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Take a look at a selection of our recent media coverage:
8th May 2025
The risk of giving birth to a child with congenital heart disease is approximately 50% higher for mothers with anaemia compared to those without, research has found.
Published in BJOG: An International Journal of Obstetrics & Gynaecology, the researchers said the findings have the potential to substantially reduce the number of children born with congenital heart disease – currently estimated as approximately 2.5 million globally each year.
Using data from the UK Clinical Practice Research Datalink GOLD database of electronic health records, the researchers analysed electronic health records from 2,776 women who had a child diagnosed with congenital heart disease. These cases were matched to 13,880 women whose children did not have a congenital heart disease diagnosis.
The researchers used the World Health Organization definition of anaemia (< 110 g/L haemoglobin) and analysed women with a haemoglobin measurement in the first 100 days of pregnancy and a child diagnosed with congenital heart disease within the first five years of life.
The findings showed that of 123 mothers whose babies had congenital heart disease, 4.4% of the women had anaemia. Of the 390 mothers whose babies had normal heart function, 2.8% of the mothers had anaemia. After adjusting for potential influencing factors, the odds of giving birth to a child with congenital heart disease were 47% higher among anaemic mothers.
Dr Duncan Sparrow PhD, associate professor and British Heart Foundation senior basic science research fellow at the University of Oxford, and the corresponding author on the study, said: ‘We already know that the risk of congenital heart disease can be raised by a variety of factors, but these results develop our understanding of anaemia specifically and take it from lab studies to the clinic. Knowing that early maternal anaemia is so damaging could be a game-changer worldwide.’
The Population Attributable Fraction (PAF) was calculated to be 1.4% from the 2.8% prevalence in the population measured. However, previous estimates suggest levels of anaemia may be as high as 7% in the first trimester and up to 13% in some areas. In these cases, maternal anaemia may account for up to 6.2% of UK congenital heart disease cases.
Dr Sparrow added: ‘Because iron deficiency is the root cause of many cases of anaemia, widespread iron supplementation for women – both when trying for a baby and when pregnant – could help prevent congenital heart disease in many newborns before it has developed.’
The researchers suggested a clinical trial of periconceptional iron supplementation would be beneficial in light of their results, stating it would be a minimally invasive and low-cost intervention which could prevent some congenital heart disease if iron deficiency anaemia is proven to be a cause.
Last year, research found that diet and exercise interventions before and during pregnancy could lower cardiovascular risk in children of obese mothers.
A version of this article was originally published by our sister publication Nursing in Practice.
Some bacteria have already become resistant to ceftazidime/avibactam – one of the new antibiotics introduced to the NHS in 2017.
A new study published by the UK Health Security Agency (UKHSA) highlights the risk, and although the levels of resistance are currently low, it provides a stark reminder that appropriate antibiotic use is essential to slowing the development of resistance.
Antibiotic resistance occurs naturally, but it can be accelerated by increased use, whether the use is appropriate or not. Ceftazidime/avibactam treats some of the most serious hospital infections, such as bloodstream infections. The drug is a ‘reserve’ classified antibiotic and clinicians only prescribe it in exceptional circumstances, typically when patients have hard-to-treat infections caused by known multi-drug resistant bacteria, often when other antibiotics have failed.
The UKHSA researchers analysed data from routine surveillance samples between 2016 and 2020 to assess the levels of ceftazidime/avibactam testing, resistance and usage in England, providing baselines for future monitoring. Routine surveillance samples provided reported ceftazidime/avibactam resistance categorisation and reference laboratory samples, allowing the assessment of minimum inhibitory concentration (MICs) and molecular data.
The analysis shows that 6.3% of bacteria tested in routine surveillance already showed resistance to the drug. Resistance levels varied across bacterial species and fluctuated slightly over time, stabilising as routine surveillance testing was established. Nearly 70% of NHS Trusts used the antibiotic during the study period.
Dr Colin Brown, UKHSA deputy director responsible for antimicrobial resistance (AMR), said: ‘This study reminds us how important resistance surveillance is. Research like this means clinicians and prescribers can access the most relevant information available to prescribe the best antibiotics for their patients, while protecting the long-term effectiveness of antibiotics for future use.’
The researchers said that to treat infections effectively, carbapenemase gene detection and variant identification in ceftazidime/avibactam surveillance are important and suggest that healthcare professionals must monitor and identify resistant bacteria targeted by this antibiotic.
To support the initiatives to keep antibiotics working, the UKHSA has launched a new digital campaign to tackle the threat of antibiotic resistance and help keep antibiotics working. The campaign is aimed at younger generations and is named after a new mascot, ‘Andi Biotic’. Over the six-week digital campaign, Andi will answer uncertainties people have about antibiotics, ensuring they understand when these medicines are appropriate, the importance of taking them only when prescribed, and why they should never be saved for future use.
Dr Brown added: ‘We aren’t going to be able to tackle antibiotic resistance solely by finding new drugs. While we continue to support innovation in developing new treatments, resistance will emerge, and so it’s important that we all work together to keep antibiotics working.’
In February, the UKHSA widened the list of first-option antibiotics in an effort to tackle AMR.
Later that month, the National Audit Office warned that the Government has made ‘limited progress’ in achieving its vision of containing AMR and questioned the UK’s resilience to this public health threat. The public spending watchdog was joined by organisations such as the British Society for Antimicrobial Chemotherapy in urging the Government to invest in the NHS to ensure the healthcare workforce is fully equipped to tackle AMR.
Last year, research aimed at quantifying excess antibiotic use in an acute UK hospital found that nearly a quarter of antibiotic days of therapy were unnecessary.
A version of this article was originally published by our sister publication Nursing in Practice.
Women with endometriosis have a significantly higher risk of developing autoimmune and autoinflammatory diseases, a study shows.
Conditions such as osteoarthritis, rheumatoid arthritis, multiple sclerosis, coeliac disease and psoriasis are among the comorbid conditions significantly linked to endometriosis.
For the first time, researchers at the University of Oxford identified a genetic correlation between endometriosis and many of these diseases, suggesting a shared genetic basis may explain the increased risk.
The findings are published in the journal Human Reproduction and examine both the clinical associations and the biological mechanisms that can drive these comorbidities.
The study, funded by the charity Wellbeing of Women UK, analyses data from 8,223 women with endometriosis and over 64,000 with immune-related disease from the UK Biobank. This data enabled the researchers to examine the link between endometriosis and 31 different autoimmune diseases and investigate a possible biological basis for the increased comorbidity across immunological conditions. The autoimmune diseases analysed included 17 classical autoimmune, 10 autoinflammatory and four mixed-pattern diseases.
The researchers analysed retrospective data to determine whether endometriosis was more commonly experienced before or after a coexisting autoimmune disease. They conducted a cross-sectional analysis to uncover common associations between conditions and also conducted genome-wide association studies (GWAS) and used Mendelian randomisation methods to explore shared genetic factors and potential causal links.
The results showed women with endometriosis had a 30-80% higher risk of developing immune-related conditions, particularly autoimmune diseases like rheumatoid arthritis, multiple sclerosis, and coeliac disease, and autoinflammatory conditions such as osteoarthritis and psoriasis.
The researchers discovered a strong genetic correlation between endometriosis and both osteoarthritis and rheumatoid arthritis, and to a lesser extent, with multiple sclerosis.
The study is the first to provide genetic evidence suggesting a potential causal relationship between endometriosis and rheumatoid arthritis, indicating that the existence of one condition may contribute to the development of the other.
Professor Krina Zondervan, head of the Nuffield Department of Women’s and Reproductive Health at John Radcliffe Hospital, University of Oxford, and joint senior author, said: ‘Very large studies integrating clinical and genetic information, such as conducted here, are able to provide valuable new insights into disease biology. In this case, we have provided solid evidence of a link between endometriosis and subsequent risk of diseases such as osteoarthritis and rheumatoid arthritis, and we have shown this has a biological basis.’
It is hoped that this new information can be leveraged to look for new treatment avenues that may work across all of these conditions. The findings highlight the importance of long-term monitoring of immunological comorbidities, including conditions such as fatigue, joint pain, psoriasis and gastrointestinal issues, as well as understanding the links between such conditions and endometriosis.
Janet Lindsay, CEO of Wellbeing of Women, added: ‘This research is an important step towards building a more accurate understanding of endometriosis, a condition that affects one in 10 women globally. For too long, there has been too little investment in research into women’s health issues like endometriosis. The findings show a link between endometriosis and autoimmune diseases that could pave the way towards faster diagnosis and more personalised treatments.’
The research team said further studies focusing on biomarker identification, clinical trials and targeted treatment options will be critical in moving from understanding the genetic and phenotypic associations to actionable healthcare solutions.
A version of this article was originally published by our sister publication Nursing in Practice.
6th May 2025
The Pre-DX trial is investigating pre-operative Oncotype DX testing on core biopsy for breast cancer instead of the traditional post-operative approach. Here, with an introduction from Hospital Healthcare Europe editor Helena Beer, the lead investigator of the trial, Mr Henry Cain, discusses this ‘natural next step’ in the evolution of novel approaches to breast cancer diagnostics, what the trial found and how it’s set to transform clinical practice.
When considering post-surgery adjuvant therapy for patients with oestrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer, genetic testing has been shown to effectively guide recommendations.
Standard practice is to order the test in the post-operative setting on a specimen from the excised invasive carcinoma, but recent efforts have focused on determining whether earlier testing is possible.
Mr Henry Cain, consultant oncoplastic breast surgeon at the Royal Victoria Infirmary, part of Newcastle upon Tyne Hospitals NHS Foundation Trust, has observed meaningful improvements in the patient pathway by shifting the ordering of the test from oncologists post-surgery to surgeons immediately following the procedure. This has the benefit of shorter waiting times for adjuvant treatment.
But a group of UK researchers, led by Mr Cain, set about pushing the boundaries even further by performing the test on the diagnostic core biopsy in the pre-operative setting – the technical possibility of which had been intimated.
‘Coupled with increasing confidence in the reliability of core biopsy testing, it made sense to take this a step further and explore testing even earlier at the point of diagnostic biopsy,’ he says. ‘This shift offered the opportunity to further streamline care and potentially alleviate patient anxiety by providing crucial treatment information much earlier in the journey.’
The result was the Pre-DX trial, and its findings were recently presented at the 19th St. Gallen International Breast Cancer Conference 2025, which Mr Cain delves into here.
The primary aim was not to alter treatment sequencing, since patients in this cohort are not candidates for neoadjuvant treatment, as they typically have small cancers suitable for breast-conserving surgery. Instead, the trial sought to understand whether testing earlier in the pathway could improve efficiency within the standard treatment process and enhance the patient experience.
We aimed to reduce unnecessary appointments and deliver care more efficiently. From a patient perspective, we wanted to see whether addressing key treatment questions earlier, such as the need for chemotherapy, could reduce stress and uncertainty at a difficult time. Our hypothesis was that having this clarity earlier would positively impact patients’ emotional wellbeing.
While clinical appointments are essential, they are also resource intensive. We often see patients returning for visits where little new information is shared – appointments that could have been avoided if results had been available earlier. Reducing these touchpoints not only makes the journey less burdensome for patients but also eases pressure on breast services.
Fewer unnecessary appointments mean shorter treatment timelines and a more efficient use of NHS resources. This translates into better throughput and a less stressful care experience.
The trial showed that patients who received their results earlier had lower anxiety and depression scores by the time they reached adjuvant treatment. We tracked these metrics at multiple points to ensure that we weren’t simply shifting anxiety to an earlier stage.
Patients consistently told us that their two biggest concerns at diagnosis were: “Will I need a mastectomy?” and “Will I need chemotherapy?” By answering one of those questions earlier, we helped reduce the emotional toll of uncertainty. The data confirmed what we had long heard anecdotally – that earlier clarity can significantly ease a patient’s mental burden.
The good news is that integrating pre-operative genetic testing into routine practice is straightforward. The criteria remain the same – the key is accurately identifying patients who meet them at an earlier stage.
Ordering and discussing the test is no different from the post-operative setting. The only additional step is communication with pathology teams to ensure that the correct biopsy specimen – one with a minimum of 2mm tumour focus – is submitted for testing. Our trial demonstrated a test success rate of 98-99% on core biopsy, in line with traditional post-operative specimens.
In summary, the process fits seamlessly into existing workflows and offers meaningful benefits for both patients and the clinical teams.
I wouldn’t say that we encountered any hurdles that were particularly difficult to overcome. In fact, the reason the trial succeeded is that it was very carefully considered and designed to fit in seamlessly with the normal clinical pathway in each unit.
The key principle we adhered to was ensuring the trial didn’t require any additional steps, biopsies or processes beyond standard practice, as we didn’t want to create any extra burdens for the units. The trial was designed with real-world application in mind from the very beginning.
Our aim was to avoid a situation where we investigated an intervention that – even if successful in the trial setting – would be incredibly difficult to implement into routine practice.
In my view, the trial exemplifies a well-considered, well-designed study, which succeeded in minimising potential logistical and technical challenges.
The small number of patients who switched to neoadjuvant treatment reflects the deliberate design of the trial. Our aim was not to explore a change in treatment sequencing but to assess how early genomic testing could improve the standard surgical pathway.
We specifically targeted ER-positive, HER2-negative patients who were already scheduled for surgery, as most in this group would not typically receive neoadjuvant therapy. The low switch rate therefore validates the inclusion criteria and confirms that the pathway studied was both appropriate and consistent with real-world practice.
The trial clearly demonstrated that pre-operative genomic testing can deliver a positive impact on the standard patient pathway and experience. The findings support data from other studies demonstrating the oncological utility of the test in patients requiring downstaging, providing valuable information at the point of diagnosis.
Yes, absolutely. Covid-19 threw a spanner in the works. When we designed trials before the pandemic, we were basing our models on patients typically having six to eight appointments as part of their standard workup.
Then everything changed. Many units in the control arm ended up having only two or three appointments, as they tried to minimise face-to-face contact. This significantly affected clinical touchpoints. It became much more difficult to demonstrate a sizeable reduction, since many of those appointments had already been removed from the system.
These reductions were a response to a crisis. We may have streamlined the process, but it impacted the quality of care. A lot of results were given over the phone, often not by the treating physician. Appointments were combined and the personal touch was often lost.
Since the end of the pandemic, we have seen a rebound, with most units returning to a more standardised, face-to-face approach. However, it’s important to remember that in the Pre-DX trial, we didn’t dictate how units should use the genetic test results, it was simply another piece of data.
The trial didn’t mandate specific changes in the intervention arm. However, when this becomes standard practice, units looking to make those efficiencies will be aiming to leverage this to their benefit.
The trial wouldn’t have been possible without strong multidisciplinary collaboration. From the start, we needed accurate radiology to stage the patient pre-operatively. Then there were the pathological inputs and surgeons. The oncologists also needed to be comfortable with the results from the core biopsies and the plan for addressing them. It was critical to achieve the buy-in of all these groups.
The design of trial and intervention meant that no additional work was required for the healthcare professionals, which was a critical factor in winning their support. It did not require additional biopsies – only that radiologists and surgeons continued to do what they do every day, providing accurate readings and advice on biopsies.
We made the process as seamless as possible, integrating smoothly into existing workflows and creating an environment open to collaboration.
The trial did exactly this. The test’s ability to identify patients who will and will not benefit from chemotherapy early in their diagnostic pathway allows for a radically more tailored treatment strategy.
Instead of a one-size-fits-all approach, clinicians can confidently de-escalate treatment for the approximately seven out of 10 of patients unlikely to require chemotherapy, sparing them from unnecessary side effects and improving their quality of life.
Conversely, the trial enables the early identification of the 30% of patients who do require chemotherapy, allowing for a timelier referral to oncology and potentially a shift in the treatment sequence. This proactive approach allows for earlier initiation of chemotherapy, potentially improving outcomes for this higher-risk group.
By integrating the Pre-DX findings into clinical practice, we can move towards a more efficient patient pathway, directing resources and expertise to those who need them most.
Further research should prioritise two key areas: the long-term oncological impact of early genomic testing and, crucially, the integration of patient-reported outcomes and quality of life measures directly into clinical trial design.
Regarding the oncological impact, I’d like to see continued investigation into trials that stratify patients based on clinical staging and genomic risk profiles, using tools such as the Oncotype DX test to guide treatment pathways. Specifically, the research should focus on long-term outcomes such as overall survival, recurrence rates and the ability to reduce mortality by tailoring treatment intensity based on these early genomic assessments. These studies should aim to definitively demonstrate whether early, genomically informed treatment decisions lead to improved survival and reduced recurrence compared to traditional approaches.
Equally important is a shift in how we approach patient experience within clinical trials. We need more research that illustrates that “bolting on” patient experience as an afterthought is simply not sufficient. Instead, it should be an integral component of trial design, influencing treatment decisions and endpoints alongside traditional oncological measures.
This would involve proactively assessing patient wellbeing, emotional state and quality of life at various points through the treatment journey. Trials could explore how different treatment pathways – guided by genomic risk and incorporating patient feedback – impact anxiety, depression, fatigue and overall satisfaction with care.
Ultimately, the goal is to develop treatment strategies that not only improve oncological outcomes but minimise the emotional and psychological burden on patients, ensuring they navigate their breast cancer journey as seamlessly as possible. This requires a fundamental shift in how we value and integrate patient experience into the research process, giving it the same weight as traditional oncological endpoints.
2nd May 2025
Acute appendicitis serves as a critical indicator of emergency healthcare performance, and the AlliGatOr study is set to examine global variations in appendectomy care. Project lead Theophilus Teddy Kojo Anyomih discusses the study’s aims, its potential to inform policy recommendations and how its findings around best practice could help strengthen emergency care systems and improve patient outcomes worldwide.
Acute appendicitis is one of the most frequent surgical emergencies worldwide. Yet, the choice between conservative (non-operative) management and appendicectomy is influenced by a complex interplay of clinical, systemic and sociocultural factors. Patient presentation, access to imaging, surgical workforce availability, and even the patient’s ability to afford care all contribute to this decision.
In high-resource settings, early diagnosis supported by imaging enables tailored care pathways, often including laparoscopic surgery. In contrast, many low- and middle-income countries (LMICs) face limited diagnostic and surgical resources, leading to delayed or even missed operative intervention. In some contexts, conservative management with antibiotics may be adopted – not because it is optimal, but because surgery is unavailable.
This global heterogeneity in resources and decision-making is a key motivator behind the Appendicitis Global Outcomes (AlliGatOr) study. By comparing systems worldwide, we aim to distinguish decisions driven by clinical best practices from those shaped by logistical constraints.
AlliGatOr leverages a common emergency condition to illuminate how surgical systems function across diverse contexts. By using appendicitis as a tracer condition, the study provides real-time insight into the performance, equity and resilience of emergency surgical care worldwide.
Coordinated by the National Institute for Health and Care Research (NIHR) Global Surgery Unit at the University of Birmingham, the study is supported by a vast network of collaborators spanning multiple countries and hospitals. Its delivery is powered by national leads, consultant hospital leads, co-leads and mini-teams comprising residents and trainees, medical students and allied professionals.
This inclusive and decentralised model builds local capacity, empowers teams on the ground and fosters peer-to-peer learning across borders.
The AlliGatOr study has two key aims:
1. To identify areas for system strengthening in emergency surgical care
2. To evaluate global variation in the presentation, diagnosis, management and outcomes of acute appendicitis.
To achieve these goals, the study collects standardised data across eight predefined 14-day windows between February and May 2025. During each period, participating teams record all consecutive appendicectomy cases, collecting detailed patient-level data on presentation, imaging, surgical approach and 30-day outcomes – including complications, length of hospital stay and readmissions.
In parallel, hospitals complete a mandatory site survey that provides contextual data on imaging availability, surgical expertise and resource access.
Additionally, two sub-studies are nested within AlliGatOr: one focusing on waste management and sustainability in operating theatres, and another exploring the financial burden of surgery in LMICs.
AlliGatOr is not just a data collection exercise: it is a mechanism for shaping policy and practice at both local and global levels. It contributes to progress in several key areas, including improving emergency surgical care, identifying disparities in access to healthcare and refining clinical guidelines.
By benchmarking metrics such as time to surgery, imaging use, access to laparoscopy and complication rates, AlliGatOr identifies modifiable bottlenecks in care delivery. Hospitals can compare their own data against global standards to drive targeted, locally led quality improvements.
Previous studies, such as Hippo, GlobalSurg 1 and 2 run by the GlobalSurg Collaborative, have revealed stark disparities in regional access to safe surgery.
AlliGatOr continues this work, mapping disparities and generating evidence for targeted investment and policy reform.
Most existing appendicitis guidelines are based on data from high-income countries. AlliGatOr provides a richer, more inclusive dataset, allowing for greater nuance in clinical recommendations. Whether adjusting imaging expectations or tailoring antibiotic use, the study redefines what ‘best practice’ means across different contexts.
As of April 2025, we are in period six of eight in our data collection timeline. The response has been phenomenal. Of over 2,000 hospitals registered globally, more than 1,100 across 108 countries have already contributed data. We have captured high-quality information from over 22,000 patients, making this the largest international cohort on appendicitis ever assembled.
This remarkable momentum reflects the strength of our collaborative network and the global commitment to improving emergency surgical care. Each data point brings us closer to uncovering the trends and insights that could reshape clinical practice.
One of the greatest values of global collaborative studies like AlliGatOr is the ability to surface low-cost, high-impact strategies that are adaptable across systems.
The study may also validate innovations such as outpatient appendicectomy protocols or task-shifting models, offering alternative pathways to effective care. By capturing and sharing these success stories, AlliGatOr builds a global repository of practical solutions.
Turning global data into national and local policy is challenging. Barriers include political inertia, limited funding and systemic resistance to change. While data is essential, it is rarely sufficient on its own.
The strength of AlliGatOr lies in its embedded model in that research is conducted within the hospitals themselves, fostering ownership and accountability. National leads can use their own country’s data to advocate for change, whether it is improved access to imaging, surgical workforce expansion or updated training curricula.
At the international level, partnerships with the World Health Organization, Ministries of Health and academic societies will be key to translating evidence into policy. Previous NIHR Global Surgery initiatives, such as COVIDSurg and Hippo, have already influenced real-world guidelines. AlliGatOr is expected to do the same.
The multidisciplinary team (MDT) extends beyond surgeons to include emergency physicians, radiologists, anaesthetists, operating theatre staff, nurses and, increasingly, allied health professionals. Their coordinated input influences diagnostic clarity, time to theatre, surgical approach and postoperative recovery.
Well-functioning MDTs are pivotal to improving patient outcomes, ensuring timely diagnosis, safer surgery and smoother recovery. Streamlined radiology support can reduce negative appendicectomy rates, while timely anaesthesia facilitates early intervention in complicated cases. In many systems, effective MDT collaboration is underpinned by clear protocols, rapid communication and a culture of shared decision-making.
However, in resource-constrained settings, MDTs often operate under strain, affecting both the reliability and timeliness of care. AlliGatOr captures this variability, offering an opportunity to benchmark how team structures influence outcomes and where improved MDT integration could offer the greatest benefit.
Our vision is for AlliGatOr to transform how appendicitis, and by extension, emergency surgery, is delivered worldwide. Specifically, we hope to see:
Ultimately, the quality of appendicitis care should not depend on where a patient lives. AlliGatOr brings us one step closer to achieving true global equity in emergency surgical care.
In a world where disparities in healthcare access persist, and emergency systems are under immense pressure, global collaborative research is not a luxury – it is a necessity. The AlliGatOr study is a powerful example of what can be achieved when clinicians worldwide unite around shared challenges.
Its legacy will extend beyond publications or conference presentations. It will live on in better-informed policies, stronger systems and, ultimately, in lives saved through safer, more equitable and more efficient surgical care.
Theophilus Teddy Kojo Anyomih MBChB
National Institute for Health and Care Research Global Surgery Unit, University of Birmingham, UK
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.
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