University Hospital Southampton NHS Foundation Trust is an NHS foundation trust which operates the Southampton General Hospital, the Princess Anne Hospital, Southampton Children’s Hospital, and the New Forest Birth Centre at Ashurst, Hampshire. It also provides a few services at the Royal South Hants Hospital and previously operated Countess Mountbatten House, a palliative care service at Moorgreen Hospital, which has since been renamed Mountbatten Hampshire.In 2016 the trust established a subsidiary company, UHS Estates Limited. The intention was to achieve VAT benefits, as well as pay bill savings, by recruiting new staff on less expensive non-NHS contracts. VAT benefits arise because NHS trusts can only claim VAT back on a small subset of goods and services they buy. The Value Added Tax Act 1994 provides a mechanism through which NHS trusts can qualify for refunds on contracted out services.
Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
Cardiac channelopathies are inherited cardiac disorders associated with potentially life-threatening ventricular arrhythmias. They are caused by genetic mutations of ion channels that alter cardiac cell membrane potential and intracellular haemostasis, and include long QT syndromes (LQTSs), Brugada syndrome and the much rarer catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, short QT syndrome and early repolarization syndrome. Presentation of these varies widely from sudden cardiac death to incidental diagnosis at the time of electrocardiography. While they are rare, diagnosis and subsequent familial screening can have significant results for both the index patient and family members. A clear understanding of the cardiac action potential helps to clarify the pathological mechanism of arrhythmogenesis that characterizes these conditions. Risk stratification of adverse outcomes from these conditions is complex and often imprecise. Medical therapy and implantable cardioverter-defibrillators have a potential role in patient management. It is recommended that complex decisions relating to these patients be discussed in a multidisciplinary team environment wherever possible. Most of this review focuses on LQTS and Brugada syndrome as these are the most common forms of cardiac channelopathies.
Potassium citrate is widely used as oral alkali therapy for the prevention of recurrent nephrolithiasis. Despite its long-standing clinical use, systematically collected real-world safety data remain limited. We performed a pharmacovigilance analysis to characterize adverse event reports associated with potassium citrate using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). FAERS reports submitted between 2014 and 2025 listing potassium citrate as the primary suspect drug were analyzed. Duplicate records were removed, and adverse events were coded using the Medical Dictionary for Regulatory Activities (MedDRA) at both the system organ class and standardized event term levels (preferred terms, PTs). Disproportionality analyses were conducted using reporting odds ratio, proportional reporting ratio, bayesian confidence propagation neural network, and multi-item gamma poisson shrinker methods. A total of 408 unique reports were included. Most reports involved adults and were physician-reported from the United States. Disproportionality analysis identified potential safety issues (signals), defined as drug event associations reported more frequently than expected in FAERS and therefore warranting further evaluation, although not establishing causality. The strongest associations involved product-related issues, laboratory investigations, and gastrointestinal disorders. When these potential safety issues were described using standardized MedDRA event terms most reflected formulation- and administration-related problems, including tablet residue in stool, abnormal solubility, swallowing difficulty, throat irritation, and foreign body sensations. Reports of rash were infrequent. This first FAERS-based analysis of potassium citrate highlights that most reported adverse events are related to formulation and administration characteristics rather than drug toxicity. These findings support the overall tolerability of potassium citrate while underscoring the importance of adherence, patient education, and formulation-specific considerations in clinical practice. As a spontaneous reporting system, FAERS is valuable for hypothesis generation, label expansion, and post-marketing surveillance, but it is not suitable for estimating the incidence or absolute risk of adverse events.
Background/Aims: Double-headed capsule endoscopy enhances visualization and diagnostic yield in small bowel evaluation but increases reading time. This study aimed to assess the diagnostic performance of AI-assisted double-headed capsule endoscopy (MiroCam MC2000) across all small bowel indications and to compare its reading efficiency with the standard manual reading mode. Methods: From May to December 2023, 242 consecutive patients (mean age 50.17 years, SD 18.3; 53% female) underwent small bowel capsule endoscopy at two UK centres for suspected Crohn's disease (48.8%), iron-deficiency anemia (23.6%), bleeding (18.6%), or other (9%). Seven experienced readers reviewed videos in standard mode (blinded to clinical data), then AI-assisted (MiroCam AI Scan) methods were applied after de-identification/randomization. Two experts provided reference standards. No adverse events occurred. Results: AI-assisted reading had sensitivity 95.3% (95% CI 90.1-98.3%) and specificity 96.5% (95% CI 91.3-99.0%) for diagnostic findings, vs. standard reading: 96.5% (95% CI 91.2-99.0%) and 85.3% (95% CI 78.0-90.9%). The positive findings rate was 83.6% vs. 80.2% (p = 0.040). Reading time decreased by 52% (38.1 vs. 18.26 min; p < 0.001). Conclusions: AI-assisted reading offers high diagnostic accuracy, superior specificity and reduced reading times, supporting its adjunctive role with expert oversight. Registered: ERGO ID 82419.
Optimal clinical application of the minimal clinically important difference (MCID) for the MMN-Rasch-built Overall Disability Scale© (MMN-RODS) scale is unknown. We retrospectively studied subjects with MMN from 2 UK neuropathy centres. Raw and centile MMN-RODS scores were collected, at initial, two intermediate, and latest assessment, and distribution-based MCIDs determined at studied time-points. The sensitivities of raw, centile and individualised MCIDs, were compared. We included 32 consecutive subjects with MMN on individualised immunoglobulin dosing regimens. First intermediate, second intermediate, and latest assessments were performed at a median of 17.0, 54.1 and 74.6 months from onset, respectively. Progressive amelioration of mean raw MMN-RODS score occurred between initial and latest assessment. The distribution-based raw MMN-RODS MCID was of 3, 4 and 5, and the distribution-based centile MMN-RODS MCID was of 6, 7 and 7, at first intermediate, second intermediate and latest assessment, respectively. At first intermediate assessment, raw and individualised MCIDs were equally sensitive, and both more sensitive than centile MCID (McNemar’s Test: p < 0.001, p < 0.001). Raw MCID, centile MCID and individualised MCID, all had equivalent sensitivity at the second intermediate and latest assessment. Neither initial MMN-RODS score, nor amplitude of treatment-induced changes in early disease stages, independently predicted total improvement amplitude or final outcome. MMN-RODS MCID cut-offs may require adaption to assessment timing. In earlier stages, raw/individualised MCID may be more sensitive than centile MCID, whereas all three methods may subsequently be equivalent. Initial disability and early treatment response do not predict achievable total improvement amplitude nor final outcome.
