Salford Royal Hospital (formerly known as Hope Hospital) is a large university teaching hospital in Pendleton, Salford, England operated by Northern Care Alliance NHS Foundation Trust. It is one of the top-performing hospitals in the United Kingdom.
The incidence of chronic subdural haematoma (CSDH) is rising in the elderly, yet there is limited research focusing on patients aged > 80. In the United Kingdom, the decision to transfer for neurosurgical intervention is dependent upon the acceptance of a CSDH management referral by a tertiary centre. This study thus aims to identify key predictors of referral acceptance in octogenarian and nonagenarian age groups, in comparison to the adult population. A multi-centre retrospective case series analysis from January 2015 to May 2020 was conducted. Patients were grouped as < 80 (‘adult’) or > 80 (‘ultra-geriatric’), with the latter further subgrouped into 80–89 (‘octogenarian’), and ≥ 90 (‘nonagenarian’). Multivariable logistic regression assessed age, headache, dementia, motor weakness, midline shift, CSDH size, and premorbid quality of life (QoL) to determine predictors of referral acceptance. With a total of 3002 patient referrals, referral acceptance was significantly higher in adults compared to the ultra-geriatric group (38.1
Objective Patients with disorders of gut-brain interaction (DGBI) and gastrointestinal dysmotility (GID) suffering from malnutrition may require jejunal feeding. Here, we surveyed the attitudes of health professionals who care for patients with DGBI and GID towards jejunal feeding.Method A 21-item digital questionnaire was designed and electronically distributed to members of the British Association of Parenteral and Enteral Nutrition. Data were then analysed arithmetically and statistically.Results 76 individuals from various professional groups involved in the nutritional care of patients with DGBI and GID completed the questionnaire, with the majority being dietitians (57%) and physicians (28%). 69% of participants worked in settings where they had no access to a neurogastroenterologist. Respondents indicated that in their experience, GID conditions were more likely to require jejunal feeding (22%-30%) compared with DGBI conditions (4%-9%). Unexpectedly, despite DGBI being milder conditions than GID, more respondents were comfortable managing patients with GID than those with DGBI (61% vs 43%). Additionally, patients with GID were felt by respondents to tolerate jejunal feeding better (22%) than those with DGBI (9%). Most respondents stated that their patients with DGBI and GID (82%) were unable to tolerate jejunal infusion rates of more than 50mls per hour. All respondents (100%) stated that >= 25% of their patients took opioids.Conclusions This study expands our understanding of health professionals' experiences of jejunal feeding in DGBI and GID and has highlighted several important issues, including poor access to neurogastroenterologists, high rates of opioid use and low tolerated infusion rates of jejunal feeding.
Background:Meningiomas affect up to 80% of patients with NF2-related schwannomatosis during their lifetime. They are managed by active monitoring, surgery, and stereotactic radiosurgery (SRS). This paper aims to synthesize the existing data, evaluate outcomes, and inform future trial design. Methods:Systematic review and meta-analysis conducted using the PRISMA framework. Six databases were searched from inception to September 2025. Patient demographics, intervention data, and outcomes were collected and pooled analyses performed. Studies were appraised using the NIH quality assessment tool. Results:Fifteen studies with 937 patients and 3637 meningiomas were included. The pooled proportion of female patients was 59.6% (95% confidence interval [CI]: 55.4-63.7). A total of 2082 tumors were monitored (mean follow-up 5.55-9.18 years) with a weighted mean growth rate of 0.508 cm3/year (95% CI: 0.0244-0.992) (available in 748 meningiomas). The weighted pooled proportion of monitored patients who developed de novo meningiomas across 3 studies was 24.6% (95% CI: 2.73-58.7). Surgical resection was performed in 203 meningiomas, with an under-reported postintervention follow-up and a pooled risk of tumor recurrence of 12.5% (95% CI: 7.98-17.9). Stereotactic radiosurgery was used in 665 meningiomas. The pooled risk of treated tumor progression was 6.29% (95% CI: 4.57-8.25), median follow-up 3.58 to 9.25 years. The pooled local control rates at 3 and 5 years were 97.1% (95% CI: 94.7-98.8) and 91.2% (95% CI: 88.4-93.6), respectively. Conclusion:NF2-associated meningiomas are challenging to manage due to their multiplicity, high growth rate, and World Health Organization grade. Active monitoring, surgery, and SRS are viable treatment options. Here, we evaluate existing outcome data to guide future trial design.
INTRODUCTION:Genetic factors are thought to play an important role in antipsychotic-induced weight gain (AIWG). This study conducted a meta-analysis of current research of the pharmacogenetic associations of adult AIWG. METHODS:The analysis included papers providing comparisons of weight gain across at least two allele combinations for at least one single nucleotide polymorphism (SNP). Inclusion criteria were, patients 18 years of age or older and had received a diagnosis of severe mental illness, for which antipsychotic medication was prescribed. The association with AIWG needed to be replicated across at least two papers reporting separate sample sets. RESULTS:Two hundred twenty-three papers were assessed for eligibility. Of the 223 papers, 148 were excluded, leaving 75 studies to be included. Six SNPs in six different genes were identified as having significant associations (p < 0.05) with AIWG. These were HTR2C rs3813929 (TT + TC vs CC), Hedge's g 0.76; MTHFR rs1801133 (TC + TT vs CC), Hedge's g 0.61; ADRA2A rs1800544 (CC + CG vs GG), Hedge's g 0.71; MC4R rs489693 (CC + AC vs AA) Hedge's g 0.127; LEPR rs1137101 (GG + AG vs AA) Hedge's g 0.18 and CNR1 rs104935 (GG + AG vs AA), Hedge's g 0.55. CONCLUSION:The study identified six SNPs that predispose adult individuals to AIWG, with HTR2C rs3813929 and ADRA2A rs1800544 showing the largest effect sizes. Five of these have a role in hypothalamic regulation of appetite/satiety. Identification of these risk-associated SNPs may assist the development of a polygene/polyphenotypic risk score to identify individuals with psychosis who are at heightened risk of experiencing AIWG.
In moderate-to-severe traumatic brain injury (TBI), anemia may exacerbate secondary cerebral injury, and patients with multiple trauma may be especially vulnerable to cerebral hypoxia. We conducted a secondary analysis of the HEMOTION trial (liberal transfusion strategy > 10 g/dL vs. restrictive > 7 g/dL), to assess whether multiple trauma modifies the effect of transfusion strategy after moderate-to-severe TBI. We included all HEMOTION trial participants (n = 742) and defined multiple trauma using three definitions: (1) extracranial injury with Injury Severity Score (ISS) > 15; (2) extracranial injury requiring emergency extracranial surgery; (3) spinal injury with neurological deficit. The primary outcome was the 6-month Glasgow Outcome Scale Extended (GOS-E). We tested interactions between transfusion strategy and multiple trauma status using sliding dichotomy and hierarchical Poisson regression, with sensitivity analyses using classical dichotomy (GOS-E ≤ 4) and proportional odds models. Secondary outcomes included mortality, quality of life (EQ-5D-5L, QOLIBRI), functional independence (FIM), and depression (PHQ-9). We found no interaction between multiple trauma status and transfusion strategies on the 6-month GOS-E across all three definitions. The adjusted relative risk (RR) of an unfavourable outcome with the liberal strategy was 0.87 (95
