Hinchingbrooke Hospital is a small district general hospital in Hinchingbrooke near Huntingdon, Cambridgeshire. Opened in 1983, it serves the Huntingdonshire area, and has a range of specialities as well as an emergency department and a maternity unit. The hospital is managed by the North West Anglia NHS Foundation Trust.
AIM:To evaluate whether simulation-based I-PASS handoff training improves ICU nurses' knowledge, perceptions of handoff communication and safety attitudes. BACKGROUND:Effective handoff communication is crucial for ensuring patient safety and reducing errors. However, simulation-based training (SBT) with structured protocols, such as I-PASS, is rarely used in Egyptian nursing education, highlighting a gap. DESIGN:A quasi-experimental design was employed. METHODS:A convenience sample of 57 ICU nurses was studied from June to December 2023. Data were collected using the I-PASS Handoff Knowledge Questionnaire, Perception of Handoff Communication Tool and Patient Safety Questionnaire. Nurses completed baseline assessments, participated in two simulation-based I-PASS scenarios and repeated assessments post-intervention. Statistical analyses examined the training's impact and its relationships with participants' socio-demographic characteristics. RESULTS:Significant improvements were observed in I-PASS knowledge, perceptions of handoff communication and safety attitudes (all p < 0.001). Nursing qualifications and place of residence have shown a significant correlation with perceptions of handoff communication and safety attitudes (p < 0.05). CONCLUSION:Simulation-based I-PASS handoff training significantly enhances ICU nurses' knowledge, perceptions of handoff communication and safety attitudes. Targeted, context-sensitive educational interventions are necessary to strengthen handoff practices and improve patient safety within the Egyptian healthcare system. RELEVANCE TO CLINICAL PRACTICE:Structured simulation-based training, such as I-PASS, can be effectively integrated into nursing education to standardise handoff communication and improve patient safety outcomes in intensive care settings. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
BACKGROUND:An inverse relationship between surgical volume and outcomes has been suggested, with higher-volume hospitals and surgeons achieving better results, prompting debate over the centralization of surgical services. However, minimum volume thresholds are unclear, and volume is a poor proxy for quality. Despite the significant global burden of colorectal cancer, the benefits of high-volume care remain uncertain. This umbrella review synthesized the evidence on volume-outcome associations in colorectal surgery. METHODS:An umbrella review (PRISMA 2020) was conducted to evaluate systematic reviews and meta-analyses of the hospital/surgeon volume-outcome relationship in colorectal cancer. The Cochrane Library, PubMed, Embase, and MEDLINE were searched to 1 October 2025. Volume definitions and outcomes were extracted and meta-analysed by subgroup. A MeaSurement Tool to Assess Systematic Reviews 2 and Risk of Bias in Systematic Reviews were used for analysis of bias. RESULTS:A total of 150 unique records was identified, with 10 systematic reviews meeting the inclusion criteria. High- versus low-volume hospitals demonstrated an inverse relationship in terms of postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.73, 95 per cent confidence interval 0.64 to 0.82), colon cancer (fixed-effect model: odds ratio 0.74, 0.70 to 0.78; random-effects model: odds ratio 0.75, 0.69 to 0.81), and colorectal cancer (fixed- and random-effects models: odds ratio 0.77, 0.67 to 0.88). High- versus low-volume surgeons demonstrated an inverse relationship with respect to postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.69, 0.59 to 0.81), colon cancer (fixed-effect model: odds ratio 0.70, 0.63 to 0.77; random-effects model: odds ratio 0.68, 0.55 to 0.85), and colorectal cancer (fixed- and random-effects models: odds ratio 0.67, 0.60 to 0.74). There were no consistent significant differences in rates of the secondary outcomes (anastomotic leak rate, permanent stoma formation, local recurrence rate, rate of abdominoperineal excision of the rectum). CONCLUSION:High-volume hospitals and surgeons are associated with both improved short- and long-term outcomes for patients undergoing colorectal cancer surgery. However, a specific cut-off definition for high- versus low-volume hospitals and surgeons is yet to be elucidated owing to the heterogeneity of existing volume definitions. Future studies are required to confirm a threshold for this dose-response relationship.
BACKGROUND:Women with abnormal uterine bleeding (AUB) is reported in 10-30% of women and is a significant cause of iron deficiency anemia (IDA), with long-term effects on women's quality of life. This retrospective study looked at the underlying causes of AUB and the contributory factors that required blood transfusions. OBJECTIVES:This study aimed to identify the treatable causes of AUB in patients who needed blood transfusion and parenteral iron in the reproductive age group and provide appropriate treatment to these underlying pathologies. METHODS:A retrospective study was conducted in reproductive age group women with anemia due to AUB over a period of 10 years from January 2013 to December 2022. All women with significant uterine bleeding, who required blood transfusion were included in this study. Women with pregnancy, and hemolytic anemia, were excluded from the study. RESULTS:During the study period 266 women needed blood transfusion for AUB. The mean age was 37.66 ± 11.4 years, mean parity 3, mean body mass index (BMI): 29.4 ± 8.9 kg/m2, and most reported regular cycles. The most common etiology of AUB was uterine fibroids in 37.9% followed by ovulatory dysfunction in 15%. The mean hemoglobin was at 5.7 ± 1.14 gm/L, mean ferritin was 11.01 ± 21.88 ng/mL, mean number of blood transfusion was 2.83 ± 1.2 at first presentation and about 24% needed further transfusions. About 70% of them preferred oral hormonal treatment. Surgical management was required in about 35% of patients. CONCLUSION:The main cause of AUB was leiomyoma and anovulation. The morbidity of blood transfusion was easily avoidable in these women.
Abstract Aims Pancreatic cancer has a poor prognosis and limited modifiable risk factors. Micronutrients may influence pancreatic carcinogenesis through antioxidant, metabolic, and epigenetic mechanisms. This narrative review aimed to synthesise contemporary epidemiological evidence on the association between key dietary micronutrients and pancreatic cancer risk. Methods A literature search was conducted using PubMed, MEDLINE, and Embase, in 2022, March 2024 and August 2025. Primary observational studies examining dietary intake or circulating levels of selected vitamins (A, B6, B9, B12, C, D, and E) and minerals (iron, magnesium, selenium, and zinc) in relation to pancreatic cancer were included. Preclinical studies, reviews, and meta-analyses were excluded. Evidence was synthesised without quantitative pooling. Results Seventy-three studies were included. Overall, findings were heterogeneous across micronutrients, study designs, and exposure assessment methods. Dietary intake of most micronutrients, including vitamin A, vitamin D, zinc, iron, and vitamin B12, was not consistently associated with pancreatic cancer risk. More frequent inverse associations were reported for vitamin C, vitamin E, selenium, folate, vitamin B6, and magnesium, particularly in case–control studies and biomarker-based analyses. Prospective cohort studies generally reported weaker or null associations. Associations for circulating micronutrient concentrations were often stronger but inconsistent. Conclusions Current epidemiological evidence does not support strong or consistent associations between most individual micronutrients and pancreatic cancer risk. Modest protective associations for magnesium, folate, and vitamin B6 warrant further investigation. Future large prospective studies with repeated dietary and biomarker assessments are needed to clarify causality and sort micronutrient-specific effects from broader dietary and metabolic patterns.
