University College Hospital

BackgroundThe clinical and prognostic implications of asymptomatic tuberculosis remain poorly understood.MethodsWe conducted a multicentre prospective cohort study to evaluate the association between asymptomatic tuberculosis (TB) and treatment outcomes. Individuals with rifampicin-susceptible pulmonary TB were enrolled from the Cohort Study of Pulmonary Tuberculosis. Asymptomatic TB was defined as the absence of any TB-related symptoms at diagnosis. The primary outcome was a favourable outcome, defined as treatment success without recurrence. Multivariable logistic regression models were used to assess associations between asymptomatic TB and favourable outcomes. The Cox proportional hazards model was applied to evaluate effect of asymptomatic TB on failure to complete treatment within 1 year. Stratified analyses by symptom status and mode of detection were performed to examine stratum-specific effects.ResultsOf 1071 individuals with pulmonary TB, 32.7% were asymptomatic. Compared to symptomatic patients, asymptomatic individuals were younger, less likely to be underweight and more often diagnosed through population health screening rather than clinical presentation or opportunistic testing. Asymptomatic TB was associated with higher likelihood of favourable outcome in multivariable models (adjusted odds ratio (aOR) 1.50, 95% CI 1.04–2.20) and a reduced risk of failing to complete treatment within one year in survival analyses (adjusted hazard ratio 0.66, 95% CI 0.45–0.95). Asymptomatic TB detected through health screening had the most favourable outcomes (aOR 2.41, 95% CI 1.34–4.66).ConclusionAsymptomatic TB was significantly associated with treatment success without recurrence and particularly in patients identified through health screening. Our results support symptom-agnostic screening in TB control programmes.

Computed tomography (CT) is the standard imaging modality for evaluating mild traumatic brain injury (mTBI) in emergency settings. However, most CT scans reveal no intracranial injury, raising concerns about unnecessary radiation exposure, healthcare costs, and diagnostic delays. Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) are promising biomarkers for mTBI assessment. The i-STAT® TBI Plasma cartridge enables rapid assessment of these biomarkers. This study evaluated clinical performance of the TBI Plasma cartridge, focusing on its potential to reduce unnecessary CT utilization and improve diagnostic turnaround times. A single-centre observational study was conducted in an academic emergency department. Adult patients presenting with head trauma and a GCS of 15 were enrolled. TBI biomarker testing was performed and compared to CT findings. In 141 adult patients, the TBI plasma cartridge demonstrated 100% sensitivity, 34.1% specificity, 6.3% positive predictive value (PPV), and 100% negative predictive value (NPV). Among patients <90 and<65years old, specificity was 34.6% and 60.7% respectively. In patients with non-elevated biomarkers, CT imaging could have been avoided in 32.6% of patients, saving an estimated 72.8h. Diagnostic wait time associated with TBI biomarker testing was 14.3h (4.6%) less than waiting for CT results alone. The TBI plasma cartridge demonstrated excellent sensitivity and NPV in identifying patients without intracranial injury on CT. These findings suggest the potential for the TBI cartridge to efficiently and safely rule-out unnecessary CT imaging and reduce turnaround times for diagnostic test results, which may facilitate improved ED throughput.

Objective.Ultrasound (US) is commonly used to guide minimally invasive procedures; however, its effectiveness is often limited by poor needle-tip visibility. This work presents a 3D US imaging and needle-tip tracking system based on US multilateration, toward real-time, safe and efficient guidance.Approach.The proposed system integrates a fiber-optic hydrophone within a medical needle to receive US transmissions from a sparse 2D matrix array probe used for 3D imaging. Chirp excitation was employed to improve the signal-to-noise ratio and enable robust time-of-arrival estimation. A multilateration algorithm was employed for needle-tip localization relative to the US probe, requiring fewer US elements and achieving substantially faster performance than existing methods.Main results.The system achieved spatial tracking accuracy of1.27±0.65 mm using only 13 active elements, representing an order-of-magnitude increase in tracking speed from 3.77 to 45.45 Hz compared to a conventional delay-and-sum-based tracking algorithm with 256 elements. The translational potential of the system was further demonstrated withex vivochicken tissue, and a clinically realistic femoral nerve block phantom.Significance.These results demonstrate the feasibility of a multilateration-based system that combines 3D anatomical visualization with needle tracking. With further improvements towards real-time operation and validation under clinically relevant conditions, this approach could improve the precision and safety of US-guided interventions.

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.

Background: Understanding the patterns of documentation among endodontic caregivers, ranging from students and registrars to consultants, can provide valuable insights into systemic strengths and weaknesses within dental service delivery frameworks. Objective: This study evaluated the adequacy of radiographic documentation in endodontic treatment, assessing the frequency of preoperative, intraoperative, and postoperative radiographs, and determining factors associated with adequate reportage. Methods: A retrospective review was conducted on 357 patient records treated for endodontic conditions at a tertiary dental hospital. Data extracted included demographic variables, designation of the attending caregiver, radiographic documentation, diagnosis, and treatment type. Adequacy of radiographic reportage was defined by inclusion of the coronal surface, apical structures, periodontal ligament space, and canal patency in the recorded findings. Descriptive and inferential statistics, including chi-square tests, were performed at a 5% significance level. Results: Patients were predominantly aged 20–29 years (25.2%) and female (56.0%). Most treatments were rendered by registrars (88.2%). Although 96.9% of cases had preoperative radiographs, and 88.5% and 85.7% had master cone and obturation radiographs respectively, only 16.2% of records met the criteria for adequate documentation. Acute apical periodontitis (36.4%) was the most common diagnosis, and conventional root canal therapy accounted for 86.8% of treatments. The association between caregiver designation and adequacy of radiographic documentation was not statistically significant (p = 0.287). Conclusion: While radiographs were widely utilized in endodontic care, comprehensive documentation was suboptimal. Structured training and adherence to documentation protocols are essential to improve radiographic reporting standards and ensure medico-legal accountability in clinical practice.

When patients report a penicillin allergy (self-reported penicillin allergy, SRPA), clinicians alter their antibiotic management of the patient. However, fewer than 5% of SRPA have life-threatening reactions, and receiving narrower spectrum antibiotics may result in under treatment. Reports from community studies suggest that patients with SRPA are more likely to come to harm, but as SRPA implies exposure to healthcare, it is unclear whether additional harm is as a result of co-morbidities and the need to receive healthcare, rather than a harm in itself. This raises the question of how great an impact SRPA has on hospital and ICU mortality for patients admitted to hospital. A literature search will be performed using MEDLINE, Embase and CINAHL (via OVID) in October 2024. The eligible studies will be of adult hospitalised patients with penicillin allergy compared with their non-allergic counterparts. We will extract demographic and outcome data including whether the patients were treated in ICU and mortality (28-days, in-ICU or in-hospital). If possible, the results will be pooled for a meta-analysis by combining the all-cause mortality of patients at 28 days, in-ICU or in-hospital. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies is less than 10. Previous reports of poor outcomes from SRPA are often based around increased risk of increased antibiotic use and antibiotic resistance. The requirement of SRPA to develop where there is exposure to healthcare and co-morbidities may mean that these outcomes are derived from poorer health rather than from SRPA perse. The impact of SRPA on hospitalised patients is less understood, with outcomes that are well-defined, such as mortality. This review will outline the differences that exist, and a meta-analysis may define the size of any differences. PROSPERO CRD42024537658.

Surveillance of individuals with a familial predisposition to pancreatic ductal adenocarcinoma (PDAC) is likely to increase overall survival. Our objective was to determine the impact of EUROPAC risk-stratification (Family Risk, FR), in such predisposed individuals. Observational study of registered asymptomatic individuals undergoing surveillance for PDAC. Individuals without a known pathogenic variant (PV-), ineligible for genetic assessment in the NHS, in whom significant pancreatic lesions were found, were subjected to additional germline testing. Between January 2000 and April 2025, 893 individuals started surveillance, median age of 52 years. 508 individuals (404 PV- and 104 with a pathogenic variant (PV+)) in the 20 years prior to 2020 without stratification were compared to 385 (269 PV- and 116 PV+) in the five years from 2020 who had FR risk-stratification applied. Four (0·8 %) individuals had actionable pancreatic findings prior to risk stratification vs. 14 (3·6 %), who underwent risk-stratified surveillance (p = 0·001). Pancreatic lesions deemed operable were found in three (0·6 %) and 11 (3 %), p = 0·007, with two (0·4 %) and nine (2 %) undergoing resection, p = 0·009, respectively. PV- individuals with significant findings were subsequently found to contain mutations, many not in the UK genetics test directory, provided the FR was > 30. The median (IQR) time in surveillance prior to a lesion being detected was four (2 - 7) years. Overall, 78 % of EUROPAC detected precursor lesions or pancreatic cancers were stage II or lower. The risk-stratified group (FR) identifies neoplastic pancreatic lesion in individuals, regardless of PV status suggesting the key usefulness of this approach.