Portsmouth Hospitals NHS Trust

In non-small cell lung cancer (NSCLC), non-invasive alternatives to biopsy-dependent driver mutation analysis are needed. We reviewed the effectiveness of radiomics alone or with clinical data and assessed the performance of artificial intelligence (AI) models in predicting oncogene mutation status. A PRISMA-compliant literature review for studies predicting oncogene mutation status in NSCLC patients using radiomics was conducted by a multidisciplinary team. Meta-analyses evaluating the performance of AI-based models developed with CT-derived radiomics features alone or combined with clinical data were performed. A meta-regression to analyze the influence of different predictors was also conducted. Of 890 studies identified, 124 evaluating models for the prediction of epidermal growth factor-1 (EGFR), anaplastic lymphoma kinase (ALK), and Kirsten rat sarcoma virus (KRAS) mutations were included in the systematic review, of which 51 were meta-analyzed. The AI algorithms' sensitivity/false positive rate (FPR) in predicting mutation status using radiomics-based models was 0.754 (95% CI 0.727-0.780)/0.344 (95% CI 0.308-0.381) for EGFR, 0.754 (95% CI 0.638-0.841)/0.225 (95% CI 0.163-0.302) for ALK and 0.475 (95% CI 0.153-0.820)/0.181 (95% CI 0.054-0.461) for KRAS. A meta-analysis of combined models was possible for EGFR mutation, revealing a sensitivity of 0.806 (95% CI 0.777-0.833) and a FPR of 0.315 (95% CI 0.270-0.364). No statistically significant results were obtained in the meta-regression. Radiomics-based models may offer a non-invasive alternative for determining oncogene mutation status in NSCLC. Further research is required to analyze whether clinical data might boost their performance. Question Can imaging-based radiomics and artificial intelligence non-invasively predict oncogene mutation status to improve diagnosis in non-small cell lung cancer (NSCLC)? Findings Radiomics-based models achieved high performance in predicting mutation status in NSCLC; adding clinical data showed limited improvement in predictive performance. Clinical relevance Radiomics and AI tools offer a non-invasive strategy to support molecular profiling in NSCLC. Validation studies addressing clinical and methodological aspects are essential to ensure their reliability and integration into routine clinical practice.

Research has shown elevated perceived stress (PS) and Imposter Phenomenon (IP) levels among healthcare students; however, apprenticeships remain understudied. This study aimed to compare the levels of PS and IP between Medical Imaging students on traditional (BSc UG) and apprenticeship (BSc DA and MSc DA) courses at one university in the United Kingdom. The study used an online survey applying the Perceived Stress Scale (PSS-10) and the Clance Imposter Phenomenon Scale (CIPS). Statistical analysis and thematic analysis were undertaken. PSS-10 (n = 49 responses)- BSc DA students had a lower level of PS (mean = 18, p < 0.05) than BSc UG and MSc DA students (mean = 24). Most respondents reported moderate or high levels of stress. Thematic analysis highlighted stressors included university and personal factors and overlap between the two areas. CIPS (n = 45 responses)- The highest levels of IP were in BSc UG students (mean = 71) and the lowest in the BSc apprentices (mean = 63), however, p > 0.05. Over 60 % of all students had clinically significant IP levels. Thematic analysis found feelings of 'not belonging' and 'self-perception' enhanced feelings of IP, and self-belief was protective. Most students continue to have high levels of PS and IP regardless of course. Qualitative responses for both found similar contributing factors for all courses; however, 'not belonging' only contributed to IP for BSc UG students and protective factors for PS and IP were only mentioned by apprentices. Due to high levels of PS and IP, educational interventions may aid implementation of coping measures to support students. Further research on PS and IP in the first year of practice would allow a greater understanding of the impact of different educational models.

BACKGROUNDMajor trauma is the sixth leading cause of death worldwide and the leading cause of death and disability in the population aged 5 years to 45 years. The assessment is typically guided by strict protocols to quickly identify life-threatening conditions before conducting a comprehensive evaluation of other injuries. Whole-body computed tomography (WBCT) is often indiscriminately used in trauma cases.AIMTo assess the effective use of WBCT in patients with trauma across radiology departments in State of Kuwait, evaluate the true incidence of critical injuries, and minimize unnecessary radiation exposure.METHODSThis multicenter, retrospective study across seven radiology departments included 1367 patients with trauma who underwent WBCT between 2022 and 2023, according to the American College of Radiology guidelines. Data on age, sex, injury mechanism, clinical indications, dose-length product, and WBCT findings were collected and analyzed using IBM SPSS version 25.RESULTSOf 1367 referrals, 578 (42.3%) had no significant findings, while 789 (57.7%) showed positive trauma-related results. Among the positive findings, 530 patients (38.8%) had major injuries, including solid organ and vertebral column injuries. The most common causes of WBCT referrals were road traffic accidents (911 patients, 66.6%), falls from height (182 patients, 13%), falls of heavy objects (112 patients, 8%), head trauma (82 patients, 6%), buggy accidents (28 patients, 2%) and others. Negative WBCT findings had a mean effective dose of 19.98 ± 10.26 mSv.CONCLUSIONThis national audit demonstrates that a substantial proportion of WBCT scans in patients with trauma are negative (42.3%), underscoring the need to rationalize imaging practices. The findings highlight the importance of evidence-based stewardship to enhance trauma care delivery in State of Kuwait.

Background Chronic disease in young adults is associated with poor healthcare engagement, poor health-related outcomes, and high-risk behaviours. However, there is minimal data regarding the outcomes of young adults with severe asthma. In this study we aimed to assess asthma characteristics and outcomes in young adults aged 16–25 years compared to older age-groups. Methods Using the UK Severe Asthma Registry, we undertook a retrospective observational analysis, comparing baseline assessment and annual follow-up data in young adults against other age-groups. We investigated differences in medication use, healthcare utilisation, exacerbation rates, lung function, airway inflammation, quality of life and co-morbidities using univariate and multivariable analysis. Results Registry data from 2812 participants was included, including 236 (8.4%) young adults. This age-group had the lowest levels of adherence and highest fractional exhaled nitric oxide, highest rates of emergency department attendance and hospitalisation, the second highest rate of intubation, and most frequently reported anxiety and depression. Data from the first annual review confirmed this age-group still had the highest rate of emergency department attendance, hospitalisation and the smallest improvement in asthma control. Conclusion In this cohort, young adults with severe asthma were at a higher risk of poor clinical outcomes, when compared to other age-groups. The higher rates of emergency treatment, admission and higher levels of airway inflammation suggest that they may experience more severe exacerbations, the reasons for which require further investigation. If a causative link is supported by further work, these findings suggest that age-specific management strategies should be explored towards improving clinical outcomes.

Abstract Introduction and aims Zinc is an essential electrolyte required for normal growth and development. Zinc has also been shown to improve neutrophilic dermatoses such as sterile pustular disorders due to reduction of phagocytic function of granulocytes, which in turn modulates the production of inflammatory proteins. However, there have been recent case reports of zinc supplementation resulting in hypocupraemia. Moreover, there are no existing international guidelines that suggest monitoring serum copper when replacing zinc. We aim to show that zinc supplementation is a safe and effective treatment and although there is a theoretical risk of hypocupraemia, this is not a real demonstrated phenomenon and should not prevent treatment. Methods Data were collected prospectively for patients who had been started on zinc replacement by our department, which required serum levels of both zinc and copper. Results There were no patients included in our population who displayed low serum copper as a result of zinc supplementation. The duration of zinc supplementation ranged from 1 to 13 years. Conclusions Zinc is a safe and cheap treatment available for neutrophilic disorders. This could be particularly helpful for patients in lower-income countries where expensive treatments and monitoring may not possible. Perhaps monitoring of serum copper levels once a year while on supplementation could prove beneficial. However, evidence is weak at this point and further data collection and evaluation is required.

To identify outcome domains of importance to adults undergoing prosthetic rehabilitation following lower limb amputation in low- and middle-income countries (LMICs), based on their lived experiences described in qualitative literature. Systematic review and qualitative synthesis informed by a critical realist perspective and reported according to ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. CINAHL, PsycInfo, Web of Science and Trip databases were searched from inception to April 2024. We included qualitative studies exploring the views and experiences of adults (≥18 years) using lower limb prosthesis in LMICs (World Bank definition). Studies including upper limb amputees, non-prosthetic users, mixed samples that could not be disaggregated or not reporting first-person accounts were excluded. Two reviewers independently screened studies using predefined criteria. Data were extracted from results sections, including participant quotations and author interpretations. Reflexive thematic analysis was conducted to identify outcome domains across studies. Study quality was appraised using the CASP (Critical Appraisal Skills Programme) qualitative checklist; no studies were excluded based on quality. Five studies involving 55 participants from Nepal, Kenya, Cambodia, Bangladesh and Kiribati met the inclusion criteria. Four outcome domains were identified: (1) The importance of a prosthesis: highlighting access, socket comfort, durability and functional suitability; (2) valued activities: particularly the importance of work and participation in daily living tasks; (3) acceptance following limb loss: encompassing community participation and self and social acceptance; and (4) independence: including reduced reliance on family and greater control over daily life. Across settings, participants emphasised prosthesis durability, work participation and culturally relevant function. Evidence on meaningful outcomes of prosthetic rehabilitation in LMICs is extremely limited. Findings indicate that access to a comfortable and durable prosthesis enabling work and daily living is central to recovery, alongside social acceptance and independence. These domains may provide initial insights into outcome measurement and development in low-resource settings. Further primary research across diverse LMIC contexts is urgently needed.

Abstract Aim Current recommendations for the clinical staging of patients undergoing resection for early oesophago-gastric (OG) cancer are variable and the value of staging investigations is unclear. The aim of this study was to assess current practice for staging early OG cancers across the UK, and the accuracy of staging with reference to nodal disease at surgery. Method Data for surgical patients was extracted from the CONGRESS database, a large UK-based multi-centre dataset for patients with T1N0 OG cancer between 2015 and 2022. Logistic regression analysis was performed to assess the association of different staging investigations on subsequent nodal upstaging. Cox regression analysis was used to analyse for impact on overall survival (OS). Results 497 patients from 28 centres were included, 13.1% of which underwent N upstaging from clinical to pathological staging. The rate of unexpected LNM was 12.7% in patients who underwent a CT pre-treatment, compared to 18.2% in patients with no staging investigations. Patients that underwent no staging investigations were also more likely to have unexpected nodal metastases at surgery (OR 6.66 (95%CI 1.34-33.24), p=0.021). The addition of PET-CT, EUS and staging laparoscopy had no significant impact on N upstaging (p=0.062, 0.053, and 0.690 respectively). No combination of staging modality had a significant impact on OS. Conclusions Current guidelines are variable in their recommendation of pre-operative staging investigations for early OG cancer. This study suggests CT plays an important role in the staging of this population. Other staging modalities could be considered selectively, rather than routinely, to preserve resources and accelerate treatment pathways.

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.