2026

One-Stage or Two-Stage Revision for Infected Shoulder Arthroplasty: A Head-to-Head Meta-Analysis of Comparative Studies (2026)

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Type of publication:

Systematic review

Author(s):

Selim, Amr; *Ibrahim, Abdelrahman; Abbas, Azhar; Sadiq, Salman; Farhan-Alanie, Muhamed M; *Ahmed, Mohammed Lyeeq; Rhee, Jae.

Citation:

JBJS Reviews. 14(7), 2026 Jul 01.

Abstract:

BACKGROUND: Periprosthetic joint infection (PJI) following shoulder arthroplasty is a devastating complication associated with substantial morbidity and revision burden. While 2-stage revision has traditionally been regarded as the gold standard for chronic shoulder PJI, single-stage revision has emerged as a potential alternative. The aim of this systematic review was to directly compare infection-related outcomes and complications between single-stage and 2-stage revision arthroplasties for shoulder PJI.

METHODS: This systematic review was prospectively registered with PROSPERO (CRD420251159566) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, and Web of Science were searched up to September 22, 2025. Comparative observational studies and randomized controlled trials (RCTs) evaluating single-stage vs. 2-stage revision for shoulder PJI in adults were eligible; no RCTs were identified. Primary outcomes were reinfection and infection control success; overall complications were secondary. Odds ratios (ORs) were calculated within each study and pooled using a random-effects model. Risk of bias was assessed with the Risk of Bias in Non-randomized Studies of Interventions tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment,
Development and Evaluation.

RESULTS: Thirteen retrospective comparative studies involving 260 patients (127 single-stage and 133 two-stage) were included. Compared with 2-stage revision, single-stage revision showed a lower, but not statistically significant, odds of reinfection (OR 0.46, 95% confidence interval [CI] 0.21-1.04; p = 0.06; I2 = 0%) and overall complications (OR 0.52, 95% CI 0.18-1.53; p = 0.24; I2 = 0%) and a higher, but nonsignificant, odds of infection control success (OR 1.57, 95% CI 0.45-5.40; p = 0.48; I2 = 17%).

CONCLUSION: Single-stage revision demonstrated infection control and complication rates comparable with 2-stage revision for shoulder PJI. Although no statistically significant differences were observed, trends favored single-stage revision. Given that the certainty of the evidence was graded as low, these findings should be interpreted with caution, and high-quality RCTs are required to define optimal patient selection and surgical strategy.

LEVEL OF EVIDENCE: Therapeutic Level III.

DOI: 10.2106/JBJS.RVW.26.00055

Carbapenem-resistant Enterobacterales across the UK: A nationwide study of carbapenemase testing and novel antimicrobial activity (2026)

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Type of publication:

Journal article

Author(s):

Baltas I.; Drury K.; Harrison T.; Moore N.; Lester R.; Chattaway M.A.; England B.; Cattrall J.W.S.; Donaldson C.J.; Jamal Khan D.P.; Carroll A.; Ball D.; Wareham D.W.; Pahalage R.; Banavathi K.; Drazho B.; Shorrocks R.E.; Hlaing W.; Adhikaree N.; Ryan F.; Thompson J.V.; Connolly G.; Shibu P.; Ale E.; Mirfenderesky M.; Jain S.; Fowler S.; Beard K.; Hughes G.; Bonnici G.; Mohammed T.; Brown K.; Drazich-Taylor S.; Martinez A.S.; Lipworth S.; Crawford-Jones D.; Elnour M.; Moore J.; Democratis J.; McCormick J.; Hussain A.; Islam J.; Jenkins D.; Stoesser N.; Hopkins K.; Demirjian A.; Hatcher J.; Soares A.L.; Kirby A.; Grandjean L.; Riley U.; Stephens J.; Joseph A.; Winzor G.; Jackson K.E.; Kandil H.; Barker B.; Planche T.; Jawad S.; Merrick B.; Snell L.B.; Subbaraj K.P.; Munthali P.G.; Clayton J.J.; Varghese R.; Jones C.R.; Hardman N.L.; Komosa M.M.; Heppell B.M.; Halstead F.D.; Qaiser S.; Mavrogiorgou E.; Nye C.; Bamber S.; Locke T.E.; Whatmore J.; Mohamed F.; Adobah E.; Knox K.; Campbell O.; Carson A.A.; North P.; Albur M.; Tickell-Painter M.; Mooney H.; Coward A.; Shah A.; Choudhury R.Y.; Sughayer H.M.; Graham C.; Mutch C.P.; Dewar S.; Hesing S.C.; Khan S.; Garcia-Mingo A.; Garcia D.M.; Penciu F.; Kosaraju K.; Davey E.; Vazquez A.M.; Qazzafi Z.; *Anand M.; Navalan H.; Roberts S.; Mermerelis D.; Read A.; Rangaiah J.; Austin-Hutchison R.; Price J.R.; Peters J.; Stevens M.; Knapper F.; Merchant N.; Davies F.; Vanstone G.L.; Allen D.; Prior-ong M.; Tuharska Z.; Soper I.; Tsui R.; Watts A.; Kakkar N.; Patel M.; Townsley H.; Saajan P.; Claxton A.P.; Burns P.J.; Jeppesen C.A.; Lee M.; Tudor A.; Macnaughton E.; McKeating C.; Dhillon R.; Okoliegbe I.; Sakka N.E.; Scott K.S.; Wang D.B.; Wilson B.; Laing-Herridge K.; Diver-Hall E.

Citation:

International Journal of Antimicrobial Agents. 67(10) (no pagination), 2026. Article Number: 107898. Date of Publication: 01 Oct 2026. [epub ahead of print]

Abstract:

Background Carbapenem-resistant Enterobacterales (CRE) are increasing in the UK, but the drivers of this rise and effective treatment options remain uncertain. Methods Ninety-seven acute National Health Service Trusts, including 192 UK hospitals, submitted data on 8840 consecutive, non-duplicate CRE (October 2023 to September 2024) and local laboratory methods. Results Predominant CRE species were Klebsiella pneumoniae (30.6%, 2709/8840), Escherichia coli (29.3%, 2592/8840), Enterobacter cloacae complex (22.2%, 1966/8840). Overall, 21.8% (1927/8840) of CRE were collected in outpatient settings. Overall, 85.5% (7279/8513) of CRE underwent carbapenemase detection testing, with significant variation depending on species, specimen type, and baseline antibiogram. Carbapenemases detected were OXA-48-like (22.3%, 1967/8840), NDM (18.6%, 1645/8840), KPC (9.2%, 817/8840), IMP (2.0%, 178/8840), VIM (0.7%, 62/8840), multi-carbapenemase producers (4.0%, 351/8840). Overall, 51.2% (4526/8840) of CRE were tested against >=1 novel agent. In-house antimicrobial susceptibility testing availability was common for ceftazidime-avibactam (90.7%, 88/97) and cefiderocol (73.2%, 71/97), while less common for meropenem-vaborbactam (41.2%, 40/97), imipenem-relebactam (21.6%, 21/97), aztreonam-avibactam (11.3%, 11/97). OXA-48-like- (97.6%, 1138/1166) and KPC producers (96.2%, 429/446) remained susceptible to ceftazidime-avibactam; KPC producers to meropenem-vaborbactam (99.4%, 160/161) and imipenem-relebactam (98.4%, 62/63). Cefiderocol resistance was 32.4% overall and higher among NDM- (58.4%) and multi-carbapenemase producers (50.3%). Ceftazidime-avibactam plus aztreonam synergy was performed for 17.2% (286/1658) of aztreonam-resistant metallo-beta-lactamase-producers; synergy was observed in 78.7% (225/286) of cases. Colistin resistance was 10.6% (153/1445) among non-intrinsically resistant species. Conclusions Whilst most UK CRE are tested for carbapenemases, coverage gaps persist. The community burden of CRE is increasing. Cefiderocol resistance is concerningly high, particularly among metallo-beta-lactamase-producers.

DOI: 10.1016/j.ijantimicag.2026.107898

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Understanding the Nuanced Concept of Hemodynamic Incoherence and Its Underlying Physiology (2026)

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Type of publication:

Journal article

Author(s):

Rola P.; *Miller A.; Haycock K.; Spiegel R.; Rikhraj K.; Kattan E.; Hernandez G.

Citation:

Journal of Clinical Medicine. 15(15) (no pagination), 2026. Article Number: 5811. Date of Publication: 01 Aug 2026. [epub ahead of print]

Abstract:

Hemodynamic incoherence is commonly defined as a dissociation between normalization of macrocirculatory variables and persistent impairment of tissue perfusion. However, this phenomenon is not physiologically homogeneous. We propose a conceptual distinction between two forms of macro-microcirculatory incoherence. Type 1 incoherence represents primary microcirculatory dysfunction, in which intrinsic alterations in microvascular regulation and flow distribution lead to heterogeneous capillary perfusion despite apparently adequate upstream hemodynamics, as observed in sepsis. In contrast, Type 2 incoherence reflects secondary impairment of microcirculatory flow resulting from hemodynamic constraints elsewhere in the circulation, including excessive vasoconstriction, limited cardiac forward flow, or venous congestion. In this setting, impaired perfusion arises from ineffective transmission of flow across the system rather than primary microvascular failure. The four-interface model of the circulation provides a unifying physiological framework to interpret these mechanisms as failures of energy transfer across sequential hemodynamic domains. Recognizing these distinct forms of incoherence may improve not only physiologic interpretation of shock and help avoid conflating fundamentally different mechanisms under a single conceptual entity, but also be key in individualizing therapeutic interventions to the proper phenotypes of tissue malperfusion

DOI: 10.3390/jcm15155811

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Routine pre-operative CT imaging in Grade 2 endometrial cancer: A two-year retrospective review of clinical impact (2026)

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Type of publication:

Conference abstract

Author(s):

*Alayande G.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S14), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: The British Gynaecological Cancer Society (BGCS) guidance does not recommend routine pre-operative CT imaging in low-grade endometrial cancer due to its low diagnostic yield and limited impact on outcomes. At Shrewsbury and Telford Hospital NHS Trust, however, all patients with confirmed Grade 2 (or higher) endometrial cancer undergo preoperative CT-TAP in line with local guidance. Objective(s): To assess adherence to local guidance and determine whether pre-operative CT influences gynaecological management. A secondary aim was to evaluate the frequency and consequences of incidental findings. Method(s): We retrospectively reviewed patients diagnosed with Grade 2 endometrial cancer between April 2023 and May 2025 using the Somerset Cancer Register. Patients diagnosed postoperatively were excluded. Electronic records were examined to assess whether CT findings altered management, defined as referral to a tertiary centre. Result(s): Of 52 identified patients, 46 met inclusion criteria. All underwent pre-operative CT imaging. Findings suggestive of metastatic disease were reported in 13% (6/46), prompting tertiary referral in four surgically fit patients; one was later found to have stage IA disease, representing potential overtreatment. Incidental findings occurred in 45% (21/46), with 38% (8/21) requiring further investigation. Most were clinically insignificant, though one led to a new breast cancer diagnosis. Conclusion(s): In this cohort, routine pre-operative CT imaging in Grade 2 endometrial cancer influenced management in a clinically meaningful way. Nevertheless, potential overtreatment and the implications of incidental findings should inform imaging decisions.

DOI: 10.1111/1471-0528.70281

Audit of compliance with trust PMB protocol V6 in the management of postmenopausal bleeding in women not on HRT (2026)

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Type of publication:

Conference abstract

Author(s):

*Huda N.-U.; *Sahu B.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S40), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Postmenopausal bleeding (PMB) occurs in 5-10% of women who are not on hormone replacement therapy (HRT). Around 90% of women diagnosed with endometrial cancer present with vaginal bleeding. National guidance and local Trust protocol PMB V6 recommend urgent referral and timely investigation to exclude malignancy. Early and effective triage is essential to meet the Faster Diagnosis Standard. Objective(s): To assess compliance with Trust PMB protocol V6 (November 2024) for the management of postmenopausal bleeding in women not on HRT, and to evaluate whether diagnosis was established within 28 days in line with the Faster Diagnosis Standard. Method(s): A retrospective audit was conducted of women not on HRT referred with PMB. Compliance was assessed against Trust standards, including triage, transvaginal ultrasound (TVS), endometrial thickness (ET) measurement, and appropriate use of hysteroscopy and biopsy. Outcomes were compared with protocol targets. Result(s): There was excellent compliance with diagnostic management in secondary care. Most women underwent timely TVS with accurate ET measurement, and those with ET >= 8 mm or additional risk factors appropriately proceeded to hysteroscopy. Women with thin endometrium were safely discharged without intervention. However, delays were identified in achieving diagnosis within 28 days. These were mainly due to delays in triage, investigations, review of results, and communication with patients. Conclusion(s): While diagnostic management of PMB showed strong compliance with Trust protocol, gaps were identified in meeting the Faster Diagnosis Standard. Separating HRT and non-HRT pathways, improving triage, and strengthening communication are essential to optimise resource use, improve patient experience, and ensure timely cancer exclusion.

DOI: 10.1111/1471-0528.70281

Placental site trophoblastic tumour beyond the reproductive years: A rare cause of postmenopausal bleeding (2026)

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Type of publication:

Conference abstract

Author(s):

*Kabra S.; *Alayande G.; *Malik N.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S44-S45), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Placental site trophoblastic tumour (PSTT) is a rare subtype of gestational trophoblastic neoplasia arising from intermediate trophoblastic cells at the placental implantation site. It typically occurs in women of reproductive age following a prior pregnancy, although rare cases have been reported in perimenopausal and menopausal women. A UK population-based study reported only 75 cases over a 21-year period. Objective(s): To report a rare presentation of PSTT in a menopausal woman. Method(s): Case report and literature review. Result(s): A 46-year-old woman presented with heavy vaginal bleeding after two years of amenorrhoea. Her last pregnancy was a term caesarean section three years previously. Transvaginal ultrasound showed a postmenopausal endometrial thickness of 6 mm, and she was referred through the urgent suspected cancer pathway. Diagnostic hysteroscopy was attempted but abandoned due to poor visualisation from active bleeding. Pipelle endometrial biopsy revealed an infiltrative lesion composed of intermediate trophoblastic cells with immunohistochemistry positive for AE1/AE3 and human placental lactogen (hPL), consistent with PSTT. MRI pelvis demonstrated a 3 cm lesion involving the anterior myometrium extending into the endometrial cavity. Staging CT of the chest, abdomen and pelvis showed no distant metastasis. Following multidisciplinary discussion with the regional gestational trophoblastic disease centre, hysterectomy was recommended as definitive treatment. Conclusion(s): PSTT is a rare but important differential diagnosis for postmenopausal bleeding. Early histopathological diagnosis, appropriate imaging and multidisciplinary management are essential for optimal outcomes.

DOI: 10.1111/1471-0528.70281

Beyond virilisation: Two non-functional ovarian steroid cell tumours and a critical review of the literature (2026)

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Type of publication:

Conference abstract

Author(s):

*Huda N.-U.; *Chai A.C.; *Sahu B.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S40-S41), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Ovarian steroid cell tumours (SCTs) are rare sex cord-stromal neoplasms (<0.1% of ovarian tumours). Most secrete androgens causing virilisation, but up to 40% are nonfunctional and discovered incidentally. Their variable presentation and overlapping histology make diagnosis challenging. Objective(s): To describe two cases of non-virilising ovarian SCTs managed at our institution, review their management, and contextualise findings within the current literature. Method(s): We report two patients diagnosed with nonfunctional ovarian SCTs. Case 1: a 77-year-old woman with an incidental left ovarian mass; Case 2: a 56-year-old woman presenting with postmenopausal bleeding and right ovarian mass. Both underwent surgical excision. Histopathology and immunohistochemistry (inhibin, calretinin, Melan-A) confirmed diagnosis. Patients were followed with imaging, tumour markers, and hormonal assays. A literature review of major series and molecular insights was conducted.
Result(s): Case 1 had a large (16 x 10 cm) left-sided tumour, FIGO stage IA, with no malignant features. Case 2 had a smaller (5.5 x 4 cm) right-sided tumour, FIGO stage IC2, with capsular invasion. Both patients had uneventful recoveries and remain recurrence-free on long-term surveillance. Literature review highlights the heterogeneity of SCTs, with non-functional tumours comprising ~40% of cases, generally presenting at early stages, and showing favourable outcomes with surgery alone. Histologic predictors of malignancy include tumour size >= 7 cm, mitotic activity, necrosis, and atypia. Molecular data suggest potential links with VHL, FH, and APC mutations, but prognostic markers remain limited. Conclusion(s): Non-functional ovarian SCTs may present incidentally and are often cured with surgery. Accurate diagnosis relies on histology and immunohistochemistry, and lifelong follow-up is recommended due to unpredictable malignant potential.

DOI: 10.1111/1471-0528.70281

Audit on the recognition and initial management of ovarian cancer in secondary care: Compliance with NICE CG122 & QS18 (2026)

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Type of publication:

Conference abstract

Author(s):

*Huda N.-U.; *Sahu B.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S41), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Ovarian cancer is the sixth most common cancer in women in the UK and is often diagnosed at an advanced stage due to non-specific early symptoms. NICE Clinical Guideline CG122 and Quality Standard QS18 provide recommendations for timely recognition, investigation, and referral. Objective(s): To evaluate whether women presenting with symptoms suggestive of ovarian cancer were investigated and managed in accordance with NICE CG122 and QS18 in our NHS Trust. Method(s): A retrospective audit was conducted on 20 women referred to the gynaecology department with suspected ovarian malignancy. Data collected included age, tumour markers (CA125), risk of malignancy index (RMI), imaging, tissue diagnosis, chemotherapy decisions, tertiary care involvement, and access to support services. Result(s): Most patients (95%) were over 40 years old. Advanced-stage disease was present in 65% of cases. Compliance with tumour marker testing and imaging was generally high, but RMI calculation and referral documentation were inconsistent. Ninety percent of advanced-stage patients had tissue diagnosis prior to chemotherapy. Definitive surgery was mainly performed in tertiary centres. Support needs were not routinely identified, and trial participation was limited. Delays in investigations and referral were noted in a minority of cases, and atypical presentations posed diagnostic challenges. Documentation regarding lymph node assessment during staging was incomplete. Recommendations: Enhance patient flagging to support services, provide targeted clinician education on NICE guidelines, and share audit feedback with tertiary partners. Conclusion(s): While most patients received appropriate investigations and referral, improvements are needed in early recognition, documentation, and holistic care planning. Ongoing audit and education are essential to optimise adherence to guidelines and improve outcomes in ovarian cancer management.

DOI: 10.1111/1471-0528.70281

Management of post-menopausal women who are high-risk HPV positive with normal, borderline, or mildly dyskaryotic cytology and unsatisfactory colposcopy (2026)

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Type of publication:

Conference abstract

Author(s):

Stout A.; *Sutherland D.; China S.; Byrom J.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S80-S81), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Unsatisfactory colposcopy is common, occurring in 10-20% of women. Post-menopausal women who are high-risk HPV positive with normal, borderline, or mildly dyskaryotic cytology and unsatisfactory colposcopy represent an increasing management dilemma. Currently, there is no guideline for this group. Management among UK colposcopists is thought to vary. Objective(s): Our survey aimed to collate opinions of BSCCP members regarding management of this patient group, and identify a consensus opinion. We sought to compare trends with a similar survey conducted in 2018, following the introduction of primary HPV screening. Method(s): All BSCCP members were invited to complete an online survey conducted between 29/01/2026 and 05/03/2026. Result(s): We received 141 responses from medical and nursing colposcopists, the majority being experienced practitioners. Management strategies varied considerably. 60.7% would perform see-and-treat LLETZ in all or high-risk patients, while 17.9% would never offer treatment at first review. If histology was not obtained initially, 52.9% recommended repeat cytology and colposcopy at 12 months. For persistent disease >24 months, 52.2% recommended LLETZ, with an additional 45.6% considering treatment based on patient preference or risk factors. Hysterectomy was offered by 84.9% in persistent cases with risk factors or on request. Compared with 2018, see-and-treat LLETZ was more common, follow-up intervals were longer, and MDT discussion less frequent. Conclusion(s): Practice among UK colposcopists in this patient group remains variable, and demand for national guidance is high. Our survey demonstrated variety in practise on initial presentation, with a preference for excisional treatment or hysterectomy in cases of persistent disease.

DOI: 10.1111/1471-0528.70281

Variation in antenatal anaemia guidelines across the NHS in the United Kingdom: A cross-sectional study (2026)

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Type of publication:

Journal article

Author(s):

Haynes S.; Balboula I.; Collins P.; *Parry-Smith W.; Fye H.; *Elsmore A.; Collis R.; De Lloyd L.; Churchill D.; Bell S.F.; Stanworth S.J.

Citation:

British Journal of Haematology. (no pagination), 2026. Date of Publication: 2026. [epub ahead of print]

Abstract:

Antenatal anaemia affects up to 30% of pregnant women in the United Kingdom and is a recognised clinical priority. National management guidance is published by the British Society of Haematology (BSH), but the extent to which local National Health Service (NHS) guidelines align with it is unknown. We conducted a cross-sectional document analysis of antenatal anaemia guidelines from 49 NHS sites across the United Kingdom, obtained through two national research programmes. Two reviewers independently extracted data on screening, diagnosis, treatment and monitoring, using the 2020 BSH guideline as the national reference standard. The included guidelines represented approximately 33% of annual UK births. Screening and diagnostic haemoglobin thresholds were broadly consistent with BSH guidance, whereas substantial variation was concentrated in treatment and monitoring: oral iron indications, dosing and duration; haemoglobin thresholds and clinical criteria for intravenous iron; and the timing, biomarkers and response definitions used after treatment. Ferritin thresholds, reassessment intervals and response criteria were frequently absent or divergent. Variation was greatest in domains where the underlying evidence base is least resolved. These findings characterise the nature and extent of guideline-level variation across NHS maternity care and identify priority areas for future research and national guideline development.

DOI: 10.1111/bjh.70780

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