IntroductionObstetrics and Gynaecology (O&G) is one of the most litigious medical specialities. This study aimed to analyse the trends and reasons for litigation claims in O&G within the UK National Health Service (NHS) over a 17-year period.MethodsUsing data requested from NHS Resolution under the Freedom of Information Act 2000, an analysis was carried out which included the total number and rate of litigation claims in O&G, the number of these claims that were successful (settled or closed), the damages paid due to successful claims, and the reasons for successful claims between financial years 2006/07 and 2023/24.Results29,129 litigation claims were made in the speciality of O&G between 2006/07 and 2023/24. 66.0% (19,239/29,129) were in Obstetrics, and 34.0% (9890/29,129) were in Gynaecology. 60.8% (17,698/29,129) of O&G claims were successful. The rate of claims in Obstetrics increased per 1000 births (1.1 in 2006 to 2.5 in 2023/24) from the start to the end of the study period. The primary causes for successful claims in Obstetrics included failure/delay of treatment (16.5%, 1943/11,806), failure/delay in diagnosis (8.8%, 1042/11,806) and failure to make response to abnormal fetal heart rate (7.9%, 931/11,806). For Gynaecology, the primary causes were failure/delay of treatment (15.2%, 898/5892), intra-operative problems (15.1%, 888/5892) and failure/delay in diagnosis (12.5%, 735/5892). Never events accounted for 9.3% (790/17,698) of successful claims in O&G.ConclusionO&G has become an increasingly litigious speciality over the last two decades. Although delay in treatment or diagnosis accounted for the highest proportion of successful claims, never events accounted for just under 10% of cases. More work can be done to reduce the risk of these adverse events.
BackgroundPoint-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI) testing can reduce diagnostic turnaround in the emergency department (ED), but real-world operational data remain mixed.MethodsObservational before-after service evaluation at a high-volume UK tertiary ED (Queen Elizabeth University Hospital, Glasgow; ∼200,000 attendances/year). On 12 November 2025 a new chest-pain pathway combined bedside POC hs-cTnI (Abbott i-STAT Alinity) with a reduction in the serial-sampling interval from 0-3 to 0-2 hours, via an immediate hard switch; disposition thresholds were unchanged. The primary outcome was ED length of stay (LOS); interrupted time series (ITS) assessed the temporal association with implementation.ResultsOf 1381 attendances (718 pre- and 663 post-implementation), median LOS fell from 382 to 319 minutes (-63; p < 0.001), and from 510 to 335 minutes among serial-testing patients (-175; Wilcoxon p < 0.001). Four-hour breach fell from 78.8% to 67.3% overall (-11.6 percentage points; 95% confidence interval (CI) -16.2 to -6.9) and from 95.7% to 72.7% in serial testers. ITS showed an immediate level change at go-live (-144 minutes; p < 0.001); estimated capacity released ∼51 bed-hours/day.ConclusionImplementing this POC-based pathway was temporally associated with immediate reductions in ED LOS and 4-hour breach, greatest among serial-testing patients. Benefit is likely greatest where overcrowding and slow laboratory turnaround coexist.
Introduction and aimsGuidelines recommend secondary prevention implantable cardioverter defibrillator (SP-ICD) therapy after significant ventricular arrhythmia. However, landmark SP-ICD trials enrolled patients with mean ages of 58-65 years. No randomised evidence guides SP-ICD use in patients aged ≥80 years, despite the increasing importance of competing modes of death when assessing benefit. We aimed to describe the patient journey and clinical outcomes of individuals aged ≥80 years receiving an SP-ICD at a single high-volume centre over 7 years.Methods and resultsWe retrospectively reviewed all consecutive device implants at a regional Scottish centre from 2014 to 2021 to identify SP-ICD implantation in patients aged ≥80 years. Clinical data were then obtained from electronic health records. Thirty-eight patients received an SP-ICD. Survival free from ICD deactivation or death at 6 months, 1 year and 2 years was 95%, 84% and 71%, respectively. During follow-up, 21 patients (55%) received appropriate therapy. There was an overall complication rate of 13%. One patient received inappropriate ICD therapy, and five patients (13%) experienced ICD shock storm.ConclusionOctogenarians receiving SP-ICDs experienced frequent appropriate defibrillator therapy and acceptable survival, but complications were common. These findings emphasise patient-centred decision-making and counselling about risks, future therapies and potential device deactivation.
ObjectiveTo examine associations between systemic inflammation, sex hormones, and vitamin D levels in U.S. women.MethodsA cross-sectional study was conducted using NHANES 2021-2023 data from 3179 women aged 18-80 years. Participants were grouped by high-sensitivity C-reactive protein (hs-CRP) quartiles. Demographic, anthropometric, lifestyle, dietary, and clinical variables were analyzed. Serum biomarkers included hs-CRP, sex hormones, lipid parameters, and 25-hydroxyvitamin D3 (25OHD3). Multivariable linear regression assessed independent associations between hs-CRP and endocrine markers after adjustment for confounders.ResultsWomen in the highest hs-CRP quartile had higher age, body weight, waist circumference, body mass index, and prevalence of hypertension and diabetes than those in the lowest quartile. Higher hs-CRP levels were associated with lower concentrations of 17α-hydroxyprogesterone, androstenedione, anti-Müllerian hormone (AMH), dehydroepiandrosterone sulfate, follicle-stimulating hormone (FSH), sex hormone-binding globulin, and 25OHD3. After adjustment, hs-CRP remained positively associated with AMH (β = 0.212, p = 0.007), estrone (β = 0.142, p = 0.048), low-density lipoprotein cholesterol (β = 0.241, p = 0.002), and total cholesterol (β = 0.224, p = 0.001), and inversely associated with FSH (β = -0.194, p = 0.039) and luteinizing hormone (β = -0.191, p = 0.019).ConclusionSystemic inflammation was associated with reproductive hormones and lipid profiles, while many associations weakened after adjustment for adiposity. These findings highlight complex links between inflammation, endocrine function, and cardiometabolic health, influenced by obesity-related factors.
ObjectivesAccurate triage of lumbar spine magnetic resonance imaging (MRI) referrals for sciatica is important for patient assessment, diagnosis and surgical planning. This study evaluates the accuracy and speed of large language models (LLMs) in automatically vetting lumbar spine MRI referrals from general practice.MethodsThree LLMs (GPT-4, Claude Opus, Gemini) were tasked with assigning an outcome (Accept - Routine, Accept - Urgent, Reject) and flagging MRI contraindications for lumbar spine referrals. Three prompts of increasing detail, including clinical guidelines and training examples, were used. Two radiology registrars synthesised 120 referrals, vetted by two board-certified radiologists, with a third resolving disagreements. Performance was assessed using accuracy, precision, recall and F1 scores.ResultsInter-rater agreement between radiologists was substantial for vetting outcome (Cohen's κ = 0.76) and contraindication detection (κ = 0.68). Claude Opus with the full prompt achieved the highest accuracy (0.86) for vetting outcomes. GPT-4 with the instruction-only prompt achieved the highest F1 score (0.88) for contraindication detection. LLMs completed the task substantially faster than radiologists (9.8 ± 1.0 vs 135.0 ± 45.0 min).ConclusionsLLMs demonstrate promising performance in vetting radiological referrals for sciatica, particularly with detailed context. All models identified all urgent referrals, suggesting potential for prioritising vetting worklists and improving timeliness of care.
BackgroundPatients attending tertiary healthcare centres often travel long distances for routine outpatient consultations, leading to time loss, financial burden, and reduced access to care. Telehealth offers an opportunity to reduce unnecessary patient travel while maintaining appropriate clinical care.AimTo evaluate the impact of introducing telehealth consultations on patient travel distance, travel time, and estimated fuel costs within a tertiary surgical outpatient service in NHS Scotland.MethodsThis quality improvement project used a single Plan-Do-Study-Act (PDSA) cycle. Between January and April 2025, 50 patients scheduled for routine outpatient interviews were converted from face-to-face to video consultations using an NHS-approved platform (NHS Near Me). Avoided round-trip travel distance was calculated using patient postcodes. Travel time and fuel cost savings were estimated using standardised metrics.ResultsA total of 3014.4 miles of patient travel were avoided, corresponding to an estimated 144.7 h of travel time saved and £452.16 in fuel costs. No consultations required rescheduling due to technical failure. Informal patient feedback indicated high acceptance and satisfaction with telehealth consultations.ConclusionTelehealth substantially reduced patient travel burden for suitable outpatient consultations and improved access to care. Wider adoption of telehealth for routine outpatient interviews within NHS Scotland is feasible and recommended.
