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BMJ (Clinical research ed.)
Assessing early effects of Australia's Social Media Minimum Age Act on adolescents' social media use: observational study
Barnes C, Hall A, Mantach S et al. · 2026 Jun 24
Study Type: Observational study (pre-post with regression discontinuity design)
Key Question: Did Australia's minimum age-16 law for social media accounts reduce adolescent social media use in the three months following implementation?
Key Findings: - Over 85% of under-16s still reported using regulated platforms at three-month follow-up, predominantly via their own accounts (54–68%)
- Circumvention was common: 15–19% used fake accounts; 6–11% accessed via private browsers; age verification was largely limited to self-declaration or selfies
- Regression discontinuity analyses found no statistically significant reduction in daily use or time spent at the age-16 threshold (p≥0.60)
Clinical Relevance: As the UK considers similar age-based social media restrictions, this provides early real-world evidence that legislative minimum age requirements alone are unlikely to meaningfully reduce adolescent exposure without robust verification infrastructure.
Limitations: Small sample (n=408), short follow-up (three months), and self-reported outcomes introduce significant measurement and maturation bias.
Anesthesia and analgesia
Live Interactive Music Therapy Across the Perioperative Continuum: A Scoping Review
Devlin K, Shegogue JC, DeGroot C et al. · 2026 Jun 23
Study Type: Scoping review (PRISMA-ScR compliant)
Key Question: What are the characteristics and impacts of live, certified music therapist-delivered therapy across the perioperative period?
Key Findings: - 25 studies (1,821 patients, age 9 months–94 years, diverse surgical specialties) met inclusion criteria from 2,095 identified articles
- Music therapy was delivered preoperatively (n=17), intraoperatively (n=8), and postoperatively (n=15), with measurable effects on anxiety, mood, and pain across age groups
- Paediatric interventions favoured active/play-based preoperative approaches (measured behaviourally via m-YPAS); adult interventions were more evenly distributed across timepoints using self-report outcomes (VAS)
Clinical Relevance: For UK anaesthetic teams seeking non-pharmacological adjuncts to reduce perioperative anxiety and analgesic requirements, this review maps current evidence, though service availability of certified music therapists within NHS settings is likely limited.
Limitations: Small sample sizes, expectancy bias, inconsistent intervention reporting, and absence of therapist-contact control groups significantly limit generalisability.
Circulation
Consumption of Fructose-Containing Food and Beverage Sources in Childhood Through to Adulthood and Risk of Hypertension: A Prospective Cohort Study
Nguyen M, AlEssa HB, Glenn AJ et al. · 2026 Jun 22
Study Type: Prospective cohort study
Key Question: Does consumption of fructose-containing foods and beverages (SSBs, fruit juice, whole fruit) from childhood through adulthood affect incident hypertension risk?
Key Findings: - SSBs (≥2 servings/day) and fruit juice (≥1.5 servings/day) were independently associated with higher hypertension risk (HR 1.52 [95% CI 1.27–1.83] and HR 1.35 [95% CI 1.06–1.71], respectively)
- Whole fruit intake showed no significant association with hypertension (HR 0.79 [95% CI 0.59–1.05])
- Substituting one daily SSB serving with whole fruit, milk, or water was associated with 22%, 13%, and 9% lower hypertension risk respectively
Clinical Relevance: Supports current NHS guidance limiting SSB and fruit juice consumption from childhood; fruit juice should not be considered a safe alternative to SSBs for cardiovascular risk reduction.
Limitations: Hypertension was self-reported, introducing potential misclassification bias.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Association between interventional cardiologist practice characteristics, CABG use, and clinical outcomes
Blackman J, Quon S, Francis DP et al. · 2026 Jun 23
Study Type: Retrospective cohort study (administrative health data)
Key Question: Does inter-operator variation in CABG referral rates among interventional cardiologists affect long-term patient outcomes?
Key Findings: - CABG referral rates varied 13-fold across 40 interventionalists (2.03%–26.4%), with substantial operator-level variation independent of hospital factors (ICC 0.358)
- Higher operator CABG rates correlated with lower PCI utilisation (R=−0.60) and less extensive PCI (R=−0.52)
- Among 73,603 revascularised patients, higher operator CABG rate was associated with significantly fewer repeat revascularisations (HR 0.075), with no difference in mortality or MACE
Clinical Relevance: This supports the case for consistent multidisciplinary Heart Team decision-making in UK catheter laboratories, where operator-driven variation in CABG referral may compromise revascularisation durability without clinical justification.
Limitations: Observational design using administrative data from a single Canadian province limits causal inference and generalisability to NHS practice.
JAMA dermatology
Online vs In-Person Care for Atopic Dermatitis: A Randomized Clinical Trial
Armstrong AW, Roberts AM, Kostandy G et al. · 2026 Jun 24
Study Type: Randomised clinical equivalence trial
Key Question: Does an asynchronous, online team-based connected health (TCH) model produce equivalent improvements in atopic dermatitis severity compared to conventional in-person care over 12 months?
Key Findings: - EASI difference between groups: −0.01 (95% CI −0.22 to 0.20); within equivalence margins
- POEM and vIGA differences were similarly within prespecified equivalence bounds across 300 participants (149 TCH, 151 in-person)
- Clinical equivalence was demonstrated across all three primary and secondary outcomes at 12 months
Clinical Relevance: With NHS dermatology facing sustained demand pressures and geographic access inequity, this trial supports asynchronous teledermatology as a clinically equivalent alternative to in-person AD management, strengthening the evidence base for scalable remote care pathways.
Limitations: The trial was conducted across California outpatient clinics, limiting direct generalisability to NHS settings with differing workforce structures, referral pathways, and patient demographics.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Development and Validation of a Modified Sudbury Vertigo Risk Score for Predicting Central Causes of Dizziness in the Emergency Department
Soma S, Kamitani T, Sasaki S · 2026 Jun
Study Type: Retrospective cohort study (clinical prediction model development and validation)
Key Question: Can a modified Sudbury Vertigo Risk Score — replacing BPPV diagnosis with history-based variables — reliably identify central causes of dizziness in ED patients?
Key Findings: - Central aetiology confirmed in 5.2% of 2,958 patients; modified model achieved AUROC 0.81 (95% CI 0.77–0.85) vs 0.85 (95% CI 0.82–0.88) for the original Sudbury score
- The modified model's miss rate (false negatives) was 0.9% (95% CI 0.4–2.1%) vs 0.0% for the Sudbury model — a clinically meaningful safety trade-off
- The modified model identified 18.7% of patients as low-risk (vs 26.8%), indicating reduced efficiency alongside the lower safety margin
Clinical Relevance: For UK ED clinicians unable to reliably assign a BPPV diagnosis at triage, this modified tool offers a history-only alternative, though its higher miss rate warrants caution before adoption.
Limitations: Single-centre retrospective design limits generalisability; no external validation cohort was used.
Diabetes care
Erratum. Diabetes Body Project: Acute Effects of an Eating Disorder Prevention Program for Young Women With Type 1 Diabetes. A Multinational Randomized Controlled Trial. Diabetes Care 2025;48:220-225
Hennekes MHCL, Haugvik S, Wit M et al. · 2026 Jun 23
Study Type: Erratum / Correction notice
Key Question: Not applicable — this notice corrects an omission of funding acknowledgement in a published RCT examining an eating disorder prevention programme for young women with Type 1 Diabetes.
Key Findings: - No new data or findings are presented
- The sole correction adds a previously omitted NIH grant acknowledgement (P30 DK036836, Joslin Diabetes Center Clinical Research Center)
- The original article (Diabetes Care 2025;48:220–225) remains otherwise unchanged
Clinical Relevance: The underlying RCT addresses disordered eating in Type 1 Diabetes — a clinically significant comorbidity relevant to UK endocrinology and diabetes services — but this notice contains no new clinical information.
Limitations: Not applicable — this is an administrative correction only; clinicians should refer to the original article (DOI: 10.2337/dc24-1599) for study content.
Gastroenterology
Epithelial FOXP3 orchestrates O-glycosylated IL-6 secretion to drive pancreatic fibrocarcinogenesis
Gong R, Wang J, Ren M et al. · 2026 Jun 23
Study Type: Translational mechanistic study (human tissue analysis with genetically engineered mouse models)
Key Question: Does epithelial FOXP3 drive early pancreatic fibrosis and carcinogenesis via a glycosylation-dependent IL-6 signalling mechanism?
Key Findings: - Epithelial FOXP3 (E-FOXP3) transactivates GALNT1, which O-glycosylates IL-6 at threonine-165, enabling its secretion and activation of pancreatic stellate cells via gp130/MAPK-ERK signalling
- Epithelial-specific FOXP3 knockout attenuated fibrosis and delayed PanIN progression; knock-in induced spontaneous stromal activation and accelerated neoplasia
- A fasting-mimicking diet suppressed the E-FOXP3–GALNT1 axis, reducing IL-6 glycosylation and pancreatic fibrosis in vivo
Clinical Relevance: Identifies a druggable early-stage fibrocarcinogenic pathway in PDAC — a cancer with persistently poor UK outcomes — and raises interest in dietary intervention as a stromal-targeting strategy.
Limitations: Predominantly preclinical; human tissue data are correlative, with no clinical intervention evidence yet available.
BMJ (Clinical research ed.)
Assessing early effects of Australia's Social Media Minimum Age Act on adolescents' social media use: observational study
Barnes C, Hall A, Mantach S et al. · 2026 Jun 24
Study Type: Observational study (pre-post with regression discontinuity design)
Key Question: Did Australia's minimum age-16 social media legislation meaningfully reduce social media use in under-16s within three months of implementation?
Key Findings: - Over 85% of under-16s still reported using regulated platforms at follow-up, predominantly via their own accounts (54–68%)
- Daily use reduced modestly in 14–15 year olds (78% → 69%) but was stable in 12–13 year olds; regression discontinuity analysis found no statistically significant discontinuity at the age threshold (p≥0.60)
- Circumvention was common: fake accounts (15–19%) and private browsing (6–11%); age verification was mostly self-declared age or selfie upload
Clinical Relevance: As UK policymakers consider similar age-restriction legislation, this signals that minimum-age laws alone are unlikely to achieve short-term reductions in adolescent social media exposure without robust enforcement mechanisms.
Limitations: Small sample (n=408), short follow-up (~3 months), and self-reported outcomes limit conclusions about longer-term policy effects.
Annals of surgery
Normothermic Machine and Regional Perfusion in U.S. DCD Liver Transplantation: A National Comparative Analysis Supporting Adoption as Standard of Care
Acuna SA, Dayala H, Jones-Carr ME et al. · 2026 Jun 23
Study Type: Retrospective cohort study (national registry analysis)
Key Question: Does normothermic regional perfusion (NRP) or normothermic machine perfusion (NMP) confer superior graft survival in DCD liver transplantation compared to conventional super-rapid recovery with static cold storage?
Key Findings: - Both SRR-NMP and NRP-SCS significantly reduced graft loss versus SRR-SCS (HR 0.54, 95%CI 0.32–0.92 and HR 0.42, 95%CI 0.29–0.61, respectively)
- No significant difference in graft or overall survival between NRP-SCS and SRR-NMP
- Adding NMP to NRP-procured livers conferred no additional survival benefit over NRP-SCS alone
Clinical Relevance: With DCD donation expanding under NHS Blood and Transplant strategy, this large dataset supports both NRP and NMP as equivalent, legitimate standards of care — informing UK centre-level decisions about procurement pathway investment.
Limitations: Retrospective registry design with surrogate-marker identification of NRP and back-to-base NMP introduces potential misclassification bias.
Age and ageing
Effects of a home-based exercise and physical activity intervention after inpatient rehabilitation on real-world mobility in older adults with cognitive impairment: a secondary analysis of a randomised controlled trial
Werner C, Ullrich P, Degli Angeli L et al. · 2026 Jun 01
Study Type: Secondary analysis of an RCT
Key Question: Does a 12-week home-based exercise and physical activity programme improve real-world mobility in cognitively impaired older adults following inpatient geriatric rehabilitation?
Key Findings: - Small but statistically significant post-intervention improvements in walking pace and pattern (stride length, walking bout duration, walking speed) in shorter walking bouts, measured via wearable sensor
- No improvement in overall walking amount in either group at any timepoint
- Gains were not sustained at 12-week follow-up, suggesting effects are transient without continued intervention
Clinical Relevance: For UK geriatric teams managing post-rehabilitation care, this highlights that even structured home exercise programmes may not translate into meaningful increases in daily walking activity in older adults with cognitive impairment — a key consideration when designing post-discharge pathways.
Limitations: As a secondary analysis, the study was not powered for these digital mobility outcomes, limiting confidence in the effect size estimates.
Blood
Niche-targeted therapy via YAP/TAZ activation enhances hematopoietic regeneration
Uemura S, Yamashita M, Yokomizo-Nakano T et al. · 2026 Jun 22
Study Type: Preclinical mechanistic study (murine model)
Key Question: Can pharmacological activation of YAP/TAZ in bone marrow niche cells (endothelial cells and mesenchymal stromal cells) accelerate haematopoietic regeneration following myeloablative injury?
Key Findings: - YAP/TAZ are rapidly upregulated in MSCs and ECs after myeloablative stress, acting as transcriptional regulators that preserve MSC identity (via Ebf1/Ebf3) and sustain CXCL12 and angiogenic factor expression
- YAP/TAZ signalling coordinates sinusoidal vascular remodelling and HSC retention post-myelosuppression; conditional loss impaired haematopoietic recovery
- Pharmacological YAP/TAZ activation enhanced BM niche reorganisation and accelerated haematopoietic regeneration across multiple myelosuppressive models
Clinical Relevance: This identifies a tractable niche-targeted strategy that could reduce post-transplant cytopenias or chemotherapy-related marrow failure — areas of unmet need in UK transplant and intensive chemotherapy programmes.
Limitations: Findings are entirely preclinical (murine); human translatability and pharmacological agent safety profiles require prospective validation.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
DASC-LOT Framework and S3 Metric: A Novel Evaluation and Benchmarking Method to Assess Initiation, Duration, and Spectrum of Antimicrobial Usage at Inpatient Hospital Settings
Goto M, Imai S, Cho H et al. · 2026 Jun 25
Study Type: Retrospective cohort study with methodological framework development and validation
Key Question: Can a novel three-component metric (DASC-LOT / S3) more precisely benchmark inpatient antimicrobial stewardship performance across hospitals than existing single-measure metrics?
Key Findings: - Marked inter-hospital variation in antimicrobial use across 118 VHA hospitals: DASC/1,000 days present ranged 1,311–5,275; LOT/1,000 days present ranged 132–518
- The composite S3 metric (integrating initiation, duration, and spectrum) ranged from 0.703 to 1.572 across hospitals, with risk-adjustment models incorporating up to 116 patient-level variables
- Radar chart visualisation enabled hospital-specific identification of stewardship weaknesses across all three domains separately
Clinical Relevance: NHS stewardship teams currently rely heavily on Days of Therapy metrics; this framework could support more granular benchmarking and targeted interventions across NHS trusts.
Limitations: Derived exclusively from US Veterans Health Administration data, limiting direct generalisability to NHS inpatient populations and prescribing contexts.
American journal of respiratory and critical care medicine
Airway Mucus Plugs in Asthma and COPD: Pathobiology, Imaging, and Implications for Clinical Trials
Bosma CB, Aaron SD, Celli BR et al. · 2026 Jun 22
Study Type: Commentary / narrative review
Key Question: What is the pathobiology and clinical significance of airway mucus plugs in asthma and COPD, and how should they be incorporated into clinical trials and practice?
Key Findings: - Mucus plug burden (quantified via CT bronchopulmonary segment scoring) correlates with increased exacerbations, accelerated spirometric decline, and higher mortality in COPD
- Biologic therapies in asthma have demonstrated measurable reductions in CT-quantified mucus plug burden alongside spirometric improvement, supporting mucus plugging as a treatable trait
- Standardised quantitative CT scoring methods are still maturing but are considered sufficiently developed for research and clinical integration
Clinical Relevance: For UK ICU/critical care teams managing severe asthma or COPD exacerbations, CT-quantified mucus plug burden may offer a practical phenotyping and prognostic tool, and could inform selection of biologic therapy in refractory cases.
Limitations: As a review/commentary, no primary data are presented; conclusions depend on the quality and heterogeneity of cited studies.
American journal of kidney diseases : the official journal of the National Kidney Foundation
Mitochondrial Alterations and CKD
Pinzon-Cortes JA, Narongkiatikhun P, Yuan L et al. · 2026 Jun 22
Study Type: Narrative review
Key Question: What is the role of mitochondrial dysfunction in CKD pathogenesis, and which diagnostic and therapeutic strategies targeting mitochondrial pathways show promise?
Key Findings: - Mitochondrial remodelling — affecting bioenergetics, redox balance, dynamics, and biogenesis — is implicated in both diabetic and non-diabetic CKD progression
- Established agents (SGLT2 inhibitors, GLP-1 receptor agonists, non-steroidal MRAs) and emerging therapies (NAD⁺ boosters, CoQ10 derivatives, dual GIP/glucagon receptor agonists) may exert benefit partly via mitochondrial pathway modulation
- Multi-omics integration and spatial profiling are enabling development of mitochondrial health scores for precision phenotyping and individualised therapy
Clinical Relevance: With SGLT2 inhibitors and non-steroidal MRAs already embedded in NHS CKD management, understanding their mitochondrial mechanisms may inform future combination strategies and novel therapeutic targets.
Limitations: As a narrative review, conclusions are not derived from systematic evidence synthesis and are subject to selection bias.
Annals of neurology
Gut-Brain Axis Modulation by Short-Chain Fatty Acids Exerts Disease-Modifying Effects in a Murine Model of Drug-Resistant Epilepsy
Bera AA, Sapia RD, Volpedo G et al. · 2026 Jun 20
Study Type: Preclinical animal study (murine model with human brain tissue correlative analysis)
Key Question: Does short-chain fatty acid (SCFA) supplementation modify disease trajectory in drug-resistant epilepsy?
Key Findings: - SCFA supplementation (acetate, propionate, butyrate mixture) reduced progressive epilepsy phenotype and decreased the progression index 3-fold over 70 days of EEG monitoring, without significantly reducing overall daily seizure frequency
- Treatment reduced seizure clustering, improved cognitive deficits, and restored hippocampal and intestinal histopathological changes
- Metabolomic profiling and human DRE brain tissue analysis supported gut-brain axis dysfunction as a mechanistic contributor to disease progression
Clinical Relevance: For UK neurologists managing drug-resistant epilepsy — a group with very limited disease-modifying options — SCFAs represent a potentially accessible therapeutic avenue warranting clinical translation.
Limitations: Findings are limited to male mice only, restricting generalisability; human tissue analysis is correlative rather than interventional.
Acta neurochirurgica
Intracranial pressure changes and outcomes in the early phase of experimental subarachnoid hemorrhage: severity of subarachnoid hemorrhage and maximum intracranial pressure
Fujii K, Takeuchi S, Toyooka T et al. · 2026 Jun 20
Study Type: Experimental animal study (rat model)
Key Question: Does maximum ICP in the early phase of experimental SAH correlate with neurological outcome and SAH severity, and can it serve as a reliable severity classifier?
Key Findings: - Maximum ICP strongly correlated with neurological score, SAH grade, and 24-hour mortality across four groups (sham; mild <50 mmHg; moderate 50–149 mmHg; severe ≥150 mmHg)
- Higher maximum ICP was associated with greater cortical and hippocampal neuronal damage, apoptosis, and oxidative stress on histology at 24 hours
- Moderate ICP group (50–149 mmHg) identified as the most reproducible and clinically translatable tier for SAH research
Clinical Relevance: Establishes ICP monitoring as a valid severity-stratification tool in preclinical SAH models, which has implications for interpreting translational research underpinning future ICP-targeted therapies relevant to UK neurocritical care practice.
Limitations: Findings are confined to a rodent model and may not translate directly to human SAH pathophysiology or ICP dynamics.
American journal of obstetrics and gynecology
The Role of Placental Anastomoses in Severe Brain Injury After Fetal Demise in Monochorionic Twins: A Multicenter Retrospective Study
Rondagh M, Zwinkels LCM, Spekman JA et al. · 2026 Jun 22
Study Type: Multicenter retrospective cohort study
Key Question: Does the number and diameter of arterio-arterial (AAA) and veno-venous (VVA) placental anastomoses predict severe brain injury in the surviving monochorionic twin following fetal demise?
Key Findings: - Severe brain injury occurred in 25% (19/75) of pregnancies; affected placentas had larger AAA diameter (2.5 vs 1.6 mm, p<0.01) and larger VVA diameter (3.0 vs 1.5 mm, p=0.02)
- Presence of VVA (OR 3.47, 95% CI 1.10–10.96) and total AAA/VVA cumulative diameter (OR 1.27, 95% CI 1.09–1.48) were independently associated with severe brain injury
- Discordant cord insertion was more frequent in the brain injury group (47% vs 20%, p=0.03)
Clinical Relevance: These findings may inform counselling and surveillance intensity for monochorionic twin pregnancies complicated by fetal demise in UK fetal medicine units.
Limitations: Associations were non-significant when restricted to single fetal demise cases, likely reflecting insufficient statistical power in this small exploratory cohort.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Small Cemetery Within
Önder AH · 2026 Jun 23
Study Type: Commentary / reflective piece
Key Question: How does cumulative emotional exposure affect oncology clinicians over the course of their careers?
Key Findings: - Describes an intangible, accumulating psychological burden resulting from repeated patient loss in oncology practice
- Each clinical encounter is framed as leaving a lasting emotional imprint on the clinician, irrespective of clinical outcome
- The piece argues this burden remains largely invisible within professional and institutional frameworks
Clinical Relevance: Oncology clinicians in the NHS face high rates of moral distress and burnout; this piece draws attention to the unacknowledged psychological cost of sustained exposure to patient death and suffering, relevant to workforce wellbeing strategies.
Limitations: Not applicable — reflective commentary without primary data.
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*Note: This is a reflective/literary piece. No quantitative findings, study population, or methodology are present. The summary is necessarily interpretive based on the abstract provided.*
American journal of ophthalmology
Zeb1 mediates injury-induced mesenchymal transition in the mouse corneal endothelium in vivo
Heur M, Brabletz S, Stemmler MP et al. · 2026 Jun 21
Study Type: In vivo experimental animal study (conditional knockout mouse model)
Key Question: Does targeted deletion of Zeb1 in the corneal endothelium inhibit injury-induced endothelial-mesenchymal transition (EnMT) and retrocorneal membrane (RCM) formation?
Key Findings: - Conditional Zeb1 knockout (intracameral 4-OHT) significantly attenuated surgical injury-induced corneal oedema: central corneal thickness 106.8 ± 11.1 µm (injury + 4-OHT) vs 182.2 ± 15.5 µm (injury alone), p <0.00001
- Zeb1 targeting suppressed FGF2- and injury-induced upregulation of EnMT markers (COL1, fibronectin, vimentin) and preserved E-cadherin expression
- Conditional Zeb1 deletion inhibited injury-dependent RCM formation in vivo
Clinical Relevance: ZEB1 represents a potential therapeutic target for anterior segment fibrosis and corneal blindness, offering a non-transplant strategy relevant to a NHS corneal graft waiting list context.
Limitations: Findings are limited to a murine model; translation to human corneal endothelial biology requires validation.
Clinical orthopaedics and related research
What Is the Effect of Robot Reduction in Displaced Pelvic Fractures? A Multicenter Randomized Clinical Trial
Zhao C, Ge Y, Cao Q et al. · 2026 Jul 01
Study Type: Multicentre RCT (Level I evidence)
Key Question: Does robotic closed reduction improve reduction quality and reduce radiation exposure compared with manual closed reduction in displaced pelvic fractures?
Key Findings: - Robotic reduction achieved excellent/good reduction (Matta criteria) in 96% vs 48% with manual technique (RR 2.00, 95% CI 1.47–2.72; p<0.001)
- Intraoperative surgeon fluoroscopic exposures were significantly lower with robotic reduction (median 0 vs 38; p<0.001)
- No significant difference in 12-week Majeed functional scores (69 vs 71; mean difference −3, 95% CI −11 to 6; p=0.55)
Clinical Relevance: Robotic reduction offers substantially improved anatomical outcomes and reduced radiation burden for pelvic ring fractures, relevant to UK major trauma centres considering robotic platform investment.
Limitations: Short follow-up (12 weeks) limits conclusions on functional recovery, and the study was conducted in Chinese tertiary centres, limiting generalisability to NHS trauma systems without cost-effectiveness data.
Journal of pain and symptom management
Minimal Comfort Feeding in Advanced Dementia: Attitudes of Hospice and Palliative Care Professionals
Becker C, Wechkin H, Bern-Klug M et al. · 2026 Jun 22
Study Type: Cross-sectional exploratory survey study
Key Question: Are hospice and palliative care professionals willing to accept and implement Minimal Comfort Feeding (MCF) for patients with advanced dementia?
Key Findings: - 83% (35/42) of respondents agreed MCF is an acceptable care option for people with advanced dementia
- 93% (39/42) would be comfortable discussing MCF with patients in early dementia or at risk as a future planning option
- Respondents were divided on practical implementability, despite high attitudinal acceptance
Clinical Relevance: MCF represents a novel, potentially patient-centred approach to nutrition and hydration decisions in advanced dementia — a common and ethically complex challenge in UK palliative care and care home settings.
Limitations: Convenience sample of 51 attendees at a single US conference introduces significant selection bias, severely limiting generalisability to UK clinical practice.
Histopathology
Perivascular epithelioid cell tumours of the genitourinary tract: clinicopathological features and molecular landscape
Yaprak Bayrak B, Akgul M, Cheng M et al. · 2026 Jun 26
Study Type: Review article (narrative/synthesis)
Key Question: What are the clinicopathological, immunohistochemical, and molecular features of perivascular epithelioid cell tumours (PEComas) arising in the genitourinary tract, and how should they be classified and risk-stratified?
Key Findings: - Renal AML represents the most common and best-characterised GU PEComa, serving as the reference model for understanding the broader PEComa family
- Extrarenal GU PEComas are rare, morphologically heterogeneous, and diagnostically challenging—particularly on limited biopsy material
- The authors advocate molecular driver-based classification over organ-site or legacy terminology to guide diagnosis and risk stratification
Clinical Relevance: For UK pathologists encountering unusual mesenchymal GU tumours, this review offers a practical framework for diagnosis and malignant risk assessment, particularly relevant when evaluating small biopsies where morphology alone is insufficient.
Limitations: As a narrative review without systematic methodology or original data, conclusions reflect expert synthesis rather than evidence-graded analysis.
Aesthetic surgery journal
Impact of Facial Regions on Perceived Age: A 3D Modeling Study
Bravo FG, Ch'ng S · 2026 Jun 20
Study Type: Experimental perception study (3D modelling/survey-based)
Key Question: Which facial region — periocular, perioral, midface-lower face, or neck-jawline — contributes most to perceived youth when rejuvenated in isolation?
Key Findings: - Neck-jawline rejuvenation was most frequently ranked as appearing youngest (54/101 participants); perioral rejuvenation was most often ranked oldest (71/101)
- Mean perceived-youth rankings: neck-jawline 1.8, midface-lower face 2.2, periocular 2.6, perioral 3.6 (P<0.001)
- Periocular and midface-lower face regions did not differ significantly from each other (P=0.4)
Clinical Relevance: When resource, recovery, or patient preference limits comprehensive facial rejuvenation, these findings support prioritising jawline/neck procedures — relevant to NHS and private practice treatment planning conversations.
Limitations: Participants assessed a single digitally sculpted female model, limiting generalisability across ages, ethnicities, and sexes.
JAMA psychiatry
Use and Misuse of GLP-1 Receptor Agonists Among People With Eating Disorders
Peiper NC, Zibbell JE, LaJoie AS et al. · 2026 Jun 24
Study Type: Insufficient information — abstract content not provided; cannot determine study type or findings.
Key Question: What are the patterns of use and misuse of GLP-1 receptor agonists (e.g., semaglutide, liraglutide) among individuals with eating disorders?
Key Findings: - Abstract text was not supplied; specific findings, effect sizes, or prevalence data cannot be extracted.
- The title suggests the study examines both therapeutic use and potential misuse/diversion in an eating disorder population.
- No further detail available from the information provided.
Clinical Relevance: Directly relevant to UK psychiatry practice given widespread NHS prescribing of GLP-1 agonists for obesity and emerging concerns about their potential for misuse in patients with restrictive or purging eating disorders.
Limitations: Abstract not provided; full assessment of methodology and limitations is not possible.
American journal of public health
Postpandemic Telehealth Use: Patterns and Barriers for Older Adults in the United States, 2024
Chandrasekaran R · 2026 Jul
Study Type: Cross-sectional analysis of nationally representative survey data
Key Question: What are the patterns of and barriers to telehealth use among older adults in the US in the postpandemic period?
Key Findings: - Only 31.4% of device-owning older adults used telehealth in 2024; video and phone-only use were near-equal (~12% each), suggesting no clear dominance of video modality
- Higher telehealth use was associated with Hispanic ethnicity (AOR 1.92), lung disease (AOR 2.32), and depression (AOR 1.89); non-metropolitan residence significantly reduced odds (AOR 0.36)
- Video specifically required higher income and independent app use; 45.7% of non-users preferred in-person care and 13.4% reported never being offered telehealth
Clinical Relevance: As NHS England expands remote consultation, these findings highlight equity risks for rural, lower-income, and digitally excluded older patients if audio-only options are deprioritised.
Limitations: US-specific, device-owning sample only, likely underestimating barriers among the most digitally excluded older adults.
AJR. American journal of roentgenology
Utilization of Emergency Department (ED) Neuroimaging From 2016 to 2025: Analysis in Over 3 Million ED Encounters from the Multicenter Cosmos EHR Dataset
Rai P, Rajeev R, Malhotra A et al. · 2026 Jun 24
Study Type: Retrospective analysis (multicentre EHR database study)
Key Question: How has utilisation of emergency department neuroimaging changed across the United States between 2016 and 2025?
Key Findings: - Abstract content insufficient to extract specific numerical findings, effect sizes, or statistical results — the full data are not present in the submission provided.
- Study draws on over 3 million ED encounters from the Cosmos EHR dataset, suggesting substantial statistical power.
- Temporal trends in CT and/or MRI use for neurological presentations across a 9-year period are the primary focus.
Clinical Relevance: Understanding neuroimaging utilisation trends is directly relevant to UK radiology departments managing ED demand, workforce planning, and referral appropriateness — particularly given NHS pressures around imaging capacity and GIRFT (Getting It Right First Time) priorities.
Limitations: As only the title and author information were provided rather than a full abstract, a complete methodological appraisal is not possible.
American journal of respiratory and critical care medicine
Airway Mucus Plugs in Asthma and COPD: Pathobiology, Imaging, and Implications for Clinical Trials
Bosma CB, Aaron SD, Celli BR et al. · 2026 Jun 22
Study Type: Commentary/narrative review
Key Question: What is the pathobiological basis, clinical significance, and trial utility of airway mucus plugs in asthma and COPD?
Key Findings: - Mucus plug burden, quantified via CT-based scoring (e.g., bronchopulmonary segment mucus plug score), correlates with increased exacerbations, accelerated spirometric decline in both asthma and COPD, and excess mortality in COPD
- Biologic therapies in asthma trials have demonstrated measurable reductions in mucus plug burden alongside spirometric improvement, supporting mucus plugging as a treatable trait
- Quantitative imaging methods for mucus plug scoring are under active development but lack standardisation
Clinical Relevance: CT-quantified mucus plug burden may offer UK respiratory clinicians a phenotyping and treatment-monitoring tool, particularly when considering biologic therapy eligibility and response in severe asthma and COPD.
Limitations: As a narrative review, no primary data are presented and evidence synthesis is not systematic.
Annals of the rheumatic diseases
Referral pathways and duration of care for musculoskeletal complaints across Europe: an analysis of primary and secondary care
Gomon G, Raffray M, Betancort Rodríguez C et al. · 2026 Jun 22
Study Type: Retrospective analysis of routinely collected healthcare data
Key Question: How do referral pathways and duration of rheumatology care for MSK complaints vary across five European healthcare systems?
Key Findings: - Primary care MSK burden was consistent across countries (25–30% of residents consulting annually), but referral rates to rheumatology varied markedly (5–38%)
- 46–70% of referred patients were discharged within 3 months; only 13–43% entered long-term rheumatology follow-up
- The UK and Sweden, despite lower referral rates and fewer rheumatologists per capita, maintained higher rates of long-term rheumatology care, attributed to selective triaging systems
Clinical Relevance: This confirms that the NHS selective triaging model concentrates rheumatology resource on complex cases, which is relevant when interpreting international benchmarking data or developing cross-national diagnostic tools applicable to UK practice.
Limitations: UK primary care consultation rates were unavailable, limiting direct comparison of the full care pathway for the NHS cohort.
BJU international
Artificial intelligence in genitourinary oncology: publication trends and systematic review
Kim A, Moore NA, Dong T et al. · 2026 Jun 26
Study Type: Systematic review with publication trend analysis (including RCT sub-analysis)
Key Question: What is the current volume, trajectory, and quality of evidence for AI applications in genitourinary oncology?
Key Findings: - Publications grew from 14 (2013) to 362 (2023), with marked acceleration from 2019; the vast majority were retrospective (n=962 of 1220 included studies)
- Only 4 RCTs identified across the entire field — three in prostate cancer, one in urothelial cancer — covering diagnostics, prognostication, and treatment planning, all showing performance gains over conventional approaches
- Risk of bias varied across RCTs, primarily relating to randomisation methodology and intervention fidelity
Clinical Relevance: Despite widespread clinical interest in AI-assisted diagnostics and treatment planning for prostate, renal, and urothelial cancers, the evidence base underpinning NHS adoption decisions remains almost entirely observational.
Limitations: Only four RCTs were available for systematic review, making definitive conclusions about efficacy or safety impossible.