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What should be discussed when considering an induction of labour? A UK-wide, multi-centre Delphi study to develop a core information set for induction of labour (2026)

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Type of publication:

Journal article

Author(s):

Bunni, Eve; Kingdon, Carol; Bradley, Vicky; Hunt, Alexandra; Mahdi, Amy; Axcell, Thomas; Jagadish, Ria; Fox, Sophie; O'Dair, Millie; Simms, Charlotte; Munn, Yee Tan; Bonnett, Laura; Greenfield, Benjamin; Cunningham, Caroline; Holt, Siobhan; Burden, Christy; Ficquet, Joanna; Otero-Romero, Elena; *Parry-Smith, William; Black, Mairead; Merriel, Abi.

Citation:

BMJ Open. 16(5):e118024, 2026 May 27.

Abstract:

OBJECTIVE: To develop a core information set for induction of labour. Rates of induction of labour for childbirth are rising in many high-income countries. In England, a third of women have their labours induced. National guidelines recommend women receive information to make informed decisions about induction.

DESIGN: Two-stage consensus study using modified Delphi.

SETTING: UK.

PARTICIPANTS: Pregnant people, parents and professionals.

OUTCOMES: Stage 1: A long list of information points was identified through a systematic review of reviews, reviewing patient leaflets, qualitative interviews and a stakeholder survey, with ongoing patient, public and professional involvement. Stage 2: Think-aloud interviews were undertaken to refine the Delphi survey before a two-round modified Delphi process where participants voted on the importance of the information items. Pre-specified criteria were used to select items taken forward to a consensus meeting.

RESULTS: 199 information points were identified through systematic review (110), patient information leaflets (162), qualitative interviews (58) and a survey (93). 46 unique information items entered the first Delphi round after four think-aloud interviews, 2 items were added following round 2. 368 people (310 parents/58 professionals) participated in round 1 and 177 people (154 parents/23 professionals) in round 2. 44 items met inclusion criteria; one item excluded, and three items were carried forward for consensus meeting discussion where 12 overarching information points were agreed on.

CONCLUSIONS: This study has established a consensus-based core information set for induction of labour from a sample of the birthing population and staff providing their care. The resultant set has been populated with evidence in line with national guidelines. It can be used by women and clinicians as a standardised starting point from which to personalise discussions about birth.

TRIAL REGISTRATION NUMBER: COMET Initiative registration 2600: Developing a core information set for induction of labour.

DOI: 10.1136/bmjopen-2026-118024

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What do student and educator perspectives reveal about assisted dying in the UK medical curriculum? A narrative review (2026)

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Type of publication:

Journal article

Author(s):

Smith, Benjamin; Roberts, Megan; *Talha, Saarah.

Citation:

Annals of Palliative Medicine. 15(2):24, 2026 Mar.

Abstract:

OBJECTIVE: Assisted dying is a highly complex and evolving ethical area in the United Kingdom (UK) healthcare, with ongoing legislative developments creating urgency. UK medical students, potentially the first generation to navigate its legalisation, face an inconsistent curriculum. This review examined the inclusion and quality of assisted dying education in UK undergraduate medical schools, analysing curricular extent and alignment with General Medical Council (GMC) end-of-life care expectations.

METHODS: A narrative literature review was conducted. Searches of PubMed and Scopus (2004-2025) focused on assisted dying, palliative care, and UK medical undergraduate education. Six publications were included and analysed thematically regarding student attitudes, ethical education, and curricular gaps.

KEY CONTENT AND FINDINGS: Teaching on assisted dying is fragmented, inconsistent, and often superficial, typically confined to isolated workshops. Active-learning modules improve ethical reasoning, but general progression often conveys only current legal frameworks. Student attitudes are diverse, influenced by religious background and clinical exposure. A major finding is the scarcity of robust UK-specific research on implementation. This deficiency risks future doctors being unprepared to professionally and ethically navigate the evolving legal landscape.

CONCLUSIONS: The UK medical education system lacks a standardised, integrated approach to teaching assisted dying. The curriculum is insufficiently robust, and evidence for implementation is scarce. Medical schools must be proactive to potential legislative change. A standardised framework incorporating case discussions, dedicated ethics/law sessions, and communication skills training is essential to prepare the future workforce for this challenging issue.

DOI: 10.21037/apm-2025-1-138

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Tjalma Syndrome: A Rare Autoimmune Cause of Multisystem Serositis (2026)

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Type of publication:

Journal article

Author(s):

Kodamanchile, Aaditya; Ekhelikar, Sowmya; AbiMusaAsa'ari, Ahmad Kamal Azri; Aboushehata, Moustafa; *Ahmad, Nawaid.

Citation:

Cureus. 18(3):e105188, 2026 Mar.

Abstract:

Tjalma syndrome is a rare manifestation of systemic lupus erythematosus (SLE) characterized by pleural effusion, ascites, and elevated cancer antigen 125 (CA-125) levels in the absence of ovarian malignancy. We report the case of a woman in her 50s who presented with recurrent pleuritic chest pain, dyspnea, peripheral edema, ascites, and constitutional symptoms. Initial investigations were inconclusive, resulting in repeated admissions and multidisciplinary referrals. Subsequent immunological testing confirmed SLE. Given the constellation of serositis and elevated CA-125, a diagnosis of Tjalma syndrome was established. Treatment with immunosuppressants such as corticosteroids, hydroxychloroquine, and azathioprine resulted in symptomatic improvement. However, the disease course was complicated by constrictive pericarditis requiring pericardiectomy and later inflammatory arthritis requiring escalation of immunosuppression. This case highlights the importance of considering autoimmune etiologies in patients with unexplained multisystem effusions and elevated tumor markers, thereby avoiding misdiagnosis and unnecessary oncological interventions.

DOI: 10.1177/17562848261446551

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The UK vedolizumab real-life experience study in inflammatory bowel disease (VEST): patient characteristics, drug persistence and patient-centred outcomes (2026)

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Type of publication:

Journal article

Author(s):

Bodger, Keith; Booker, Cheryl; Taylor, Frederick; Ahmad, Tariq; Bloom, Stuart; *Butterworth, Jeffrey; Kok, Klaartje; Lobo, Alan; Irving, Peter; Cummings, J R Fraser.

Citation:

Therapeutic Advances in Gastroenterology. 19:17562848261446551, 2026.

Abstract:

Background: VEST was a multi-centre study of real-world use of vedolizumab in inflammatory bowel disease (IBD) in routine practice in the United Kingdom.

Objectives: To describe real-world indications, effectiveness, patient-reported outcomes and safety.

Design: Prospective observational cohort study at 22 centres.

Methods: Patients receiving vedolizumab as part of standard care were included. Data were collected at infusion visits for activity indices (Harvey-Bradshaw Index (HBI) or partial Mayo Score (PMS)), physician global assessment (PGA), patient-reported quality-of-life and treatment perception (IBD-Control Questionnaire) and adverse events. Clinical response (Wk14) was defined as a reduction in HBI 3 or PMS 2, clinical remission as HBI 4 or PMS 1 and analysed using non-responder imputation. One-year persistence was defined as continuing on vedolizumab after an infusion at 48 weeks. Biomarker and endoscopic data were not available.

Results: 364 patients, mean age: 48 years; 132 (36%) with Crohn's disease (CD), 224 (62%) with UC and 8 (2%) with IBD-U; 174 (48%) male; 142 (39%) receiving steroids at baseline (Wk0); 141 (39%) bio-naive. At baseline, 279 (77%) had "active" disease. One-year persistence: 58% overall (54% for active disease). Among persistent cases (n = 212), median (IQR) IBD-Control-8 scores improved from 6 (3-10) at baseline to 14 (10-16) at post-induction (Wk14) and 1 year (p < 0.001 vs baseline). Corresponding scores for IBD-Control-VAS were: 50 (30-70), 80 (65-90) and 85 (70-95), respectively (p < 0.001 vs baseline). Each domain of IBD-Control-8 showed improvement. Baseline and post-induction health status (activity index, PGA or IBD-Control) were associated with 1-year persistence, but no significant associations were observed for disease type, duration, bio-naive status or baseline steroids. Of those with active disease at Wk0, clinical remission rates were 29%, 30% and 38% for CD, UC and IBD-U, respectively, and steroid-free remission rates were 26%, 27% and 38%. Similar remission rates were observed at 1 year. Possible adverse events leading to treatment cessation were rare (3%).

Conclusion: In routine clinical practice in the UK, vedolizumab demonstrated high levels of persistence. Similar rates of clinical response, remission and 1-year persistence were seen in UC and CD patients, and in bio-experienced versus naive cases. Persistent cases experienced significant and sustained improvements in quality of life and treatment perception. Persistence does not imply anti-inflammatory efficacy, as biomarker data were not available.

DOI: 10.1177/17562848261446551

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Rotating Hinge Knee Versus Constrained Condylar Knee Revision: A Single Centre, Retrospective Comparative Study (2026)

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Type of publication:

Journal article

Author(s):

*Bishi, Habeeb; Afzal, Irrum; Wang, Chao; Stammers, John; Madanipour, Suroosh; Radha, Sarkhell; Field, Richard; Mitchell, Philip; Alazzawi, Sulaiman.

Citation:

Cureus. 18(7):e112443, 2026 Jul.

Abstract:

Introduction In revision total knee arthroplasty, rotating hinge implants (RHK) have been presumed to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). This study aimed to compare patient-reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high-volume elective orthopaedic centre with a previously validated bespoke database. Methods Patients (n=108) who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EuroQol Five Dimensions (EQ5D), EuroQol Five Dimensions (EQ5D)-Health State and Oxford Knee Scores were collected pre-operatively and at one year post-operatively. Complication data was collected at six weeks, six months and one year post-operatively. National Joint Registry (NJR) data were interrogated, in addition to our orthopaedic database, to investigate implant survival with a maximum follow-up of 12 years. Results There was no statistical significant difference between RHK and CCK in implant survival at two to 12 years of follow up. In addition, we observed no statistical significant difference in the PROMs scores and complication rates of the two implants. Conclusion This study shows that both the RHK and CCK remain viable options in revision arthroplasty; the implant survival and complication rates were comparable. We recommend future research through prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty.

DOI: 10.7759/cureus.112443

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Refining prognosis in advanced renal cell carcinoma: international real-world validation of the Meet-URO score in first-line immunotherapy combinations (2026)

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Type of publication:

Journal article

Author(s):

Rebuzzi, Sara Elena; Ghose, Aruni; Rudman, Sarah; Venugopal, Balaji; Young, Kate; Frazer, Ricky Dylan; Ayodele, Olubukola; Stares, Mark; O'Carrigan, Brent; Ali, Waqas; McGrane, John; Jain, Ankit; Fiala, Ondrej; Chauhan, Vishwani; Michael, Agnieszka; Zarkar, Anjali; Kapur, Gaurav; Charnley, Natalie; Afshar, Mehran; Vengalil, Salil; Forde, Caroline; Brown, Janet; Urun, Yuksel; Bianchini, Diletta; Bahl, Amit; *Srihari, Narayanan; Di Costanzo, Fabrizio; Smalley, Benjamin; Parkes, Joanne; Crabb, Simon; Vasudev, Naveen; Poprach, Alexandr; Brown, Nicholas; James, Lijo; Haywood, Sophia; Tapia, Jose; Vijay, Anupama; Parry, Jane; Cheung, Michael; Mahajan, Ishika; Moon, Niall O; Abrol, Ritika; Tkadlecova, Michaela; Soe, Yamin Shwe Yee; Zargham, Anum; Smith, Michelle; Ashley, Sophie; Hardy, Orla; Patel, Grisma; Tun, Kyaw Kyaw; Johnston, Emma; Sarwer, Abdullah; Bolek, Hatice; Shrestha, Roshani; Challapalli, Amarnath; *Meegan, James; Anpalakhan, Shobana; Buono, Francesco; Kolarikova, Eva; Leung, David Ka-Wai; Murianni, Veronica; Catalano, Fabio; Bimbatti, Davide; Buti, Sebastiano; Signori, Alessio; Fornarini, Giuseppe; Rescigno, Pasquale; Teoh, Jeremy Yuen Chun; Banna, Giuseppe Luigi.

Citation:

Oncologist. 31(7), 2026 Jun 06.

Abstract:

BACKGROUND: Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the International Metastatic RCC Database Consortium (IMDC) criteria with neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases. Developed in the immunotherapy era, it has demonstrated superior prognostic accuracy compared to the IMDC score across various clinical settings and treatment strategies. Its validation in the context of first-line immune-based combinations has been awaited.

METHODS: External validation of Meet-URO was performed using a large retrospective real-world cohort of mRCC patients treated with first-line immune-based combinations. Secondary analyses included a comparison with the IMDC score for predicting overall survival (OS) and progression-free survival (PFS). Additionally, restricted mean survival time (RMST) was assessed.

RESULTS: A total of 1,418 patients were included in the analysis: 54% received ICI-ICI regimen (nivolumab plus ipilimumab), while 46% received the ICI-TKI combination. At baseline, 52.5% of patients had an NLR >= 3.2, and 32% had bone metastases. After a median follow-up of 26.8 months, the median OS and median PFS were 34.7 and 11.3 months, respectively. Meet-URO demonstrated effective prognostic stratification, identifying patient groups with markedly different outcomes (median OS 11.5-51.4 months; 3-year OS 26-66%; RMST 20.0-42.8 months). Compared to IMDC, Meet-URO showed a significantly better OS (c-index 0.675 vs 0.643; DELTAc = 0.032, P < .001) and PFS (c-index 0.60 vs 0.58; P < .001) prediction performance.

CONCLUSIONS: Meet-URO demonstrated robust prognostic accuracy. Its integration into routine clinical practice and use as a stratification factor in clinical trials may support more personalized treatment strategies and enhance clinical trial design.

DOI: 10.1093/oncolo/oyag203

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Liver Transplantation as a Salvage Therapy Option in Colorectal Liver Metastases: Feasibility, Oncologic Outcomes, and Survival After Failure of Conventional Therapy-A Systematic Review and Meta-Analysis (2026)

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Type of publication:

Systematic review

Author(s):

Soomro, Faiza Hashim; Kazmi, Tehreem Fatima; *Ansar, Mehwish; Gulnaz, Nadia; Arshad, Rabia; Aiste, Gulla.

Citation:

Cancers. 18(8), 2026 Apr 15.

Abstract:

Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.3390/cancers18081254

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Incidence, reason for treatment delay and patient-reported outcome of patients affected by a chronic Achilles tendon rupture in a Swedish population (2026)

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Type of publication:

Journal article

Author(s):

Nilsson, Niklas; Larsson, Elin; Dyrehag, Emma; *Carmont, Michael; Brorsson, Annelie; Nilsson Helander, Katarina.

Citation:

BMC Musculoskeletal Disorders. 27(1), 2026 May 01.

Abstract:

BACKGROUND: As the incidence of ATR is increasing the risk of ruptures being missed escalates and more injuries are suspected to become chronic. This study aimed to assess the incidence and causes of delayed diagnosis in chronic ATR. Additionally, the patient-reported outcome of surgical versus non-surgical treatment following delayed presentation was evaluated.

METHODS: The study is of patients with chronic ATR treated at the Sahlgrenska University Hospital between 2015 and 2020. Patients were identified using specific International Classification of Diseases (ICD) codes for ATR and included all patients in whom the treatment had been delayed for more than 14 days. The patients who accepted to participate in the study completed the Achilles tendon Total Rupture Score (ATRS) and a questionnaire regarding recovery rate in percentage.

RESULTS: Out of the 958 patients with ATR, 102 were identified as chronic, comprising 11% of the overall dataset. A total of 75 patients were included. Patients with chronic injury exhibited higher age, BMI, and comorbidity rates compared with patients with acute ruptures. Fifty-two (84%) patients delayed seeking medical attention. The rates of patients initially receiving an incorrect diagnosis was low, with 10 (1%) directly associated with trauma and 28 (3%) during later medical visits. Patients that were surgically treated (n = 57) for their chronic Achilles tendon rupture yielded significantly higher median (IQR) ATRS scores; 77 (50 ; 92) vs. 34 (23 ; 82) and recovery rates; 85% (70 ; 95) vs. 40% (20 ; 78) compared with patients treated with a non-surgical approach (n = 18).

CONCLUSIONS: This study reveals that chronic ATRs constitute a significant portion of all ATR. These were primarily due to "patient's delay" rather than the relatively rare misdiagnosis. Patient-reported outcomes, such as ATRS scores and self-reported recovery, exhibit considerable variability. Surgical intervention gave superior patient reported outcome compared with non-surgical treatment for patients affected by a chronic Achilles tendon rupture.

DOI: 10.1186/s12891-026-09890-y

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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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Holistic management of juvenile idiopathic arthritis across all ages: British Society for Rheumatology Guideline scope (2026)

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Type of publication:

Journal article

Author(s):

Compeyrot-Lacassagne, Sandrine; Beesley, Richard P; Bray, Lisa; Bridges, Angharad; Chaplin, Hema; Ciurtin, Coziana; Cleary, Gavin; Cooray, Samantha; Aragon Cuevas, Octavio; Cuthbert, Verna; Deepak, Samundeeswari; Earle, Emily; Ferreira, Andreia; Kearsley-Fleet, Lianne; Gupta, Jo; Houston, Rebecca; Hum, Ryan Malcolm; Humphreys, Jenny H; *Jayasekera, Hirushi S; Jones, Sarah; MacFadyen, Christine; Nisbet, Jennifer; Arunath, Visvalingam; Prior, Yeliz; Rogers, Valerie; Shoop-Worrall, Stephanie J W; Solebo, Ameenat Lola; Waller, Rosemary; Williamson, Luke Daniel; Wilson, Debbie; Wright, Catherine; Sen, Ethan S.

Citation:

Rheumatology Advances in Practice. 10(2):rkag052, 2026.

Abstract:

What does this mean for patients? Juvenile idiopathic arthritis (JIA) is the most common type of arthritis that starts before the age of 16 years. Many children and young people (CYP) continue to be affected by JIA and may need to be on treatment when they are adults. Most CYP with JIA have swollen, stiff and painful joints for at least 6 weeks. JIA can also affect other parts of the body. This includes the skin, the places where tendons join bones (called entheses) and sometimes internal organs. Some young people may also develop inflammation in their eyes, called uveitis. If this is not treated, it can affect eyesight and could lead to sight loss. People with JIA often need medicines to control inflammation. They are usually cared for by a team of healthcare professionals called a multidisciplinary team. This team may include doctors, nurses, pharmacists, physiotherapists, occupational therapists, podiatrists, psychologists and youth workers. They work together to help manage symptoms and prevent long-term damage. The British Society for Rheumatology (BSR) is the main organisation in the UK for healthcare professionals who care for people with JIA. BSR writes guidelines that help healthcare teams provide high-quality care. These guidelines are written with input from experts and people with lived experience. They help make sure that everyone receives good care wherever they live, including during the move from child to adult services. This article explains how BSR will develop a new guideline to diagnose, treat and monitor children, young people and adults with JIA. The guideline will follow the BSR protocol for creating clinical guidelines.

DOI: 10.1093/rap/rkag052

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