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Patient Safety bulletin November 2025 (current awareness bulletin)
No full textThis is a bulletin produced by the Somerset NHS Foundation Trust Knowledge and Library Service. It is intended to provide a range of the most up-to-date resources, including recently published guidelines and research articles, news and policy items at the time of the production. Please note, you may not get access to full-text articles or links may be disabled
The Current Landscape of Pancreatic Cancer Management in Sub-Saharan Africa - A Perspective Review.
No full textThis 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). Health Science Reports published by Wiley Periodicals LLC.Background and aims: Pancreatic cancer remains a significant public health challenge in Sub-Saharan Africa (SSA), with a high mortality-to-incidence ratio driven by late-stage diagnoses, limited therapeutic access, and systemic healthcare disparities. This perspective aims to synthesize current evidence on the epidemiology, diagnostic capacity, treatment options, and structural barriers contributing to poor outcomes, while highlighting opportunities for targeted interventions and policy reforms.
Methods: We conducted a narrative review of peer-reviewed literature, regional reports, and epidemiological studies describing the burden and management of pancreatic cancer across SSA. Data were synthesized to characterize diagnostic pathways, surgical and palliative care practices, workforce capacity, and environmental risk factors. Strategies to address identified gaps were developed based on published evidence from similar resource-constrained settings.
Results: Available data indicate that over 80% of patients in SSA present with advanced or metastatic disease. Diagnostic imaging, including CT and MRI, remains inaccessible in many regions, and biopsies are frequently obtained intraoperatively due to limited endoscopic capacity. Curative surgical resections are rare (< 10%), with palliative bypass procedures predominating. Chemotherapy and radiotherapy services are inconsistently available, and access to opioid analgesics remains below 50% in many centres. Contributing factors include underdeveloped infrastructure, insufficient specialized training, high out-of-pocket costs, and heavy metal environmental exposures.
Conclusion: Improving pancreatic cancer outcomes in SSA requires a comprehensive, multi-sectoral response that prioritizes infrastructure investment, workforce training, and equitable access to diagnostics and therapies. Establishing regional cancer centres, expanding perioperative and palliative nursing roles, strengthening cancer registries, and enforcing environmental regulations are critical steps. Collaboration with international organizations and community stakeholders will be essential to develop context-specific guidelines and sustainable solutions that can reduce disease burden and improve survival rates in the region
Dentistry, high BMI and intravenous sedation (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
Investigating the acceptability of cervical screening, using conventional clinician-taken cervical samples or urine self-sampling, at 6 weeks postnatal: A cross-sectional questionnaire.
No full textObjectivesUnited Kingdom (UK) guidelines recommend delaying cervical screening due during pregnancy to 12 weeks postnatal, despite a lack of supporting evidence. This questionnaire-based study aimed to determine the feasibility of a clinical study of cervical screening and urine self-sampling for human papillomavirus (HPV) at 6 weeks postnatal, as pilot work suggested this would improve uptake, if offered at the routine postnatal check-up.MethodsFemales who were pregnant/recently pregnant were invited to participate in a web-based questionnaire. Questions assessed acceptability of postnatal cervical screening at 6 weeks postnatal, analysed with chi-square, Fisher's exact and Mann-Whitney tests. Free-text responses were coded using the Theoretical Framework of Acceptability (TFA) to conduct a qualitative content analysis.ResultsAmong the 454 participants, 266 (58.6%) would be more likely to undergo cervical screening if offered at 6 weeks postnatal, and an even higher proportion expressed increased willingness if urine self-sampling were offered ( = 338; 74.4%). Two-thirds (308/454; 67.8%) would be willing to be screened at 6 weeks postnatal for a research study and 356/454 (78.4%) if it would be limited only to urine self-sampling. When considering screening modality, over half (245/454; 54%) would prefer urine self-sampling to cervical screening, although a fifth (93/454; 21%) preferred conventional sampling. Free-text responses were provided by 279 participants, and these highlighted that affective attitude and burden TFA constructs underpinned prospective acceptability of having screening at 6 weeks postnatal.ConclusionsOffering cervical screening at the 6-week postnatal check-up has potential to increase cervical screening participation. Most participants would be interested in taking part in the research. The feasibility of screening at 6 weeks postnatal and concurrent acceptability should be tested in pilot clinical studies.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Medical Research Council, National Institute for Health and Care Research, Manchester Biomedical Research Centre (grant numbers MR/X030776/1, NIHR300650, NIHR203308)
MCAS and HEDS as well as comorbid conditions (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
Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial.
Full text link© 2025 Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground
The health risks of severe obesity can be reduced with metabolic and bariatric surgery, but it is uncertain which operation is most effective or cost-effective. We aimed to compare Roux-en-Y gastric bypass, adjustable gastric banding, and sleeve gastrectomy in patients with severe obesity.
Methods
By-Band-Sleeve is a pragmatic, multi-centre, open-label, randomised controlled trial conducted in 12 hospitals in the UK. Eligible participants were adults (aged ≥18 years) meeting national criteria for metabolic and bariatric surgery. Initially, a 2-group trial (Roux-en-Y gastric bypass versus adjustable gastric banding) became a 3-group trial to include sleeve gastrectomy at 2·6 years from study opening, when it became widely used in the UK. Co-primary endpoints were weight (proportion achieving ≥50% excess weight loss) and quality-of-life (EQ-5D utility score) at 3 years. If the proportion achieving at least 50% excess weight loss was non-inferior (<12% difference between groups) and quality-of-life was superior, sleeve gastrectomy and Roux-en-Y gastric bypass were considered more effective than adjustable gastric banding, and sleeve gastrectomy more effective than Roux-en-Y gastric bypass. Cost-effectiveness of the procedures was compared. This trial is registered with ClinicalTrials.gov, NCT02841527, and ISRCTN, 00786323.
Results
Between Jan 16, 2013, and Sept 27, 2019, 1351 participants were randomly assigned; five withdrew consent and 1346 (mean age 47·3 [SD 10·6] years, 1020 [76%] women, 324 (24%) men, and two with missing data, mean weight of 129·7 kg [23·6] and mean BMI of 46·4 [6·9] kg/m2) were included in this report. Of 1346 participants, 462 (34%) were in the Roux-en-Y gastric bypass group, 464 (34%) in the adjustable gastric banding group, and 420 (31%) in the sleeve gastrectomy group. 1183 (88%) participants underwent surgery. 276 (68%) of 405 participants in the Roux-en-Y gastric bypass group, 97 (25%) of 383 participants in the adjustable gastric banding group and 141 (41%) of 342 participants in the sleeve gastrectomy group achieved at least 50% excess weight loss (adjusted risk difference: Roux-en-Y gastric bypass vs adjustable gastric banding 41% [98% CI 34 to 48]; sleeve gastrectomy vs adjustable gastric banding 15% [5 to 24]; sleeve gastrectomy vs Roux-en-Y gastric bypass, –26% [–36 to –16%]). Mean EQ-5D scores were 0·72 for Roux-en-Y gastric bypass, 0·62 for adjustable gastric banding, and 0·68 for sleeve gastrectomy (adjusted mean difference: Roux-en-Y gastric bypass vs adjustable gastric banding 0·08 [0·04 to 0·12], sleeve gastrectomy vs adjustable gastric banding 0·05 [0·01 to 0·09], and sleeve gastrectomy vs Roux-en-Y gastric bypass –0·03 [–0·07 to 0·01]). 1651 adverse events were reported following surgery (5·7 per year after sleeve gastrectomy, 6·0 per year after Roux-en-Y gastric bypass, and 4·6 per year after adjustable gastric banding). There were 11 deaths from randomisation to 3 years: one attributable to surgery (in the adjustable gastric bypass group, during the surgical admission) and ten not attributable to surgery (four each in the Roux-en-Y gastric bypass and adjustable gastric banding groups and two in the sleeve gastrectomy group). Roux-en-Y gastric bypass was most cost-effective.
Interpretation
Roux-en-Y gastric bypass and sleeve gastrectomy are more effective than adjustable gastric banding. Sleeve gastrectomy has inferior weight loss and lower mean quality of life score compared with Roux-en-Y gastric bypass. Based on this evidence, it is recommended that patients electing to have metabolic and bariatric surgery are advised to have Roux-en-Y gastric bypass. Where contraindicated or unfeasible, sleeve gastrectomy should be offered. This evidence does not support adjustable gastric band as standard treatment for severe obesity.National Institute for Health and Care Research Health Technology Assessment Programme
Prevalence of co-occurrence of ADHD and Autism (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
Randomized Controlled Trials of Weight Loss Before Hernia Surgery: A Systematic Review and Meta-Analysis.
No full textCopyright © 2025 McLurcan, Sanders, Hollyman, Lamb and Findlay. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these termsPurpose: Hernia repairs are one of the commonest operations performed in the world. In Europe and the United States of America more than half of patients undergoing hernia surgery are overweight or obese; body weight is therefore key modifiable risk factor before surgery. We aimed to identify, appraise, and synthesise the randomized controlled trial (RCT) evidence for any weight loss interventions before any form of hernia surgery.
Methods: A search was performed in April 2025 of the PubMed, EMBASE and CENTRAL databases. Meta-analysis was performed using random effects to assess mean difference in weight, and fixed effects for odds ratio of complications. Bias was assessed using the Cochrane Rob2 tool. Certainty effect was assessed using GRADE methodology. This review was registered with PROSPERO (ID 1024784).
Results: 1,707 studies were screened, 20 retrieved, and 4 reports of 3 RCTs included. A total population of 219 patients largely underwent ventral hernia repair, although 2 RCTs also included patients undergoing non-hernia surgery. Interventions comprised very low calorie diets (VLCD), and a multidisciplinary programme. Meta-analysis for VLCD did not show a reduction in weight loss (3.64 kg [95% confidence interval -2.07 - 9.35]) or complications [odds ratio 0.36 (0.1-1.28)]. Risk of bias was "high," and certainty of effect "very low."
Discussion: Despite the prevalence and importance of obesity in patients undergoing elective hernia repair, and the popularity of weight loss as part of prehabilitation, the randomized evidence of how to effect weight loss, and whether this translates into an improvement in clinical outcomes is minimal. This highlights the urgent need for large and robust RCTs to determine if weight loss before hernia repair is effective in improving outcomes for patients, and how this is best achieved
Implementing recommendations for routine mismatch repair (MMR) immunohistochemistry (IHC) testing of endometrial cancer and subsequent patient management.
No full text© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.Lynch syndrome is associated with an increased risk of cancer, including endometrial cancer. We audited the introduction of a nurse-led testing and management pathway for Lynch syndrome. All 191 patients diagnosed with endometrial cancer at Somerset NHS Foundation Trust between January 2022 and December 2023 were tested for mis-match repair (MMR) protein immunohistochemistry; germline testing was offered to all 13 who were eligible. Seven patients were diagnosed with Lynch syndrome; all were referred for bowel screening and Helicobacter pylori testing. Information about prophylactic aspirin recommendations was missing for 3/7 patients. We established an effective, nurse-led Lynch syndrome testing pathway, in line with national guidelines
Mental Health & Learning Disabilities bulletin February 2025 (current awareness bulletin)
No full textThis is your monthly Current Awareness Bulletin produced by Somerset Foundation Trust Knowledge & Library Services. It is intended to provide you with a range of the most up-to-date resources, including recently published guidelines and research articles, news and policy items