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Background Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.

Endorings is a distal attachment consisting of two layers of circular flexible rings that evert mucosal folds. Aims: Investigate if Endorings Colonoscopy (ER) improves polyp and adenoma detection compared to standard colonoscopy (SC).Methods: Multi-centre, parallel group, randomised controlled trial. Results: Total of 556 patients randomised to ER (275) or SC (281). Colonoscopy completed 532/556 (96%) cases. EndoRings removed in 74/275 (27%) patients. Total number of polyps in ER limb 582 vs 515 in SC limb, p=0.04. Total number of adenomas in ER limb 361 vs 343 for SC limb, p=0.49. A statistically significant difference in the mean number of polyps per patient in both the Intention to Treat (ITT) (1.84 SC vs 2.10 ER, p-value 0.027) and Per Protocol (PP) (1.84 SC vs 2.25 ER, p-value 0.004). Conclusions: Our study shows promise for the EndoRings device to improve polyp detection.

Background and rationale: this protocol describes a review that is being undertaken to respond to a growing number of reports that there may be a relationship between infection with Covid-19 and a new diagnosis of Type 1 diabetes. We intend to synthesise the literature in order to identify what is currently known and to inform how best research using electronic health records can further explore this relationship to understand the risks and provide appropriate public health guidance. Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin, usually due to an auto-immune response which destroys the islets of Langerhans cells in the pancreas ( https://www.diabetes.org.uk/ ). The majority of Type 1 cases occur in childhood or adolescence. There is no cure, and treatment is reliant on replacing insulin using injections or pumps to be able to allow sugar in the bloodstream to enter the cells and control the blood glucose levels. The exact triggers for the development of Type 1 diabetes are unknown, but exposure to viruses and other environmental factors are thought to be important (Filippi and von Herrath, 2008). Seasonal variation in the incidence of new cases has often been attributed to increased viral circulation, for example associated with the return of children to schools (Turtinen et al., 2022, Nishioka et al., 2020). It is unclear whether the SARS-Coronavirus-2 virus (SARS-Cov-2), which is responsible for the Covid-19 pandemic, may influence the development of Type 1 diabetes, although evidence is emerging that there may be an association (Barrett et al., 2022). The public health approach to controlling SARS-Cov-2/Covid-19 in the UK has varied between regions and also between children and adults. Whereas the focus of the vaccination program has been on reducing hospital admission and death, particularly in older adults and people with clinical vulnerabilities, vaccination for adolescents aged 12-17 were introduced in August/September 2021, and a 2 dose course for children aged 5-11 in 2022. Given the high rates of Covid-19 positivity in educational establishments and the lack of other precautionary measures, such as mandatory use of face coverings, adequate ventilation and air filtration, the scope for transmission to children and subsequent sequelae, such as Long Covid, remains significant (Zimmermann et al., 2022). Additionally, the increased difficulty in accessing both primary and secondary care health services during periods of lockdown and in the post-lockdown era may have contributed to delays in diagnosis and increased severity of presentation, and this may also be reflected in the global literature.As the pandemic continues with successive waves of new variants of the virus, with as-yet unknown effects on the immune system and long-term health, we would like to focus on the potential role of Covid-19 in the development of new-onset Type 1 diabetes as a matter of urgency, to be able to inform public health and parental decisions about vaccination and safety measures in schools, and also to inform subsequent research using large routinely collected data sources, such as the SAIL databank and the Brecon paediatric diabetes cohort. For this purpose, a rapid review is the most suitable methodology due to its resource-efficient methods of producing a quality knowledge synthesis that can guide stakeholders to future public health and/or research funding decisions.

Rapid Review

Laparoscopic fundoplication has become a standard surgical treatment for gastro-oesophageal reflux disease. Many of these patients also have a hiatus hernia that is repaired at the same time. However, suture-only repair of larger hiatus hernias has recurrence rates as high as 50%. Evidence on the effectiveness and safety of surgical mesh to reinforce hiatal repair compared with suture-only repair is currently lacking. This study aims to assess the feasibility of running a randomised controlled trial comparing the results of large hiatus hernia repair with DynaMesh-HIATUS® crural reinforcement versus standard suture repair alone. This is a single-centre, double-blind, parallel group randomised feasibility study. Forty patients with large hiatus hernia will be randomised to standard laparoscopic suture repair or suture repair with cruroplasty using the DynaMesh-HIATUS® circumferential mesh, with a 3-year follow-up period. Participants and assessors will be blinded to treatment allocation. Outcomes include trial process indicators (eligible participants, recruitment, and retention rates), surgical indicators (placement of mesh, operative complications, length of stay), adverse events, patient quality of life and symptom scores and mesh position after 1 year, and patient quality of life measures to 3 years. Feasibility will be assessed by rates of recruitment, retention, and successful surgical procedures. Clinical and patient-related outcomes for the two surgical methods will be described, and those most appropriate to include in a definitive trial identified. Correlation will be made between the position of the mesh on magnetic resonance imaging (MRI) and clinical outcomes. The DYNAMIC study will provide information to design and deliver a definitive randomised controlled trial of DynaMesh-HIATUS® cruroplasty compared with suture repair alone. https://doi.org/10.1186/ISRCTN76437720

Additional file 1: Supplemental Table 1. Entry and exit to the cohort in each calendar year by age group. Supplemental Table 2. Entry and exit to the cohort in each calendar year by frailty category. Supplemental Table 3. Mean length of follow-up by age group and frailty category.

Older people with a diagnosis of dementia are at higher risk of poor outcomes following a hospital admission, such as death and longer lengths of stay. It is not known whether older people with other causes of cognitive impairment are at a similar risk, whether dementia or other cognitive impairments are independent risk factors, and whether staffing levels may differentially influence outcomes.This work is based on a secondary care dataset of more than 20,000 hospital admissions. The characteristics of older people with acute hospital admissions and their outcomes according to the presence of dementia/cognitive impairment are described, and the associations between dementia/cognitive impairment and mortality, length of stay and readmission investigated. The clinical dataset was linked to data on nurse staffing to understand how varying staffing levels influence mortality and readmission in people with any cause of cognitive impairment.Cognitive impairment was found to be prevalent in the older hospital population. Patients with cognitive impairment but no diagnosis of dementia had a similar risk of dying in hospital and longer lengths of stay as compared to patients with an existing diagnosis of dementia. There was an independent association between cognitive impairment (with or without a diagnosis of dementia) and higher hospital mortality, longer hospital stays and higher readmissions to hospital after controlling for other significant risk factors. Nurse staffing time per patient above mean values significantly decreased mortality for all patients, with a greater effect for patients with cognitive impairment, as well as reducing readmissions in this group. Increased nursing assistant hours improved mortality rates in patients with cognitive impairment but were significantly associated with increased mortality in cognitively intact patients.The thesis includes two articles which establish a vulnerable clinical population in hospital and provide estimates of associations with poor outcomes, and a further article which highlights staffing levels as a consideration for modifying care for this patient group. The results provide evidence that although older people with cognitive impairment are at higher risk from worse hospital outcomes, this risk may be modified by appropriate provision of nursing workforce. Further work is required to understand the mechanisms of risk reduction with higher staffing levels for older hospitalised patients with cognitive impairment.

Supplemental material, REVISED_Supplemental_Material_-_Programme_of_Practice for Mindfulness-Based Interventions in Recurrent Ovarian Cancer: A Mixed-Methods Feasibility Study by Emily Arden-Close, Felicity Mitchell, Gail Davies, Lauren Bell, Carole Fogg, Ruth Tarrant, Roslyn Gibbs and Chit Cheng Yeoh in Integrative Cancer Therapies