Type of publication:
Journal article
Author(s):
Rai, Tanvi; *Millward, Helen; *Siddall, Kate; Riddell, Nathan S; *Elsmore, Amy; Dhadda, Amrit; *Willson, Seren; Collis, Rachel; *Parry-Smith, William; Collins, Peter; Hinton, Lisa; Bell, Sarah.
Citation:
International Journal of Gynaecology & Obstetrics. 2026 May 16.
DOI: 10.1002/ijgo.71079
Type of publication:
Systematic review
Author(s):
*Phelan, Harriet; Davie, Cameron.
Citation:
Emergency Medicine Journal. 2026 Jun 09.
Abstract:
A short systematic review was undertaken to answer the following three-part question: in adult patients with suspected sepsis, is adjunct resuscitation with human albumin solution (HAS) associated with improved patient-oriented outcomes? A systematic keyword search of EMBASE, MEDLINE, Cochrane and Google Scholar databases returned three relevant papers which were subsequently used in the final analysis. The author, year, country of publication, patient group studied, study type, key findings and study weaknesses are tabulated. The results suggest that resuscitation with HAS is not recommended in the emergency department in suspected sepsis and larger studies are required to address this clinical question.
DOI: 10.1136/emermed-2026-216135
Type of publication:
Journal article
Author(s):
Gaspar, Maxime; Maffulli, Nicola; Memain, Geoffrey; *Carmont, Michael R; Hardy, Alexandre; Arnaud, Choplin.
Citation:
Sports Medicine. 2026 Jul 26.
Abstract:
BACKGROUND: The annual incidence of Achilles tendon ruptures has increased by almost 3%. Despite the large amount of data available on post-injury treatment, there is a lack of evidence-based criteria to guide return to running after surgery.
OBJECTIVE: The aim of this study was to reach a consensus among experts on the criteria for resuming running following surgery for Achilles tendon rupture.
METHODS: Thirty-five international Achilles tendon experts were invited to participate in this modified Delphi study. The study was conducted in three rounds, with a threshold of 75% agreement (or disagreement) required for an item to achieve consensus. Sixteen clinical criteria were submitted to the expert panel. A five-point Likert scale was used. The study was conducted between January and June 2025.
RESULTS: Eight criteria achieved consensus after three rounds: seven criteria reached consensus for inclusion, and one criterion reached consensus for exclusion (calf circumference symmetry). The seven criteria were (1) the absence of pain in daily life; (2) the absence of pain during and after rehabilitation sessions; (3) walking without limping; (4) the ability to walk on tiptoes; (5) the ability to perform ten single-leg heel rises; (6) good single-leg balance; and (7) the patient feeling psychologically ready to resume running.
CONCLUSION: An expert consensus on the criteria to return to running after surgery for Achilles tendon rupture has been developed. These criteria, agreed by experts, may inform clinical decision making regarding return to running, but they require prospective validation before they can be used as decision rules. Further studies are needed to refine these criteria and evaluate their impact on functional outcomes during the return-to-running phase.
DOI: 10.1007/s40279-026-02506-4
Type of publication:
Journal article
Author(s):
*Miller, Ashley; Peck, Marcus; Conway, Hannah; Parulekar, Prashant; Rubino, Antonio; Stephens, Jennie; Wilkinson, Jonathan; Kirk-Bayley, Justin; Waraich, Manni; Griksaitis, Michael.
Citation:
The Journal of the Intensive Care Society. 17511437261470613, 2026 Jul 31.
Abstract:
Haemodynamic ultrasound is central to bedside assessment of circulatory failure in critical care. The Focused UltraSound in Intensive Care HaemoDynamics (FUSIC HD) programme was originally designed to provide a structured national framework for physiologically focused ultrasound assessment, distinct from comprehensive diagnostic echocardiography. Since publication of the original framework, experience from training cohorts, logbook review, and centralised summative assessment has shown that a broader range of haemodynamic parameters can be acquired and interpreted in routine practice. This article outlines the rationale, development process, and methodological principles underpinning the recent revision of the FUSIC HD dataset. The updated framework incorporates additional assessment of left ventricular performance, right ventricular function, and pulmonary vascular loading, together with a refined approach to estimating left atrial pressure while maintaining emphasis on physiological coherence, bedside feasibility, and avoidance of unnecessary diagnostic complexity. The aim is not to expand diagnostic echocardiography capability, but to support more integrated haemodynamic interpretation in critically ill patients within an established training and governance structure.
DOI: 10.1177/17511437261470613
Link to full-text [no password required]
Type of publication:
Journal article
Author(s):
Spiegel, Rory; Haycock, Korbin; *Miller, Ashley; Weingart, Scott; Farkas, Joshua; Ajmo, Ian; Rola, Philippe.
Citation:
American Journal of Emergency Medicine. 110:411-415, 2026 Sep 15.
Abstract:
The Surviving Sepsis Campaign (SSC) Guidelines once represented what was considered the pinnacle of care for patients with sepsis and septic shock. Unfortunately, over the past decade, successive iterations of the guidelines have drifted from what is now considered optimal care for critically ill patients with sepsis and septic shock. Moreover, the guidelines have shifted from recommendations intended to guide and support physicians based on the best available evidence, to mandated "bundles" which exert substantial influence over what is considered "standard of care" in sepsis management. This. Document is intended to serve as a refutation of sorts. A rebuttal to the most controversial and influential recommendations in the Surviving Sepsis Campaign Guidelines, while also offering guidance on how clinicians might move beyond the protocolized, metric-based care that has become the current standard promoted by the SSC and similar organizations.
DOI: 10.1016/j.ajem.2026.09.025
Type of publication:
Journal article
Author(s):
*Olagunju, Naomi; *Cheetham, Mark; Savage, Katrein; Briggs, Tim W R; Gray, William K.
Citation:
Colorectal Disease. 28(9):e70622, 2026 Sep.
Abstract:
AIMS: The decision to create an ileostomy following anterior resection is a clinical one based on the judgement of the surgical team. However, there are few data to support decision-making. This study aimed to explore variation in, and factors associated with, ileostomy creation rates following surgery for rectal cancer in England.
METHODS: This exploratory, retrospective analysis used observational data from England's Hospital Episode Statistics (HES) dataset. All patients aged >=17 years undergoing an elective anterior resection with ileostomy creation from 1 April 2016 to 31 March 2024 were included. The primary outcome of interest was ileostomy creation at the time of index surgery.
RESULTS: In total, 17,540 anterior resections for rectal cancer were included, and 5,954 patients (33.9%) had a diverting ileostomy. Rates of ileostomy creation declined over time, from 38.6% in 2016/17 to 29.7% in 2023/24, while the number of anterior resections remained relatively stable, other than during the COVID-19 pandemic. There was substantial variation in ileostomy creation rates across hospital trusts from 5.8% to 62.5%. Greater odds of ileostomy creation were associated with younger age, male sex, mild/moderate frailty, living in a less deprived area, Asian ethnicity, higher surgeon and trust volume and earlier time periods.
CONCLUSIONS: Rates of ileostomy creation are falling, but there is huge variation in creation rates across providers and patient groups. Standardised guides on when to create an ileostomy may help reduce the extent of this variation.
DOI: 10.1111/codi.70622
Type of publication:
Journal article
Author(s):
*Bastock, Daniel; Amarnani, Raj.
Citation:
Cureus. 18(7):e111990, 2026 Jul.
Abstract:
Sleep is increasingly being recognised as an important factor influencing athletic performance, recovery and overall health. This narrative review aims to discuss the factors that can affect sleep in athletes and how sleep can affect performance. Traditionally, athlete well-being has focused on training and nutrition; however, new evidence and initiatives now highlight sleep as an important element of performance. This review examines current evidence on sleep duration, sleep quality and sleep disturbances in athletic populations, with a particular focus on the effects related to competition. Athletes often report shorter sleep durations than non-athletes, despite experiencing less sleep fragmentation and quicker sleep onset. One study found that on nights before a competition day, athletes went to bed earlier (22:56 hr +/- 49.2 min), woke up later (8:12 hr +/- 58.6 min) and slept for longer (7:57 hr +/- 60.9 min). A significant number of athletes face poor sleep quality, difficulty falling asleep, and excessive daytime sleepiness. Sleep disruptions are also common around competitions, with post-competition nights showing reductions in total sleep time and sleep quality compared to pre-competition nights. Factors contributing to this include late competition times, heightened physiological and psychological arousal, increased caffeine intake, travel demands and use of technology. Overall, these findings demonstrate that inadequate and disturbed sleep is widespread among athletes, especially during competition periods, which may impact recovery, cognitive function and emotional stability.
DOI: 10.1002/wjs.70558
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
Balasubaramaniam, Vignesh; Mun Wong, Geoffrey Yuet; Martinino, Alessandro; Sarodaya, Varun; Abulazayem, Mohamed; Wazir, Ishaan; Scarano Pereira, Juan Pablo; Marques, Claudia Neves; Said, Amira; Wadhawan, Himanshu; Graham, Yitka; *Jain, Rajesh Kumar; *Riera, Manel; Mahdi, Ahmed Salah; Ammar, Ahmed Siddique; Mohamed, Aboelazaiem; Alfarwan, Ahmad; Sanli, Ahmet Necati; Aymar, Akilimali; Alkaseek, Akram; Khamees, Almu'atasim; Ouyahia, Amel; Kosti, Angeliki; Dawle, Anjali; Maqbool, Baila; Abdelhadi, Bassem; Parmar, Chetan; Colak, Elif; Erginoz, Ergin; Verras, Georgios-Ioannis; Abd El Hady, Haithm G; Hamdan, Hasan K H; Bakeer, Hibad Bileid; Alhadad, Hoda Salem; Elzayat, Ibrahim; Gerogiannis, Ioannis; Demma, Jonathan Abraham; Al-Shami, Khayry; Shalabi, Laila; Frountzas, Maximos; Manoj, Matthew Antony; Tokocin, Merve; Campanelli, Michela; Omar, Mohammad A; Farag Karamelghani, Mohammed Akasha; Rais, Mounira; Abu Jayyab, Mustafa Ahmad; Allahverdiyeva, Nigar; Gentileschi, Paolo; Abizade, Rashad; Huseynov, Sahib; Das, Aashna; Uludag, Server Sezgin; Cyclewala, Shabnam S; Meric, Serhat; Omarov, Taryel; Bakewell, Zoe Rachael; Singhal, Rishi; Mahawar, Kamal.
Citation:
World Journal of Surgery. 2026 Sep 10.
Abstract:
BACKGROUND: Necrotizing soft tissue infection is a rapidly progressive soft tissue infection with a high mortality rate. Limited contemporary data exist on abdominal wall necrotizing soft tissue infections. This study aimed to assess 30-day mortality and morbidity and identify associated clinical factors.
METHODS: This was a prospective, multinational, multicenter audit of adult patients (>= 18 years) with abdominal wall necrotizing soft tissue infection presenting between January 1 and June 30, 2022. Data on demographics, comorbidities, clinical features, treatment, and outcomes were collected. Univariate and multivariate regression analysis were performed to identify independent risk factors for morbidity and mortality.
RESULTS: A total of 331 patients were included from 63 centers in 27 countries. Thirty-day morbidity and mortality occurred in 200 patients (60.4%), with 47 deaths (14.2%). A LRINEC score >= 6 was observed in 134 out of 263 (51.0%) of cases. Common presenting signs were skin changes in 287 out of 327 cases (87.8%), pain out of proportion to clinical findings in 236 out of 311 cases (75.9%), and gas in soft tissue on imaging 210 out of 329 cases (63.8%). The median time to first antibiotics was 2 hours (Range 0-240 hours). The median time to surgery was 6 hours (Range 1-384 hours). In the mortality group, 29 out of 47 (61.7%) had diabetes, 33 out of 47 (70.2%) had hypertension, and 25 out of 47 (53.2%) had obesity. Bowel resection (38.3%, 18 out of 47), stoma formation (44.7%, 21 out of 47) and ICU admission (89.4%, 42 out of 47) were more common in the mortality group (p < 0.05, OR 7.47). On multivariable analysis, polymicrobial infection (OR 1.73 CI 1.01-2.95) and bowel resection (OR 3.10 CI 1.22-7.88) were independently associated with morbidity, while increasing age (OR 1.04 CI 1.01-1.07), elevated creatinine (OR1 CI 1.00-1.01), bowel resection (OR 7.47 CI 2.99-18.62), and longer time to antibiotics (OR 1.02, CI 1.00-1.04) were independently associated with mortality (p < 0.05).
CONCLUSION: Abdominal wall necrotizing soft tissue infection is associated with high early morbidity and mortality. Delays in recognition and treatment remain critical contributors. Risk stratification may assist early identification and management.
DOI: 10.1002/wjs.70558
Type of publication:
Journal article
Author(s):
Azzopardi, Matthew; Chong, Yu Jeat; Smith, Ella P; Barahim, Eman Khalid; *Jenyon, Thomas; Elsheikha, Hany M; Carnt, Nicole; Lakshminarayanan, Rajamani; Mehta, Jodhbir S; Rauz, Saaeha; Ting, Darren S J.
Citation:
Clinical Microbiology Reviews. 39(3):e0027725, 2026 Sep 10.
Abstract:
SUMMARY Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection with rising global incidence, largely driven by increased contact lens use. Management remains challenging due to limited therapeutic options, variable clinical responses, and a lack of standardized treatment guidelines. Diagnosis is frequently delayed because of the non-specific clinical presentation, and early use of topical corticosteroids can exacerbate disease severity and worsen outcomes. The formation of highly drug-resistant cysts in chronic infection further complicates treatment. Currently, prolonged combination therapy with topical biguanides and aromatic diamidines remains the mainstay of treatment. However, recent evidence supports the use of topical biguanide monotherapy (in higher concentrations) in AK with comparable outcomes to combination treatment. Adjunctive therapies, including azoles, miltefosine, and corticosteroids, may be beneficial in refractory disease. Surgical interventions, such as therapeutic keratoplasty, are often required in advanced or non-responsive cases. The choice of therapy is frequently empirical, guided by clinician experience and drug availability. Emerging therapeutic approaches, including antimicrobial peptides, synthetic polymers, bioactive natural compounds, and ultraviolet C therapy, show promise as more effective or better-tolerated alternatives. This review provides an up-to-date overview of current medical and surgical treatments, explores novel interventions in the pipeline, and highlights the need for evidence-based, individualized management strategies in AK.
DOI: 10.1128/cmr.00277-25
Type of publication:
Journal article
Author(s):
*Alawattegama, Lakna Harindi; Al-Saadi, Nina; Bosanquet, David; Chetter, Ian; Fabre, Ismay; Garnham, Andrew; Gwilym, Brenig; Hitchman, Louise; Long, Judith; Magill, Laura; Worrallo, Katie; Pinkney, Thomas; Popplewell, Matthew; Wall, Michael.
Citation:
International Wound Journal. 23(4):e70846, 2026 Apr.
Abstract:
Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.
DOI: 10.1111/iwj.70846
Link to full-text [open access - no password required]
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Find out more by visiting either the Improvement Hub Intranet pages (only available on a Trust PC) or the Improvement Hub page on the SaTH website.