Morriston Hospital

Surveillance of individuals with a familial predisposition to pancreatic ductal adenocarcinoma (PDAC) is likely to increase overall survival. Our objective was to determine the impact of EUROPAC risk-stratification (Family Risk, FR), in such predisposed individuals. Observational study of registered asymptomatic individuals undergoing surveillance for PDAC. Individuals without a known pathogenic variant (PV-), ineligible for genetic assessment in the NHS, in whom significant pancreatic lesions were found, were subjected to additional germline testing. Between January 2000 and April 2025, 893 individuals started surveillance, median age of 52 years. 508 individuals (404 PV- and 104 with a pathogenic variant (PV+)) in the 20 years prior to 2020 without stratification were compared to 385 (269 PV- and 116 PV+) in the five years from 2020 who had FR risk-stratification applied. Four (0·8 %) individuals had actionable pancreatic findings prior to risk stratification vs. 14 (3·6 %), who underwent risk-stratified surveillance (p = 0·001). Pancreatic lesions deemed operable were found in three (0·6 %) and 11 (3 %), p = 0·007, with two (0·4 %) and nine (2 %) undergoing resection, p = 0·009, respectively. PV- individuals with significant findings were subsequently found to contain mutations, many not in the UK genetics test directory, provided the FR was > 30. The median (IQR) time in surveillance prior to a lesion being detected was four (2 - 7) years. Overall, 78 % of EUROPAC detected precursor lesions or pancreatic cancers were stage II or lower. The risk-stratified group (FR) identifies neoplastic pancreatic lesion in individuals, regardless of PV status suggesting the key usefulness of this approach.

Burns are a leading cause of childhood injury. Analysis of pediatric burn epidemiology is essential for targeting educational and public health strategies, but there is limited available UK data, particularly traversing the COVID-19 pandemic. We hypothesize that the last 20years have seen significant changes in injury patterns and service provision, with a marked effect from national lockdown measures. This study aims to describe the epidemiology of pediatric burns referrals and admissions within a pediatric burns unit in the United Kingdom over 20years (2005-2024). A retrospective analysis was performed for pediatric patients referred to our center between 2005 and 2024. The International Burn Injury Database (iBID) was used to extract demographic and injury information. Data before, during, and after COVID-19 lockdown periods were compared. A total of 6919 patients met the inclusion criteria. In total, 1872 (27.1%) of the patients required admission. There was a significant reduction in admission rate following COVID despite an increase in average TBSA (P < .01). Most cases were scalds (n = 3100, 44.8%) or contact burns (n = 2650, 38.3%). The majority of patients were aged under 5years (n = 4529, 65.5%), with a rise in referrals for older children across the study period. There was a noticeable rise in aerosol-related flash burns, cold burns, and treadmill-related friction burns during and after the pandemic. This study provides epidemiological data for the development of public health initiatives and adaptation of pediatric burns services. Emerging mechanistic trends and service re-design following the COVID pandemic require further multicenter evaluation to inform future care.

ABSTRACTBackgroundIn the United Kingdom (UK), newly qualified doctors are routinely responsible for out‐of‐hours (OOH) care, often managing acutely unwell patients with limited supervision. Despite national recommendations encouraging OOH experience during medical school training, there is no formal curriculum for OOH practice.ObjectivesThis scoping review aimed to identify the range of educational interventions designed to prepare UK medical students for OOH clinical responsibilities and assess their reported effects on perceived and actual preparedness.MethodsFollowing Joanna Briggs Institute methodology, a systematic search of seven databases and grey literature sources was conducted. Eligible studies involved UK‐based medical students and reported empirical outcomes on educational interventions focused on OOH preparedness. Data were extracted and synthesised using the Template for Intervention Description and Replication checklist and Kirkpatrick's evaluation hierarchy.ResultsEighteen studies were included, primarily using quasi‐experimental designs of simulation‐based teaching. Interventions targeted a wide range of competencies, including prioritisation, communication, clinical decision‐making, and leadership. Thirteen studies demonstrated improvements in learner confidence or attitudes (Kirkpatrick Level 2a), while only three showed measurable performance improvement (Level 2b), and one demonstrated behavioural change (Level 3). Most lacked long‐term follow‐up. Grey literature analysis revealed inconsistent institutional expectations for OOH experience.ConclusionsEducational interventions on OOH are well‐received and enhance perceived preparedness. Current interventions often lack objective assessment and long‐term evaluation. This review was limited to published sources and may not reflect all current practice. Nationally standardised, longitudinal curricula supported by robust evaluation strategies are needed to improve graduate preparedness for OOH practice.

Horizontal neck lines are a common aesthetic concern among aging and younger populations. Hyaluronic acid (HA) fillers are increasingly used in this region, yet their effectiveness, safety, and optimal application strategies remain under-investigated. This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024550863), aimed to evaluate the efficacy and safety of HA fillers for horizontal neck lines. Comprehensive searches of Ovid MEDLINE and Embase were performed up to May 2024. Eleven studies (n = 379) met the inclusion criteria. Pooled analysis demonstrated significant improvements in the Global Aesthetic Improvement Scale (mean, 1.75, 95% CI, 1.53-1.96) and wrinkle grading (mean difference, 1.43, 95% CI, 0.72-2.15). Instrumental assessments confirmed enhancements in hydration, elasticity, and dermal structure. The pooled retreatment rate within 12 months was 50%, and the complication rate 14%, with only mild, transient effects reported. Patient satisfaction was consistently high. In summary, HA fillers represent an effective and well-tolerated option for treating horizontal neck lines, producing sustained improvements in both aesthetic appearance and skin quality.Level of Evidence: 4 (Therapeutic)

AimTo ascertain the safety and feasibility of robotic simultaneous resection of synchronous colorectal cancer and liver metastases.MethodsA PRISMA-compliant systematic review with proportion meta-analysis was conducted. All retrospective or prospective observational studies including patients aged ≥ 18 with synchronous colorectal cancer and liver metastases undergoing robotic simultaneous resection were eligible. The outcomes included conversion to open, operative time, intraoperative blood loss, Clavien-Dindo ≥ III complications, 30-day mortality, anastomotic leak, R0 resection, and length of hospital stay.ResultsSeven eligible studies including 165 patients were identified. The mean age was 62.8years (95% CI: 60.5-65.2), mean body mass index was 26.5 (95% CI: 24.6-28.4), and 52.0% (95% CI: 37.9-66.1) were male. The mean operative time was 406.5min (95% CI: 358.2-454.7) and mean intraoperative blood loss was 150.0mL (95% CI: 124.5-175.6). Conversion to open occurred in 3.9% (95% CI: 1.0-6.8), Clavien-Dindo ≥ III complications in 9.3% (95% CI: 4.7-13.8), 30-day mortality in 0.9% (95% CI: 0.0-2.4), and anastomotic leak in 4.3% (95% CI: 0.9-7.6). R0 resection was achieved in 99.0% (95% CI: 97.5-100), and the mean length of hospital stay was 6.7days (95% CI: 5.5-7.9).ConclusionsSingle-arm meta-analysis suggests that robotic simultaneous resection of synchronous colorectal cancer and liver metastases may not only be feasible and safe but also may be advantageous in terms of conversion avoidance, complexity handling, and perioperative recovery. More studies with larger sample size are required to inform long-term oncological outcomes and selection criteria and to provide comparative evidence.

Abstract Tibial plateau fractures (TPFs) are complex intra-articular injuries associated with long-term disability if not optimally treated. In low- and middle-income countries (LMICs), where high-energy trauma is prevalent and health system resources are constrained, management strategies, and outcomes differ substantially from those reported in high-income countries. This systematic review synthesizes evidence from LMICs on treatment approaches, functional outcomes, and complications following TPFs. We systematically searched PubMed, EMBASE, Scopus, and regional databases for studies conducted in LMICs, published up to May 2025. Eligible studies included adult patients with TPFs managed surgically, reporting functional or radiological outcomes. Data were extracted on demographics, fracture type, surgical technique, and outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale and Cochrane ROB-2 tools. Fifteen studies comprising 1,213 patients from South Asia, and Africa were included. Patients were predominantly male (65–75%) with mean ages between 35 and 45 years; road traffic accidents were the leading cause. Dual plating yielded superior alignment and higher Knee Society Scores (75–85) but carried increased infection rates (10–18%). Ilizarov and hybrid fixators achieved high union rates (&gt;90%) with acceptable function, although pin-tract infections (15–20%) and malalignment (10–12%) were common. Arthroscopic-assisted fixation improved articular reduction but was limited to tertiary centres. A randomized trial demonstrated that immediate weight-bearing enhanced gait recovery without increased implant failure. Across studies, complication rates exceeded those reported in high-income countries, reflecting systemic barriers such as limited rehabilitation access, implant scarcity, and inadequate soft tissue care. In LMICs, satisfactory union and functional recovery can be achieved following TPF surgery, but complication rates remain high. Dual plating offers superior stability, while Ilizarov fixation provides a resource-appropriate alternative. System-level improvements in rehabilitation, infection prevention, and trauma infrastructure are critical to narrowing outcome disparities with high-income countries.