North Devon District Hospital,Northern Devon Healthcare NHS Trust

Abstract Background Artificial intelligence (AI) is increasingly embedded Gen-Z, with ChatGPT emerging as an educational tool. Its application has expanded rapidly across disciplines, including medical education, where it is widely used. Robust evidence synthesising its effectiveness in undergraduate medical education is still evolving. This study aimed to evaluate the impact of ChatGPT-assisted teaching compared with traditional educational methods in undergraduate medical students. Materials and Methods A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Independent searches were performed across PubMed, Embase, Ovid full-text journals, and the Cochrane Library using the terms “ChatGPT” and “medical education” in titles and abstracts until 25th September 2025. Randomised controlled trials involving undergraduate medical students were included. The intervention was ChatGPT-assisted teaching, with traditional classroom and bedside teaching as the comparator. Statistical analysis was performed using RevMan 5.0 with a random-effects model. Results Six randomised controlled trials met the inclusion criteria, comprising 361 undergraduate medical students (182 in the ChatGPT group and 179 in the traditional teaching group). ChatGPT-assisted learning was associated with significantly higher assessment scores, with a pooled mean difference of 6.21 points in favour of ChatGPT (95% CI 2.03–10.39, p = 0.004). Heterogeneity was substantial (I² = 98%), indicating marked variability between studies. Conclusion ChatGPT-assisted teaching significantly improves learning outcomes in undergraduate medical students compared with traditional teaching. However, the very high heterogeneity and potential publication bias necessitate cautious interpretation, and further high-quality trials are required to define optimal educational implementation.

Aims: Day-case joint arthroplasty, where patients are discharged on the day of surgery, is increasingly used to meet rising demand in a resource-efficient manner. NHS England guidance states that all patients should be placed on an ambulatory pathway (zero to one night stay). However, little is known about the prevalence, structure, and implementation of day-case protocols across the UK. Methods: An online survey was sent to all NHS institutions performing hip or knee arthroplasty. Respondents reported the presence of day-case, ambulatory (zero to one night stay), or generic enhanced recovery protocols. Data were collected across 21 questions covering key perioperative domains and analyzed descriptively, and model health system data was used to assess length of stay (LoS). Results: Overall, 63 responses were received covering 86 hospitals (56 trusts), of which 78 (91%) perform day-case surgery. In total, 41 (48%) had a dedicated day-case protocol, 23 (27%) had ambulatory protocols, and 15 (17%) used generic enhanced recovery pathways. Only 22% of hospitals with a day-case pathway placed all patients on it by default. Protocol content showed substantial variation, including the use of sedation as part of anaesthesia (49%), presence of therapy services beyond 17:00 (59%), and nurses competent in assessing day zero mobility (56%). One third of hospitals had no mechanism for patients to contact out-of-hours support. LoS was shorter in hospitals using day-case or ambulatory protocols when compared with those that did not, however, this did not reach statistical significance. Conclusion: While day-case joint arthroplasty is widely performed in the NHS, dedicated protocols are used in fewer than half of hospitals, and considerable variation exists. These results can be used collaboratively by hospitals that are trying to establish pathways, and to guide further research aiming to identify best practice and provide standardization for day-case protocols. Cite this article: Bone Jt Open 2026;7(5):651–658.

AIMS:The use of cephalomedullary nailing (CMN) to treat extracapsular hip fractures is a well-established fixation method. Nationally, the use of CMN has increased from 67.7% in 2012 to 90.9% in 2025 for subtrochanteric fractures (National Hip Fracture Database). Although rare, implant failure is a recognised complication which poses risk to patients who are otherwise already burdened with high morbidity and mortality. The purpose of this study is to review the outcomes of CMN fixations for proximal femoral fractures, with particular focus on implant failure. We analysed patient demographics, surgical factors, and fracture patterns to identify factors associated with rate of implant failure. METHODS:This was a retrospective longitudinal cohort study of CMN fixations at a district general hospital between January 2020 and October 2024. All adult proximal femoral fractures treated with long CMN were included. Data collection was obtained from clinical records and relevant imaging. Measurement of radiological parameters was performed to evaluate quality of reduction. Multivariable logistic regression modelling was performed to analyse results. RESULTS:Long CMN was used for 208 cases. Of these, the majority were female (74.5%) with a mean age 82 years. Open reduction and augmentation with cerclage wires was used in 27.4% of cases (n = 57). An overall implant failure rate of 4.3% (n = 9) was identified. Implant failure occurred more frequently following open reduction with cerclage wire augmentation compared with closed reduction alone (10.5% vs 2.0%, p = 0.006). This association remained significant following multivariable adjustment for potential confounders. CONCLUSION:Outcomes of CMN fixation in this cohort were comparable to those reported in the literature. After adjustment for the measured reduction parameters, open reduction with cerclage wire augmentation was associated with increased odds of implant failure. However, given the retrospective design and small number of failure events, causal inference cannot be established, and these findings should be interpreted cautiously. Patients requiring open reduction and cerclage wire augmentation likely represent more complex fracture patterns and may benefit from closer postoperative surveillance until fracture union.

PURPOSE:This study investigated the self-perceived competence, knowledge, confidence and attitudes of the UK optometric workforce with regard to nutritional advice for patients. METHODS:A validated questionnaire (NUTrition COMPetence) was used to survey the optometric workforce, which was adapted to UK optometric practice and nutritional guidelines. Distribution of the questionnaire was conducted online via social media, local optical councils, and personal contacts and sent to a random sample of members of the College of Optometrists UK. To better understand the sample, further information on educational background, years in practice and current roles were collected. RESULTS:Two hundred and sixty individuals completed the questionnaire, of which 238 identified as GOC registered optometrists, with the majority working in a community setting (n = 189). Self-perceived confidence in nutrition knowledge was [mean score (SD) 17.19 (±4.11) out of a maximum of 35 points], nutrition skills [mean score (SD) 23.73 (±7.80) out of a maximum count of 55], nutrition related counselling and communication [mean score (SD) 26.06 (±6.82) out of a maximum of 45 points]. Attitudes towards nutrition care scored highest with 31.33 (±6.06) out of 40 and was rated highest out of all constructs. Higher qualifications were associated with increased levels of self-reported confidence and communication of nutrition information (p = 0.015). CONCLUSIONS:UK optometrists have a very positive attitude towards providing nutritional care. However, there is a lack of training which impacts confidence and ultimately patient advice. Within the current framework of the UK National Health Service and its focus to make every contact count, it is paramount to implement more nutritional training.

Abstract Background Guideline-directed medical therapy (GDMT) following acute coronary syndromes (ACS) reduces mortality, recurrent events and improves long-term outcomes. Beyond initiation, GDMTs should be progressively up-titrated to the maximum tolerated dose for full therapeutic benefits. Although efforts have focused on optimising prescribing before discharge, less is known about the GDMT retention and optimisation in the early post-discharge phase. Evaluating real-world patterns at 30 and 90 days is therefore critical to identify gaps in secondary prevention and strengthen transition-of-care pathways to primary care and community clinicians. Purpose This study aims to assess 30- and 90-day GDMT retention and optimisation following ACS, and to evaluate the impact of discharge communication on subsequent up-titration. Methods We conducted a prospective study of adults admitted with ACS and discharged with confirmed unstable angina or myocardial infarction between August and December 2024. Patients who died during admission or follow-up or underwent inpatient cardiac surgery were excluded. Demographics, prescriptions, and discharge communication data were collected from hospital and primary care records for lipid lowering therapies (LLT), renin–angiotensin–aldosterone system inhibitors (RAASi), and beta-blockers. Retention and up-titration were assessed at 30 and 90 days compared to discharge. Statistical analysis was performed using Fisher’s exact test, with significance set at p < 0.05. Results Eighty-nine patients were included (60 males; median age 70 ± 13.2 years). Among eligible patients, discharge prescribing rates were 94.2% for high-intensity statins (HiS), 96.1% for RAASi, and 97.3% for beta-blockers. Retention remained high for HiS (95% at 30 days; 91% at 90 days) and beta-blockers (100% at 30 days; 97% at 90 days) but declined markedly for RAASi (95% at 30 days; 75% at 90 days). Dose optimisation was limited: only 4.1% and 9.6% of patients underwent RAASi up-titration at 30 and 90 days, while beta-blockers were up-titrated in 8.3% and 9.7%, respectively. Lipid monitoring was suboptimal, with only 40.2% undergoing LDL-C testing at 90 days and LLT escalation occurring in just 3.4% of patients. Over half of GDMT discharge prescriptions included communication regarding optimisation; however, inclusion of an up-titration plan was not associated with subsequent optimisation at follow-up for HiS (p = 0.26 at 90 days), RAASi (p = 0.60 at 30 days; p = 0.69 at 90 days) or beta-blockers (p = 0.20 at 30 days; p = 1.00 at 90 days). Conclusions Despite achieving substantial GDMT optimisation at discharge, variable retention trajectories and low rates of dose escalation were observed. The absence of an association between communication and subsequent optimisation highlights the need for a multifaceted and systematic approach to maintain therapeutic momentum beyond discharge and improve long-term cardiovascular outcomes.