King's College Hospital is a major trauma centre in Denmark Hill, Camberwell in the London Borough of Lambeth, referred to locally and by staff simply as "King's" or abbreviated internally to "KCH". It is managed by King's College Hospital NHS Foundation Trust. It serves an inner city population of 700,000 in the London boroughs of Southwark and Lambeth, but also serves as a tertiary referral centre in certain specialties to millions of people in southern England. It is a large teaching hospital and is, with Guy's Hospital and St. Thomas' Hospital, the location of King's College London School of Medicine and one of the institutions that comprise the King's Health Partners, an academic health science centre. The chief executive is Dr Clive Kay.
Despite improvement in treatment, rheumatoid arthritis (RA) management remains inconsistent. To evaluate the worldwide disparities in the use of biological and targeted molecules (advanced) RA therapies, focusing on differences across continents and socioeconomic strata, and to identify factors associated with their utilisation. Cross-sectional analysis of the international COVAD-2 cohort, including demographics, socioeconomic factors, disease characteristics, patient-reported outcomes, and treatments. Primary outcomes assessed treatment distribution by continent, secondary outcomes evaluated distribution by Human Development Index (HDI), with predictors analysed using multivariable logistic regression. At the time of analysis, COVAD2 included 10,739 participants; 2007 had RA, 1997 with geographical data included in this study (mean age 50.9 years, 88.1
The prospective pediatric Continuous Renal Replacement Therapy (ppCRRT) registry identified the degree of fluid accumulation (FA) at continuous kidney replacement therapy (CKRT) initiation as a predictor of adverse outcomes in children. These predate major advancements in CKRT technology and fluid stewardship. We aimed to describe the epidemiology of FA at CKRT initiation and associated outcomes in a contemporary paediatric cohort. Secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), a retrospective, multicenter study (35 centers, 9 countries) of patients ≤ 25 years treated with CKRT from 2015 to 2021. Primary Outcome: survival to ICU discharge. Secondary outcomes: ventilator-free and ICU-free days. A total of 1027 patients were included in this analysis. Survival to ICU discharge was 64.5
Refractory overactive bladder (OAB) lacks formal definition and is poorly understood. Its management requires patients to choose an invasive treatment, including intravesical botulinum toxin A (BOTOX®), sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS), which have varying rates of efficacy and side effects. These decisions can be complex for patients to make, especially within the time constraints of outpatient clinic appointments. A new patient decision aid (PDA) has been developed to support patients during this shared decision-making process. This study assesses decisional conflict scores and patient satisfaction in those who use a novel PDA for refractory OAB. Consecutive new patients with refractory OAB were provided with the PDA prior to decision-making. Patients then had a virtual follow-up appointment to assess their decisional conflict, using a validated scale. The total decisional conflict score was calculated. Treatment choice and free-text feedback were also analysed. Twenty-five patients were included. Following use of the PDA, a range of treatment choices were made, including SNM (n = 6), PTNS (n = 10), BOTOX® (n = 6) and continuation with medical therapy (n = 3). Overall, decisional conflict was low, with 100
Purpose Although there are consistent guidelines of standardised glioblastoma patient care, there may be variation in treatments delivered due to differences in patient characteristics or adherence to guidelines across centres. This study explores the variation in treatments for glioblastoma patients across centres in a comprehensive multi-year brain tumour patient cohort in England. Methods We analysed data from the Gliocova project that contains over 50,000 adult brain tumour patients diagnosed between 2013 and 2018 in England. We selected a glioblastoma patient cohort and explored treatment rates, systemic predictors of treatment, variation in treatment across surgical centres and survival rates for different treatment groups. Results We analysed data from 11 359 patients with a histological diagnosis of GBM. Almost 80% of glioblastoma patients received at least some treatment after brain surgery, with 40% receiving the guideline recommended aggressive treatment (47% in the under-70s cohort). Age, sex, deprivation status, comorbidities, surgery type (resection versus biopsy) and ethnicity were identified as systemic predictors of receipt of post-operative treatment. There was also variation in receipt of post-operative treatment (64%-86%) and receipt of aggressive treatment (16%-65%) across centres. Patients receiving aggressive treatment had highest survival (15.6 months); in patients receiving any post operative treatment survival was 12.5 months and in patients receiving surgery only survival was 2.5 months. Conclusion 22% of glioblastoma patients undergoing surgery receive no further treatment and there is variation in post-surgical treatment both at centre and individual patient level. We suggest that centres should measure and report rates of no further treatment as part of standard clinical governance.
Urolithiasis has been increasingly recognized as a manifestation of systemic metabolic dysfunction rather than solely a local urinary disorder. In this multicenter cross-sectional study, we evaluated and compared the associations and discriminatory performance of four commonly used metabolic indices, homeostasis model assessment of insulin resistance (HOMA-IR), plasma atherogenic index (PAI), triglyceride-glucose (TyG) index, and metabolic score for insulin resistance (METS-IR), in relation to calcium oxalate stone formation. A total of 1206 adults (666 stone formers and 540 non-stone formers) were enrolled across seven tertiary centers, and calcium oxalate stone composition was confirmed by stone analysis. Metabolic indices were calculated using established formulas. Receiver-operating characteristic analyses and multivariable logistic regression models adjusted for age, sex, body mass index, hypertension, and diabetes mellitus were performed. HOMA-IR, PAI, and METS-IR demonstrated statistically significant but very limited discriminatory capacity, with AUC values only marginally exceeding 0.50, whereas TyG did not show significant discriminatory performance. In adjusted analyses, PAI (OR 1.72, 95%CI 1.09-2.71) and METS-IR (OR 1.05, 95%CI 1.01-1.08) were independently associated with stone formation, while HOMA-IR and TyG were not. These findings suggest that composite metabolic indices integrating lipid metabolism and adiposity may better reflect the metabolic milieu associated with calcium oxalate stone disease than glucose-centered insulin resistance markers alone. Although their standalone discriminatory performance is very limited, these indices may provide pathophysiological insights and serve as hypothesis-generating tools for future research.
