Princess Royal University Hospital

National privacy laws diverge between the European Union and United States, hindering transatlantic health data exchange and slowing AI-driven medical innovation. In response, the German Ministry of Health launched the pre-competitive Data for Health initiative, leading to the BRIDGE Pilot Study (2023-2025), a researcher-led effort to address this regulatory and legal gap. Using a mixed-methods approach, including structured surveys (n = 56 expert responses), ranking of steps via relative importance indexing, and 4 Delphi meetings, experts co-developed a practical framework composed of 30 steps in 3 consecutive phases for legally compliant and technically interoperable EU-US health data collaboration. The framework emphasizes early data protection assessments, secure transfer protocols, and iterative governance checks. The final consensus framework provides a stepwise guide to navigate regulatory and legal complexities and operationalize cross-border research. Ongoing input from researchers and stakeholders will help ensure the framework remains adaptable and provides a clear, scalable foundation for cross-border health data exchange.

Background and objectivePlacenta accreta spectrum (PAS) is a severe obstetric complication associated with significant maternal morbidity and mortality. As cesarean delivery rates continue to rise, the prevalence of PAS is increasing, creating a growing challenge for healthcare systems. This study aimed to present a comprehensive analysis of the multidisciplinary management of PAS in a tertiary care center.MethodsWe performed a retrospective case series of eight consecutive cases of PAS managed at a tertiary care government hospital between January 2023 and December 2024 (24 months). Data were collected from hospital records, including patient demographics, clinical presentation, imaging findings, surgical management, and maternal outcomes. All cases were managed by a dedicated multidisciplinary team.ResultsThe study included eight patients with a mean age of 29.6 years. All patients had undergone at least one previous cesarean section. The mean gestational age at diagnosis was 32 weeks, and the mean gestational age at delivery was 36.4 weeks. Six patients underwent cesarean hysterectomy, one had a hysterotomy with uterine artery embolization (UAE), and one had a conservative management approach. The mean estimated blood loss was 2.1 litres. There were no maternal deaths, and the most frequent complication observed was bladder injury (n=2).ConclusionsThis study highlights the importance of a multidisciplinary approach in the management of PAS. Early diagnosis, individualized management strategies, and a coordinated team of specialists can lead to favorable maternal outcomes, even in complex cases. Our results highlight the importance of establishing specialized centers of excellence for managing PAS.

Artificial intelligence (AI) is affecting the practice of orthopedic surgery, offering innovative solutions from preoperative planning to intraoperative guidance and real-time adaptation. This review highlights current advancements in AI-driven imaging analysis, anatomical segmentation, and implant selection, highlighting improvements in surgical precision, efficiency, and patient-specific customization. Intraoperatively, AI enables real-time image processing, integration with robotic systems, and adaptive feedback mechanisms that enhance accuracy, reduce complications, and personalize care. Clinical applications span joint replacement, spine, and trauma surgery, where AI supports diagnosis and offers support in decision-making, often surpassing conventional methods. Despite these promising developments, challenges remain regarding data quality, model generalizability, transparency, and ethical considerations. Future directions emphasize explainable AI, multimodal data integration, and closer synergy between AI, robotics, and digital health to advance personalized orthopedic care.

Fournier's gangrene (FG) is a life-threatening multi-aetiological and polymicrobial infective necrosis of the external genitalia, perineum, and peri-anal regions. Early recognition and aggressive multidisciplinary medical and surgical management are essential to reduce long-term morbidity and mortality. Acute appendicitis is a rare cause of FG. Here, we report the management of a 90-year-old man presenting atypically with a perforated appendicitis resulting in FG.

Hospital admission for heart failure (HF) is associated with increased mortality risk. Patients admitted with HF can be divided into those with a known previous diagnosis of HF and de novo cases. However, few studies have compared these groups. We compared long-term outcomes of patients with de novo versus acute decompensated HF (ADHF). We included data from two London hospitals, King's College Hospital and Princess Royal University Hospital. Data from all admissions were collected from the National Institute for Cardiovascular Outcomes and Research (NICOR) National Heart Failure Audit (NHFA) between 2020 and 2021. The outcome measure was all-cause mortality. A total of 561 patients were included in the study. One third (29%) were de novo hospitalisations. Over a median follow-up of 15 (interquartile range 4-21) months, 257 (46%) patients died. Hospitalisation for ADHF was associated with higher all-cause mortality during follow-up (51% vs 34%, p<0.001). In adjusted models, hospitalisation for ADHF remained independently associated with higher all-cause mortality during follow-up (HR 0.60, 95% CI 0.38-0.96; p=0.03). Amongst patients hospitalised for HF, having a history of HF is associated with a higher risk of all-cause mortality than de novo cases. This may have implications for randomised studies that do not routinely document patients' HF history. Prospective studies are needed to elucidate the risk profiles of these two distinct populations for better risk stratification.

BackgroundThe national agenda to increase care outside the acute setting through virtual wards offers key opportunities for palliative care services to give intensive, timely support to enable patients to die at home, where otherwise they would need care in hospital/hospice setting. Coordinated, integrated services across professional groups/settings is essential to achieve this.AimTo evaluate a new model of working to expedite hospital discharges and avoid hospital admissions for patients requiring enhanced support to die at home.MethodHospital at Home accepts patients to: Frailty, Respiratory, IVs, Palliative pathways with joint working across pathways. We evaluated outcomes for patients under palliative pathway. Referrals were from: hospital, GPs, Rapid Response and hospice. Two clinicians (nurse/paramedic), with access to medical support, led the service with in-reach to the hospital and Hospital at Home team.ResultsOver 22 weeks, 106 patients accepted, 26% from hospital, 74% in home/care homes. 42% known to community palliative care (CPCT) but required urgent/intensive support. 66% were seen within 4 hours and 85% within 24 hours. 85% had 1–3 visits before either death (12%) or discharge to other services (50% to CPCT, 25% to GP). Three patients were admitted to hospice, one didn’t get out of hospital. Patient care focused on symptom control, support at end-of-life, complex discussions between patient, family and health care professionals to establish ceilings of treatment and hold risk, with urgent procurement of equipment and medications. Hospital admission avoided in 15% and hospital discharge expedited in 30%. Family and care home staff support were key. Challenges included development of coordinated IT systems, facilitating cross-organizational working and development of shared ethos and education.ConclusionThis is a flexible and responsive service seeking to join up care across organizations and settings. Learning and ongoing evaluation are shaping its development to establish its role within the wider system.

Radiotherapy (RT) has become an integral part of cancer treatment worldwide; it aims to arrest the uncontrolled growth of tumor cells by using high-energy rays. Radiation proctitis is a known clinical manifestation after the RT regime for pelvic malignancies. Radiation proctitis can have a variable presentation, and there are a lot of patient-related factors that can affect the eventual outcome. In most instances, it is self-limiting; however, it can become chronic in some cases and can affect the quality of life. Many treatment options are recommended, but there has been no consensus on the treatment protocols for managing this known clinical condition. We have tried to briefly describe its pathogenesis, important factors affecting the outcome, and available treatment strategies.

Abstract Introduction Low cystic duct insertion is uncommon, and the presence of multiple large stones in the cystic duct with normal laboratory investigation is rare. The infrequency with which it is encountered and the management done makes this an interesting presentation. Case presentation A 61-year-old female with incidental gall stones and possible CBD/cystic duct stones on a CTAP during a workup for management of an incisional hernia of the abdomen. The patient initially presented with abdominal pain that was thought to be due to the incisional hernia. On examination, the patient had a soft abdomen with no jaundice and normal laboratory investigations. MRCP scan demonstrated multiple gall stones and cystic duct stones suggestive of Mirizzi syndrome. The patient underwent laparoscopic repair of the incisional hernia and cholecystectomy with an on-table cholangiogram. Cholangiogram showed a low inserting cystic duct joining the common hepatic duct at the sphincter of Oddi with an almost nonexistent common bile duct and a cystic duct containing multiple mega-large stones. The cystic duct was explored and stones were milked out except the most inferior stone which was impacted at the sphincter of Oddi. This was dislodged with a Fogarty catheter and all stones were retrieved. Completion cholangiogram demonstrated complete clearance of the biliary tree with dye entering the duodenum. The patient recovered well postoperatively with no complications at 1 month post-operative. Conclusion This case illustrates a rare presentation of large cystic duct stones in the presence of abnormal anatomy and provides an option for surgical management.

Purpose of the ReviewThis review summarizes current knowledge regarding cricoid pressure in rapid sequence induction. It assesses anatomical concepts, current practice, guidance, evidence of safety and efficacy, and future directions.Recent FindingsGuidelines have variable recommendations for cricoid pressure, and surveys underscore this variation in practice. Systematic reviews and meta-analyses suggest that cricoid pressure may be associated with worse views at direct laryngoscopy, but there is currently no robust data demonstrating that cricoid pressure reduces the risk of pulmonary aspiration. However, evidence demonstrates that correct anatomical localization of the cricoid cartilage is inaccurate without the use of ultrasound, and therefore most of the existing evidence is currently unreliable regarding true efficacy. Moreover, the widespread use of videolaryngoscopy means that worsening views at laryngoscopy might be less of a concern than previously thought.SummaryCurrent literature and global practice suggest that it is a clinician’s decision based on individual patient risks, and that cricoid pressure—as it is currently performed—likely provides no benefit but probably does minimal clinically relevant harm. The role of accurate cricoid cartilage localization and videolaryngoscopy remains to be fully investigated.