Northwick Park Hospital

Abstract Introduction At University College London Hospital, over 100 patients annually undergo resection and free flap reconstruction for head and neck cancer. Effective post-operative monitoring is crucial for early detection of changes that may signal threatened reconstruction, helping to reduce complications, minimise length of hospital stay, and improve resource utilisation. This complex task is undertaken by a diverse multidisciplinary team, many of whom lack standardised training in flap monitoring creating the potential for variability in skill and practices. Methods We used QI methodology to conduct anonymous survey of 53 staff members across eight groups revealed significant gaps in confidence and education. In response to the findings we implemented a threefold intervention: a free flap observation chart, a unified escalation protocol, and an multimedia e-Learning module created using Articulate RISE360. Results Our survey highlighted 37.7% felt confident in assessing free/pedicled flaps, 60.4% in escalating concerns, and 52.8% had no formal training. Importantly, 100% supported the need for dedicated educational resources. Our targeted interventions led to improved staff confidence and competence in monitoring and escalation, demonstrated in the dedicated pre- and post e-learning feedback. Conclusions Empowering staff with standardised education, prompt and appropriate intervention can be enacted to mitigate delays in return to theatre and reduce length of stay. These outcomes directly contribute to a more sustainable healthcare service by optimising resource allocation and improving operational efficiency. This is the first NHS-based e-Learning module focused on flap monitoring, representing an innovative and scalable solution for modernising multidisciplinary education and improving patient care.

Elective caesarean section is a common and painful procedure. Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare-centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia. A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta-analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included. Sixty-one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50-100 μg or diamorphine 300 μg pre-operatively, and paracetamol, non-steroidal anti-inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs, with opioids used for rescue. The surgical technique should include a Joel-Cohen incision. The peritoneum should not be closed. An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up-to-date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long-acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques.

Arterial pressure is one of the most variable of human physiological measurements, as can be recognized by an examination of any of the 24 hour records that are produced by the new continuous recorders. There is a general tendency for pressure to increase during the day—mean evening values being a few mm Hg higher than mean morning values. Systolic pressure varies more than diastolic pressure, and in many people the highest systolic pressure during the 24 hours exceeds twice the lowest value ; in some hypertensive subjects systolic pressure by night may be lower than diastolic pressure by day.

Previous stage I-III colon cancer trials demonstrated improved peri-operative and similar long-term oncological outcomes with minimally invasive approaches compared with open surgery. Subsequent technical developments, including intracorporeal anastomosis, complete mesocolic excision (CME), refined pathologic grading systems and robotic approaches are increasingly used despite minimal supporting evidence. This international phase II trial aims to assess patient, surgical and pathological outcomes following robotic (RRHC) with laparoscopic right hemicolectomy (LRHC) for right sided colon cancer. Prospective, international multicentre pilot randomised phase II trial for patients with right colon adenocarcinoma, randomised 2:1 to robotic (RRHC) or laparoscopic (LRHC) surgery performed by accredited surgeons. Primary outcome was 90-day surgical morbidity measured using the Comprehensive Complication Index (CCI). Standardised pathology reviews, patient reported quality of life and surgeon task load index data was captured. RRHC vs. LRHC surgery allocation was 19 vs. 10, mean operative time 3.8 vs. 3.1 h with no operative mortality, all had R0 resection, CME rate 53 vs. 50% and intact mesocolon 94 v 100%. CCI was significantly lower at 30 and 90 days after RRHC (median (Q1, Q3): 0 (0, 9) vs. 21 (21, 26); median difference: 21; 95% CI 9-26; p = 0.005 at 30 days; p = 0.008 at 90 days). No significant differences in pathological nor quality of life data was observed. Surgeons task load data tended to favour robotic procedures. Median follow-up was 6 months. Limited funding led to early study closure. RRHC improved short-term surgical morbidity and surgeon physical demand and performance whilst obtaining similar quality of life and pathological specimen quality compared to LRHC for right sided colon cancer, supporting the case for larger randomised trials. ACTRN12620001378910.

Artificial intelligence (AI) and intensive learning show promise in ophthalmology, using optical coherence tomography (OCT) to diagnose conditions such as diabetic retinopathy. However, precise segmentation of retinal fluid remains challenging, especially in atypical cases and low-quality scans. In hospital settings, manual segmentation is time-consuming; however, integrating human expertise with AI could improve efficiency and accuracy in quantifying retinal pathologies. This review assesses the efficacy of human-AI collaborative workflows for enhancing the accuracy, efficiency, and clinical utility of retinal pathology quantification in OCT.We conducted a systematic review of the literature from 2021 to 2025 across three databases: PubMed, Web of Science, and Scopus. This review included nine studies that quantified retinal pathology using human-AI collaborative workflows in OCT. Two independent reviewers screened the records, extracted relevant data, including study design, AI architecture, and performance metrics, and assessed the quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies - 2nd version (QUADAS-2 ) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. This systematic review of nine AI-OCT studies (2021-2025) found that hybrid AI-clinician workflows achieved expert-level reliability for 11 of 13 retinal biomarkers across cohorts of 16-1,097 individuals. AI architectures, including U-Net variants, polypoidal choroidal vasculopathy (PCV)-Net, and custom convolutional neural networks (CNNs), performed well for well-defined features such as retinal layers (Dice 0.94), intraretinal/subretinal fluid (Dice 0.61-0.67), and atrophic areas (F1 0.78-0.89), but struggled with complex biomarkers like sub-retinal pigment epithelium (sub-RPE) lesions (Dice 0.11). Clinician agreement on fluid volumes was strong (Pearson r > 0.85), though volumetric errors increased in atrophic regions. These workflows reduced processing time by over 50% compared with manual grading while improving monitoring precision for neovascular age-related macular degeneration (AMD) and retinitis pigmentosa complications in both single-center and international trial settings.Combining AI quantification with clinician expertise enhances both the accuracy and efficiency of retinal pathology assessments. This integration supports personalized treatment planning and facilitates large-scale research. Hybrid approaches address AI's limitations, highlighting their practicality for clinical use in ophthalmology. We suggest incorporating hybrid AI-human workflows in clinical practice to improve the efficiency and accuracy of OCT analysis. Future developments in AI should focus on standardized training for complex biomarkers, such as sub-RPE lesions.

Purpose There is limited information about dysphagia therapy for adults with dysphagia and tracheostomy tube (TT). We describe current empirical evidence to guide clinical practice and facilitate future discussions. Methods and Materials We conducted a scoping review to identify methodological features of dysphagia therapy in adults with a TT. Results Ten electronic databases from inception to November 2024 were searched. Based on inclusion criteria, 24 studies were analysed. The papers were divided into therapy approaches: (i) oral phase (ii) oropharyngeal phase (iii) oropharyngeal and respiratory phase iv) pharyngeal phase and v) respiratory phase and were reported against the adapted version of the Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide [1]. Seven papers reported on pharyngeal electrical stimulation (PES) which showed statistically significant results for decannulation, whilst nine studies used multiple dysphagia therapy interventions without clear distinctions in methodological approach. Outcome measures are varied and limited in use. Conclusion Various dysphagia therapies have been described for use in patients with TT but outside of PES, it is challenging to draw conclusions on the effect of specific dysphagia therapies on swallowing outcomes. More research is required to establish standardised protocols and outcome measures.

BackgroundStress echocardiography is a key imaging modality for assessing coronary artery disease in the UK. Traditionally, stress echo services were led by consultant cardiologists, but evolving workforce models have increased the involvement of cardiac physiologists and scientists. This study, as part of the National Review of Stress Echocardiography Practice (BSE N-STEP), aimed to evaluate current stress echo workforce structures and test outcomes across a group of UK hospitals to inform future workforce planning.ResultsData were analysed from 8506 stress echocardiograms, conducted between September 2020 and June 2023 across 34 UK hospitals. Based on the supervising workforce, stress echocardiograms were allocated into either a doctor-led (DL) or cardiac physiologist/scientist and nurse-led (CNL) model. 56.9% of stress echocardiograms were DL, while 42.7% were conducted under a CNL model. Physiologists/scientists were the most frequently involved staff (81.9%). The primary indication for stress echocardiography was ischaemia evaluation (89.4%). Dobutamine stress echocardiography was more common in DL services (63.0 vs. 56.3%, p < 0.001), while CNL services performed more exercise stress echocardiography (42.8 vs. 36.4%, p < 0.001). Test positivity rates were similar between DL and CNL models (17.1 vs. 17.7%, p = ns), though the CNL group had a lower complication rate (2.2 vs. 5.3%, p < 0.001). Reporting of stress echocardiograms remained consultant-led in 82% of cases, but physiologist/scientist-led reporting showed an increase over time. Training was primarily provided to registrars/fellows (60.2%), with physiologist/scientist trainees accounting for 32.4%. ConclusionsThis study provides a contemporary overview of stress echocardiography workforce models in the UK, highlighting the increasing role of cardiac physiologists and scientists in supervising and reporting stress echocardiography. Despite these shifts, consultant cardiologists remain central to stress echo reporting. The findings support the integration of multidisciplinary workforce models to enhance service efficiency. These insights will aid in future workforce planning and training strategies to optimise stress echocardiography service provision across the NHS. Supplementary InformationThe online version contains supplementary material available at 10.1186/s44156-025-00088-x.

<h2>ABSTRACT</h2><h3>Objectives</h3> To perform a systematic literature review (SLR) to inform the EULAR Task Force "Points to Consider for the definitions of Difficult-to-Manage (D2M) and Treatment-Refractory (TR) psoriatic arthritis (PsA)". <h3>Methods</h3> The SLR addressed 3 separate questions concerning the following: (1) prevalence, (2) outcomes, and (3) predictors of D2M/TR PsA. A search was conducted in MEDLINE (Ovid), Cochrane Database of Systematic Reviews, CENTRAL, EMBASE, and Epistemonikos from inception to March 3, 2024, as well as EULAR/ACR abstracts for 2023/24 and 2022/23, respectively. This systematic review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. Data are summarised descriptively. Meta-analysis was not possible due to significant heterogeneity and/or lack of high-quality evidence. Risk of bias (RoB) was assessed using the Newcastle-Ottawa Scale. <h3>Results</h3> Overall, 70, 4, and 25 articles/abstracts were included for questions 1, 2, and 3, respectively. For question 1, 30/70 records had low/moderate RoB, with the prevalence of D2T PsA ranging from 5% to 80% depending on both the timepoint at which prevalence was measured and the definition of D2M/TR PsA applied, which varied significantly between studies. For question 2, all records had a high RoB; therefore, no conclusions could be drawn. For question 3, all records had a moderate RoB, and 84 categories of potential predictors were identified, with large differences in strength and direction of association between studies. <h3>Conclusions</h3> Despite significant heterogeneity in the published literature regarding the scope, definition, long-term outcomes, and predictors of D2M/TR PsA, certain patterns emerged that helped shape the final EULAR Task Force recommendations.

BackgroundRadiotherapy (RT) is a well‐established treatment modality in multiple myeloma (MM), particularly for skeletal‐related events. However, its role is likely evolving with the introduction of modern systemic treatments.MethodsWe conducted a retrospective analysis of a large, single‐centre MM cohort treated with contemporary protocols to describe current patterns of RT use.ResultsRT continues to offer clinical benefit, with shifting patterns of use observed compared to historical cohorts.ConclusionRT remains relevant in the modern MM landscape and may hold increasing value in later treatment stages. We postulate a future role as bridging therapy prior to CAR‐T/bispecific antibody treatment.Trial RegistrationThe authors have confirmed clinical trial registration is not needed for this submission

Introduction: Ignoring medical students on clinical placements is a form of mistreatment that is often overlooked. It is unclear how much research has been done on the topic. We performed the first United Kingdom (UK)-based systematic review on the topic of ignoring medical students. We employed a novel technique that incorporated the use of artificial intelligence (AI) to assist with the review.Methods: With the assistance of AI, Boolean search terms were generated to search through five databases in July 2025. Studies that described UK medical students being ignored were included in the final analysis. Inductive thematic analysis was performed to identify common themes between the studies. The Critical Appraisal Skills Programme (CASP) checklist for qualitative studies and the Mixed Methods Appraisal Tool (MMAT) for mixed-methods studies were utilized to assess study quality.Results: Six studies met the criteria to be included in the final analysis. Four common themes were identified when it came to ignoring medical students: exclusion from learning opportunities, emotional and professional invisibility, reporting barriers, and conflicting priorities between medical students and staff. Most of the CASP and MMAT points were met for the included studies, although studies had a small sample size, were often single-center studies, and had a skew toward students in the Midlands.Discussion: This novel AI-assisted systematic review provided vital information on how and why medical students are ignored in the UK. We propose that a vicious cycle exists when it comes to ignoring medical students. Specifically, students feel ignored, which leads to demotivation, ultimately resulting in disengagement. This leads to staff feeling as though students are uninterested, resulting in further ignoring of medical students. There is limited literature on the prevalence of ignoring medical students, and this is something that needs to be explored in the future.