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Take a look at a selection of our recent media coverage:
19th March 2025
Dilated cardiomyopathy is diagnosed twice as often in males than in females. A new three-part study, which included a systematic literature review, meta-analysis and a population study, examined the reasons behind this.
The researchers considered whether dilated cardiomyopathy is more common in one sex than the other, how genetics contribute to this difference, and whether diagnostic practices account for any differences between the sexes.
The findings revealed that the sex ratio disparity of diagnoses arose from a combination of underdiagnosis in women and a greater susceptibility for men, driven by additional genetic or environmental factors that increase disease manifestation in genetically predisposed individuals.
The researchers examined multiple data sources to identify potential biases or biological influences on disease prevalence. A literature search identified existing studies with sex ratio data for patients with dilated cardiomyopathy.
Meta-analysis and metaregression analysis were used to compare the proportion of female participants in an overall dilated cardiomyopathy cohort and the following subtypes: all genetic, individual selected genes (TTN and LMNA), and gene-elusive.
In addition, population dilated cardiomyopathy sex ratios were analysed from diagnostic codes and compared with those obtained from sex-specific means, such as International Classification of Diseases-coded, novel imaging-first, and genotype-first data from the UK Biobank imaging cohort.
Considering 99 studies, the researchers analysed data from 37,525 participants with dilated cardiomyopathy, 30% of whom were female, giving a male-to-female ratio of 2.38:1.
Within subgroup cohorts, similar patterns emerged. In patients with identified dilated cardiomyopathy genetic variants, the male-to-female ratio was 2.22:1. For patients with no genetic variants, the male-to-female ratio was 2.29:1.
The UK Biobank data showed a 4.5:1 ratio of men to women with dilated cardiomyopathy. However, when the researchers used sex-specific diagnostic techniques, such as imaging-first and genotype-first diagnostic approaches, the ratios changed to 1.7:1 and 2.3:1, respectively.
The results showed that the condition is more common in men, and, even after adjusting diagnostic criteria to account for sex, the male predominance in the development of the disease persists.
The researchers suggested that future work should evaluate sex-specific dilated cardiomyopathy diagnostic criteria and examine the genetic, reproductive and environmental factors contributing to differences in disease risk in male and female patients.
Reference
Bergen, N et al. Systematic Review, Meta-Analysis, and Population Study to Determine the Biologic Sex Ratio in Dilated Cardiomyopathy. Circulation 2025; Feb 03: DOI: 10.1161/CIRCULATIONAHA.124.070872.
17th March 2025
Women aged 50 or older, who are three years post-breast cancer diagnosis and cancer-free, show non-inferior results when given less than annual mammography compared to annual screening, a new study has revealed.
Less frequent breast cancer screenings were found to be equally effective in terms of breast cancer-specific survival, recurrence-free interval and overall survival. These findings suggest that leaving more time between mammograms could be a suitable option for this group of women.
The research was undertaken as part of Mammo-50 – a phase three randomised trial running across 114 NHS hospitals in the UK. Between 2014 and 2018, some 5,000 women who had undergone curative surgery were randomly assigned to a cohort of either annual mammography (n=2,618) or less frequent mammography (n=2,617), with a median follow-up of 5.7 years.
The co-primary outcomes were breast cancer-specific survival, with a 3% absolute non-inferiority margin, and cost-effectiveness. The results of the latter will be published separately. Additional outcomes analysed included recurrence-free interval, overall survival and referrals back to the hospital system.
Nearly three-quarters of the women (n= 3,858, 73.6%) were aged 60 years or older. The majority had undergone breast conservation surgery (80.3%), 87.4% had invasive disease, 2.1% had cancer that spread to the lymph nodes, and 82.7% had oestrogen receptor-positive tumours.
During the study and follow-up period, 343 women died. This included 116 who died of breast cancer, 61 from the annual mammography group and 55 in the less frequent mammography group.
The researchers found the five-year breast cancer-specific survival was 98.1% in the annual mammography group and 98.3% in the less frequent mammography group, providing evidence that less frequent mammograms did not negatively affect breast cancer rates.
After five years, 94.1% of the annual mammography group and 94.5% of the less frequent mammography group remained cancer-free. Survival from any cause was 94.7% for the annual mammography group and 94.5% for the less frequent mammography group.
The researchers suggested that less frequent mammograms for breast cancer-specific survival, recurrence-free interval and overall survival should be recommended for patients aged 50 years or older.
Reference
Dunn, J et al. Annual versus less frequent mammographic surveillance in people with breast cancer aged 50 years and older in the UK (Mammo-50): a multicentre, randomised, phase 3, non-inferiority trial. The Lancet 2025; Feb 01: DOI: 10.1016/S0140-6736(24)02715-6.
14th March 2025
The triple combination medicine deutivacaftor/tezacaftor/vanzacaftor (brand name Alyftrek) has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA) for treating eligible patients with cystic fibrosis.
This is a once-daily, next-in-class triple combination cystic fibrosis transmembrane conductance regulator (CFTR) modulator treatment.
Deutivacaftor/tezacaftor/vanzacaftor is indicated for people with cystic fibrosis aged six years and older who have at least one F508del mutation or another responsive mutation in the CFTR gene, including additional mutations not previously approved with other CFTR modulator therapies.
The manufacturer Vertex Pharmaceuticals is working with the National Institute for Health and Care Excellence (NICE) and the NHS to ensure eligible patients can access this new therapy, with a decision expected during the summer.
David Ramsden, chief executive of the Cystic Fibrosis Trust, said the ‘MHRA approval is another important step in making sure as many people with CF as possible can benefit from the best available treatments’.
He added: ‘We never forget that these medicines are not a cure, and do not work for some people. Cystic Fibrosis Trust will not stop until everyone with CF can live a life that’s not limited by their condition.’
This follows the approval of deutivacaftor/tezacaftor/vanzacaftor in the US in December for the same age group. Marketing authorisation applications are ongoing with the European Medicines Agency and other markets.
The MHRA approval was based on the results of two head-to-head randomised phase 3 trials (Skyline 121-102 and 121-103) involving 480 participants aged 12 years and over, and supported by data from an additional open‑label, phase 3 trial (Ridgeline 121-105, Cohort B1).
The primary endpoint for the trials was absolute change in FEV1 percentage predicted from baseline (most recent value before treatment on Day 1) through Week 24 (with non-inferiority of deutivacaftor/tezacaftor/vanzacaftor shown if the lower bound of the 95% CI for the primary endpoint was –3.0 or higher).
Safety was assessed in all participants who received at least one dose of study drug during the treatment period.
Deutivacaftor/tezacaftor/vanzacaftor was found to be as effective at improving lung function as the standard of care ivacaftor/tezacaftor/elexacaftor (brand name Kaftrio). It was also found to be more effective at reducing sweat chloride levels than the standard of care.
The study drug also showed potential as a treatment option for people with a small number of gene mutations not covered by the license for ivacaftor/tezacaftor/elexacaftor.
The authors wrote that once-daily dosing with deutivacaftor/tezacaftor/vanzacaftor reduced treatment burden, potentially improving adherence, compared with the twice-daily regimen of the current standard of care.
The most common side effects in the clinical trials were headache (15.8%) and diarrhoea (12.1%), the MHRA noted.
Professor Alex Horsley, who led the Skyline trials, is professor of respiratory medicine at the University of Manchester, consultant at the Manchester Adult Cystic Fibrosis Centre and medical director of the NIHR Manchester Clinical Research Facility at Wythenshawe Hospital.
Commenting on the findings, he said: ‘The deutivacaftor/tezacaftor/vanzacaftor Phase 3 trial results showed that it is possible to further improve CFTR protein function with this once-a-day, more flexible and less burdensome regimen.
‘Children and adults taking the new triple combination therapy were more likely to have carrier levels of sweat chloride compared to those on the ivacaftor/tezacaftor/elexacaftor regimen, which we hope will translate to reduced risk of developing CF-related complications in the long term.’
The license for ivacaftor/tezacaftor/elexacaftor was extended by the MHRA in November 2023 to include children aged two to five years old.
Last year, it was found that ivacaftor use was ‘safe and effective’ from one month old.
13th March 2025
The Government has announced it will abolish NHS England in a bid to ‘strip out duplication’ with the Department of Health and Social Care (DHSC).
The move is to set to reduce bureaucracy, make savings and empower NHS staff to deliver better care for patients, according to the DHSC.
According to the announcement, NHS England ‘will be brought back into the DHSC entirely’ to ‘put an end to the duplication resulting from ‘two organisations doing the same job’ and ‘more resources will be put back into the frontline rather than being spent on unnecessary admin’.
The Government said the move would ‘reduce complex bureaucracy’ and ‘undo the damage caused by 2012 reorganisation’, led by then-health secretary Andrew Lansley and which saw the formation of NHS England as an arms-length body in 2013.
‘The reforms will reverse the 2012 top-down reorganisation of the NHS which created burdensome layers of bureaucracy without any clear lines of accountability. As Lord Darzi’s independent investigation into the state of the NHS found, the effects of this are still felt today and have left patients worse off under a convoluted and broken system,’ the announcement said.
The Government said that in practice this will mean:
The plans will also see ‘more power and autonomy to local leaders and systems’, the Government added.
In a statement to Parliament, health secretary Wes Streeting said: ‘This is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction, and most expensive NHS in history.
‘When money is so tight, we can’t justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline.
‘NHS staff are working flat out but the current system sets them up to fail. These changes will support the huge number of capable, innovative and committed people across the NHS to deliver for patients and taxpayers.
‘Just because reform is difficult doesn’t mean it shouldn’t be done. This Government will never duck the hard work of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for you when you need it.’
Sir James Mackey, who has been named transition CEO of NHS England, said: ‘We know that while unsettling for our staff, today’s announcement will bring welcome clarity as we focus on tackling the significant challenges ahead and delivering on the Government’s priorities for patients.
‘From managing the Covid pandemic, the biggest and most successful vaccine campaign which got the country back on its feet, to introducing the latest most innovative new treatments for patients, NHS England has played a vital role in improving the nation’s health. I have always been exceptionally proud to work for the NHS – and our staff in NHS England have much to be proud of.
‘But we now need to bring NHS England and DHSC together so we can deliver the biggest bang for our buck for patients, as we look to implement the three big shifts – analogue to digital, sickness to prevention, and hospital to community – and build an NHS fit for the future.”
Incoming NHS England chair Dr Penny Dash said: ‘I am committed to working with Jim, the board and wider colleagues at NHS England to ensure we start 25/26 in the strongest possible position to support the wider NHS to deliver consistently high-quality care for patients and value for money for taxpayers.
‘I will also be working closely with Alan Milburn to lead the work to bring together NHSE and DHSC to reduce duplication and streamline functions.’
Responding to the announcement, Royal College of Physicians clinical vice president Dr John Dean said: ‘The decision to abolish NHS England is undoubtedly a big one.
‘We need to see the detail, but physicians will want to be assured that critical plans expected this year including the 10-year plan, the long-term workforce plan revision, the Leng review and the review of postgraduate medical training will be delivered as planned, and that clinical leadership and expertise will be protected in the transition. Patients are our priority.
‘The NHS has been through some of its toughest years in recent memory, and it will take significant efforts to turn things around. This reorganisation must not become a distraction from the huge job ahead, and we feel for all the NHS England staff affected by the news. We will work with the transition team and Department of Health and Social Care as the new structures for delivering the Government’s ambitions to fix the NHS become clearer.‘
In a joint statement, Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, said: ‘This is the end of an era for the NHS and marks the biggest reshaping of its national architecture in a decade.
‘Our members will understand the dynamics at play here, but it comes at an extremely challenging time, with rising demand for care, constrained funding and the need to transform services. History tells us this will cause disruption while the transition is taking place. Much of Trust and [integrated care system] ICS leaders’ focus will need to go on stabilising the NHS in the short term as they prioritise patient care but we also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming 10-year plan.
‘Our members will want to see strong voices maintained for the health service in future policy making and the major decisions that affect leaders and their staff. NHS England was set up to provide arms-length operational independence for the NHS from Government and it will be important that the service maintains its ability to inform policy-making and all decisions that affect operational delivery.
‘The NHS Confederation and NHS Providers and our diverse memberships will work with the Government to help this transition go smoothly and to ensure the 10-year plan helps the Government to meet its ambitions. Local NHS organisations and other bodies will need to be involved in this transformation as the immediate next steps become clearer, so that an optimum operating model can be created.‘
A version of this article was originally published by our sister publication Pulse.
With research revealing that half of adults say they struggle to access trusted health information, effective communication between healthcare professionals and patients is vital. Kathy Oxtoby looks at how to best support patients to manage their conditions once they leave hospital through effective signposting to credible and reliable health information.
In these digital days, health information seems easier to access than ever. Less clear, however, is whether that information is evidence-based, trustworthy, safe and of high quality.
‘Misinformation and disinformation are making it increasingly difficult for people to find credible health information,’ says Sophie Randall, director of the Patient Information Forum (PIF).
Indeed, PIF’s recent survey with Ipsos, which forms the basis of their ‘Knowledge is Power’ report, found one in two adults find it difficult to access trusted health information, while one in 10 had been impacted by misinformation.
‘It is important to remember that a significant minority of people are digitally excluded and lack the skills, motivation, data or devices to search online independently for health information,’ says Sophie. ‘This makes it really important for healthcare professionals to signpost people to trusted information.’
This is certainly of note as eight in 10 respondents said better access to credible health information would improve their health management.
But providing information to patients is only half the battle. Not all patients will value the same types of information, the ways in which they best consume information will differ, and the interpretation of information will also vary between individuals.
So, what should healthcare professionals do to ensure they are supporting patients in the best possible way?
Chris Mackie, director of digital at the Health and Social Care Alliance Scotland, says it’s important to think about what ‘good’ looks like in terms of health information access.
‘Getting it right means getting information early, and that means potential harmful health outcomes being avoided,’ he says. But he notes that there are problems with having both ‘too much, or not enough information’, so finding the balance is crucial.
Dr Liz O’Riordan is an author and former breast surgeon who has spoken widely about her own experiences with breast cancer.
‘[As a patient], your medical team give you information about the treatments you’re going to have, and you get a lot of leaflets that you might never look at,’ she says. ‘However, when you go home and start living your life with your illness, you have lots of questions, such as “What to eat?”, “What’s normal?”, and how to cope with side effects.’
Bringing together her professional and patient experiences, she says providing patients with information about side effects they may experience and how to deal with them can be particularly empowering.
‘[It makes patients] feel in control and that you do care about them,’ says Dr O’Riordan. ‘If you signpost them to what’s going to happen, and how to cope, what to do, and who to call if they’re worried, it makes things bearable and liveable.
‘It will also improve drug adherence – telling patients these are the side effects, they’re normal, they’re not nice, but these are the things you can do to cope.’
In making sure this information is covered, ‘your patients will be happier, you’ll get better results, and it will save money in the long run’, she adds.
Sophie estimates that ‘even people with complex needs are only likely to spend 10 hours a year with health professionals’. There’s only so much that can be said during that time, so additional information is required to help them for the other 8,750 hours.
Having the internet at patients’ fingertips can fuel an element of curiosity about their condition and a desire to gain reassurance and validation that can be difficult to ignore.
‘Patients want certainty and hope, and they want to know how to live, not to just be alive, and that’s not the kind of information you would ask your doctor,’ says Dr O’Riordan. ‘Patients are now turning to social media and online to get that information.’
But she is ‘stunned’ about how much misinformation is available, and at how quickly that misinformation space is growing.
A recent study from City St George’s, University of London revealed, for example, that 81% of cancer cures discussed by content creators on TikTok were fake and did not contain legitimate medical advice.
And while Sophie says, ‘people are less likely to trust information on social media’, the sheer quantity of information available to those who are digitally able can be overwhelming and, in some cases, damaging.
‘The worry is patients will get medical information online that will do them more harm than good,’ says Dr O’Riordan. This could be physical, emotional or even financial harm.
For health professionals, ‘your patients aren’t going to do as well as they should, you may get worse results and you can’t help people the way you want to’, Dr O’Riordan adds.
In such cases, advise about the risks of social media and online misinformation and instead suggest relevant charities or patient organisations for patients to access further information.
The Knowledge is Power report found only one in 10 UK adults with long-term conditions are signposted to patient organisations, meaning the vast majority of people are missing out on what could be invaluable continued support.
‘Everyone should be signposted to clear, usable health information to help them practice self-care,’ says Sophie. ‘People with long-term conditions should also be signposted to the specialist information provided by health charities and patient organisations to help them to self-manage. This can be particularly crucial in the rare disease space.’
In fact, people who access trusted health information from specialist health charities reported being more confident to self-manage long-term conditions, ask questions in appointments and take part in shared decision-making.
‘Importantly, people felt much less isolated and alone when they were involved with health charities’, Sophie adds.
As such, given the ‘toxic information environment, the new challenges of artificial intelligence (AI) and the likely changes to the health system, credible health information should be integrated into care pathways. This must include signposting to national health charities’, she says.
Dr Melanie Dalby, member of the Royal Pharmaceutical Society (RPS) Hospital Expert Advisory Group, says pharmacy staff will likely be aware of organisations such as Macmillan Cancer Support for cancer care, but ‘they may be less aware of smaller organisations and the information material they offer’.
Doing research about charities and patient organisations relevant for the most common conditions, as well as for specific patients with less common diseases, can be useful for developing a curated reference tool for consultations.
According to Dr O’Riordan, the essential information health professionals should signpost patients to includes side effects, risks and what to expect from their condition – and this is a bare minimum.
‘Digital signposting is key,’ she says. ‘You need to digitally signpost patients to helpful online resources that will help them get their life back and learn to live with their illness.’
Dr Dalby warns that time constraints play a role and ‘pharmacy staff are more likely to focus on the immediate clinical needs rather than directing the patient to broader health information’.
But it’s here that healthcare professionals need to think beyond their specific role as a doctor or pharmacist providing medication.
‘Look at what has happened to the patient before they arrived at your door that has contributed to their condition and what could help them after they leave you,’ says Chris. ‘It’s not just about taking the pills that you have prescribed, but what would help the patient’s life more generally. Looking at the whole person is important.’
Healthcare professionals should consider trusted information sources ‘and have those at your fingertips to pass on to patients’, says Chris.
As a starting point, they can look for the PIF TICK on health information provided by PIF’s 150 certified organisations and healthcare professionals. These organisations can be found using the PIF TICK directory.
‘The PIF TICK credibility mark shows information is evidence based, up to date and easy to use and understand,’ says Sophie.
The Knowledge is Power report revealed that two in three UK adults said independent verification of health information would increase their trust. This is what the PIF TICK strives to achieve with its 10-step accreditation process for NHS, charity, voluntary and private sector organisations and, importantly, individual health content creators creating and publishing health information.
Information should be signposted throughout the patient journey, says Sophie, but there are obviously times of high demand for information. ‘These include at the point of diagnosis, when making treatment decisions and at end of life,’ she explains.
Dr O’Riordan says that it’s important to acknowledge that ‘patients want different information at different points, and every patient is different. ‘By giving information at every point of contact you’ll never miss anybody,’ she advises.
Everyone has the right to information they can understand and use. But it is even more important for those already at risk of health inequalities.
‘To ensure information reaches those who need it most, we need to work with users to tailor information. This includes making sure it is accessible, uses plain language and is culturally appropriate,’ Sophie says.
Victoria Taylor, head of clinical support at the British Heart Foundation (BHF), says the charity has been ‘working hard to improve the accessibility of our information whether that is through spoken pages, easy read booklets for people with learning disabilities, information available in multiple languages and generally working to make sure our information is as easy to read and understand as possible’.
If patients are not digital or health literate, healthcare professionals should look at obtaining support for them through a family carer, a Community Links Worker or other role, depending upon what is available locally, Chris says.
Information flow and record keeping between multidisciplinary team members is important so that everybody knows what is happening with the patient, what individual team members are doing to support them and what signposting has been suggested.
‘You want people to be on the same page,’ says Chris, and this can help avoid duplicating information, which is pertinent in pressurised healthcare environments.
PIF believes national governments should support development of a health literacy-friendly NHS. This includes training in information provision for healthcare professionals.
‘We are also calling for NHS organisations delivering care to have a dedicated lead for health information mandated,’ explains Sophie. ‘This should be resourced to ensure consistent and effective delivery of information meeting national standards.’
From a system perspective, credible information from certified sources ‘should be embedded in the NHS App and face-to-face interactions across the NHS’, she adds.
For Chris, ‘the future of health information is digital’, and much of that will be via AI. ‘The future will see these technologies really improve with a view to complementing traditional, in-person health services,’ he says.
And Dr O’Riordan agrees, saying: ‘Patients are looking for information online, whether you want them to or not. AI is growing at a huge speed and can be a very good tool. And healthcare organisations will start creating their own digital resources.’
Emerging technologies, such as AI, present lots of opportunities, such as increased personalisation in what information patients receive and how they access it, but it also comes with challenges.
‘It’s important that healthcare organisations work together and share what we learn with one another as we trial new approaches, to make sure we can realise potential benefits in a way that gives patients confidence,’ Victoria says.
Health information access is ‘a complex, but not impossible problem’, says Chris. ‘It’s about education, digital literacy, health literacy, systems change and workforce development.
‘But most important are the relationships patients have with their doctors or pharmacists. If trust exists, then good information can flow.’
Dr Dalby stresses the importance of always speaking to the patient and/or carer to understand their preferences regarding health information. ‘Ensuring information is accessible, reliable and tailored to their needs is key to providing effective healthcare support,’ she says.
When it comes to practical tips, Dr O’Riordan says healthcare professionals should ask patients at a one-year follow up clinic what information they used to support the management of their condition and what they found useful. From this information, she suggests making a QR code for patients to access resources sourced from other patients.
And she advises health professionals to visit major charity forums to see the questions patients are asking. This will ‘open your eyes about the kind of information they are looking for’ so you are better equipped to help, she says.
Returning to her point about medication side effects, Dr O’Riordan’s final message is simple: ‘If the treatment you are giving a patient causes side effects, please tell them how to cope with them. And remember, patients’ lives continue when they leave your clinic. So, what can you do to help them?’
12th March 2025
A new study proposes that intensive care unit (ICU)-led antibiotic allergy assessment and testing programmes are feasible, effective and safe, even without specialised immunology and allergy services.
The findings support expanding ICU-led antibiotic allergy assessment and testing, which could reduce the unnecessary use of alternative antibiotics and improve patient outcomes.
Many patients who receive antibiotics in the ICU will have an incorrectly documented allergy to them, most commonly related to penicillin. Mislabelling issues can lead to using less effective or broader-spectrum antibiotics, which can cause drug-resistant bacteria, increased Clostridium difficile infections, and longer hospital stays.
To determine whether ICU staff could undertake allergy assessment and testing programmes independently, the researchers set out to verify allergy labels and check whether patients were allergic to antibiotics, particularly penicillin.
Between September 2022 and September 2023, the ICU ward at St James’s Hospital in Dublin, Ireland, admitted 78 patients with a documented antibiotic allergy label. The researchers divided the 62 patients eligible for the study into four risk groups: non-immune mediated reactions, low-, intermediate-, and high-risk allergies.
Non-immune mediated reactions were directly de-labelled. Low-risk allergies underwent direct drug provocation testing and intermediate-risk cases received skin testing followed by drug provocation and high-risk allergies were confirmed without testing.
The researchers found that many patients had outdated or incorrect allergy information, leading clinicians to avoid using their first-choice medication, such as penicillin, and instead use less effective and often more expensive alternatives.
Most patients (94%) with non-immune, low- or intermediate-risk allergies were de-labelled. A total of 13 patients (21%) were risk-assessed as having non-immune-mediated reactions and were directly de-labelled.
Some 38 patients (61%) were risk evaluated as having low- or intermediate-risk allergies, and antibiotic allergy testing was performed on 35 of these patients. High-risk allergies were confirmed in 11 patients (18%). The researchers reported no adverse events during testing.
Antibiotic allergy assessment and testing were successful in critically ill patients, and drug provocation testing without prior skin testing was safe in patients with low-risk allergies.
The study highlighted how ICU-led antibiotic allergy assessments and testing can optimise antibiotic selection and mitigate the risks of antimicrobial resistance.
The researchers suggested that such testing should be standard practice in ICU units worldwide and would be beneficial in wards with limited resources and no immunology specialists.
This adds to previous research published last year by the University of Birmingham that found de-labelling low-risk penicillin allergy patients outside specialist clinics to be ‘potentially achievable’.
Reference
Alamin, S et al. Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study. Journal of Critical Care 2025; Feb: DOI: 10.1016/j.jcrc.2024.154977.
We are thrilled to announce Clinical Excellence in Cardiovascular Care 2025, our free, one-day virtual event taking place on 2 July 2025.
This event is designed to provide UK healthcare professionals with the latest insights and innovations in cardiovascular medicine from leading experts across the UK.
Produced in partnership with Hospital Healthcare Europe and Hospital Pharmacy Europe, this virtual event is tailored to multidisciplinary teams across NHS trusts and beyond. Every session is carefully curated to deliver cutting-edge research, case studies and expert knowledge from Centres of Excellence to enhance clinical practice in cardiology.
This event is essential for professionals working within multidisciplinary teams, including heads of cardiology/consultant cardiologists, cardiology nurses, intensive care nurses/clinical nurse specialists, internists, hospital pharmacists and clinical directors.
‘Informative and very relevant to my area of practice. Opportunity to expand and to share what I have learnt.’
Analiza Maramo, Cardiac Specialist Nurse, 2024 attendee
‘In-depth review of each topic with useful information that will improve and support our care of the patients.’
Dr Huda Abdelmouti, Associate Specialist with interest in cardiology, 2024 attendee
Don’t miss this opportunity to advance your expertise in cardiovascular care and connect with top professionals in the field. Register now to secure your spot at Clinical Excellence in Cardiovascular Care 2025!
10th March 2025
A new study highlighting how clinicians’ beliefs can influence the application of rapid molecular diagnostics in intensive care has suggested a new ‘behaviourally intelligent’ approach to prescribing.
Clinicians acknowledged the importance of rapid molecular diagnostic testing, which can facilitate earlier refinement of antimicrobial therapy and improve antimicrobial stewardship.
However, the study showed that the results of the tests were often not acted on – a phenomenon the researchers described as following ‘mindlines’, which they said related to informal, experience-based knowledge rather than official guidelines.
The researchers found that the test had a limited impact on prescribing decisions. Clinicians reported concerns about the potential consequences of undertreatment to both the patient and prescriber. These concerns often outweigh antimicrobial stewardship considerations and sometimes led to ‘just-in-case’ antibiotic prescriptions.
The study was embedded within the INHALE trial, which examines the use of the BioFire FilmArray Pneumonia Panel (Pneumonia Panel) for antibiotic prescribing in hospital-acquired and ventilator-associated pneumonia (HAP/VAP) in UK intensive care units.
The researchers conducted semi-structured interviews with 20 intensive care clinicians to determine which factors affected antibiotic prescribing decisions.
Clinicians frequently prioritised personal experience and clinical judgment over test results, adopting an approach of ‘treat the patient, not the result’. Even when tests showed the de-escalation of antibiotics as appropriate, many clinicians took a cautious approach and maintained antibiotic coverage to mitigate perceived risks.
The findings illustrated a tension between prescribing guidelines and ‘mindlines’. They also highlighted the limitations of relying solely on technological solutions like rapid molecular diagnostics to influence prescribing.
The researchers suggested that a ‘technology plus’ approach that is ‘behaviourally intelligent’ would be more effective. The new approach would recognise that clinicians face challenges that can be both cognitive and systematic when applying technological solutions to patient care.
The study highlighted the complexities of clinical decision-making in intensive care units. While rapid molecular diagnostics can improve antimicrobial stewardship, the potential of such tests is constrained if clinicians’ beliefs, emotions and the wish to save lives – which are often key drivers of their antibiotic prescribing – are not understood or accounted for.
Successful implementation of this new approach requires that new technologies and guidelines be behaviourally intelligent and aligned with clinicians’ work methods, the researchers concluded.
Reference
Stewart, S.F. et al. Guidelines vs mindlines: a qualitative investigation of how clinicians’ beliefs influence the application of rapid molecular diagnostics in intensive care. Antimicrob Agents Chemother. 2025, Feb. 05: DOI: 10.1128/aac.01156-24.
Researchers have used machine learning to predict which patients with advanced bladder cancer are most likely to respond to immunotherapy with immune checkpoint inhibitors (ICIs).
ICIs were a major breakthrough in the treatment of advanced bladder cancer, researchers wrote in the journal Nature Communications, but were only effective in a subset of patients.
Bladder cancer also showed a high degree of heterogeneity, with five muscle-invasive subtypes, and it had been hypothesised that the subtypes with a high proportion of infiltrated immune cells were more likely to respond to ICI.
For this study, the authors integrated mutation and gene expression data from 707 patients from six cohorts of advanced bladder cancer patients treated with anti-programmed cell death protein 1 (PD-1) and anti-programmed death-ligand 1 (PD-L1) ICI to build computational predictive models.
Machine learning tools enabled them to identify key variables that influenced the success of immunotherapy treatment.
Analysis of the dataset found that, contrary to the hypothesis, patients with high immune filtration, such as those with basal-squamous and luminal-infiltrated tumour types, did not show an overall better response.
For non-immune-infiltrated subtypes, other biomarkers appeared to be particularly relevant, the researchers noted, which illustrated the importance of accounting for specific tumour types or the degree of immune inflammation.
Overall, the neuronal subtype of tumour was found to have the highest response rate to immunotherapy.
‘It has been hypothesised that this kind of tumour could be more responsive to ICI due to the expression of tissue-restricted neuronal or neuro-endocrine proteins, together with low [transforming growth factor β] TGF-β expression values,’ the study authors wrote, adding that their study ‘confirmed that TGF-β levels are particularly low in this class’.
In other findings, the study confirmed that the number of somatic mutations in the tumour was associated with immunotherapy treatment response, but researchers also found enrichment in the apolipoprotein B mRNA editing catalytic polypeptide-like (APOBEC) mutational signature and abundance of pro-inflammatory macrophages were major factors associated with response.
In addition, they found several unexplored markers of response to ICI, including the number of non-stop mutations.
‘The results have uncovered unexplored ICI associated variables and have shed light on the complex interplay between tumour biology, the immune microenvironment and treatment response,’ the study authors wrote.
‘Our study underlines the importance of subtype-specific factors for personalised treatment strategies and enhanced patient outcomes in the era of immunotherapy.’
The study was conducted by researchers at the Biomedical Informatics Research Programme (GRIB) and the Cancer Programme at the Hospital del Mar Research Institute in Barcelona, Spain, with the collaboration of the city’s Pompeu Fabra University.
Commenting on the findings, study lead author Lilian Marie Boll, a researcher for the GRIB, said: ‘The key to our study is understanding the response mechanisms within these subgroups, rather than treating all bladder cancer as a single entity.’
Study co-author Dr Joaquim Bellmunt, coordinator of the Urologic Cancer Research Group at the Hospital del Mar Research Institute and the Dana-Farber Cancer Institute in Boston, US, said the study expanded the current knowledge base of tumour heterogeneity, which was a limiting factor in immunotherapy efficacy.
‘It highlights the importance of identifying immune cell populations that facilitate immunotherapy response, while others have inhibitory effects,’ he said.
The findings add to other recent literature on bladder cancer, including a study that found multiparametric magnetic resonance imaging (mpMRI) was both feasible and beneficial in reducing treatment delays in the initial staging of muscle-invasive bladder cancer.
This prospective open-label, randomised study found using mpMRI in the muscle-invasive bladder cancer pathway reduced the time to correct treatment by 45 days compared to standard investigation.
The researchers concluded that introducing mpMRI ahead of transurethral resection of bladder tumour into the standard pathway was beneficial for all patients with suspected muscle-invasive bladder cancer as it could improve clinical decision making and accelerate the time to treatment.
Machine learning has also recently been used to improve the personalised prognostication of aggressive skin cancers, such as Merkel cell carcinoma.
Respiratory rate is often measured inaccurately, so there is an urgent need for reliable technology that can consistently monitor this early indicator of declining health for patients in hospital and at home. Here, Isis Terrington describes the development of a novel medical-grade, wearable monitor, which does not require direct skin contact, and its impending clinical evaluation at University Hospital Southampton NHS Foundation Trust.
Changes in respiratory rate are often the initial marker of a patient’s clinical deterioration and therefore the first opportunity to identify and treat acute issues.
It is well established that the early detection of critical illness leads to improved morbidity and mortality rates and reduces the need for services such as high dependency or critical care.1–4 Therefore, it is crucial that these high-risk patients are identified promptly to enhance their outcomes.
Respiratory rate constitutes a vital component of the standard physiological assessment for all hospitalised patients, particularly those with severe conditions such as sepsis or pneumonia, or in cases of haemorrhaging. In addition to its role in detecting acute illness, monitoring respiratory rate is essential for patients with chronic conditions such as asthma, chronic obstructive pulmonary disease and heart failure.
Current methods of monitoring respiratory rate are limited. The most common method of assessment is intermittent manual breath counting. On a general ward, this is completed every four to six hours, or more frequently in patients at higher risk of deterioration, such as every 10 minutes in the post-operative recovery unit.
However, in addition to this being labour-intensive, studies have revealed significant inaccuracies associated with manual counting, including the effects of personal bias and environmental pressures.5,6
Unlike all other vital signs – such as heart rate, blood pressure and temperature – respiratory rate is the only parameter lacking a standard electronic monitoring device for general ward patients. In recent years, an increasing number of continuous monitors have entered the market. None, however, have gained widespread acceptance due to a combination of device inaccuracy, invasiveness leading to patient discomfort, and cost.
Many of these devices determine respiratory rate by detecting subtle changes in heart rate that occur throughout the respiratory cycle, sensed by either photoplethysmography or electrocardiogram. While affordable and simple to use, this method of measuring respiratory rate is unreliable in certain patient subgroups, particularly those with abnormal heart rhythms, such as atrial fibrillation, where heart rate irregularities lead to desynchrony in respiratory rate calculations.
As critical illness can further induce abnormal heart rhythms, heart rate-based systems, although suitable for use in lifestyle devices such as smartwatches, present a risk of inaccuracy in an acute medical setting. Consequently, there is an increasing need for a medical-grade respiratory rate monitor that is non-invasive, affordable and accurate for all patients, regardless of any potential cardiac or respiratory conditions.
Our research team at the University of Southampton, in partnership with researchers at the University of Nottingham and part-funded by the National Institute for Health Research, has developed a continuous monitor based on capacitance technology.
The PneumoRator is a small, wearable device (see main image) that is attached to the chest via a simple, non-irritant adhesive patch, which allows for wireless monitoring.
The PneumoRator measures the capacitance variation of a contact sensor caused by breathing, enabling accurate detection of subtle changes due to chest expansion or variations in lung composition. Weighing only 20 g, it is affordable and capable of significantly reducing movement artifacts using gyroscopic technology, making it a novel respiratory rate monitor.
Extensive testing has demonstrated that it achieves accuracy within two breaths per minute, making it highly reliable in comparison to manual respiratory counts. The device’s capacity to filter out movement artefacts enables patients to mobilise normally while still providing precise respiratory rate data, which presents a challenge for many other devices on the market. This feature is particularly crucial for post-operative patients, for whom early mobilisation is a vital aspect of their long-term recovery.
Alongside the practical difficulties of creating an accurate monitoring device, meticulous validation of these devices presents its own challenges.
The gold standard for measuring respiratory rate is capnography, which assesses levels of CO2 being inhaled and exhaled. This is particularly relevant during invasive mechanical ventilation where the respiratory rate is closely monitored and CO2 levels can be exported as raw data.
Accessing raw data from a proposed gold standard is essential for the validation process and yet most clinical devices do not facilitate this, making capnography exceptionally valuable. Capnography serves as a true gold standard for measuring the actual respiratory rate rather than providing a derived metric, and it also enables access to its raw data.
Data from the PneumoRator and the capnograph will be processed using the same algorithm, and their concordance will be evaluated using Bland-Altman plots. Once we can demonstrate the high accuracy of the PneumoRator as a clinical sensor, we will evaluate the algorithm we develop to display the measured respiratory rate.
Decisions regarding the development of the algorithm will include factors such as defining the duration for averaging the respiratory rate and the refresh rate, as well as identifying and managing noisy signals caused by actions such as talking and coughing.
Different algorithms will alter the displayed respiratory rate, hence the importance of validating against raw data rather than post-processed data to determine the accuracy of the device. Most commercially available devices have not undergone this level of scrutiny, opting instead to validate the sensor and the algorithm simultaneously.
There are also clinically used devices that are CE marked yet exhibit remarkably wide limits of agreement on their Bland-Altman plots7 when compared against their selected gold standards. For these devices, users cannot discern whether the lack of concordance results from the sensor or the algorithm.
Our team will soon begin the first clinical trial of the PneumoRatoron patients having major surgery at University Hospital Southampton NHS Foundation Trust. We will monitor their respiratory rate while they are anaesthetised and continue this for up to the first 48 hours of their recovery.
This will act as a validation trial against raw capnography data from the theatre and in the recovery room, followed by manual respiratory rate counts once the patients are on the ward.
The trial will assess the accuracy of the PneumoRator compared with the current standard respiratory rate methods most commonly used in UK hospitals. Additionally, we will evaluate the patient experience of the device to determine its durability and comfort, enabling us to explore the potential for longer-term wear.
This trial represents a significant step forward in formulating a device that addresses current clinical needs. We will subsequently advance our technology to enable the respiratory rate to be transmitted to an electronic patient record system via the Health Level 7 protocol, while also developing a patient-facing app for use at home.
Integrated algorithms will identify concerning trends, potentially alerting the relevant clinicians through various modalities about the possible need for intervention and escalation of care. Further clinical trials assessing markers of patient deterioration and mortality will evaluate the impact of using a PneumoRator compared with standard care.
The implementation of continuous monitoring and the management of potential alarm fatigue will also require collaboration with clinical teams to ensure that both the sensitivity and specificity of the alerts are clinically appropriate.
With ever-increasing technological advancements, respiratory rate monitoring remains an important issue for healthcare. We are excited to start the clinical trial of our novel device, which will bring us one step closer to improving the early detection of deteriorating patients and strengthening clinical outcomes.
Isis Terrington MBChB BSc
Clinical research fellow (critical care), University Hospital Southampton NHS Foundation Trust
With thanks to co-researchers:
Neil White PhD DSc CEng CPhys FIET FInstP SMIEEE
Professor of intelligent sensor systems and director of the ECS Centre for Healthcare, School of Electronics and Computer Science, University of Southampton
Harry Akerman MBBS FRCA
Alexander Jackson MBChB
Both of University Hospital Southampton NHS Foundation Trust
Mahdi Shaban PhD
School of Electronics and Computer Science, University of Southampton
Rod Lane PhD CEng MIET
Zelemiq Ltd, Salisbury
Yang Wei PhD
Amjad Ali PhD
Both of the Department of Engineering, Nottingham Trent University
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