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Management of Ankle Fractures: Does the Timing of Surgical Intervention Have an Impact on Patient Outcomes?
Full text link© Copyright 2025 Safdar 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 Orthopaedic surgeons frequently manage patients presenting with an ankle fracture. It has been observed that these injuries can be present in both young and elderly patients. Surgical intervention with open reduction and internal fixation is often performed for unstable ankle fractures. Methods This study was performed at a district general hospital in the United Kingdom and is a retrospective cohort study. The electronic database was reviewed from January 2021 to December 2024 to identify and review the notes for the patients to be included in the study. After identifying the patients, they were divided into two groups. The patients who had surgical intervention in less than 10 days were allocated to the early surgery group, and the patients who had surgery at day 10 or after day 10 of the injury were allocated to the delayed surgery group. Results Overall, 96 patients were included in this study, where 29 (30.21%) had early surgical intervention and 67 (69.79%) had delayed surgical intervention. The results were not statistically significant for patient outcomes between the two groups. A correlation was observed between the age of the patients and the length of hospital stay. Conclusion At present, there is no definitive consensus with regards to the optimal timing for surgical intervention of ankle fractures. The results of this study highlight that there was no significant difference for post-operative complications between the two groups, which is consistent with the literature. A study with a larger sample size is required to analyse the long-term patient outcomes
Impacts of lived experiences on staff (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
Self-supervised Text-vision Alignment for Automated Brain MRI Abnormality Detection: A Multicenter Study (ALIGN Study).
No full textPurpose To develop a self-supervised text-vision framework to detect abnormalities on brain MRI scans by leveraging free-text neuroradiology reports, eliminating the need for expertlabeled training datasets. Materials and Methods This retrospective and prospective multicenter study included 81,936 brain MRI examinations and corresponding radiology reports for adult patients at two UK National Health Service (NHS) hospitals during January 2008-December 2019 for training and internal testing, and 1,369 prospectively collected examinations between March 2022-March 2024 from four separate NHS hospitals for external testing (clinicaltrials.gov NCT043681). A neuroradiology language model (NeuroBERT) was trained using self-supervised tasks to generate report embeddings. Convolutional neural networks (one per MRI sequence) were trained to map scans to embeddings by minimizing mean squared error loss. The framework then detected abnormalities in new examinations by scoring scans against query sentences using textimage similarity. Model diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC). Results The framework achieved an AUC of 0.95 (95% CI: 0.94, 0.97) for normal versus abnormal classification and generalized to external sites with examination-level AUCs of 0.90 (95% CI: 0.86, 0.93), 0.87 (95% CI: 0.83, 0.90), 0.86 (95% CI: 0.83, 0.90), and 0.85 (95% CI: 0.81, 0.89). In five zero-shot classification tasks-acute stroke, multiple sclerosis, intracranial hemorrhage, meningioma, and hydrocephalus-the framework achieved a mean AUC of 0.89 (range, 0.77-0.93). For visual-semantic image retrieval, mean precision was 0.84 among the top 15 images across seven pathologies. Conclusion The self-supervised text-vision framework accurately detected brain MRI abnormalities without expert-labeled datasets. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license
Impact on diabetes-related health outcomes using a digitally-enabled diabetes self-management platform in Somerset, UK: An interrupted time-series analysis.
Full text link© 2025 The Authors. Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/)Background: The MyWay Diabetes (MWD) digital platform aims to improve diabetes management through personalised access to health records, structured education, and other self-management features.
Purpose: We aimed to assess health outcomes in MWD users with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) over 6 years of use.
Methods: An interrupted time-series analysis in MWD users with T1DM or T2DM in Somerset, UK, compared pre- and post-MWD registration trends to estimate differences in health outcomes (HbA1c, blood pressure, lipids, BMI, weight). Generalised estimating equations modelling adjusted for participant baseline characteristics and identified significant predictors.
Results: A total of 7207 people (T1DM: n = 750 (52.3 % female, mean age 51.2 (SD15.8)), T2DM: n = 6457 (58.1 % male, mean age 64.7 (SD12.0))) were included in the analysis. The study showed some health outcomes improved significantly for T2DM between pre- and post-MWD registration. HbA1c reduced by 8.6 mmol/mol at 24 months post-MWD registration, with greatest improvements observed in users who were younger, had shorter diabetes durations and who were frequent MWD users. All health outcomes for T1DM were unchanged.
Conclusion: The large HbA1c reduction for T2DM is notable for a scalable digitally-enabled self-management intervention and adds to the evidence base for digital interventions for diabetes self-management
Psychological Interventions Added to Standard Care Improve Pain and Function Outcomes in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.
Full text linkThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly
cited.
© 2025 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.Objective: Knee osteoarthritis is a primary cause of disability across the world and current standard care fails to address all biopsychosocial contributions to pain. The current review aims to evaluate randomised controlled trials examining the effect of adding cognitive behavioural therapy or pain coping skills training to standard care on pain and function outcomes for individuals with knee osteoarthritis.
Data sources: Systematic searches were conducted of CINAHL, EMBASE (OVID), Medline (EBSCO) and PsycINFO databases until July 2024 with no date restrictions.
Methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias was assessed using the Risk of bias 2 tool. Meta-analysis using a random-effects model was carried out using the Statistical Package for the Social Sciences, and effect sizes from standardised mean differences were calculated using Cohen's d statistic. Heterogeneity was assessed using I-squared and Tau-squared tests.
Results: Four randomised controlled trials met eligibility criteria (n = 628, mean age 62.91), demonstrating a low risk of bias. The addition of cognitive behavioural therapy or pain coping skills training to standard care for knee osteoarthritis produced statistically significant changes in standardised mean differences (p < 0.001), showing small to medium effect sizes in pain (0.488) and function (0.340) between 3- and 6-month time points. Heterogeneity measured by I-squared and Tau-squared was low for pain and function.
Conclusion: Adding psychological interventions to standard care for knee osteoarthritis improves outcomes in both pain and function. These findings support the integration of psychological interventions into clinical practice
Barriers and enablers to physical activity (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
Frailty assessments at home following a fall for hospital prevention (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
Increasing research capacity in an academically isolated mental health trust.
No full text© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.Aims and method: Involvement in clinical mental health research can be a challenge for services isolated from academic institutions, limiting opportunities for patients to receive innovative interventions and for clinicians to explore interest in research. We aimed to increase mental health research capacity in Somerset NHS Foundation Trust via a range of initiatives from collaboration between a senior clinician and research and development colleagues.
Results: Over the course of the project, the number of participants recruited to National Institute for Health and Care Research-adopted mental health and dementia research projects quadrupled over a 2-year period, from 57 to 232, and the number of projects hosted rose from 9 to 23. A total of 165 clinicians signed up to receive information about ongoing studies.
Clinical implications: We found considerable appetite for becoming involved in research among mental health clinicians, and were able to provide opportunities for research experience as well as access to innovative studies for local patients
Venesection treatment in haemochromatosis – current best practice from the BSG/BASL Special Interest Group
No full texthttp://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.Haemochromatosis is the most common single gene disorder affecting the population of the UK, resulting in iron overload and organ damage. Venesection (therapeutic phlebotomy) has been the primary treatment offered to patients for more than half a century. Despite the prevalence of the condition in the UK, there has been little progress in new treatments being offered over this time. Moreover, there is a lack of robust research to guide the optimal frequency, timing and treatment targets for venesection treatment in haemochromatosis.
Retrospective cohort studies established a clear mortality benefit when treatment is commenced before the development of liver cirrhosis—assumed to be due to limiting the progression of liver disease and development of hepatocellular carcinoma. However, the benefit of venesection on symptoms of haemochromatosis lacks quality evidence.
In this best practice description, we review the currently available literature on the benefits and limitations of venesection treatment. We describe current practice as reflected by the experiences of a multidisciplinary team of professional members of the British Society of Gastroenterology/British Association for the Study of the Liver haemochromatosis Special Interest Group. We describe a framework and recommendations for treatment in addition to describing the management of treatment side effects and complications. Through this work and the establishment of consistency in treatment, patients will benefit from better evidence-based care and the profession will be better able to identify the potential value of future treatments
Changing the bar for B12 deficiency: possible clinical impact of NICE’s thresholds revisions
No full textOpen Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/