.
The anterior quadratus lumborum block (aQLB) is a fascial plane block targeting the interfascial plane between the quadratus lumborum and psoas major muscles, aiming to achieve both somatic and visceral analgesia through potential spread of local anesthetic toward the thoracolumbar nerve roots. Despite years of clinical use and a growing body of randomized trials across different surgical settings, uncertainty remains regarding its mechanisms of action, patterns of local anesthetic spread, and overall clinical effectiveness. This scoping review aimed to systematically map and synthesize the available evidence on aQLB and identify key knowledge gaps relevant to clinical practice and future research. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to February 14, 2026. The search terms included variations of aQLB and related terminology. Only randomized controlled trials were included in this review. A total of 1174 records were identified, of which 360 underwent full-text assessment, and 119 randomized controlled trials were included. Most studies were conducted in Asia (63
Human pharmaceuticals are increasingly detected in environments around the world, with growing international calls to mitigate the ecological and human health risks posed by these novel entities. Exposure to pharmaceutical pollutants can negatively affect the behaviour, reproduction, and health of wildlife, contributing towards declining ecological health and global biodiversity loss. Pharmaceuticals in the environment are also driving rising levels of antimicrobial resistance, a major public health threat. Developing strategies to mitigate these public and environmental health risks has been greatly limited by diverse and often conflicting stakeholder interests and the need to retain the major human health and socioeconomic benefits that pharmaceuticals provide. In this Personal View, we propose a multistakeholder, systems-based approach for high-income countries to develop transformational national mitigation strategies. Applying this approach to a UK case study highlighted the growing risks caused by the unsustainability of the current UK health-care pharmaceutical system and enabled us to identify 37 synergistic intervention points that target both the tangible easy wins and the deep-rooted social drivers of the issue. We believe our approach will support high-income countries in minimising the public and environmental health risks associated with pharmaceutical pollution, by driving long-term sustainability across the pharmaceutical lifecycle, for a positive pharmaceutical future.
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.
Aim: To ascertain the potential value of pelvic point-of-care ultrasound (POCUS) in the timely management of Emergency Department (ED) patients presenting with first trimester pregnancy complications. Objectives: To perform a systematic review and meta-analysis with the primary outcome being the comparison of ED length of stay (ED LoS), time to ultrasound (US) diagnosis and time to operative room (OR) treatment in patients under 20 weeks gestation with complications of first trimester pregnancy when comparing POCUS to traditional specialist radiology ultrasound (RADUS). Method: In accordance with PRISMA guidelines we performed a literature search based on specific inclusion criteria and used 2 reviewers to screen appropriate studies for inclusion. Papers were then critically appraised using RoB-2 and ROBINS-I assessment tools before having data extracted for inclusion in meta-analysis where possible. Results: We identified 13 papers for inclusion in systematic review which measured a single or multiple outcome measures. 10 papers addressed the ED LOS outcome, 5 studied time to ultrasound diagnosis and 4 measured time to operative treatment. Of those studies, 6 contained sufficient data to be included in meta-analysis for ED LoS and 3 could be pooled for time to US diagnosis outcome. Insufficient usable studies were identified for time to OR treatment meta-analysis. The POCUS group had a reduced ED LoS of 59.6 min (95
Chronological age remains widely used in perioperative decision-making but incompletely captures the biological heterogeneity that influences postoperative outcomes. Frailty has substantially advanced surgical risk assessment by shifting attention from age toward multidimensional vulnerability and diminished physiological reserve. Nevertheless, patients with similar frailty profiles often experience markedly different recovery trajectories, suggesting that baseline vulnerability alone may not fully explain postoperative adaptation. This narrative conceptual review was developed through a targeted search of PubMed/MEDLINE, Scopus, and Google Scholar, focusing on frailty, physiological reserve, physical resilience, intrinsic capacity, prehabilitation, and postoperative recovery. Peer-reviewed clinical studies, reviews, and conceptual frameworks from geroscience and perioperative medicine were synthesized to develop an integrated model of surgical resilience. Emerging evidence indicates that frailty and resilience represent related but distinct constructs. Frailty primarily identifies vulnerability before stress exposure, whereas resilience reflects the dynamic capacity to withstand, adapt to, and recover from physiological perturbation. Recent perioperative studies suggest that postoperative outcomes are influenced not only by baseline reserve but also by the interaction between reserve, surgical stress exposure, and recovery capacity. Within this framework, skeletal muscle function, nutritional status, cognition, inflammatory burden, and functional independence appear to contribute to an individual’s adaptive potential. Surgery represents a uniquely informative human model through which stress–response biology and recovery trajectories can be studied longitudinally. We propose surgical physiological resilience as a dynamic stress–recovery phenotype emerging from the interaction among three interconnected domains: baseline reserve, surgical stress load, and recovery capacity. This framework extends current frailty-based approaches by incorporating longitudinal adaptation and recoverability after surgical stress. Reframing perioperative medicine around resilience may support trajectory-based risk stratification, targeted prehabilitation strategies, longitudinal functional monitoring, and the future development of a dynamic Surgical Resilience Index capable of capturing postoperative heterogeneity more accurately than chronological age or static vulnerability measures alone.
