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Smoking cessation in pregnancy: Exploring service users' lived experiences.
Full text linkBackground/Aims: Sherwood Forest Hospitals NHS Foundation Trust established a specialist tobacco dependency team to run an in-house opt-out smoking cessation service supported by an incentive scheme. This study's aim was to understand service-users' perceptions of engaging with the team during the intervention. Methods: Semi-structured interviews were conducted with a convenience sample of 13 pregnant people who had achieved a smoke-free birth following attendance at the service. The data were analysed inductively through thematic analysis. Results: The participants reported strong emotional responses to the team. Non-judgemental support helped reduce barriers, minimise stigma and enhance their ability to achieve a smoke-free birth. Concern for the baby's health was a key motivation to quit smoking. Conclusions: This study reports rich insights into service-users' lived experiences of smoking cessation while pregnant. Such insights are useful for service design, clinician training and the design of smoking-cessation messages. Implications for practice: Using a non-judgemental behaviour change approach will reduce barriers of perceived shame and stigma to increase engagement with tobacco dependence treatment services. Healthcare professionals should not assume that people are fully aware of the dangers of tobacco use.https://www.britishjournalofmidwifery.com/content/research/smoking-cessation-in-pregnancy-exploring-service-users-lived-experiences
European expert consensus on a structured approach to circular stapling anastomosis in minimally invasive left-sided colorectal resection.
No full textAIM: The aim of this work is to develop and operationally define performance metrics that characterize a reference approach to circular stapling anastomosis during minimally invasive left-sided colorectal resection and to obtain face and content validity through a consensus meeting. METHOD: Three expert colorectal surgeons with advanced experience with minimally invasive surgery, a senior behavioural scientist and a research fellow with experience in performance metrics development formed the Metrics Group. Technical support was provided by device engineers. Published guidelines, training materials, manufacturers' instructions for use and unedited videos of circular stapling anastomosis in minimally invasive left-sided colorectal resection were used to deconstruct the task into defined, observable performance units or metrics (i.e. procedural phases, steps, errors and critical errors). The performance metrics were then subjected to detailed review by 16 expert colorectal surgeons in a modified Delphi process. RESULTS: Performance metrics for circular stapling anastomosis during minimally invasive left-sided colorectal resection had three procedural phases with 32 steps, 40 errors and 38 critical errors. After the modified Delphi process the agreed performance metrics consisted of three procedural phases, 36 steps, 42 errors and 39 critical errors. A group of expert colorectal surgeons from Europe verified the face and content of these metrics. After discussion, all procedural phases received unanimous consensus by the Delphi panel. CONCLUSION: Circular stapling anastomosis during the minimally invasive approach to left-sided colorectal resection can be broken down into procedural phases and steps, with errors and critical errors known as performance metrics. We consider the metrics essential for the development of structured training in using circular stapling anastomosis in the minimally invasive approach to left-sided colorectal resection
Disparity in endoscopic localisation of early distal colorectal cancers: a retrospective cohort analysis from a single institution.
Full text linkBACKGROUND: Accurate staging of distal colorectal cancers is paramount in guiding neoadjuvant therapy, peri-operative, and ostomy planning. Early colonic lesions can be difficult to visualise on computed tomography (CT) scans, with tumour location solely deduced via endoscopy with the potential for introducing error. We aimed to address the paucity in literature in this area and assessed the accuracy of radiological and endoscopic localisation of distal colorectal cancers. METHODS: Retrospective analysis of an electronic database of patients at a large District General Hospital (DGH) diagnosed with distal colorectal cancer between January 2014 to January 2023 was performed. Patient demographics, investigations, endoscopic, and operative findings were analysed. Outcomes were assessed to determine disparities between pre-operative endoscopy and final tumour location. RESULTS: A total of 212 patients were endoscopically diagnosed with distal sigmoid tumour. Of these, 207 (97.6%) had a CT scan performed with 25.1% (52/207) lesions not being identified on this imaging modality with the remainder (74.9%; 155/207) being reported as visible. 38.2% (79/207) of tumours were in the sigmoid colon, 17.4% (36/207) rectosigmoid, and 19.3% (40/207) in the rectum. Pre-operative magnetic resonance imaging (MRI) was performed in 42.5% (90/212) of cases showing 84 tumours: 6.0% (5/84) sigmoid colon, 9.5% (8/84) rectosigmoid and 83.3% (70/84) rectal cancers (upper: 34, mid-rectum: 26, low: 10), with one anal cancer. 42.3% (22/52) of patients with non-visible lesions on CT had MRI scans: 68.2% (15/22) had rectal cancer (upper: 10, mid-rectum: 4, low: 1). Of the 30 where MRI was not performed, 46.7% (14) had sigmoid cancer, 16.7% (5) rectosigmoid, and 33.3% (10) rectal intraoperatively. Overall, 30.7% (65/212) of patients reported as having a distal sigmoid lesion endoscopically in fact had rectal cancer intra-operatively (rectosigmoid lesions excluded). CONCLUSION: Endoscopic localisation of distal colorectal tumours can be unreliable for accurate staging and operative planning. A pre-operative MRI scan should be considered in such instances, and particularly for non-visible lesions on CT scan. This may improve peri-operative planning, staging accuracy and patient outcomes
Long-Term Improvements in Glycemia and User-Reported Outcomes Associated with Open-Source Automated Insulin Delivery Systems in Adults with Type 1 Diabetes in the United Kingdom: A Real-World Observational Study.
No full textObjective: To evaluate real-world outcomes in adults with type 1 diabetes initiating open-source automated insulin delivery systems (OS-AID). Methods: Adults with type 1 diabetes who commenced OS-AID, between May 2016 and April 2021, across 12 centers in the United Kingdom were included. Anonymized clinical data, collected during routine clinical care between December 2019 and November 2023, were submitted to a secure web-based tool within the National Health Service network. Outcomes included change in hemoglobin A1c (HbA1c), sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), user opinion of OS-AID, and event rates (hospital admissions, paramedic callouts, severe hypoglycemia, and adverse events) between baseline and follow-up. Results: In total, 81 OS-AID users were included (51.9% male; 90.1% White British; mean age 41.4 years; median diabetes duration 25 years [IQR 17-32]). Over a mean follow-up of 1.7 years, HbA1c reduced by 0.8% (9 mmol/mol) (7.3 ± 1.1% vs. 6.5 ± 0.7%; P < 0.001), and the percentage of individuals achieving HbA1c ≤ 7.0% (53 mmol/mol) increased from 48.6% to 75.7% (P < 0.001). Diabetes-related distress score reduced by 0.9 (95% confidence interval [CI] -0.3, -1.5; P = 0.006), and Gold score reduced by 0.7 (95% CI -0.1, -1.3; P = 0.022). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) reduced (27.8% at baseline vs. 8.3% at follow-up; P = 0.039). Of those asked, all participants stated that OS-AID had a positive impact on quality of life. The number of hospital admissions was low. Conclusions: The use of OS-AID is associated with long-term improvements in HbA1c, hypoglycemia awareness, and diabetes-related distress in type 1 diabetes. These benefits were achieved without increased rates of hospital admissions, diabetic ketoacidosis, or severe hypoglycemia
A group psychological intervention for postnatal depression in British mothers of South Asian origin - the ROSHNI-2 RCT
Full text link© 2025 Husain et al. This work was produced by Husain et al. under the terms of a commissioning contract issued by the Secretary of State
for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence,
which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed.
See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and
the DOI of the publication must be cited.BACKGROUND: Postnatal depression is more common in British South Asian women than white women in the United Kingdom. Despite empirical evidence suggesting the effectiveness of cognitive-behavioural therapy as a first line of treatment, little evidence is available regarding its applicability to different minority ethnic groups. OBJECTIVES: Determining the clinical and cost-effectiveness of a culturally adapted group psychological intervention (Positive Health Programme) in primary care for British South Asian women with postnatal depression compared with treatment as usual. SETTING: General practices and children's centres in the North West, East Midlands, Yorkshire, Glasgow and London. PARTICIPANTS: British South Asian women meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) depression criteria, aged 16 years or above, with infants up to 12 months. DESIGN: A multicentre randomised controlled trial with an internal pilot and partially nested design to compare treatment as usual plus the Positive Health Programme with treatment as usual in British South Asian women with postnatal depression, with a qualitative study to examine the acceptability and feasibility of the intervention. INTERVENTION: The Positive Health Programme, a culturally adapted group intervention based on the principles of cognitive-behavioural therapy delivered by facilitators over 12 sessions. OUTCOMES MEASURES: The primary outcome was recovery from depression (Hamilton Depression Rating Scale ≤ 7) at end of intervention (approximately 4-6 months). Analysis of the primary outcome and the long-term follow-up (at 12 months) used a logistic random-effects model to estimate the odds ratio of caseness between treatments, adjusting for centre, severity of depression and education at baseline. Cost data were collected using an Economic Patient Questionnaire. RESULTS: Seven hundred and thirty-two participants across four study centres were randomised by the Manchester Clinical Trials Unit. At 4 months, almost half of patients in the treatment (Positive Health Programme) group were recovered (138 or 49%), whereas 105 (37%) were recovered in the control (treatment as usual) group. By 12 months, the control (treatment as usual) and treatment (Positive Health Programme) group had over 50% recovery at 140 (54%) and 141 (54%), respectively. For the primary outcome, recovery from postnatal depression at end of intervention, we found a significant effect such that the odds of achieving recovery in the treatment group were almost twice as high compared to the treatment as usual group (odds ratio 1.97, 95% confidence interval 1.26 to 3.10). Between the two groups, there was no significant difference in the odds of recovery at 12 months (odds ratio 1.02, 95% confidence interval 0.62 to 1.66), highlighting a need for more intensive therapies and/or longer-term care plans for this group of patients. QUALITATIVE RESULTS: The intervention was considered feasible and acceptable from the perspectives of Positive Health Programme participants, facilitators, and general practitioners. The findings suggest improved emotional and social support and an enhanced sense of well-being. ECONOMIC EVALUATION: Positive Health Programme implementation was estimated to cost an average of £408 per participant. The intention-to-treat analysis shows that the Positive Health Programme intervention costs £22,198 per quality-adjusted life-year gain. Positive Health Programme was cost-effective on average but with a substantial uncertainty: the probability that Positive Health Programme was cost-effective was 44% (65%) at the willingness to pay £20,000 (£30,000) per quality-adjusted life-year. The Positive Health Programme was highly cost-effective for those who attended 5-8 sessions, costing £9040 per quality-adjusted life-year. LIMITATIONS: The study sample limits generalisability with other ethnic minority groups, and the cost-effectiveness analysis did not explore recall bias. CONCLUSIONS: The results of this study provide robust evidence that the culturally adapted psychological intervention for postnatal depression in South Asian women is effective at the primary end point and acceptable to women. FUTURE WORK: Further development of the Positive Health Programme intervention and evaluation, with longer-term outcome follow-ups and exploration of cost-effectiveness of remote delivery of the Positive Health Programme. STUDY REGISTRATION: Current Controlled Trials ISRCTN10697380. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/68/08) and is published in full in Health Technology Assessment; Vol. 29, No. 6. See the NIHR Funding and Awards website for further award information.https://www.journalslibrary.nihr.ac.uk/hta/KKDS662
The Impact of Near-Peer Teaching Methods in Undergraduate and Postgraduate Surgical Education Using the Kirkpatrick Evaluation Model: A Systematic Review.
No full textOBJECTIVES: The aim of this study was to use the Kirkpatrick evaluation model (levels 1-4) to analyze the impacts of NPT programmes on learners and tutors within surgical education. METHODS: This study was registered prospectively on the international platform of registered systematic reviews and meta-analysis protocols (INPLASY)- INPLASY202450037. The study was conducted following the PRISMA guidelines. A search of PubMed, Medline, Embase, PsycINFO and CINAHL was performed from inception till March 30, 2024. Quality appraisal of the included studies was performed using the mixed methods appraisal tool (MMAT). RESULTS: 22 studies were included in the final analysis. The results showed that NPT was better or at least comparable to senior faculty-led teaching for improved satisfaction ratings for most clinical and nonclinical parameters; improved learners' knowledge and basic surgical skills; and improved clinical practice for leading ward rounds (Kirkpatrick model, levels 1-3). NPT did not improve learners' interest in pursuing a surgical career. No evidence was reported for the impact of NPT on healthcare/educational organizations (Kirkpatrick model, level 4). For tutors, there was evidence that showed that NPT had positive impacts on their basic surgical, mentoring and teaching skills. Quality appraisal showed that the included studies had high to moderate quality. CONCLUSION: This study has shown that there is high to moderate quality evidence for the impact of NPT in undergraduate and postgraduate surgical education for levels 1 and 2 of the Kirkpatrick models, with some evidence for its impact on learners at level 3 of the Kirkpatrick model within postgraduate surgical education. Future research should be focused on the impact of NPT on real-life behavioral changes and on organizations (levels 3 and 4 of the Kirkpatrick models, respectively) within a surgical educational context
The prognosis of pain and function in people with hand and thumb base osteoarthritis: a systematic review.
Full text linkBACKGROUND: This systematic review has summarized evidence regarding the course of hand pain, hand function, and prognostic factors that predict changes in symptoms in people with hand and thumb base osteoarthritis. METHODS: A systematic search of electronic databases was conducted for longitudinal studies on hand osteoarthritis. Two reviewers assessed eligibility quality appraisal, and extracted data on pain, function and prognostic factors. A narrative synthesis was undertaken, and the strength of the evidence was appraised using a modified Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS: Of 9523 articles identified, 24 papers with 8,496 patients met the inclusion criteria. Twelve studies reported on the course of hand pain and 13 on hand function. 25-29% of participants reported worsening pain and 23-59% a deterioration in hand function over 10 years. There is moderate evidence that, on average, function and grip strength deteriorate over time with minimal changes in average hand pain. Twelve studies assessed the prognostic factors for hand OA. Moderate evidence suggests baseline pain and diabetes are associated with changes in hand function and pain; lower quality evidence for other health and psychological factors. CONCLUSIONS: Over 10 years, there is, little change in hand pain, but some deterioration in hand function. Deterioration in hand pain and function is associated with diabetes and higher baseline pain severity. Further research is very likely to improve our understanding of prognostic factors for symptomatic progression in hand OA
What's new in paediatric asthma?
No full textIt is well documented that asthma outcomes for children and young people in the UK are amongst the worst in Europe and in high-income countries worldwide. Several reports in the last 10 years have evaluated the reasons for the poor outcomes, with a high degree of concordance between the report findings. In this review, we summarise the key findings of these reports and how they are being addressed by new treatment strategies in updated guidance published annually by the Global Initiative for Asthma (GINA) and the latest update of the joint British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) Asthma guideline. We discuss the importance of an early and accurate asthma diagnosis; the problem of poor recognition of asthma severity and the dangers of short acting beta agonists (SABA) overuse and inhaled corticosteroid (ICS) underuse. We summarise the evidence for anti-inflammatory reliever (AIR) strategy and maintenance and reliever therapy (MART) which are now advocated in all new asthma guidance due to compelling evidence showing their positive impact on most treatment outcome measures. Finally, we highlight changes to Salbutamol weaning guidance in children discharged from hospital following an acute asthma exacerbation.https://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(25)00124-6/abstrac
989 Obturator Hernia: A Rare Surgical Emergency
Full text linkAim Obturator hernias are a rare pelvic hernia with an incidence of approximately 1%. These are more common in emaciated, elderly women and typically present with acute obstruction. Diagnosis can be challenging as clinical signs are non-specific and CT scan is the optimal imaging modality. Treatment is surgical and both open and laparoscopic methods have been demonstrated. We present a safe and effective approach to repair an acutely obstructed left sided obturator hernia using a laparoscopic Transabdominal preperitoneal (TAPP) technique. We aim to demonstrate the anatomical landmarks neighbouring an obturator hernia that require consideration for a safe repair. Method An 86-year-female presented with acute abdominal pain, vomiting and constipation. A CT scan confirmed an acutely obstructed left sided obturator hernia. Laparoscopy demonstrated small bowel herniating through the obturator canal in keeping with the transition point of obstruction. The hernia was reduced and small bowel viable. A pre-peritoneal flap was created and Prolene mesh placed to cover the defect. The pre-peritoneal flap was closed over the mesh and fixed in place using an absorbable strap fixation device. Care was taken to avoid injury to the obturator nerve and artery. Results The patient made an excellent recovery and was discharged at day five. They were followed up three months later and reported their long-term intermittent symptoms of obstruction were cured after surgery. Conclusions Obturator hernias are a rare presentation to the emergency general surgical take. They can cause diagnostic uncertainty and an operative challenge. Laparoscopic TAPP repair is a safe and effective approach for obturator hernias.https://academic.oup.com/bjs/article/112/Supplement_10/znaf128.075/816494
Interventions for helping people recognise early signs of recurrence in bipolar disorder
No full textThis is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness of EWS plus TAU or EWS plus psychological therapy versus TAU alone or psychological treatment (without EWS) independently on time to recurrence of any bipolar episode and hospitalisation, and other clinically relevant outcome measures. To evaluate the effectiveness of intermittent medication used on recognition of EWS without continued mood-stabilising medication versus TAU involving continued mood-stabilising medication on time to recurrence of any bipolar episodes.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015343.pub2/ful