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Operative times of 7 common Orthopaedic Trauma procedures: is there a difference between trainees and consultants?
No full textBackground Surgical training in the UK is under increasing pressure with a high demand for service provision. This raises concerns about the resultant negative impact this is having on training opportunities for surgical trainees in theatre due to a high demand for surgical procedures to be performed expediently by consultants. This is due to the assumption that trainee take significantly longer time to operate in theatre and thus result in a slow progress of theatre lists. Objective We evaluated the differences in operative time between orthopaedic trainees and orthopaedic consultants, as well as provided realistic timings for each stage encompassed within the entire duration a patient is in theatre. Methods From our trauma unit electronic theatre database, we retrospectively collected data for six Joint Committee of Surgical Training (JCST) mandatory procedures. Information collected included patients’ ASA grading, total surgical time and grade of surgeons. Results A total of 956 procedures were reviewed, 71.8% hip procedures, 14.2% intramedullary nail fixations and 14.2% ankle fixations. 46.2% and 53.8% of the procedures were performed by consultants and trainees as first surgeon, respectively. Conclusion On average, consultants were found to be 13 minutes quicker in performing the hip procedures and this difference was found to be statistically significant (p 0.05).https://orthopedicreviews.openmedicalpublishing.org/article/143291-operative-times-of-7-common-orthopaedic-trauma-procedures-is-there-a-difference-between-trainees-and-consultant
Comparative Effects of P2Y12 Inhibitors on Thrombus Biology and Inflammatory Responses in Atherothrombotic Cardiovascular Disease: A Systematic Review of Randomized Controlled Trials.
Get PDFThis systematic review investigates the biological impact of various P2Y12 receptor inhibitors on thrombus composition and inflammatory activity in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). A comprehensive literature search across four major databases identified four randomized controlled trials that met the inclusion criteria for evidence synthesis. These trials examined ticagrelor, prasugrel, cangrelor, and genotype-guided strategies in comparison to clopidogrel, assessing outcomes such as inflammatory cell infiltration, platelet reactivity, and myocardial reperfusion parameters. Overall, ticagrelor and prasugrel were associated with more favorable modulation of thromboinflammatory and vascular healing markers compared with clopidogrel; these effects were most evident in studies evaluating neutrophil infiltration, myeloperoxidase activity, and early post-PCI ischemic events. However, variations in study design, endpoints, and follow-up duration limited direct comparisons and precluded definitive conclusions. In addition, one mechanistic study protocol describing the assessment of extracellular vesicle-based biomarkers was identified but excluded from the evidence synthesis due to the absence of outcome data. Collectively, the available evidence provides preliminary mechanistic support for the hypothesis that certain P2Y12 inhibitors may exert anti-inflammatory and thrombus-modifying effects beyond their platelet-inhibiting effects. Larger, standardized, and mechanistically focused trials are warranted to validate these findings and guide precision-based antiplatelet therapy in cardiovascular disease
Continuous glucose monitoring and microvascular complications in diabetes: Bridging glycemic metrics with clinical outcomes.
No full textContinuous glucose monitoring (CGM) has emerged as a complementary and more dynamic method for evaluating glycemic control in people with diabetes. Relevant studies examining the association between CGM parameters, including time in range (TIR), glycemic variability (GV), and time in tight range (TITR), and diabetic nephropathy, retinopathy, and neuropathy, were reviewed. Evidence consistently demonstrates that lower TIR and TITR, as well as higher GV, are associated with increased risk and severity of microvascular complications in both type 1 and type 2 diabetes. Studies employing corneal confocal microscopy and sudomotor function testing further support these associations for small-fibre neuropathy. Although CGM-guided therapy improves TIR and GV, data directly linking optimisation of these metrics to reduced complication rates remain limited. Most available studies are cross-sectional or retrospective, with short CGM durations and heterogeneous methodologies. CGM-derived indices provide valuable insights into glycemic quality beyond HbA1c and may serve as complementary tools for early risk stratification and individualised management of diabetic microvascular disease. However, prospective and interventional trials are required to confirm whether improving CGM metrics can translate into clinically meaningful reductions in microvascular morbidity. Broader access to CGM and standardisation of its key metrics will be essential to fully realise its potential in modern diabetes care
Enhancing the quality of systematic reviews and meta-analyses
No full textSystematic reviews and meta-analyses are often considered the highest level in evidence hierarchies, and therefore are often drawn upon when considering changes in policy. Despite journals implementing measures aiming to enhance the quality of systematic reviews they publish, the authorship raise concerns about the quality of existing and ongoing systematic reviews, particularly relating to transparency and bias minimisation. Building on the current guidelines, standards and tools, we suggest a 'meta checklist' which aims to maximise methodologically sound, unbiased and reproducible reviews of the best scientific quality while considering feasibility throughout the process.https://www.cambridge.org/core/journals/bjpsych-open/article/enhancing-the-quality-of-systematic-reviews-and-metaanalyses/E28E4FBFF461913180BEFBC45FC2EFD
A systematic review of interventions with families of trans people
No full textIntroduction Trans people experience poorer mental health than their cisgender counterparts, likely as a result of minority stress. Caregivers can contribute to minority stress through discrimination, rejection and lack of acceptance. Interventions with family members may provide a way to address conflict and lack of acceptance of gender within the family. Method A systematic review was conducted following PRISMA guidelines. Searches were conducted in PsycInfo, Embase, MEDLINE, Cinahl Plus and ProQuest Theses and Dissertations databases on 16 February 2024 to identify concepts relating to “transgender” and “family intervention.” Results Seven studies were included in the review. Four evaluated interventions relating to family therapy, two to caregiver support groups, and one to an online psychoeducational programme. Outcomes related to mental health were reported on most commonly with positive results; however, overall study quality was poor, and study designs varied. Discussion More studies on the efficacy of family-based interventions with trans people have been published in recent years. Due to heterogeneity, the conclusions that can be drawn from this review are limited. Recommendations are made for increasing the quality of future studies. The recent increase in studies assessing family interventions with trans people is an encouraging sign, and several interventions were identified that show promise in the ways they have adapted for the needs of trans people.https://www.tandfonline.com/doi/full/10.1080/26895269.2025.249261
“I lost my best friend too” : exploring experiences of parental death in Black adolescents from low socio-economic backgrounds through interpretative phenomenological analysis
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license by Taylor & Francis Group, LLC.Literature exploring impacts of parental death on young people demonstrates profound effects both individually, and within the family system. Family roles and responsibilities may change for all, with potential additive impacts of socio-economic status (SES), but these are presently under-explored. The present study therefore aims to address this knowledge gap. Semi-structured interviews were conducted with eight Black adolescents aged 16?18?years, identified as having low SES. Data were analyzed verbatim using interpretative phenomenological analysis. Five themes were developed, each containing further subthemes: (1) They should be here, (2) The weight of grief, (3) Redefining family and finances, (4) Navigating external support and (5) Moving forward from loss. The findings demonstrate unique experiences and challenges faced by Black adolescents from low SES groupings following parental death, identifying both its profound emotional impacts and its wider systemic effects on familial roles, financial stability and access to supports.https://www.tandfonline.com/doi/full/10.1080/07481187.2025.259831
Gastrointestinal Dystonia in children and young people with severe nurological impairment & palliative care needs: a systematic review
No full textBackground: Increasing numbers of young people with severe neurological impairment are suffering from gastrointestinal symptoms, which may result in nutritional failure and ultimately death. Gastrointestinal dystonia is a recently described clinical diagnosis amongst patients with severe neurological impairment, and no systematic review of existing evidence currently exists. Aim: To conduct a systematic review of existing evidence for the management of gastrointestinal dystonia in children and young people with severe neurological impairment and palliative care needs. Method: A systematic review assessing pharmacological and non-pharmacological treatments was undertaken using standard Cochrane methodology. We searched Cochrane CENTRAL, MEDLINE, EMBASE, and PsycInfo. All databases were searched from inception, and no language restrictions were used. Results: 1580 references were identified. After abstract screening, 56 references were reviewed at full text, and a case report and case series were identified for inclusion. Low-quality, indirect evidence exists for the management of gastrointestinal dystonia, including symptom management, hydration and nutrition decisions, and end-of-life care. Conclusions: There is a paucity of existing evidence directly relating to gastrointestinal dystonia, but low-quality indirect evidence from studies of children with severe neurological impairment and gastrointestinal symptoms exist, which may begin to inform clinical practice.https://www.mdpi.com/2227-9067/12/10/135
Mixed-methods non-randomised single-arm feasibility study assessing delivery of a remote vocational rehabilitation intervention for patients with serious injury : the ROWTATE study
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employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ GroupObjectives This study aimed to evaluate the feasibility of delivering a vocational rehabilitation intervention (Return to Work After Trauma—ROWTATE), remotely to individuals recovering from traumatic injuries. The primary objectives were to assess therapists’ training and competence, adapt the intervention and training for remote delivery and assess the feasibility and fidelity of remote delivery to inform a definitive randomised controlled trial.Design A mixed-methods feasibility study incorporating (1) telerehabilitation qualitative literature review, (2) qualitative interviews preintervention and postintervention with therapists and patients, (3) a team objective structured clinical examination to assess competency, (4) usefulness of training, attitudes towards (15-item Evidence-Based Practice Attitude Scale) and confidence in (4-item Evidence Based Practice Confidence Scale) evidence-based practice, intervention delivery confidence (8-bespoke questions) and intervention behaviour determinants (51-items Theoretical Domains Framework) and (5) single-arm intervention delivery feasibility study.Setting The study was conducted in two UK Major Trauma Centres. The intervention and training were adapted for remote delivery due to the COVID-19 pandemic.Participants Therapists: Seven occupational therapists (OTs) and clinical psychologists (CPs) were trained, and six participated in competency assessment. Seven OTs and CPs participated in preintervention interviews and surveys; six completed post-intervention interviews and four completed post-training surveys. Patients: 10 patients were enrolled in the single-arm feasibility study and 4 of these participated in postintervention qualitative interviews. Inclusion criteria included therapists involved in vocational rehabilitation delivery and patients admitted to major trauma centres. Exclusion criteria included participation in other vocational rehabilitation trials or those who had returned to work or education for at least 80% of preinjury hours. Intervention: The ROWTATE vocational rehabilitation intervention was delivered remotely by trained OTs and CPs. Training included competency assessments, mentoring and adaptation for telerehabilitation. The intervention was delivered over multiple sessions, with content tailored to individual patient needs.Results Therapists found the training useful, reported positive attitudes (Evidence-Based Practice Attitude Scale mean=2.9 (SD 0.9)) and high levels of confidence in delivering evidence-based practice (range 75%–100%) and the ROWTATE intervention (range 80%–100%). Intervention barriers identified pretraining became facilitators post-training. Half the therapists needed additional support post-training through mentoring or additional training. The intervention and training were successfully adapted for remote delivery. High levels of fidelity (intervention components delivered: OTs=84.5%, CPs=92.9%) and session attendance rates were found (median: OT=97%, CP=100%). Virtually all sessions were delivered remotely (OT=98%, CP=100%). The intervention was acceptable to patients and therapists; both considered face-to-face delivery where necessary was important.Conclusions The ROWTATE intervention was delivered remotely with high fidelity and attendance and was acceptable to patients and therapists. Definitive trial key changes include modifying therapist training, competency assessment, face-to-face intervention delivery where necessary and addressing lower fidelity intervention components.Trial registration number ISRCTN74668529.Data are available on reasonable request. The data that participants have consented to share will become available to potential researchers at the end of the ROWTATE research programme. Requests detailing the research aims and use of the data should be sent to the research team via email: [email protected]://bmjopen.bmj.com/content/bmjopen/15/11/e104518.full.pd
Comparison of the diagnostic performance of the central vein sign and CSF oligoclonal bands supporting the diagnosis of multiple sclerosis
Get PDFBackground and Objectives The central vein sign (CVS) describes the presence of venules within multiple sclerosis (MS) brain lesions, visible on T2*-weighted MRI. In the upcoming revision of the MS diagnostic criteria, the simplified “rule of 6” (i.e., finding 6 lesions with a central venule) can support the diagnosis of MS as an alternative to lumbar puncture (LP). We evaluated whether a T2*-weighted MRI scan is more sensitive than oligoclonal bands (OCBs) for diagnosing MS at presentation with a typical clinically isolated syndrome (CIS). We also compared the tolerability of LP and the additional MRI. Methods Participants requiring an LP to meet the 2017 McDonald diagnostic criteria for MS were enrolled in this multicenter, prospective, diagnostic superiority study from 3 UK neuroscience centers. A six-minute T2*-weighted sequence was used to assess the CVS using 2 definitions: a 40% threshold of all eligible lesions and the rule of 6. These were compared with OCBs, using the clinical diagnosis at 18 months as the reference standard. Results Of 113 participants, 99 (mean age: 38, female: 73%) have completed all study activities: 80 were diagnosed with MS, 10 remained CIS, 8 had alternative diagnoses, and 1 remained without a diagnosis. No significant difference in diagnostic sensitivity was detected between 40% CVS threshold (90% [CI 81%–96%]) and OCB testing (84% [CI 74%–91%]) (p = 0.332). The rule of 6 had a sensitivity of 91% (CI 83%–96%). Side effects were reported by 75% following LP compared with 9% following MRI. All participants preferred their MRI scan over their LP. Discussion CVS and OCB testing is equally sensitive in supporting the diagnosis of MS in cases of typical CIS. CVS assessed using the 40% threshold, and the simpler rule of 6 produces equivalent diagnostic performance. Compared with OCB testing, CVS testing seems safer and better tolerated by patients. Further studies are needed to evaluate CVS specificity, particularly outside of typical CIS cases, as studied here. Classification of Evidence This study provides Class IV evidence that CSF OCBs and the CVS are equally sensitive in supporting a diagnosis of MS in patients presenting with CIS.https://www.neurology.org/doi/abs/10.1212/WN9.000000000000001