The James Cook University Hospital is a major tertiary referral hospital, district general hospital and major trauma centre in Middlesbrough, North Yorkshire, England located on the A172 (Marton Road). Having 1,024 beds, it caters for most specialities and forms part of the South Tees Hospitals NHS Foundation Trust, along with the Friarage Hospital in Northallerton.
The COVID-19 pandemic impacted healthcare globally, with significant delays in elective services. This service evaluation aimed to capture the impact of delays in pessary maintenance appointments on patient’s symptom experience and clinical findings. All patients attending routine pessary maintenance appointments over a 6-month period during the COVID-19 pandemic were asked a series of questions concerning vaginal symptoms. Clinician observation of erythema and erosion were recorded. Descriptive statistics, for both total duration in situ and delay in pessary maintenance appointments, were calculated on the basis of pessary type for each symptom. Of the 208 questionnaires received, 173 were analysed and 35 excluded (incomplete data). Pessary distribution: ring (n = 99), Gellhorn (n = 52), shelf (n = 22). There was a moderate correlation with time pessary in situ and symptoms of discharge and odour in all pessaries, with a weak relationship between symptoms and delay in pessary maintenance appointments. Patients using a pessary longer than 6 months, were unlikely to report worsening symptoms related to delay in pessary maintenance appointments, with the majority reporting no symptom change. Whilst clinician findings of erythema and erosion correlated strongly with duration of pessary use, severe changes were observed when pessaries were in situ at least 11 months. These findings indicate that in select patients, extending pessary maintenance appointments beyond 6 months may have little effect on patient symptoms but, beyond 10 months risks increasing the incidence of severe erythema and erosion. This can help reduce burden on appointments for both patients and providers and reduce wastage of single use resources.
Routine measurement of gastric residual volumes involves regularly aspirating the entire stomach contents to assess the volume and colour of the aspirate to inform feeding. This is an established practice in many United Kingdom and Australian neonatal units for preterm infants receiving gastric tube feeds. The rationale is to assess feed tolerance and to predict and potentially prevent necrotising enterocolitis, a serious gut condition. Routine measurement of gastric residual volumes may also be associated with adverse outcomes and harm, including delayed achievement of full enteral feeds and longer neonatal unit stay. Evidence to support the routine measurement of gastric residuals is poor, and previous small trials have not been generalisable to UK or Australian neonatal care. The aim of the neoGASTRIC trial is to test whether avoiding routine measurement of gastric residual volumes in preterm infants reduces the time taken for an infant to reach full enteral feeds without increasing necrotising enterocolitis. neoGASTRIC is an individually randomised controlled trial in neonatal units in the UK and Australia. A target of 7040 infants born before 34 weeks’ gestation will be randomly allocated, prior to receiving 24 h of enteral feeds > 15 ml/kg/day, on a 1:1 basis to have no routine gastric residual volumes measured, or to have gastric residual volumes measured routinely. Opt-out consent will be used with parent and staff views explored as part of an embedded process evaluation. The primary superiority outcome is time to reach full milk feeds ≥ 145 ml/kg/day for three consecutive days. Bell’s stage 2 or 3 necrotising enterocolitis following blinded adjudication will be the key secondary, non-inferiority safety outcome. Other neonatal core outcomes and health care resource use and costs prior to discharge will be evaluated. neoGASTRIC will address a research priority that affects more than 20,000 preterm infants in the United Kingdom and Australia annually. Even modest improvements in clinical outcomes and resource use could result in large clinical benefits and savings at a population level. ISRCTN 16710849. Prospectively registered on 8 February 2023.
Objective The UK faces a significant obesity crisis, and multiple management options are now available, including pharmacotherapy, endoscopic and surgical interventions. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a National Institute for Health and Care Excellence-approved, minimally invasive obesity care procedure, which is a safe and effective option for selected patients. Despite its promise, National Health Service (NHS) providers lack standardised guidance for the implementation of this intervention. This initiative is aimed at creating a comprehensive pathway for the implementation of ESG within the NHS using a diverse stakeholder approach.Methods A modified nominal group technique (NGT) was employed, bringing together a diverse group of healthcare professionals (HCPs) involved in obesity management from primary and secondary care, commissioner representatives and patient groups in an iterative consensus-building process. The NGT methodology allowed for structured discussion, prioritisation of key elements and sequential refinement of the pathway through multiple rounds of expert input and feedback.Results The panel reached agreement on HCP requirements, resource allocation and identified key considerations for successful ESG implementation. Critical elements included primary care engagement, dietetic support, psychological assessment and anaesthetic involvement alongside the procedural aspects of training and mentoring, patient selection and technical factors. Notably, no areas of significant disagreement were identified throughout the process, enabling the development of a comprehensive framework for ESG delivery.Conclusion This framework provides practical proposals to facilitate ESG implementation across NHS centres, supporting multidisciplinary care delivery while acknowledging operational feasibility within existing NHS resource constraints.
For upper tract urothelial carcinoma (UTUC), the comparative effectiveness of open (ONU), hand-assisted laparoscopic (HALNU), laparoscopic (LNU), and robotic nephroureterectomy (RNU) remains debated. We performed a network meta-analysis to compare their perioperative safety, oncologic outcomes, and efficiency. Three databases were searched through August 11, 2025. A frequentist network analysis was performed (ONU as reference). Primary outcomes were 5-year overall survival (OS), cancer-specific survival (CSS), major complications, and mortality. Secondary outcomes included bladder/intravesical recurrence-free survival (BRFS), recurrence-free survival (RFS), progression-free survival (PFS), metastasis-free survival (MFS), positive surgical margins (PSM), estimated blood loss (EBL), operative time, and length of stay (LOS). Treatments were ranked using SUCRA. Eighty-eight studies involving 70,783 patients were included. Minimally invasive approaches were associated with lower perioperative morbidity compared with ONU. Major complications were reduced with LNU and RNU, and mortality was lower with RNU and LNU. Minimally invasive techniques had lower EBL and shorter LOS, although operative times were longer. Across oncologic outcomes, most pairwise comparisons demonstrated overlapping confidence intervals. Five-year survival outcomes did not differ between approaches. RNU showed favorable estimates for OS and BRFS versus ONU, but these findings were not consistently significant. PSM rates were similar across techniques. SUCRA rankings generally favored RNU for perioperative safety outcomes. Minimally invasive techniques, especially RNU, are associated with improved perioperative safety and recovery compared with open surgery, while long-term oncologic outcomes appear broadly comparable across techniques. These findings are however limited by the observational nature of available evidence, warranting further validation.
Background Robotic right hemicolectomy is increasingly performed for neoplastic disease, but the optimal method of anastomosis remains debated. Intracorporeal anastomosis (ICA) may offer advantages in reducing wound complications and postoperative ileus, while extracorporeal anastomosis (ECA) is technically simpler. Evidence specific to oncologic populations, however, is limited. Methods We conducted a retrospective observational study of patients undergoing robotic right hemicolectomy for neoplastic pathology at a tertiary academic centre between January 2023 and December 2024. Patients were stratified into ICA and ECA groups. Primary outcomes included early postoperative recovery (time to bowel movement, anastomotic leak, and 30-day readmission). Secondary outcomes assessed operative time, wound complications, postoperative ileus, systemic inflammatory response (C-reactive protein (CRP) and white cell count (WCC)), length of stay, and oncologic adequacy (lymph node harvest, tumour staging). Statistical analyses included t-test, Mann-Whitney U test, chi-square test, or Fisher's exact test, with significance set at p <0.05. Results Eighty-three patients were included: 61 (73.5%) underwent ICA, and 22 (26.5%) underwent ECA. Baseline demographics, body mass index (BMI), and prior abdominal surgery rates were comparable between groups. ICA was associated with longer operative time (176.1 vs 153.7 minutes, p = 0.06). Anastomotic leaks were rare (ICA 2/61, 3.3%; ECA 0/22; p = 1.0). Wound infections occurred only in the ECA group (13.6% vs 0%, p = 0.02), and postoperative ileus was more frequent with ECA (13.6% vs 0%, p = 0.02). Readmission rates were similar (ICA 9.8% vs ECA 9.1%, p = 1.0). There were no significant differences in systemic inflammatory markers or length of hospital stay. Lymph node yield (24.9 vs 22.4, p = 0.33) and tumour stage distribution were comparable, confirming oncologic adequacy. One postoperative death occurred in the ICA group, unrelated to anastomotic integrity. Conclusion In robotic right hemicolectomy for neoplastic disease, ICA was associated with lower rates of wound infection and postoperative ileus compared with ECA, without increased leak rates or compromise in oncologic adequacy. Despite slightly longer operative times, ICA demonstrated favourable short-term morbidity. Prospective multicentre studies are warranted to confirm these findings and guide surgical decision-making in colorectal oncology.
