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Minimal Data Elements for Surveillance and Reporting Of Musculoskeletal Injuries in the MILitary (ROMMIL) International Consensus Statement.

INTRODUCTION: A systematic approach to collecting and reporting injury data in military settings is necessary to maximize the impact of musculoskeletal injury-related research. An international consensus on recommended core data set of elements to capture and report is necessary. The purpose was to summarize the process and results from an international consensus study to establish recommended common minimum data elements for surveillance and Reporting Of Musculoskeletal injuries in the MILitary (ROMMIL). METHODS: A ten-step hybrid consensus process was performed. Knowledge users were embedded in the process for co-creation of pertinent questions, data elements, and voting. Evidence synthesis included a scoping review on the barriers and facilitators to implementing injury prevention programs, followed by a knowledge user survey. A sequential three round Delphi study refined and validated the final elements in the recommendation checklist. Consensus recommendations were presented to an international audience of stakeholders. Participants voted on each statement with 0 representing no importance, 5 somewhat important, and 10 maximum importance. RESULTS: The consensus recommendation includes one data principle of keeping continuous data continuous and 33 minimum data elements. Data elements include demographics, lifestyle, service branch, musculoskeletal/surgical history, exposure, and injury characteristics. The data principle endorsed by knowledge users recommends that continuous variables (e.g. age, weight, exposure) remain continuous and not categorized into groups. Dissenting viewpoints are detailed to provide fair and balanced consensus recommendations. CONCLUSIONS: The ROMMIL checklist could be leveraged by clinicians, researchers and knowledge users working in miliary settings when comparing and harmonizing data across studies, service branches, and countries. The ROMMIL checklist will support improved data synthesis to better inform evidence-based practice in military medicine, and the ability to generate more useful prognostic models to quantify injury risk.

CONSORT 2025 Statement: Updated Guideline for Reporting Randomized Trials.

IMPORTANCE: Well-designed and properly executed randomized trials are considered the most reliable evidence on the benefits of health care interventions. However, there is overwhelming evidence that the quality of reporting is not optimal. The CONSORT (Consolidated Standards of Reporting Trials) statement was designed to improve the quality of reporting and provides a minimum set of items to be included in a report of a randomized trial. CONSORT was first published in 1996, then updated in 2001 and 2010. Herein, we present the updated CONSORT 2025 statement, which aims to account for recent methodological advancements and feedback from end users. OBSERVATIONS: We conducted a scoping review of the literature and developed a project-specific database of empirical and theoretical evidence related to CONSORT to generate a list of potential changes to the checklist. The list was enriched with recommendations provided by the lead authors of existing CONSORT extensions (harms, outcomes, nonpharmacological treatment), other related reporting guidelines (Template for Intervention Description and Replication [TIDieR]), and recommendations from other sources (eg, personal communications). The list of potential changes to the checklist was assessed in a large, international, online, 3-round Delphi survey involving 317 participants and discussed at a 2-day online expert consensus meeting of 30 invited international experts. We have made substantive changes to the CONSORT checklist. We added 7 new checklist items, revised 3 items, deleted 1 item, and integrated several items from key CONSORT extensions. We also restructured the CONSORT checklist, with a new section on open science. The CONSORT 2025 statement consists of a 30-item checklist of essential items that should be included when reporting the results of a randomized trial and a diagram for documenting the flow of participants through the trial. To facilitate implementation of CONSORT 2025, we have also developed an expanded version of the CONSORT 2025 checklist, with bullet points eliciting critical elements of each item. CONCLUSIONS AND RELEVANCE: Authors, editors, reviewers, and other potential users should use CONSORT 2025 when writing and evaluating manuscripts of randomized trials to ensure that trial reports are clear and transparent.

MOLECULAR AND FUNCTIONAL CHARACTERISATION OF DISTINCT RESIDENT AND MIGRATORY SKIN FIBROBLAST POPULATIONS IN SYSTEMIC SCLEROSIS

LOWER LIMB MUSCLE STRENGTH AND BALANCE IN OLDER ADULTS WITH DISTAL RADIUS FRACTURE: A SYSTEMATIC REVIEW

PyPropel: a Python-based tool for efficiently processing and characterising protein data.

BACKGROUND: The volume of protein sequence data has grown exponentially in recent years, driven by advancements in metagenomics. Despite this, a substantial proportion of these sequences remain poorly annotated, underscoring the need for robust bioinformatics tools to facilitate efficient characterisation and annotation for functional studies. RESULTS: We present PyPropel, a Python-based computational tool developed to streamline the large-scale analysis of protein data, with a particular focus on applications in machine learning. PyPropel integrates sequence and structural data pre-processing, feature generation, and post-processing for model performance evaluation and visualisation, offering a comprehensive solution for handling complex protein datasets. CONCLUSION: PyPropel provides added value over existing tools by offering a unified workflow that encompasses the full spectrum of protein research, from raw data pre-processing to functional annotation and model performance analysis, thereby supporting efficient protein function studies.

Engineering TCR-controlled fuzzy logic into CAR T cells enhances therapeutic specificity.

Chimeric antigen receptor (CAR) T cell immunotherapy represents a breakthrough in the treatment of hematological malignancies, but poor specificity has limited its applicability to solid tumors. By contrast, natural T cells harboring T cell receptors (TCRs) can discriminate between neoantigen-expressing cancer cells and self-antigen-expressing healthy tissues but have limited potency against tumors. We used a high-throughput platform to systematically evaluate the impact of co-expressing a TCR and CAR on the same CAR T cell. While strong TCR-antigen interactions enhanced CAR activation, weak TCR-antigen interactions actively antagonized their activation. Mathematical modeling captured this TCR-CAR crosstalk in CAR T cells, allowing us to engineer dual TCR/CAR T cells targeting neoantigens (HHATL8F/p53R175H) and human epithelial growth factor receptor 2 (HER2) ligands, respectively. These T cells exhibited superior anti-cancer activity and minimal toxicity against healthy tissue compared with conventional CAR T cells in a humanized solid tumor mouse model. Harnessing pre-existing inhibitory crosstalk between receptors, therefore, paves the way for the design of more precise cancer immunotherapies.

Secular Trends in Incidence, Prevalence, and Survival of Pancreatic Cancer in the United Kingdom: A Population-Based Cohort Study from 2000 to 2021

Efficacy of nitric oxide donors and EDTA against Pseudomonas aeruginosa biofilms: Implications for antimicrobial therapy in chronic wounds

Iron in Clinical Practice

Exploring take-home opioid stewardship (ETHOS) in UK postoperative patients.

BACKGROUND: Surgery is one of the most common indications for a patient's first opioid prescription, with some patients progressing to unintended long-term use. There is no current data from the United Kingdom on how much patients use of the opioid medication dispensed at discharge from hospital. This study investigates discharge opioid prescribing and usage following common surgical procedures. METHODS: This cohort study was conducted at the Oxford University Hospitals NHS Foundation Trust and involved 20 of the most commonly performed adult surgical procedures. At least 20 patients per procedure were surveyed using a standardised telephone questionnaire 6-8 days after discharge to establish the amount of used and unused opioids. Opioid doses were converted to oral morphine equivalent (OME) for analysis. RESULTS: The amount of opioid given to patients after all types of surgery far exceeded requirement, with often large variations in prescribing practices for the same procedures, most notably in trauma and orthopaedics.For the cohort of 426 patients, a total of 55 080 mg OME was dispensed on discharge, with only 34.4% actually used by patients, leaving a total of 36 108.5 mg OME unused in the community, risking inappropriate opioid use, overdose, or diversion. CONCLUSIONS: Opioid overprescribing is common after surgery and represents waste, expense, and risk to patients. There is a clear need to develop a procedure-specific evidence-base for discharge opioid prescribing, adopting an "enough but not too much" approach to ensure that patients have adequate analgesia to facilitate functional surgical recovery, but not more than is needed.

After Surgery for Ankle Fracture, Early Weight-Bearing Was Noninferior to Delayed Weight-Bearing and Is Likely Cost-Effective

Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: the World Hip Trauma Evaluation 5 (WHiTE 5) trial (vol 104-B, pg 922, 2022)

Five-year outcomes for patients with a displaced fracture of the distal tibia

Aims To report the outcomes of patients with a fracture of the distal tibia who were treated with intramedullary nail versus locking plate in the five years after participating in the Fixation of Distal Tibia fracture (FixDT) trial. Methods The FixDT trial reported the results for 321 patients randomized to nail or locking plate fixation in the first 12 months after their injury. In this follow-up study, we report the results of 170 of the original participants who agreed to be followed up until five years. Participants reported their Disability Rating Index (DRI) and health-related quality of life (EuroQol five-dimension three-level questionnaire) annually by self-reported questionnaire. Further surgical interventions related to the fracture were also recorded. Results There was no evidence of a difference in patient-reported disability, health-related quality of life, or the need for further surgery between participants treated with either type of fixation at five years. Considering the combined results for all participants, there was no significant change in DRI scores after the first 12 months of follow-up (difference between 12 and 24 months, 3.3 (95% confidence interval -1.8 to 8.5); p = 0.203), with patients reporting around 20% disability at five years. Conclusion This study shows that the moderate levels of disability and reduced quality of life reported by participants 12 months after a fracture of the distal tibia persist in the medium term, with little evidence of improvement after the first year.

Overcoming obstacles - Tension, Time and Territories: A qualitative study of clinicians’ experience of a clinical trial for displaced distal radius fractures in children

Leading through expertise: a qualitative study of clinician’s experience of a paediatric clinical trial for displaced medial epicondyle fracture

Striving to recover - wrist splint or plaster cast: a qualitative study of patients’ experience of recovery after a distal radius fracture

Injury: a neglected global health challenge in low-income and middle-income countries.

The impact of complications on quality of life and mortality after hip fracture

Aims: Complications are to be key drivers of poorer outcome but there is limited information on how they influence quality of life (QoL) after hip fracture. The aim of this study was to investigate the relationship between complications, QoL, and mortality after hip fracture. Methods: The World Hip Trauma Evaluation (WHiTE) study is a multi-centre, prospective cohort study that collected data from patients ≥60 years who received operative treatment for their hip fracture. Patients were followed up for 120 days after surgery. The primary and secondary outcomes were health-related QoL (EQ-5D-5L) and mortality, respectively. Linear and logistic regression models were fitted to assess the relationship between complications, EQ-5D-5L, and mortality. Results: Among 24,523 patients with a hip fracture, the mean differences in EQ-5D-5L in patients who had surgery-specific complications were: prosthesis dislocation -0.14 (95% CI: - 0.20 to -0.08); fixation failure 0.00 (95% CI: -0.15 to 0.14); peri-prosthetic or peri-implant fracture -0.08 (95% CI: -0.18 to 0.02); re-operation for any indication -0.09 (95% CI: -0.14 to -0.05); surgical site infection (SSI) -0.06 (95% CI: -0.10 to -0.01); and deep SSI -0.13 (95% CI: -0.20 to -0.07). The mean differences in EQ-5D-5L for the general complications were: acute kidney injury -0.05 (95% CI: -0.07 to -0.02); blood transfusion -0.01 (95% CI: -0.03 to 0.01); lower respiratory tract infection -0.07 (95% CI: -0.09 to -0.05); urinary tract infection 0.01 (95% CI: -0.01 to 0.03); cerebrovascular accident (CVA) -0.17 (95% CI: -0.25 to -0.09); myocardial infarction (MI) -0.14 (95% CI: -0.20 to -0.08); and venous thromboembolism 0.03 (95% CI: -0.02 to 0.08). Conclusions: We observed worse health-related QoL in patients who had a complication after hip fracture. Those who underwent revision surgery or had a prosthesis dislocation or deep SSI experienced similar levels of disability to those with a CVA or MI.

Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK

Background The most common fractures in children are torus (buckle) fractures of the wrist. Controversy exists over treatment, which ranges from splint immobilisation and discharge to cast immobilisation, follow-up, and repeat imaging. This study compared pain and function in affected children offered a soft bandage and immediate discharge with those receiving rigid immobilisation and follow-up as per treating centre protocol. Methods In this randomised controlled equivalence trial we included 965 children (aged 4–15 years) with a distal radius torus fracture from 23 hospitals in the UK. Children were randomly allocated in a 1:1 ratio to the offer of bandage group or rigid immobilisation group using bespoke web-based randomisation software. Treating clinicians, participants, and their families could not be masked to treatment allocation. Exclusion criteria included multiple injuries, diagnosis at more than 36 h after injury, and inability to complete follow-up. The primary outcome was pain at 3-days post-randomisation measured using Wong-Baker FACES Pain Rating Scale. We performed a modified intention-to-treat and per protocol analysis. The trial was registered with ISRCTN registry, ISRCTN13955395. Findings Between Jan 16, 2019, and July 13, 2020, 965 children were randomly allocated to a group, 489 to the offer of a bandage group and 476 to the rigid immobilisation group, 379 (39%) were girls and 586 (61%) were boys. Primary outcome data was collected for 908 (94%) of participants, all of whom were included in the modified intention-to-treat analysis. Pain was equivalent at 3 days with 3·21 points (SD 2·08) in the offer of bandage group versus 3·14 points (2·11) in the rigid immobilisation group. With reference to a prespecified equivalence margin of 1·0, the adjusted difference in the intention-to-treat population was –0·10 (95% CI –0·37 to 0·17) and–0·06 (95% CI –0·34 to 0·21) in the per-protocol population. Interpretation This trial found equivalence in pain at 3 days in children with a torus fracture of the distal radius assigned to the offer of a bandage group or the rigid immobilisation group, with no between-group differences in pain or function during the 6 weeks of follow-up. Funding UK National Institute for Health and Care Research.

Cost-utility analysis of standard dressing compared with incisional negative-pressure wound therapy among patients with closed surgical wounds following major trauma to the lower limb (vol 102-B, pg 1072, 2020)