The Queen Alexandra Hospital (commonly known as QA Hospital, or simply QA) in Cosham, Portsmouth, is one of the NHS hospitals serving the city of Portsmouth and the surrounding area. There are several small treatment outstations which have been opened to relieve the overload at the QA Hospital. It is publicly owned and is administered by the Portsmouth Hospitals University NHS Trust and has a Ministry of Defence Hospital Unit attached.
BACKGROUND:Early diagnosis is crucial in improving oral cancer outcomes. Patient education materials support timely recognition and management. However, these resources are often written above recommended reading levels, beyond patients' health literacy and limiting accessibility. OBJECTIVES:To assess the readability of available patient information on oral cancer by the NHS, to evaluate three large language models (LLMs; ChatGPT, Claude and Gemini) in simplifying texts while preserving their content, and to propose an improved leaflet based on UK materials, expert review and LLM adjustment to match average UK reading levels. METHODS:Materials were collected from NHS-affiliated websites. Original and LLM-simplified texts were assessed using validated readability tools (FRES, FKGL, GFI, CLI and SMOG). Content fidelity was assessed using character 3-5-g cosine, sentence-content retention and latent semantic analysis (LSA). An expert review was applied to the proposed leaflet. RESULTS:LLM-revisions significantly improved readability across all five indices (p < 0.0001). Mean FRES of original texts was 66.4 ± 7.7, while Claude (81.6 ± 6.2) was the only model to surpass the 80 benchmark. Semantic similarity to source text remained high (LSA means 0.97 ± 0.04, 0.94 ± 0.09 and 0.96 ± 0.08; character 3-5-g cosine 0.85 ± 0.05, 0.80 ± 0.08 and 0.82 ± 0.08 for respective models). Baseline readability of the proposed leaflet was comparable to NHS materials (FRES 65.7); Claude increased this to 81.2. CONCLUSIONS:LLM-based simplification enhanced readability while preserving content fidelity. This approach can help enhance accessibility, particularly for populations disproportionately affected by oral cancer. With human oversight, it could be adopted at the policy level to standardise patient education and reduce health literacy disparities.
Tennis is a high-impact unilateral sport that may enhance bone mineral density (BMD) during growth, although evidence in young players has been limited. This review finds that tennis participation is associated with higher site-specific BMD, with lean body mass (LBM) being the strongest predictor, while training-related associations remain inconsistent. Osteoporosis is defined by compromised bone strength due to reduced bone mass and deterioration of bone microarchitecture, leading to an increased risk of fragility fracture and associated morbidity and mortality. Peak bone mass (PBM) is largely accrued during childhood, adolescence, and young adulthood, making youth a critical period for optimizing bone health. High-impact sports such as tennis may promote osteogenic responses of bone, yet evidence in younger populations remains limited. This narrative review explores findings from 15 studies examining BMD in paediatric, adolescent, and young adult tennis players, identified through a systematic search of PubMed, Google Scholar, and Embase. Across studies, tennis players demonstrated significantly higher BMD compared to controls, particularly in the dominant upper limb, reflecting site-specific adaptations to unilateral loading. LBM was highlighted as the strongest predictor of BMD, while associations with training frequency and strength measures were mixed. Overall, tennis participation during growth appears to be associated with favourable site-specific skeletal adaptations. However, small sample sizes and heterogeneity in study design, participant maturity, and outcome reporting limit generalisability, underscoring the need for further research.
Sepsis and septic shock, and the sequelae of septic cardiomyopathy (SCM), are a common yet major concern in the intensive care unit and are associated with high mortality (Zakynthinos, 2025). Traditionally, echocardiography using two-dimensional ejection fraction (2DEF) is used to diagnose SCM. However, these measurements may be affected by other confounding factors (Berman, 2022). Different methods of detecting cardiac dysfunction such as global longitudinal strain (GLS) or biomarkers (NT-ProBNP or Troponin T) are not routinely used. Furthermore, 2DEF measurements are subject to poor sensitivity and specificity, with documented inter-operator errors (Kim, 2022). To evaluate relationship between LVEF, GLS and biomarkers across 90 days in patients with sepsis/septic shock on ICU. A single UK site, prospective cohort study of patients on ICU meeting criteria for sepsis/septic shock. Simpson’s biplane 2DEF and GLS performed by single operator. Biomarker samples taken within 24hrs of echo. Data collection took place at days 1, 3 (no biomarker), 30 and 90 as inpatient or returning outpatient. Normal values were defined by British Society Echocardiography and National Institute Clinical Excellence guidelines respectively. Statistical significance was determined using Pearson Correlation and Principal Component Analysis (PCA). From 118 patients enrolled, 105 met inclusion criteria at time of echo, all were on inotropes or vasopressors. Mean age 60yrs, 61% male, 38% female. Days 1, 3, 30 and 90 results shown in table 1. Loss to follow up over the study was 33%. At day 1 there was no significant correlation between 2DEF and any biomarker (NT-ProBNP r =0.15,p =0.55, Troponin T, r =0.25 ,p=0.27). Nor any significant relationship between GLS and Troponin T (r = 0.20, p =0.390). Conversely there was a borderline relationship between GLS and NT-pro-BNP, (r =0.49, p=0.05) at day 1. Over 90 days,despite a normal 2DEF in many cases, GLS and biomarkers were frequently abnormal and persisted beyond recovery (see figure 1). PCA mimic these findings with no 2DEF and GLS relationship but some degree of inter-relationship between GLS and NT ProBNP. Generally, 2DEF is the chosen method for the diagnosis of SCM. Given that many patients have normal 2DEF despite abnormal GLS and biomarkers, this study raises the question of ‘what is a normal LVEF’ for ICU patients with sepsis. Perhaps given the fluid loading, sepsis-driven vasodilatation, and inotropic support, an otherwise normal 2DEF of 50-60% may be impaired in this cohort. As such, GLS and biomarkers may identifying subtle (potentially subclinical) dysfunction in sepsis or septic shock. These changes persist to day 90, despite clinical recovery. While 2DEF is the primary factor influencing decision-making in the ICU, the relationship between GLS and NT ProBNP post day 3 requires further investigation with regards to genuine persisting myocardial dysfunctionTable 1 Figure 1
Background Comorbidity, older age, frailty and socioeconomic deprivation are associated with higher risk of complications and death following resection for colon cancer. Minimally invasive surgical (MIS) resection is associated with earlier recovery, fewer postoperative complications and potentially lower early mortality than open surgical (OS) resection. We investigated the likelihood of receiving MIS vs OS resection by patient characteristics, and whether MIS resection reduces mortality after elective resection for colon cancer. Methods We analysed cancer registration data linked to secondary care records of 21,931 patients diagnosed with stage I-III colon cancer in NHS Trusts in England, in 2021 and 2022. We focused on elective operations completed as either MIS resections or OS resections. We used an emulated trial to estimate the impact of MIS resection on one-year mortality (expressed as Average Treatment Effect) compared with OS resection. Inverse-probability-weights with regression adjustment ensured comparability between the surgical groups. Findings MIS resection was attempted in 18,264 (83.3% of 21,931) patients and completed in 16,271 (74.2% of 21,931), among whom higher levels of deprivation, frailty, comorbidity and stage at diagnosis were independently associated with lower odds of receiving MIS resection. Observed one-year mortality was 7.7% after OS resection (436 deaths among 5660) vs 2.9% after MIS resection (472 deaths among 16,271). In the emulated trial, the average treatment effect of MIS resection was a reduction in one-year mortality from 6.8% to 3.0%; with the largest absolute reductions among patients aged 85 years or more, frail patients, and those with major comorbidities. Interpretation The emulated trial confirms that MIS resection for colon cancer reduces mortality at one year, compared with OS resection. However, patients in higher-risk groups, who were most likely to benefit from MIS resection, were less likely to receive it. The NHS needs to eliminate ongoing inequalities in optimal surgery for colon cancer. Funding Cancer Research UK C7923/A29018; Medical Research Council MR/T032448/1 and MR/W021021.
