Approximately 15 million people in the UK live with obesity and at least 5 million of these are people with severe obesity (PWSO). Severe obesity significantly compromises health, well-being and quality of life and reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Several studies suggest the potential of group-based intervention in Specialist Weight Management Services (SWMS), but PWSO remain underrepresented in research, and evidence on optimal design and outcomes is limited. The success of the PROGROUP feasibility randomised controlled trial (RCT) (ISRCTN22088800) informed the development of this study and additional adjustments have been made in response to the rollout of obesity management medication in the National Health Service (NHS). This study aims to assess the effectiveness and cost-effectiveness of PROGROUP in SWMS and primary care.

The RCT will be conducted in SWMS, alongside an implementation study in primary care. The RCT will recruit cohorts of 30 participants to be randomised 1:1 within-cohort to PROGROUP (intervention) or usual care (control). The implementation arm will recruit cohorts of 15 to PROGROUP. The primary objectives for the study are to undertake a process evaluation and economic evaluation of PROGROUP in the RCT and to assess its implementation in primary care. Baseline data and outcome differences at 6 months will be analysed. These will include weight, other clinical measures and patient-reported outcomes, including social and life-satisfaction measures.

This study is approved by an NHS Research Ethics Committee (REC reference: 23/WS/0101). Results will be reported in a manuscript that will be submitted to a peer-reviewed medical journal as open access. A lay summary of the findings will be published online, and participants and sites will be signposted to this.

ISRCTN13721429.

Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a non-surgical intervention that allows controlled colonic washouts, improving symptom control. Evidence supporting TAI for LARS is limited by small sample sizes and is primarily observational, highlighting the need for a rigorous randomised controlled trial (RCT). This study aims to compare TAI with conventional LARS care on QoL, bowel function, faecal incontinence and satisfaction in adults with LARS following LAR.

This is a pragmatic, multicentre, crossover RCT conducted at eight academic hospitals across Quebec, Ontario and British Columbia, Canada. Eligible participants are adults (≥18 years) with an LARS score >20, at least 6 months post-LAR and without an ostomy or active colorectal complications. Participants will be randomised to receive either 3 months of daily TAI or conventional LARS care, followed by a 1 month washout and crossover to the alternate intervention. The TAI intervention includes an irrigation system, access to a web-based educational platform and virtual training with a research team member. Primary outcome is difference in global QoL between interventions, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Secondary outcomes include bowel function (LARS score), faecal incontinence (Cleveland Clinic Faecal Incontinence Score) and satisfaction. Sample size (n=66, accounting for 10% attrition) was determined using Monte Carlo simulations to detect a 6-point difference in QoL with 85.8% power. Data will be analysed using linear mixed-effects models accounting for period, treatment and sequence effects. All study data will be collected via Research Electronic Data Capture and maintained in secure, password-protected systems; participant confidentiality will be ensured throughout. Safety monitoring will include training on proper TAI technique and reporting of adverse events.

The study has received ethics approval from each participating site. The trial adheres to the Canadian Tri-Council Policy Statement on the use of human participants in research. Findings will be disseminated through peer-reviewed journals, conference presentations and scientific meetings, with authorship following the International Committee of Journal Editors guidelines.

NCT05007015.

Peer support is being integrated into the new maternal mental health services in England to further the development of the recovery approach in relation to loss. Psychological support after miscarriage (pregnancy loss prior to viability) is often overlooked, despite significant psychological morbidity. This systematic review explored the effectiveness of peer support interventions to improve mental health outcomes after miscarriage.

Systematic review

A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national call for evidence.

Study designs with a quantitative evaluative component or mixed-methods studies reporting effectiveness were eligible if they involved women and/or partners who had experienced miscarriage and been offered a peer support intervention. Any peer support versus control (no treatment, wait list and usual care) or peer support versus another psychosocial intervention was eligible for inclusion. Studies that report any of the following broad groups of outcomes (whether validated measures or by self-report) were eligible for inclusion: (a) personal recovery, (b) mental health recovery, (c) health service use and (d) social outcomes.

Two independent reviewers used standardised methods to search and screen for eligible studies.

Of the 4342 titles screened, 100 potentially relevant full-text papers were retrieved and screened resulting in seven randomised controlled trials and two controlled trials identified across 10 papers. Of these, seven did not evaluate a peer-led intervention, one reported only on women who had experienced pregnancy loss later than 24 weeks gestation, and one reported a peer support intervention for those who experienced pregnancy loss at any age of gestation but did not disaggregate data for those who experienced miscarriage. Thus, no studies were eligible for inclusion. This indicates a significant gap in the current literature. The inconsistencies and limitations in existing research approaches are explored in detail.

This systematic review has identified an evidence gap as there is currently no robust evidence for the effectiveness of peer support interventions after miscarriage. Given the drive for the inclusion of peer support in new maternal mental health services, there is therefore a need for targeted intervention research to provide reliable evidence to determine effective peer support interventions for this population.

CRD42024518248

To explore the acceptability of the Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS) intervention and trial procedures for participants.

A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone.

Primary care.

Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30–60 min.

COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes.

Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally.

Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions.

These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial.

Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.

Miscarriage, defined in the UK as loss of pregnancy prior to 24 weeks gestation, can have long-term psychological implications. Clinical guidelines for perinatal bereavement care do not provide guidance on how best to support the mental health of women, and their partners, after miscarriage. Peer support (support from those who share common characteristics) is often sought, but there is little understanding of its access and use. We conducted a systematic review to understand the barriers to and facilitators of the implementation of peer support to improve mental health outcomes for parents after miscarriage.

Systematic review and thematic synthesis.

A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national Call for Evidence.

Qualitative and mixed-methods studies exploring motivations, experiences and preferences for peer support after miscarriage were included.

Two independent reviewers used standardised methods to search, screen, extract and code included studies. Suitable studies were evaluated using the Critical Appraisal Skills Programme Qualitative Research Checklist. Findings were extracted and subjected to a thematic synthesis.

Across nine studies included in the review, three overarching themes were developed, with seven subthemes, capturing both barriers and facilitators. ‘Engaging in relational recognition’ reflects the validation and connection that arise through experiential resonance, often heightened by the context of exclusion from broader social or clinical support. ‘Mechanisms of Communality’ describe how communality is enacted through dynamic peer interactions, including modelling and facilitating grief, benchmarking physical change and mattering through reciprocity, highlighting mutual support and shared coping. ‘Dynamics of Access’ consider factors which shape engagement, including changing needs of individuals across time and modalities of support and their effects.

These findings form the first synthesis of peer support after miscarriage and bring a nuanced service user perspective of barriers and facilitators by examining evidence from diverse studies. Peer support after miscarriage was seen to be a dynamic, relational process shaped by shared experience, mutual exchange and context-specific factors. Findings underscore key policy and practice considerations, including the use of trauma-informed, loss-sensitive approaches and consideration of intersectionality, that should be reflected when offering peer support services, with and for, those who have experienced miscarriage.

CRD42024518248.

Congenital malformations (CMs) are the leading cause of infant mortality. Still, the aetiology remains unknown in 70% of cases. The most accepted hypothesis is that hereditary and environmental elements concur in altering embryo-fetal development. Recently, the role of the environment has been emphasised.

Women are exposed to several xenobiotics during pregnancy. This review aims to study the available literature on the exposure of pregnant women to pesticides through drinking water to see if there is any evidence of correlation to the onset of any kind of congenital anomalies.

We will conduct a systematic literature review in The Cochrane Library, Embase and PubMed for studies published between 1 January 2005 and 31 January 2026. Articles will be included if they examine pregnant women as the study population, exposure to pesticide active ingredients and metabolites present in drinking water, and any type of CM in their children as the main outcome. The screening of title, abstract and full text as well as the data extraction will be conducted independently through two investigators. A third investigator will resolve any eventual conflicts. Each included study will be evaluated according to the NIH’s quality assessment tools. Grading of Recommendations Assessment, Development and Evaluation approach will be used for summarising and assessing certainty in the bodies of evidence produced by the review. This study is registered with PROSPERO, CRD420251063011.

The completed work will be published in a scientific journal for dissemination. Due to the nature of the study, an ethical approval is not necessary since no patient data or other information will be directly collected.

Burn injuries constitute a significant health concern, requiring immediate first aid to mitigate further tissue damage and complications. Most countries worldwide recommend application of 20 min of cool running water (20CRW) within 3 hours of the burn as the cornerstone in burn first aid management. Despite its widespread acceptance and proven benefits in reducing the severity of burns and subsequent interventions, concerns regarding the risk of hypothermia following this intervention persist, representing at least a perceived barrier to the delivery of 20CRW. When it does occur, hypothermia in patients with burns has been associated with higher mortality rates, even after controlling for burn injury severity. Developing an understanding of the incidence of post-burn hypothermia following 20CRW, with a specific focus on potential predictive and/or causative factors, is quintessential.

A retrospective cohort study of all adult and paediatric patients with thermal burn injuries presenting to one of 11 participating Australian or New Zealand hospitals between 1 January 2024 and 31 December 2024 will be conducted. The primary outcome is the incidence of hypothermia in patients with burns following their arrival at the emergency department (ED). Secondary outcomes include influence of burn first aid cooling, risk factors influencing hypothermia, impact of hypothermia on clinical patient outcomes and incidence of hypothermia in patients with burns in non-ED settings.

Ethical approval was granted by the Children’s Health Queensland Human Research Ethics Committee (CHQHREC; HREC Ref No: HREC/25/QCHQ/114285) as well as Health and Disability Ethics Committees, New Zealand (HDEC; Ref No: 2026 EXP 23892). The study findings will be formally disseminated through peer-reviewed journals and conference presentations.