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Implementing Quick Response (QR)-Coded Patient Information Leaflets to Reduce Environmental Impact in Urology Outpatient Clinics: A Pilot Study (2025)

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Type of publication:

Journal article

Author(s):

Matei, Ana; *Chin, Yew Fung; Hughes, Thomas; Mahmalji, Wasim.

Citation:

Cureus. 17(7):e87891, 2025 Jul.

Abstract:

Background and aim Patient information leaflets (PILs) printed in paper form are a commonly used adjunct tool in urology clinics. These help to facilitate the information transfer between doctor and patient. They are detrimental to the environment and costly. Quick response (QR) codes can be used as another option for delivering the leaflets and would reduce the environmental burden. The aim of this paper is to evaluate patient response to the introduction of QR codes as a replacement for paper-based PILs. Methods This pilot study followed the introduction of QR codes of commonly used leaflets sourced from the British Association of Urological Surgeons (BAUS). The study was conducted in a urology clinic at the Hereford County Hospital over a one-month period. The acceptability of the QR codes was recorded. Data such as patient demographics and the type of leaflet were also documented and tabulated. Results Thirty-one patients required PILs, out of which 80% agreed to PILs via QR codes. The mean age of the participating patients was 76. The replacement of paper with QR codes for the one-month period reflects an average estimated saving of 1.88 kg of carbon dioxide emissions and around 238 sheets of paper. Discussion The introduction of QR codes has seen an increase in most sectors, including, more recently, the medical industry. They can be used with a wide range of functions within the industry ranging from medical education to patient identification. These can also be more easily distributed in various forms to cater to all needs. Limitations, such as the currently limited variety of urology PILs available, also need to be considered. Conclusion QR codes of the PILs are a generally accepted alternative. The widespread introduction of QR codes reduces the total environmental impact of paper documents while also reducing production costs.

DOI: 10.7759/cureus.87891

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The 3,550 g Challenge: An Atypical Presentation of a 3.5 kg Seminoma Manifesting as Dry Skin (2025)

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Type of publication:

Journal article

Author(s):

Omorphos, Nicolas; Mohsin, Mohamed Shamil; *Mok, Spencer; Kitchen, Mark; Ho, Kuo J.

Citation:

Cureus. 17(7):e87174, 2025 Jul.

Abstract:

A 43-year-old male presented to the emergency department with a seven-year history of progressive left-sided scrotal swelling. On examination, a large mass was palpable in the left hemiscrotum, accompanied by eczema-like skin changes and a decubitus ulcer. Tumor markers were significantly elevated, particularly lactate dehydrogenase, and an urgent ultrasound confirmed the presence of a testicular tumor. CT revealed a scrotal mass originating from the left testis, along with bilateral inguinal lymphadenopathy. The patient underwent a left inguinal orchidectomy, and histopathological analysis confirmed a 3,550 g classical seminoma. He was subsequently referred to oncology for adjuvant chemotherapy.

DOI: 10.7759/cureus.87174

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Barriers to the safe discussion of the experience and management of menopausal symptoms: A systematic literature review (2025)

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Type of publication:

Journal article

Author(s):

Thavabalan, Karish; *Ovenell, Alistair; Pierce, Poppy; Sutaria, Aman; Parkhouse, Annabelle; Baydemir, Numan; Lally, Theodore.

Citation:

Maturitas. 201:108683, 2025 Aug 05.

Abstract:

As the number of women experiencing menopause continues to rise each year, the need for open and supportive discussions around the experience and management of menopausal symptoms becomes more imperative. Although research has identified numerous challenges women face during this life stage, many studies examine these barriers in isolated settings. Furthermore, how these challenges impact women's ability to safely discuss menopause remains poorly understood. This systematic literature review
sought to identify and synthesise the barriers that hinder safe discussions about the experience and management of menopausal symptoms. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, 21 qualitative studies were included. Six themes were identified regarding symptom experience: lack of support from friends and family, lack of workplace support, fear of menopause onset, variation in symptom experience, poor-quality information, and societal judgement. Two themes were identified regarding symptom management: perceived onus to endure symptoms and poor experiences with healthcare professionals. Notably, the themes revealed widespread shortcomings that collectively hinder safe discussions about menopause. Future work should prioritise intersectional approaches that tackle barriers across home, social, work, and healthcare settings. Proactive measures, such as placing a greater emphasis on menopause in medical education and developing culturally relevant resources, are crucial for fostering safe, informed discussions and improving care for all women.

DOI: 10.1016/j.maturitas.2025.108683

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Therapeutic Duel of Rifaximin Versus Lactulose in Hepatic Encephalopathy: A Systematic Review (2025)

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Type of publication:

Systematic Review

Author(s):

Oriko, David O; Khawaj, Zainab; Cheema, Muhammad Usairam; Talreja, Anjali; Tayyab, Muhammad Abbas; Zamir, Muhammad Hamza; Iqbal, Maheen; Farooq, Umer; *Ekomwereren, Osatohanmwen; Tariq, Muhammad M; Hasan, Abdul Haseeb.

Citation:

Cureus. 17(6):e86193, 2025 Jun.

Abstract:

This systematic review aimed to compare the clinical efficacy of rifaximinversus lactulose in the management of hepatic encephalopathy (HE) by analyzing evidence from randomized controlled trials (RCTs). A comprehensive search across major databases identified seven eligible RCTs encompassing 693 adult patients diagnosed with overt or minimal HE. Findings demonstrated that rifaximin is at least as effective as lactulose in reversing HE symptoms, with some studies reporting significantly higher HE reversal rates when rifaximin was used in combination with lactulose (e.g., 76% vs. 50.8%, p<0.004), reduced mortality (23.8% vs. 49.1%, p<0.05), and shorter hospital stays (5.8 vs. 8.2 days, p=0.001). While other trials reported similar efficacy between the two agents (e.g., HE improvement: 84.4% vs. 95.4%, p=0.315), rifaximin was generally associated with better tolerability and fewer gastrointestinal side effects. These results support rifaximin as an effective and well-tolerated therapeutic option, either as monotherapy or in combination with lactulose. Further large-scale, multicenter trials are warranted to assess long-term outcomes, recurrence rates, and cost-effectiveness.

DOI: 10.7759/cureus.86193

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Effects of Race, Ethnicity and Socioeconomic Deprivation on Postpartum Haemorrhage in High-Income Countries: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Systematic Review

Author(s):

*Elsmore, Amy; Alayande, Gbenga; Mainwaring, Elizabeth; Jafarpour, Mahfam; Rimmer, Michael P; Cockburn, Neil; *Curtis, Jason; *Ilaalagan, Ragave; Al-Wattar, Bassel; Bell, Sarah; *Karunakaran, Bala; *Parry-Smith, William; Wu, Pensee.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology.  2025 Jul 09.

Abstract:

BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of mortality and morbidity globally. While individual studies have revealed disparities in outcomes, a comprehensive summary of PPH risk across diverse groups is lacking.

OBJECTIVES: To quantify the association between ethnicity, deprivation and risk of PPH in high-income countries (HICs).

SEARCH STRATEGY: A systematic search of MEDLINE, CINAHL, EMBASE and Google Scholar from inception to 20 August 2024.

SELECTION CRITERIA: Observational and experimental studies from HICs that reported the outcome of PPH in at least two ethnic or socioeconomic groups.

DATA COLLECTION AND ANALYSIS: Two reviewers performed independent data extraction. A random-effects model was used to estimate the risk. A subgroup analysis was performed by geographical region and time period.

MAIN RESULTS: A total of 79 studies with 169 579 388 women were included, spanning 15 HICs. Ethnic minority women experienced a higher risk of PPH compared to the majority White or European group. This was seen across Black (OR 1.16, 95% CI 1.09, 1.23), Asian (OR 1.33, 95% CI 1.27, 1.39), Hispanic (OR 1.20, 95% CI 1.12, 1.29) and women from the minority ethnic group within a given study (OR 1.13, 95% CI 1.03,1.24). Due to data limitations, eight studies on PPH and socioeconomic status were summarised
narratively, indicating a higher PPH risk for those experiencing deprivation.

CONCLUSIONS: Women from an ethnic minority background or exposed to socioeconomic deprivation had an increased risk of PPH in HICs. Standardisation of data collection for ethnicity and socioeconomic status is recommended to accurately quantify and address these disparities.

DOI: 10.1111/1471-0528.18278

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Metformin for patients with metastatic prostate cancer starting androgen deprivation therapy: a randomised phase 3 trial of the STAMPEDE platform protocol (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gillessen, Silke; Murphy, Laura; James, Nicholas D; Sachdeva, Ashwin; El-Taji, Omar; Abdel-Aty, Hoda; Adler, Amanda I; Amos, Claire; Attard, Gerhardt; Varughese, Mohini; Gale, Joanna; Brown, Simon; *Srihari, Narayanan; Birtle, Alison J; Brown, Mick; Chan, Kitty; Chowdhury, Simon; Cross, William; Dearnaley, David P; Din, Omar; Dutey-Magni, Peter; Gilbert, Duncan C; Gilson, Clare; Gray, Struan; Grist, Emily; Hofmann, Uschi; Hudson, Andrew M; Jain, Yatin; Jeyasangar, Ganesan; Jones, Robert; Kayani, Mahaz; Langley, Ruth E; Malik, Zafar; Mason, Malcolm D; Matheson, David; McAlpine, Connor; Macnair, Archie; Millman, Robin; Murphy, Claire; Padden-Modi, Minal; Parikh, Omi; Parker, Chris; Rush, Hannah; Russell, Martin; Srinivasan, Rajaguru; Sundar, Santhanam; Tanguay, Jacob S; Turco, Fabio; Williams, Patrick; Sydes, Matthew R; Parmar, Mahesh K B; Brown, Louise C; Clarke, Noel W.

Citation:

Lancet Oncology. 2025 Jul 07.

Abstract:

BACKGROUND: Metformin is a widely used anti-diabetic drug. Several studies have suggested that metformin has anticancer activity in some malignancies, including prostate cancer. Metformin might also mitigate the adverse metabolic effects of androgen-deprivation therapy (ADT). We hypothesised that metformin might improve survival in patients with metastatic hormone-sensitive prostate cancer and reduce metabolic complications associated with ADT.

METHODS: The STAMPEDE multi-arm, multi-stage, randomised phase 3 trial recruited patients with high-risk locally advanced or metastatic adenocarcinoma of the prostate staged by conventional imaging with isotope bone and CT scanning. This publication reports findings for the most recent STAMPEDE research question, testing the addition of metformin to standard of care for non-diabetic (glycated haemoglobin [HbA1c] <48 mmol/mol [equivalent to <6.5%]) patients with metastatic disease with adequate renal function (glomerular filtration rate >=45 ml/min/1.73 m2) and WHO performance status 0-2. This trial recruited from 112 hospitals in the UK and Switzerland to the STAMPEDE protocol. Patients were randomly allocated (1:1) to standard of care or standard of care plus metformin 850 mg twice daily. Random assignment was by telephone using minimisation with a random element of 20% (developed and maintained by the MRC Clinical Trials Unit at UCL), stratified for randomising hospital, age (<70 years vs >=70 years), WHO performance status (0 vs 1 or 2), type of ADT, regular long-term use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs; yes vs no), pelvic nodal status (positive vs negative), planned radiotherapy (yes vs no), and planned docetaxel or androgen receptor pathway inhibitor (ARPI) use (docetaxel vs abiraterone, enzalutamide, or apalutamide vs none). Standard of care comprised ADT with or without radiotherapy and with or without docetaxel or ARPI. The primary outcome measure was overall survival, defined as the time to death from any cause, assessed in the intention-to-treat population. Safety was assessed in patients who started treatment. The trial is registered with ClinicalTrials.gov, NCT00268476 and ISRCTN, ISRCTN78818544.

FINDINGS: Between Sep 5, 2016, and Mar 31, 2023, 1874 patients with metastatic disease were randomly allocated to standard of care (n=938) or standard of care plus metformin (n=936). The median patient age was 69 years (IQR 63-73) and the median PSA was 84 ng/mL (24-352). 1758 (94%) of 1874 patients were newly diagnosed with metastatic disease and 116 (6%) were diagnosed with metachronous relapsing disease. 1543 (82%) of 1874 patients received ADT plus docetaxel and 52 (3%) received abiraterone, enzalutamide, or apalutamide. The median time to most recent case report form follow-up was 60 months (IQR 49-72). 473 deaths were reported in the standard of care group; median survival was 61.8 months (IQR 29.7 to not reached). There were 453 deaths in the metformin group; median survival was 67.4 months (32.5 to not reached; HR 0.91, 95% CI 0.80-1.03; p=0.15). Grade 3 or worse adverse events were reported in 487 (52%) of 938 patients in the standard of care group and 523 (57%) of 921 patients in the standard of care plus metformin group. 61 (7%) patients in the standard of care group and 84 (9%) patients in the standard of care plus metformin group reported at least one grade 3 or worse gastrointestinal adverse event; all other body systems showed no difference in grade 3 adverse events. There were six drug-related deaths in the standard of care group and one in the standard of care plus metformin group.

INTERPRETATION: We did not find significant evidence of an overall survival benefit of adding metformin to standard of care in the overall population of patients with metastatic hormone-sensitive prostate cancer. The side-effect profile of metformin was as expected and consisted mainly of diarrhoea. Adverse metabolic side-effects of ADT were significantly reduced in the metformin group compared with the standard of care group.

FUNDING: Cancer Research UK, Prostate Cancer UK, and UK Research and Innovation Medical Research Council.

DOI: 10.1016/S1470-2045(25)00231-1

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Artificial Intelligence and Digital Therapy for Adolescent Mental Health in the UK; Opportunities, Barriers, and Ethical Consideration (2025)

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Type of publication:

Journal article

Author(s):

Adindu K.N.; Akubue N.; Jude N.O.; Onakoya A.; Chukwunonye C.; Odion O.; *Okengwu C.G.; Uchechukwu N.; Osita-Obasi P.Z.; Ezike A.; Bello I.; Olenloa E.; Eruteya O.O.; Oyewole S.A.

Citation:

SSRN. (no pagination), 2025. Date of Publication: 20 May 2025. [preprint]

Abstract:

Background: Adolescence constitutes a critical developmental stage marked by the onset of mental health difficulties, yet timely access to effective mental health care remains a significant challenge for many adolescents in the United Kingdom (UK). Artificial intelligence (AI)-enabled digital therapies present innovative opportunities to address these gaps. Objective(s): This systematic review critically assesses current evidence on AI-driven digital interventions for adolescent mental health within the UK, highlighting their potential opportunities, barriers to implementation, and pertinent ethical considerations. Method(s): Employing a mixed-methods design, a systematic literature review adhering to PRISMA guidelines was combined with thematic analysis of semi-structured interviews. Comprehensive database searches (MEDLINE, PsycINFO, Web of Science; 2013-2023) targeted studies involving UK adolescents (ages 11-19) using AI-based mental health technologies. Included studies underwent rigorous quality appraisal (Cochrane RoB 2.0, ROBINS-I, CASP). Additional insights were gathered through stakeholder interviews (clinicians, AI developers, adolescent users). Result(s): Twenty-seven studies met inclusion criteria, investigating interventions such as AI chatbots, predictive analytics, mobile apps, and virtual environments targeting anxiety and depression. Key opportunities identified include enhanced accessibility for underserved populations, personalization through adaptive algorithms, proactive early-risk detection, scalability, cost-efficiency, and improved engagement via interactive interfaces. Significant implementation barriers encompassed technical infrastructure limitations, data security concerns, insufficient longitudinal efficacy data, socioeconomic disparities, and clinician scepticism. Ethical challenges emphasized informed consent, algorithm transparency, potential biases, unclear accountability, and clinician deskilling risks. Conclusion(s): AI-driven digital interventions offer substantial promise for augmenting adolescent mental health services in the UK. However, realizing their full potential necessitates addressing infrastructural, ethical, and evidentiary challenges through robust governance frameworks and continued rigorous research.

DOI: 10.2139/ssrn.5253224

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Improving patients’ understanding about pleural effusion management options (2025)

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Type of publication:

Conference abstract

Author(s):

*Maimuna Adamu, *Greenway Tammy, *Jennifer Nixon

Citation:

Future Healthcare Journal. 2025 Volume 12, Issue 2, Supplement, June 2025. Abstracts from Medicine 2025: The future of medicine. RCP annual conference.

Abstract:

Introduction and objective
Various treatment options are available for managing recurrent pleural effusions, each with its merits. These include: (1) symptomatic control with medication; (2) ambulatory repeated pleural aspiration; (3) inpatient chest drain and talc pleurodesis; and (4) home-based indwelling pleural catheters. British Thoracic Society (BTS) guidelines recommend that, in the context of malignant pleural effusion (MPE), ‘decisions on the best treatment modality should be based on patient choice’.1 There are different factors to consider in choosing a treatment option, such as symptoms, availability of resources, need for hospitalisation and risk of requiring further pleural interventions. In our Trust, this information was given to patients in an unstructured verbal context, with variation between each practitioner. The objective of our project was to provide information on the different pleural effusion management options in a standardised written format as a tool to help patients reach an informed decision about their preferred option.

Methods
This quality improvement project was conducted in two cycles using the plan–do–study–act (PDSA) methodology. The patient population included were those attending our weekly outpatient pleural list within a 3-month period, who already had a diagnosis of MPE or if the clinical details (history, examination or imaging) were highly suggestive of MPE. The first cycle involved assessing our current practice against the BTS guidelines for pleural disease. A telephone-based questionnaire was administered, assessing how much patients understood and retained about the different methods of pleural effusion management after attending the pleural list. Our intervention involved designing and producing a pleural effusion management options patient information leaflet (Fig 1). The leaflet included information about pleural effusions and each of the management options listed above, with illustrative diagrams. We received input from our Trust’s health literacy team to ensure that the information was written in a way patients could understand. The leaflet was then given to clinically appropriate patients attending the pleural list. The same questionnaire was repeated after the leaflet had been in use for 4 months, and pre and post-intervention results were compared.

Results
Fig 2 summarises the findings. At baseline (n=21), only 48% of patients felt they had enough information to choose their preferred management option if their pleural effusion recurred. None knew about the option of symptomatic management with medication. After the intervention (n=20), there was a significant improvement in understanding of the pleural effusion management options, with 95% of patients now satisfied that they had enough information to choose their preferred management option.

Conclusion
This project demonstrates the benefits of providing structured, written information to patients with recurrent pleural effusion. This intervention enhanced patient understanding and helped patients to make informed choices about their treatment options, in alignment with the BTS guidelines

DOI: 10.1016/j.fhj.2025.100412

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Exploring the Association Between Myocardial Infarction and Cognitive Decline: A Narrative Review (2025)

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Type of publication:

Journal article

Author(s):

Issimdar, Iqrah A; Mudegowdar, Rohit; *Gupta, Anchal R; Patel, Keval B; Elshoura, Anas; Bhanushali, Vidhi Mahendra; Joseph, Joshua R; Meiyalagan Varalakshmi, Aishwarrya; Sahotra, Monika; Kashif, Mazin; Binny, Vivasvat; Pathan, Nahila A; Siddiqui, Humza F.

Citation:

Cureus. 17(5):e84957, 2025 May.

Abstract:

The association between cognitive impairment (CI) and myocardial infarction (MI) has been highlighted in recent years. Several studies have reported an increased incidence of cognitive decline (CD) following MI, emphasizing the need for early identification and intervention in such patients. Previous research findings have been inconsistent due to the presence of various unaccounted factors potentially contributing to CD and disparities in the methods utilized to assess cognition such as the Mini-Mental State Examination, Mini-Cog and self-evaluation questionnaires. This emphasizes the potential for a more standardized tool of assessment to investigate the onset of CD amongst MI patients in a reliable manner. This literature review delineates the correlation between MI and CI, exploring the pathogenesis, risk factors, management and preventive strategies. Cerebral hypoperfusion, underlying atherosclerosis and neuroinflammation are crucial in the development of CD after MI. Hence, it is important to consider the 'heart-brain axis' for targeted therapy of CD in MI patients. Old age is a common risk factor for CD and MI. However, the impact of variables including gender and comorbidities is underreported, which can potentially alter the relationship between cognitive outcomes and MI. The implementation of multidisciplinary-oriented cardiac rehabilitation programs and a universal screening tool to follow up on patients with established CI post-MI has shown favorable outcomes and has reduced the risk of adverse health consequences. Optimizing medical management and regular monitoring of serum brain natriuretic peptide (BNP) and hemoglobin levels are essential in preventing CD after MI. Psychological evaluation and counselling also help attenuate CD. Additionally, preventive strategies addressing modifiable risk factors and implementing anti-inflammatory diets have proven beneficial. Ongoing research is focused on the study of novel interventions targeting the neuroinflammatory process. Recently a new member of the C-reactive protein family, pentraxin 3, has been identified as a specific vascular inflammatory biomarker produced by cells in atherosclerotic lesions that can potentially aid in recognizing CD. It is imperative to establish uniform guidelines to recognize and manage CI among patients following MI to improve quality of life among the elderly population.

DOI: 10.7759/cureus.84957

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A systematic review and network meta-analysis of interventions to preserve insulin-secreting beta cell function in people newly diagnosed with type 1 diabetes: results from randomised controlled trials of immunomodulatory therapies (2025)

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Type of publication:

Systematic Review

Author(s):

Beese, Sophie E; Price, Malcolm J; Tomlinson, Claire; Sharma, Pawana; Harris, Isobel M; Adriano, Ada; Quinn, Lauren M; Gada, Ritu; *Horgan, Thomas J; Maggs, Fiona; Burrows, Martin; Nirantharakumar, Krishnarajah; Thomas, G Neil; Andrews, Robert C; Moore, David J; Narendran, Parth.

Citation:

BMC Medicine. 23(1):351, 2025 Jul 01.

Abstract:

BACKGROUND: Type 1 diabetes is characterised by the immune-mediated destruction of pancreatic beta cells. We aimed to determine the effectiveness of immunotherapies for preserving residual beta cell function in newly diagnosed (stage 3) type 1 diabetes.

METHODS: Searches were carried out in MEDLINE, Embase, Cochrane CENTRAL and trial registries until 31st Jul 2024. RCTs of immunotherapies to preserve beta cells in newly diagnosed type 1 diabetes were included. Data were extracted using a bespoke, piloted extraction sheet. Risk of bias was assessed using Cochrane Risk of Bias Tool 1. A random effects network meta-analysis was undertaken in R. The primary outcome was C-peptide. Interventions were analysed by class.

RESULTS: Sixty trials were included (4597 patients, 32 intervention classes). Forty-one trials of 42 interventions were eligible for network meta-analysis. Eleven interventions demonstrated statistically significantly higher levels of C-peptide than placebo at 12 months, mesenchymal stem cells (autologous and Wharton's jelly-derived cells), azathioprine, interferon-alpha (5000 IU), autologous dendritic cells, anti-TNF golimumab, low-dose ATG, 3 mg 1-course anti-CD3 teplizumab, baricitinib, cyclosporin and 9/11 mg 2-course anti-CD3 teplizumab but with substantial heterogeneity present (I2 = 66%). Azathioprine ranked highest (median ranking 3rd); however, rankings demonstrated relatively wide confidence intervals and thus uncertainty in exact rank order of near adjacent therapies. Risk of bias assessment identified poor reporting, particularly in older trials, but few studies demonstrated high risk overall.

CONCLUSIONS: Eleven of 42 interventions demonstrated statistically significantly higher C-peptide levels than placebo at 12 months in the network meta-analysis. These results have identified the 11 most promising therapies trialled and help to direct future head-to-head clinical trials to support approvals for interventions to treat those newly diagnosed with type 1 diabetes. However, data for some interventions originated from small studies (mesenchymal stem cell therapies, azathioprine, autologous dendritic cells) and findings should be considered as hypothesis generating and interpreted with caution due to evidence heterogeneity.

SYSTEMATIC REVIEW REGISTRATION: The protocol for the systematic review was registered on PROSPERO, the international database of prospectively registered systematic reviews (registration: CRD42018107904).

DOI: 10.1186/s12916-025-04201-z

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