Musgrove Park Hospital is a large NHS hospital located in Taunton, Somerset, England, run by Somerset NHS Foundation Trust. Originally a US Army General Hospital during the Second World War, it became an NHS hospital in 1951.
OBJECTIVES:To conduct data-driven sensitivity analyses to evaluate whether refined definitions of childhood-onset systemic lupus erythematosus (cSLE) treat-to-target goals provide better protection against moderate-severe flares and new damage, compared with original consensus-derived targets. METHODS:The UK JSLE Cohort Study was utilized. Childhood-SLE target attainment was determined at each visit. Removal or transformation of cSLE target criteria ('variations') were investigated, for Childhood Lupus Low Disease Activity State (cLLDAS), cSLE Clinical Remission on Steroids (cCR) and cSLE Clinical Remission off Steroids (cCR-0). The impact of such variations on the hazards of subsequent moderate-severe flare and new damage was assessed, using Prentice-Williams-Peterson (PWP) models. Two-sided t-tests compared the hazard ratios (HRs) obtained from the PWP gap-time models for the original and varied cSLE target definitions. RESULTS:Two variations of cLLDAS demonstrated significantly better protection against moderate-severe flare, including transformation of SLEDAI-2K cut-off to ≤3 (HR 0.13 [0.09, 0.19], P < 0.001); and transformation of PGA cut-off to ≤0.25 (HR 0.14 [0.10, 0.20], P < 0.001). These variations in cLLDAS did not impact on the hazards of new damage. No variations of cCR and cCR-0 led to a significant improvement in hazards of moderate-severe flare/new damage (all P > 0.05). A modified version of cLLDAS, combining these two transformations was also assessed, demonstrating further improvement in protection against moderate-severe flare (HR 0.12 [0.08, 0.17], P < 0.001). CONCLUSIONS:Refining the cLLDAS definition by lowering the SLEDAI-2K cut-off to ≤3 and PGA to ≤0.25 may enhance protection against moderate-severe flare, but not new damage. No variations of cCR or cCR-0 showed significant improvement.
OBJECTIVES:To explore the motivations, barriers and systemic challenges experienced by senior doctors' engagement with compassionate and inclusive medical leadership (CIML) within Somerset NHS Foundation Trust, and to identify evidence-based strategies to support sustainable leadership development. DESIGN:A sequential mixed-methods study integrating quantitative survey data with qualitative thematic analysis and postsurvey facilitated group discussions. SETTING:Somerset NHS Foundation Trust, a large integrated healthcare organisation providing acute, community, mental health, learning disability and GP services across Somerset. PARTICIPANTS:Senior doctors including consultants and specialty associate specialist and specialist (SAS)-grade doctors. Participants included 156 survey respondents and 39 participants in postsurvey group discussions. OUTCOME MEASURES:Identifying leadership challenges, motivations, recruitment barriers and systemic facilitators of CIML engagement. Validation of survey findings through stakeholder discussions grounded in NHS leadership principles. RESULTS:Of the 692 eligible participants, 156 responded (22.5%) and 39 (5.64%) participated in the postsurvey group discussions. Key barriers to leadership engagement included time constraints (28%), lack of administrative support (20%), poor work-life balance (15%) and non-transparent recruitment practices (35%), echoing national concerns regarding clinician burnout and structural inequities. Qualitative themes reinforced these findings, highlighting cultural and systemic challenges, especially for women and ethnic minority doctors. Stakeholder discussions underscored the need for structured mentorship, protected time and inclusive leadership pathways. CONCLUSIONS:Systemic reforms, including mentorship programmes, transparent recruitment processes, leadership induction and protected time for leadership development, are essential to fostering sustainable and inclusive medical leadership. Engaging senior doctors in co-produced leadership strategies may help strengthen engagement and support more inclusive leadership cultures.
Introduction Pleural mesothelioma (PM) is often presaged by benign asbestos-associated pleural inflammation (AAPI), offering a unique window of opportunity for translational research. The PREDICT-Meso International Accelerator Network is leveraging this natural history to perform target identification and develop novel therapies for early-stage or pre-invasive disease. This requires assembly of a unique bioresource of longitudinal human tissue samples spanning the terminal stages of PM evolution, development of preclinical models for drug screening and reliable tools for risk prediction in patients presenting with AAPI.Methods and analysis Mesothelioma Observational study of Risk prediction and Generation of paired benign-meso tissue samples, Including a Nested MRI Substudy (Meso-ORIGINS) is a prospective, multicentre observational study, comprising two arms (A and B), with a nested MRI substudy in arm A. Arm A will recruit 300 AAPI patients and perform 6-monthly surveillance for 2 years. Suspicion of PM evolution will prompt repeat biopsy and banking, delivering a primary objective of ≥38 longitudinal AAPI-PM tissue pairs. This target reflects a projected PM evolution rate of 14% (95% CI 10.5 to 19.2) derived from a prior multicentre feasibility trial. Multiomic risk profiling will be performed in arm A, using blood proteomics, exhaled breath metabolomics and perfusion MRI. Arm B will recruit 300 patients with suspected PM, permitting collection of multiregion pleural biopsies in patients spanning AAPI and PM timepoints for evaluation of anatomical heterogeneity. Where possible, patients in arm B diagnosed with AAPI will be recruited to arm A for 2-year surveillance +/− repeat biopsy in subsequent PM evolution cases. Pleural fluid will be collected in arm B for cell-line generation and diagnostic biomarker evaluation. Exhaled breath will be collected in arm B for diagnostic biomarker evaluation.Ethics and dissemination The study has ethical approval (REC Ref 21/WS/0120). Results will be disseminated via peer-reviewed journals and national/international scientific conferences. Tissues, data and derived omics will be shared via the PREDICT-Meso Research Tissue Bank (REC Ref 21/WS/0011).Trial registration number ISRCTN22929761.
Introduction: Robotic gastrectomy is increasingly used in the surgical management of gastric cancer. Indocyanine green (ICG) near-infrared fluorescence imaging has emerged as a technique that enables real-time visualization of lymphatic drainage pathways, potentially facilitating more precise and individualized lymph node dissection. However, the clinical value of ICG-guided fluorescent lymphography during robotic gastrectomy remains incompletely established. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and the Cochrane Library were searched from database inception to 31 January 2026 for comparative studies evaluating ICG-guided fluorescent lymphography versus standard robotic gastrectomy for gastric cancer. Statistical analyses were performed using R (version 4.4.2) and the meta package. Results: Six studies, including 406 patients, met the inclusion criteria. Use of ICG was associated with a higher number of retrieved lymph nodes (mean difference [MD] 8.48; 95% CI 4.61-12.36; p = 0.001; I2 = 55.5%). Operative time was modestly shorter in the ICG group (MD -10.84 min; 95% CI -21.08 to -0.61; p = 0.038). There were no significant differences in intraoperative blood loss (MD -4.02 mL; p = 0.289), length of hospital stay (MD -0.82 days; p = 0.131), or postoperative complications (odds ratio 0.83; 95% CI 0.46-1.49; p = 0.534). Conclusions: ICG-guided fluorescence imaging during robotic gastrectomy is associated with increased lymph node retrieval and a small reduction in operative time without evidence of increased perioperative morbidity. Larger prospective studies are required to confirm these findings and to evaluate long-term oncologic outcomes.
Background: Compression neuropathies are common during military training. Cadets of Bangladesh Military Academy often become vulnerable to compression palsies which renders them unable to perform training activities for a considerable time period. Pressure palsies may be acute or chronic. The major risk factors include carrying heavy loads, improper pack fitting, thin body habitus and training event or activity. Recognition of pre-disposing factors are important to reduce the occurrence of pressure palsies and facilitate smooth training. The purpose of this study was to observe the pattern, predisposing factors, training time loss and recovery status of the cadets with compression neuropathy in Bangladesh Military Academy. Methods: A cross-sectional study was conducted in CMH, Bhatiary which included all cadets presenting with features of neuropathy following a history of nerve compression from 8 September 2024 to 7 September 2025 and attended subsequent follow up within this time frame. The sample size was 32. Results: The mean age of the respondents was 20.68 ± 1.15 years, majority being male. Mean BMI was 20.62 ± 1.68 kg/sq. meters. Majority of the (62.5%) affected cadets were first-termers. 62.5% cases were backpack palsies. 14 (43.8%) palsies occurred following Exercise Podokkhep while majority (56.2%) developed symptoms within 4 hours of compression. 43.8% cases were mono-neuropathy while 56.3% were brachial plexopathy, mostly (62.5%) being Neuropraxia. Majority (65.6%) of the cadets had partial recovery. The mean training time loss was 8.02 ± 5.27 weeks. Independent sample t-test showed statistically significant relations between abnormal NCS and training time loss (p value 0.009) and abnormal NCS and number of recurrence among the cadets (p value 0.001). Conclusion: The study emphasizes on cadets with low BMI, less muscular junior term cadets, big pack compression and the duration of compression as major predisposing factors of compression neuropathy. It also demonstrates that most of the cases are Neuropraxia which recovered within 8 weeks and had better prognosis. It recommends necessary precautions to tackle these risk factors to prevent neuropathy. Bangladesh Armed Forces Med J Vol 59 No (1) June 2026, pp 55-61
