown in Adults With Intellectual Disabilities? Perceptions of Service Users, Carers and Professionals
No full textPlacement breakdown is a common cause of avoidable admissions to intellectual disability inpatient services among people with intellectual disability. The Dynamic Support Register with intensive support function was introduced to help minimise these admissions. This study explored the perceptions of service users, carers and professionals of the extent to which the Dynamic Support Register identifies early risk of placement breakdown and reduces admissions. Semi-structured interviews were conducted with four service users, five community learning disability team professionals and five carers (paid and unpaid). Interviews were audio-recorded and transcribed verbatim and analysed using the constructs of Normalisation Process Theory. Key factors influencing the placement breakdown were identified. There was consensus that increasing understanding and awareness of the Dynamic Support Register with intensive support among health and social care professionals, service users and families would improve the provision of timely and appropriate support. The intensive support function provided by the community learning disability team for people on the Dynamic Support Register was viewed to have reduced avoidable inpatient admissions. The Dynamic Support Register identifies early risk of placement breakdown and, with intensive support from the community learning disability team, could minimise avoidable inpatient admissions. However, limited awareness among primary care, health and social care professionals highlights the need for increased training to optimise its impact
Subjective experiences in adults’ successful inner development beyond distressing anomalous states
No full textThe primary aim of my study was to appreciate and learn from research participants who had lived through distressing anomalous experiences and created lives they considered successful on their own terms. This research also aimed to articulate views informed by the participants’, that could contribute to clinical and societal narratives. The potential for individuals to improve their navigation through distressing anomalous experiences, and formal mental health services, appeared evident. Recommendations are made to improve mainstream psychiatric practice.
Primarily I sought to meet the participants as whole human beings, to listen to their views, to provide a platform, amplify, discuss, provide context, consider implications and gather
recommendations. The research participants had struggled with isolation and some profoundly disorientating experiences that were not understandable in any ordinary way. Through their lives they acquired considerable insight into inner challenges, distressing anomalous experiences and how they developed beyond distress and confusion. The creation of lives the participants considered successful demonstrates the validity of their insights.
This research sought to foreground the participants’ voices, so often sidelined in academic work. The understandings of psychiatric survivors, holistic clinicians and academics have not yet permeated through to mainstream psychiatric practice, but this research contributes to the body of evidence.
The following narrative strands contributed most visibly to participants’ inner development: acknowledgement of the personal challenges of inner development, the development of
psychological inner qualities such as courage, persistence, independence, active learning, emancipation from problematic cultural and subcultural influences Additionally, relationships with helpers in a broad sense, and the integration of inner experiences were significant narrative strands.
The participants all had physical, existential, emotional and cognitive challenges while immersed in profound difficulties in lifestyle, social relations and ability to live in the everyday world. They particularly struggled with isolation, despair, fear, learning to understand themselves and create a place for themselves in the world. The creation of a fundamentally revised and re-integrated identity was a particular challenge that was successfully addressed. With great courage, persistence and independence, the participants fought their way through to creating a life that was successful on their own terms. This involved developing their lives in the everyday material and cultural worlds whilst establishing a nurturing connection to the realm of anomalous experiences.
The research methodology primarily involved presenting the participants with the title; “Inner development beyond distressing anomalous experiences“, then engaging and learning from the participants’ responses. An essentially participant-led approach was employed in interviews and a synthesis of dialogical and narrative methodologies was applied in the research. Four participants from the USA did seven interviews (one participant missed an interview), three from Britain did two interviews each.
In attempting a thesis that prioritized participants’ voices, tensions arose when communicating such ideas within a typical thesis structure. Initially I sought to foreground participant material before discussing definitional issues, available literature and methodology. When I tried to maintain clarity of exposition, critical thinking and comprehensibility for the reader, this initial approach was challenging. The final version of the thesis reverts to a more traditional structure and order of material, although I provide an outline of literature before the methodology, bringing participant material forwards and placing a more detailed literature chapter after the participant material to provide a structural indication of my ideal of privileging the voice of participants.
The originality of this doctorate lies in the participants' unique contribution, and analytic insights concerning dynamics between everyday consciousness and the realm of anomalous experiences
Does an Increase in Number of Deep Burrowing Earthworms Enhance Subsurface Nutrient Losses?
No full textDeep burrowing earthworms Lumbricus terrestris can be abundant along subdrain trenches, creating macropores that may serve as preferential flow paths for particles and agrochemicals to subdrains. We examined L. terrestris abundance, subdrain water discharge, and nutrient loss trends during 2002–2022 in an arable no‐till clay soil with an emerging L. terrestris density gradient. Additionally, we analyzed subdrain water discharge during heavy rainfall events and traced material movement from topsoil to subsurface drains utilizing a 137Cs marker. Between 2003 and 2009, inoculated L. terrestris started to establish at the upper edge of the field site and successive samplings revealed gradual population growth and colonization downslope. Along the 134 m field strips (N = 2), a L. terrestris mean burrow count in 2022 reached 37 m−2 (range 29–54) with a mean individual count of 27 m−2 (13–54) at the upper edge close to the inoculation area, but on average only 5 burrows (0–8) and 2 individuals m−2 (0–8) were recorded at the lower edge. Simultaneously with L. terrestris spreading, water, sediment and nutrient discharges via subsurface drains nearly doubled. Despite these concomitant trends, statistical analyses did not support the hypothesis that long‐term drainage discharges were coupled with the L. terrestris gradient. Neither were storm water discharges, nor topsoil (specifically 137Cs) migration to drains in agreement with the L. terrestris gradient. Long‐term increase in discharges were likely due to increased precipitation outside the growing season (2002–2022 trend for Oct‐Apr precip. +2.4 mm year−1) and increasing winter/spring temperatures (2002–2022 trend for Jan‐Mar temp. +0.12 deg. year−1). Additionally, different backfill materials of the upper (topsoil) and lower (wood chips) parts of the field may have affected the results. Under the given environmental conditions and cultivation, the agronomic benefits of L. terrestris activity do not appear to come with a cost of increased subdrain leaching
Balancing act of academic clinical fellows in UK emergency medicine: a qualitative study
No full textBackground
Emergency medicine (EM) faces significant workforce challenges in sustaining clinical academic careers. Academic clinical fellowships (ACFs) offer protected research time, but little is known about how EM ACFs experience and navigate these posts.
Methods
Semi-structured interviews were conducted with 20 current and former EM ACFs from 12 universities in England and Wales. Interviews were analysed using thematic analysis following Braun and Clarke’s six-phase approach. A mixed inductive and deductive framework was applied. Reflexivity and positionality were addressed through multi-researcher coding and consensus development.
Results
Six themes were identified: (1) Elements of surprise—structural ambiguity and unexpected barriers; (2) Unclear direction—limited guidance and inconsistent supervision; (3) Loneliness—professional isolation and detachment from clinical peers; (4) Engagement—enthusiasm linked to research alignment and supervisory support; (5) Repeated generic hurdles—difficulty balancing academic and clinical demands; (6) EM-specific hurdles—reduced exposure to key rotations and limited academic mentorship within EM. Fellows reported uncertainty about extensions to training and programme variability.
Conclusions
The EM ACF provides valuable entry into clinical academia; however, inconsistent structures, supervisory support and clarity in expectations hinder its full potential. Standardised induction, tailored supervision and flexible but transparent pathways are needed. These findings can inform policy, training programmes and institutional practices to better support the next generation of clinical academics in EM in the UK
‘Science is important, but why?’ Primary-age children’s lack of understanding of why we study STEM and the nature of science careers
No full textDespite persistent concerns about STEM workforce shortages in the UK, efforts to promote science study and careers have had limited success in translating into aspirations among young people. It is common for young people in Western industrialised societies to be told that it is important that they study science, but the impact of such messaging, particularly among younger children, is poorly understood. Our study asks whether pupils have absorbed the concept that science is important, why they think this is the case, and what knowledge they have of the careers that may follow from science study. Data was collected via interviews and surveys with 255 young people aged 10–11 in the North West of England. A large majority of our cohort agreed that it was important and useful to study science. However, any understanding of why this might be was superficial and circular; science matters to pass exams, gain qualifications, or become a science teacher, rather than being linked to diverse STEM careers, innovation or real-world applications. Pupils’ knowledge of science careers was narrow and stereotypical, dominated by the generic term “scientist”, medical jobs, and a handful of other roles such as astronaut or palaeontologist. Few participants recognised the breadth of science careers outside of roles encountered in daily life or those prominent in the media. These results highlight a disconnect between superficially positive attitudes and a shallow comprehension which fails to connect school science with potential career paths. Our analysis suggests that this mismatch is likely to impact low-SES groups more severely, thus threatening efforts to improve equity in the STEM workforce. We suggest a number of potential contributing factors, and propose a series of recommendations to tackle this deficit, including introducing more careers-relevant content and access to role models into primary school science lessons