University Hospitals Birmingham NHS Foundation Trust

Cutaneous leishmaniasis (CL) is a vector-borne protozoal infection that causes skin lesions. Military personnel make up around 45% of UK cases. This study reports an outbreak of 35 soldiers with suspected CL from an exercise in Belize. A prospective clinical analysis was conducted to characterise case presentations. Diagnostic results, time to cure and adverse effects were recorded. Thirty cases had laboratory-confirmed CL and three had suspected/resolved CL. Fifty percent of lesions were on the ear or face and 45% were on sites normally covered by clothing. Combined laboratory testing of skin biopsies confirmed a diagnosis in all cases. Ninety-three percent of species identified were Leishmania mexicana. Initial treatment was with miltefosine in 27 of the 30 confirmed cases. Five patients required second-line treatment with liposomal amphotericin B and one patient required third-line treatment with meglumine antimoniate. This study characterised the largest outbreak of CL from Belize in British Army personnel for at least 25y. Aspects of this outbreak were atypical and more research is required to investigate these. A simultaneous testing strategy with histology, microscopy and polymerase chain reaction of biopsy samples was sensitive. Treatment with miltefosine was less effective than expected in L. mexicana infection.

The integration of generative AI (GenAI) and large language models (LLMs) in healthcare presents both unprecedented opportunities and challenges, necessitating innovative regulatory approaches. In this perspective, we discuss the risks of GenAI and LLM-based medical devices, the limitations of current medical device regulation frameworks when applied to GenAI or LLMs, and advocate for global collaboration in regulatory science research through engaging multidisciplinary expertise and focusing on the needs of diverse populations.

Traumatic brachial plexus injuries (TBPI) are life-changing and can lead to permanent changes in function and pain within the arm and hand. Historically, TBPI research has reflected the priorities of researchers and clinicians rather than those with personal experience of living with a TBPI. The James Lind Alliance (JLA), supported by the National Institute for Health Research, has developed a rigorous methodology for increasing public engagement in research by giving an equal voice to patients, carers, and healthcare providers to ensure that their concerns are represented in future health research programmes. These projects are called priority setting partnerships (PSPs). A JLA PSP, comprising patients, carers and clinicians, was created and completed to agree future research priorities in adult TBPI. The JLA PSP methodology was followed throughout. One-hundred and fifty-four respondents replied to an initial survey generating 704 questions. These were assessed, grouped and combined to create 68 summary questions or 'uncertainties'. Three were excluded after literature review suggested they had already been answered by research. Seventy-nine respondents answered an interim prioritization survey, choosing their top ten from the summary questions. In a workshop, nine patients, two carers and 11 clinicians met, discussed and ranked the top 22 questions from the interim survey to identify the top 10 research priorities. Psychology, physical therapy treatments and management pathways were among the top ranked priorities. These results will inform researchers and funding bodies about research priorities for patients, carers and clinicians to direct future research on TBPI. V.

Assessment and management of dry eye disease (DED) in the UK is increasingly taking place outside of specialist ophthalmology settings. While comprehensive, evidence-based international guidance exists, much of it does not reflect the realities of practice in the UK. A panel of experts was brought together to identify areas of consensus on assessment, management, and appropriate referral of DED in the UK National Health Service (NHS). A questionnaire was circulated to a panel consisting of 15 optometrists, ophthalmologists, and corneal specialists with experience and expertise in DED. Based on their responses, consensus statements were developed and underwent two rounds of voting, in which respondents indicated to what extent they agreed with each statement. A core steering panel of seven experts discussed the results and provided further context for the statements. Strong or very strong consensus was reached for 57/62 statements. Statements with very strong consensus included guidance on the minimum symptoms and signs to be assessed on initial presentation and simple guidance for grading the severity of the disease. Statements regarding initial treatment were divided by setting (primary and secondary care), and a strong or very strong consensus was reached on 17/20 statements relating to treatment options in these settings. Statements specific to referral included approximate target timelines, where possible, as well as guidance on key supporting information to help improve the efficiency of patient care. This consensus provides a UK-focused resource to support consistent and effective care for patients with DED within the NHS.

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.

This study evaluates the dynamic changes in the quantity and quality of neutrophil-derived cell-free DNA (cfDNA) in whole blood and plasma samples from severe thermal and traumatically injured patients. Neutrophil-derived cfDNA, a component of neutrophil extracellular traps (NETs), is released during immune responses to injury and infection. Excessive NET formation mediates inflammation, tissue damage, and coagulopathy. Increased cfDNA levels in burn and trauma patients are reported to be associated with poor clinical outcomes, indicating their potential as biomarkers for predicting sepsis and MODS. Blood samples were obtained from two cohorts of burns (n = 96) and trauma (n = 147) patients. Neutrophil-derived cfDNA was quantified in plasma by SYTOX Green fluorescence and the size of extracted DNA was measured by electrophoresis. A microfluidic assay was also performed to capture NET-derived chromatin from burn patients' fresh whole blood samples. Captured NETs were stained with SYTOX green and anti-citrullinated histone antibodies. Stimulated whole blood or isolated neutrophils from healthy controls were used to generate NETs as positive controls. Circulating cfDNA levels were significantly elevated in plasma from both burns (days 1-14 postinjury) and trauma patients (<1-72 hours) compared to healthy controls. Electrophoresis revealed a prominent nucleosome band (~150 base pairs) in both burns and trauma plasma, with nucleosome oligomers detected within ultra-early samples (<1-hour posttrauma). The density of nucleosome bands correlated with cfDNA concentrations. Microfluidic capture of circulating NET-derived chromatin demonstrated increased levels in whole blood from burns, particularly at day 1 postinjury. NET-derived chromatin, cfDNA, and nucleosomes are elevated following severe burns and trauma. The dynamic changes in cDNA support their contribution to inflammation and as a key biomarker.

Chronic diseases account for 74% of global deaths. In the UK, multimorbidity prevalence is projected to nearly double by 2035. Addressing this burden requires a holistic, multidisciplinary approach that considers genetic, lifestyle, environmental, and psychosocial factors. The increasing focus on holistic care has revived interest in traditional and complementary healthcare practices, with a 2013 survey indicating that 23.6% of the UK’s ethnic population utilizes these modalities. Among these practices, Ayurveda has gained significant global traction. Despite the growing popularity of Ayurveda, discussions between patients and healthcare professionals (HCPs) remain limited. Consequently, patients often explore Ayurveda centres independently, risking unreliable sources that could have serious consequences on their health. Opening conversations about Ayurveda is crucial to ensure patients are well-informed. These conversations largely depend on the awareness, attitudes, and having the confidence and the ability to signpost patients to reputable Ayurvedic centres. The study utilized a cross-sectional survey to assess UK HCPs’ awareness, attitudes, and training needs on Ayurveda. After a pilot test, an anonymous Google Form was distributed, yielding 147 responses. Cronbach’s alpha for the questionnaire was 0.9261, indicating high internal consistency. Descriptive statistics, Chi-Square Test, and Fisher’s Exact Test were used for data analysis. Of 147 surveyed HCPs, 10.2% were very familiar with Ayurveda, 46.3% somewhat familiar, and 43.5% had little to no familiarity. Herbal medications (59.6%) and dietary interventions (41.1%) were most recognized. Only 10.9% fully understood Ayurveda’s known safety and effectiveness. Most (80.3%) felt unprepared to advise patients on Ayurveda, and majority (83%) had no formal training. Regarding attitudes, 46.2% supported including Ayurveda as a treatment option, and 82.3% thought it should be regulated by the Medicines and Health Products Regulatory Agency (MHRA) or the NHS. The majority (70.7%) favoured collaboration with Ayurvedic practitioners. Attitudes about Ayurveda’s role in chronic disease varied, with 47.7% believing it could help those not benefited by conventional medicine. A strong majority (83.7%) supported patient education on its benefits and risks, and most (86.4%) willing to learn more. In terms of patient engagement, nearly half (47.6%) refrained from offering definitive advice on Ayurveda, and only a few (8.8%) referred patients to Ayurvedic practitioners. However, most (84.4%) supported interprofessional cooperation. Key challenges to integration included lack of scientific evidence (55.1%) and limited understanding (44.2%), with many advocating for research (51.7%) and education (45.6%). Ethnicity significantly influenced responses (p<0.001), with Asians showing familiarity but limited understanding, Black respondents displaying more knowledge and support for integration, and White respondents expressing scepticism and a need for regulation. The survey highlights significant gaps in awareness and understanding of Ayurveda among UK healthcare professionals, alongside varying attitudes toward its integration in chronic disease management. Most HCPs expressed support for collaboration with Ayurvedic practitioners and for educating patients about its benefits and risks. These findings underscore the need for enhanced education and structured training programs for HCPs to enable safe and informed discussions about Ayurveda in clinical practice. In response to the identified gaps, an educational video was subsequently developed by the University of Birmingham for HCPs to address knowledge gaps and support informed patient decisions on Ayurveda.

Remote cochlear implant (CI) programming is increasingly used to expand access to follow-up care. This systematic review evaluated the clinical effectiveness and implementation outcomes of synchronous, asynchronous and hybrid remote CI programming in adults and children. PubMed, Embase, Scopus, CINAHL and the Cochrane Library were searched from January 2010 to July 2025. Eligible studies were randomised or observational designs reporting clinical outcomes (speech perception, aided thresholds, impedances, threshold/comfort levels) and/or implementation outcomes (feasibility, satisfaction, technical performance). Two reviewers independently screened, extracted data and assessed risk of bias. Given heterogeneity in design and outcomes, a narrative synthesis was conducted. Eleven studies (n = 356 CI recipients) met inclusion criteria. Across comparator studies, remote programming produced no clinically meaningful differences relative to in-person programming for speech perception (7/7 studies) or aided thresholds (5/5), and programming parameters remained stable (5/5). Feasibility was high, with session-completion rates typically ≥ 85%. CI recipients and clinicians reported favourable satisfaction, citing reduced travel burden and increased flexibility. Key challenges included intermittent connectivity, need for additional preparation or troubleshooting, limited digital literacy among older adults, and caregiver dependency in paediatric sessions. Remote CI programming yields clinical outcomes comparable to in-person programming and is feasible and well accepted across delivery models. However, small sample sizes, limited paediatric evidence, inconsistent technical reporting and a lack of cost-effectiveness data limit confidence in large-scale adoption. Standardised technical endpoints and rigorous multicentre evaluations are required to support scalable and equitable implementation.

Chronic pain affects up to 60% of people with chronic kidney disease (CKD), yet remains under-recognised and under-treated. Pain management in this population is complicated by altered drug pharmacokinetics, polypharmacy, and the potential nephrotoxicity of conventional analgesics. Despite the high prevalence and significant impact on quality of life, evidence-based guidance specific to pain management in CKD remains limited. This systematic review aims to evaluate the effectiveness and safety of both pharmacological and non-pharmacological interventions in reducing chronic pain intensity among people with CKD on dialysis, not on dialysis, and kidney transplant recipients, across all stages of CKD. The primary outcome is the effectiveness of interventions in reducing chronic pain intensity as assessed by pain assessment tools. We will conduct a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov from their inception to the present date to identify studies for chronic pain management in people living with CKD. Study screening will be conducted independently by two reviewers. One reviewer will extract data from each study, with a second reviewer cross-checking for accuracy and completeness. Data will be extracted on study characteristics, participant demographics, intervention components, pain outcomes, and adverse events. The certainty of evidence will be evaluated independently by two reviewers using the GRADE approach. Where applicable, data will be combined in meta-analyses using random-effects models. Additionally, a network meta-analysis will be performed if enough studies are available. This review will synthesise the current evidence for pain management strategies in CKD, by evaluating effectiveness of interventions among people receiving different renal replacement therapy modalities with varying pain and disease phenotypes. Findings will highlight the comparative effectiveness of various interventions while considering their safety profiles specific to the CKD context. The review will identify gaps in the literature and provide recommendations for clinical practice and future research. This review seeks to deliver a thorough evaluation of pain management strategies for people living with CKD. This systematic review is supported by the UK Kidney Association (UKKA), and findings will inform the upcoming UKKA guideline on symptoms management in people with CKD, alongside the other symptoms including itch, fatigue, and gastrointestinal symptoms. This review will aid clinicians in making well-informed decisions regarding pain management strategies, ensuring a balance between effectiveness and the specific risks associated with CKD.