North Devon District Hospital

Genome editing has emerged as a transformative approach for understanding and treating retinal degenerative diseases. Combining this technology with pluripotent stem cells provides an ideal platform for modeling human development and disease, and investigating emerging therapeutic strategies ultimately aimed towards in vivo correction. This approach enables both functional studies to understand retinal degeneration and the early development of targeted therapies for inherited disease. This review offers a comprehensive overview of genome-editing techniques and the ability to create new clinically relevant models to understand human disease in retinal research, focusing on the use of the CRISPR-Cas9 system in induced pluripotent stem cells (iPSCs) and embryonic stem cells (ESCs), as well as highlighting recent advancements in base and prime editing. Gene editing in various retinal diseases is discussed in context of studies focusing on disease modeling or developing therapeutic strategies. Continued refinement of these techniques will be essential for advancing translational applications in retinal disease treatment.

BackgroundIncisional and non-incisional ventral hernias are common and important causes of symptoms, functional restriction, and complications, with significant potential to impact upon quality of life. The goals of hernia repair are to treat, prevent or improve these. However, outcomes of surgery remain relatively poor with significant gaps within the evidence base, which may be due to inconsistent use of outcome measures. The aim of this study was to appraise outcome reporting in the recent literature of randomized controlled trials (RCTs).ObjectivesThis scoping review aimed to map and categorize the outcome measures reported in RCTs of incisional and non-incisional ventral hernia repair.Eligibility criteriaAll RCTs assessing any intervention related to incisional, primary, or recurrent ventral hernia repair between2015 and 2025 were included.Source of evidenceA literature search was performed of the PubMed, EMBASE (1974 to present), and Cochrane Central Register of Controlled Trials databases in November March 2025.Charting methods Data was extracted independently by two reviewers. All outcomes reported by the included studies were identified and recorded.Results118 RCTs were included. Their outcomes were mapped into five main broad categories. The commonest outcomes used were short-term operative complications (72.9%), hernia recurrence (59.3%), pain (57.6%), and quality of life (33.9%). Patient-reported outcomes were measured in 78 (66.1%) randomized controlled trials, of which 15 assessment tools were identified; 11 were generic, and 4were hernia-specific. There was considerable heterogeneity in how and when these endpoints were assessed and defined.ConclusionThis scoping review found considerable differences in outcome reporting in contemporary RCTs of incisional and non-incisional ventral hernia. These have significant implications for translating evidence into practice, and its synthesis, and support the need for a core outcome set in this field. However, we identified areas such as abdominal wall function which are infrequently reported and require consideration.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10029-025-03553-y.

<h3></h3> Our Work and Wellbeing Check-In pulls together emotional wellbeing and performance review. In adopting more agile people practices, we have moved from a cumbersome annual appraisal to a more dynamic, light touch quarterly check-in. This has enabled a more continuous approach to feedback, learning and recognition, ensuring that employees are supported holistically (by addressing stressors and identifying support needs, enhancing resilience) whilst also achieving organisational objectives. Evolving over four years, the format has been informed by staff and is owned by the Leadership Team and has contributed significantly to improvements in organisation culture e.g. morale (55.75% to 78.91%), work life-balance (72.56% to 82.03%), speaking up (59.29% to 73.44%), reasonable workload (67.26% to 80.47%). The e-form walks staff through a reflection on their wellbeing over the last three months, asking them to self-score a number of statements including how supported they feel, work life balance, self-esteem, stress levels, enjoyment and achievement, etc. This facilitates a meaningful conversation with their manager about what they can do together to improve their wellbeing. Using appreciative enquiry, it encourages staff to reflect on how they have demonstrated our core competencies, met their objectives for the previous quarter, their successes and any challenges during that period. Finally, it looks forward with objectives for the next quarter, linked to the hospice’s strategic objectives, any development needs, longer-term aspirations and development goals. At quarter end the self-score data is aggregated, giving a kite chart for each element and the data is averaged to give us our ‘Hospice Happiness Score’, currently 84%. This means that we now have a snapshot of staff wellbeing and morale on a quarterly basis, enabling us to quickly respond to any dips in morale that may be identified, rather than relying solely on subjective observation and feedback and a bi-annual staff survey.

Chronic low back pain (CLBP) is a significant global concern. Its prevalence continues to rise, and current management strategies demonstrate, at best, moderate effectiveness. The purpose of this study was to explore the concept of uncertainty tolerance and how it affects an individual’s ability to hope, as well as how both of these factors influence emotion regulation. These concepts are highly relevant for both patients and clinicians during CLBP consultations. A social constructivist meta-ethnographic study—a highly interpretative type of qualitative review—was conducted to generate new theory and provide valuable insights into this unique area of pain management. A framework was followed; its iterative analytical process involves multiple search strategies in accordance with PRISMA guidelines. The analysis explored relationships among studies, generated conceptual ideas, and ultimately developed a substantive theory. This review represents the first worked example of a theory generating review process. One model is created to illustrate how individuals with CLBP regulate their emotions; it also considers both the influencing factors and the resulting outcomes of this process. The model identifies pathways leading to either adaptive or maladaptive emotional regulation strategies. Tolerance of uncertainty and ability to hope are key concepts that influence emotion regulation and play a vital role in the physical and psychological well-being of people with CLBP. Further research is required to explore how the model can be operationalised in clinical practice.

PurposeHernia repairs are one of the commonest operations performed in the world. In Europe and the United States of America more than half of patients undergoing hernia surgery are overweight or obese; body weight is therefore key modifiable risk factor before surgery. We aimed to identify, appraise, and synthesise the randomized controlled trial (RCT) evidence for any weight loss interventions before any form of hernia surgery.MethodsA search was performed in April 2025 of the PubMed, EMBASE and CENTRAL databases. Meta-analysis was performed using random effects to assess mean difference in weight, and fixed effects for odds ratio of complications. Bias was assessed using the Cochrane Rob2 tool. Certainty effect was assessed using GRADE methodology. This review was registered with PROSPERO (ID 1024784).Results1,707 studies were screened, 20 retrieved, and 4 reports of 3 RCTs included. A total population of 219 patients largely underwent ventral hernia repair, although 2 RCTs also included patients undergoing non-hernia surgery. Interventions comprised very low calorie diets (VLCD), and a multidisciplinary programme. Meta-analysis for VLCD did not show a reduction in weight loss (3.64 kg [95% confidence interval −2.07 – 9.35]) or complications [odds ratio 0.36 (0.1–1.28)]. Risk of bias was “high,” and certainty of effect “very low.”DiscussionDespite the prevalence and importance of obesity in patients undergoing elective hernia repair, and the popularity of weight loss as part of prehabilitation, the randomized evidence of how to effect weight loss, and whether this translates into an improvement in clinical outcomes is minimal. This highlights the urgent need for large and robust RCTs to determine if weight loss before hernia repair is effective in improving outcomes for patients, and how this is best achieved.

Abstract Background In early 2024, 25 research-ready nurses specialising in IBD joined the United Kingdom IBD Nurse Research Network (UK IBD NRN). This network is dedicated to collaborating on national service evaluation and research initiatives, aiming to enhance service delivery and improve patient experiences within IBD care. Each year, the network will undertake one project, with a ballot for ideas held towards the end of the project. The first initiative focuses on monitoring advanced therapies (AT-IBD) used in the UK for treating IBD. Current recommendations for monitoring advanced therapies in IBD remain ambiguous, and the efficacy of proactive therapeutic drug monitoring (TDM) is still uncertain. To address this, we sought to explore the variations in monitoring practices across IBD services in the UK, focusing on key areas such as access to medication, adherence to monitoring protocols, and the effectiveness of therapeutic drug monitoring. Methods Data collection instruments using REDCap were created and launched in November 2024. Data includes site demographics, a minimum of ten and a maximum of 25 reactively and proactively monitored cases. The case data is collected from retrospective monitoring events and anonymised. Descriptive statistics are used to report results. Results Seventeen unique users are entering data from 15 sites. The survey is open to all four nations of the UK. Responses have been received in England and Wales. Of the 17 users (15;82.4%) reported having had training to interpret blood results. IBD patient population was reported by seven out of eleven sites, with a total of 39,843 reported. Two sites shared the entire local population, and three were reported as unknown. The seven sites that reported the IBD patient population used an electronic health record. There is variance in the pre-screening undertaken (Figure 1); access to advanced therapies appears different, with some sites not having access to newer small-molecule medications (Figure 2). There is wide variation in routine and TDM frequency across all therapies. Conclusion The AT-IBD project is ongoing, with full results anticipated to provide insights into current practices for monitoring advanced therapies in the UK. The collected data may offer valuable insights regarding adherence and the effectiveness of advanced therapy monitoring, particularly concerning patient safety and outcomes. The UK IBD NRN remains committed to providing opportunities for training, collaboration, and research for IBD nurses across the UK.

As advancements in total knee arthroplasty progress at an exciting pace, two areas are of special interest, as they directly impact implant design and surgical decision making. Knee morphometry considers the three-dimensional shape of the articulating surfaces within the knee joint, and knee phenotyping provides the ability to categorize alignment into practical groupings that can be used in both clinical and research settings. This annotation discusses the details of these concepts, and the ways in which they are helping us better understand the individual subtleties of each patient's knee.

Abstract Aims Post-operative urinary retention (POUR) is a common complication following inguinal hernia repair. Left untreated POUR can result in significant patient discomfort, acute kidney injury, detrusor muscle damage and infection. It was observed that the detection and management of POUR in our trust following planned day case inguinal hernia repair was varied, often resulting in unplanned admission. We therefore carried out a review of how our trust is managing these patients. Methods A retrospective analysis of all patients undergoing planned day case inguinal hernia repair in a single institution between March 2023 and August 2023 was performed. Patients having open, laparoscopic, or robotic repair were included. Data was collected on demographics, documentation of POUR, time to diagnosis, bladder scan volume, catheterisation, overnight stay and follow up for all patients. Results 124 patients underwent inguinal hernia repair. 13 patients reported experiencing POUR (10.4%). 9 patients experienced POUR during their initial admission, of which 8 had unplanned overnight admissions. 5 patients were not managed with catheterisation despite having significant volume of urine detected on bladder scan (&amp;gt;700ml). Time to diagnosis varied with POUR not being detected for 24 hours for one patient. 4 patients went into retention after discharge and re-presented via the emergency department. Conclusion Significant variation in the detection and management of patients with POUR was noted in this cohort. Introduction of a POUR pathway in day-surgery describing both diagnosis and management has therefore been created to try and address this, to improve outcomes and reduce hospital admission.