2026

Temporal Trends and Demographic and Geographic Disparities in Stroke Mortality Among US Adults Aged 25-64 Years (1999-2020): A CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Analysis (2026)

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Type of publication:

Journal article

Author(s):

Farahmandian, Ronit; Kananyan, Mariam; Alonso, Jorge E; Saro-Naenwi, Naomi; Ajibade, Tolulope; Kaurani, Purvi; Gudapati, Vamsi Krishna; Gomez-Sauceda, E Lucano; Clarke, Cleve; Arra, Srihitha; Imam, Bashir; *Gupta, Anchal R; Makkieh, Yahya.

Citation:

Cureus. 18(8):e113934, 2026 Aug.

Abstract:

BACKGROUND: Stroke remains a major contributor to mortality in the United States. Understanding long-term temporal changes and demographic and geographic disparities in stroke mortality is essential for identifying high-risk populations and guiding targeted prevention strategies.

METHODS: This retrospective observational study analyzed stroke mortality among US adults aged 25-64 years from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Deaths with stroke recorded as the underlying cause were identified using International Classification of
Diseases, 10th Revision (ICD-10) codes I60-I64 and were analyzed collectively as overall stroke mortality. Age-adjusted mortality rates per 100,000 population were assessed overall and stratified by sex, race, US Census region, and urbanization level. Joinpoint regression was used to identify temporal changes and estimate the annual percent change (APC) for each temporal segment and the average annual percent change (AAPC) across the complete study period.

RESULTS: A total of 382,253 stroke deaths were identified. The overall age-adjusted mortality rate (AAMR) decreased significantly from 1999 to 2012 (APC, -2.41%; 95% CI, -2.77 to -2.21), remained statistically unchanged from 2012 to 2018, and increased significantly from 2018 to 2020 (APC, 4.36%; 95% CI, 1.51 to 6.06). The full-period AAPC was -1.23% (95% CI, -1.42 to -1.11). Men had higher AAMRs than women and experienced a significant increase during 2018-2020. Black or African American adults had the highest race-specific AAMR, the South had the highest regional AAMR, and noncore counties had the highest urbanization-specific AAMR. Full-period AAPCs were significantly negative across all examined subgroups; however, significant later-period increases occurred among men, American Indian or Alaska Native adults, White adults, residents of the
West, large fringe metropolitan counties, and noncore counties.

CONCLUSION: Premature stroke mortality declined substantially over the complete study period, but progress was uneven across demographic and geographic groups. Persistently elevated mortality and recent reversals in selected populations highlight the need for targeted prevention and continued surveillance.

DOI: 10.7759/cureus.113934

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Impact of surgical timing on wound complications following ankle fracture fixation: A 22-year retrospective cohort study (2026)

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Type of publication:

Journal article

Author(s):

Zahra, Wajiha; Gomaa, Abdul-Rahman; Babatunde, Jubril; Seifo, Mina; *Cool, Paul; *Pickard, Simon.

Citation:

Journal of Clinical Orthopaedics & Trauma. 76:103405, 2026 May.

Abstract:

Background: Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections.

Methods: A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48 h), Intermediate (48 h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates.

Results: There was no significant association between surgical timing and the incidence of superficial wound infections (p = 0.274). However, a significant difference was observed in deep wound infection rates (p = 0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p < 0.001) and deep infections (p = 0.019). Patients over 60 years had an increased risk of superficial infections (p = 0.016) but not deep infections (p = 0.261). Superficial wound infections required longer hospital stay (p < 0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p < 0.001) and deep infections (p < 0.001).

Conclusion: In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections.

Level of evidence: IV.

DOI: 10.1016/j.jcot.2026.103405

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Variation, temporal trends and factors associated with ileostomy reversal after anterior resection surgery for rectal cancer in England: An observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

*Olagunju N; *Cheetham M; Savage K; Briggs TWR; Gray WK

Citation:

Colorectal Disease. 28(3):e70427, 2026 Mar.

Abstract:

AIMS: The presence of a temporary ileostomy following anterior resection for rectal cancer substantially impacts the quality of life of patients and long-term functional outcomes. Timely reversal of the ileostomy can help to minimise negative impacts. Using an administrative dataset for England, this study aimed to explore temporal trends in ileostomy reversal rates, variation in reversal rates across trusts and factors associated with delayed reversal.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics (HES) dataset for England. All patients aged >=17 years undergoing a planned anterior resection for rectal cancer with ileostomy creation between April 1, 2016, and March 31, 2023, were identified. The primary outcome of interest was ileostomy reversal within 18 months.

RESULTS: Data were available for 5,275 ileostomy creations during the study period. Ileostomy was reversed within 18 months in 3,338 (63.5%) patients. Frailty, socio-economic deprivation, open surgery and anastomotic leak were associated with failure to reverse ileostomy within 18 months. There was a steady decrease in rates of ileostomy reversal within 18 months over the course of the study period.

CONCLUSIONS: This study highlights a need to review current ileostomy closure pathways across England, provide equitable access to timely reversal and improve the shared decision-making process between clinicians and patients undergoing surgery for rectal cancer.

DOI: 10.1111/codi.70427

Consensus Statements on the Definition of Surgical Success Following Obstetric Urinary Pelvic Floor Fistula Repair: An IUGA-ICS Proposal (2026)

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Type of publication:

Journal article

Author(s):

Maljaars LP; Corcos J; Ghoniem G; Goh JTW; Greenwell TJ; Kupualor D; Pope R; *Rachaneni S; Regmi MC

Citation:

International Urogynecology Journal. 2026 Mar 18.

Abstract:

INTRODUCTION: Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries.

MATERIALS AND METHODS: A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement.

RESULTS: Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life.

DISCUSSION: The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of "incurable" fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective.

CONCLUSION: The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.

DOI: 10.1007/s00192-025-06413-6

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Exploring Correlations Between Holistic Needs In Lung Cancer Patients: Insights From Dependancy Tool Data (2026)

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Type of publication:

Conference abstract

Author(s):

Rayson V.; *Greenway T.; Kelly M.; Barnett N.; Kelly S.; Dalrymple P.; Ross J.; Middleton E.; Glover S.; Smith B.; Wilson J.; Weir J.; Shepherd P.; Laguardia A.

Citation:

Lung Cancer. Conference: 24th Annual British Thoracic Oncology Group Conference 2026. EICC Edinburgh, Edinburgh United Kingdom. 212(Supplement 1) (no pagination), 2026. Article Number: 109110. Date of Publication: 01 Feb 2026.

Abstract:

Introduction Holistic assessment is central to personalised cancer care, capturing physical, emotional, practical, and family-related concerns. Understanding how these domains interact can inform integrated care planning and resource allocation. This analysis investigates correlations between patient-reported concerns using the Macmillan Holistic Needs Assessment (HNA), and an adapted dependency tool, aiming to identify patterns that influence complexity and support needs. Method A retrospective secondary analysis was conducted using patient-reported HNA data collected from 210 lung cancer patients across the UK, covering all disease stages. Five domains were examined: Physical Symptoms (0-40), Physical Concerns (0-76), Practical Concerns (0-64), Emotional Concerns (0-48), and Family Concerns (0-20). Pearson correlation coefficients were calculated, where 1.00 indicates perfect correlation and 0.00 indicates no correlation. Data interpretation focused on identifying strong, moderate, and weak associations and exploring potential drivers based on patient responses. Outcomes Strongest correlation: Physical Symptoms Physical Concerns (r = 0.75) Emotional Concerns strongly linked to Practical (r = 0.65) and Family Concerns (r = 0.62) Practical Concerns moderately correlated with Physical Symptoms (r = 0.49) and Family Concerns (r = 0.54) Weakest correlation: Physical Symptoms Family Concerns (r = 0.40) Interpretation: Physical burden drives broader physical concerns, while emotional distress is amplified by practical and family-related challenges. Variability suggests influence from coping strategies, socio-economic context, and perceived family impact. Conclusion The Dependency Tool data gathered does demonstrate a correlation between several types of patient concerns. The strongest link identified is between physical symptoms and physical concerns. Despite CNS's subjective identification of a strong link between patients' emotional concerns and their physical concerns, the evidence only demonstrates a moderate correlation. There is stronger evidence that psychosocial distress is closely tied to logistical challenges and perceived family burden. Disclosure No significant relationship.

DOI: 10.1016/j.lungcan.2026.109110

Paediatric and adult neurological point-of-care ultrasound: Review of the evidence, and the UK accreditation pathway (2026)

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Type of publication:

Journal article

Author(s):

Waraich M.; Zoica B.; Alexander E.; Stephens J.; Conway H.; Griksaitis M.; Kirk-Bayley J.; *Miller A.; Parulekar P.; Peck M.; Rubino A.; Wilkinson J.N.

Citation:

Journal of the Intensive Care Society. (no pagination), 2026. Date of Publication: 2026. [epub ahead of print]

Abstract:

Neurological emergencies such as stroke and traumatic brain injury are major contributors to morbidity and mortality in critically ill patients. These conditions frequently result in alterations in cerebral haemodynamics, including raised intracranial pressure, which require timely recognition and management to optimise outcomes. Neuro point-of-care ultrasound (NeuroPOCUS), incorporating transcranial Doppler (TCD), transcranial colour-coded duplex (TCCD) ultrasound, and optic nerve sheath diameter (ONSD) measurement, offers a non-invasive, bedside means of assessing cerebral physiology and is increasingly recognised as a valuable adjunct in neurocritical care. Despite the successful adoption of point-of-care ultrasound in critical care through established accreditation pathways such as FUSIC and CACTUS, the UK has lacked a dedicated framework for NeuroPOCUS. To address this gap, we have developed and launched a UK-specific NeuroPOCUS accreditation programme, combining structured theoretical teaching with supervised practical training. The pathway addresses the distinct needs of both paediatric and adult populations, combining theoretical learning with practical application. Core learning materials include neuroanatomy, Doppler principles, standardised insonation techniques, and interpretation of cerebral blood flow velocities and indices such as pulsatility (PI) and resistivity (RI). Supporting resources feature videos of transcranial colour-coded Duplex (TCCD) imaging in normal subjects and clinical case examples. Participants will complete a logbook of 50 supervised cases, facilitated by remote mentorship. A novel accreditation pathway provides an opportunity for further research into the use of NeuroPOCUS in neurocritical care. This article outlines the core techniques of NeuroPOCUS, the physiological insights it offers, key clinical applications, and the proposed accreditation pathway aimed at standardising practice and clinician training in the care of critically ill patients with neurological injury or dysfunction.

DOI: 10.1177/17511437261428885

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Correlation Between Cycle Threshold Value and CT Severity Score During COVID-19 Pandemic (2026)

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Type of publication:

Journal article

Author(s):

Udayakumar C.; M V.; Kumar K.; *Jayaram A.

Citation:

International Journal of Pharmacy Research and Technology. 16(1) (pp 391-397), 2026. Date of Publication: 01 Jan 2026.

Abstract:

Introduction: The novel SARS CoV-2 was declared as a public health emergency in January 2020. Patients infected with this virus show different severity of disease symptoms ranging from mild disease to that requiring intensive care and death. Therefore, it is important to have a test with the ability to predict the prognosis of patients at diagnosis and can aid in management decisions. Material(s) and Method(s): This study is a hospital based prospective observational study. The study includes the patients who are tested RTPCR positive within 72 hours of onset of symptoms. Patient who underwent Chest CT between 5th-7th day after the onset of symptoms were included in the study. Patients with RTPCR negative, RTPCR positive without Chest CT, asymptomatic RTPCR positive patients were excluded from the study. Viral RNA will be extracted by using extraction kits, and RTPCR performed in VRDL laboratory, SIMS, Shimoga. Using primers and probes targeting the RNA-dependent RNA polymerase (RdRp) gene fragment will be detected in the sample. A positive and a negative control were included in each run to generate a valid result. A Ct value of 15-35 was defined as a positive result. Computed tomography images of the chest will be obtained using 64 Slice Phillips CT machine. CT severity score will be calculated by looking for the presence of inflammatory abnormalities (like ground-glassopacities, mixed ground-glass opacities, or consolidation) in each lobe. Each lobe will then be awarded 0 to 4 points, depending on the percentage of involvement in each lobe: 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%), or 4 (76-100%. Total severity score will then be calculated with cut off being 7 for mild disease. Result(s): The mean age in the mild COVID-19 group was 49.52 years and in the moderate COVID-19 group was 51.84 years. The gender distribution showed that 68% (68/100) of the subjects were males while 32% (32/100) of them were females. On comparison of the haematological parameters, there was a statistically significant difference in the mean platelet count between the mild and moderate COVID-19 group (3.04 L versus 2.19 L, respectively, p-value=0.01). Among the biochemical parameters, a statistically significant difference between the mild and moderate COVID-19 groups were found in the following parameters- mean AST, mean ALT, mean D-dimer and mean serum ferritin. Conclusion(s): Viral load can be used as an early prognostic marker to assess severity. The utility of CT severity score, RT-PCR Ct value and other various clinical, radiological and immunological indices for supplementing the clinical diagnosis of COVID-19 cannot be overemphasized especially in a pandemic situation. CT chest severity score correlates with cycle threshold values in assessing severity of disease. However since the sample size is small further studies are required to prove the same.

DOI: 10.48047/ijprt/16.01.43

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National multi-specialty robotic surgery training curriculum and implementation for UK surgical residents: a delphi consensus (2026)

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Type of publication:

Journal article

Author(s):

Francis N; Shakir T; McLarty E; Haddad F; *Farquharson A; Garnham A; Siddiq S; Bannon A; Collins J; Yassin N

Citation:

Journal of Robotic Surgery. 20(1), 2026 Aug 29.

Abstract:

Robotic-assisted surgery is now established across multiple surgical specialties in the United Kingdom, yet training for surgical residents remains variable, resource-dependent, and insufficiently standardised at national level. This study sought multispecialty expert consensus on the essential components of a national robotic surgery training curriculum for UK surgical residents. A four-round modified Delphi study was conducted between September and December 2025 under the RaDaR network of the Royal College of Surgeons of England. Round 1 used open-ended questionnaires with independent dual-coder thematic analysis; Round 2 was a hybrid face-to-face and online meeting with live anonymous electronic voting; Rounds 3 and 4 were online questionnaires addressing statements not yet reaching the pre-defined consensus threshold of 70% agreement or greater. The panel comprised consultant surgeons, surgical trainees, curriculum and training authorities, and industry representatives with deliberately bounded, non-clinical input. 25 participants completed the final round. Of 26 statements, 22 (84%) reached consensus. A three-tier framework of device, basic skills, and procedural training was endorsed, with device training introduced during Phase 1 (76%) and basic skills and procedural training introduced after Phase 1 (96% and 88% respectively). Competency assessment integrated within the Annual Review of Competence Progression was supported (84%), alongside multi-source funding; trainee self-funding was not endorsed. This consensus offers a pragmatic foundation for standardising robotic surgery training for UK residents, contingent on coordinated investment in platform access, simulation infrastructure, and faculty development.

DOI: 10.1007/s11701-026-03864-x

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Unscheduled PMB and HRT-An analysis of urgent unscheduled bleeding referrals in accordance with BMS 2024 guidelines (2026)

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Type of publication:

Conference abstract

Author(s):

Chopra S.; Kaur H.; *Chai A.; *Sahu B.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S25), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Management of unscheduled bleeding on HRT is an integral part of investigating endometrial cancer, due to the increasing referrals to the Urgent Suspicion of Cancer Pathway (USCP). Objective(s): We aimed to retrospectively assess the impact that this pathway will have on our clinical practice. Method(s): Patients referred to the gynaecology cancer services at Shrewsbury and Telford Hospitals (SaTH) between March and October 2024 were retrospectively included. Under the BMS 2024 guidelines, data was extracted, including but not limited to demographics, time since menopause, HRT duration, parity, cancer risk factors, and amendment status during primary care. The recorded biopsy results served as the outcome. Result(s): Of the 1308 referrals identified, 627 (47.9%) were referred while actively using HRT. The rate of endometrial cancer diagnosis was significantly lower in the HRT cohort (0.15% (1/627)) when compared to the non-HRT cohort (4.55% (31/681)). Age was not included as a major risk factor, despite higher predictive value for uterine cancer in women over 55. The BMS pathway, although designed primarily for use in primary care, was complex and difficult to apply within a standard 10-min GP consultation when identifying patients requiring secondary care referral. Conclusion(s): We developed a simplified modified pathway to support our GP colleagues. We incorporated age as an additional risk factor and tailored the pathway to reflect best practice and the needs of our local population. The success of this initiative may support the development and adoption of similar pathways in other services.

DOI: 10.1111/1471-0528.70281

Obstetric Bleeding Study UK (OBS UK): protocol for a stepped wedge cluster randomised trial investigating the clinical and cost-effectiveness of a maternity quality improvement programme to reduce excess bleeding and need for transfusion after childbirth (2026)

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Type of publication:

Journal article

Author(s):

Kotecha S.J.; Potter C.; Hope-Bell J.; Riddell N.S.; Munnery K.; Onyimadu O.; Liberty C.; Taylor H.; Dop C.; De Lloyd L.; *Parry-Smith W.; Townson J.; Pallmann P.; Moody G.; Moriarty Y.; Deere R.; Barlow C.; Dhadda A.; *Elsmore A.; Willson S.; *Millward H.; *Siddall K.; Sanders J.; Stanworth S.J.; Black M.; Petrou S.; Rai T.; Slade P.; Hinton L.; Fye H.; Gur Geden A.; Collis R.E.; Collins P.; Bell S.

Citation:

BMJ open. 16(8) (pp e118723), 2026. Date of Publication: 20 Aug 2026.

Abstract:

INTRODUCTION: Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK. METHODS AND ANALYSIS: OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3-18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3-18 months) during which OBS PPH care will be delivered.The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation. ETHICS AND DISSEMINATION: OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants. TRIAL REGISTRATION NUMBER: ISRCTN17679951

DOI: 10.1136/bmjopen-2026-118723

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