St Albans City Hospital

Background/Objectives: Large Language Models (LLMs) may help translate complex Magnetic Resonance Imaging (MRI) fistula reports into accessible, patient-friendly summaries. This study evaluated the clinical utility, safety, and patient acceptability of Generative Pre-trained Transformer (GPT-4o) in generating such reports. Methods: A three-phase study was conducted at a single centre. Phase I involved prompt engineering and pilot testing of GPT-4o outputs for feasibility. Phase II assessed 250 consecutive MRI fistula reports from September 2024 to November 2024, each reviewed by a multi-disciplinary panel to determine hallucinations and thematic content. Phase III randomised patients to review either a simple or complex fistula case, each containing an original report and an Artificial Intelligence (AI)-generated summary (order randomised, origin blinded), and rate readability, trustworthiness, usefulness and comprehension. Results: Sixteen patients participated in Phase I pilot testing. In Phase II, hallucinations occurred in 11% of outputs, with unverified recommendations also identified. In Phase III, 61 patients (mean age 48, 41% female) evaluated paired original and AI-generated summaries. AI summaries scored significantly higher for readability, comprehension, and usefulness than original reports (all p < 0.001), with equivalent trust ratings. Mean Flesch-Kincaid scores were markedly higher for AI-generated summaries (66 vs. 26; p < 0.001). Clinicians highlighted improved anatomical structuring and accessible language, but emphasised risks of inaccuracies. A revised template incorporating Multi-Disciplinary Team (MDT)-focused action points and a lay summary section was co-developed. Conclusions: LLMs can enhance the readability and patient understanding of complex MRI reports but remain limited by hallucinations and inconsistent terminology. Safe implementation requires structured oversight, domain-specific refinement, and clinician validation. Future development should prioritise standardised reporting templates incorporating clinician-approved lay summaries.

Perianal fistulising Crohn's disease (pfCD) affects 1 in 5 Crohn's patients and requires frequent MRI monitoring. Standard radiology reports are written for clinicians using technical language often inaccessible to patients, which can cause anxiety and hinder engagement. This study evaluates the feasibility and safety of AI-generated patient-friendly MRI fistula summaries to improve patient understanding and shared decision-making. MRI fistula reports spanning healed to complex disease were identified and used to generate AI patient-friendly summaries via ChatGPT-4. Six de-identified MRI reports and corresponding AI summaries were assessed by clinicians for hallucinations and readability (Flesch-Kincaid score). Sixteen patients with perianal fistulas were randomized to review either AI summaries or original reports and rated them on readability, comprehensibility, utility, quality, follow-up questions, and trustworthiness using Likert scales. Patients rated AI summaries significantly higher in readability (median 5 vs. 2, p = 0.011), comprehensibility (5 vs. 2, p = 0.007), utility (5 vs. 3, p = 0.014), and overall quality (4.5 vs. 4, p = 0.013), with fewer follow-up questions (3 vs. 4, p = 0.018). Clinicians found AI summaries more readable (mean Flesch-Kincaid 54.6 vs. 32.2, p = 0.005) and free of hallucinations. No clinically significant inaccuracies were identified. AI-generated patient-friendly MRI summaries have potential to enhance patient communication and clinical workflow in pfCD. Larger studies are needed to validate clinical utility, hallucination rates, and acceptability.

Abstract ObjectivesThe aim of this study was to conduct a pilot evaluation of a novel six‐week school‐based intervention (‘Haven Schools’) on young people's psychological wellbeing.MethodsOne hundred and forty‐one students (ages 12–16 years) from 11 schools in England attended up to six sessions of the intervention at their school during the day. Psychological wellbeing was evaluated at each session using the overall score on the Young Person's Core‐10 (YP CORE‐10) outcome measure, and anxiety and self‐harm were evaluated using individual questions in the YP CORE‐10.ResultsParticipants' psychological wellbeing was significantly better at their last session compared to their first session. Anxiety and thoughts of self‐harm were also significantly lower in last sessions compared to first sessions. Attendance was good, with 64% attending at least four sessions (M = 3.99 sessions attended).ConclusionsThe Haven Schools programme appears to have promising initial results; however, further investigation using a control group and longer‐term follow up are warranted.Patient Consent StatementThis was an analysis of secondary data used to evaluate the programme, and therefore did not fall within the remit required for ethical review. Each school managed the issue of parental consent differently depending on their own rules. One school felt that it was not necessary to get parental consent as they felt it could be a barrier to some young people attending as they may not want their parents to know. However, most schools sent parents of students who indicated an interest an information letter, and asked parents to email the school with consent.

In response to Nikki Bell’s Forum article “Why breadth beats depth” (p19) in which she says that subject-matter experts do not necessarily make the best teachers, and that having broader knowledge of the sciences is often more useful while communicating with students.

Current glycoconjugate vaccines are a group of products with similar gross structures, are manufactured by common processes, under common regulatory requirements and with similar critical quality attributes (CQAs). The analytical methods used to characterise and control the quality of this family of products are similar. Due to their relatively simple structures, high purity and the limitations of in vivo approaches, physicochemical methods have been widely used to characterise these vaccines and predominate for the control of these products. Product control typically uses a subset of the methods used for characterisation. This chapter attempts to provide a structured guide to the manufacturing processes, regulatory requirements and analytical methods applied to current products, and in the expectation that similar requirements will exist for future novel products.

Psychoanalysis (including analytical psychology), once a pioneering and forward-looking movement of the early 20th century has now become a conservative backward-looking 'tradition'. After considering some of the internal problems associated with this historical change such as idealization and tribalism, some ways forward are suggested - a focus on clinical excellence as practical craft, openness to the unknown and engagement with others beyond the confines of private practice.