St Bartholomew's Hospital

ABSTRACT Introduction Most of the existing algorithms for manifest accessory pathway (AP) localization fall short in the diagnostic accuracy of distinguishing different pathway locations, particularly in the septal region. Objective and Methods This study aims at testing an ECG criterion, the PR/QRS ratio for differentiating manifest right septal APs from the right free wall APs. PR interval, QRS width and PR/QRS ratio were measured in the most pre‐excited lead. AP location was determined in LAO 45°. Septal locations: from 12 to 6 O'clock including right anterior at 12 O'clock, right anteroseptal between 12 and 3 O'clock, right mid‐septal at 3 O'clock, right posteroseptal between 3 and 6 O'clock and right posterior at 6 O'clock. Free wall locations: extending between 6 and 12 O'clock including right posterolateral between 6 and 9 O'clock, right lateral at 9 O'clock and right anterolateral between 9 and 12 O'clock. Results Among 89 patients, a higher 100*PR/QRS ratio was observed in the septal wall group when compared to the free wall APs group (77.86 +/− 0.91 vs. 64.95 +/− 2.07 < 0.001). Compared to PR interval and QRS duration, PR/QRS ratio had the best predictive performance with the highest accuracy (88.8%) and the largest area under the ROC curve (0.878) with a sensitivity of 93.8%, specificity of 75% and PPV of 91%. Conclusion The PR/QRS ratio is a simple yet powerful tool in localizing right sided accessory pathways that can potentially improve preprocedural counseling. However, this single‐center derivation study should be considered hypothesis‐generating and requires external validation.

To determine the future priorities for ectopic pregnancy research. Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for future ectopic pregnancy research. Healthcare professionals, people with lived experience of ectopic pregnancy, and others were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. Not applicable. Top 10 research priorities for ectopic pregnancy. The initial survey was completed by 855 participants from 35 countries, and 1,220 potential research questions were submitted. Three clinical practice guidelines and 43 Cochrane systematic reviews identified a further 24 potential research questions. A rationalized list of 49 confirmed research uncertainties was entered into an interim prioritization survey completed by 413 respondents from 20 countries. The top 10 research priorities were identified during a consensus development meeting involving 37 participants from 10 countries. These research priorities are diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of ectopic pregnancy. We anticipate that the identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with lived experience of ectopic pregnancy, and others, will help research funding organizations and researchers to develop their future research agenda.

AimsMultiple guidelines provide recommendations for assessing future risk of cardiovascular events in asymptomatic individuals without known coronary artery disease (CAD). We systematically reviewed current national and international guidelines that include imaging strategies for detecting subclinical CAD.Methods and resultsMEDLINE and EMBASE were searched for relevant guidelines published between January 2010 and December 2025. Major international guideline repositories and medical society websites were also screened. Two reviewers independently screened records assessed methodological rigour using the AGREE II instrument and extracted recommendations. Of four identified guidelines, three met predefined rigour thresholds and were included in the final analysis. Guidelines discouraged coronary artery calcium (CAC) use as a population-wide screening tool or in high-risk individuals. All three guidelines recommended limited use of scoring as a risk modifier in asymptomatic individuals when cardiovascular risk remains uncertain or near treatment thresholds and highlighted its role in shared decision-making. Differences were observed in the target populations for CAC assessment, recommendation strength, and re-screening intervals. Although CAC scoring was the principal imaging modality evaluated, CT coronary angiography was discussed in one guideline but not recommended due to insufficient evidence of clinical benefit.ConclusionCardiovascular imaging for the detection of asymptomatic coronary artery disease is not recommended in the guidelines for population screening or in high-risk patients. CAC use is recommended in specific cases such as where patients are near treatment thresholds for primary prevention. Ongoing randomized studies may provide further outcomes and cost effectiveness driven insights.

Approximately 10–15% of inpatients carry a penicillin allergy label, yet up to 90% are incorrect when tested. These inaccurate labels deprive patients of first-line beta-lactam antibiotics and are associated with higher surgical site infection rates, prolonged hospital stays, and increased costs, leading to use of broader-spectrum alternatives that contribute to antimicrobial resistance. Addressing this issue represents both a key perioperative challenge and a global antimicrobial stewardship priority.

The management of advanced prostate cancer has evolved significantly with the advent of androgen receptor-targeted agents (ARTAs) and docetaxel, which now form the cornerstone of first-line systemic therapy in advanced disease. However, as increasing numbers of patients progress after exposure to both an ARTA and docetaxel, optimal treatment sequencing in the post-ARTA, post-docetaxel metastatic castration-resistant prostate cancer (mCRPC) setting remains an area of clinical uncertainty, with limited comparative data to guide decisions. This narrative review synthesises the current evidence surrounding treatment strategies for mCRPC in this later-line setting. Available therapeutic options include radioligand therapy (e.g. lutetium-177–PSMA-617), cabazitaxel, PARP inhibitors (particularly for patients with DNA repair gene alterations), second-line ARTAs, further chemotherapy and immunotherapeutic approaches. However, direct head-to-head trials comparing these modalities are sparse, and much of the available data comes from retrospective or subgroup analyses, necessitating a nuanced interpretation of outcomes and limitations. Beyond efficacy, this article emphasises the critical role of practical and individualised considerations in therapy selection. These include toxicity profiles, patient comorbidities and preferences, biomarker-driven stratification (e.g. BRCA status, PSMA expression, sites of metastases), and health system factors such as drug availability and reimbursement policies, which may significantly influence access to optimal care. Finally, the review provides an overview of promising emerging therapies poised to expand the treatment landscape for mCRPC. These include bispecific T cell engagers, androgen receptor degraders, and antibody–drug conjugates, which are currently under investigation in clinical trials and may soon offer new avenues for treatment beyond traditional mechanisms.

Management of cardiovascular disease (CVD) requires a multidisciplinary approach based on expert input from physicians, nurses, and many different allied professionals (APs). Key challenges in CVD include health inequalities, sub-optimal risk factor detection and adherence with clinical guidelines, human resourcing issues, and inadequate patient education. Allied professionals can play key roles in addressing these challenges. However, current service models will need to be transformed to better integrate APs. Appropriate strategies may include the development of shared pathways with improved definition of roles and responsibilities, creation of 'competency frameworks' to facilitate advanced practice among APs, and enhanced sharing of best practice models.