Croydon University Hospital

When I graduated in 1995, hospital medicine in the UK was organised around a "firm"-a team of consultants, registrars, senior house officers, and house officers who knew their patients, and each other.The firm model had flaws: standards varied, hours were long, and the culture could be paternalistic.Yet it delivered something we have since lost: continuity, tacit knowledge, and shared accountability.The European Working Time Directive (EWTD), introduced in the UK in 1998, and rota redesign dismantled this structure.Studies of the EWTD highlight mixed effects: there were some improvements in work-life balance, but also reductions in continuity, team cohesion, and training quality.The number of handovers multiplied, and responsibility for the patient journey often became unclear.

Computer vision and image-based artificial intelligence (AI) are increasingly being used in orthopaedic imaging. Applications in lower limb orthopaedic surgery present unique diagnostic, biomechanical and surgical planning challenges. This review systematically maps how computer vision has been applied to lower limb orthopaedic imaging, identifying key tasks, modalities and algorithmic trends in published studies.A scoping review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Ovid MEDLINE and Embase were searched from January 1995 to October 2025. Studies were included if they applied an automated or semi-automated computer vision method to imaging of the hip, knee, ankle or foot. Exclusions included conference abstracts, ongoing clinical trials and studies without full text.Twenty studies met the inclusion criteria. The knee was the most frequently studied region (40%), followed by the hip (30%), ankle (15%) and foot (10%). Radiographs (40%) and CT (45%) were the dominant imaging modalities, while MRI (10%) and ultrasound (5%) were less common. Deep learning was employed in 85% of studies, primarily using convolutional architectures such as U-Net, YOLO, and ResNet. Across tasks, reported diagnostic accuracies were typically above 85%, and segmentation Dice coefficients frequently exceeded 0.85. Despite strong technical results, only 20% of studies included external validation, with no prospective clinical trials identified.Computer vision research in lower limb orthopaedics is diversifying and progressing from diagnostic classification toward quantitative measurement and intraoperative integration. Despite promising accuracy and automation potential, the evidence base is constrained by predominantly single-centre retrospective designs and scarce external validation. Future studies should prioritise reproducibility, large-scale validation and clinical practice deployment.

Computer vision has advanced in spinal imaging, enabling automated interpretation of radiographs, CT, and MRI for diagnosis, surgical planning, and postoperative assessment. The spine’s complex anatomy and high imaging volume make it a key area for algorithmic assistance. This scoping review maps current applications of computer vision in spinal orthopaedics and describes the clinical tasks, imaging modalities, and computational methods used in published studies.A systematic search of Ovid MEDLINE and Embase was performed from January 1995 to October 2025. Studies were included if they applied automated or semi-automated computer vision techniques to spinal imaging for diagnostic, morphometric, or surgical planning. Two reviewers screened and recorded data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.Twenty studies met the inclusion criteria. CT (45%) and MRI (35%) were the dominant imaging modalities, followed by radiographs (15%) and ultrasound (5%). Deep learning methods were employed in 90% of studies, mainly convolutional architectures such as U-Net, ResNet, and YOLOv5. Segmentation and vertebral labeling were the most common tasks (60%), achieving Dice coefficients of 0.86-0.97 and accuracies of 90-98%. Fracture detection networks (25%) reached AUCs of 0.91-0.95, while morphometric measurement algorithms (15%) produced intraclass correlations of 0.93-0.98 compared with human analysis. Despite strong technical performance, only 20% of studies included external validation, and none conducted prospective testing.Computer vision has demonstrated strong performance in spinal image segmentation and fracture detection, particularly on CT and MRI. Nevertheless, clinical translation remains limited. Future research should prioritize multi-center datasets, real-world validation, and integration into surgical clinical practice to support preoperative and intraoperative care.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1302:"<h3></h3> In 2022, GIRFT (Getting It Right First Time, an NHS England programme to improve timeliness and quality of care) issued guidance, based on Southampton recommendations on when neurologists should follow-up/discharge patients. These were amended in Southwest London to take into consideration nurse specialists, the use of patient-initiated follow-up and recognised that this was a way of rationing care without evidence. In 2023, evaluation of the practice at Croydon University Hospital (a district general hospital with 6 consultant neurologists), found that for patients with headache/epilepsy, 72.2% and 73.5% matched guidance over a 2 and 6 month period respectively. In 2024 the analysis was repeated using the same methods. 93 and 112 patients were analysed for headache and epilepsy respectively. The adherence to the guidance increased to 83% and 85%. This data illustrates that the consultants were discharging patients according to the guidance prior to the publication of this and have since further integrated the guidance into their practice. Thereby ensuring that clinic capacity is maintained as appropriately as possible. We hope to repeat this study with other trusts in the region to study trends and aid in reflection of practice. anitkunan{at}nhs.net ";}

IntroductionThe combination of a high critical shoulder angle (CSA), the presence of radiographic greater tuberosity (GT) irregularities, and the patient’s age can aid surgeons in diagnosing rotator cuff tears (RCTs). This study aims to assess the usefulness of these simple radiographic measures in a clinical outpatient setting. We hypothesise that a high CSA, together with the presence of GT irregularities and the patient's age, is associated with a high probability of RCT.MethodsRadiographs of 150 patients were examined retrospectively. The final cohort consisted of 150 patients: 50 with normal shoulders (group A), diagnosed clinically and radiologically using MRI scan, 50 with subacromial impingement (SAI) (group B), and 50 with RCTs (group C). The CSA was measured electronically on true anteroposterior (AP) shoulder radiographs using a picture archiving and communication system (PACS). The presence of radiographic GT irregularities was also recorded according to the following classification: 0 = normal, 1 = sclerosis, and 2 = irregularity or a bony chip. A senior and one training surgeon took measurements. Mean CSAs were used for analysis, as confirmed by a high interobserver agreement, as determined by an interclass correlation coefficient (ICC) calculation. The p-value was set at 0.05.ResultsThe mean CSA for groups A, B, and C was 32.4 (standard deviation (SD) ± 1.5), 34.8 (SD ± 3.2), and 39.3 (SD ± 3.4), respectively. Statistical analysis showed excellent discrimination between normal and cuff pathology, with an area under the curve (AUC) of 0.881 and an optimal CSA cutoff of 34.6° (sensitivity, 74%; specificity, 92%; accuracy, 80%). We then sought a cutoff between SAI and cuff tears and found 36.9 to be significant (AUC 0.848). CSA of ≥36.9° can differentiate between SAI and cuff tears (sensitivity, 78%; specificity, 76%; accuracy, 77%). Combining the CSA of ≥34.8° with GT of 2 can outstandingly discriminate a cuff tear (AUC 0.920, up from 0.848 with CSA alone). The addition of age can generate further improvement, with an AUC of 0.953 (sensitivity, 80%; specificity, 96%; accuracy, 88%).ConclusionThis study shows that at age 40 years, RCT was predicted if CSA ≥ 44.9° (GT = 1) or ≥41.0° (GT = 2); at age 50 years, thresholds were CSA ≥ 42.0° (GT = 1) or ≥38.0° (GT = 2); and at age 60 years, CSA ≥ 39.1° (GT = 1) or ≥35.1° (GT = 2). Applying these age-banded thresholds yielded a sensitivity of 80%, a specificity of 96%, and an overall accuracy of 88%. Therefore, a simple radiograph-based model combining CSA, GT morphology, and age may allow clinicians to stratify patients at the first point of contact, streamlining diagnostic pathways, reducing unnecessary advanced imaging, and guiding early intervention strategies.

A female patient, 38 years old, G2+P0+A1, at 20 weeks plus six days of gestation, was admitted to the emergency with a complaint of watery vaginal discharge for the last 72 hours. There was a hind-water rupture of membranes, and the AmniSure test was positive. She had an OPD visit about a month back, and during that visit, her urine was sent for culture and sensitivity report, which showed E. coli, but she had not taken treatment as she did not come back. Her emergency room baseline labs were in the normal range, and high vaginal swab (HVS) and urine culture and sensitivity results returned negative later. She was asymptomatic for chorioamnionitis. A prophylactic antibiotic was started. Two days later, she developed a fever. She was counseled about septicemia and the risk of maternal death, but she refused. A few hours later, she expelled the fetus and went into hypotension. ERPC (Evacuation of retained products of conception) was done, and one unit of packed red cells was transfused. She was shifted to the ICU. Broad-spectrum IV antibiotics were started. All inflammatory markers were high during her illness. Chest X-ray showed bilateral pleural effusion. She stayed in the ICU for three days and was then discharged. The objective is to discuss a case of septicemia due to preterm premature rupture of membranes (PPROM) and chorioamnionitis, probably following a urinary tract infection (UTI) caused by E. coli, and its management.

Background:The funding of primary care is subject to intense debate internationally. Three main funding models predominate: capitation, pay-for-performance, and fee-for-service. A number of systematic reviews regarding the effect of primary care funding structures have been published, but not synthesized through an equity lens. Given the urgent need for evaluating funding models and addressing inequalities, a reliable, synthesized evidence base concerning the effects of funding on inequalities is imperative.Aims:This umbrella review aims to systematically evaluate all systematic reviews available on the effect of different primary care funding models in high-income countries on inequalities in funding, access, outcomes, or experience from inception until 2024.Methods:Three databases (MEDLINE, EMBASE, Cochrane) and a machine learning living evidence map were searched. s and titles were double screened, before two authors independently screened full texts, extracted data, and performed quality assessments utilizing the AMSTAR2 tool.Findings:The search identified 2480 unique articles, of which 14 were included in the final review. Only one review compared reimbursement systems; capitation systems were more equitable between ethnic groups compared to pay-for-performance in terms of primary care access, continuity, and quality. Twelve reviews reviewed the impact of the introduction of pay-for-performance models, predominantly focusing on the Quality and Outcomes Framework (QOF) in the UK. Synthesized findings suggest that QOF’s introduction coincided with reduced socioeconomic health inequalities in the UK overall, but not in Scotland. Overall, inequalities in age narrowed, but inequalities measured by sex widened. One review found evidence that targeting funding for minority groups, with poorer health, was effective. A further review found that introducing privately provided general practices in Sweden and allowing patients to choose these over public-owned options generally benefitted those with higher income and lower health needs. We identify a range of gaps in the literature, which should inform future research.

Background/Objectives: This paper will compare the outcomes-safety and efficacy-of three minimally invasive glaucoma surgeries (MIGSs),the Hydrus Microstent, iStent, and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), for intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). Methods: A literature search of Ovid Medline and Embase identified studies evaluating the Hydrus, iStent, and GATT. Data on IOP reduction, medication use, and complications were analyzed. Results: Studies show the Hydrus, iStent, and GATT reduce IOP and medication burden in POAG patients, with some complications. For the Hydrus, studies showed 37.09% (27.5 ± 4.4 to 17.3 ± 3.7 mmHg) and 25% (16.8 to 12.6 mmHg) IOP reduction. Meanwhile, medication burden decreased from 2.5 ± 0.7 to 1.0 and from 2.1 to 1.15. For the iStent, studies showed a 36.39% (21.1 to 13.4 mmHg) and 8.19% (17.1 to 15.7 mmHg) IOP drop. Medication burden decreased from 2.87 to 1.24 and from 1.7 to 0.26. For GATT, studies showed a 49.33% (27.70 ± 10.30 to 14.04 ± 3.75) and 39.09% (26.40 ± 6.37 to 16.08 ± 2.38) IOP drop. Medication burden reduced from 3.73 ± 0.98 to 1.82 ± 1.47 and from 3.12 ± 0.80 to 0.45 ± 0.96. Conclusions: The Hydrus, iStent, and GATT are effective alternatives to trabeculectomy for mild to moderate POAG. They reduce and control IOP and dependence on medications with manageable safety profiles. In all three options, there were some clinically significant complications based on the p-value. For the Hydrus, it was PAS. For the iStent, they were PAS, FB sensation, IOP spikes, and microhyphema. For GATT, it was IOP spikes. However, further long-term studies, especially randomized controlled trials, are needed to support these results.