North Tyneside General Hospital is a district general hospital located on Rake Lane in North Shields, Tyne and Wear. It is managed by Northumbria Healthcare NHS Foundation Trust.
IntroductionExercise can improve outcomes for people with Parkinson's. Telerehabilitation (TR) may lower costs and maximise clinician time but its efficacy for gait and balance in early Parkinson's is uncertain. We conducted a randomized controlled feasibility trial of individualised real-time physiotherapy delivered via videoconference.MethodsWe recruited people with early (<4 years' duration) Parkinson's from 2 English NHS hospitals. The TR group had 1 × 60 min, 4 × 30 min video calls and 2 × 10 min calls. These calls occurred within 12 weeks of randomization. Experienced physiotherapists prescribed individualized exercises. The usual care group received standard exercise advice from their physician. Physical activity was measured using Fitbit Inspire. A qualitative process evaluation was undertaken.Results84 people were screened, 64 were eligible and 40 recruited. 21 and 19 were randomized to TR and usual care respectively. 90% of study instruments were completed per protocol.Median [interquartile range; IQR] change in Unified Parkinson's Disease Rating Scale (UPDRS) at six months was -3.5 [-8 to 2.5] for the TR group and 7 [0 to 17] for usual care, effect size (Cohen's D = -0.537). Median [IQR] change in weekly step count was 4215 [-8769 to 19664] for the TR group versus -2185 [-10764 to 3143] for usual care (Cohen's D = 0.198). Participants found the intervention acceptable. Most participants were confident in using the videoconference systems.ConclusionA definitive trial of TR for early Parkinson's is feasible. UPDRS and step count are suitable outcomes.
This letter describes the various common treatable traits in people with RCC and emphasises the importance of multidisciplinary input, especially speech and language therapy, for this condition https://bit.ly/4hVcQw7.
INTRODUCTION:Heart failure (HF) hospitalizations are frequent and lengthy, and usually involve treatment with intravenous diuretics to relieve congestion. SUBCUT HF II is evaluating the safety and efficacy of an alternative ambulatory care strategy using a novel subcutaneous formulation of furosemide delivered via a wearable pump. METHODS:The SUBCUT HF II trial is a multicentre, randomized, active comparator trial involving 20 hospitals in the UK. Eligible participants are patients with HF receiving inpatient treatment with intravenous loop diuretic. Patients are randomized to either early supported discharge, using a novel formulation of subcutaneous furosemide (SQIN-Furosemide) administered by a wearable pump (SQIN-Infusor), or continued inpatient treatment using intravenous furosemide. RESULTS:The primary endpoint is days spent alive and out of hospital at 30 days. As of October 2025, 168 of 170 patients have been randomized. CONCLUSION:The SUBCUT HF II trial is testing the safety and efficacy of an ambulatory care approach to managing patients presenting to the hospital with HF. TRIAL REGISTRATION:ClinicalTrials.gov identifier NCT05419115.
Dietary fibre may influence bile acid (BA) metabolism via interactions with gut microbiota. We hypothesised that dietary fibres with distinct fermentative properties, resistant starch (RS) and polydextrose (PD), would differentially alter BA profiles in plasma and faeces through gut microbiota-mediated mechanisms. BA profiles were analysed by ultra-performance liquid chromatography mass spectrometry in plasma (n = 74) and faeces (n = 50) from a double-blind, randomised, placebo-controlled 2 × 2 factorial trial. Healthy participants consumed 23 g/day Hi-maize®260 (type 2 RS) and/or 12 g/day Litesse®Ultra™ (PD) for 50 days. The intervention effects of RS and PD on BA profile were investigated using general linear models and beta regression models. Genus abundances derived from 16 S rRNA gene sequencing were used to investigate fibre-specific microbial correlations with BA profiles. Supplementation with RS, but not PD, increased a range of conjugated BAs and deoxycholic acid (FDR < 0.05). Concentrations of taurochenodeoxycholic acid (FDR = 0.027) and taurine conjugated BAs (FDR = 0.049) in plasma correlated positively with Akkermansia abundance in response to RS. Although neither RS nor PD altered BA concentrations in faeces, RS decreased (p = 0.032) and PD increased (p = 0.012) faecal proportions of primary BAs. PD reduced secondary BA transformation ratios (p < 0.05), along with shifts in related microbial associations. There were negative correlations between plasma primary conjugated BAs and faecal secondary BAs in response to RS specifically (p < 0.05). RS increased plasma BAs, particularly conjugated BAs, whereas PD reduced faecal secondary BA transformation. The distinct impacts of RS and PD on BA profiles and fibre-specific microbial associations may underlie their differential metabolic effects. Trail registration The DISC Study was registered with https://clinicaltrials.gov/ (Identifier NCT01214681) in 2010.
Abstract Clinical trials indicate that acalabrutinib, a second-generation Bruton tyrosine kinase inhibitor, is safe and effective for treating patients with chronic lymphocytic leukemia (CLL), but real-world evidence on its clinical effectiveness is limited. This ongoing multicenter retrospective chart review included UK adults with previously untreated CLL who received acalabrutinib monotherapy as part of a UK-wide early access program. These patients received their first dose of acalabrutinib between 1 April 2020 and 1 April 2021. Data from 282 patients (male patients, n = 156 [55%]) collected from 29 sites across the United Kingdom revealed a median age of 73.9 years (interquartile range [IQR], 68.6-79.4) at acalabrutinib initiation (index date) and a median time of 3.0 years (IQR, 1.2-5.7; n = 281) from CLL diagnosis to treatment. The median follow-up was 48.9 months (IQR, 45.0-52.3). At the 3-year landmark, real-world progression-free survival was 82.5% (95% confidence interval [CI], 78.2-87.1), and real-world overall survival was 84.3% (95% CI, 80.2-88.7). Additionally, 72.3% of patients (95% CI, 67.3-77.8) remained on acalabrutinib treatment. The most common reasons for acalabrutinib discontinuation were adverse events (AEs; 31/87 [36%]), death (16/87 [18%]), and disease progression (14/87 [16%]). Of the 270 patients with recorded information, 99 patients (37%) experienced ≥1 prespecified AE, of which the most frequent were upper respiratory tract infection (n = 21 patients [8%]), rash (n = 13 [5%]), and neutropenia (n = 12 [4%]). This study adds to a body of clinical trial and further postmarketing evidence demonstrating the effectiveness and safety of acalabrutinib within routine UK clinical practice.
