Like other UK medical schools it is based on the principles and standards of 'Tomorrow's Doctors', an initiative by the General Medical Council outlining the role of British practitioners. Since opening in 2003, BSMShas produced more than 1,500 new doctors who now work across the UK..
Youth mental health services are struggling to meet demand, highlighting the need for changes aligned with young people’s needs. The CATALYST project (Co-designing and testing an Asset-based TAsk-sharing modeL for Youth mental health Services in deprived communiTies) uses place-based approaches to inform improvements to mental health support for 16–25-year-olds. In addition to improving access to care, there is an urgent need to prevent escalation of mental health issues through earlier, community-based interventions. This paper presents a situational analysis of Brighton and Hove, UK, a coastal area with high levels of socioeconomic inequality, to explore why young people are not being reached by existing services, and what could improve access. We conducted a desk-based review of 21 policy, strategy, and research documents, and a series of interviews and focus groups. Participants (N = 34) included young people, community members, and professional stakeholders. Data were analysed using a framework analysis guided by the research questions. We identified eight barriers and five facilitators to accessing support across system-, service-, and individual-levels. Participants described a system under strain, characterised by a lack of funding, workforce capacity, siloed referrals, and high access thresholds. Young people described low levels of trust in the system and experiences of exclusion and isolation. However, a strong voluntary sector, and community-based models like Single Points of Access (SPOAs) were seen as promising facilitators for accessible mental health support. The findings align with other areas with high levels of deprivation, but Brighton and Hove’s vibrant voluntary sector offers unique opportunities. Mobilising these assets through increased community partnership and use of task-sharing could enhance access to timely and appropriate mental health support. These approaches have implications for prevention practice by facilitating earlier identification of emerging mental health difficulties and providing ongoing, community-based support to prevent escalation.
The modulating factors within the tumor microenvironment, for example, transforming growth factor beta (TGF-β), may limit the response to chemo and immunotherapy protocols in colorectal cancer (CRC). In the current study, the therapeutic potential of targeting the TGF-β pathway using Pirfenidone (PFD), a TGF-β inhibitor, either alone or in combination with five fluorouracil (5-FU) has been explored in preclinical models of CRC. The anti-proliferative and migratory effects of PFD were assessed by MTT and wound-healing assays respectively. Xenograft models were used to study the anti-tumor activity, histopathological, and side effects analysis. Targeting of TGF-β resulted in suppression of cell proliferation and migration, associated with modulation of survivin and MMP9/E-cadherin. Moreover, the PFD inhibited TGF-β induced tumor progression, fibrosis, and inflammatory response through perturbation of collagen and E-cadherin. Targeting the TGF-β pathway using PFD may increase the anti-tumor effects of 5-FU and reduce tumor development, providing a new therapeutic approach to CRC treatment.
Effective postoperative recovery after video-assisted thoracoscopic surgery (VATS) remains a significant challenge, with patients frequently experiencing moderate to severe pain, pulmonary decline, and postoperative nausea and vomiting (PONV) despite modern multimodal analgesia. Intravenous lidocaine has been proposed as an opioid-sparing adjunct with systemic analgesic and antihyperalgesia properties, but its role in VATS is uncertain. This systematic review and meta-analysis identified a total of 31 studies, of which 9 randomized controlled trials involving 672 patients met the inclusion criteria and were included in the final quantitative and qualitative synthesis. Five trials (n = 328) assessing 24-hour opioid use and 3 trials (n = 242) assessing 48-hour use showed no reduction in postoperative morphine consumption with lidocaine. Similarly, pooled movement pain scores at 24 and 48 hours (3 trials, n = 200 each) demonstrated no significant difference between groups. Although 4 trials (n = 272) reported a marked reduction in intraoperative remifentanil requirements, this did not translate into improved postoperative analgesia. In contrast, lidocaine produced a consistently favorable antiemetic effect: 5 trials (n = 360) showed a significant reduction in PONV with negligible heterogeneity. Limitations included small sample sizes, varying bolus and infusion regimens, heterogeneity in background analgesic protocols, and incomplete reporting of outcomes such as inflammatory markers and pulmonary physiology, all of which reduce confidence in effect estimates. Overall, current evidence indicates that while intravenous lidocaine is safe and offers a reproducible reduction in PONV, it does not improve postoperative pain or opioid consumption following VATS. Larger, standardized trials are required to determine whether specific subgroups or dosing strategies may yield a greater benefit in thoracic minimally invasive surgery.
IntroductionPeter Shaw (1694-1763) was an English physician who practised in London and Scarborough, Yorkshire. He was appointed physician to Kings George II and III. Shaw published many medical texts as well as translations of Lord Francis Bacon and Robert Boyle.MethodHistorical examination of Shaw's text A Treatise of Incurable Diseases (1723).ResultsShaw states that 'incurable' conditions offer an opportunity to examine the cause of disease and its treatment. He proposes a model for a comparative trial of 'antidote' for hydrophobia (rabies) in one of two dogs and - if successful - in humans.ConclusionShaw's proposal is an early model for translational medical research from animals to humans to ensure effectiveness and safety. The evidence suggests that Shaw's was an inspiration for Hauksbee the Younger's 1743 proposed 'experimentum crucis' of venereal disease treatments. That is because in 1731 they co-authored 'An Essay for Introducing a Portable Laboratory'. Furthermore, Hauksbee reveals that Shaw was actively involved in early enquiries into the efficacy of his venereal medication. Due to shared roots in Lichfield and an interest in spa water treatment, the authors conjecture that Shaw's comparative approach might have roots in Sir John Floyer's 1702 controlled trial of cold-water on athleticism.
Cardiovascular diseases (CVDs) remain a major global health challenge, accounting for substantial illness and death worldwide. Growing evidence suggests that insulin resistance (IR) has a substantial role in their development and progression. A recently introduced IR surrogate marker, the Cholesterol-HDL-Glucose (CHG) index, has been suggested as an index for identifying metabolic disturbances, but its value in predicting cardiovascular mortality has not been clearly established. This study set out to examine how well the CHG index predicts cardiovascular mortality when compared with the Triglyceride-Glucose (TyG) index and its variants combined with obesity measures. We analyzed data from middle-aged adults (35–65 years) in the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study, with data collected from 2011 to 2020. Cardiovascular and all-cause mortalities were tracked over at least 10-year follow-up. The CHG, TyG and its derived substitutes were calculated, and their associations with mortality outcomes were assessed using univariate and multivariate Cox regression models. Additionally, receiver operating characteristic (ROC) analysis, Harrell’s C-index, restricted cubic spline (RCS), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), likelihood-based pseudo-R² and the share of explainable log-likelihood, decision curve analysis (DCA) for clinical utility, Kaplan-Meier survival curves, Fine and Grey subdistribution hazard models, E-value for robustness of associations, and subgroup analysis were performed in statistical analysis. Among 7467 participants who were analyzed, higher CHG values were strongly associated with a greater risk of both cardiovascular and all-cause mortality. Each standard deviation (SD) increase in CHG value, raise the risk of cardiovascular mortality by 35.4%, and 31.9% in competing-risk analysis, which was higher than TyG and its related markers. For all-cause mortality, 1-SD increase in CHG was associated with 21.4% higher risk. In predicting cardiovascular mortality, CHG outperformed TyG and its derivatives on ROC, C-index, IDI, pseudo-R², share of log-likelihood and DCA measures. For all-cause mortality, certain TyG-based indices performed better. RCS modeling indicated a linear relationship between CHG and cardiovascular mortality, and a non-linear relationship with all-cause mortality. Survival analysis, robustness checks, and subgroup analyses supported these findings, with no evidence of effect modification for cardiovascular mortality. Elevated CHG is independently associated with a higher risk of cardiovascular mortality and shows a consistent linear pattern. It provides stronger predictive value for cardiovascular death than TyG and its derivatives, supporting its role as a useful marker for assessing CVD risk.
