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A Retrospective Study on the Role of Tranexamic Acid in Reverse Total Shoulder Arthroplasty for Trauma Patients With Complex Proximal Humerus Fractures.
Get PDFBackground The role of tranexamic acid (TXA) in primary elective hip, knee, and shoulder arthroplasty is well established. This is a retrospective study, which explores the efficacy of TXA in proximal humerus fractures (PHF) requiring shoulder arthroplasty. Design and methods Patients undergoing reverse total shoulder arthroplasty (RSA) for PHF between January 2022 and May 2024 in Queen Elizabeth Hospital (QEH), Birmingham, UK were identified. Patients were administered 1 g of intravenous TXA injection preoperatively during anesthetics induction. The parameters reviewed included changes in hemoglobin (Hb) levels from preoperative to postoperative, postoperative blood transfusion rates, and length of hospital stay. Results Out of 78 patients, 35 (45%) patients received TXA whereas 43 (55%) patients did not receive TXA preoperatively. No significant drop in Hb levels from preoperative to postoperative was observed (TXA: 1.7 ± 1.2 g/dL vs. non-TXA: 2.0 ± 1.3 g/dL, P = 0.30). Seven out of 78 (8.9%) patients required blood transfusion (3 (TXA) vs. 4 (non-TXA); 6 (86%) females vs. 1 (14%) males). In the blood transfusion cohort, patients from both groups required a longer length of hospital stay postoperatively (TXA: 20.3 + 16.0 days vs. non-TXA: 18.5 ± 14.8 days, P = 0.88). Conclusion Intravenous 1 g of TXA preoperatively was not associated with a significant decrease in postoperative Hb reduction in trauma patients undergoing RSA for PHF. Females undergoing RSA are at a greater risk of blood transfusion despite TXA administration. Future studies should consider investigating the dose-dependent efficacy of intravenous TXA on Hb drop postoperatively on trauma patients undergoing RSA
Personal explanations for psychosis : a systematic review and thematic synthesis
Get PDF© The Author(s) 2025. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND AND HYPOTHESIS: Psychosis refers to the state whereby one's experience of reality differs from those around them. The ineffability of psychosis does not render the experience void of meaning, and the ways individuals integrate their experiences of psychosis into their life narratives cannot be dismissed. Meaning is an essential part of recovery. This review aimed to identify categories of personal explanations that people with psychosis use to explain their experiences. STUDY DESIGN: This systematic review is based on a preregistered protocol (CRD42023421125). Four databases, MEDLINE, Embase, Scopus, and PsycINFO, and 5 journals were searched April to November 2023. Qualitative and mixed-methods studies that explored the personal explanations employed by adults who experience psychosis, regardless of diagnostic status, were included. STUDY RESULTS: Twenty-five studies met the inclusion criteria, representing the views of 682 participants from 15 countries. Included studies were appraised using the CASP Qualitative Studies Checklist. RESULTS: were synthesized using thematic analysis. Personal explanations for psychosis experiences were grouped into 5 themes: Physical and psychiatric; Traumatic and adversarial; Emotional; Religious, spiritual, and magical; No explanation. Participants reported multiple explanations for their experiences. CONCLUSIONS: Individuals with experience of psychosis seek to explain these experiences, and these personal explanations may be multiple and complex in nature. The identified personal explanations can be used to further explore the ways that people situate their experiences into their personal context. This understanding should be utilized by professionals to support the provision of recovery-oriented care, with implications for assessment, treatment, intervention, and recovery outcomes.https://academic.oup.com/schizbullopen/article/6/1/sgaf006/805133
Facilitators and barriers to participation of patients with treatment resistant depression in a randomised controlled trial of two forms of personalised magnetic resonance imaging targeted transcranial magnetic stimulation (the BRIGhTMIND trial)
Get PDFThe Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, 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 you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. 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-nc-nd/4.0/.BACKGROUND: Magnetic resonance imaging (MRI) can personalise the site of transcranial magnetic stimulation (TMS) delivered as a course of 20 sessions for treatment-resistant depression (TRD). Facilitators and barriers to a randomised controlled trial (RCT) of MRI personalised TMS is understudied. AIM: Qualitative analysis to explore facilitators and barriers behind RCT participants' experience of personalised MRI-targeted TMS in people with TRD. METHODS: Nineteen participants from the BRIGhTMIND RCT of two forms of MRI personalised TMS, completed semi-structured interviews exploring the reasons behind the uptake and experience of TMS. The sample included fifteen participants who completed the treatment course and four who declined to proceed before randomisation. Interviews were analysed using thematic analysis, co-produced between researchers and patients and public involvement contributors. RESULTS: Facilitators were "hope" regarding the treatment itself, the influence of research staff, interest in a new treatment, and altruism. Barriers were concerns about their ability to commit to the trial and the nature of the TMS itself. Throughout the themes, clinicians and researchers made a difference by explaining and setting realistic expectations of the treatment and building rapport through daily patient contact. CONCLUSION: The study highlights the importance of understanding patients' concepts and experiences of TMS. The provision of optimal information to patients twinned with offering TMS outside office hours and the most efficacious, acceptable regimes of TMS delivery may maximise participation (Trial registration number ISRCTN19674644, registered on 01/10/2018). TRIAL REGISTRATION: Trial registration: ISRCTN19674644|| http://www.isrctn.org/ ) registered on 01/10/2018. Trial Identifying numbers: CPMS 39297, IRAS 245025.https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-06893-
Pramipexole augmentation for the acute phase of treatment-resistant, unipolar depression : a placebo-controlled, double-blind, randomised trial in the UK
Get PDF2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0
license.BackgroundAbout 30% of patients with depression treated with antidepressant medication do not respond sufficiently to the first agents used. Pramipexole might usefully augment antidepressant medication in such cases of treatment-resistant depression, but data on its effects and tolerability are scarce. We aimed to assess the efficacy and tolerability of pramipexole augmentation of ongoing antidepressant treatment, over 48 weeks, in patients with treatment-resistant depression.https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00194-4/fulltex
A systematic review exploring perceptions of Tourette syndrome and tic disorders using the common-sense model of illness representations
Get PDF© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.OBJECTIVE: Tic disorders (TDs) are neurodevelopmental conditions characterised by tics and typically appear during childhood. The Common Sense Model of Self-Regulation (CSM) provides a useful theoretical framework for understanding health beliefs in people with TDs - and parents' beliefs given 'shared' illness experiences between child and parent. Exploring health beliefs in adults can also provide insight as to how TD-related beliefs may evolve over time. This systematic review aimed to use the CSM to synthesise findings from published studies exploring illness perceptions in people with TDs and parents. METHODS: Six databases were searched for studies reporting findings assessing perceptions and beliefs of TDs that aligned with ≥1 CSM illness representation dimension. Forty-four studies were eligible and narratively synthesised. RESULTS: The evidence particularly highlights the negative consequences of TDs upon employment opportunities, schooling and education, social lives and relationships - with experiences of stigma and discrimination weaving throughout these consequences. Findings from several studies reflecting emotional responses report feelings of self-consciousness, abnormality, and anxiety arising from TDs. CONCLUSION: Findings have identified potential implications for research and practice, including identifying TD-related knowledge and beliefs that could be addressed through psychoeducation, and physiological and psychological outcomes which could be addressed through appropriate interventions. PROTOCOL REGISTRATION: PROSPERO CRD42023446800.https://www.tandfonline.com/doi/full/10.1080/08870446.2025.2502515#d1e60
Virtual reality interventions for mental health and well-being in palliative care : systematic review and narrative synthesis - outcomes, techniques, processes and mechanisms
No full textPURPOSE: This review systematically synthesises the evidence on changes in mental health and wellbeing observed in palliative care patients following virtual reality (VR) interventions. METHODS: In July 2024, systematic searches were conducted across five databases (Embase, PsycINFO, Medline, CINAHL Complete and Academic Search Complete), supplemented by hand searches and citation chaining. Search concepts included "virtual reality" and "palliative care". Inclusion criteria were established for adults receiving VR interventions in palliative care settings, limited to English language articles published in peer-reviewed journals. Study designs, sample characteristics, key findings, participant experiences and author interpretations were extracted.Each study included in the narrative synthesis was quality appraised. RESULTS: Of the 1264 citations identified, 13 studies were deemed eligible for inclusion in this review. A narrative synthesis approach was used. Studies were evaluated of mixed quality. Reported changes include reduced pain, anxiety and depression, as well as improvements in mood and quality of life. While few changes reached statistical significance, qualitative reports corroborated the presence of meaningful change. Few participants reported adverse effects. Authors most frequently attributed the observed changes to distraction, with additional mechanisms proposed including cognitive processing, choice and immersion. CONCLUSIONS: While distraction is often assumed to be the primary mechanism of action for VR interventions in palliative care, this claim lacks robust empirical evidence as few studies directly assess distraction or degree of immersion. Future research should investigate the efficacy of VR interventions and elucidate the underlying mechanisms of change in mental health and well-being in this population.https://spcare.bmj.com/content/15/5/550.lon
Evolution of multidisciplinary obesity treatments: past, present, and future role of nutrition.
No full textObesity is a complex chronic disease requiring lifelong comprehensive treatment. In addition to lifestyle counseling that improves nutrition and physical activity, a promising new generation of obesity medications has been added to bariatric procedures as therapeutic options to achieve weight reduction and improve health outcomes. With the promise of effective and safe treatments comes the need to emphasize maximal reduction of body fat and minimal loss of vital body components, including skeletal muscle and bone. Nutrition is a critical aspect of obesity care and is leveraged to support preservation of lean tissues, such as skeletal muscle, through adequate, daily, high-quality protein intake and intake of key micronutrients. More targeted nutrition approaches that promote muscle protein synthesis include amino acid supplementation with leucine and its metabolite β-hydroxy β-methylbutyrate. Another potential target for support is the gut microbiome, as its adequate function is increasingly seen as playing a role in human health and metabolism. Obesity is a heterogenous disease, and there is considerable interest in specific metabolic phenotypes that might be used to tailor nutrition strategies. As research advances on these and other fronts, there is the potential to identify precision nutrition strategies for individualized, more effective approaches to lifelong obesity management
Improving surgical outcomes through non-technical skills: the case for better training and national evaluation
Get PDFAbstract: Effective communication and teamwork are as crucial as technical proficiency for achieving positive surgical outcomes. Non-technical skills (NTS)-including communication, leadership, decision-making, and situational awareness—enhance surgical performance by fostering awareness and capability among both trainees and experienced surgeons. Despite growing recognition of its importance, NTS training is not uniformly implemented in surgical education, leaving a significant gap. This study examines opportunities to expand NTS training within surgical practice. A survey at a local hospital assessed the availability of NTS training and perceived needs among 38 surgical trainees and professionals. The majority acknowledged the value of NTS in improving clinical performance but reported limited focus on human factors in daily practice. Complementing the survey, a literature review was conducted across Medline, EMBASE, and PsycINFO databases, identifying 414 relevant articles, 114 of which focused on clinical or educational contexts. Of these, 61 studies emphasized psychomotor skill assessment via direct observation, patient outcomes, and peer feedback, underscoring the critical role of effective evaluation methods. Findings indicate that while NTS training is appreciated, its effectiveness depends heavily on feedback quality and team dynamics, particularly in addressing challenging behaviors. The study highlights the need for enhanced training design and robust feedback mechanisms. Although current evidence linking NTS training to improved patient outcomes is largely anecdotal, there is strong professional support for broader implementation. The authors advocate for a systematic, nationwide evaluation to determine the true impact of NTS training on surgical performance and outcomes.http://www.ijoro.or
Exploring the organisation and delivery of falls management in care homes for older people in England
No full textBACKGROUND: To explore the organisational context of English care homes in delivering falls management and identify barriers and facilitators to help design future service delivery. METHODS: Non-participant observations and semi-structured interviews in one region of England with care home staff, commissioners and individuals involved in the organisation of falls management, care home managers, care home owners and residents. Barriers and facilitators were identified by thematic analysis and mapped against the Consolidated Framework for Implementation Research (CFIR). RESULTS: 17 interviews were undertaken including staff and a resident from three care homes. Delivering falls management in care homes was complex and challenged by difficulties in integration across a disjointed system, workforce challenges and managing complexity of resident needs with multiple competing priorities. Facilitators included consistent and regular multi-disciplinary support, valuing team working within the care home, and between the care home and external agencies, and the ability to retain care home staff who developed and honed skills over time and who valued their advocacy role for residents. Variation in care home environments, and access to healthcare support were highlighted. CONCLUSIONS: The delivery of falls management in care homes is complex and involves a number of interacting systems. Implementation strategies to support future delivery need to consider the pressure on care homes and wider systems, workforce challenges and variation between settings.https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-025-06127-
Efficacy and Safety of Vitamin E in Adults With Metabolic Dysfunction-Associated Steatohepatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Get PDFThis systematic review and meta-analysis evaluated the efficacy and safety of vitamin E supplementation in adults with metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH). A comprehensive search of PubMed, Cochrane Library, Embase, and Scopus databases was conducted from inception to May 25, 2025, identifying randomized controlled trials comparing vitamin E versus placebo in MASH patients. After screening 752 records, three high-quality randomized controlled trials were included in the final analysis. The pooled analysis demonstrated that vitamin E significantly reduced serum alanine aminotransferase levels compared to placebo (mean difference (MD): -12.27, 95% confidence interval (CI): -16.66 to -7.89) and aspartate aminotransferase levels (MD: -7.08; 95% CI: -14.93 to 0.76). Vitamin E was associated with significantly higher odds of fibrosis improvement (odds ratio (OR): 1.96, 95% CI: 1.25-3.09) with no heterogeneity observed across studies. However, MASH resolution showed no statistically significant difference between groups (OR: 1.71, 95% CI: 0.69-4.27) with substantial heterogeneity, though sensitivity analysis excluding one study revealed a significant benefit. The studies varied in vitamin E dosing from 300 to 800 mg daily, with two conducted in the United States and one in China. These findings suggest that vitamin E supplementation provides biochemical and histological benefits in MASH patients, particularly in reducing liver enzyme levels and improving fibrosis. However, the limited number of trials and varying outcome definitions highlight the need for larger, standardized multinational studies to establish optimal dosing recommendations and long-term safety profiles