Chelsea and Westminster Hospital NHS Foundation Trust

High-risk industries such as aviation have long since understood that technical competencies alone do not guarantee safety or success. Surgical disciplines including robot-assisted surgery (RAS) have achieved this understanding relatively recently, despite also being considered high-risk. Both disciplines face challenges from technical (TS) and non-technical skill (NTS) perspectives, requiring calm, controlled, and skilled management to overcome adversity. Whilst aviation demonstrates admirable safety records, RAS has been highlighted as a potential health technology hazard. Comparisons are increasingly being drawn between the technology, culture, safety practices, and training modalities of RAS and aviation. Aviation recognises NTS limitations and reflects this through its simulation-based training. Whilst the amended intraoperative dynamics of RAS constitute unique NTS challenges, the inclusion of NTS within formalised RAS training curricula is comparatively negligible. Virtual-reality (VR) simulation in aviation allows pilots to achieve and maintain their TS and NTS competencies. Simulation’s role in the development and maintenance of RAS competencies is not treated with parity; however, RAS VR simulation has the potential to improve the feasibility of the integration of simulation with RAS training. The incorporation of aviation-based safety practices in RAS needs further consideration, given that surgery remains behind its high-risk counterparts. RAS stands to benefit from adopting key components of their practices, including work environment, culture, simulation, and the standardisation and regulatory oversight of its training programmes. Through implementing established safety practices utilised in other high-risk industries, RAS has the potential to reduce the frequency and severity of adverse events, with patients becoming the ultimate beneficiaries.

This chapter examines the distinct challenges for healthcare professionals in perioperative and critical care medicine (CCM) settings, identifying factors that may increase the risk of harassment. Despite existing legal policies against discrimination and abuse, healthcare workers often endure harassment and violence, both from colleagues and patients, which further compromises their well-being. CCM physicians are especially vulnerable, as they frequently deal with high-stress situations and care for some of the most unstable patients. The work environment in critical care units is often impersonal, characterized by high noise levels, limited privacy, and little opportunity for relaxation. These factors can contribute to both burnout syndrome (BOS) and harassment, particularly among female physicians and minorities. The impact of the COVID-19 pandemic has further exacerbated these issues, with many healthcare professionals reporting increased stress, burnout, and feelings of isolation, bullying, and harassment. Pregnant and childless physicians may also face discrimination and harassment for different reasons, which will be addressed separately in this chapter. There is a scarcity of psychological support available to healthcare workers in these settings, highlighting the urgent need for increased access to mental health resources, protection policies, and a culture that promotes respect and well-being. The authors emphasize the importance of improving working conditions and implementing strategies to combat bullying, discrimination, and harassment, fostering a healthier, more supportive environment for all healthcare professionals.

Heart failure with reduced ejection fraction is a chronic, progressive medical condition affecting millions of individuals worldwide. It is associated with high morbidity and mortality. The use of “foundational quadruple therapy” titrated to the maximum tolerated doses improves survival, quality of life, and reduces heart failure-related hospitalisation. Despite this evidence, there is a consistent trend of suboptimal dose up-titration, prolonged optimisation periods, and early therapy discontinuation. Virtual wards offer a potential innovative solution in transforming heart failure management by combining rapid medication optimisation with remote monitoring to improve patient outcomes. This retrospective study employed a single-group pre-post design to evaluate the effectiveness of a prescribing pharmacist in the rapid uptitration of Guidelines Directed Medical Therapy (GDMT) in patients with heart failure with reduced ejection fraction within a virtual ward setting. The study assessed clinical outcomes of 86 patients at baseline, following discharge from the virtual ward (typically after 4 weeks), and at 3–6 months post-discharge. Improvements were seen in NYHA scores, cardiac systolic function, and Optimal Medical Therapy (OMT) scores. The median Left Ventricular Ejection Fraction increased from 29% at baseline to 39% post-optimisation, signifying improved myocardial performance and a reduction in the severity of left ventricular dysfunction. Post-optimisation, 37% of patients attained an optimal OMT score of 8, 52% attained an acceptable score (5–7), and only 5% remained in the suboptimal range (0–4). Additionally, 84% of patients were prescribed all four foundational therapies. There was no notable increase in adverse events such as hypotension, bradycardia, or hyperkalaemia. Remote up-titration of heart failure medications within a virtual ward environment is a promising approach, offering a fast, feasible, safe, and efficient treatment solution for patients who are otherwise undertreated.

Background Evaluation of clinical performance is essential in all medical school programmes. Students undergo multiple clinical placements in different disciplines and settings, and typically must pass an end-of-placement supervisor sign-off evaluation to progress. However, the validity of this sign-off model remains unclear. This study aims to assess the extent to which this assessment method predicts performance in summative medical school examinations. Methods We compared summative knowledge and clinical skills examination scores with end-of-placement supervisor sign-off ratings of ‘knowledge’, ‘clinical skills’ and ‘practical skills’ for medical undergraduate students, across three clinical placements at Imperial College London, UK (n = 355). Statistical analysis for predictive validity was performed through Ordinary Least Squares regression. Results End-of-placement supervisor ratings in hospital did not significantly predict student performance in summative knowledge tests or clinical skills assessment. ‘Knowledge’ and ‘practical skills’ ratings lacked predictive validity across all supervisors. Statistically significant predictive validity was evident for GP supervisor ratings of ‘clinical skills’ and examination scores, but the effect size was educationally insignificant (p = 0.01, r² = 0.02). Conclusions End-of-placement supervisor ratings did not demonstrate educationally significant predictive validity towards end-of-year examinations. Multi-source feedback, embedded in-placement assessment, and additional formalised supervision time in supervisors’ work schedules could be beneficial to improve the educational value for the student and the clinical placement sign-off process. Different sign-off requirements could be considered for GP and hospital settings, with tailoring of constructs to suit the clinical environment.

Background Despite increasing multimorbidity among people with HIV, its impact on health outcomes over time remains uncertain. We explored how distinct multimorbidity patterns affect a broad range of health outcomes over a 3–5-year period. Methods Principal component analysis (PCA) was used to identify multimorbidity patterns at baseline. Burden z-scores were calculated for each individual/pattern at baseline and a follow-up visit, and the differences in scores over time were examined. Participants completed health assessments including questionnaires (physical/mental health (SF-36), depressive symptoms (CES-D and PHQ-9, falls, frailty and healthcare utilisation), cognitive testing and pain mannequins tests. Multivariable regression models assessed associations between changes in morbidity burden z-scores and health outcomes. Results Six multimorbidity patterns were identified in 1073 participants: “ cardiovascular disease” (CVD) , “ sexually transmitted infections” (STIs) , “ metabolic” , “ mental/joint” , “ neurological” , and “ cancer/other” . Subsequent analyses included 793 participants (median [interquartile range; IQR] age 53 [47–59] years; 86% male; 97% on ART) with follow up data. CVD and metabolic burden were associated with specialist appointments (CVD: β = 1.47; metabolic: β = 1.53, p < 0.01) and ED visits (CVD: β = 1.44; metabolic: β = 1.89, p < 0.01), mental/Joint and neurological burden with poorer physical and mental health, frailty and recurrent falls (p < 0.01), and cancer/other burden with higher depressive scores (β = 3.28, p < 0.001), widespread pain (OR = 2.20, p < 0.001), and hospital visits (OR = 2.31, p < 0.001). Conclusion Distinct morbidity patterns differentially affected health outcomes and healthcare utilisation over time, underscoring the need for targeted, integrated care to improve quality of life and address their complex needs.

Sexual and gender minority (SGM) individuals continue to experience disparities in cancer risk, screening, treatment, and outcomes. Despite advances following the 2017 ASCO recommendations, inequities persist, driven by systemic barriers, stigma, and discrimination in health care. State-level and federal-level actions threaten health care access to for sexual minority women (SMW) and transgender and gender-diverse (TGD) people creating additional barriers to safe and evidence-based health care. This review outlines the literature and gives practical recommendations for breast and gynecologic cancer care of SMW and TGD people. SMW and transgender men and nonbinary people with a cervix share multiple barriers to cervical cancer screening with lower uptake. TGD individuals face additional barriers, including gender dysphoria during examinations. Current evidence supports offering human papilloma virus self-sampling to improve screening uptake. Evidence supports lower breast cancer risk in TGD people compared with cisgender women but advice must be tailored to surgical history and hormone use. For TGD individuals with cancer, gender-affirming hormone therapy should be managed through shared decision making, balancing oncologic risk with quality-of-life considerations. Cancer care must account for the unique needs of SGM populations, emphasizing cultural humility, structural competency, and trauma-informed care. While broader health care reforms are needed to address the systemic inequities that underlie these disparities, clinicians have an obligation to provide affirming, patient-centered care that recognizes the impact of societal discrimination on health and fosters trust with SGM patients.

Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally. Early diagnosis and intervention are crucial for preventing disease progression. The concept of early COPD is considered to represent the initial phase of the disease course. However, different terms are used, and a standardised definition is lacking. This has hindered research and clinical utility. This systematic review aims first to examine current early COPD research and outline the definitions and terms used to help reach consensus and direct future clinical research. Second, it will identify currently proposed markers and tools for predicting the progression of early COPD and the quality of evidence to help direct future research and facilitate the development of novel management strategies. Methods and analysis This study will search for all clinical studies on early COPD, using a standardised search strategy, searching CENTRAL (the Cochrane Library), MEDLINE (Ovid), PubMed, Scopus, Web of Science and Google Scholar. Titles and abstracts will be reviewed and compared against inclusion and exclusion criteria. Stage 1 of this review will assess the terms and definitions used for early COPD. Stage 2 will assess studies presenting additional markers or tools for predicting the progression of early COPD. Study quality will be assessed using a modified Downs and Black checklist for observational studies and the risk of bias (RoB) 2 tool for randomised controlled trials. This protocol has been registered in PROSPERO (CRD42025645320). Ethics and dissemination This systematic review will use freely available data within the literature and will not directly involve human participants; therefore, ethical approval is not required. The results of this systematic review will be prepared and submitted for presentation as conference presentation(s) and for publication as a peer-reviewed article. PROSPERO registration number CRD42025645320.

Background Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that clinically resembles sepsis thus obscuring the underlying condition and delaying its diagnosis and therapy. Among the most common triggers are lymphomas and infectious diseases. Lymphoma-associated HLH appears to be more common in People living with HIV (PLWH). Methods Retrospective cohort study comprising all adult HIV-infected patients with HLH treated at St. Joseph Hospital Berlin-Tempelhof, Germany, defined by HLH 2004-criteria and the HScore, between April 2020 and November 2024. Results 22 patients were included with at least 5/8 positive HLH criteria and a median HScore of 222 points. Median age was 44 [29–66] years. The median CD4-count at HLH-diagnosis was 100/µL [14–936]. In 8 (36%) patients the HIV-viral load was undetectable. HLH led to the diagnosis of HIV in 6 (27%) patients. In 20/22 patients an LPD was the HLH trigger. Hodgkin’s lymphoma, HHV8-positive multicentric Castleman disease and HHV8-positive primary effusion lymphoma accounted for 8 (36%), 5 (23%) and 3 (14%) cases respectively. Kaposi sarcoma inflammatory cytokine syndrome (KICS) HHV8-positive plasmablastic lymphoma, HHV8-positive diffuse large B-cell lymphoma, DLBCL and invasive Aspergillosis were each found in 1 (4%) patient. All patients with Hodgkin’s lymphoma had bone marrow involvement. In 1 patient simultaneous malaria and multiple myeloma were diagnosed. 11/22 (50%) patients had HHV8-associated conditions. 5 (23%) patients died within 30 days of the HLH-diagnosis. Conclusion Lymphomas and HHV8-associated diseases are common triggers of HLH in PLWH and are linked to a high mortality rate.

The interactions between the human bacterial microbiome and essential bodily functions are well established for organ systems such as the oral cavity, gut, and female reproductive tract. However, the urinary microbiome, particularly its viral component, remains largely unexplored. Emerging evidence suggests that the urinary microbiome may play a significant role in the development of overactive bladder syndrome (OAB). This study aims to fill this knowledge gap by investigating the potential link between the urethral virome and female overactive bladder syndrome, and by aligning these findings with the bacterial microbiome. Prospective pilot study including 15 patients with overactive bladder syndrome and five controls. Current urinary tract infection and antibiotic therapy within the last two months were ruled out and controls were matched to cases by age and body mass index. Urethral swabs (Copan eSwab® urethra) were taken from each participant at one single time point. Subsequent viral isolation, purification, and enrichment were conducted using the ViPEP method. Next-generation sequencing was performed on pooled samples, followed by bioinformatic analysis to identify and classify viral contigs. Phylogenetic analysis was conducted to assess genetic relationships among identified viral sequences. The bacterial microbiome was analyzed by sequencing of the variable V3-4 region of the eubacterial 16 S rDNA gene on the Illumina MiSeq platform. We identified twenty-one viruses and bacteriophages only in pooled urethral swab samples of the OAB group, but no valid detections were retained in the control group after analysis. The most abundant human virus in urethral swab samples was human papilloma virus, whereas the most abundant bacteriophages belong to the family of Siphoviridae. In the bacterial microbiome analysis, we identified statistically higher levels of Veillonella and Bacteroides in OAB samples. Results of this pilot study suggest a difference in the urethral virome between women with OAB and healthy controls. When looking deeper into the detected virus families and species, we might postulate a unique microbial pattern of OAB patients. This pattern suggests an interplay of immunosuppression, autoimmune processes and a larger diversity of bacterial and viral microbes. Current evidence strongly suggests a disturbance of the healthy microbiome of the urogenital tract in patients with OAB, leading to subclinical chronic inflammation and thus typical OAB symptoms. Further research should focus on interventions aimed at restoring a healthy microbiome in OAB patients to mitigate inflammation and improve symptom control. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-025-98780-9.

Background Patients with ileocolic Crohn’s disease often require surgery that can result in temporary stoma formation. Stomas are associated with a morbidity and can negatively impact quality of life. This study aimed to investigate the short-term (6-month) and mid-term (18-month) outcomes of intended temporary stomas in patients with Crohn’s disease. Methods A trainee-led, international multicentre, retrospective study was conducted on all patients who underwent surgery for Crohn’s disease in collaborating centres over 4 years (2017–2020). The primary outcome was the proportion of patients with Crohn’s disease who underwent stoma reversal surgery by 6- and 18-month postoperative follow-up. Secondary outcomes included: the time interval between formation and reversal of stoma and predictors for non-reversal and stoma-related morbidity (postoperative complications, related readmissions and complications due to stoma reversal surgery). Results A total of 401 patients underwent stoma formation for Crohn’s disease over the 4 years across the 44 collaborating centres. The temporary stomas had been reversed in 30.2% of patients at the 6-month and 56.9% at the 18-month follow-up. Reasons for non-reversal included ongoing medical treatment for Crohn’s disease (respectively 6-month and 18-month: 37.6%, 39.3%), patient unfit for surgery (respectively 6-month and 18-month: 14.5%, 16.8%), patient preference (respectively 6-month and 18-month: 12.1%, 20.2%) and due to waiting lists (respectively 6-month and 18-month: 12.1%, 8.1%). Overall, 63.3% of patients had a temporary stoma reversed with a median time interval of 6 months. The stoma-related overall morbidity rate was 29.4%. Conclusions A large proportion of temporary stomas for Crohn’s disease were not reversed at 6 and 18 months following initial surgery. Patients are exposed to the risk of non-reversal and risk of developing stoma complications for significantly longer intervals of time and, in some cases, indefinitely.

Biodynamic interventions are targeted suggestions for postural changes thought to quicken the progress or ease the discomfort of labor and birth, especially when fetuses are not in the optimal position. Although biodynamic interventions carry almost no risks and come from a rich anecdotal body of evidence, they have generally not been subject to rigorous evaluation. Current clinical practice guidelines support the use of intravenous oxytocin and manual or instrumental rotation for delayed labor progress and fetal malposition; however, these interventions are associated with increased risks of maternal and neonatal morbidities. The use of biodynamic interventions may be an effective alternative to optimizing fetal position and labor progress, with fewer associated risks. This state of the science review examines research describing the efficacy of various biodynamic interventions on labor progress, fetal malposition, and mode of birth within specific clinical contexts. The review also seeks to draw out key findings for clinical practice and identify gaps in the literature for future research.

This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of gonorrhoea. It is an update of the 2018 guideline.

Objectives This audit aimed to evaluate adherence to local and national guideline1–3 in the care of neonates born to mothers with positive serologies for Hepatitis B, Hepatitis C, HIV, and syphilis at a large district general hospital. We aimed to identify areas requiring improvement locally, and to share learning points nationally. Methods Data was collected retrospectively on the demographics, clinical parameters, treatment, and follow-up of neonates born to mothers with positive serologies, focusing on key performance indicators from reference guidelines. Information from the most recent 20–30 neonates born 2020–2024 was gathered from a database maintained by infectious disease midwives and electronic medical records. HIV Of 22 neonates born to HIV positive mothers, all received antiviral therapy (AZT) postnatally. 20 (91%) babies received AZT within four hours and two (9%) received AZT outside the optimal 4-hour window.¹ No babies missed blood tests, and all PCRs at 6 weeks, 12 weeks, and 22 months were negative. Syphilis Of 23 neonates born to mothers with positive syphilis serology, one met high-risk criteria and required treatment at birth.² Nine (39%) mothers were treated in pregnancy. Of this group, 8/9 (89%) had serology at birth, of which 6/8 (75%) IgM negative, but only 2/9 (22%) were followed up. Hepatitis B Of 22 HBsAg positive mothers, none had acute infection. Hepatitis B vaccine was administered to all infants, and administered within 24 hours in 20/22 (91%) of babies. Two babies required Hepatitis B immunoglobulin (HBIG) due to prematurity, one received HBIG within the required 24h,³ the other was transferred out. Hepatitis C Of 24 HCV IgG positive mothers, seven (29%) were PCR positive. Almost all high-risk babies (6/7, 86%) underwent HCV PCR testing at 12 weeks, all had undetected HCV RNA. Clinic follow-up was only documented for 4/7 (57%) babies born to PCR positive mothers. Conclusion While the management of infants born to mothers with Hepatitis B and HIV met guidelines effectively, improvements are needed in the care and follow-up of neonates exposed to Hepatitis C and syphilis, particularly in ensuring appropriate blood tests and follow-up. We identified clinician education and improvement in local referral pathways and guidelines with the development of proformas as first potential interventions to trial as well as retrospectively following up babies missed to follow up. References • Gilleece Y, Tariq S, Bamford A et al. British HIV association guidelines for the management of HIV in pregnancy and postpartum 2018. HIV Med. 2019; 20 Suppl 3 :s2-s85 • Kingston M, Wilson J, Dermont S, Fifer H, Chan K, Lyall H, McMaster P, Shawkat E Thomas-Leech A. British association of sexual health and HIV (BASHH) UK guidelines for the management of syphilis in pregnancy and children 2024. International Journal of STD & AIDS. 2024; 0 (0):1–13 • Guidance on the hepatitis B antenatal screening and selective neonatal immunisation pathway. https://www.gov.uk/government/publications/hepatitis-b-antenatal-screening-and-selective-neonatal-immunisation-pathway/guidance-on-the-hepatitis-b-antenatal-screening-and-selective-neonatal-immunisation-pathway--2#app3

Why did you do this work? Status epilepticus (SE) is a common paediatric emergency treated with a standard algorithm leading to Rapid Sequence Induction (RSI) and intubation. These children are typically transferred to Intensive Care by a Paediatric critical care transport team (PCCT). Knight et al.¹ highlighted significant variation in extubation practices across UK hospitals, with local rates ranging from 2% to 74% and a low reintubation rate (5%). Regions with higher extubation rates had clear criteria and conducted annual SE audits. We aimed to assess our practices and improve extubation rates through audit and feedback. What did you do? Patients <16 years who were managed for SE with RSI were identified by reviewing data provided by our PCCT. Data was analysed (prior to our intervention) by retrospective review of case notes between March 2023 to February 2024, a period of 12 months. Following this in March 2024 we delivered a presentation at grand round to the paediatric multidisciplinary team (MDT) at our trust, highlighting the key findings of Knight et al’s paper and signposted to our PCCT’s SE Extubation Guideline (the intervention). Data was then collected prospectively post intervention between March 2024 and August 2024, over a period of 6 months. What did you find? We identified a total of 27 patients intubated for SE, of which 11 did not meet criteria and were excluded, leaving us with 16 patients (7 pre intervention and 9 post intervention). In the pre-intervention period 7 patients underwent RSI for SE. All (100%) of these patients were transported to PICU therefore local extubation for this period was 0% and not considered. In the post intervention period, 9 patients underwent RSI for SE and 7 out of 9 were transported to PICU and 2 out of 7 (22%) were extubated locally. In all cases who were transported, extubation was not considered. Of those patients who were transferred to a PICU, 9 out of 14 (64%) were extubated within 24 hrs. What does it mean? Our review has shown that local extubation rates significantly increased from 0% to 22% after team education and the integration of the PCCT’s SE Extubation guideline. This study also identified several cases where extubation could have been appropriate but wasn’t considered highlighting the need for further education, especially among the wider MDT. To maintain progress, we plan to re-audit these practices in 12 months, aiming for continuous improvement. Reference • Phillip Knight, et al.Can critical care transport be safely reduced in children intubated during emergency management of status epilepticus in the United Kingdom: a national audit with case-control analysis. 2024 May 17; 109 (6):476–481.

Why did you do this work? Faltering growth (FG) describes weight gain less than expected for age and sex. Secondary care referral is advised for children with food allergy and FG,¹ conditions which have been previously associated in studies2 3; however, data from the UK is limited. There is variation in practice regarding investigation and management, but gold standard care requires access to a dietician. We evaluated local allergy clinic data to assess our management of children with food allergies and FG against national standards, implement service improvement to achieve best practice, and share our learning. What did you do? We audited data retrospectively on 321 patients attending paediatric allergy clinics between August and December 2022, based on the criteria of age between 0 and 16 years old and at least one confirmed or suspected allergy to any foodstuff. We collected data on patient demographics, number and type of food allergies, associated atopic conditions, diagnosis of FG and dietician involvement. Chi Squared tests were conducted using Yates correction to account for small sample sizes. Findings were presented at a departmental quality improvement meeting, with teaching on faltering growth parameters and NICE quality standards. Although the paediatric allergy clinic allows for referral to a paediatric dietician, this is currently not an integrated aspect of the clinic, therefore a business case is in processto incorporate a dietician into the allergy clinic in order to fulfil gold standard multi-disciplinary team involvement What did you find? Children with FG were 2.5 times more likely to have dietician involvement (20% vs 8%without FG). Chi squared tests confirmed significance at p=0.003 (or p=0.006 if a Yates correction is employed to account for small sample size). Importantly not all children with FG and allergies are involved with a dietician indicating the standard is being partially but not fully met. Patients with dietician involvement are significantly younger than those who without (2.97 years vs 5.72 years, p < 0.001). Patients with dietician involvement are also significantly more likely to have more confirmed or suspected food allergies than those without DI (3.83 allergies vs 2.75 allergies, p < 0.001). This finding remains significant if considering only confirmed allergies (2.54 confirmed allergies vs 2.03 confirmed allergies, p = 0.045). However, we found no statistically significant increased FG in children with food allergies (compared to the non-allergic population modelled in NICE guidelines), until there were 5 or more suspected or confirmed allergies. What does it mean? The primary hypothesis of this study was that children with food allergy and FG should have dietician involvement. This audit supports improvement initiative of an integrated dietician in allergy clinics. The data suggests food allergies are not predictive of FG until there are a large number of allergies, therefore clinicians working in settings where they see a high number of allergies may have different experiences. More research is needed to better identify and target interventions to at-risk children. References • NICE. (2011, February 23). Overview | Food allergy in under 19s: assessment and diagnosis | Guidance | NICE. https://www.nice.org.uk/guidance/cg116 • Isolauri E, Sutas Y, Salo MK, Isosomppi R, Kaila M. Elimination diet in cow’s milk allergy: risk for impaired growth in young children. The Journal of pediatrics 1998; 132 (6):1004–9. Epub 1998/06/17. • Christie L, Hine RJ, Parker JG, Burks W. Food allergies in children affect nutrient intake and growth. Journal of the American Dietetic Association 2002; 102 (11):1648–51. Epub2002/11/27.

Why did you do this work? Journal clubs are useful in helping clinicians stay up to date with the evidence within their specialty. They provide an opportunity for doctors to critically appraise the quality of research and discuss the implications of research findings for clinical practice.¹ The aim of this quality improvement project was to explore attendees’ previous experiences of journal club, to determine their confidence at selecting, critically appraising, and presenting research papers, to explore what attendees would like out of journal club, and to improve attendees’ confidence and experiences of journal club. What did you do? A survey was sent out to paediatric doctors at the start of their placement, prior to the first journal club session. A 12-month journal club rota was created (September 2023 – August 2024), giving as many doctors as possible the opportunity to present at journal club sessions, prioritising the more junior members of the team with less journal club experience. To improve attendees’ confidence at selecting, appraising, and presenting a study, and in response to comments in the survey seeking ‘support in (critically) appraising papers’ and an ‘improved understanding of research design and medical statistics’, a ‘How to journal club’ manual and a journal club cheat sheet were developed. Sessions were held once a month and a follow-up survey was sent to identify levels of confidence, recommendations, and areas for improvement. What did you find? Initial survey showed that while 23.1% of respondents had never attended a journal club before, by the end of the programme, 80% had attended at least two sessions. While 76.9% of respondents had never presented at journal club, 60% had the opportunity to present a paper over the course of the programme. By the end of the programme, the median confidence at finding a research paper for journal club had increased from 2 (IQR 1 – 3.5) to 3.5 (IQR 3 – 4) [p = 0.07], the median confidence at critically appraising a paper had increased from 3 (IQR 2 – 4) to 4 (IQR 3 – 4) [p = 0.28], and the median confidence at presenting at journal club had increased from 2 (IQR 1 – 3.5) to 4 (IQR 3 – 4) [p = 0.06] (figures 1 and 2). 76.9% of respondents initially and 80% at the end of the programme believed that journal club activities were useful in changing clinical practice. • Download figure • Open in new tab • Download powerpoint Abstract 8419 Figure 1 Confidence at presenting at journal club in the pre-journal club survey • Download figure • Open in new tab • Download powerpoint Abstract 8419 Figure 2 Confidence at presenting at journal club in the post-journal club survey What does it mean? Respondents felt that journal club was ‘clinically useful’, allowing them to ‘critically appraise’, ‘learn about new research’, and keep their ‘practice evidence-based and safe’. Respondents would have liked more protected, frequent, and interactive journal club sessions, in addition to dedicated critical appraisal sessions. Despite our small sample size, our project shows that journal club is valuable in improving trainees’ confidence in selecting, critically appraising, and presenting research studies. It should continue to be part of departmental teaching programmes. Reference • Aronson JK. Journal Clubs: 2. Why and how to run them and how to publish them. BMJ Evidence-Based Medicine. 2017 Dec 1; 22 (6):232-4.

Why did you do this work? Jaundice remains one of the main reasons for term admission to neonatal unit.1 2 This currently makes up 15% of term admission. Babies with jaundice above the exchange blood transfusion line (EBTL) require admission to the unit leading to separation of mother and baby.2–4 Our aim as Identify risk factors associated with jaundice particularly those babies admitted with jaundice above EBTL to help reduce mother-baby separation. What did you do? Data was collected retrospectively from Badgernet for all term babies (≥37week gestation) admitted to the neonatal unit with a diagnosis of jaundice from January 2022 to December 2023. Information on: gestational age, sex, mode of delivery, birth weight, maternal ethnicity, maternal blood group, antibody status and DAT results, length of stay in hospital (LOS), days on phototherapy (DOP), feeding at time of admission and additional treatment for jaundice.Chi-square test was used to identify associated risk factors. Univariate and multivariate analysis were used to identify risk factors and relationship in babies with jaundice above EBTL. What did you find? 91 babies were admitted with Jaundice.52.72%(48) were males. 53% of mothers were of Asian ethnicity. 45% of mothers were Blood group O-Positive. 2 mothers had abnormal antibodies. 57(63%) were born at 37 weeks, 14% at 38 weeks (figure 1) Mean birth weight was 3.059 kg(SD±567 g). LOS ranged from 1 – 49 days(IQR 3.5), average DOP was 1.5days(SD±1.1). 46(51%) were breastfeeding at admission (figure 2) 31%(28 babies) had jaundice above EBTL. 10 were DAT positive. 3 required Intravenous immunoglobulin Maternal blood group O positive and Asian ethnicity (p<0.001) were associate with being Jaundice. 37 weeks gestation (p<0.001), normal vaginal delivery (p= 0.012) and breastfed babies (p<0.0001) were more likely to be admitted with Jaundice. Male sex was associated with Jaundice below EBTL (p= 0.031), Gestational age, maternal ethnicity, mode of delivery, feeding and maternal blood group individually had no significant impact on jaundice above EBTL Feeding method as the only significant factor influencing Jaundice above EBTL (p<0.05) What does it mean? Babies born at 37weeks gestation, male sex, maternal blood group O positive, babies of mothers of Asian origin, breastfeeding babies and those born via virginal birth were associated with jaundice Breastfeeding was the only significant risk factor that influenced being admitted with jaundice above EBTL. Identifying babies with the above risk factors in addition to close monitoring and equate breastfeeding support could help early detection and initiation of treatment on the postnatal or transitional care. • Download figure • Open in new tab • Download powerpoint Abstract 8349 Figure 1 Gestational age of babies admitted with jaundice • Download figure • Open in new tab • Download powerpoint Abstract 8349 Figure 2 Feeding methods at admission References • Battersby C, Michaelides S, Upton M, et al. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open. 2017. • Jaundice in new-born babies under 28 days Clinical guideline [CG98] Last updated: 31 October 2023Accessed August 2024 • Neonatal Jaundice (Cross-site) guideline, Chelsea and Westminster NHS foundation trust. Feb 2021 • Valerie J Flaherman, et al. Guidelines for management of jaundice in the breastfeeding infant 35 weeks or more of gestation. Breastfeeding Medicine 2017; 12 (5).

Background Artificial intelligence (AI) systems have been implemented to improve the diagnostic yield and operators’ skills within endoscopy. Similar AI systems are now emerging in bronchoscopy. Our objective was to identify and describe AI systems in bronchoscopy. Methods A systematic review was performed using MEDLINE, Embase and Scopus databases, focusing on two terms: bronchoscopy and AI. All studies had to evaluate their AI against human ratings. The methodological quality of each study was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Results 1196 studies were identified, with 20 passing the eligibility criteria. The studies could be divided into three categories: nine studies in airway anatomy and navigation, seven studies in computer-aided detection and classification of nodules in endobronchial ultrasound, and four studies in rapid on-site evaluation. 16 were assessment studies, with 12 showing equal performance and four showing superior performance of AI compared with human ratings. Four studies within airway anatomy implemented their AI, all favouring AI guidance to no AI guidance. The methodological quality of the studies was moderate (mean MERSQI 12.9 points, out of a maximum 18 points). Interpretation 20 studies developed AI systems, with only four examining the implementation of their AI. The four studies were all within airway navigation and favoured AI to no AI in a simulated setting. Future implementation studies are warranted to test for the clinical effect of AI systems within bronchoscopy.

Introduction Treatment decisions for stress urinary incontinence (SUI) are preference sensitive, because the disease is non-lethal and there are multiple reasonable treatment options. However, little is known about patients’ and physicians’ preferred decision-making styles for SUI. To aid physicians in their counselling and decision-making in consultations for SUI, we studied patients’ and physicians’ preferred and perceived decision-making in medical specialist consultations for SUI. Methods This mixed-methods study combined the validated control preference scale (CPS) and the CPS perception version, and semi-structured, in-depth interviews with both patients and physicians. This study took place in Canada, the United Kingdom and the Netherlands. Sixteen physicians from all three countries and seventeen women from the Netherlands and Canada were interviewed. Results All women expressed a preference for being involved in the decision-making process, either by informative or shared decision-making (SDM) in the CPS, because they valued the autonomy to make their own choice regarding treatment for SUI and appreciated receiving information and advice from their doctor. Physicians also preferred an involved patient, but used medical expertise to steer towards their preferred treatment option. Physicians found SDM difficult to understand, expressing different interpretations. Conclusions SDM is not a precise concept either for patients or physicians, with multiple interpretations. All patients with SUI want to be involved in the decision-making process, either by informative or by shared decision-making. Physicians both express the desire to involve patients in their decision making, but conversely to steer patients towards the decision that they feel suits them best.