The Golden Jubilee University National Hospital is a hospital in Clydebank, near Glasgow, Scotland. It was opened in 1994 and is managed by a Special Health Board appointed by NHS Scotland.
BACKGROUND:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) has been associated with increased stent optimization and reduced adverse events among patients with complex coronary-artery lesions, but adoption of this strategy in Western countries remains low. Although practice guidelines recommend intracoronary imaging for anatomically complex lesions, evidence from current European practice is limited. METHODS:In this investigator-initiated, international, open-label, randomized, controlled trial, we assigned patients undergoing complex PCI to either IVUS-guided PCI, performed with the use of prespecified stent-optimization criteria, or angiography-guided PCI. The primary end point was target-vessel failure, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization. RESULTS:Of the 2020 patients who underwent randomization, 1010 in the IVUS-guided PCI group and 1009 in the angiography-guided PCI group were included in the primary analysis. The mean age of the patients was 69 years, 79.4% were men, and 27.4% presented with an acute coronary syndrome. The mean procedure duration was 88.8 minutes with IVUS-guided PCI and 66.2 minutes with angiography-guided PCI. Dilation with balloon angioplasty after stent implantation was performed in 91.3% of the IVUS-guided PCI procedures and in 84.5% of the angiography-guided PCI procedures. At a median follow-up of 19.0 months (interquartile range, 15.2 to 23.4), target-vessel failure had occurred in 140 patients (13.9%) in the IVUS-guided PCI group and in 112 patients (11.1%) in the angiography-guided PCI group (hazard ratio, 1.25; 95% confidence interval, 0.97 to 1.60; P = 0.08). Procedural complications occurred in 11.3% of the IVUS-guided PCI procedures and in 10.2% of the angiography-guided PCI procedures. The frequency of adverse events appeared to be similar in the two groups. CONCLUSIONS:Among patients undergoing complex high-risk PCI, a strategy of routine IVUS-guided PCI performed with the use of prespecified stent-optimization criteria was not associated with a lower risk of target-vessel failure than angiography-guided PCI alone. (Funded by Boston Scientific; IVUS-CHIP ClinicalTrials.gov number, NCT04854070.).
Importance:High-flow nasal oxygen therapy (HFNOT) is used for noninvasive respiratory support following cardiac surgery despite uncertainty about its clinical effectiveness or associated costs. Objective:To determine whether prophylactic HFNOT in patients at increased risk of respiratory complications following cardiac surgery has clinical benefits compared with standard oxygen therapy (SOT). Design, Setting, and Participants:This adaptive, parallel group, randomized clinical trial collected and analyzed data from 17 cardiac surgery centers in 3 countries between October 7, 2020, and June 19, 2024. Eligible participants included adults undergoing nonemergent cardiac surgery with any of the following risk factors for pulmonary complications: chronic obstructive pulmonary disease, asthma, lower respiratory tract infection in the last 4 weeks, a body mass index of 35 or greater, or currently or recently smoking for longer than 10 pack-years. Outcome assessors were blinded. A preplanned sample size re-estimation was conducted after 300 participants completed the 90-day follow-up. Intervention:Participants were randomized at a 1:1 ratio with concealed allocation to HFNOT or SOT administered for at least 16 hours immediately after postoperative extubation. Main Outcomes and Measures:The primary effectiveness outcome was days alive and at home (DAH) without increased support compared with baseline in the first 90 days (DAH90). Any day of increased support, including at home, would provide a value of 0 for that day. Secondary outcomes included DAH90 without considering the additional support component. Results:A total of 1280 patients were recruited (mean [SD] age, 62.9 [10.5] years; 892 [69.7%] men; 640 in each group), of whom 1224 (95.6%) had complete DAH90 data. The primary outcome of median DAH90 was 0 (IQR, 0-79) for the HFNOT group and 0 (IQR, 0-87) for the SOT group (median difference, 0 [95% CI, 0-0]; P = .75). Secondary clinical outcomes, including DAH90 without considering whether additional support was required, were similar between groups. Conclusions and Relevance:In this randomized clinical trial of HFNOT in patients at increased risk of postoperative pulmonary complications after nonemergent cardiac surgery, HFNOT did not improve DAH90 without increased support. These findings do not support the implementation of routine prophylactic HFNOT after cardiac surgery. Trial Registration:isrctn.org Identifier: ISRCTN14092678.
Robotic-assisted hip and knee replacement has been increasingly adopted in orthopaedic practice, offering potential advantages in surgical precision and workflow consistency. However, its efficiency compared with conventional manual methods in real-world NHS practice remains debated. This retrospective observational study analysed routinely collected data from the Arthroplasty Rehabilitation in Scotland Endeavour (ARISE) programme, including patients undergoing unilateral primary hip or knee replacement between 2020 and 2024. Robotic-assisted status, type of surgery, and operative duration were examined. Uptake of robotic-assisted hip and knee replacement was assessed annually, and comparative analyses evaluated operative times between robotic-assisted and manual procedures. Robotic-assisted hip and knee replacements increased from 101 procedures in 2020 to 1164 in 2024, representing a tenfold rise. Despite this growth, robotic cases accounted for fewer than 10% of all hip and knee replacements, with uptake concentrated in a small number of centres. Median operative durations were similar between robotic-assisted and manual procedures for both hips and knees. However, robotic surgeries demonstrated narrower interquartile ranges and fewer outliers. Knee replacements showed consistently higher adoption than hip replacement across the study period. Robotic-assisted hip and knee replacement has expanded rapidly in NHS Scotland, though access remains uneven across hospitals. Operative efficiency is comparable to conventional methods, but improved consistency may offer service-level benefits such as more predictable theatre scheduling. Wider adoption will require strategic investment in infrastructure, training, and equitable resource distribution to maximise the potential benefits of robotic-assisted technology within the NHS.
Prolonged waiting times for hip and knee arthroplasty are associated with deterioration in health-related quality of life. The lived experience of waiting for arthroplasty remains poorly characterised. This study evaluated patients’ experiences of preoperative information, advice, and support, and identified groups reporting the lowest satisfaction. The ‘ What Are the Implications to Delayed Access to Arthroplasty ?’ (WAIT-DATA) study was a prospective multicentre audit of patients awaiting elective hip or knee arthroplasty across 14 UK hospitals. Participants completed a standardised questionnaire assessing satisfaction with nine domains of preoperative information and support, each rated on a five-point Likert scale. Composite “Information and Advice” and “Support” scores were derived, and associations with demographic, clinical, and psychosocial factors were examined using multivariable linear regression. Among 851 respondents (mean age 69; 57.7% female), overall satisfaction was moderate. Patients were generally well informed about their condition (mean 4.14±0.92) and operation (4.34±0.88), but less satisfied with support for weight management (3.49±0.98), general health (3.54±1.01), and mental wellbeing (3.46±1.02) (p < 0.001). Older age, obesity, deprivation, and new physical or mental diagnoses were associated with lower satisfaction, although effect sizes were small. Poorer self-reported health and quality-of-life change showed stronger links with dissatisfaction, particularly regarding waiting time. Almost half reported opioid use, and most described deteriorating function and activity while waiting. Patients awaiting arthroplasty experience significant physical and psychological decline yet receive inconsistent support. The waiting period should be reframed as an active phase of preparation, with proactive multidisciplinary support helping patients to “wait well” rather than “wait poorly.”
Background Myocardial Infarction with No Obstructive Coronary Arteries (MINOCA) or Nonischemic Myocardial Injury affects approximately 1 in 9 patients presenting with acute coronary syndrome, yet evidence-based therapies are lacking. Coronary microvascular dysfunction is implicated in the pathogenesis of suspected MINOCA, but its prevalence, prognostic implications and treatment are uncertain.The objectives are, first, to assess the prevalence of coronary microvascular dysfunction in patients with suspected MINOCA and, second, to implement endotype-informed stratified medicine involving patients with coronary microvascular dysfunction to treatment with eplerenone, a cardio- and vasculo-protective mineralocorticoid receptor antagonist. Methods This is a prospective, registry-based, multicenter, diagnostic study and nested, randomized, controlled, open-label, blinded-endpoint (PROBE) basket trial. Up to 400 patients with clinically suspected MINOCA and one or more cardiovascular risk factors will be enrolled into a registry-based diagnostic study. Coronary microvascular function will be assessed during invasive angiography using thermodilution. Patients with an index of coronary microvascular resistance (IMR) ≥ 25 will be randomized 1:1 to eplerenone (25-50 mg daily for 6 months) or standard care without eplerenone (control group) (n = 150 randomized). Final endotypes will be centrally adjudicated by a panel of blinded cardiologists.The primary outcome of the diagnostic study is the proportion of patients with IMR ≥ 25 during index coronary angiography. Secondary outcomes include coronary flow reserve, cardiovascular MRI parameters, patient-reported outcome measures, biomarkers of myocardial fibrosis and vascular inflammation, health outcomes and health economic assessments.The primary outcome of the randomized trial is the within-individual change in NT-proBNP at baseline, 1 month, and 6 months, based on intention-to-treat. Secondary outcomes include mechanistic blood biomarkers and patient-reported outcome measures. Value This registry-based randomized trial will provide novel evidence on endotype-informed secondary prevention therapy with eplerenone for suspected MINOCA.
