Staff Publication

Clinical outcome reporting in randomised controlled trials of remote obstetric antenatal monitoring: a systematic review (2026)

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Type of publication:

Systematic review

Author(s):

Le Vance, Jack; Man, Rebecca; Adeoye, *Adekunle; Amaranathan, Sneha; Massey, Sian; Gurney, Leo; Morris, R Katie; Morton, Victoria Hodgetts

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 322:115122, 2026 Jun.

Abstract:

BACKGROUND: Over the last decade, remote technological initiatives for obstetric antenatal care have rapidly developed. However, variation in outcome reporting can preclude effective data synthesis. A remedy for this is to develop of a core outcome set (COS). However, prior to this, it is necessary to examine the heterogeneity of outcome reporting.

METHODS: MEDLINE, Embase, Cochrane Database of Clinical Trials (CENTRAL), Web of Science, and PubMed databases from January 2015 to November 2025. Randomised controlled trials (RCTs), RCT protocols or pilot RCTs which assessed any outcome for any type of remote monitoring device during the obstetric antenatal period were included. Study characteristics, outcomes definitions and timings were extracted and descriptively analysed.

RESULTS: Of the 4904 papers screen, 40 studies were included (24 full RCTs, 10 protocols and six pilot RCTs) The most common remote monitoring devices used, either in isolation or in combination, were blood pressure (n = 17, 42.5%) and blood glucose (n = 16, 40.0%). In total, 1004 verbatim outcomes were noted, categorised into 361 unique outcomes, across 72 domains. Outcome definition was heterogenous, with glycaemic monitoring demonstrating the largest variation, with 29 different definitions. Longer-term outcomes were infrequently reported, with fewer than 6% of all outcomes evaluating more than 3 months postpartum. Maternal remote monitoring devices were most commonly assessed, with 29 studies solely evaluating these devices. No single outcome was reported in all studies.

CONCLUSION: This review demonstrates a lack of consistent outcome reporting for trials examining remote antenatal monitoring devices. Consequently, the development of a COS is recommended.

DOI: 10.1016/j.ejogrb.2026.115122

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Apocrine Hidrocystoma of Foreskin: A Rare Benign Cystic Lesion (2026)

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Type of publication:

Journal article

Author(s):

Han, Lin Aung; *Potter, Laura; *Bardapure, Mallikarjun.

Citation:

Cureus. 18(4):e107284, 2026 Apr.

Abstract:

Apocrine hidrocystoma is a benign cystic tumour arising from apocrine sweat glands. Its occurrence on the penile foreskin is exceedingly rare, representing an uncommon lesion of the external genitalia. A review of the literature suggests that only a limited number of cases -- approximately 13 involving external genitalia -- have been reported worldwide. We present the case of a 50-year-old gentleman who was referred to the urology service with a gradually enlarging, multiloculated, non-proliferative cyst arising from the foreskin. Patient underwent excisional biopsy with complete circumcision under local anaesthesia. Histopathology examination confirmed the diagnosis of apocrine hidrocystoma. Apocrine hidrocystomas are mostly located in the head and neck region, particularly the periorbital area, external auditory meatus, and axilla, with genital involvement being exceptionally uncommon. Complete surgical excision is both diagnostic and curative with a low risk of recurrence. Reports of apocrine hidrocystoma involving the foreskin remain scarce in the literature. To our knowledge, this represents the first reported case from Royal Shrewsbury Hospital.

DOI: 10.7759/cureus.107284

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An overview of cell salvage in orthopaedic hip and knee arthroplasty surgery (2026)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; Golding, Steven; Nandra, Rajpal; Banerjee, Robin.

Citation:

Journal of Perioperative Practice. 36(4):186-191, 2026 Apr.

Abstract:

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditionally used in such cases, it carries risks and potential complications. Consequently, intraoperative cell salvage presents itself as an appealing alternative, particularly in hip and knee arthroplasty procedures. Intraoperative cell salvage involves the collection and reinfusion of a patient's own blood (autologous blood) lost during surgery. Studies have consistently shown that autologous blood collected via intraoperative cell salvage has fewer complications and greater benefits compared to donated blood. However, despite these advantages, the widespread adoption of intraoperative cell salvage in UK hospitals remains limited, primarily due to associated costs. While the integration of intraoperative cell salvage into blood management services may incur initial expenses, research suggests that it could ultimately prove to be cost-effective. This is because improved patient outcomes associated with intraoperative cell salvage may lead to reduced postoperative complications and shorter hospital stays. Thus, there is a growing imperative to overcome financial barriers and promote the implementation of intraopertive cell salvage as a standard practice in perioperative care across UK health care settings. The purpose of this scoping literature review is to consolidate the available information on the current use of intraoperative cell salvage and to identify intraoperative cell salvage techniques and devices described for use in an arthroplasty setting.

DOI: 10.1177/17504589241293406

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An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2026)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative (2026)

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Type of publication:

Journal article

Author(s):

Vide, Joao; Santos, Francisco; Dantas, Sofia; Seica, Emanuel; Caetano, Joao; Mendes, Daniel; Sousa, Manuel Resende; Anderson, Mette; Guelfi, Matteo; Hong, Choon Chiet; van Dijk, Pim; Spennacchio, Pietro; Cordier, Guillaume; van Dijk, Niek; Ling, Samuel; Hua, Yinghui; Vega, Jordi; Fernandes, Pedro; *Carmont, Michael.

Citation:

Knee Surgery, Sports Traumatology, Arthroscopy. 34(4):1452-1463, 2026 Apr.

Abstract:

PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.

LEVEL OF EVIDENCE: Level IV.

DOI: 10.1002/ksa.70327

A Multicomponent Intervention to Improve Maternal Infection Outcomes (2026)

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Type of publication:

Journal article

Author(s):

Lissauer, David; Gadama, Luis; Waitt, Catriona; Whyte, Sonia; Burnside, Girvan; Anilkumar, Aiswarya; Makuluni, Regina; Okwaro, Peace; Yang, Liu; Waitt, Peter; Musopole, Owen; Bilesi, Rosemary; Maseko, Bertha; Lwasa, Joel; Mugahi, Richard; Olaro, Charles; Lamorde, Mohammed; Makuta, Mirriam; Kachiwaya, Chimwemwe; Mkandawire, Tionge; Malunga, Adrian; Chitsulo, Nyadani; Abitimo, Prisca; Ayabo, Tabitha; Weeks, Andrew; Martin, James; Hemming, Karla; Gallos, Ioannis; Monk, Edward J M; Riches, Jennifer; Chapuma, Chikondi; Nanyondo S, Judith; Lorencatto, Fabiana; Monahan, Mark; Allegranzi, Benedetta; Dunlop, Catherine; Atkins, Lou; Rosala-Hallas, Anna; Roberts, Tracy; Gamble, Carrol; Malata, Address; Desmond, Nicola; Kommwa, Edward; Merriel, Abi; *Parry-Smith, William; Smith, Rebecca; Ndumu, Ivy; Williams, Eleanor; Faque, Bob; Banda, Gertrude; Nyondo-Mipando, Alinane L; Twimukye, Adelline; Chater, Tim; Diplas, Aristotelis; Brizuela, Vanessa; Souza, Joao Paulo; Rylance, Jamie; Cheshire, James; Hawker, Lydia; Coomarasamy, Arri; Bonet, Mercedes.

Citation:

New England Journal of Medicine. 394(17):1685-1695, 2026 Apr 30.

Abstract:

BACKGROUND: Maternal infection and sepsis are major causes of maternal death and severe illness worldwide, particularly in low- and middle-income countries. Inconsistent implementation of evidence-based recommendations for infection prevention and management and delays in detection and treatment of maternal sepsis contribute to the number of preventable deaths.

METHODS: We conducted a cluster-randomized trial to assess a multicomponent intervention, the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) program. This program was designed to support health care providers in achieving three goals: adherence to World Health Organization (WHO) hand-hygiene standards; adoption of evidence-based practices for maternal infection prevention and management; and early detection of sepsis and use of the FAST-M (fluids, antibiotics, source control, transfer if required, and monitoring) treatment bundle. Usual care was provided in the control group, along with dissemination of guidelines. The primary outcome was a composite of infection-related maternal death, infection-related near-miss event (events in which women survived a life-threatening complication), or severe infection-related illness (deep surgical-site, deep perineal, or body-cavity infection) among women who were pregnant or had recently been pregnant.

RESULTS: We randomly assigned 59 health facilities (where 431,394 women gave birth during the trial) in Malawi and Uganda to the intervention group (30 clusters) or the usual-care group (29 clusters). A primary-outcome event occurred in 1.4% of the patients in the intervention group and in 1.9% of those in the usual-care group (risk ratio, 0.68; 95% confidence interval, 0.55 to 0.83; P<0.001). This effect was generally consistent between countries and among facilities of difference sizes and was sustained over time.

CONCLUSIONS: Implementation of the APT-Sepsis program led to a significantly lower risk of a composite of infection-related maternal death, infection-related near-miss event, or severe infection-related illness than usual care. (Funded by the Joint Global Health Trials scheme and others; APT-Sepsis ISRCTN number, ISRCTN42347014.).

DOI: 10.1056/NEJMoa2512698

A multicentered retrospective cohort study comparing JAK inhibitor therapies in moderate-to-severe ulcerative colitis (2026)

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Type of publication:

Journal article

Author(s):

Kumar, Aditi; Baxter, Joshua; Rimmer, Peter; Noble, Ben; Bower, Joshua; Makki, Mujeeb Ullah; Hatta, Ayiesha; Chikhlia, Anmol; Cheesbrough, Jonathan; Disney, Ben; *Muir, Josh; *Karova, Mariya; *Butterworth, Jeffrey; Sagar, Nidhi; Al-Talib, Ismaeel; Nahal, Jasbir; Ali, Nasima; Sagar, Vandana; Varyani, Fumi; Smith, Sam; Bourne, Stephanie; Hsu, Yu-Kai; Eltahir, Almoiez; de Silva, Shanika; Harvey, Philip.

Citation:

Crohn's & Colitis 360. 8(2):otag045, 2026 Apr.

Abstract:

Background: Tofacitinib, filgotinib, and upadacitinib are Janus kinase inhibitors (JAKi) that have demonstrated efficacy in ulcerative colitis (UC) against placebo. This study aims to compare the clinical efficacy between these drugs.

Methods: This is a multicentered, retrospective cohort study. Patients with UC starting a JAKi were recruited between 2018 and 2024 when starting their first JAKi. Clinical remission and response, based on clinical scores, calprotectin, and endoscopic measurement, were assessed at 3 and 6 months. Both independent and combined variable outcomes were analyzed.

Results: Two hundred and seventy patients were included in the analysis, of which 70 (26%) were on upadacitinib, 51 (19%) on filgotinib, and 149 (55%) on tofacitinib. Clinical, biochemical, and endoscopic remission at 6 months was 91%, 71%, and 80% for upadacitinib; 78%, 67%, and 50% for filgotinib; 73%, 51%, and 44% for tofacitinib. Upadacitinib demonstrated significantly greater clinical response (P = .027) and remission (P = .037) rates at 6 months than tofacitinib. Drug persistence at 12 months was 86% for upadacitinib, 72% for filgotinib, and 69% for tofacitinib. Upadacitinib demonstrated significantly greater 6-month remission rates compared to tofacitinib in the bio-exposed cohort (71% vs 52%, P = .022) and in the bio-naive cohort (93% vs 50%, P = .009). The incidence rates for hospital admissions were 10.2, 21.9, and 14.1 and for colectomies were 6.7, 10.0, and 5.0 per 1000 patient-months at risk for upadacitinib, filgotinib and tofacitinib, respectively.

Conclusion: This study demonstrates that upadacitinib is more likely to achieve 6-month response and remission compared to tofacitinib. In both bio-naive and bio-exposed patients, upadacitinib was more likely to achieve remission at 6 months. The efficacy of JAKi does not appear diminished by prior biologic use.

DOI: 10.1093/crocol/otag045

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Improving Adequacy of Fine-Needle Aspiration Cytology in Non-Thyroid Head and Neck Patients Using Concurrent Liquid Cytology Sample Preparation: A Prospective Study (2026)

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Type of publication:

Journal article

Author(s):

Yeung, Thomas; Oh, Soo; *Ahsan, Syed Farhan; *Harrison, Katherine; *Hope, Helen.

Citation:

Cytopathology. 2026 Apr 04.

Abstract:

OBJECTIVE: Cytological evaluation of head and neck masses is an important diagnostic tool and aspect of pre-operative planning in Ear, Nose and Throat surgery. Samples acquired via fine-needle aspiration cytology (FNAC) may be processed as dry slides (conventional) or as liquid cytological preparation. Adequacy, defined as the quantity and quality of cellular material obtained, is a determinant of correct cytological diagnosis. This study aimed to investigate the adequacy of dry slide samples alone versus dry slides in combination with liquid cytological preparation in non-thyroid masses.

METHODS: A single-centre study was undertaken between 2015 and 2018 at a District General Hospital Pathology unit. An initial retrospective analysis of adequacy data was undertaken over a nine month period from 1st January to 30th September 2015. All samples in this period were prepared as dry slides and obtained by two ENT surgeons and two radiologists. From 2017 onwards, samples were prepared as both dry slides and liquid cytology. Prospective re-audit of adequacy was undertaken over a nine month cycle in 2018. Individual clinicians' adequacy rates and overall adequacy were recorded in both cycles.

RESULTS: In the 2015 audit cycle, 134 of 207 (64.7%) samples were deemed adequate. In the 2018 re-audit, 156 of 202 (77.2%) samples were adequate. All four clinicians achieved higher adequacy rates in the re-audit cycle.

CONCLUSIONS: This study demonstrated promising improvement in overall and individual clinician adequacy rates following the introduction of liquid cytological preparation concurrently with dry slides. Collaborative research from further centres would increase sample size and allow higher validity.

DOI: 10.1111/cyt.70076

Intranetwork variation in neoadjuvant therapy delivery for borderline resectable and locally advanced pancreatic cancer: a UK multicentre cohort study (2026)

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Type of publication:

Journal article

Author(s):

Labib, P L; Alarabiyat, M; Powell-Brett, S; Hall, L; Rehman, S; Edwards, D; Ma, Y T; Sivakumar, S; Good, J; Candish, C; Nagy, A; Tsalic, M; Hafeez, T; Kunene, V; *Chatterjee, A; Roberts, K J; Chatzizacharias, N.

Citation:

Annals of the Royal College of Surgeons of England. 2026 Apr 09.

Abstract:

INTRODUCTION: Pancreatic cancer (PC) treatment in the UK is coordinated via regional referral networks, but formal neoadjuvant chemotherapy (NAC) pathways for borderline resectable and locally advanced PC (BR/LAPC) are rare. This cohort study assessed intranetwork variation in access to diagnostics, time to treatment and patient outcomes following NAC for BR/LAPC in our network.

METHODS: All patients with BR/LAPC referred from regional network hospitals between 2017 and 2021 were reviewed. Data were collected on time from first diagnostic computed tomography scan to endoscopy, commencement of NAC, NAC regimens administered and patient outcomes.

RESULTS: In the 155 patients who commenced NAC, there were significant differences in median time to biliary drainage and endoscopic ultrasound between referral hospitals. Time from decision to treat to first administration of NAC was long (median 64 days). There were significant differences in the proportion of patients commenced on mFOLFIRINOX (0-100%, p<0.001) and the proportion completing NAC (0-100%, p=0.012). The likelihood of proceeding to surgical resection was similar between centres.

CONCLUSIONS: There is significant intranetwork variation in access to interventional endoscopy and choice of NAC regimen. Centralised tracking of patients receiving NAC, development of locally agreed treatment protocols and an update to national guidelines are needed to standardise NAC pathways for BR/LAPC.

DOI: 10.1308/rcsann.2026.0023

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Relationship between social deprivation, CEAP score and time to varicose vein surgery: A single-centre retrospective analysis (2026)

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Type of publication:

Journal article

Author(s):

*Crossdale, Martin; *Damaraju, Sandeep; *Smith, Benjamin; *Alawattegama, Lakna Harindi; *Bhanderi, Shivam; *Jones, Steven.

Citation:

Phlebology. 2683555261444161, 2026 Apr 17.

Abstract:

Introduction: Inequalities in access to planned venous surgery are not well understood. We aimed to explore the relationships between disease severity, socioeconomic deprivation, procedure performed, and waiting times. Methods We analysed retrospectively collected data from 302 patients undergoing varicose vein surgery at a single NHS Trust in Shropshire, England between 1st January 2024 to 31st December 2024. Spearman's correlation, chi-squared testing, and Kruskal-Wallis tests were used to examine associations between CEAP score, Index of Multiple Deprivation (IMD) decile, procedure performed, referral-to-treatment time and time on the waiting list. Results The median age was 54 years (IQR 26), with equal male and female representation. The most common CEAP score was C2, median IMD decile was 6 (IQR 4), and median time on the surgical waiting list was 215 days (IQR 278). There was no statistically significant association between IMD and either wait time or CEAP score, in either England or Wales. CEAP score did not correlate with waiting list time (Spearman's rho = -0.031, p = 0.59). CEAP score was not associated with procedure performed (chi2 = 20.0, df = 35, p = 0.98). Similarly, no association was seen between IMD and procedure in England, Wales, Shropshire, or Telford & Wrekin. Conclusion In this cohort, socioeconomic deprivation was not associated with disease severity, procedure selection, or delays to intervention, although the under-representation of the most deprived deciles may limit the strength of this conclusion. The lack of correlation between CEAP score and waiting time may suggest there are other factors limiting clinical prioritisation.

DOI: 10.1177/02683555261444161