North Bristol NHS Trust is a National Health Service trust that provides community healthcare and hospital services to Bristol, South Gloucestershire and North Somerset, England. The trust employs 8,000+ staff delivering healthcare across Southmead Hospital, Cossham Hospital and the Bristol Centre for Enablement, and the local communities. Medical teaching facilities are provided in association with the University of the West of England, Bristol University, and the University of Bath.
With the advent of new effective treatments for obesity, the field is rapidly changing creating an urgent need for evidence to guide best patient management. To help prioritise and plan for future trials, a meeting of experts was convened with the aim of reviewing the current literature to identify and prioritise current knowledge gaps; identify relevant research questions, and discuss appropriate trial methodologies that could be utilised to address the identified gaps in a timely and pragmatic manner. Participants included research-active academic surgeons and physicians, and industry representatives from various pharmaceutical and device companies. This report summarizes the key outcomes from this meeting. Treatment options for obesity are rapidly evolving. To provide best personalised care for patients, more evidence is required to understand how to best utilise currently available treatments as well as combine treatments. Trials focused on improving the treatment of obesity may need to be pragmatic and more agile than the traditional RCT to enable real time impact on patient care.
We sought to describe current perceptions and attitudes to management of of brain abscess (BA) or sub-/extra-dural empyema (SDE/EDE) in the United Kingdom (UK) to compare this to the 2024 European Society of Clinical Microbiology and Infectious Diseases BA guidelines. We conducted a web-based survey of infection specialists (IS) and neurosurgeons (NS) at neurosurgical centres across the UK. IS from 27/39 (69
Although we are making progress in overcoming infectious diseases and cancer, one of the major medical challenges of the mid‐21st century will be the increasing prevalence of stroke. Occlusions in large vessels are especially debilitating, yet effective treatment—needed within hours to achieve best outcomes—remains limited because of geographic accessibility. One solution for improving timely access to mechanical thrombectomy in geographically diverse populations is the widespread deployment of robotic surgical systems. Artificial intelligence assistance may enable the safe and effective upskilling of operators in this emerging therapeutic delivery approach. Our aim was to establish consensus frameworks for developing and validating artificial intelligence–assisted robots for thrombectomy. Objectives included standardizing effectiveness metrics and defining reference testbeds across in silico, in vitro, ex vivo, and in vivo environments. To achieve this, we convened experts in neurointervention, robotics, data science, health economics, policy, statistics, and patient advocacy. Consensus was built through an incubator day, a Delphi process, and a final position statement. We identified that the 4 essential testbed environments each had distinct validation roles. Realism requirements vary: simpler testbeds should include realistic vessel anatomy compatible with guidewire and catheter use, whereas standard testbeds should incorporate deformable vessels. More advanced testbeds should include blood flow, pulsatility, and disease features, such as atheromatous plaques. There are 2 macroclasses of effectiveness metrics: one for in silico, in vitro, and ex vivo stages focusing on technical navigation (eg, path‐following error), and another for in vivo stages, focused on clinical outcomes (eg, modified treatment in cerebral infarction scores). Patient safety is central, and not a barrier, to this technology's development. One requisite patient safety task needed now is to correlate in vitro measurements to in vivo complications.
Introduction We aimed to establish the clinical characteristics of children and young people (CAYP) currently receiving deep brain stimulation (DBS) therapy for the management of movement disorders in the UK to better inform planning of future service provision. Methods Cross-sectional service evaluation of centres providing DBS for the management of movement disorders in childhood. Results A total of 139 CAYP were identified across three centres. Median age at surgery was 9.8 years (range 2.0-18.9 years), and median duration of DBS was 4.4 years (range from 1 week to 15.75 years). Modal Gross Motor Function Classification System level was V (n=66). The most common causes of movement disorder were dyskinetic cerebral palsy (69/139, 49.6%), dystonia due to mutations in the lysine methyltransferase 2B gene, aka DYT-KMT2B, (13/139, 9.4%) and dystonia due to mutations in the Torsin-1A gene, aka DYT-TOR1A, (9/139, 6.5%). A monogenetic cause of dystonia without evidence of central nervous system pathology on MRI was identified in 30 CAYP (21.6%). Clinically significant dystonia was present in all CAYP, with significant chorea in 47/139 (33.8%) and significant spasticity in only 13/139 (9.4%). No tone-reducing medications were currently used by 43/139 (30.9%) of CAYP. The remaining 96/139 CAYP were currently receiving 1-6 tone-reducing medications, most commonly gabapentin (n=58), clonidine (n=50) and a form of benzodiazepine (n=43). Despite care being provided by paediatric services, 37/139 (26.6%) of CAYP were >18 years of age. Conclusions CAYP currently receiving DBS therapy represent a heterogeneous population in terms of dystonia aetiology, functional level and additional pharmacological management. Only 102 CAYP<18 years of age are currently receiving DBS therapy in the UK, representing a small proportion of the population who could benefit from this intervention.
BACKGROUND:Previous studies have indicated that crowding within the emergency department (ED) is associated with longer lengths of stay in the ED and higher mortality. Boarding, the time patients spend waiting for an inpatient bed after ED assessment, represents a clinically unproductive delay and occupies scarce ED resources. We explore the association of medical patient boarding not only with their outcomes but also indirectly for other patients in the ED and those in and awaiting ambulances. METHODS:A retrospective cohort study using routine data for 3 EDs in England from July 2023 to May 2025 was performed. Direct, delay-related harm outcomes of medical patient boarding time were investigated: inpatient length of stay and 30-day re-admission and mortality rates. Indirect, crowding-mediated outcomes of medical patient boarding levels consisted of time in ED for non-admitted patients, ambulance handover times and Category 1, Category 2 and Category 3 ambulance response times. Mixed-effects regression analysis modelled each relationship while controlling for potential confounding. RESULTS:The study examined 49 034 medical admissions, 210 334 non-admitted ED patients, 88 633 ambulance handovers and 146 278 ambulance responses. Medical patients, accounting for two-thirds of ED admissions, constituted 81% of total ED boarding time. Regression analysis showed that for a typical 25-bed ED, each additional five medical boarders was associated with an extra 7.9 min and 51.9 min ambulance response times for Category 2 and Category 3 calls and an extra 9.9 min of extra ambulance handover time. For admitted medical patients, each additional 4 hours of boarding time was associated with an extra 8.6 hours of inpatient length of stay and an 8.4% increase in the odds of 30-day mortality. CONCLUSION : Boarding medical patients in the ED is associated with a significant increase in their risk of harm, including higher mortality and longer hospital stays. It also adversely affects other patients by delaying ambulances and reducing overall bed availability through extended inpatient stays.
