Chelsea and Westminster Hospital is a 430-bed teaching hospital located in Chelsea, London. Although the hospital has been at its present site since only 1993, the hospital has a rich history in that it serves as the new site for the Westminster Hospital. It is operated by Chelsea and Westminster Hospital NHS Foundation Trust, and has close ties with Imperial College London. Many of the hospital's employees hold research contracts with Imperial College London, and the hospital plays an integral role in teaching students at Imperial College London.
Background Testing for HIV, linkage to treatment, and access to pre-exposure prophylaxis (PrEP) (medication that reduces the risk of acquiring HIV) is essential for early HIV diagnosis, treatment, and prevention. General practice could play a key role in maximising HIV testing opportunities and supporting access to PrEP. Aim To develop an intervention for general practice to increase HIV testing and facilitate access to PrEP. Design and setting This was a person-based approach (PBA) intervention development study using the capability, opportunity, motivation, behaviour model in South West England. Method A scoping review and semistructured interviews with healthcare professionals (HCPs) and local organisation representatives with an interest in HIV prevention/health care were conducted to understand the challenges and find potential solutions to increase HIV testing and facilitate access to PrEP in general practice. Intervention development used focus groups with HCPs and the public. Purposive sampling ensured diversity of practices and participants. Data were analysed using the PBA table of planning and the collaborative and intensive pragmatic qualitative approach. Results Barriers identified included lack of clinician knowledge of HIV and PrEP, concern about stretched resources, and a lack of systematic testing methods. Proposed strategies included simpler testing approaches to normalise testing and reduce HIV stigma. The intervention developed consists of: education, a prompt to test, simplified and standardised testing, PrEP signposting processes, patient information, and practice champions. Conclusion Research is needed to explore the feasibility and the effectiveness of this multicomponent intervention to increase testing and access to PrEP within general practice. Funding barriers also need to be addressed.
Objective Population-based studies have demonstrated that partial resections (PR), including subtotal colorectal resections, are performed in 40-70% of patients with inflammatory bowel disease (IBD)-associated colorectal cancer (CRC). Data on their outcomes are scarce. Our aim is to compare oncological and postoperative outcomes between PR and proctocolectomy (PC) in IBD centres in England. Methods Data of all adult patients with IBD undergoing colorectal resections in 2004-2019 for dysplasia and CRC were collected from three centres. Descriptive statistics, survival, univariable and multivariable analyses were applied. Results Of 131 patients identified, 43 underwent PR and 88 PC. There were more patients with Crohn's disease, primary sclerosing cholangitis and advanced stage cancer in the PR cohort, while PC had more extensive colitis and multifocal neoplasia. Median follow-up was 90 months (range 11-204) and 89 months (range 0.5-211), respectively. Synchronous cancer in a segment different from the original neoplasia was found in 9/131 (7%). Metachronous cancer was found in 1/43 (2%) at 10 years in the PR cohort. Five of 43 (12%) had completion surgery for dysplasia. The PC cohort had significantly higher stoma rates (65% vs 93%, p<0.001). No significant difference in overall survival was observed between PR and PC (85% vs 93% at 5 years (p=0.684)). Conclusions The study suggests comparable oncological outcome between partial including subtotal colorectal resection and PC in selected patients with IBD-associated neoplasia. Stoma avoidance may be achieved with PR but at the cost of future colitis flares, surveillance and completion surgery. The findings are consistent with the published literature and collectively can be used to inform the shared decision-making process around extent of resection in carefully selected patients.
Immunodeficiency, whether congenital or acquired, iatrogenic (e.g. allograft recipients) or infectious (e.g. human immunodeficiency virus (HIV)), is associated with an increased risk of malignancy. In the case of HIV infection, most cancers are associated with oncogenic virus infection. Although the overall risk of any cancer is increased 2–3-fold in people living with HIV, there are three acquired immune deficiency syndrome (AIDS)-defining cancers whose relative risk is dramatically higher. These three AIDS-defining illnesses are Kaposi's sarcoma, high-grade B cell non-Hodgkin's lymphoma (including primary cerebral lymphoma) and invasive cervical cancer. Since the introduction of combination antiretroviral therapy, the incidence of the AIDS-defining malignancies has declined in populations with access to these medications. In contrast, the effect on the incidence of other cancers has been small; however, the increased longevity of people living with HIV and the ageing of this population mean that there has been a rise in the number of cases of non-AIDS-defining malignancies. Recent advances in the management of malignancy in people with HIV have led to similar outcomes to those for the general population.
Indocyanine Green (ICG) fluorescence imaging is increasingly used in emergency bowel surgery to assess intestinal perfusion. While literature reports high technical efficacy, intraoperative interpretation remains variable. This systematic review explores how cognitive and systemic human factors influence ICG's perceived effectiveness, compared to reported quantitative outcomes. A systematic search of PubMed and Embase identified 31 original studies from 266 screened articles. Qualitative synthesis was guided by ENTREQ principles. Bias identification followed a thematic approach using cognitive bias categories based on established clinical decision-making frameworks. ICG was reported to influence surgical decision-making in 302 of 308 cases. However, discrepancies between fluorescence findings and clinical actions occurred in 38.3% of cases. Common cognitive patterns included confirmation and anchoring bias, overconfidence in fluorescence interpretation, and reliance on ICG to support pre-established surgical decisions. Systemic limitations included lack of interdisciplinary input, case-report bias, and absence of standardized interpretation protocols. These were analyzed across a full article-by-article bias matrix and summarized by domain and sentiment. ICG is not solely a diagnostic tool, but a cognitive interface shaped by time pressure, decision momentum, and human interpretation. Rather than providing objective certainty, ICG often reinforces existing clinical judgments. Addressing bias-awareness and integrating interdisciplinary frameworks may enhance interpretive consistency and improve patient outcomes. These findings call for greater cognitive standardization in the intraoperative use of ICG during emergency surgery.
Robotic-assisted surgery offers technical advantages over laparoscopy, including improved dexterity and visualisation. However, its role in inflammatory bowel disease (IBD) remains poorly defined, with existing studies limited by variability and lack of standardisation. This systematic review aimed to evaluate the reproducibility, operative detail, outcome reporting, and procedural consistency in the current literature on robotic-assisted surgery for IBD. A systematic review was conducted following PRISMA 2020 guidelines and registered on PROSPERO (CRD42024514488). Comprehensive searches of five databases and grey literature from January 2015 to April 2024 were performed. Studies involving robotic surgery in adult IBD patients were included. Methodological quality was assessed using the Newcastle–Ottawa Scale. Sixteen studies involving 614 patients met inclusion criteria. Most were retrospective (81.3
