University Hospitals of Leicester NHS Trust was created in April 2000 with the merger of the Leicester General Hospital, Glenfield Hospital and Leicester Royal Infirmary.At that time it was one of the six biggest NHS trusts in England with a budget of over £600 million per annum and 12,000 staff. It treats in excess of 1 million patients per annum, delivers 10,000 babies a year and provides the largest emergency service (admissions and ED attendances). It has one of the best records in the country for cardiac care and also specialises in kidney disease, cancer and vascular surgery. Its research programmes in cardio-vascular science, stroke medicine and diabetes are internationally renowned.It was originally led by Philip Hammersley CBE (Chairman, 2000–06), Dr Peter Reading (Chief Executive, 2000–07) and Dr Allan Cole (Medical Director, 2000–10). In May 2008 new chief executive, Malcolm Lowe-Lauri, joined the trust from Kings College Hospital. John ADLER has been CEO since 2013.
Abstract Background Transcatheter closure of ventricular septal defects (VSDs) presents technical challenges in patients with complex anatomies and residual post-surgical defects. This study aimed to evaluate the feasibility, safety, and early outcomes of percutaneous VSD closure using a range of occlusion devices in a heterogeneous patient population. Methods This was a retrospective single-centre observational study of patients who underwent percutaneous VSD closure between 2017 and 2024 at a tertiary congenital cardiac centre. Results Twenty patients were included (12 females, 8 males) with a median age of 5.5 years (range 6 months–72.9 years) and median body weight of 18 kg (range 6.4–127 kg). Native VSDs were present in 14 patients and residual post-surgical defects in 6. Defect types included perimembranous (n = 13; including 3 Gerbode defects) and muscular (n = 7). Procedural success was achieved in 95% (19/20). Immediate complete occlusion occurred in 65% (13/20), while 7 patients had small residual shunts that remained haemodynamically insignificant at 1-year follow-up. Complications included one case of transient haemolysis and one case of ventricular ectopy requiring surgical device retrieval. No cases of complete heart block, device embolisation, or significant valve injury were observed during follow-up. Conclusion Percutaneous VSD closure using a range of occlusion devices is feasible and safe across different anatomies and age groups, with high procedural success and low complication rates at one-year follow-up.
BACKGROUND:Capsule endoscopy (CE) is a valuable tool used in the diagnosis of small intestinal lesions. The study aims to systematically review the literature and provide a meta-analysis of the diagnostic accuracy, specificity, sensitivity, and negative and positive predictive values of AI-assisted CE in the diagnosis of small bowel lesions in comparison to CE. METHODS:Literature searches were performed through PubMed, SCOPUS, and EMBASE to identify studies eligible for inclusion. All publications up to 24 November 2024 were included. Original articles (including observational studies and randomized control trials), systematic reviews, meta-analyses, and case series reporting outcomes on AI-assisted CE in the diagnosis of small bowel lesions were included. The extracted data were pooled, and a meta-analysis was performed for the appropriate variables, considering the clinical and methodological heterogeneity among the included studies. Comprehensive Meta-Analysis v4.0 (Biostat Inc.) was used for the analysis of the data. RESULTS:A total of 14 studies were included in the present study. The mean age of participants across the studies was 54.3 years (SD 17.7), with 55.4% men and 44.6% women. The pooled accuracy for conventional CE was 0.966 (95% CI: 0.925-0.988), whereas for AI-assisted CE, it was 0.9185 (95% CI: 0.9138-0.9233). Conventional CE exhibited a pooled sensitivity of 0.860 (95% CI: 0.786-0.934) compared with AI-assisted CE at 0.9239 (95% CI: 0.8648-0.9870). The positive predictive value for conventional CE was 0.982 (95% CI: 0.976-0.987), whereas AI-assisted CE had a PPV of 0.8928 (95% CI: 0.7554-0.999). The pooled specificity for conventional CE was 0.998 (95% CI: 0.996-0.999) compared with 0.5367 (95% CI: 0.5244-0.5492) for AI-assisted CE. Negative predictive values were higher in AI-assisted CE at 0.9425 (95% CI: 0.9389-0.9462) versus 0.760 (95% CI: 0.577-0.943) for conventional CE. CONCLUSION:AI-assisted CE displays superior diagnostic accuracy, sensitivity, and positive predictive values albeit the lower pooled specificity in comparison with conventional CE. Its use would ensure accurate detection of small bowel lesions and further enhance their management.
BACKGROUND:Clinical documentation is a major contributor to physician burnout, and artificial intelligence (AI) scribes are increasingly being adopted to help reduce the burden of documentation. These tools automatically generate clinical notes from patient-provider conversations using speech recognition and natural language processing. However, their usability and effectiveness still remain an issue. AIM:To synthesise the existing evidence on usability-related barriers and facilitators influencing the adoption and use of AI scribes for clinical documentation in healthcare settings. METHOD:The scoping review employed the methodology developed by Arksey and O'Malley in 2005 and further expanded by Levac and Colquhoun in 2010. We searched PubMed, Scopus, Ovid MEDLINE, and Web of Science to identify relevant studies published in English between 2015 and 2025. All findings were reported according to PRISMA guidelines for scoping reviews. RESULTS:Of 4588 identified records, 14 studies met the inclusion criteria and employed qualitative, quantitative, and mixed-methods. AI scribes were consistently associated with reduced cognitive load, faster documentation, improved work-life balance, and positive user experience. However, common barriers included frequent errors, excessive note length, limited formatting options, and poor integration with electronic health records (EHR). Editing demands varied by clinician experience, with some finding that time savings were lost when substantial corrections were needed. Overall, usability was rated more favourably in routine or protocol-driven visits, with mixed outcomes reported on long-term burnout and workflow impact. CONCLUSION:AI scribes show promise in reducing documentation burden and improving clinical workflow, but important usability challenges remain. Enhancing accuracy, streamlining integration, and allowing greater customization will be essential to support broader adoption and sustained use in clinical practice.
Aims:In the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT), surgical fixation was compared with cast immobilization, with the primary endpoint being the outcomes at one year. The aim of the current study was to assess the radiological outcomes (union and the development of osteoarthritis (OA)) of the two forms of treatment at five years. Methods:Patients who remained in the trial at five years after randomization were invited to have plain radiographs and a CT scan of the injured wrist, and a posterior-anterior radiograph of the contralateral wrist. This imaging was reviewed by three observers independently for union of the fracture and the distribution and severity of OA. This analysis followed a pre-specified statistical analysis plan. The relationship between OA and the Patient-Rated Wrist Evaluation (PRWE) scores at five years was assessed. Results:Of the 439 patients who were randomized, 267 (60.8%) provided imaging at five years. Their characteristics were similar to those of the original cohort. A total of 182 patients (68.2%) (n = 92 fixation, n = 90 cast) had complete union and seven had a nonunion (2.6%; n = 3 fixation, n = 4 cast). Fractures with a minimum of 20% union at one year consolidated with the passage of time without intervention. Progression of OA in the joints around the scaphoid was seen in both groups from baseline to five years. By five years, 140 patients (52.4% of those with imaging at five years) had OA in at least one joint with similar prevalences in both groups. The prevalence of OA, the number of arthritic joints and the maximum severity of OA, was similar in the two groups. A total of 344 of the initial cohort of 439 patients (78.4%) provided a valid PRWE score at five years and the mean score was higher in those with more severe OA, indicating worse pain and function. Conclusion:Between one and five years after randomization, union consolidated in those with > 20% bridging without intervention. The proportion of patients with full, almost full, partial, slight, and nonunion for the two forms of treatment remained similar at five years. The prevalence and severity of OA increased during the five years but was similar in both groups.
BACKGROUND:Cardiovascular disease (CVD) is the leading global cause of mortality and disproportionately affects low- and middle-income countries (LMICs). Although screening is essential for prevention and early detection, its effectiveness and implementation in LMICs remain unclear. OBJECTIVES:The objective of the study was to evaluate the diagnostic performance, detection yield, and linkage-to-care outcomes of CVD and major cardiometabolic risk-factor screening programs in LMICs. METHODS:We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO, CRD420251241426). Databases were searched through November 2025. Observational and interventional studies assessing cardiovascular or major cardiometabolic screening programs in LMICs were included. Primary outcomes were detection rates and linkage to care. Secondary outcomes included risk-factor control, cardiovascular events, mortality, and cost-effectiveness. Owing to heterogeneity, results were synthesized narratively. RESULTS:Seventeen studies from Asia, sub-Saharan Africa, and Latin America were included. Screening approaches comprised risk-prediction models, point-of-care testing, community health worker-led programs, and mobile health platforms. Diagnostic performance ranged from area under the curve 0.64 to 0.91. Locally adapted risk models generally outperformed imported scores, whereas simplified tools showed acceptable discrimination. Screening identified a substantial burden of undiagnosed disease, with up to 55% meeting hypertension criteria and approximately 40% classified as high risk for diabetes. However, considerable attrition occurred across the care cascade, with preventive service uptake ranging from 15% to 58% and confirmatory testing as low as 22%. Community health worker-led programs demonstrated >90% sensitivity and specificity compared with clinician assessment. CONCLUSIONS:CVD screening programs in LMICs can effectively identify unmet cardiometabolic risk, but weak linkage to care limits impact. Strengthening integrated screening-to-treatment pathways is essential to improve outcomes.
