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Nasogastric tube insertion using lidocaine spray in adult stroke patients (evidence summary)
No full textThis is an evidence summary produced by the Somerset NHS Foundation Trust Knowledge and Library Service
Disclaimer: We will endeavour to use the best, most appropriate and most recent sources available to ensure that the information supplied is accurate, up-to-date and evidence-based. It is the responsibility of the requestor to determine the accuracy, validity and interpretation of the search results. No responsibility can be taken by the library for any action taken on the basis of this information. New evidence may have been published since the date this evidence summary was created
How are primary and secondary care changing the way they work together (evidence summary)
No full textThis is an evidence summary produced by the Somerset NHS Foundation Trust Knowledge and Library Service
Disclaimer: We will endeavour to use the best, most appropriate and most recent sources available to ensure that the information supplied is accurate, up-to-date and evidence-based. It is the responsibility of the requestor to determine the accuracy, validity and interpretation of the search results. No responsibility can be taken by the library for any action taken on the basis of this information. New evidence may have been published since the date this evidence summary was created
Quantification of Droplet Aerosol Generation During Phacoemulsification and Pars Plana Vitrectomy
No full text© Copyright 2026
Suresh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction Intraocular procedures such as phacoemulsification and pars plana vitrectomy (PPV) may generate fine droplet aerosols that are relevant to infection control, particularly in the context of SARS-CoV-2. Data on aerosol production during cataract and vitrectomy surgery, especially in human tissue and with different wound constructions, remain limited. This study used a high-sensitivity optical particle spectrometer to quantify droplet aerosols (0.12-8.00 μm in diameter) generated during phacoemulsification in cadaveric human eyes with 2.2 mm and 2.75 mm corneal incisions, to assess whether hydroxypropyl methylcellulose (HPMC) reduces aerosol production, and to measure aerosol generation during individual steps of PPV. Methods Tests were performed on one model eye and two human cadaveric eyes. A printed optical particle spectrometer (POPS) was used to measure droplet aerosol generation during phacoemulsification through 2.2 mm and 2.75 mm main corneal incisions, with and without HPMC coating, and during predefined stages of 23-gauge PPV. Particle number concentration (PNC, particles cm⁻³) was recorded each second and summarised as mean PNC for each condition. Results In this small series, mean PNC during phacoemulsification without HPMC appeared to be higher with 2.75 mm incisions than with 2.2 mm incisions, and counts of particles >1 μm in diameter were also greater. Application of HPMC was associated with reduced aerosol counts. The maximum measured mean PNC without HPMC for 2.2 mm corneal incisions was 88 cm⁻³, which fell to 66 cm⁻³ with HPMC (p<0.05). For 2.75 mm incisions, the maximum measured mean PNC without HPMC was 493 cm⁻³, falling to 61 cm⁻³ with HPMC (p<0.05). No increase in droplet aerosol was detected during vitrectomy apart from during air infusion through a leaking trocar valve. Conclusion To our knowledge, this is the first study to use whole cadaveric human eyes in combination with a high-sensitivity optical particle spectrometer to quantify airborne particle number and size during phacoemulsification and PPV. In this model, droplet aerosol production during cataract surgery appeared lower with 2.2 mm incisions and with HPMC coating of the cornea. Droplet aerosols may be generated during vitrectomy when air infusion is delivered through a leaking trocar valve, highlighting the importance of port integrity
Randomized controlled trial of job crafting as a digital health intervention for occupational burnout in psychological therapists
No full textFor the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission.Objective: Occupational burnout is common in the mental healthcare workforce, with negative consequences for professionals and patients. This study aimed to evaluate the efficacy of a digital health intervention to alleviate burnout in psychological therapists. Method: This randomized controlled trial recruited 135 therapists working across 17 psychological services in England. The intervention involved six online group webinars based on principles of job crafting. Half of the participants accessed the intervention immediately (group 1) and half were assigned to a waitlist control group (group 2). After 6 weeks, group 2 started the intervention. Participants completed measures of burnout (primary outcome), wellbeing, and job satisfaction at four time-points (baseline, 6, 12, 36 weeks). Outcomes were compared between groups using mixed-effects models controlling for baseline severity and clustering by service. Results: Differences between groups were statistically significant after 6 weeks, favoring job crafting versus waitlist control in burnout (d = 0.43, p < .001), wellbeing (d = -0.39, p = .023), and job satisfaction (d = -0.28, p = .006) measures. However, the magnitude of improvements relative to baseline levels declined over a 36-week period. Conclusion: A brief job crafting intervention led to short-term improvements in occupational health indicators
Enhancing heart valve disease surveillance: a quality improvement project demonstrating cost-effective triaging and Clinical Scientist-led services to improve patient care.
No full text© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The
Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available
in this article, unless otherwise stated in a credit line to the dataHeart valve disease (HVD) is increasing in prevalence in the UK due to the ageing population, placing greater demands on diagnostic heart valve clinics. While many services recognise the need to improve efficiency and standardisation, initiating and implementing excellent quality improvement projects (QIPs) remains a challenge. Particularly for time-constrained service leads with limited resources and experience. This QIP describes a practical, replicable intervention to enhance HVD surveillance services using structured process mapping, root cause analysis and iterative Plan-Do-Study-Act (PDSA) cycles. Key issues identified included premature surveillance bookings, delays in result dissemination, and underutilisation of Clinical Scientists, contributing to inefficient workflows for consultant cardiologists and unnecessary visits for patients. The project introduced guidelined-aligned surveillance intervals, a refined triaging system, and a parallel Clinical Scientist-Led Valve Clinic (SLVC) pathway. Over four PDSA cycles, adherence to British Society of Echocardiography surveillance guidelines improved from 33% to 88%. Mean surveillance earliness was reduced from 3.4 months to 1.2 months in the Cardiologist-Led Care (CLC) pathway and to 0.5 months in the SLVC. Result dispatch times also improved significantly, with SLVC letters averaging 1.4 days (93% dispatched within five working days). A simple cost model suggested a 21% cost reduction if the SLVC pathway was scaled across the surveillance population, with estimated productivity gains of 12% in CLC and 17% through the SLVC, yielding a total projected improvement of 15%. These gains are attributed to optimised triaging, reduced overprocessing and the lower per-patient cost of SLVC delivery. This paper provides a detailed, real-world example of an adaptable QIP. It offers a practical framework for improving HVD surveillance services in resource-constrained settings while achieving measurable clinical and operational benefits
Five-Year Analysis of Microbial Keratitis Incidence, Isolates, and In Vitro Antimicrobial Sensitivity in the South West of England: An Epidemiological Study.
No full textCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland.
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).To determine the incidence, causative organisms, and treatment effectiveness for microbial keratitis (MK) in the Southwest of England. Retrospective analysis of 872 corneal scrapes (January 2018-December 2022). Microbiology results were evaluated for organism growth and antimicrobial sensitivity. Data were divided into two groups for trend analysis (A: 2018-2020, B: 2021-2022). Of the 872 scrapes, 357 (39.6%) were culture positive. Bacteria accounted for 90.2% of cases, followed by viruses (2.8%), fungi (2.5%), mixed bacterial growth (2.5%), and Acanthamoeba (2.0%). The estimated incidence of MK was 9.69/100,000/year. Group B had a significantly higher overall MK incidence, with no change in pathogen distribution. was the most frequent isolate (69 cases, 19.3%). In vitro sensitivity to fluoroquinolones was 94.4% for Gram-positive and 98.6% for Gram-negative bacteria. All fungal isolates were sensitive to at least one antifungal. Bacterial pathogens dominate MK in the Southwest of England, with over 90% sensitivity to chloramphenicol, fluoroquinolones, and aminoglycosides, indicating low antimicrobial resistance. Fluoroquinolones remain the recommended first-line therapy for MK. Fungal and protozoal keratitis are rare (<3% of cases), supporting bacteria-focused empirical treatment with close monitoring
Finerenone and Its Cardiorenal Protective Effects: A Meta-Analysis of 21,731 Patients From Randomized Trials.
No full textFinerenone, a nonsteroidal mineralocorticoid receptor antagonist, has emerged as a promising therapy for patients with diabetes, chronic kidney disease, heart failure (HF), or diabetes. We aimed to summarize the current evidence on its cardiovascular (CV) and renal benefits. A systematic search of PubMed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov was conducted up to July 21, 2024. Randomized controlled trials assessing finerenone's effects on CV and renal outcomes were pooled using a random-effects model, with results expressed as risk ratios (RRs) or mean differences (MDs) with corresponding 95% confidence intervals. Nine randomized controlled trials with 21,731 participants were included. Finerenone significantly reduced all-cause mortality (RR, 0.92; P = 0.03), major adverse CV events (RR, 0.85; P < 0.00001), and HF hospitalizations (RR, 0.82; P < 0.00001). It lowered the risk of sustained ≥57% estimated glomerular filtration rate decline (RR, 0.70; P = 0.01), slowed overall estimated glomerular filtration rate deterioration (MD, -1.65; P = 0.02), and reduced urine albumin-to-creatinine ratio (MD, -0.28; P < 0.00001). CV death showed a nonsignificant reduction (RR, 0.90; P = 0.05), while myocardial infarction risk (P = 0.37), adverse events (P = 0.40), and discontinuations (P = 0.45) were similar between groups. However, hyperkalemia risk was higher with finerenone (RR, 2.05; P < 0.00001). Finerenone provides significant cardiorenal benefits, reducing CV events, HF hospitalizations, and kidney disease progression in patients with chronic kidney disease, HF, and diabetes, with a favorable safety profile aside from increased hyperkalemia risk. These findings support its role as an effective add-on to standard cardiorenal therapies
The use of Family Therapy or Maudsley Approach for the treatment of Anorexia Nervosa (evidence summary)
No full textThis is an evidence summary produced by the Somerset NHS Foundation Trust Knowledge and Library Service
Disclaimer: We will endeavour to use the best, most appropriate and most recent sources available to ensure that the information supplied is accurate, up-to-date and evidence-based. It is the responsibility of the requestor to determine the accuracy, validity and interpretation of the search results. No responsibility can be taken by the library for any action taken on the basis of this information. New evidence may have been published since the date this evidence summary was created
Evidence relating to protected characteristics (e.g. age, disability, gender identity, ethnicity) and how these may influence experiences of violence, aggression, or perceptions of safety (evidence summary)
No full textThis is an evidence summary produced by the Somerset NHS Foundation Trust Knowledge and Library Service
Disclaimer: We will endeavour to use the best, most appropriate and most recent sources available to ensure that the information supplied is accurate, up-to-date and evidence-based. It is the responsibility of the requestor to determine the accuracy, validity and interpretation of the search results. No responsibility can be taken by the library for any action taken on the basis of this information. New evidence may have been published since the date this evidence summary was created
Anemia in pregnancy: a systematic review and meta-analysis of prevalence, determinants, and health impacts in Egypt.
No full text© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Background: The WHO considers anemia in pregnancy a severe public health issue when prevalence surpasses 40%. In response, we conducted a systematic review and meta-analysis to examine anemia among pregnant women in Egypt, focusing on its prevalence, determinants, and associated complications.
Methods: We conducted a systematic literature search for studies published between January 1, 2010, and August 18, 2024, to identify studies from Egypt reporting on anemia in pregnant women, including its prevalence, associated determinants, and complications. A meta-analysis was conducted using a random-effects model to estimate pooled prevalence, odds ratios (OR), and standardized mean differences (SMD). Sensitivity analyses and publication bias were performed. All statistical analyses were conducted using R software.
Results: Eighteen studies met the eligibility criteria with a total sample size of 14,548. The overall prevalence of anemia among pregnant women was 49% (95% CI: 42-57), with no significant difference between Upper and Lower Egypt (P = 0.66). The sensitivity analysis demonstrated the absence of influential outliers and Egger's test indicated no evidence of publication bias (P = 0.17). Anemia prevalence was significantly higher in the third trimester (65%) compared to the second trimester (47%) (P = 0.03). Among anemic pregnant women, most cases were mild (47%) and moderate (47%). The determinants of anemia among pregnant women included being over 30 years old (OR: 1.95), residing in rural areas (OR: 1.76), illiteracy (OR: 1.93), birth spacing < 2 years (OR: 2.04), lack of iron supplementation (OR: 2.59), presence of intestinal parasites (OR: 1.38), antenatal visits < 5 (OR: 5.27), multiparity, and low income, all with statistical significance (p < 0.05). Regarding dietary determinants, a low intake of meat, vegetables, fruits, and high tea consumption was consistently associated with a higher risk of anemia. For neonatal complications, infants born to anemic mothers had significantly lower Apgar scores, gestational ages, and birth weights (P < 0.05), with birth weight being the most adversely impacted (SMD = -1.3).
Conclusions: This meta-analysis shows 49% anemia prevalence in pregnant Egyptian women, indicating severe health concern. The findings highlight the urgent need for targeted interventions aimed at addressing the key determinants identified in this study