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Safety and Efficacy of Busulphan Based on Dosing Patterns in the Real-World Management of Myeloproliferative Neoplasms.
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 properlycited.© 2025 The Author(s). eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.Introduction: Myeloproliferative neoplasms (MPNs), such as polycythaemia vera (PV), essential thrombocythemia (ET) andmyelofibrosis (MF), are primarily treated by managing blood counts to reduce the thrombotic risk using cytoreductive agents.Busulphan, an oral alkylating agent, has been historically used for MPN management due to its myelosuppressive effects, butconcerns about its risk of leukaemic transformation have limited its use.Methods: This real-world retrospective study evaluated the safety and efficacy of busulphan in 115 MPN patients across 13 UKhospitals. Responses in patients with ET and PV only were assessed using European LeukemiaNet (ELN) criteria.Results: With a median age of 78 years, the overall response rate was 78.1%, with 29% of PV and 18% of ET patients achievingcomplete responses. Dosing regimens were similarly distributed between repeated single doses of busulphan (31%), courses oftreatment lasting 1–4 weeks (30%) and continuous therapy for more than 4 weeks (35%). No cases of disease progression to acuteleukaemia or myelofibrosis were recorded during the median follow-up of 23 months. Adverse events were infrequent, with fatigueand cytopaenia being the most common (4% each).Conclusion: Busulphan demonstrated a favourable safety profile and is a viable cytoreductive option, particularly for elderlypatients who are intolerant to hydroxycarbamide.Trial Registration: The authors have confirmed clinical trial registration is not needed for this submissio
Critical care and the law - pertinent cases from 2024.
No full textThis review by the Legal and Ethical Advisory Group (LEAG) follows the 2023 summary, reviewing the important legal cases and Prevention of Future Deaths reports (PFDs) ruled or issued in 2024 that are pertinent to Intensive Care Medicine. The legal cases include Human Rights cases, Clinical Negligence cases, and rulings of the Court of Protection. Not all of the cases relate to events which have occurred in Intensive Care, however the rulings will have a bearing on Intensive Care practice
Simple hysterectomy with pelvic lymphadenectomy versus radical hysterectomy with pelvic lymphadenectomy for women with stage IA2-IB1 cervical cancer.
No full textRationale: Radical hysterectomy is a standard operation for women with early-stage cervical cancer, involving removal of the womb, cervix (neck of the womb), surrounding tissues (parametrial tissue), and part of the vagina. Given a relatively low risk of parametrial involvement in a selected group of women with early-stage cervical cancer, simple hysterectomy (removing only the uterus and cervix) with pelvic lymphadenectomy (surgical removal of the lymph glands found in the pelvis) might be an alternative option to reduce risk of complications.
Objectives: To determine the benefits and harms of simple hysterectomy with pelvic lymphadenectomy versus radical hysterectomy with pelvic lymphadenectomy for women with stage IA2-IB1 cervical cancer.
Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), Web of Science Core Collection, PubMed, and two trial registry databases, along with reference checking and citation searching. The last search date was 19 March 2025.
Eligibility criteria: We included randomised clinical trials comparing simple hysterectomy with pelvic lymphadenectomy versus radical hysterectomy with pelvic lymphadenectomy for women with cervical cancer FIGO 2019 stage IA2-IB1.
Outcomes: Critical outcomes were all-cause mortality, overall survival (OS), cancer-related mortality, and disease-free survival (DFS). Important outcomes included cancer recurrence, adverse events, sexual dysfunction, cost-effectiveness, and quality of life (QoL).
Risk of bias: Two review authors independently assessed the risk of bias of each included study using the Cochrane Risk of bias 2 (RoB 2) tool.
Synthesis methods: We conducted meta-analyses using random-effects models to calculate hazard ratios (HRs), risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) for all outcomes. We used GRADE to assess the certainty of evidence.
Included studies: We included two trials involving 740 participants. One small trial was conducted in Brazil (40 participants). The larger trial, involving 700 participants, included centres in Western Europe, South Korea, and Canada. In this larger trial, 75.0% of participants were white. We classified one report as awaiting classification, and did not identify any ongoing studies.
Synthesis of results: Critical outcomes Low-certainty evidence revealed that simple hysterectomy may result in little or no difference in all-cause mortality (RR 1.12, 95% CI 0.44 to 2.89; I2 = 0%, 2 studies, 740 participants), OS (HR 1.26, 95% CI 0.48 to 3.28; I2 = 0%, 2 studies, 740 participants), and DFS (HR 1.01, 95% CI 0.48 to 2.11; I2 = 53%, 2 studies, 740 participants) compared to radical hysterectomy. The evidence is very uncertain about the effect of simple hysterectomy on cancer-related mortality (RR 3.64, 95% CI 0.61 to 21.92; I2 = 0%, 2 studies, 740 participants; very low-certainty evidence). Important outcomes Low-certainty evidence showed that simple hysterectomy may result in little or no difference regarding the rate of cancer recurrence compared to radical hysterectomy (RR 1.56, 95% CI 0.73 to 3.35; I2 = 0%, 2 studies, 740 participants). Simple hysterectomy likely reduces the rate of adverse events compared to radical hysterectomy (RR 0.82, 95% CI 0.70 to 0.97; I2 = 0%; 2 studies, 740 participants; moderate-certainty evidence). Sexual function and QoL outcomes appeared to be more favourable for women undergoing simple hysterectomy at some time points. Additionally, simple hysterectomy was the dominant strategy in terms of cost-effective assessment. We downgraded the certainty of the evidence primarily due to some concerns about risk in one included study, and due to imprecision of the pooled results.
Authors' conclusions: Simple hysterectomy may be a viable option for carefully selected women with early-stage cervical cancer, as it may result in little to no differences in survival and cancer recurrence rates compared to radical hysterectomy. Additionally, there were likely fewer perioperative adverse events and there may be better short-term QoL and sexual function in women undergoing simple hysterectomy. The included studies did not directly compare the effect of the route of surgery (open versus minimal access). This review has a limited representation of non-white women and women from low-resource settings
Heliotherapy to treat inflammatory skin disease, in particular eczema and psoriasis (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
Mental Health & Learning Disabilites bulletin October 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
How are gaps in mental health operational management skills met elsewhere and what are the advantages/disadvantages of not having operational managers’ skills? (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
Management of post-operative anaemia in patients undergoing surgery for colorectal cancer: a qualitative focus group-based study.
Full text linkOpen 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: Optimal management of anaemia following surgery for colorectal cancer remains unclear. Peri-operative anaemia is common in patients undergoing resectional surgery for colorectal cancer. A significant amount of research has been conducted into the management of pre-operative anaemia; however, little work has investigated post-operative anaemia. We intended to investigate the facilitators of and barriers against the standardised correction of post-operative anaemia. These can aid in identifying optimum treatment for patients following surgery for colorectal cancer.
Methods: Four focus groups were held with 29 participants from a multidisciplinary panel of healthcare professionals from two different NHS hospital sites in the UK. The discussions were audio recorded and underwent professional transcription. Transcripts were checked against recordings before undergoing thematic analysis using a realist approach.
Results: Four themes were identified. The key barriers to standardised post-operative anaemia correction were a lack of protocoled guidelines or a defined pathway, insufficient education and training, and systemic barriers, such as financial drivers and drug availability. The key facilitator identified was collaboration and communication.
Discussion: This study has identified several key barriers and thresholds which can be used in future studies to improve the standardised management of post-operative anaemia
Effectiveness of hypnosis for pain management in colorectal surgery: project proposal for a systematic review
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Recurrent syncopal events preceded by transient abnormal gait disturbance.
No full textA previously fit and well patient in his 70s presented after recurrent transient loss of consciousness following dinner with alcohol consumption. Each event has been preceded by several minutes of transient abnormal posture and gait. More specifically, there were several minutes of stiffening of legs, shuffling gait and gait ataxia. Initial clinic investigations, including ECG, echocardiogram, CT and MRI head scans, vestibular tests and biochemistry for vitamins and electrolytes, proved inconclusive. However, a positive tilt table test demonstrated severe orthostatic hypotension (OH) with loss of consciousness.Acute alcohol consumption worsens OH, and prolonged hypotension can potentiate cerebral hypoperfusion leading to syncopal events. Compromise to posterior circulation during these events may cause transient gait abnormalities. Such cases have not been widely documented in the literature. Transient gait disturbance in syncope remains underexplored. Further research and documentation are needed, informing better diagnostic and management strategies
Use of tap water over sterile water in mouth care and oral suctioning in ICU (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