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Should eosinophilic oesophagitis be treated in children? What are the long-term consequences of eosinophillic oesophagitis? (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
The role of heart rate variability in cardiac surgery: applications and innovations
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/.Background
Heart rate variability, the physiological variation in time intervals between successive heartbeats, is a valuable marker used to index the functionality of the cardiac Autonomic Nervous System in healthy individuals and patients with cardiovascular and non-cardiovascular disorders. In cardiac surgery, heart rate variability can be a crucial tool for the operative management of patients. This manuscript reviews the role of heart rate variability in surgery, its current applications, and emerging trends in clinical settings.
Main body
Clinically, heart rate variability is used to evaluate surgical risk by identifying patients with impaired autonomic function who may be predisposed to complications such as arrhythmias or hemodynamic instability. During surgery, heart rate variability monitoring provides real-time insights into autonomic responses to anesthesia, fluid management, and surgical stress. Postoperatively, heart rate variability is instrumental in detecting early signs of sepsis, myocardial dysfunction, and autonomic dysregulation, thereby guiding timely interventions. Despite its clinical potential, heart rate variability analysis faces challenges, including variability in measurement techniques, limited standardization of interpretation, and the influence of confounding factors such as medications and mechanical ventilation. Additionally, real-time integration into surgical workflows remains underdeveloped.
Conclusions
Emerging trends in heart rate variability in cardiac surgery include the use of artificial intelligence for automated heart rate variability analysis, wearable biosensors for continuous monitoring, and tailored therapeutics. There are also new advances in machine-learning algorithms for heart rate variability interpretation, which are promising for enhancing ischemia detection and refining real-time decision-making during high-risk cardiac procedures. Thus, future research should focus on refining heart rate variability–based predictive models and integrating heart rate variability metrics into multimodal perioperative management strategies to improve surgical outcomes
Examining the Cognitive, Practical, and Emotional Demands of Managing Physical Activity in Adolescents With Type 1 Diabetes: A Qualitative Study With Adolescents, Parents, and Healthcare Professionals.
No full textCopyright © 2025 Emma Joanne Cockcroft et al. Pediatric Diabetes published by John Wiley & Sons Ltd. This is an open accessarticle under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in anymedium, provided the original work is properly cited.Objective: Adolescents with type 1 diabetes (T1D) face unique barriers to physical activity (PA), and most do not meet recommended targets despite its recognised health benefits. To address the lack of tailored, evidence-based support for this group, this study explores how adolescents manage PA and how it is influenced by the wider support system, including parents, carers, and healthcare professionals (HCPs).
Research design and methods: Semi-structured interviews were conducted with adolescents with T1D (n = 11), parents/carers (n = 15), and HCPs (n = 11). Adolescents were aged between 12 and 18 (64% female). HCPs were dieticians (n = 7), nurses (n = 2), a doctor (n = 1) and a health and wellbeing practitioner (n = 1). Interviews explored practical, emotional, and contextual factors influencing PA. Data were analysed using thematic analysis.
Results: Participants described cognitive, emotional, and practical demands of managing T1D during PA. Thematic analysis identified three overarching themes: (1) the mental effort required to manage diabetes with PA, including parental anxiety, desire for normality, and unpredictability of glucose responses; (2) practical and organisational challenges, such as access to supportive environments, technology, and activity-specific logistics; and (3) adaptive management strategies, including trial and error, parental involvement, peer learning, and variable clinical support. Current support was often generic, leading families to rely on self-devised strategies and informal networks to support their individual needs.
Conclusion: Enhanced, youth-friendly, and activity-specific guidance is needed for adolescents with T1D. This should include training for healthcare professionals, teachers, and coaches. Future work should prioritise the co-design of resources and interventions with young people and families, integrating structured peer support.This study was funded via an National Institute for Health andCare Research (NIHR) School for Primary Care Research Post-doctoral Fellowship (C010) award to the corresponding author(EC). RPD is supported by NIHR Award (Ref NIHR304587).This study was supported by the National Institute for Healthand Care Research Exeter Biomedical Research Centre
Do-not-attempt-cardiopulmonary resuscitation decisions in critical care: The gap between theory and practice.
No full textThe provision or withholding of Cardiopulmonary Resuscitation (CPR) is often a source of much controversy. Do-Not-Attempt CPR (DNACPR) decisions have been discussed extensively from an ethical and legal point, not to mention featuring heavily in the news. We aim to discuss various aspects of DNACPR decision-making with particular relevance to the Intensive Care environment. In doing so, we highlight important concepts associated with decision-making and common challenges encountered. Firstly, we provide a broad oversight of the current context in which such decisions are made before describing the principal ethical points of consideration and their relevance. This is followed by insights from a legal point as well as practical suggestions for approaching such decisions. It is hoped that these will help to assist clinicians with making such complex decisions under challenging circumstances
Efficacy and Safety of Aldosterone Synthase Inhibitors in Hypertension: A Systematic Review and Meta-Analysis.
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). Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.Background: Hypertension remains a major contributor to global cardiovascular morbidity and mortality. Aldosterone, a key hormone in blood pressure regulation, plays a significant role in hypertension pathophysiology. This has led to growing interest in aldosterone synthase inhibitors (ASIs) as a potential treatment. This meta-analysis aims to evaluate the efficacy and safety of ASIs in managing hypertension.
Methods: A systematic search of PubMed, Google Scholar and Cochrane Central was conducted up to 13 July 2025, to identify randomised controlled trials (RCTs) evaluating ASIs in hypertensive adults. Data were analysed using RevMan version 5.4, employing random-effects models with significance set at p < 0.05.
Results: A total of 8 RCTs were included, with a total of 2003 participants in the ASI group and 650 participants in the placebo group. ASIs significantly reduced systolic blood pressure (SBP) compared to placebo (MD: -6.01 mmHg; 95% confidence interval [CI]: -9.31 to -2.71; I2 = 85%; p = 0.0004); diastolic blood pressure (DBP) was found to be comparable between the two groups (MD: -2.20 mmHg; 95% CI: -4.46 to 0.06; I2 = 69%; p = 0.06). There was a significant reduction in serum aldosterone levels favouring ASI use (MD: -1.46; 95% CI: -2.76 to -0.16; I2 = 99%; p < 0.00001). The risk of serious (RD: 0.00; 95% CI: -0.01 to 0.02; I2 = 30%; p = 0.75) and non-serious adverse events (RD: 0.05; 95% CI: -0.02 to 0.12; I2 = 64%; p = 0.20) did not differ significantly between ASI and placebo groups. However, ASI use was associated with a significantly higher risk of hyperkalemia (RD: 0.04; 95% CI: 0.02 to 0.06; I2 = 70%; p = 0.002).
Conclusion: ASIs effectively lower SBP and serum aldosterone in adults with hypertension. They appear safe overall but may increase the risk of hyperkalemia
Warm compression and perineal massage in the second stage of labour: a proposal for an audit of women's records of care and midwives' knowledge
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Inequalities in Gastrointestinal Care Provision in the United Kingdom.
No full textBackground: Gastrointestinal (GI) and liver diseases impose a substantial burden on the United Kingdom's health system, ranking among the leading causes of mortality, cancer-related deaths, and hospital admissions. Despite the universal framework of the National Health Service (NHS), profound inequalities persist across socioeconomic, geographic, and ethnic lines.
Objectives: This review focuses on colorectal cancer (CRC) and hepatocellular carcinoma (HCC) as exemplar conditions, synthesising current evidence on disparities across the care continuum and exploring strategies to mitigate them.
Methods: Current national data and published evidence were reviewed to assess inequities in disease prevalence, access to care, and outcomes across socioeconomic strata, regions, and ethnic groups. The analysis also examined workforce distribution, policy frameworks, and emerging interventions aimed at addressing these disparities.
Results: Disease prevalence and outcomes are markedly worse in socioeconomically deprived regions; liver disease mortality is more than twice as high in the poorest deciles, and CRC survival is significantly lower among disadvantaged populations. Access to care remains uneven-deprived groups exhibit lower CRC screening uptake, delayed diagnoses, and higher emergency presentation rates. Routine HCC surveillance in at-risk patients is inconsistently delivered. Workforce shortages and maldistribution exacerbate these inequities, with under-resourced regions facing longer waiting times and limited specialist access. Systemic challenges, including social determinants, data deficits, and policy underprioritisation, further hinder progress.
Emerging developments: Promising advances include the NHS's expansion of community diagnostic centres, targeted workforce investment, national hepatitis C virus (HCV) elimination programmes, and structural interventions such as minimum unit pricing for alcohol. Technological innovations-including non-invasive diagnostics and digital tools-offer additional opportunities to bridge care gaps.
Conclusions: Targeted actions, such as implementing primary care FibroScan services, CRC outreach initiatives with GP endorsement, and patient navigation for HCC surveillance, are critical to reducing inequalities and improving outcomes. By addressing upstream determinants and ensuring that innovations reach under-served populations, the UK can progress toward reducing GI health inequalities, improving outcomes, and achieving more uniform digestive health across al
Pulmonary embolism rule out criteria (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
Fighting the spread
No full textNitesh Kumar outlines the management of dental infections and abscesses.
Aim
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To understand the principles of recognition and treatment of patients with spreading dental infection in the hospital and general practice environment using the ‘ABCDE’ approach.
Objective
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Identify common signs of spreading dental infection.
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Describe how to assess the patient using the ‘ABCDE’ approach.
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Discuss the treatment and management of a patient with a spreading infection from a dental abscess
Digital inclusion or exclusion and accessing health and social care (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