This website is intended for healthcare professionals only.
Take a look at a selection of our recent media coverage:
2nd May 2025
Hospital Healthcare Europe is delighted to announce respiratory consultant and cystic fibrosis expert Dr Uta Hill as a speaker at the upcoming Clinical Excellence in Respiratory Care event on 7 May 2025.
Dr Hill is the cystic fibrosis clinical lead and bronchiectasis co-clinical lead at the Cambridge Centre for Lung Infection at Royal Papworth Hospital NHS Foundation Trust. She will share her expert insights on redefining the clinical landscape of cystic fibrosis.
Her session will cover recent advances in cystic fibrosis care, including the development of cystic fibrosis transmembrane conductance regulator modulator therapy and its impact for patients, as well as the changing pathways for adult cystic fibrosis care and the transition from paediatrics.
This session follows on from her contribution to the previous Clinical Excellence in Cardiovascular Care event in May 2024 in which she joined a panel discussion on the evolution of imaging techniques to support the diagnosis and staging of respiratory diseases.
Find out more about the upcoming Clinical Excellence in Respiratory Care event and register for free to hear the latest from Dr Hill on cystic fibrosis and a jam-packed agenda of other respiratory topics.
This latest event in HHE’s Clinical Excellence series brings together renowned experts from recognised Centres of Excellence and other key institutions to share best practice and explore the latest advances in respiratory care.
From modern smoking cessation and the when, why and how of lung transplantation, to wearables and artificial intelligence in sleep medicine and the management of pathogens in asthma, plus Dr Hill’s cystic fibrosis session and a range of sponsored sessions, it’s not to be missed.
The event is free to attend and will be delivered virtually live and on-demand, all tailored to provide maximum convenience and work around your busy schedule.
Select sessions most relevant to your clinical practice, specifically tailoring the day to your needs, and gain CPD hours from the comfort of your computer.
The event is fast approaching so register now to join us for Clinical Excellence in Respiratory Care on 7 May.
You can watch a selection of previous Clinical Excellence event sessions in the Catch-up zone now, as well as being able to access a whole host of additional long-reads and interviews with prominent clinicians from Centres of Excellence and beyond in the Respiratory zone – look out for the orange Clinical Excellence tag.
A newly developed handheld medical device could potentially replace a stethoscope as a tool for detecting valvular heart disease, UK researchers report.
Unlike a stethoscope, the flexible multi-sensor device could be used by people without medical training to record heart sounds and could capture high-quality sounds when used over a patient’s clothing.
Reporting a proof-of-concept and validation study in the IEEE Journal of Biomedical and Health Informatics, researchers from the University of Cambridge said valvular heart disease was one of the most common causes of heart failure and had been described as the next ‘cardiac epidemic’.
Yet they noted more than half of patients with significant valvular heart disease remained undiagnosed, and more than half of patients in Europe received surgery too late, when surgery was less effective.
‘A key reason for this underdiagnosis is that accurate cardiac auscultation requires significant skill and can be a time-consuming and intimate process,’ they wrote.
Of note, they found auscultation was only performed on 35% of UK patients with symptoms indicative of valvular heart disease, and female patients were less likely to receive a complete cardiac exam.
In the UK, the NHS and NICE have identified early detection of heart valve disease as a key goal for improving patients’ quality of life and reducing healthcare costs.
The newly developed device, which fits in the palm of the hand, has six high-sensitivity piezoelectric sensors embedded in a flexible substrate of silicone gel and is placed at key auscultaton locations by the patient.
The six sensors, compared with one on a digital stethoscope, increased the likelihood of capturing high-quality signals from the key auscultation sites and eliminated the need for skilled chest placement, they explained.
‘To address challenges from localised heart sound vibrations and noise interference, we developed time-frequency signal quality algorithms that automatically select the best sensor in the device and reject recordings with insufficient diagnostic quality,’ the study authors wrote.
In the study, researchers asked 40 healthy participants with a diverse range of ages and body mass index (BMI) measurements to use the device to record their heart sounds, with an expert researcher in the room to make sure the device was placed at the correct points.
For males, the device performance was deemed excellent at the three main auscultation sites: aortic, mitral and tricuspid. Every male participant achieved a passable recording at tricuspid and mitral sites regardless of BMI, the researchers reported.
There were similar results from the device for normal and underweight female participants, but performance was reduced for females with a higher BMI at tricuspid and mitral sites.
‘The impact of BMI was further compounded when recordings were attempted whilst patients wore a bra,’ they noted.
The researchers suggested future iterations of the device could use real-time signal quality feedback to guide the users on where to place the device to obtain an optimum signal and that female users could be asked to make a first attempt with a bra and then remove it if the signal quality was insufficient.
Further research would also be needed to assess if unsupervised patients could use the device, perhaps with directions from an instruction manual or smartphone app, they said.
Senior study author Professor Anurag Agarwal, head of the Fluids Group and the Acoustics Lab at the University of Cambridge’s Department of Engineering, said the accuracy of stethoscope examination for diagnosing valvular heart disease was fairly poor, and required a clinician to conduct the examination.
‘To make sure we’re diagnosing heart valve disease early enough that simple interventions can improve quality of life, we wanted to develop an alternative to a stethoscope that is easy to use as a screening tool,’ he said.
‘If successful, this device could become an affordable and scalable solution for heart health screening, especially in areas with limited medical resources.’
The next step will be a prospective clinical study in a representative patient population, where the device will be integrated with a machine learning algorithm to support automated screening for valvular heart disease.
Cambridge Enterprise – the university’s commercialisation arm – has filed a patent on the device.
With digital transformation in mental health services ramping up, consultant psychiatrist Dr Arokia Antonysamy discusses the current demands, practices and challenges in mental health how leveraging artificial intelligence for assessment and treatment can lead to improved mental health outcomes.
In the midst of the global pandemic, many sectors – including mental health – tentatively embraced digital solutions like teleconsultation through remote working to maintain continuity of care. Yet there was a swift regression to traditional in-person assessments, even before the full deployment of Covid-19 vaccines.
A puzzling resistance surfaced, rooted in the perception that remote work diminishes staff commitment.1 In reality, studies have shown increased productivity, engagement, better retention and job satisfaction.2,3 This traditionalist view holds back the essential evolution of mental health practices into the digital age.
Consider the realm of robotic surgeries, first introduced in the 1980s. The hesitance to adopt such technologies broadly stemmed from cost considerations, liability fears and concern over reduced surgical workforce capacity. This hesitance is emblematic of a larger trend in healthcare, where investment and progress in specialised fields can be incremental at best ─ and mental health, often seen as a ‘Cinderella speciality’, lags far behind.
Digital transformation encompasses the adoption and integration of digital technologies to improve the delivery, accessibility and effectiveness of services. In mental health, this transformation involves various components including telepsychiatry, mobile health applications, wearable devices, artificial intelligence (AI) and data analytics.
The application of AI across various industries, including healthcare, has been promising. Yet, the mental health sector remains underfunded and overlooked when it comes to this digital innovation. The reluctance to invest in modern technologies could be detrimental,4 stalling innovative advancements that can potentially revolutionise mental health practices.
The prevalence of common mental disorders in adults aged 16-64 increased from 14.1% in 1993 and 16.3% in 2000 to 17.5% in 2014.5 Additionally, long waiting times force 78% of patients to seek mental health help from emergency services and about a quarter wait for more than 12 weeks to start treatment, according to the Royal College of Psychiatrists.6
The existing gateway system, which mandates all referrals to secondary care mental health services to go through general practitioners (GPs), presents significant hurdles. Face-to-face GP consultations have become increasingly scarce, compounding the public’s dwindling confidence in primary care services.7 Most of the hospital admissions to psychiatric wards stem from crisis situations or emergency departments, rather than through planned referrals.8
Conversations with community members paint a stark picture of the challenges in accessing mental health services. A national survey of public attitudes to AI in healthcare noted many respondents find it beneficial due to the speed and efficiency, citing the lengthy waiting times and bureaucratic hurdles associated with specialist appointments as the main drivers towards public remaining open to technological approaches.9
Digital transformation holds the promise of revolutionising mental healthcare delivery by bridging the current gaps involving long waits, the limited number of therapy choices available to patients and the number of sessions not being sufficient to satisfy patient need.10
Telepsychiatry platforms through remote working can provide timely and accessible consultations, circumventing the need for lengthy waiting lists and physical appointments. This eco-friendly approach provides opportunities for assessments to take place in the comfort of patients’ own homes. From my own experience, I have observed better patient and family engagement, reducing the number of ‘did not attends’.
AI-powered algorithms can streamline triage processes remotely, identifying high risk individuals and prioritising their access to care. Mobile applications and wearable devices offer continuous monitoring and support, empowering individuals to actively manage their mental wellbeing. Streamlining the whole pathway enables quick assessments and interventions, causing less disruption to individuals’ work or studies, thereby alleviating the indirect burden on society
Among adolescents and young adults, trust and stigma surrounding mental health are significant barriers to seeking help.11 In January 2025, BBC News reported increasing numbers of young people turning to AI therapist chatbots, with 18 million messages being shared with one particular psychologist chatbot since November 2024.12 AI-driven platforms may be able to draw them towards seeking help early, facilitating early intervention13 and recovery, reducing the likelihood of social isolation and withdrawal. However, the risk of these platforms lacking empathy, which is a core component of the human interaction, along with the lack of knowledge in crisis interventions and not capturing the non-verbal cues, cannot be underestimated.14
Discrimination issues also exist in current practices in mental health, where patients from ethnic minority groups have limited access to psychotherapy despite the absence of language and culture barriers.15 Those from minority ethnic group are more likely to be detained under the mental health act than their white counterparts.16
AI has the potential to address discrimination issues through developing predictive models that take into account all the cultural factors to eliminate biases17 that can impact on response to treatment and patient experience and outcomes.
Traditionally, psychiatric doctors and experts rely on exhaustive assessments to determine the most suitable medication regime for the patient. These lengthy assessments consider a multitude of factors including a patient’s current and past history, vulnerability factors since birth, social history, family background, hospital admissions, physical health, medication history, risk factors, response limiting factors and other relevant information.
By harnessing the power of AI, these complex datasets can be distilled into actionable insights providing consultant psychiatrists with a comprehensive overview to guide treatment decisions. This collaborative approach not only reduces the risk of errors but also enhances efficiency,18 enabling doctors to see more patients and address treatment needs promptly.
Recent studies have highlighted the efficacy of self-help cognitive behavioural therapy interventions, which can be as effective as traditional face-to-face therapies19 or medication regimes in some populations. AI presents an opportunity to augment self-help interventions by incorporating interactive elements that engage and support individuals in managing their mental wellbeing.
However, while the potential of AI in self-help interventions is vast, efforts to mitigate human biases inherent in research methodologies are crucial during the process of predictive modelling to ensure the validity and inclusivity of AI-driven interventions.
Social factors also play a crucial role in mental health recovery with close knit community structures often associated with better prognosis20 and this goes some way to explain the faster recovery rate in the Eastern world.
However, social factors are often overlooked in mental health treatments in developed countries, partly due to the family structures being more nuclear with limited support from extended families. AI can narrow this gap by gathering evidence from global sources on key social components important to recovery.
While the potential of AI in revolutionising mental health care is huge, several challenges impede its widespread adoption and implementation.
The use of AI in mental health practice, where utmost trust and confidentiality is fundamental, raises complex ethical and legal concerns regarding patient privacy, consent and data security.
Ensuring compliance with regulatory frameworks such as the General Data Protection Regulation and adherence to Information Commission Office guidelines is essential to build public confidence in using these technological aids.
Additionally, Floridi and Cowls’ five-principles framework can be used by those who design, study, implement or research AI in mental health to provide assurance to users.21
Mental health professionals undergo many years of training and continue to keep up to date with clinical advances through regular appraisal and revalidation.
With AI emerging at the interface, professionals fear AI replacing their expertise gained from all those years of training and experience, leading to serious concerns around decision-making and accountability, especially when things go wrong.
The role of AI either as an ‘automator’, where it can perform the activities of an admin assistant like note taking and summarising at a speed beyond the scope of humans,22 or as an ‘augmenter’ where it quickly aids the decision-making process are creating fears around job losses.
Clinical jobs in mental health are critical to offer the human oversight and the exchange of emotional intelligence coupled with a comprehensive assessment.23
The practice of psychiatry is not about treating the disease, it’s about treating the person. The fundamental aspect of this is the human interaction that is the epitome of mental health care.
Healthcare professionals and the public are equally concerned about the perceived lack of empathy and lack of human interaction in AI-driven solutions. There are serious concerns around humans losing this unique aspect in the longer term if they are left with interacting with robots for most part of their care.
AI should not replace human intervention entirely. Trained professionals must be available to review interactions, provide support and intervene when necessary. However, children and adolescents with increasing digital literacy find chatbots less intimidating than humans and the only way to resolve any safety issues is to ensure robust governance processes.24
The clinical validity and evidence base for the AI application remains questionable. Despite the growing interest in AI-driven mental health interventions, robust clinical input and evidence of effectiveness is limited.25
Rigorous research studies, randomised controlled trials and long-term outcome assessments are needed to establish the efficacy, safety and cost-effectiveness of AI-powered interventions in diverse patient populations.
AI algorithms are susceptible to bias,26 reflecting and perpetuating existing inequalities within healthcare systems.
Biases in training data, algorithmic decision-making and patient outcomes can disproportionately impact marginalised populations and exacerbate disparities in mental healthcare access and treatment.
All AI algorithms should be carefully built and underpinned by safety to mitigate as much bias as possible.
Access to AI-driven mental health interventions may be limited by socioeconomic factors, digital literacy and technology infrastructure. Marginalised communities including those in rural and low-income areas may face barriers in accessing and utilising AI-powered services, widening existing disparities in mental health services.
Global leaders have called for coordinated action to scale up the use of technology in mental health interventions,27 advocating community based approaches to ensure equity and access to technology.28
Integrating AI technologies into existing mental health digital systems requires significant investments in infrastructure and IT workforce, organisational buy-in and workforce training.
Such integration requires clinicians to gain technological proficiency to augment their professional capability and enhance decision-making in person-centred care.
The opaque nature of AI algorithms poses a challenge in understanding how information is fed into this technological black hole and therefore how decision-making is achieved.
Predictive modelling can provide reassurance to some extent. Ensuring transparency, interpretability and accountability in AI-driven decision-making processes is critical to build trust among clinicians, patients, carers, commissioners and other stakeholders.
Digital transformation has the potential to catalyse unprecedented advancements in mental health services. AI applications in mental health treatment represent a paradigm shift in how we approach patient care and support. Embracing the opportunities AI can offer is paramount to enhance treatment decision-making,29 empower individuals with self-help interventions and strengthen social support networks.
However, this transformation requires concerted efforts from policy makers, healthcare providers, technology developers, community stakeholders and healthcare professionals to ensure equitable access, transparency and effective implementation.
Dr Arokia Antonysamy
Consultant psychiatrist, regional medical director at Cygnet Health Care and executive MBA at Warwick Business School
I would like to thank Professor Hila Lifshitz-Assaf for all her support and stimulating discussions around AI.
1st May 2025
Consistent adherence to pulmonary hypertension-specific oral therapy significantly improves clinical outcomes, according to a new prospective study evaluating patients with pulmonary arterial hypertension (PAH) and distal chronic thromboembolic pulmonary hypertension (CTEPH).
These two conditions are progressive, life-limiting diseases where timely, consistent medication use is critical to stabilise symptoms and prolong survival. Previous research has highlighted suboptimal adherence rates in this population, yet detailed real-world evaluations have been lacking.
Recognising that poor medication adherence can increase hospitalisation rates and worsen prognosis for chronic diseases in general, this study aimed to provide robust data on adherence rates and their clinical consequences for this patient group.
The Swiss research team prospectively followed 93 patients (66% women; mean age 57 years) treated with pulmonary hypertension-targeted oral therapies between 2013 and 2023.
Medication adherence was assessed using pharmacy refill records and self-reported questionnaires, with adherence defined as greater than or equal to 80%. Patients’ clinical status was monitored over time using a simplified four-strata risk assessment model.
Overall, 78% of patients were classified as adherent and showed improvement across all risk parameters. In contrast, non-adherent patients showed limited clinical gains. Patients with adverse drug reactions were 75% more likely to be non-adherent, while older age and higher baseline disease severity were associated with better adherence.
As noted by the authors, ‘insufficient adherence and potential contributing factors should be regularly considered, especially in patients without improvement after starting disease-specific therapy.’
As demonstrated by this study, sustained medication adherence is crucial for achieving clinical improvements in PAH and CTEPH. Proactive identification of patients at risk of poor adherence and early management of side effects could improve outcomes in this cohort and would be suitable for future research projects in this disease area.
Reference Reimann L et al. Medication adherence and clinical outcome in patients with pulmonary arterial hypertension or distal chronic thromboembolic pulmonary hypertension. BMJ Open Respir Res. 2025;12:e003023.
This article was originally published by our sister publication Hospital Pharmacy Europe.
29th April 2025
NHS App services are being offered by 87% of hospitals in the UK, which has saved 1.26 million clinical hours since July, according to the Department of Health and Social Care (DHSC).
Estimates also suggest that around 1.5 million missed hospital appointments have been prevented and 5.7 million staff hours saved in total over the past eight months, due to easier access to information and services through the app.
These hours and appointments have led to the equivalent of £622m in savings, according to the DHSC.
The app has also enabled almost 12 million fewer paper letters to be sent by hospitals since July, saving around £5.2m in postage costs. Forecasts predict that in-app notifications for planned care will also prevent the need for 15.7 million SMS messages this year, with the DHSC estimating savings of £985,000.
In July 2024, 68% of hospitals were offering appointment and other services through the NHS App, and the increase to 87% has exceeded the Government target of 85% by the end of March 2025.
The national director for NHS digital channels recently said a further aim is to achieve ‘at least’ 100 million logins a month by 2026.
Commenting on the NHS App success, health secretary Wes Streeting said: ‘This Government is determined to get our NHS fixed and fit for the future – and this is just one of the innovative ways through the Plan for Change that we’re helping patients, cutting waiting lists and saving taxpayers money all at the same time.
‘By putting the latest technology into the hands of patients so they can access services quicker, we’re freeing up more time for doctors and nurses to focus on treating people and getting waiting lists down.
‘This Government is doing things differently. Every missed appointment and wasted staff hour saved means another patient getting the care they need as we drive a digital NHS revolution through our Plan for Change.’
Prime Minister Keir Starmer added that the NHS has been ‘stuck in the dark ages’.
‘NHS reform has to come through better use of tech – it’s the fuel we need to power change,’ he said.
‘As we deliver our Plan for Change to end hospital backlogs, I want to see more and more people having the option to use the app, so that everyone benefits from more control and choice over their treatment.’
Dr John Dean, clinical vice president of the Royal College of Physicians welcomed the news of NHS App services being more widely available across hospitals.
‘A focus on incrementally building functionality in the NHS App to support patients to manage their own healthcare will lead to better more connected digital systems that work better for staff and patients, freeing up time and increasing productivity,’ he said.
‘We are keen to work closely with NHS England and the Government to ensure that the NHS App is rolled out and improved in ways that most benefit patients and clinicians. It is also vital that we ensure sufficient mitigations are put in place so that those without access to the app are not excluded from accessing the same quality of patient care.’
Rachel Power, chief executive of the Patients Association, added: ‘The NHS figures showing 1.5 million prevented missed appointments and 1.7 million staff hours saved demonstrate just how transformative this innovation can be.
‘While this digital progress is vital and the 20% increase in hospital participation is welcome, we must also ensure no one is left behind. Digital access remains a barrier for many, so we welcome the initiative providing support for online health services at 1,400 libraries across England. This kind of practical support needs to remain a key priority as services continue to modernise.’
Sophie Randall, director of the Patient Information Forum, recently said that credible information from certified sources to support patients in their care ‘should be embedded in the NHS App’, as well as in face-to-face interactions across the NHS.
28th April 2025
Exposure to indoor pollutants is a significant asthma trigger, and recent guidelines from the European Academy of Allergy and Clinical Immunology assess the effects of key indoor air pollutants on the development of asthma and on asthma-related outcomes. Here, Professor Ioana Agache, one of the lead authors, discusses how asthma management can be improved by following these recommendations, while emphasising that broader action is also necessary to achieve meaningful progress in enhancing indoor air quality and asthma prevention and control.
Allergies and asthma are diseases influenced by environmental factors, both in their onset and progression. Among the many triggers for asthma, indoor exposure to pollutants is particularly significant, as people often spend a large part of their time indoors. Approximately 2.4 billion people, especially in low- and middle-income countries, are exposed to dangerous levels of indoor air pollutants.
Environmental control plays a vital role in asthma management. Given the complexity of the indoor exposome, an intervention approach that targets multiple indoor aggressors is likely to be an effective strategy.
Incorporating the evaluation of indoor exposure along with personalised adaptation and mitigation measures into the asthma management plan is highly recommended. Particular attention should be given to the most vulnerable groups: children, pregnant women, the elderly with multiple comorbidities, individuals with disabilities and those who are socio-economically disadvantaged.
Environmental-driven asthma endotypes – that is, individuals susceptible to environmental factors rather than genetic influences – could also benefit from this approach.
The 2025 European Academy of Allergy and Clinical Immunology (EAACI) Guidelines on Environmental Science For Allergy And Asthma emphasise management in the context of indoor pollution.
Previous guidelines have a broader focus on general health or respiratory health and are, therefore, not particularly specific for managing patients with asthma. Additionally, this guideline is evidence-informed, adhering to the GRADE system – the highest-quality framework for guideline development – unlike many documents based on expert opinion.
The 2025 guideline highlights the importance of distinguishing between different types of exposure that can occur over the course of a lifetime:
The EAACI guidelines recommend reducing exposure to indoor pollutants through frequent indoor air monitoring and the use of smart ventilation systems. They advise preparedness for adverse asthma-related outcomes, such as loss of control, exacerbations and lung function decline, in settings with high levels of indoor pollution. For healthcare professionals, the evidence suggests incorporating environmental measures into their clinical advice for patients with asthma.
Adaptation measures to reduce the impact of indoor air pollutants on asthma-related outcomes at an individual level include:
Guidance from healthcare professionals in applying and monitoring the efficacy of these measures is warranted.
The guideline provides recommendations on the risk provided by exposure to major indoor pollutants, such as volatile organic compounds, cleaning agents, dampness/mould and pesticides, on developing asthma, asthma symptoms, impaired lung function, deterioration of asthma control and exacerbations, together with adaptation and mitigation measures, thus facilitating both asthma prevention and control.
Additionally, the guideline discusses indoor pollutants of emerging concern, including phthalates, microplastics, lead, radon, asbestos and emissions from particulate matter such as cooking stoves, indoor fireplaces and heaters. It also mentions perfluorocarbons, UV filters, synthetic musk, parabens, siloxanes, neonicotinoids and drug residues.
The EAACI guideline advocates for assessing each patient’s vulnerability to environmental aggressors and, where possible, for improving resilience to these aggressions. Three key pillars to enhancing resilience are a healthy diet, a healthy microbiome and a healthy immune system.
The guidelines recommend concomitant assessment of exposure and of the patient’s vulnerability to environmental aggressors in judging the risk of adverse outcomes and in planning the adaptation and mitigation measures. The potential for adaptation should be individually evaluated in each patient with asthma and a personalised plan should be co-created together with the patient and their family.
The guideline provides a checklist for healthcare professionals managing patients with asthma, recommending that all indoor settings be evaluated: home, school, work and indoor recreational areas. Furthermore, we provide information on advanced ventilation techniques contributing to optimal indoor air quality.
Lastly, the EAACI guideline highlights the importance of integrating all individual exposures into the complex configuration of the indoor exposome, by including indoor allergens and infectious agents that interact synergistically with pollutants. This configuration is continuously influenced by outdoor pollution levels, human activities and the characteristics of the building.
The combined effects of outdoor and indoor air pollutants are linked to seven million premature deaths each year. Vulnerable populations are disproportionately impacted.
There is a significant transgenerational effect of pollutants, impacting the foetus during pregnancy and continuing throughout an individual’s lifetime, as well as being transmitted to offspring. In fact, allergies are among the first environmentally driven chronic diseases that arise during a person’s life, highlighting the impact of environmental factors that may lead to other chronic diseases in adulthood.
The epidemic rise in allergies reported in recent decades parallels an increase in autoimmune disorders, cancer and metabolic disorders. All are chronic diseases arising from excessive environmental aggression along with a dysregulated resilient response of the human body.
Climate change intensifies the impacts of both outdoor and indoor pollution. There is a clear synergy between pollutants and heat or cold stress, as well as extreme weather events, that undermines the body’s resilient response. Due to extreme weather conditions, people are more likely to remain indoors, thus increasing their exposure to indoor pollution.
The traditional method of monitoring indoor pollutants involves air and dust analysis. Therefore, the range of analytical techniques must be continuously expanded. It is highly recommended to combine classical indoor analytics with human biomonitoring to promptly detect indoor pollutants using the exposome approach.
Continuous indoor air quality monitoring offers the best way to obtain real-time data on indoor air pollutant levels, while air cleaners and smart ventilation systems are vital tools for achieving optimal indoor air quality. However, challenges persist regarding the maturation of technologies, data mining and their interpretation. Therefore, healthcare professionals recommending adaptation and mitigation plans must collaborate closely with environmental health professionals, engineers, architects and others.
Furthermore, to develop an effective intersectoral model of the public health system, governments must collaborate with academia, media, business, community-based organisations and local communities.
We hope the evidence provided by these EAACI guidelines supports the establishment of legally binding standards and goals for indoor air quality at international, national and local levels.
Asthma management recommended by the current EAACI guidelines can improve asthma-related outcomes, but community and governmental measures to enhance indoor air quality are necessary to achieve a significant impact.
Policies aimed at promoting greater adaptation, such as reducing adaptation costs or enhancing indoor air quality, can deliver immediate benefits. There is an urgent need for increased awareness of the risks associated with poor indoor air quality and for the implementation of suitable regulations for public spaces.
Public health policies must undergo significant changes to adapt to the new understanding of the ecology of health and the interconnectedness of the biological, behavioural and physical domains. Therefore, it is essential to transform national health policies by incorporating the principles of environmental health.
Ioana Agache MD PhD
Professor of allergy and clinical immunology, Transylvania University of Brasov, Romania
25th April 2025
Measuring troponin levels alongside cholesterol significantly boosts the accuracy of cardiovascular risk prediction, a UK-funded study has found.
The researchers modelled risk using conventional measures such as age, blood pressure and cholesterol, with or without troponin, in more than 62,000 patients who had taken part in studies in Europe and the US.
Adding troponin results increased the prediction accuracy of myocardial infarction or stroke within 10 years by up to four times.
The researchers then used UK data to model the implications on statin prescribing should troponin be added to the risk calculators.
On an individual basis, the difference was small but impactful at the population level, the researchers said.
For people currently found to be at intermediate risk on routine cardiovascular health assessments, the tests would prevent one myocardial infarction or stroke for roughly every 500 people tested.
Reporting the results in the Journal of the American College of Cardiology, the team said the troponin test was especially effective at spotting danger in the 35% of people currently assessed to be at intermediate risk of cardiovascular problems.
The addition of troponin tests to the calculation meant that up to 8% of people were moved from intermediate risk to high risk, making them eligible for preventive treatment.
Lead author Professor Anoop Shah, clinical cardiologist and epidemiologist at Imperial College NHS Trust and professor of cardiovascular medicine at the London School of Hygiene and Tropical Medicine, said: ‘Troponin, even in the normal range, is a powerful indicator of silent heart muscle damage. As such, the test provides an extra layer of information that we can use to boost our accuracy when predicting people’s risk.
‘We want to identify as many high risk people as possible, so that no one misses out on the opportunity to get preventative treatment.’
Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation, which funded the research, said: ‘Developments in risk prediction have helped doctors to build effective algorithms that can spot those most at risk of heart attacks and strokes.
‘But, with around 100,000 hospital admissions for heart attacks alone in the UK each year, it’s clear that there is still plenty of room for improvement.
‘This new data suggests adding this blood test to current risk prediction models could help medical professionals identify more people who are at higher risk and deliver advice and treatment to reduce their risk of future heart attack and strokes.’
A version of this article was originally published by our sister publication Pulse.
24th April 2025
Lung cancer remains the leading cause of cancer-related mortality in the UK. A recent report from the UK Lung Cancer Coalition (UKLCC) underscores the impact of lengthy genomic testing turnaround times, which may hinder access to life-prolonging targeted therapies for many patients. Professor Robert Rintoul, the UKLCC clinical lead, examines the report’s findings and proposes actionable strategies to optimise the delivery of timely, accurate and high-quality genomic testing across the UK to support more effective and prompt treatment decisions.
Genomic testing identifies the molecular characteristics of cancer, enabling patients to access targeted therapies that can significantly improve survival rates and quality of life. For clinicians, knowledge of mutations is a prerequisite for making optimal treatment decisions, including eligibility for perioperative or neoadjuvant chemo-immunotherapy.
Delays in genomic testing can significantly hinder patient treatment decisions and impact subsequent survival outcomes, especially in cases of rapidly fatal disease such as lung cancer where timely intervention is crucial. Delays not only affect the physical health of patients but also add to their emotional distress as they await critical information.
The UK Lung Cancer Coalition (UKLCC) report, Faster Testing, Better Outcomes: Genomic Testing in Lung Cancer, is a pivotal document for clinicians, policymakers and patients as it underscores the critical role of timely genomic testing in lung cancer care for up to 30,000 lung cancer patients each year.
The report highlights the need for streamlined and expedited processes to ensure clinicians make the right treatment choices for their patients based on receiving accurate and timely genomic test results. Policymakers can use the findings to address systemic inefficiencies, such as staffing shortages and outdated infrastructure, while patients benefit from reduced waiting times and improved access to life-extending treatments.
The report aims to instigate several key changes in the genomic testing pathway via 12 key recommendations, which can be summarised as follows:
The report also suggests practical solutions, such as implementing a seven-day working model for genomic labs, improving training for healthcare scientists, and introducing a single digital tracking system for patient samples.
Technology can play a transformative role in expediting genomic testing. The integration of tools such as digital tracking, advanced IT systems and AI diagnostics within the pathway will not only lead to more timely and accurate genomic test results but also ensure more personalised and efficient care and better patient outcomes.
By implementing these and other changes, the report seeks to create a more efficient and equitable system, ultimately improving outcomes for lung cancer patients across the UK.
Several barriers are preventing genomic testing from achieving the recommended 14-day turnaround time. These include:
The good news is that we have observed hospitals and regions employing successful strategies to expedite test results at every stage of the genomics pathway. For example, in terms of the pre-genomics phase – specifically tissue acquisition, sample transportation and tracking – a number of strategies have been adopted to reduce genomic testing turnaround times.
In Northern Ireland, the health system has made significant investments in the lung cancer care pathway by ensuring the presence of a pathologist or cytologist during tissue sample collection for most endobronchial ultrasound procedures.
These specialists provide real-time analysis to assess the quality of the samples and determine if additional samples are required. However, while this approach is commendable, workforce limitations may make it difficult to implement in all regions across the UK. Therefore, it is crucial for local health services and respiratory physicians performing the procedure to prioritise accuracy of tissue sampling and ensure high-quality samples are collected from the outset.
In Wales, all lung cancer tissue samples are systematically tracked from acquisition, through pathology testing and up until the sample reaches the genomics lab. This is via an interconnected IT system, which everyone involved in a lung cancer patient’s care can access.
Another successful strategy that has expedited the pathway can be witnessed in Torbay and South Devon NHS Foundation Trust. Previously, samples were transported from NHS pathology labs to the Bristol genomics hub using Royal Mail tracked delivery – a process that could take up to four days. By switching to an existing hospital transport service, which was already transporting human papillomavirus samples to the Bristol hub, the transit time was reduced to a maximum of one day.
It is clear that it can often be the simplest of changes or strategies which can make the most significant impact. Further examples of best practice covering different stages of the pathway are given in the report.
The NHS and Government have made significant strides in supporting genomic testing, but there are still gaps that need addressing to enable quicker turnaround times. While initiatives like the NHS Genomic Medicine Service in England and the National Genomic Test Directory demonstrate commitment to advancing genomic healthcare, challenges remain in areas such as staffing, technology and transport.
It is pleasing that NHS England launched a Cancer Genomic Improvement Programme to assess regional performance of turnaround times from tissue acquisition to genomics reporting – and that the national lung cancer pathways in Scotland and Wales have recently been updated with more ambitious turnaround times in mind. But it is vital that the data that feed into these programmes, or result from them, are published so that learnings can be taken forward and progress made.
With the planned abolition on NHS England, it will be important to ensure that the current focus on improving genomic testing turnaround times in England is maintained.
By working collaboratively, multidisciplinary teams (MDTs) can create a more cohesive and efficient testing pathway, ultimately ensuring patients receive timely and accurate results with the potential for better treatment outcomes. MDTs bring together pathologists, oncologists, respiratory physicians and genomic scientists to align on testing priorities and reduce delays caused by miscommunication or fragmented processes.
Collaboration allows for real-time discussions and decision-making, ensuring that tissue samples are collected, processed and analysed efficiently without unnecessary back-and-forth.
MDTs can advocate for and implement shared digital platforms to track samples and results, reducing bottlenecks in the testing pathway. Pathologists and cytologists can provide immediate feedback during procedures, ensuring high-quality samples are obtained, which minimises the need for repeat biopsies.
However, one key recommendation within the UKLCC report is that reflex genomic testing is initiated as soon as a diagnosis of non-small cell lung cancer is made – without waiting for MDT meeting confirmation.
The UKLCC recommends that the devolved NHS and Government administrations adjust genomic laboratory turnaround-time targets for lung cancer samples to seven days. Several changes in clinical practice would be necessary to effectively achieve this.
First, the genomic laboratory hubs would need to be sufficiently resourced, operating a seven-day working model. This would require staggered shifts and flexible scheduling to avoid overburdening an already stretched NHS workforce.
Enhanced training would be needed. Increasing the number of training programmes for healthcare scientists and technicians would help address staffing shortages. Upskilling existing staff to take tissue efficiently would also alleviate pressure.
IT systems, such as digital tracking platforms, would also streamline the testing process by reducing administrative burdens and improving sample management.
The UKLCC report serves as a vital call to action, highlighting the transformative impact of timely genomic testing on patient outcomes and quality of life. By addressing systemic challenges, the report paves the way for a more efficient, equitable and personalised approach to lung cancer care across the UK.
Clinical lead for the UKLCC, professor of thoracic oncology at the University of Cambridge, and honorary consultant respiratory physician at Royal Papworth Hospital NHS Foundation Trust
An at-home saliva test that assesses genetic risk of prostate cancer is more accurate at detecting clinically significant disease than prostate-specific antigen (PSA) level or magnetic resonance imaging (MRI), UK researchers have reported.
The test developed at the Institute for Cancer Research provides men with a polygenic risk score on the bases of 130 gene variants known to be associated with in increased chance of prostate cancer.
A UK trial of the test in men aged 55-69 years found it was better at detecting disease that required treatment than PSA testing and had fewer false positives, the researchers reported in the New England Journal of Medicine.
It also accurately identified men with prostate cancer that was missed by an MRI scan.
A total of 6,393 participants had their polygenic risk score calculated using the test. Of those, 745 had a risk score in the 90th percentile or higher and were invited to have further screening.
The researchers said 468 underwent MRI and prostate biopsy, with cancer detected in 187, equating to 40%.
By comparison, 25% of men with a high PSA level will actually have prostate cancer, they said.
Of the 187 men who were found to have cancer, 118 (63.1%) had a PSA level below 3.0ug/L, which would usually indicate that no further screening is required.
Results showed 55% (n=101) of this group had an intermediate or higher risk of cancer that indicated treatment, but in 74 of those their cancer would not have been detected by current screening approaches of PSA test followed by MRI.
Overall, 125 men had prostate cancer confirmed by a biopsy that was not detected by the MRI.
The team also found 40 patients with aggressive cancers they otherwise would not have known about.
The researchers said the saliva test could offer an additional screening tool to be offered to men at higher risk of prostate cancer, or those presenting with symptoms.
Future studies will follow-up the men with high scores to monitor if they go on to develop prostate cancer. The test has also been updated after more variants were detected in men of Asian and African ancestry.
Last week, health secretary Wes Streeting week told MPs he wants to see a national screening programme for prostate cancer for men at high risk but that it must be evidenced based.
The National Screening Committee is currently evaluating several options for a targeted approach.
Evidence collection includes the UK TRANSFORM trial, which is directly comparing the saliva test to PSA and MRI scan, to assess whether those with a low genetic risk may benefit from an alternative screening tool.
Professor Ros Eeles, professor of oncogenetics at the Institute of Cancer Research and consultant in clinical oncology and cancer genetics at The Royal Marsden NHS Foundation Trust, said: ‘We have shown that a relatively simple, inexpensive spit test to identify men of European heritage at higher risk due to their genetic makeup is an effective tool to catch prostate cancer early.
‘Building on decades of research into the genetic markers of prostate cancer, our study shows that the theory does work in practice – we can identify men at risk of aggressive cancers who need further tests and spare the men who are at lower risk from unnecessary treatments.’
Naser Turabi, director of evidence and implementation at Cancer Research UK, said: ‘Right now, there’s no reliable method to detect aggressive prostate cancer, but this study brings us a step closer to finding the disease sooner in those people who need treatment.
‘It’s encouraging to see that genetic testing might help to guide a more targeted approach to screening based on someone’s risk of developing prostate cancer.
‘More research is now needed to confirm if this tool can save lives from the disease so that it can be rolled out to improve diagnosis.’
A version of this article was originally published by our sister publication Pulse.
Early combination lipid-lowering therapy with statins and ezetimibe significantly improves prognosis after myocardial infarction compared with later adding ezetimibe or not giving it at all, a study finds.
Current treatment guidelines recommended giving statins immediately after a myocardial infarction to lower low-density lipoprotein cholesterol (LDL-C) levels, researchers from Sweden’s Lund University and the UK’s Imperial College London wrote in the Journal of the American College of Cardiology.
However, most patients needed an additional therapy, such as ezetimibe, to reach target lipid levels, and this ‘stepwise’ approach to additional lipid-lowering therapy often meant a delay in patients attaining recommended LDL-C levels.
The researchers used Swedish registry data from almost 36,000 lipid-lowering naive patients hospitalised between 2015 and 2022 for myocardial infarction and discharged on a statin. They conducted statistical modelling to emulate a trial comparing cardiovascular outcomes and cardiovascular death from three lipid-lowering strategies.
Outcomes were analysed for 6,040 patients (16.9%) who received statins and ezetimibe within 12 weeks of a myocardial infarction, compared with 6,495 patients (18.1%) who received statins with ezetimibe added at between 13 weeks and 16 months post-myocardial infarction, and a final group of 23,291 patients (65%) who only received statins.
They found ezetimibe combination therapy, either early or late, resulted in a greater proportion of patients reaching an LDL-C of <1.4 mmol/L compared with no add-on ezetimibe.
Early combination therapy was associated with a greater absolute and relative benefit in terms of major adverse cardiovascular events (MACE) compared with delaying combination therapy.
The researchers highlighted that approximately two-thirds of patients had not received add-on therapy with ezetimibe by 16 months post-myocardial infarction, and those patients experienced the highest risk of MACE and death.
Using the study population, they modelled that if 100% of patients received ezetimibe early, an estimated 133 myocardial infarctions could be avoided in a population of 10,000 patients in three years.
In the UK, which has an estimated 100,000 hospital myocardial infarction admissions annually, this would equate to an estimated 5,000 myocardial infarctions being prevented over a 10-year period.
Professor Margrét Leósdóttir, associate professor of internal medicine at Lund University and senior cardiology consultant at Skåne University Hospital, Malmö, Sweden highlighted that guidelines recommend the stepwise addition of lipid-lowering treatment with ezetimibe.
‘But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up,’ she said.
‘By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.’
Combination therapy was not being applied up-front because it was not included in guidelines and clinicians were cautious about potential side effects and overmedication.
‘However, there are positive effects from applying both medicines as soon after the infarction as possible. Not doing this entails an increased risk,’ Professor Leósdóttir said.
‘In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.’
Professor Leósdóttir hoped the research would provide support for changes in the recommendations to include early initiation of ezetimibe, and she noted a treatment algorithm had already been introduced at Skåne University Hospital with positive results.
Patients had achieved their treatment goals earlier and two months after the myocardial infarction twice as many patients have reduced their bad cholesterol to the target level, compared with outcomes under previous practice.
Co-investigator Professor Kausik Ray, professor of public health at Imperial College London’s School of Public Health, UK, said post-myocardial infarction care pathways must change given the study results.
‘Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS. Ezetimibe is already widely available and prescribed for relatively low cost,’ he said.
‘This add on therapy could be rolled out for around £350 a year per patient, which is a huge cost saving compared to the lasting impacts of treating heart attacks and the impact they have on patients’ lives.’
Previous research by Sweden’s Uppsala University using the Swedish National Prescribed Drug Registry found that women were less likely than men to be prescribed cholesterol-lowering drugs despite identical guidelines, with 5% of women treated with statin plus ezetimibe compared with 8% of men. This article was originally published by our sister publication Hospital Pharmacy Europe.
IMPORTANT LINKS
MORE FROM COGORA
© Cogora 2025
Cogora Limited. 1 Giltspur Street, London EC1A 9DD
Registered in the United Kingdom. Reg. No. 2147432
