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4th June 2025
Speaking at Hospital Healthcare Europe’s Clinical Excellence in Cardiovascular Care event, our panel of interventional cardiology specialists shared ideas and insights into the progress of techniques, procedures and devices for chronic coronary disease, including coronary sinus reducers. Drs Alex Zaphiriou and Sundeep Kalra and Pierluigi Costanzo discussed their evolving approaches to patients previously labelled as having no hope, the crucial need for multidisciplinary working and training, and the exciting trials set to transform clinical practice.
The past two decades – and even the past two years – have been particularly impressive within the realm of interventional cardiology, with significant advances changing clinical practice and offering patients additional solutions for difficult-to-treat conditions.
This formed the basis of a fascinating discussion between three Clinical Excellence event panellists who shared their take on this changing landscape.
Taking charge of the questions, the session chair was Dr Brian Halliday, consultant cardiologist and clinical lecturer in cardiomyopathy, at the Royal Brompton and Harefield Hospitals and the National Heart and Lung Institute in London.
He was joined by Dr Alex Zaphiriou, consultant in interventional cardiology at Queen Elizabeth Hospital, Birmingham; Dr Sundeep Kalra, consultant interventional cardiologist at London’s Royal Free Hospital; and Dr Pierluigi Costanzo, consultant interventional and structural cardiologist and clinical lead for coronary intervention at Royal Papworth Hospital NHS Foundation Trust in Cambridge.
Dr Zaphiriou: The last 12 to 18 months have been exciting for a range of patients, particularly those previously labelled as having no hope, such as those with intractable angina. Data is accumulating, which means we have more effective pharmacological and other treatments available to us. There is a group of patients who have no revascularisation options and are on the maximum tolerated medical therapy but still suffer with severe angina that is very intrusive and affects their quality of life.
Now, we have more evidence to support the use of a coronary sinus reducer. It’s not so new now, but its use is expanding, and we have more evidence to suggest that it is an effective anti-anginal therapy over and above medical therapy and revascularisation. There are a few centres now that offer this technology.
It has to be said that it’s not for every patient, but, with careful selection, the results can be very encouraging, and this has been proven with two large, double-blind, placebo-controlled trials.
Dr Halliday: Indeed, my colleague Rasha Al-Lamee at Imperial did the ORBITA-COSMIC trial, which had encouraging results showing symptom benefit in a placebo-controlled trial. Should we wait for placebo or sham controlled trials before using these types of devices?
Dr Zaphiriou: Rasha has done exceptional work, and the way she and her team ensured that the placebo effect was neutralised is exemplary. I think she has set a new standard in terms of placebo-controlled trials and, if the condition allows it, I think we should follow that route.
Dr Zaphiriou: I think it does matter. There are several hypotheses regarding how it works and the one that is substantiated with data from research is that perhaps there is a redistribution of the blood flow from the epicardium to the subendocardium aspect of the heart muscle. We know that what gets ischemic first in coronary artery disease is exactly that part of the heart muscle – the one near the endocardium.
So, Rasha’s very detailed MRI study has demonstrated that perhaps that’s the mechanism because there is redistribution. The total flow to the heart muscle, interestingly, in this study, was unchanged, but there was redistribution from the less ischemic segments to the more ischemic segments, and that’s the most likely mechanism of action.
Dr Kalra: It definitely gives us a new facet of treating this group of patients. It’s not going to be a bread-and-butter treatment strategy, because most patients we can treat with revascularisation or with medical therapy. So, it’s a small group of patients, but a group of patients that we’ve historically treated very poorly.
I think with any interventional procedure, you need to be doing sufficient volume to be able to deliver it correctly, and to optimise patient selection. We still quite haven’t worked out the responders and non-responders, and as we get more clinical experience with the device outside of research trials, we’ll understand which are the groups of patients that may benefit more from this.
But, in saying that, I don’t think this should be rolled out to every single cath lab in the country at this moment in time. You have to commit to having an infrastructure to support this technology. This means having a refractory angina multidisciplinary team so you can discuss these patients and group learn on which patients will respond and having follow-on for these patients. You need patient advocates in your hospital, your nurse specialists, your doctors and the specialists in the technology to actually be able to deliver this more effectively.
I don’t think it should be widespread that everyone suddenly does this type of procedure. In the first instance, I think we should localise it to the Centres of Excellence where they have advanced chronic total occlusion programmes. We need to really make sure there are no percutaneous or surgical revascularisation strategies before we say we’re going to implant a coronary sinus reducer in someone.
Dr Costanzo: It is a simple procedure but, like any simple procedure, it does involve some technical skills. Effectively, you’re going through the jugular vein, so the punctures need to be pristine.
In our centre, we buddy up with electrophysiologists who do cardiac resynchronisation therapy (CRT) as they are much more familiar with getting into the coronary sinus. It shouldn’t be difficult, but occasionally, even in the CRT world, we can still dissect or cause problems in the coronary sinus.
The deployment is fairly straightforward as well. Most of the time, the complications are either that you won’t manage to do the procedure because you don’t get into the coronary sinus, or you’d have a bleeding complication from the puncture. But again, it requires a certain level of skill and familiarity with the right side of the heart.
Dr Zaphiriou: One very interesting thing is that the benefit doesn’t happen straight away. On average, it takes 70 days, and up to three months, to see the full effect. So far, the longest data we have is five years. It seems that for the people who respond, the benefit is sustained, certainly between two and five years. The hope is that it’s going to be a sustainable effect. But only time will show that.
Dr Kalra: In the realms of the chronic total occlusions (CTO), we’ve had massive advances in the technology: the wires, the microcatheters, the types of kit that we have available to us to make these procedures a lot more achievable. We are getting much better results as we’ve learned new procedures and techniques.
There’s a lot of collaboration internationally now where we’re sharing knowledge and expertise through lots of joint live cases where we are able to learn from each other. I think what we are able to deliver is advanced and, historically, what may have been patients untreatable with percutaneous revascularisation, we are achieving a lot more nowadays.
Dr Kalra: Anatomy is key. The presence of a CTO doesn’t mean you should undertake a procedure on a patient. Non-CTO operators will often see a chronic total occlusion and feel that it’s something that can be referred for treatment. But anatomy is absolutely key. This has to be a bilateral conversation with a CTO operator.
We’re talking about stable angina here, so we’ve got time to treat these patients. We don’t have to rush into doing things. We should effectively counsel them and see them in the non-acute clinic setting to talk about the procedure and the risks involved.
We also have to look at the comorbidity and the overall goal that we’re trying to achieve. The data we’re looking at and what we’re trying to achieve with CTO percutaneous coronary intervention (PCI) is for symptom control. There’s no real convincing data at this moment in time that this is going to improve prognosis.
Dr Costanzo: I totally echo what Sundeep has mentioned there. In terms of CTO techniques, we are in a different world compared to even five years ago. There are different ways to deal with a CTO. Patients with stable angina do not see improved mortality with CTO PCI. It’s just to relieve the angina, make sure that the patient is on the maximum tolerated medical therapy and then you can embark on what is an antegrade approach. This means putting a catheter on the artery that is blocked, essentially doing the procedure from upstream and techniques have been refined in terms of coronary wires.
Techniques are refined and the technology keeps advancing. It is a high-risk procedure, as you might guess with all this manipulation. Within time, the risk of complications will go down, but I doubt that it will ever be as low risk as a normal PCI.
Dr Zaphiriou: I agree. The perforation risk has been reported to be as high as 4%, which is much higher than the usual PCI, and mortality perhaps is 2%, rather than the usual 1%. We have to take all of that into consideration.
The key issue for more general cardiologists or PCI operators is that it’s important that we develop networks. Find who your friendly CTO operator is, join them, do a procedure together, invite conversation and participation and don’t give up.
There are so many new things we now have at our disposal – so many new technologies and equipment – and it’s unbelievable what can be achieved, providing you team up with your experienced CTO operator, and that’s a very important message.
Dr Kalra: Multimodality imaging is used, and angiograms are just part of the equation. Patients will, almost invariably in my care, get some form of effusion imaging – cardiac magnetic resonance imaging is usually what I prefer – as we want to get an accurate burden of ischemia assessment.
But another key thing is CT coronary angiography. You want to understand what you’re dealing with, where the calcium is, where stumps are on vein graphs, where the inlet of the lesion is. Then you can assess everything with all the information before we put that patient on the table for a procedure that’s higher risk than usual PCI.
2nd June 2025
A ban on single-use vapes came into effect on 1 June, meaning it is now illegal to sell or supply single-use vapes in the UK.
The ban applies to all businesses and organisations that sell or supply disposable vapes, including healthcare settings and stop smoking services. These organisations have been told to arrange for any leftover stock of these vapes to be recycled.
It is intended to limit children’s access to cheap vapes to help to support their health and wellbeing, as well as reduce their environmental impact. Last year, the independent not-for-profit organisation Material Waste estimated that almost five million single-use vapes are either littered or thrown away in the UK every week, and the number of vape battery fires in the waste stream are on the rise.
The Royal College of Paediatrics and Child Health has noted that single-use vapes are notoriously difficult to recycle and a each product contains an average of 0.15g of lithium, the mining of which has led to water loss, ground destabilisation, biodiversity loss, increased salinity of rivers, contaminated soil and toxic waste.
As such, the College has welcomed ‘this groundbreaking legislation’ banning the supply of single-use vapes and bringing ‘the UK one step further towards a smokefree generation’, but warned the Government to not become complacent.
Dr Mike McKean, respiratory paediatric consultant and RCPCH vice president for policy, said: ‘The ban of disposable vapes, alongside the Tobacco & Vapes Bill is a welcome step forward in creating a smokefree generation, free from nicotine addiction. However, we know that these measures alone are no silver bullet.
‘We must assume that tobacco and e-cigarette companies will continue to find new ways to target young people unless Government remains vigilant, and legislation is robust. We can’t afford complacency when it comes to the health and wellbeing of our young people.’
The Tobacco and Vapes bill, which is making its way through parliament, would also prohibit smoking for anyone born after 1 January 2009, as well as restricting the packaging, marketing and flavours of non-disposable vapes.
It comes after the rapid rise in vaping in Britain has slowed, according to research published in April that found that the prevalence of vaping had remained ‘relatively stable’ since January 2024.
The recent National Child Mortality Database report on child deaths related to asthma and allergies noted the importance of encouraging smoking cessation, including use of vapes, in parents – and children where this is occurring – to reduce child exposures and improve air quality.
In October 2024, it was found that one million people vape despite never having been regular smokers.
People diagnosed with sleep disorders are at a significantly higher risk of developing dementia and other neurodegenerative conditions later in life, new research shows.
The study revealed strong associations between sleep disorders and several major neurodegenerative conditions, including Alzheimer’s disease, Parkinson’s disease, vascular dementia, general dementia and amyotrophic lateral sclerosis.
People with a diagnosed sleep disorder were found to be twice as likely to develop a neurodegenerative condition within 15 years of their diagnosis than those without sleep issues, suggesting that sleep disorders may be a predictive marker of future neurodegeneration.
The findings, published in the journal npj dementia, highlight the importance of detecting and managing sleep disorders that could potentially reduce the risk of neurodegeneration.
The collaborative study between researchers at the UK Dementia Research Institute (UK DRI) at Cardiff University and the NIH Intramural Center for Alzheimer’s and Related Dementias in the US examined data from three biobanks: the Secure Anonymised Information Linkage databank, the UK Biobank and FinnGen. Across the three biobanks, the researchers analysed the electronic health records of over a million people, examining sleep disorders related to circadian rhythms, such as narcolepsy, sleep apnoea, hypersomnia and parasomnias, as well as non-organic sleep disorders, including generalised insomnia and nightmares.
Using statistical methods, the researchers analysed relationships between different neurodegenerative diseases and sleep disorders, and determined whether disrupted sleep is an early sign of cognitive decline or whether it leads to the development of dementia.
The results showed that having a sleep disorder significantly increases the risk of going on to develop a neurodegenerative disease later in life, and this risk was greater for people who experienced recurrent sleep disorders.
For people with a general diagnosis of dementia or Parkinson’s, incidences of circadian sleep disorders and non-organic sleep disorders were associated with an increased risk of dementia in the 10 to 15 years that followed.
For those with a diagnosis of Alzheimer’s disease, circadian sleep disorders increased the risk of Alzheimer’s in the 10 to 15 years following sleep disorder diagnosis. For those with vascular dementia, circadian sleep disorders and non-organic sleep disorders increased risk of developing vascular dementia in the five to 10 years following sleep disorder diagnosis.
Dr Emily Simmonds, a bioinformatician at the UK DRI and joint first author of the study, said: ‘Our results are compelling, indicating a clear increased risk of neurodegenerative disease following a sleep disorder, across three large biobank datasets. Through analysing over one million people’s health records, we have found evidence to suggest that having a sleep disorder significantly increases someone’s risk of going on to later develop a neurodegenerative disease.’
The study also revealed that sleep disorders increased the risk of Alzheimer’s and Parkinson’s diseases independently of genetic risk.
Professor Valentina Escott-Price, the study’s coleader and group leader at the UK DRI, added: ‘Perhaps most interestingly, this increased risk was occurring independently of genetic risk factors for Alzheimer’s and Parkinson’s, with sleep disorders almost “compensating” for low genetic risk.
‘One would expect that if sleep disorders were caused by neurodegeneration, genetic risk of sleep disorder and neurodegenerative disease would line up. Further investigation is needed, but this points towards sleep disorders as a risk factor for these conditions.’
Future research will study the impact of sleep medications and whether improving sleep through medication will decrease the risk of developing dementia.
Commenting on the study results, sleep expert Professor Derk-Jan Dijk, group leader at the UK Dementia Research Institute Centre for Care Research and Technology at Imperial College London and the University of Surrey, said: ‘This study adds to the growing body of evidence that sleep disorders, such as sleep apnoea, increase the risk for neurodegenerative disease. It is therefore important that we develop scalable technologies to diagnose and treat these sleep conditions early and effectively.’
Previous research has linked irregular sleep patterns to myocardial infarction and stroke risk.
A version of this article was originally published by our sister publication Nursing in Practice.
New radiotherapy machines that will deliver up to 27,500 additional treatments per year are being rolled out across England.
The Government has paid for linear accelerator (LINAC) machines, which will be rolled out at 28 Trusts from August (see below).
Replacing older machines will save as many as 13,000 appointments from being lost to equipment breakdown.
The upgraded tech can cut the rounds of radiotherapy needed and, in some cases, halve the number of hospital visits a patient needs to make.
By March 2027, up to 27,500 additional treatments per year will be delivered, including up to 4,500 receiving their first treatment for cancer within 62 days of referral.
Equipped with cutting-edge technology, LINAC machines are safer for patients and can more precisely target tumours, causing less damage to surrounding healthy tissues. The new radiotherapy machines are particularly effective at targeting cancers in harder to treat areas, such as the chest, abdomen and pelvis.
Health and social care secretary, Wes Streeting, said there was ‘a revolution taking place in medical technology which can transform treatment for cancer patients’.
‘By reducing the number of hospital visits required and preventing cancelled appointments, these state-of-the-art radiotherapy machines free up capacity so that thousands more patients are treated on time,’ he said.
The new radiotherapy machines were allocated across England by specialised commissioning teams at NHS England.
The tech is being prioritised in hospitals which are currently using outdated treatment machines older than 10 years.
It will also increase the availability of stereotactic ablative radiotherapy (SABR) cancer treatments, which can more precisely target tumours.
Commenting on the news, NHS national clinical director for cancer, Professor Peter Johnson, said: ‘These machines will deliver more precise treatment for patients, which helps them to recover sooner, as well as enabling the NHS to treat people more efficiently as we continue in our efforts to catch and treat more cancers faster.’
Kate Seymour, head of external affairs at Macmillan Cancer Support added that the new machines marked ‘an exciting step forward for cancer treatment in England’.
‘Investment in cutting-edge technology is essential to bring down waiting times and help more people with cancer get the best care the UK has to offer, whoever and wherever they are,’ she said.
The machines are funded as part of the Government’s £70 million investment to improve cancer care through the Plan for Change.
The 28 Trusts receiving an upgraded scanner are:
A version of this article was originally published by our sister publication Healthcare Leader.
23rd May 2025
The areas to receive 13 new bone scanners, expected to deliver an additional 29,000 scans each year, have been announced by the Department of Health and Social Care (DHSC).
The equipment had been promised as part of the Government’s elective reform plan earlier this year and the DHSC has now announced the 13 areas in England that would receive the new DEXA scanners.
Seven of the new machines will enable Trusts to offer new or extended DEXA services, improving access and reducing patient journey times.
The remaining six bone scanners will replace existing machines, helping to increase the reliability of bone diagnostic services.
The bone scanners will help with early diagnosis of illness such as osteoporosis because of advanced technology that means the quality of a patient’s bones can be identified with minute detail.
The following locations will receive new scanners:
The following locations will receive replacement scanners:
Sue Mann, clinical lead for women’s health at NHS England, said the new bone scanners were a ‘welcome targeted investment’ for the NHS trusts set to receive them.
‘They measure tiny reductions in bone density that can help us diagnose osteoporosis in its early stages, before you break a bone.
‘These scanners are key tools for prevention, particularly for some women who are known to be at higher risk of osteoporosis such as those who go through early menopause,’ she said.
More than one in three women and one in five men will experience a fracture due to osteoporosis in their lifetime.
Craig Jones, chief executive of the Royal Osteoporosis Society, described the new bone scanners as ‘really good news for people with osteoporosis’.
Matthew Taylor, chief executive of the NHS Confederation, welcomed the announcement but said more investment was needed.
He said that the capital funding boost announced in the last Budget was ‘a major first step to improving the outdated infrastructure and shortage of diagnostic equipment caused by a decade of underinvestment’.
But it was ‘still at least £3.3bn a year short of what NHS leaders say is needed’, he said.
‘That is why we hope the Government will use next month’s Spending Review to increase NHS capital investment and that the forthcoming National Infrastructure Strategy will open up much needed new routes for mutual investment from the private sector,’ said Mr Taylor.
A version of this article was originally published by our sister publication Healthcare Leader.
NHS Cornwall and Isles of Scilly integrated care system (ICS) introduced a pioneering X-ray car service to help drive the left shift from hospital to community. Kathy Oxtoby reports.
The X-ray car is a collaboration between NHS Cornwall and Isles of Scilly Integrated Care Board (ICB), Royal Cornwall Hospitals NHS Trust, local GPs and Kernow Health Community Interest Company.
This service, introduced last year, ‘plays a valuable role in shifting the delivery of care from hospital into the community in line with the NHS Long Term Plan’, says Juliet Ferris, place director for the West Integrated Care Area for NHS Cornwall and Isles of Scilly ICB.
In Cornwall, more than 1,000 frail and older people are conveyed to the emergency department (ED) each year following a fall, usually by ambulance, where an X-ray then confirms no fracture.
‘By taking the X-ray to the person we could: reduce unnecessary ambulance conveyances, releasing more ambulances to respond to 999 calls; avoid ED attendances and reduce admissions including additional further tests; reduce in-patient stays (on average 2 or 3 days) and complex discharge arrangements,’ Ms Ferris says.
The X-ray car is staffed by a team of two who are equipped with an ultra-portable, low dose X-ray machine about the size of a large camera. This can be easily transported in order to safely and effectively X-ray people in their own homes. The resulting digital image is securely sent back to the radiology team at the Royal Cornwall Hospital, giving the patient a result within minutes. This often rules out a broken bone, leaving a comparatively simple medical problem that can be supported in the community.
‘Overall, this brings notable benefits for everyone involved: the patient, the ambulance service and the hospital trust,’ Ms Ferris says.
The ICB convened weekly cross organisational meetings to engage and involve people in a collaborative design of how the service would work best, solving problems together and working to a common aim.
The hospital’s imaging department was an integral part of this, and group membership evolved in response to recognition of expertise needed. Metrics and a dashboard were devised by the group, accessible by all members for review on a weekly basis to understand activity changes.
The X-ray car team saw 618 people in a year with visits completed on average in just 42 minutes. Some 535 of those – almost nine in 10 – avoided a trip to the ED, which in many cases would have otherwise been by ambulance, and were able to stay at home and be supported by services in the community.
More than 50% of referrals came from primary care. Patients and their loved ones have welcomed the initiative. They are impressed with the efficiency, and the professionalism and understanding of the team. One described it as ‘better than winning the lottery’.
Consultant radiographer Chrissie Eade from Royal Cornwall Hospitals NHS Trust says: ‘Many of the people we see are delighted to be able to stay at home. We know that frail older people quickly lose their confidence and independence in hospital, so we try to keep people at home where it is safe to do so.’
‘By its very nature, every innovation means breaking new ground. Inevitably there were some challenges to overcome, in this case primarily linked to the use of new technology which is mobile,’ Ms Ferris says. ‘Having a shared aim has been key in finding resolutions, recognising the benefits for people and the healthcare system whilst balancing safety and quality of care.’
The mobile X-ray service was originally launched in the West Integrated Care Area of Cornwall, and has since expanded to reach more people across the remote county.
Dr Matt Whiteley, clinical director for the service and a GP partner at a local practice, helped to launch the service. ‘We are incredibly proud of this pioneering project,’ he says. ‘Each year in Cornwall roughly 1,000 patients aged over 50 have a fall. Many are taken to the emergency department by ambulance. In just a year we have significantly reduced that number.’
A number of other regions around the country are now looking to implement their own X-ray cars. The ICB says the success of this project locally has also prompted consideration regarding ‘what else can be done to bring the level of care traditionally seen in a hospital into the community setting, where patients are much happier and often have better outcomes’.
A version of this article was originally published by our sister publication Healthcare Leader.
22nd May 2025
A single assay can provide real-time, intraoperative methylome classification of central nervous system (CNS) tumours with complete diagnosis available within 24 hours, UK researchers report.
DNA methylation-based classification is now a fundamental criterion in the routine diagnosis of many CNS tumour sub-types, but traditionally this was a slow process due to technological limitations.
Nanopore sequencing has been shown to reliably classify the methylation status of CNS tumours, with much faster turnaround times than array-based assays, a research team led by the University of Nottingham and Nottingham University Hospitals NHS Trust wrote in the journal Neuro-Oncology.
However, full integrated diagnosis might require subsequent additional assays to detect pathognomonic somatic mutations and structural variants, which delayed time to final diagnosis.
To overcome this, the team developed a software tool called ROBIN, which uses PromethION nanopore sequencing technology to provide real-time, intraoperative methylome classification and next-day comprehensive molecular profiling within a single assay.
The researchers tested ROBIN’s performance on 50 prospective intraoperative CNS tumour cases, finding it could achieve diagnostic turnaround time of two hours and generate robust tumour classifications within minutes of sequencing.
‘A key challenge for intraoperative tumour classification is balancing the competing needs of rapid sample processing and the requirement to generate DNA of adequate yield and read length for the subsequent detection of additional molecular features,’ the researchers wrote.
‘Previous implementations of intraoperative, ultra-fast classification do not generate libraries of sufficient read length and pore occupancy for detecting additional molecular features beyond methylation-based classification alone.’
In contrast, ROBIN was able to detect single nucleotide variants, copy number variants, and structural variants in real time, and was able to inform a complete integrated diagnosis within 24 hours.
‘Classifier performance demonstrated concordance with final integrated diagnosis in 90% of prospective cases,’ they wrote.
ROBIN operated through a web interface and ran on the local computer performing the sequencing, but its output could be viewed by a pathologist remotely, enabling a diagnosis to be made by a clinician in real time during sequencing and permitting geographically separate sequencing and clinical analysis.
Professor Matt Loose, a biologist from the School of Life Sciences at the University of Nottingham, developed a method to sequence specific parts of human DNA at higher depth using nanopore portable sequencing devices.
‘When we first were able to sequence an entire human genome in 2018, it took around five labs and six months to do, which obviously isn’t ideal when time is of the essence for a patient,’ he said.
‘This new method now allows us to choose the bits of DNA that we need to look at in order to answer specific questions, such as what type of tumour and how can it be treated.’
‘Combined with our later research where we were able to look at relevant parts of the human genome more quickly – then we now have a process where we can use ROBIN to create comprehensive classifications of tumours more quickly.’
Professor Loose said the new pathway was quicker, cheaper and more accurate than current methods, potentially costing £450 per person – or less – once scaled.
‘Our method can eliminate the need for four to five separate tests, reducing costs as a consequence as we are getting more information from the single test we do,’ he said.
‘Most importantly, it delivers results to the patients when they need them.’
Dr Simon Newman, chief scientific officer at The Brain Tumour Charity, said the delivery of an accurate diagnosis within hours of surgery would be transformative for patients, ensuring rapid access to the optimal standard of care and removing weeks of uncertainty while waiting for diagnosis and prognosis.
‘The potential to combine so many separate tests into one and deliver at a localised level is a game changer for driving equity of access to rapid and accurate molecular diagnosis,’ he said.
‘The BRAIN MATRIX trial, funded by the Brain Tumour Charity, is now exploring how this technology can match patients to personalised clinical trials across the UK.’
Artificial intelligence (AI) is revolutionising histopathology by enabling quicker, more consistent analysis of digitised tissue slides to aid cancer diagnosis. To keep pace with the surge in AI research within oncology, Dr Heba Sailem and her team at King’s College London have created an innovative dashboard – HistoPathExplorer – that allows users to generate customised searches, compare AI tools and explore emerging trends to enhance patient care.
Artificial intelligence (AI) in histopathology enables the automated analysis of digitised tissue slides, helping to detect microscopic patterns in tumour images, quantify features and support diagnostic decisions with greater speed and consistency.
These tools can assist in tasks such as tumour classification, biomarker detection and grading, offering scalable solutions to help pathologists and oncologists in routine practice.
While there is rapid development in AI capabilities, oncologists and pathologists face growing challenges in keeping pace with advancements in AI in their specialities. The field evolves quickly, with new AI models and studies emerging constantly, making it challenging to stay updated.
The overwhelming volume of publications and technical jargon adds to the difficulty. Even when relevant studies are identified, comparing them to generate meaningful evidence can be tricky due to differences in methods and reporting standards.
Another key issue is identifying relevant datasets for training AI algorithms. Many models are developed using datasets that may not reflect real-world patient diversity, limiting their generalisability and raising issues of bias.
Inconsistent reporting of performance metrics and a lack of external validation further complicate interpretation. For example, some studies only report the area under the Receiver Operating Characteristic curve – representing the model’s ability to distinguish between positive and negative cases – but do not report specificity and sensitivity.
Even when several performance metrics are reported, they can vary from dataset to dataset, raising the question about the best way to compare and assess models in a healthcare setting. Another major challenge is the ‘black box’ nature of many AI systems and the lack of transparency in how they make decisions, leading to hesitation in clinical adoption.
There is also a notable lack of AI insight in rare and less common cancers. Most AI models are trained on large datasets derived from more prevalent cancer types.
We analysed over 1,500 studies and showed that 47% focused on breast, lung, or colorectal cancers, with higher data availability. This creates a gap in innovation for cancers with fewer cases, limited annotated data or complex histological subtypes.
Moreover, certain types of clinical data, such as long-term follow-up or detailed treatment response information, are often less available, which limits the development of AI tools beyond diagnosis. As a result, 75% of the studies we reviewed focused primarily on cancer detection and subtyping, with far fewer addressing prognosis or treatment planning – equally critical areas for improving patient outcomes.
Many of the studies we reviewed lacked or omitted important details. Some, for example, reported only a single performance metric or gave limited information about the AI architecture used. Moreover, as we develop AI models, we regularly benchmark our methods against available code and datasets, which also support the reproducibility of the work. This led us to define an index to help oncologists and engineers determine the completeness of methods and clinical applicability of AI tools described in published studies.
The index has five features that assess whether a study reports at least three performance metrics for a comprehensive evaluation; includes benchmarking against other models; provides access to implementation details, such as code and data for reproducibility; uses external validation to ensure generalisability; and clearly describes the methodology, pre-processing steps and model architecture. This structured approach enables users to quickly assess the robustness and clinical readiness of AI models, supporting more informed and confident decision-making.
My group is working at the forefront of AI development in histopathology to support clinicians in making faster and more accurate patient diagnoses. We recognised the increasing number of published papers in AI for digital pathology in the past few years, reaching an average of one paper per day. This made it difficult to determine the best AI methods to exploit and the clinical areas with unmet needs.
To this end, we developed HistoPathExplorer to accelerate AI research in histopathology and its translation to the clinic. This online dashboard curated data from more than 1,500 articles and was designed to address four key goals:
By providing in-depth details of AI studies, the HistoPathExplorer dashboard empowers clinicians, researchers and policy stakeholders to make informed decisions about adopting and implementing AI in cancer diagnostics.
HistoPathExplorer bridges the gap between academic AI research and clinical practice by making complex models more accessible and interpretable to oncologists and pathologists. The platform helps to identify relevant datasets, including those from different countries, which ensures AI tools are evaluated fairly across diverse populations.
The dashboard also assists decision-makers in assessing the reliability, applicability and evidence behind AI tools by offering transparent benchmarking and a structured quality index. This enables faster synthesis of findings and more informed decisions around implementation and translation. Additionally, by highlighting where most AI efforts are concentrated, the platform reveals underexplored areas, guiding researchers toward unmet clinical needs and supporting the definition of standards for reproducibility, reporting and validation.
HistoPathExplorer was designed with this multidisciplinary need in mind. By providing an accessible, interactive platform that showcases a wide range of published AI models and methodologies in histopathology, it creates a shared space for discussion and learning across disciplines.
The platform enables clinicians to explore how different AI tools perform across diagnostic tasks, with clear explanations of methodologies and quality indicators that make the information more interpretable for non-technical users. For AI researchers, it offers insights into unmet clinical needs and real-world challenges, fostering the development of more targeted and usable models. Pathologists can better assess how well models align with diagnostic workflows and where human expertise is still critical.
Additionally, by identifying publicly available data from different countries, HistoPathExplorer encourages global dialogue, enabling researchers and clinicians to learn from diverse datasets and enhance model generalisability. This cross-border collaboration can bridge gaps between engineers and clinicians, fostering the co-design of AI tools better suited to clinical environments. Ultimately, we believe that this collaborative effort will improve diagnostic accuracy and patient outcomes, accelerating AI adoption in oncology.
Ultimately, HistoPathExplorer provides a central, user-friendly resource that enables clinicians, researchers and policymakers to navigate the fast-moving AI landscape in oncology and contribute to its safe and effective clinical translation.
To further develop HistoPathExplorer, we aim to allow users to explore, compare and apply AI models on publicly available histopathology data. This extension will enable users to visualise model outputs, understand spatial tissue features and link findings to clinical variables without requiring programming skills. This approach could significantly advance AI deployment in histopathology and have a transformative impact on the field.
Heba Sailem MSc PhD
Senior lecturer in biomedical AI and data science, School of Cancer and Pharmaceutical Sciences, King’s College London, UK
A simple, multifaceted antibiotic stewardship programme significantly improves adherence to guidelines for treating non-severe community-acquired pneumonia in children, a quasi-experimental before and after study conducted at Nantes University Hospital has demonstrated.
Electronic health record screening using predefined keywords identified 519 children between birth and 15 years and three months of age for inclusion in the study.
Following individual case review against eligibility criteria, 134 children (25.8%) with community-acquired pneumonia were included: 71 in the pre-intervention group and 63 in the post-intervention group.
The antibiotic stewardship programme intervention, which included prescriber training, guideline dissemination and case vignettes, led to a rise in guideline-concordant antibiotic duration (five days amoxicillin) from 38.0% to 79.4% (p < 0.0001).
The average course length dropped from 7.3 to 5.7 days, aligning with recommendations from the French Infectious Diseases Society, and avoided 155 antibiotic treatment days per 100 treated children.
Furthermore, correct amoxicillin dosing (±10% of the recommended dose) increased from 66% to 84% post-intervention (p = 0.03). Nasopharyngeal polymerase chain reaction testing became more frequent (61.9% vs 14.1%; p < 0.0001), possibly driven by practice changes during and after Covid-19.
Notably, no child returned for re-consultation within seven days of the end of the prescribed antibiotics as part of the antibiotic stewardship programme.
The researchers noted limitations such as the single-centre, retrospective design and relatively small sample size, which may affect generalisability. The study did not assess prescribing rationale in depth or control for confounding influences such as seasonality or the Covid-19 pandemic.
Future work should evaluate long-term sustainability of the antibiotic stewardship programme and replicate findings across diverse clinical settings, they noted.
Despite these limitations, the researchers considered the findings promising for replication in other paediatric or primary care settings.
The intervention’s low cost and ease of implementation make it a pragmatic model for reducing antimicrobial resistance through targeted prescribing, they added.
Reference
Martin Perceval L et al. Implementing an antibiotic stewardship program to reduce the duration of antibiotics in community-acquired pneumonia: Experience in a French pediatric hospital. Arch Pédiatr. 2025;32:217–222.
Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, are associated with a two-fold increased long-term risk of dilated cardiomyopathy, according to a recently published large UK population-based cohort study.
This finding addresses an important knowledge gap where the impact of HDP on developing dilated cardiomyopathy was previously unknown.
Drawing on linked UK national datasets covering over 84,000 individuals, the study found that women with HDP during their first pregnancy had a 93% higher risk of developing dilated cardiomyopathy.
Even after adjusting for multiple variables such as maternal age, gestational diabetes, postpartum hypertension and socioeconomic status, the association remained significant (adjusted hazard ratio (HR) 1.55).
The researchers also noted a clear ‘dose-response’ relationship: the risk was higher among women who had preeclampsia (HR 1.85) and markedly higher in those with severe preeclampsia (HR 4.29).
Older maternal age (HR per year of age, 1.06) and postpartum hypertension (HR 1.68) were also independently associated with higher risk of developing the condition after a hypertensive disorder of pregnancy.
Median time to diagnosis of dilated cardiomyopathy was just 5.1 years postpartum among women with HDP, compared with 10.6 years for women with normotensive pregnancies.
Underscoring the clinical importance of the findings, lead author Dr Paz Tayal stressed the need for healthcare systems to incorporate female-specific cardiovascular risk factors into long-term monitoring frameworks.
‘We need to be vigilant for the development of dilated cardiomyopathy in women with a history of hypertensive disorders of pregnancy,’ she said.
Indeed, the earlier onset of the condition in this population highlights a crucial opportunity for proactive surveillance and prevention.
The findings suggested either a shared predisposition to HDP and dilated cardiomyopathy or a cascade effect, in which HDP initiates a trajectory of cardiovascular strain, compounded by future hypertension.
This study builds on Dr Tayal’s previous work on sex differences in dilated cardiomyopathy, which suggests that the condition will continue to remain underdiagnosed in women unless clinicians remain vigilant and apply sex-specific criteria for diagnosis.
Reference
Tayal U et al. Hypertensive disorders of pregnancy and long-term risk of dilated cardiomyopathy. JAMA Cardiol 2025;10(5):498-502.
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