Sandwell General Hospital is an acute teaching hospital of the Sandwell and West Birmingham Hospitals NHS Trust in West Bromwich, England and provides an extensive range of general and specialist hospital services.
INTRODUCTION:The proportion of women entering UK medical schools has increased rapidly, with women now making up 60% of students. The changing gender composition of the medical workforce brings to the forefront the National Health Service's (NHS) need to adapt to help women thrive in the workplace. METHODS:Our Women's Clinical Network organised a free Trust-based half-day event called 'Navigating the NHS and Having a Family', open to all doctors of any gender, grade and specialty, with presentations on topics including NHS family leave entitlements and less than full-time training. Pre-event and post-event surveys collected qualitative and quantitative data. RESULTS:Pre-event, we identified a lack of knowledge regarding family leave entitlements and processes. A quarter of attendees felt it possible to have a great career and a family, pre-event. This rose to over three-quarters, post-event. We also demonstrated improved knowledge on how to navigate the NHS and have a family post-event. DISCUSSION:Changes need to be made to ensure clinicians make informed decisions when planning a family. Our half-day information session highlighted one relatively simple way in which this can be addressed. Integrating events such as ours will help disseminate information effectively and with lasting impact.
Background:Tofacitinib, filgotinib, and upadacitinib are Janus kinase inhibitors (JAKi) that have demonstrated efficacy in ulcerative colitis (UC) against placebo. This study aims to compare the clinical efficacy between these drugs. Methods:This is a multicentered, retrospective cohort study. Patients with UC starting a JAKi were recruited between 2018 and 2024 when starting their first JAKi. Clinical remission and response, based on clinical scores, calprotectin, and endoscopic measurement, were assessed at 3 and 6 months. Both independent and combined variable outcomes were analyzed. Results:Two hundred and seventy patients were included in the analysis, of which 70 (26%) were on upadacitinib, 51 (19%) on filgotinib, and 149 (55%) on tofacitinib. Clinical, biochemical, and endoscopic remission at 6 months was 91%, 71%, and 80% for upadacitinib; 78%, 67%, and 50% for filgotinib; 73%, 51%, and 44% for tofacitinib. Upadacitinib demonstrated significantly greater clinical response (P = .027) and remission (P = .037) rates at 6 months than tofacitinib. Drug persistence at 12 months was 86% for upadacitinib, 72% for filgotinib, and 69% for tofacitinib. Upadacitinib demonstrated significantly greater 6-month remission rates compared to tofacitinib in the bio-exposed cohort (71% vs 52%, P = .022) and in the bio-naïve cohort (93% vs 50%, P = .009). The incidence rates for hospital admissions were 10.2, 21.9, and 14.1 and for colectomies were 6.7, 10.0, and 5.0 per 1000 patient-months at risk for upadacitinib, filgotinib and tofacitinib, respectively. Conclusion:This study demonstrates that upadacitinib is more likely to achieve 6-month response and remission compared to tofacitinib. In both bio-naïve and bio-exposed patients, upadacitinib was more likely to achieve remission at 6 months. The efficacy of JAKi does not appear diminished by prior biologic use.
Background and study aims:Post-endoscopy upper gastrointestinal cancer (PEUGIC) is a key performance indicator for endoscopy. PEUGIC represents a delay in diagnosis: a patient has an endoscopy that did not diagnose cancer, and another investigation, usually endoscopy, 3 to 36 months later that diagnoses upper gastrointestinal (UGI) cancer. We describe a national system to identify PEUGIC and undertake root cause analysis. Methods:This retrospective national study was undertaken in the English National Health Service (NHS) and consisted of: 1) identification of PEUGIC; 2) development of an online platform for root cause analysis; and 3) pooled national analysis of PEUGIC. Two national datasets--Hospital Episode Statistics and National Cancer Registration and Analysis Service's cancer registry--enabled identification of people diagnosed with UGI cancer who had endoscopy in the previous 3 to 36 months without a cancer diagnosis (PEUGIC). The online portal informed every endoscopy provider of their PEUGIC and enabled a comprehensive root cause analysis. Results:This methodology was successful in identifying 3907 PEUGIC from January 1, 2017 to October 30, 2023. Root cause analysis was completed for 2666 PEUGIC during the study period and represents the world's largest cohort of PEUGIC. 664 (17%) PEUGIC were ineligible on local review as they did not meet study criteria. Conclusions:A process to identify PEUGIC across a national healthcare system and to perform root cause analysis is described. The methodology is transferable to other healthcare systems with large national datasets, but even without such datasets, the root cause analysis process developed allows identification of learning from PEUGIC for local endoscopy quality improvement.
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.
