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During the COVID-19 pandemic, wearing facemasks was mandatory in the United Kingdom except for individuals with medical exemptions. Facemasks cover the full lower half of the face; however, the effect of facemasks on age perception is not yet known. The present study examined whether age estimation accuracy of unfamiliar young adult women is impaired when the target is wearing a facemask. This study also examined whether makeup, which has previously been shown to increase error bias, further impairs age estimation accuracy when paired with a facemask. The findings indicate that both facemasks and makeup tend to result in overestimation of the young women's age compared to neutral faces, but the combination of both is not additive. Individual level analysis also revealed large individual differences in age estimation accuracy ranging from estimates within 1 year of the target's actual age, and age estimates which deviated by up to 20 years.

Abiraterone acetate plus prednisolone (herein referred to as abiraterone) or enzalutamide added at the start of androgen deprivation therapy improves outcomes for patients with metastatic prostate cancer. Here, we aimed to evaluate long-term outcomes and test whether combining enzalutamide with abiraterone and androgen deprivation therapy improves survival. We analysed two open-label, randomised, controlled, phase 3 trials of the STAMPEDE platform protocol, with no overlapping controls, conducted at 117 sites in the UK and Switzerland. Eligible patients (no age restriction) had metastatic, histologically-confirmed prostate adenocarcinoma; a WHO performance status of 0–2; and adequate haematological, renal, and liver function. Patients were randomly assigned (1:1) using a computerised algorithm and a minimisation technique to either standard of care (androgen deprivation therapy; docetaxel 75 mg/m2 intravenously for six cycles with prednisolone 10 mg orally once per day allowed from Dec 17, 2015) or standard of care plus abiraterone acetate 1000 mg and prednisolone 5 mg (in the abiraterone trial) orally or abiraterone acetate and prednisolone plus enzalutamide 160 mg orally once a day (in the abiraterone and enzalutamide trial). Patients were stratified by centre, age, WHO performance status, type of androgen deprivation therapy, use of aspirin or non-steroidal anti-inflammatory drugs, pelvic nodal status, planned radiotherapy, and planned docetaxel use. The primary outcome was overall survival assessed in the intention-to-treat population. Safety was assessed in all patients who started treatment. A fixed-effects meta-analysis of individual patient data was used to compare differences in survival between the two trials. STAMPEDE is registered with ClinicalTrials.gov (NCT00268476) and ISRCTN (ISRCTN78818544). Between Nov 15, 2011, and Jan 17, 2014, 1003 patients were randomly assigned to standard of care (n=502) or standard of care plus abiraterone (n=501) in the abiraterone trial. Between July 29, 2014, and March 31, 2016, 916 patients were randomly assigned to standard of care (n=454) or standard of care plus abiraterone and enzalutamide (n=462) in the abiraterone and enzalutamide trial. Median follow-up was 96 months (IQR 86–107) in the abiraterone trial and 72 months (61–74) in the abiraterone and enzalutamide trial. In the abiraterone trial, median overall survival was 76·6 months (95% CI 67·8–86·9) in the abiraterone group versus 45·7 months (41·6–52·0) in the standard of care group (hazard ratio [HR] 0·62 [95% CI 0·53–0·73]; p<0·0001). In the abiraterone and enzalutamide trial, median overall survival was 73·1 months (61·9–81·3) in the abiraterone and enzalutamide group versus 51·8 months (45·3–59·0) in the standard of care group (HR 0·65 [0·55–0·77]; p<0·0001). We found no difference in the treatment effect between these two trials (interaction HR 1·05 [0·83–1·32]; p interaction =0·71) or between-trial heterogeneity (I 2 p=0·70). In the first 5 years of treatment, grade 3–5 toxic effects were higher when abiraterone was added to standard of care (271 [54%] of 498 vs 192 [38%] of 502 with standard of care) and the highest toxic effects were seen when abiraterone and enzalutamide were added to standard of care (302 [68%] of 445 vs 204 [45%] of 454 with standard of care). Cardiac causes were the most common cause of death due to adverse events (five [1%] with standard of care plus abiraterone and enzalutamide [two attributed to treatment] and one (<1%) with standard of care in the abiraterone trial). Enzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years. Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Janssen, and Astellas. [ABSTRACT FROM AUTHOR]

Background: STAMPEDE has previously reported that radiotherapy (RT) to the prostate improved overall survival (OS) for patients with newly diagnosed prostate cancer with low metastatic burden, but not those with high-burden disease. In this final analysis, we report long-term findings on the primary outcome measure of OS and on the secondary outcome measures of symptomatic local events, RT toxicity events, and quality of life (QoL). Methods and findings: Patients were randomised at secondary care sites in the United Kingdom and Switzerland between January 2013 and September 2016, with 1:1 stratified allocation: 1,029 to standard of care (SOC) and 1,032 to SOC+RT. No masking of the treatment allocation was employed. A total of 1,939 had metastatic burden classifiable, with 42% low burden and 58% high burden, balanced by treatment allocation. Intention-to-treat (ITT) analyses used Cox regression and flexible parametric models (FPMs), adjusted for stratification factors age, nodal involvement, the World Health Organization (WHO) performance status, regular aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, and planned docetaxel use. QoL in the first 2 years on trial was assessed using prospectively collected patient responses to QLQ-30 questionnaire. Patients were followed for a median of 61.3 months. Prostate RT improved OS in patients with low, but not high, metastatic burden (respectively: 202 deaths in SOC versus 156 in SOC+RT, hazard ratio (HR) = 0·64, 95% CI 0.52, 0.79, p < 0.001; 375 SOC versus 386 SOC+RT, HR = 1.11, 95% CI 0.96, 1.28, p = 0·164; interaction p < 0.001). No evidence of difference in time to symptomatic local events was found. There was no evidence of difference in Global QoL or QLQ-30 Summary Score. Long-term urinary toxicity of grade 3 or worse was reported for 10 SOC and 10 SOC+RT; long-term bowel toxicity of grade 3 or worse was reported for 15 and 11, respectively. Conclusions: Prostate RT improves OS, without detriment in QoL, in men with low-burden, newly diagnosed, metastatic prostate cancer, indicating that it should be recommended as a SOC. Trial registration: ClinicalTrials.gov NCT00268476, ISRCTN.com ISRCTN78818544. Chris C Parker and colleagues report long-term findings on overall survival and local complications in men with metastatic prostate cancer treated with radiotherapy. Author summary: Why was this study done?: Prostate cancer is the most common cancer in males. Radiotherapy (RT) to the prostate is widely used as a radical treatment for nonmetastatic prostate cancer. A comparison was added to the STAMPEDE protocol to assess whether RT to the prostate would also be helpful for males with metastatic prostate cancer. A benefit in survival was targeted. The trial previously reported a clinically relevant, statistically significant overall survival (OS) benefit for patients with a low metastatic burden but not for men with a high metastatic burden. This long-term analysis assesses survival with substantially longer follow-up and more events and looked also at complications of local disease. What did the researchers do and find?: A randomised controlled trial of adding RT to the prostate to standard of care (SOC) was incorporated into the STAMPEDE protocol. More than 2,000 patients joined the comparison between 2013 and 2016. The data set was frozen in 2021 and analysed using standard methods. There was a clear improvement in survival with prostate RT in the low metastatic burden group. There was no improvement in survival with prostate RT in the high metastatic burden group. Symptomatic local progression and the need for later local intervention were improved with RT in the low metastatic burden group. In the low metastatic burden group, the improvement with RT was similar whether the RT was given with a daily schedule (over 4.5 weeks) or a weekly schedule (over 6 weeks). The adverse effects of RT were manageable without any impact on long-term quality of life (QoL). What do these findings mean?: Prostate RT is a relatively cheap, widely accessible, and well-tolerated treatment. Prostate RT is indicated in patients with newly diagnosed prostate cancer with a low metastatic burden. RT to the prostate is not routinely indicated for patients with a high metastatic burden. [ABSTRACT FROM AUTHOR]

Background: Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD. Methods: This was a multicentre retrospective case-control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates. Results: In total, 235 octogenarians (median age 81 (range 80-90) years) and 235 controls (age 67 (31-79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0-3) versus 0 (0-2); P=0.010) and Charlson Comorbidity Index score (7 (6-11) versus 5 (2-9); P=0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P=0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P=0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality. Conclusion: Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of pulmonary metastases on re-staging chest CT at the time of first local recurrence (LR) of trunk or extremity soft tissue sarcoma (STS). Materials and methods: Retrospective review of all patients diagnosed with recurrent STS between May 2007 and April 2018. Data collected included patient age and sex, site of primary STS, time to LR, recurrence site, initial tumour grade, recurrent tumour grade, findings of initial staging chest CT, and prevalence of pulmonary metastases on re-staging chest CT. Results: The study included 109 patients (males = 68, females = 41; mean age 56 years, range 9–92 years). The commonest tumour sub-types were myxofibrosarcoma (27.5%), undifferentiated pleomorphic/spindle cell sarcoma (20.2%), synovial sarcoma (10.1%), and malignant peripheral nerve sheath tumour (10.1%). Initial staging chest CT demonstrated pulmonary metastases in 1 of 77 (1.3%) patients for whom CT was available for review. The mean time to LR was 30.8 months (range 3–224 months). Pulmonary metastases were diagnosed on re-staging chest CT in 26 of 109 cases (23.9%), being commonest with grade 3 STS (36.1%). Pleomorphic sarcoma (85.7%) and undifferentiated spindle cell sarcoma (33.3%) were the 2 commonest tumour sub-types associated with pulmonary metastases at first LR. Conclusion: Re-staging chest CT at the time of first LR of STS identified a prevalence of 23.9% pulmonary metastases, which supports the need for chest CT at the time of LR in line with the UK guidelines for the management of bone and soft tissue sarcoma. Key Points: • Pulmonary metastases were diagnosed in 1.3% of soft tissue sarcomas at presentation. • Pulmonary metastases were identified in ~ 24% of patients at first local recurrence of soft tissue sarcoma, most commonly with pleomorphic sarcoma and Trojani grade tumours. • No patient with a low-grade recurrence had pulmonary metastases. [ABSTRACT FROM AUTHOR]

There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia. The shortage of viable donated livers limits patient access to liver transplantation. Here the authors report the use of normothermic machine perfusion to help identify viable organs from livers discarded based on current clinical criteria, which are then transplanted to recipients in a single-arm clinical trial. [ABSTRACT FROM AUTHOR]

INTRODUCTION Longer waiting times from diagnosis to surgical resection have been found to negatively impact the overall survival and quality of life of women with endometrial cancer. The Cancer Care Pathway Directorate adopted the UK National Waiting Times Monitoring Dataset Guidance, to improve the timeliness of services along the cancer care pathway. From this, three key targets were identified: 1) Maximum 14-day wait from urgent GP referral for suspected cancer to first outpatient attendance (operational standard of 93%), 2) Maximum 31-day wait from decision to treat to first definitive treatment (operational standard of 96%), and 3) Maximum 62-day wait from urgent GP referral for suspected cancer to first treatment (operational standard of 85%). The aim of this baseline audit was to chart the time-frames of the various stages in the endometrial cancer pathway of patients diagnosed with this disease between 2015 and 2016 to assess for and identify delays in referral, investigation and care. METHODS A tool was developed following consultation with key stakeholders. Data protection clearance was obtained. Patient medical and oncology files, hospital databases, and MDT documentation for confirmed endometrial cancer cases were reviewed between September 2017 - March 2018. RESULTS A total of 101 endometrial cancer cases were included in the audit. The proportion of cases which met the 14-day, 31-day and 62- day wait KPIs operational standards were 39.1%, 81.2% and 17.2% respectively. CONCLUSION The endometrial cancer care pathway timeframes did not meet the KPIs operational standards. Fast-track coordinators and nurse navigators could improve continuity and coordination of patient care. [ABSTRACT FROM AUTHOR]

Surgery of the temporomandibular joint (TMJ) is increasingly recognised as a subspecialist area of interest within our specialty and many procedures such as arthroscopy, arthroplasty, and replacement of the TMJ are becoming increasingly centralised and restricted to certain regions. We previously made a national survey of trainees and have sought to augment this with a survey of trainers to find out the nature of practice and patterns of referral nationally. We have also examined the consultants’ expectations of competent final-year trainees. To do this we made an electronic survey of Fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and received 82 responses (26%). Many just provided simple treatments within their clinical practice, only 16 did arthroscopy, and 14 alloplastic joint replacements. From those who answered the question, only 10 would allow a competent final-year trainee to do an alloplastic joint replacement under supervision. Referrals for TMJ subspecialist care were predominantly made to the West Midlands, East Midlands, and North West, with 24 respondents stating they would either refer open TMJ surgery centrally within or outside the region. Centralisation of services means that training opportunities in surgery of the TMJ are reduced, and restricted to only a few regions. Other models of training may need to be introduced such as simulation, “taster” sessions, and brief clinical attachments. For the budding subspecialist, however, a dedicated Fellowship may become essential to ensure adequate exposure before starting independent consultant practice. [ABSTRACT FROM AUTHOR]

Surgery of the temporomandibular joint (TMJ) is emerging as a subspecialty in its own right within Oral and Maxillofacial Surgery (OMFS). Recent guidelines on training and practice within this area have laid down standards of competence in certain procedures, and asked for evidence of “exposure” to others at the point of completion of higher training in OMFS. Provision of surgery of the TMJ is becoming more centralised within tertiary referral centres, with resulting disparity in opportunities for clinical experience in different training regions. We sought to gain a national perspective about this, and establish whether all trainees are truly equal when it comes to exposure to surgery of the TMJ during higher surgical training. An electronic survey was distributed to all members of an online Yahoo! group forum reserved for specialty trainees in OMFS. From those surveyed, 25 (48%) stated they had no experience of arthroscopy, while 19 (37%) and 38 (75%) reported no exposure to operations for alloplastic and autogenous replacement of the TMJ, respectively. A mode score of 1 out of 5 (44%, n = 22) was returned when they were asked to rate the likelihood of considering TMJ surgery as a subspecialty. The current survey highlights variable exposure to operating on the TMJ across geographical divides within the UK, and little interest among trainees in pursuing the subspecialty as a career. [ABSTRACT FROM AUTHOR]

The article discusses a study undertaken as part of the Evaluation of Care Across Borders (ECAB) project on cross-border care collaborations with the aim of describing pediatric cross-border care pathways and identifying factors that support or hinder its operation. Topics discussed include the Malta-Great Britain agreement that provides for free treatment of up to 180 Maltese patients in Great Britain every year where patients referred above this quota incur a charge to the Maltese government.

In the United Kingdom, most training programmes in oral and maxillofacial surgery (OMFS) do not sufficiently cover management of the temporomandibular joint (TMJ) to enable newly appointed consultants to practise independently as TMJ surgeons. We describe a one-year fellowship programme for a senior OMFS trainee who had just completed training, which included various international courses in the USA and Europe on specific aspects of TMJ surgery. Under the direct supervision of a consultant, the trainee completed 70 arthroscopic procedures, 13 TMJ cryotherapies, 16 TMJ arthrocenteses, 9 TMJ arthroplasties, and 20 total prosthetic TMJ replacements. Our experience indicates that specific training is required for those who wish to practise in the field of TMJ management and surgery. [ABSTRACT FROM AUTHOR]

Evaluates the old and the neonationalist interpretations of Australian commercial policy in the 1930s. Influence of a complex structure of pressure groups and political, bureaucratic and regulatory institutions on Australian commercial policy towards Great Britain; Adoption of inflexible positions that limited Australia in its international economic relations.

The forthcoming STAMPEDE2 trial has three comparisons in metastatic hormone-sensitive prostate cancer. We aim to determine clinical practices among STAMPEDE trial investigators for access to imaging and therapeutic choices and explore their interest in participation in STAMPEDE2. The survey was developed and distributed online to 120 UK STAMPEDE trial sites. Recipients were invited to complete the survey between 16 and 30 May 2022. The survey consisted of 30 questions in five sections on access to stereotactic ablative body radiotherapy (SABR), 177lutetium-prostate-specific membrane antigen-617 (177Lu-PSMA-617), choice of systemic therapies and use of positron emission tomography/computerised tomography and whole-body magnetic resonance imaging. From 58/120 (48%) sites, 64 respondents completed the survey: 55/64 (86%) respondents were interested to participate in SABR, 44/64 (69%) in 177Lu-PSMA-617 and 56/64 (87.5%) in niraparib with abiraterone comparisons; 45/64 (70%) respondents had access to bone, spine and lymph node metastases SABR delivery and 7/64 (11%) to 177Lu-PSMA-617. In addition to androgen deprivation therapy, 60/64 (94%) respondents used androgen receptor signalling inhibitors and 46/64 (72%) used docetaxel; 29/64 (45%) respondents would consider triplet therapy with androgen deprivation therapy, androgen receptor signalling inhibitors and docetaxel. Positron emission tomography/computerised tomography was available to 62/64 (97%) respondents and requested by 45/64 (70%) respondents for disease uncertainty on conventional imaging and 39/64 (61%) at disease relapse. Whole-body magnetic resonance imaging was available to 24/64 (38%) respondents and requested by 13/64 (20%) respondents in highly selected patients. In low-volume disease, 38/64 (59%) respondents requested scans at baseline and disease relapse. In high-volume disease, 29/64 (45%) respondents requested scans at baseline, best response (at prostate-specific antigen nadir) and disease relapse; 54/64 (84%) respondents requested computerised tomography and bone scan for best response assessment. There is noteworthy disparity in clinical practice across current study sites, however most have expressed an interest in participation in the forthcoming STAMPEDE2 trial. • STAMPEDE trial investigators have great interest in participation in STAMPEDE2. • Metastatic prostate cancer management varies significantly across UK trial sites. • PET/CT imaging is commonly used in various clinical settings. • Triplet systemic therapy will be considered by clinicians with available funding. [ABSTRACT FROM AUTHOR]

The article presents a phase IV open label randomised controlled trial to determine whether one priming dose of serogroup C meningococcal (MenC) conjugate vaccine is comparable to two doses when followed by a booster of Haemophilus influenzae type B (Hib)-MenC-Tetanus Toxoid (TT) conjugate vaccine at 12 months in infants. The study results show that the immunogenicity of one priming dose of MenC-CRM conjugate vaccine at 3 months was superior to the two dose regimen.

Reports developments related to medicine and mass media as of February 1993 in Great Britain. Involvement of doctors in the care of children with malignant disease; Efforts of the broadcast media to managed hospitals.