Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study.

BACKGROUND/OBJECTIVES: Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation. METHODS: Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation. RESULTS: Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement. CONCLUSION: Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

Child Soccer Players' Perceptions of Strength and Conditioning Training: A Multimethod Approach Using Write, Draw, Show and Tell.

PURPOSE: The use of strength and conditioning training in childhood is a hot topic surrounded by myths and misconceptions. Despite scientific evidence supporting the safety and benefits of this training for children, the lack of representation of their voices poses a challenge in designing training programs that meet their specific needs and requirements. METHODS: Children's views, experiences, and perceptions of strength and conditioning training were explored by Write, Draw, Show and Tell techniques. Sixteen grassroots soccer players aged 11-12 years took part in one of 3 focus groups exploring the topic. Data were analyzed following an inductive approach enabling themes to be explored and later deductive analyses using the Youth Physical Activity Promotion model to create pen profile diagrams. RESULTS: Strength and conditioning were frequently associated with muscle growth, coordination, endurance, and rest. Enabling factors included autonomy, resilience, physical development, and training opportunities. Reinforcing factors included social support, social interference, coaches' communication, role models, and the ways of implementation. CONCLUSIONS: Participants favor integrating strength and conditioning into their soccer training rather than conducting it as a separate session, which is reflected in their enjoyment. Nonetheless, children remain apprehensive about the potential effects of this type of training on their growth.

Coeliac axis thrombosis and acute hepatic failure in a patient with dilated cardiomyopathy.

We present the case of a female patient in her 40s who presented with jaundice, orthopnoea, paroxysmal nocturnal dyspnoea and bilateral pedal oedema. After extensive investigations, she was diagnosed with hepatic dysfunction, dilated cardiomyopathy (DCM) and coeliac axis thrombosis. Her case was further complicated with episodes of torsades de pointes due to metabolic disturbance, with consequent sudden cardiac arrest. In this case report, we explore the clinical features, pathophysiology and treatment of acute hepatic failure and coeliac axis thrombosis, secondary to DCM and alcoholic liver disease.

Agreement between Force Platform and Smartphone Application-Derived Measures of Vertical Jump Height in Youth Grassroots Soccer Players.

Given the importance of vertical jump assessments as a performance benchmarking tool, the assessment of neuromuscular function and indicator of health status, accurate assessment is essential. This study compared countermovement jump (CMJ) height assessed using MyJump2 (JHMJ) to force-platform-derived jump height calculated from time in the air (JHTIA) and take-off velocity (JHTOV) in youth grassroots soccer players. Thirty participants (Age: 8.7 ± 0.42 yrs; 9 females) completed bilateral CMJs on force platforms whilst jump height was simultaneously evaluated using MyJump2. Intraclass correlation coefficients (ICC), Standard error of measurement (SEM), coefficient of variance (CV) and Bland-Altman analysis were used to compare performance of MyJump2 to force-platform-derived measures of CMJ height. The median jump height was 15.5 cm. Despite a high level of agreement between JHTIA and JHTOV (ICC = 0.955), CV (6.6%), mean bias (1.33 ± 1.62 cm) and 95% limits of agreement (LoA -1.85-4.51 cm) were greater than in other comparisons. JHMJ performed marginally better than JHTIA when compared to JHTOV (ICC = 0.971; 95% CI's = 0.956-0.981; SEM = 0.3 cm; CV = 5.7%; mean bias = 0.36 ± 1.61 cm; LoA = -3.52-2.80 cm). Irrespective of method, jump height did not differ between males and females (p > 0.381; r < 0.093), and the comparison between assessment tools was not affected by sex. Given low jump heights achieved in youth, JHTIA and JHMJ should be used with caution. JHTOV should be used to guarantee accuracy in the calculation of jump height.

Observations of Player (de)Selection Within a Professional UK Soccer Academy.

The present study engaged in an ethnographical observation of the processes used to determine player (de)selections within a professional academy. English category-2 youth academy players (n = 96) from U10-U16 age groups undertook anthropometric profiling (height, mass and somatic maturation) and fitness assessments (10 m, 20 m & 30 m linear sprints, 505-agility test, countermovement and squat jumps). Each players lead coach (n = 4) subjectively graded players utilising a red, amber and green (RAG) rating system on a weekly (current performance) and quarterly (perceived potential) basis, across 25 weeks. A MANCOVA, controlling for maturation, was applied to determine differences in (de)selection by physical performance. Mann Whitney-U tests were used to distinguish difference in (de)selection by subjective grading (weekly and quarterly). The key finding was that quarterly subjective gradings established a higher cumulative score of green ratings in selected players and a low cumulative score of red ratings, and vice versa for deselected players (P ≤ 0.001 to 0.03). However, whilst these findings suggest that quarterly subjective grades of potential were able to provide the best predictors for player (de)selection, the findings should be viewed with caution due to high potential for confirmatory bias.

The Effects of Soccer Specific Exercise on Countermovement Jump Performance in Elite Youth Soccer Players.

The aims of the study were to examine the test−retest reliability of force-time (F-T) characteristics and F-T curve waveform of bilateral and unilateral countermovement jumps (CMJ) in elite youth soccer players and to evaluate the effects of competitive match-play on CMJ performance. 16 male youth soccer players completed CMJs on two separate occasions to determine reliability, and immediately pre, post and 48 h following a competitive match. Coefficient of variation (CV%), Intra-class correlation coefficient (ICC) and limits of agreement were used to assess reliability of discreate CMJ variables. Single factor repeated measures ANOVA were used to determine the effects of match play. Statistical parametric mapping was used to evaluate the repeatability of the CMJ force-time waveform and the effects of match play. Jump height had limited reliability in all three jumps and only a select few jump specific F-T variables were found to be reliable (CV < 10%, ICC > 0.5). Select variables were reduced immediately post game but recovered 48 h post game. The F-T curve waveform was found to be repeatable but did not differ following match-play. This study suggest that select F-T variables change following match-play and may be suitable tools to allow practitioners to detect decrements in performance. These data may help inform practitioners to use the most appropriate F-T variables to assess fatigue and recovery, with implications for performance and injury risk.

The Dose-Response Relationship Between Training-Load Measures and Changes in Force-Time Components During a Countermovement Jump in Male Academy Soccer Players.

PURPOSE: To manage physical performance in soccer, practitioners monitor the training load (TL) and the resulting fatigue. A method frequently used to assess performance is the countermovement jump (CMJ). However, the efficacy of CMJ to detect fatigue from soccer matches and training remains uncertain, as does the relationship between TL and change in CMJ performance. The aims of the present study were 2-fold. One was to observe the changes of CMJ force-time components and jump height (JH). The second was to examine dose-response relationships between TL measures and CMJ over a 6-week preseason. METHODS: Twelve male academy soccer players (17 [1] y, 71.2 [5.6] kg, and 178 [5.8] cm) were recruited. Daily changes in CMJ were assessed against baseline scores established before preseason training, along with internal and external TL measures. A series of Bayesian random intercept models were fitted to determine probability of change above/below zero and greater than the coefficient of variation established at baseline. Jumps were categorized into match day minus (MD-) categories where the higher number indicated more time from a competitive match. RESULTS: JH was lowest on MD - 3 (28 cm) and highest on MD - 4 (34.6 cm), with the probability of change from baseline coefficient of variation highly uncertain (41% and 61%, respectively). Changes to force-time components were more likely on MD - 3 (21%-99%), which provided less uncertainty than JH. Bayes R2 ranged from .22 to .57 between TL measures and all CMJ parameters. CONCLUSIONS: Force-time components were more likely to change than JH. Practitioners should also be cautious when manipulating TL measures to influence CMJ performance.

How Repeatable Is the Ergogenic Effect of Caffeine? Limited Reproducibility of Acute Caffeine (3 mg.kg-1) Ingestion on Muscular Strength, Power, and Muscular Endurance.

This study aimed to determine the effect of 3 mg.kg−1 acute caffeine ingestion on muscular strength, power and strength endurance and the repeatability of potential ergogenic effects across multiple trials. Twenty-two university standard male rugby union players (20 ± 2 years) completed the study. Using a double-blind, randomized, and counterbalanced within-subject experimental design. Participants completed six experimental trials (three caffeine and three placebo) where force time characteristic of the Isometric Mid-Thigh Pull (IMTP), Countermovement Jump (CMJ) and Drop Jumps (DJ) were assessed followed by assessments of Chest Press (CP), Shoulder Press (SP), Squats (SQ), and Deadlifts (DL) Repetitions Until Failure (RTF at 70% 1 RM). ANOVA indicated that caffeine improved both the CMJ and DJ (p < 0.044) and increased RTF in all RTF assessments (p < 0.002). When individual caffeine trials were compared to corresponding placebo trials, effect sizes ranged from trivial-large favoring caffeine irrespective of a main effect of treatment being identified in the ANOVA. These results demonstrate for the first time that the performance enhancing effects of caffeine may not be repeatable between days, where our data uniquely indicates that this is in part attributable to between sessions variation in caffeine's ergogenic potential.

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update.

Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30-80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.

Fundamental movement skills and perceived competence, but not fitness, are the key factors associated with technical skill performance in boys who play grassroots soccer.

OBJECTIVE: This study examined the association between fitness, fundamental movement skills (FMS) and perceived competence on technical skills in boys engaged in grassroots soccer. Methods: Sixty boys (8-12 years of age, Mean ± SD = 10 ± 1 years) undertook assessment of FMS, perceived competence, physical fitness (15m sprint speed, standing long jump distance and seated 1kg medicine ball throw as a composite z-score) and technical skills (dribbling, passing and shooting as a composite z-score). RESULTS: Multiple backwards linear regression was used to determine to amount of variance in technical skill explained by FMS, perceived competence and fitness. Results indicated a significant model (F 3,58= 42.04, P = .0001, Adj R2 = .680) which explained 68% of the variance in technical skills. Perceived competence (ß=.316, P =.001), Total FMS (ß=.140, P =.002), and chronological age (ß=.863), P =.001) significantly contributed to the model. CONCLUSION: This study demonstrates that better technical skills (passing, dribbling, shooting) in youth soccer are explained, alongside age, by being competent in FMS and having a more positive perception of competence. Coaches should therefore seek to encourage development of these factors during childhood for the benefit of technical skill performance.

The influence of angle-specific torque of the knee flexors and extensors on the angle-specific dynamic control ratio in professional female soccer players.

The purpose of this study was to assess whether dynamic torque ratios (DCR) from isokinetic strength assessments of eccentric knee flexors (eccKF) and concentric knee extensors (conKE) display differences when stratified into specific angle-specific DCR (DCRAST) groups. Fifty-two professional female soccer players (age 21.30 ± 4.44 years; height 166.56 ± 5.17 cm; mass 61.55 ± 5.73 kg) from the English Women's Super League completed strength assessments of both lower limbs on an isokinetic dynamometer at 60°âˆ™s-1. Angle-specific torque (AST) were used to calculate DCRAST to create sub-groups using clustering algorithms. The results identified for the dominant side that the Medium DCRAST group elicited significantly higher conKE AST when compared to Low and High DCRAST groups at increased knee extension (P ≤ 0.05). For the non-dominant side, the High DCRAST group had significantly higher and lower eccKF and conKE AST compared to the Low DCRAST group at increased knee extension (P ≤ 0.05). This study highlights that the inclusion of AST data may subsequently help practitioners to prescribe exercise that promotes strength increases at targeted joint angles. In turn, these approaches can be used to help reduce injury risk, identify rehabilitation responses and help inform return to play.

Axonics Sacral Neuromodulation System for Treating Refractory Overactive Bladder: A NICE Medical Technologies Guidance.

The Axonics sacral neuromodulation (SNM) system can be used by people with refractory overactive bladder (OAB) to reduce symptoms of urge urinary incontinence and urinary frequency, where conservative treatments have failed or are not suitable. It is the first system for this indication that makes use of a rechargeable battery to prolong the lifespan of the implanted device, with the potential advantage of reducing the frequency of surgical replacement procedures and associated complications. We describe the evidence considered by the UK National Institute of Health and Care Excellence (NICE) in their evaluation of this evidence, supported by Cedar Healthcare Technology Research Centre. Two observational studies provided descriptive data that suggested improvement in control of symptoms after implantation of the Axonics SNM system; however, there was no peer-reviewed evidence that directly compared rechargeable and non-rechargeable SNM systems. In the absence of long-term data, economic modelling relies on the accuracy of battery life estimates. The evidence supports the case for adopting the Axonics SNM system for treating refractory OAB, when conservative treatment or treatment with medicines has not worked. This conclusion is consistent with other relevant NICE guidelines. Use of Axonics SNM technology in the UK National Health Service (NHS) is associated with a potential cost saving of £6025 per person over a 15-year period when compared with an equivalent non-rechargeable SNM system, assuming the claimed battery life estimate (a minimum of 15 years) is accurate. The cost savings are estimated to start around 6 years after implantation.

Actual and perceived motor competence mediate the relationship between physical fitness and technical skill performance in young soccer players.

This study examined the role of fundamental movement skills (FMS) and perceived competence in the relationship between physical fitness and technical soccer skills in children. Seventy boys aged 7-12 years of age (Mean ± SD = 9 ± 2 years) who were regularly engaged in grassroots soccer participated in the present study. The Test of Gross Motor Development-2 (Ulrich, 2001. Test of gross motor development (2nd ed.). Austin, TX: PRO-ED) was used to assess FMS and the Perceived Physical Ability Scale for Children (Colella, Morano, Bortoli, & Robazza, 2008. A physical self-efficacy scale for children. Social Behavior and Personality: an International Journal, 36, 841-848) was used to assess perceived competence. Technical skill was determined from three tests reflecting dribbling, passing and shooting. Z-scores of each measure were summed, creating a composite measure of technical skill. Three measures of physical fitness were employed; 15m sprint time, standing long jump, and seated medicine ball (1kg) throw. Z-scores for each measure were summed creating a composite measure of physical fitness. The relationship between technical skill and FMS, fitness, perceived competence and age was examined via path analysis. Results indicated two significant mediated pathways: from physical fitness to technical skills via FMS, and from physical fitness to technical skills via perceived competence. Once these mediators had been accounted for, there was no direct link from physical fitness to technical skills. Coaches should therefore seek to avoid one-sided delivery of practice by not solely focusing on football type drills, and focusing on a range of activities which enhance a broad foundation of FMS and promote strategies to positively influence a child's perception of their own competence.HighlightsFundamental movement skills (FMS) are considered the foundation for physical activity and sport performance yet they tend to be overlooked, in favour of physical fitness, in the development of soccer talent.We examined mediating effects of FMS and perceived competence in the relationship between physical fitness and technical soccer skills in 70, 7-12 year old grassroots soccer players.We suggests there is no direct effect of physical fitness on technical skills in soccer but both FMS and perceived competence act as mediators of the physical fitness-technical skill relationship in children aged 7-12 years old.Coaches should therefore look to develop a broad base of FMS and a higher perception of competence to improve children's technical soccer skills.

Neonatal digital chest radiography- should we be using additional copper filtration?

OBJECTIVES: Copper filtration removes lower energy X-ray photons, which do not enhance image quality but would otherwise contribute to patient radiation dose. This study explores the use of additional copper filtration for neonatal mobile chest imaging. METHODS: A controlled factorial-designed experiment was used to determine the effect of independent variables on image quality and radiation dose. These variables included: copper filtration (0 Cu, 0.1 Cu and 0.2 Cu), exposure factors, source-to-image distance and image receptor position (direct / tray). Image quality was evaluated using absolute visual grading analysis (VGA) and contrast-to-noise ratio (CNR) and entrance surface dose (ESD) was derived using an ionising chamber within the central X-ray beam. RESULTS: VGA, CNR and ESD significantly reduced (p < 0.01) when using added copper filtration. For 0.1 Cu, the percentage reduction was much greater for ESD (60%) than for VGA (14%) and CNR (20%), respectively. When compared to the optimal combinations of parameters for incubator imaging using no copper filtration, an increase in kV and mAs when using 0.1-mm Cu resulted in better image quality at the same radiation dose (direct) or, equal image quality at reduced dose (in-tray). The use of 0.1-mm Cu for neonatal chest imaging with a corresponding increase in kV and mAs is therefore recommended. CONCLUSION: Using additional copper filtration significantly reduces radiation dose (at increased mAs) without a detrimental effect on image quality. ADVANCES IN KNOWLEDGE: This is the first study, using an anthropomorphic phantom, to explore the use of additional Cu for digital radiography neonatal chest imaging and therefore helps inform practice to standardise and optimise this imaging examination.

Episcissors-60 for Mediolateral Episiotomy: Evaluation of Clinical and Economic Evidence to Inform NICE Medical Technologies Guidance.

Obstetric anal sphincter injury (OASI) occurs in 2.9% of all vaginal births in the UK and can result in faecal incontinence. Where there is a clinical need for episiotomy, OASI can be minimised by accurate selection of the optimum angle of mediolateral episiotomy. Episcissors-60 are adapted surgical scissors incorporating a guide-limb to help achieve an accurate angle of mediolateral episiotomy. The ability of Episcissors-60 to reduce OASI by preventing inaccurate visual estimates of episiotomy angles was considered by the National Institute of Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). NICE concluded that Episcissors-60 shows promise for mediolateral episiotomy both in terms of clinical effectiveness and potential cost savings, but that there was not enough evidence to support routine adoption into the NHS at this time. NICE MTG47 recommends that key gaps in the evidence including patient-reported outcomes and the addition of Episcissors-60 to care bundles be addressed through research with specific focus on potential equality considerations.

The prevalence and practices of caffeine use as an ergogenic aid in English professional soccer.

The ergogenic properties of caffeine are well established, with evidence supporting beneficial effects for physical and technical elements of performance required for successful soccer match play. Despite this, recommended caffeine practices for professional soccer have not been established. Therefore, the present study aimed to evaluate the use and behaviours surrounding caffeine use in elite English soccer clubs. Representatives of 36 clubs from the top four tiers of English professional football (40%) completed an online survey that sought to determine if, when, how and why caffeine was prescribed to players as a means of improving sports performance. Of the clubs sampled, 97% indicated that caffeine is provided to players as a means of improving performance. Caffeine is most commonly administered prior to (> 94%) and during a game (> 48%), with frequency uninfluenced by time of matches. There was a broad range and lack of consistency in the timing, dose and mode of caffeine administration, but doses were typically low. Evidence from the present study indicate a translational gap between science and practice, highlighting a need for future work to better understand how caffeine consumption can be optimised with respect to the specific demands and constraints in professional soccer.

Can 3 mg·kg-1 of Caffeine Be Used as An Effective Nutritional Supplement to Enhance the Effects of Resistance Training in Rugby Union Players?

The present study uniquely examined the effect of 3 mg·kg-1 chronic caffeine consumption on training adaptations induced by 7-weeks resistance training and assessed the potential for habituation to caffeine's ergogenicity. Thirty non-specifically resistance-trained university standard male rugby union players (age (years): 20 ± 2; height (cm): 181 ± 7; body mass (kg): 92 ± 17) completed the study), who were moderate habitual caffeine consumers (118 ± 110 mg), completed the study. Using a within-subject double-blind, placebo-controlled experimental design, the acute effects of caffeine intake on upper and lower limb maximal voluntary concentric and eccentric torque were measured using isokinetic dynamometry (IKD) prior to and immediately following a resistance training intervention. Participants were split into strength-matched groups and completed a resistance-training program for seven weeks, consuming either caffeine or a placebo before each session. Irrespective of group, acute caffeine consumption improved peak eccentric torque of the elbow extensors (p < 0.013), peak concentric torque of the elbow flexors (p < 0.005), total eccentric work of the elbow flexors (p < 0.003), total concentric work of the knee extensors (p < 0.001), and total concentric and eccentric work of the knee flexors (p < 0.046) following repeated maximal voluntary contractions. Many of these acute caffeine effects were still prevalent following chronic exposure to caffeine throughout the intervention. The training intervention resulted in significant improvements in upper and lower body one-repetition maximum strength (p < 0.001). For the most part, the effect of the training intervention was equivalent in both the caffeine and placebo groups, despite a small but significant increase (p < 0.037) in the total work performed in the participants that consumed caffeine across the course of the intervention. These results infer that caffeine may be beneficial to evoke acute improvements in muscular strength, with acute effects prevalent following chronic exposure to the experimental dose. However, individuals that consumed caffeine during the intervention did not elicit superior post-intervention training- induced adaptations in muscular strength.

gammaCore for Cluster Headaches: A NICE Medical Technologies Guidance.

Cluster headaches are excruciating attacks of pain that can last between 15 min and 3 h. Cluster headaches can be episodic, where patients have long pain-free intervals between attacks, or chronic, where they do not. As part of the Medical Technologies Evaluation Programme, the UK National Institute for Health and Care Excellence (NICE) considered the clinical effectiveness and cost impact of gammaCore (electroCore), a handheld, patient-controlled device used to treat and prevent cluster headache. gammaCore is a non-invasive vagus nerve stimulator, the aim of which is to modify pain signals by stimulating the vagus nerve through the skin of the neck. Evidence suggests that gammaCore reduces the intensity and frequency of cluster headaches and that the addition of gammaCore to standard care is cost saving. Therefore, the guidance published by NICE in December 2019 recommends routine adoption of gammaCore into the UK national health service. However, the guidance noted that gammaCore does not work for everyone and recommended that treatment with gammaCore should stop after 3 months in patients whose symptoms do not improve.

The PLASMA System for Transurethral Resection of the Prostate: A NICE Medical Technologies Guidance Update.

Lower urinary tract symptoms (LUTS) in men commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP). This can be performed using either monopolar or bipolar electrosurgery. Bipolar TURP uses saline for irrigation rather than glycine, which drastically reduces the risk of TUR syndrome complications, thus allowing for increased procedure time if needed. The PLASMA system (formally known as TURis) is a bipolar TURP electrosurgery system used to treat LUTS secondary to BPH. National guidance recommending the use of TURis in the UK NHS was issued in 2014 by NICE and we now report the updated contribution from Cedar that was included in the update of that guidance for 2021. The evidence in this review suggests that the PLASMA system could be beneficial to patients in relation to hospitalisation and catheterisation time compared with monopolar TURP (mTURP). However, it appears to be comparable to mTURP for urological outcomes and worse for post-operative haematology outcomes such as decline in sodium and haemoglobin levels. Adverse events, however, occurred much less with PLASMA use.