Epsom Hospital

Introduction: The study aimed to prospectively compare the lateral and the modified tilted supine position in patients undergoing trochanteric fracture fixation using dynamic hip screws regarding the procedural difficulties and the radiologic outcomes. Materials and Methods: This randomized controlled trial recruited 64 patients with peritrochanteric fractures; 30 in group A, where patients were placed in a supine position on the operative table and 34 in group B, where patients were placed in a lateral position. Our outcome measure were the setting-up time, operating time, any operative difficulties, preoperative blood loss, postoperative wound drainage, and the amount of blood transfused. Hemoglobin levels before and at 48 hours after surgery, delay in wound healing or infection, and duration of hospital stay were noted. Radiologically, the amount of displacement, femoral neck-shaft angle (NSA), tip-to-apex distance (TAD), and modified Parker Index Ratio (PIR) were measured and reported. Patients were followed up for a minimum of 2 years. Results: The mean setting-up time was significantly shorter in the lateral position group (B). The mean fluoroscopy time was significantly longer among the supine position group (A). However, the total operative time was similar in both groups. The mean NSA in the anteroposterior view was similar in both groups. The disparity between the diastasis in both AP and lateral views was substantially higher among group B. Both groups had close PIR in both AP and lateral views and TAD at final follow-up. Conclusions: This study demonstrates that the lateral position provides shorter setting-up, fluoroscopy and operative times for peritrochanteric fracture fixation (AO types 31A1 and 31A3) using a dynamic hip screw. This highlights its potential to enhance surgical success and patient recovery. Level of Evidence: Level I.

BackgroundPeople experiencing socioeconomic disadvantage are persistently underrepresented in clinical trials, yet they experience a significantly greater burden of disease than those not experiencing socioeconomic disadvantage. Trials need to be inclusive to ensure that treatments are safe and effective for those who need them most. Resources are needed to support researchers in designing and implementing trials that are inclusive of people experiencing socioeconomic disadvantage. Building on the National Institute for Health and Care Research (NIHR) INCLUDE initiative, we developed the INCLUDE Socioeconomic Disadvantage Framework to support researchers in making trials more inclusive.MethodsThe Framework was developed over five phases: (1) outlining an initial draft of the Framework, (2) refining the initial draft Framework with public contributors, (3) refining the draft Framework with wider contributors, (4) finalising the Framework with all contributors, and (5) launch and application of the Framework.ResultsThe Framework entails four key questions: (1) Who should my trial results apply to? (2) Are people from different socioeconomic backgrounds likely to respond to the intervention in different ways? (3) Will my trial intervention and/or comparator make it harder for people from different socioeconomic backgrounds to take part in the trial? (4) Will the way I have planned and designed my trial make it harder for people from different socioeconomic backgrounds to take part? The Framework includes worksheets to support trial teams in considering strategies to address barriers to inclusion. In 2023, the Framework was launched at a webinar with ~300 registrants and is currently available to download from the Trial Forge website: https://www.trialforge.org/trial-diversity/socioeconomic-disadvantage-framework/. Public contributor considerations, collated through project meetings, to make trials more inclusive for people experiencing socioeconomic disadvantage are also appendaged to this article to support trial teams further.ConclusionThe Framework and public contributor considerations can be used to support researchers to design and conduct more inclusive trials. Future work should include evaluation of such Frameworks, further engagement with funders to increase uptake, and development and evaluation of strategies to improve inclusion.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-026-09448-2.

Abstract Environmental DNA (eDNA) monitoring has been used for great crested newt ( Triturus cristatus ) survey in the UK since the publication of a Defra‐funded trial in 2014. If eDNA results are to be used in support of a great crested newt licence, surveys must be performed during a 76‐day survey window (15 April–30 June) to coincide with peak great crested newt activity, and must follow the approved ethanol precipitation protocol. However, eDNA detection is possible in other months and filtration may be a more effective method of eDNA capture. We investigated whether the great crested newt eDNA survey season could be extended and filtration could be used for great crested newt eDNA capture by reviewing the available evidence and conducting a field study from April to October 2022. Paired water samples for ethanol precipitation and filtration were collected from 25 ponds once a month, resulting in 124 samples of each type. All samples ( N = 248) were analysed with the approved great crested newt quantitative PCR assay. Our results indicate that great crested newts can be reliably detected using both eDNA capture methods from April to August, with detection rates decreasing in September and October. Great crested newt eDNA detection was comparable or higher with filtration than ethanol precipitation. Practical implication. Acceptance of filtration for great crested newt eDNA surveys could allow more water to be processed for robust and reliable estimates of great crested newt presence. Extending the great crested newt eDNA survey season to August could allow more waterbodies to be surveyed for great crested newt presence (but not absence), and identification of sites that provide important habitat for great crested newts outside of the breeding season. This would also remove logistical challenges and costs associated with completing sampling within 11 weeks and laboratory analysis within 10 working days from sample receipt. Furthermore, great crested newt eDNA surveys could be more frequently carried out alongside monitoring for other species, which are typically surveyed from April to September/October or year‐round with conventional methods or eDNA surveys using filtration. This could enable infrastructure projects to develop more effective mitigation measures as well as reduce time required from surveyors and survey costs.

In 1998 choline was identified as an essential nutrient by the United States Institute of Medicine. Choline is known primarily for its roles in neurotransmitter production, cell membrane formation, and methyl and lipid metabolism. Since this discovery the relevance of choline to maternal, fetal, and infant health has been studied intensively. This narrative review provides a coherent update of the latest evidence for field clinicians and healthcare professionals. A PubMed/ScienceDirect search for human clinical evidence restricted to meta-analysis and systematic/review publications from the last 10 years was undertaken. Meta-analysis and review publications highlight the importance of choline in supporting maternal health and fetal development during pregnancy by showing promising roles for choline in relation to neurological development, brain and liver function, reduced neural tube defect risk, and adverse pregnancy outcome risk. However, there are clear present-day gaps between habitual choline intakes and intake recommendations with the majority of pregnant and lactating women not meeting adequate intake recommendations for choline. This gap is anticipated to widen given transitions towards plant-based diets which tend to be lower in choline. Alongside folic acid recommendations, choline supplementation should be considered in dietary recommendations by clinicians during crucial life stages such as pregnancy and lactation when physiological demands for this critical nutrient substantially increase.

As part of the HIPPY research programme we have undertaken a qualitative interview study to explore UK orthopaedic surgeons’ experiences and beliefs relating to decision-making about implant fixation types for patients who require a Total Hip Replacement, and to identify potential barriers and facilitators to changing of fixation practices amongst UK surgeons. The HIPPY programme aims to find out which implants are best for patients under 70 years of age and includes a randomised controlled trial (RCT) comparing different fixation types. There has been little empirical investigation of how orthopaedic surgeons make decisions about implant fixation, or exploration of the factors that influence and inform fixation choice for their patients, and the relative importance of these factors. This qualitative study aims to inform the HIPPY RCT and aid the implementation of its findings.In-depth qualitative interviews with UK-based consultant hip surgeons. Potential participants were invited through a national online survey of hip surgeons which opened in Jan 2024, facilitated by the British Hip Society.Interviews were completed with 19 surgeons between June and November 2024 representing 16 centres. Purposive sampling ensured that the sample reflected the breadth of fixation philosophies practiced in the UK. Preliminary findings from our ongoing iterative thematic analysis identify that surgeons’ fundamental aim is the achievement of a well reconstructed and long-lasting hip and choices about fixation are made in support of this. Important influences on surgeons’ fixation choices included training; published research and personal NJR data; patients’ age, bone quality and anatomy; and accumulated surgical experience. Both surgeons who were ‘cement-preferring’ and ‘cementless-preferring’ for younger patients perceived that their fixation choices were cost-effective.Surgeons described multiple influences on decision-making about fixation. Surgeons will consider new RCT findings alongside their own established practice and personal NJR outcome metrics, before considering changes to their fixation choices.