Wexham Park Hospital is a large NHS hospital in Slough, Berkshire. It has been managed by Frimley Health NHS Foundation Trust since 2014. Sir Andrew Morris is the chief executive of Frimley Health NHS Foundation Trust.
Abstract We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3% and 97.7%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5% vs 90.5% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n = 31), 89.6% for RT alone (n = 325), 76.8% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.
Parastomal hernia remains one of the most common long-term complications following permanent end colostomy, with significant implications for patient quality of life and healthcare resources. The recently published Chimney Trial reported a reduction in both radiological and clinically diagnosed parastomal hernia using a funnel-shaped prophylactic mesh during elective minimally invasive rectal cancer surgery. This editorial critically examines the trial's findings, strengths, limitations, and implications for clinical practice. While the results are encouraging, important questions remain regarding patient selection, mesh design, long-term safety, external validity, and clinically meaningful outcomes. Rather than closing the debate on prophylactic mesh, the Chimney Trial may redefine it by shifting attention towards the role of mesh configuration and patient-centered outcome measures.
Chronic Wounds are one of the most prevalent types of Dermatoses, which are the result of impaired Healing and Complications. In addition, Type 2 Diabetes Mellitus is one of the main causes of impaired Healing (due to the development of Complications and other factors). Therefore, it is of interest to evaluate the way T2DM influences Healing, Recurrence and Clinical Outcomes (in Dermatology Clinics) over a period of five years. A retrospective review of medical records (of chronic wound patients) identified differences between the T2DM and the Non-Diabetic Groups. The T2DM patients demonstrated a significantly longer median Healing Time than the Non- Diabetic Patients, with increased Infection Rates and an increased need for Advanced Wound Care. The rate of Recurrence and Amputation were also higher than in the Non-Diabetic Group. A Multivariate Analysis indicated that T2DM, Baseline Wound Infection and Wound Size >10 cm2 were significant predictors of Delayed Healing for T2DM Patients. Thus, these data demonstrate that T2DM places a significant burden on Wound Outcomes in a Dermatology Practice. Early identification of risk factors, multidisciplinary management and optimised glycaemic control are crucial to improving Healing and reducing complications associated with Chronic Wounds and T2DM.
Rectal stump leakage (RSL) is a clinically significant complication following Hartmann's procedure, associated with substantial morbidity, prolonged hospital stay, and challenges during subsequent reversal surgery. This study presents a structured narrative review that provides a qualitative synthesis of the available evidence on mechanisms, risk factors, and strategies to reduce the risk of RSL. Given the heterogeneity of the literature, predominantly retrospective study designs, and inconsistent definitions of stump leakage, formal quantitative synthesis was not feasible. Available evidence suggests that RSL is a multifactorial process driven by impaired tissue healing, mechanical stress, technical factors related to stump construction, and an adverse pelvic environment. Reported associations include male sex, low body mass index, short rectal stump length, and prior pelvic radiotherapy, although the strength and consistency of these relationships vary across studies. Preventive strategies, including attention to stump length and placement, optimization of tissue perfusion, and reduction of intraluminal pressure through decompression techniques, may mitigate risk, but robust comparative data remain limited. Many proposed interventions are supported primarily by observational evidence or extrapolation from anastomotic leak literature. This review emphasizes a mechanism-based, risk-informed approach to prevention while clearly distinguishing between factors supported by quantitative signals and those that remain biologically plausible but unproven. Key gaps include the absence of validated risk prediction models, the lack of prospective Hartmann-specific data, and inconsistent outcome definitions. Future research should focus on prospective cohort studies, standardized reporting frameworks, and the development of clinically applicable risk stratification tools to guide intraoperative decision-making and improve outcomes following Hartmann's procedure.
INTRODUCTION:Inadequate medication adherence is a significant problem globally, affecting up to 50% of chronic illness patients. The complications can also be significant, with increased rates of disease complications and hospitalisations due to lack of adherence. This research study seeks to find the medication adherence rate across select suburban areas in Johor, Malaysia, and to identify the relationship between medication adherence and treatment concordance. MATERIALS AND METHODS:A community-based cross-sectional study was conducted among patients with chronic diseases across various locations in Johor. A validated questionnaire, the Malaysia Medication Adherence Assessment Tool (MyMAAT) and a Modified Concordance Scale were used to explore the study objectives. RESULTS:Medication adherence is defined as a MyMAAT score of ≥54. A total of 82 chronic illness patients participated in this study, with males (48.8%) and females (51.2%). The mean age of the participants is 57.5 years old. The study reported 41.5% adherence (MyMAAT ≥54). Female vs male OR was calculated via logistic regression adjusting for confounding factors, with adherence (MyMAAT≥54) as a binary factor (OR=4.23; 95% CI 1.38-12.91; p=0.011). A statistically significant weak correlation was found between the MyMAAT score and the Modified Concordance Scale score (SR ρ=0.286, p=0.009). CONCLUSION:In conclusion, the study shows a potential relationship between medication concordance and improved patient adherence in the Malaysian setting. More research should be conducted to further verify these findings.
