RSS 1.0Chester Medical School
Chester Medical School run research programmes jointly with the Countess of Chester Hospital NHS Foundation Trust (COCH) and other hospital trusts that are relevant at regional, national and international level.
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Antibiotic use among university students in malaria therapy and its implications for antimicrobial resistance in Nigeria: a quantitative cross-sectional studyBackground: Antimicrobial resistance (AMR) is a global health crisis, driven partly by inappropriate antibiotic use. In Nigeria, malaria remains highly prevalent and often mismanaged with antibiotics, particularly in presumed malaria-typhoid co-infections. This study examined patterns of antibiotic use in malaria treatment among university students, highlighting implications for AMR. Methods: A cross-sectional survey was conducted among undergraduates purposively selected from 12 universities across Nigeria’s six geopolitical zones. Data were collected via validated online questionnaires (February–March 2025) and analysed using descriptive statistics, chi-square tests, logistic regression, and Spearman correlation (SPSS v26). Results: Of 646 respondents, > 97% demonstrated general antibiotic knowledge, yet 27.6% misidentified chloroquine as an antibiotic. While 94.6% correctly recognised antibiotics for bacterial infections, about one-fifth believed they were effective against fungal, parasitic, or viral diseases. Despite 84.7% AMR awareness, 49.1% reported using antibiotics for malaria treatment. Misuse was highest in the Northeast (62.3%), Northwest (63.7%), and South-South (32.9%). In the Northeast, key drivers included prior experience (35.4%), pharmacist advice (29.9%), and peer influence (28.0%), while only 6.7% followed physician prescriptions. Misuse correlated with the belief that antibiotics treat all illnesses (rs = 0.329, p < 0.001). Nearly half (49.5%) accessed antibiotics without prescriptions. Conclusions: High AMR awareness contrasts with persistent misuse of antibiotics for malaria, reflecting misconceptions, regional disparities, and weak regulation. Targeted education, stricter antibiotic controls, and improved diagnostics are urgently needed to curb AMR in Nigeria.
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Intermittent prophylactic antibiotics for bronchiectasisBACKGROUND: Bronchiectasis is a common but under-diagnosed chronic disorder characterised by permanent dilation of the airways arising from a cycle of recurrent infection and inflammation. Symptoms including chronic, persistent cough and productive phlegm are a significant burden for people with bronchiectasis, and the main aim of treatment is to reduce exacerbation frequency and improve quality of life. Prophylactic antibiotic therapy aims to break this infection cycle and is recommended by clinical guidelines for adults with three or more exacerbations a year, based on limited evidence. It is important to weigh the evidence for bacterial suppression against the prevention of antibiotic resistance and further evidence is required on the safety and efficacy of different regimens of intermittently administered antibiotic treatments for people with bronchiectasis. OBJECTIVES: To evaluate the safety and efficacy of intermittent prophylactic antibiotics in the treatment of adults and children with bronchiectasis. SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted searches on 6 September 2021, with no restriction on language of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of at least three months' duration comparing an intermittent regime of prophylactic antibiotics with placebo, usual care or an alternate intermittent regimen. Intermittent prophylactic administration was defined as repeated courses of antibiotics with on-treatment and off-treatment intervals of at least 14 days' duration. We included adults and children with a clinical diagnosis of bronchiectasis confirmed by high resolution computed tomography (HRCT), plain film chest radiograph, or bronchography and a documented history of recurrent chest infections. We excluded studies where participants received high dose antibiotics immediately prior to enrolment or those with a diagnosis of cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), primary ciliary dyskinesia, hypogammaglobulinaemia, sarcoidosis, or a primary diagnosis of COPD. Our primary outcomes were exacerbation frequency and serious adverse events. We did not exclude studies on the basis of review outcomes. DATA COLLECTION AND ANALYSIS: We analysed dichotomous data as odds ratios (ORs) or relative risk (RRs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures expected by Cochrane. We conducted GRADE assessments for the following primary outcomes: exacerbation frequency; serious adverse events and secondary outcomes: antibiotic resistance; hospital admissions; health-related quality of life. MAIN RESULTS: We included eight RCTs, with interventions ranging from 16 to 48 weeks, involving 2180 adults. All evaluated one of three types of antibiotics over two to six cycles of 28 days on/off treatment: aminoglycosides, ß-lactams or fluoroquinolones. Two studies also included 12 cycles of 14 days on/off treatment with fluoroquinolones. Participants had a mean age of 63.6 years, 65% were women and approximately 85% Caucasian. Baseline FEV<sub>1</sub> ranged from 55.5% to 62.6% predicted. None of the studies included children. Generally, there was a low risk of bias in the included studies. Antibiotic versus placebo: cycle of 14 days on/off. Ciprofloxacin reduced the frequency of exacerbations compared to placebo (RR 0.75, 95% CI 0.61 to 0.93; I<sup>2</sup> = 65%; 2 studies, 469 participants; moderate-certainty evidence), with eight people (95% CI 6 to 28) needed to treat for an additional beneficial outcome. The intervention increased the risk of antibiotic resistance more than twofold (OR 2.14, 95% CI 1.36 to 3.35; I<sup>2</sup> = 0%; 2 studies, 624 participants; high-certainty evidence). Serious adverse events, lung function (FEV<sub>1</sub>), health-related quality of life, and adverse effects did not differ between groups. Antibiotic versus placebo: cycle of 28 days on/off. Antibiotics did not reduce overall exacerbation frequency (RR 0.92, 95% CI 0.82 to 1.02; I<sup>2</sup> = 0%; 8 studies, 1695 participants; high-certainty evidence) but there were fewer severe exacerbations (OR 0.59, 95% CI 0.37 to 0.93; I<sup>2</sup> = 54%; 3 studies, 624 participants), though this should be interpreted with caution due to low event rates. The risk of antibiotic resistance was more than twofold higher based on a pooled analysis (OR 2.20, 95% CI 1.42 to 3.42; I<sup>2</sup> = 0%; 3 studies, 685 participants; high-certainty evidence) and consistent with unpooled data from four further studies. Serious adverse events, time to first exacerbation, duration of exacerbation, respiratory-related hospital admissions, lung function, health-related quality of life and adverse effects did not differ between study groups. Antibiotic versus usual care. We did not find any studies that compared intermittent antibiotic regimens with usual care. Cycle of 14 days on/off versus cycle of 28 days on/off. Exacerbation frequency did not differ between the two treatment regimens (RR 1.02, 95% CI 0.84 to 1.24; I<sup>2</sup> = 71%; 2 studies, 625 participants; moderate-certainty evidence) However, inconsistencies in the results from the two trials in this comparison indicate that the apparent aggregated similarities may not be reliable. There was no evidence of a difference in antibiotic resistance between groups (OR 1.00, 95% CI 0.68 to 1.48; I<sup>2</sup> = 60%; 2 studies, 624 participants; moderate-certainty evidence). Serious adverse events, adverse effects, lung function and health-related quality of life did not differ between the two antibiotic regimens. AUTHORS' CONCLUSIONS: Overall, in adults who have frequent chest infections, long-term antibiotics given at 14-day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. Intermittent antibiotic regimens result in little to no difference in serious adverse events. The impact of intermittent antibiotic therapy on children with bronchiectasis is unknown due to an absence of evidence, and further research is needed to establish the potential risks and benefits.
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The relationship between facilitating emotional cues and medical students’ clinical communication performance in qualifying examsA cross-sectional study design explored the relationship between medical students' Objective Structured Clinical Examination (OSCE) clinical communication ratings and their responsiveness to simulated patient (SP) verbal emotional cues in their qualifying OSCE. Data were collected from two cohorts of fourth-year medical students (n = 37), and responses to patient cues that facilitated further disclosure or related discussion - known as provide space responses - from two OSCE communication stations were measured by coding video footage with the Verona Coding Definition of Emotional Sequences (VR-CoDES). The 37 medical students were representative of the larger cohort (n = 508) in terms of age. A significant positive correlation with a medium effect was found between OSCE clinical communication ratings and provide space responses. OSCE clinical communication ratings could differentiate between students who adopted patient-centred facilitative behaviours and those who did not.
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“The perception of visiting Holocaust sites on undergraduate students learning process”This paper presents the main findings of a qualitative research project. The aim of the research was to explore undergraduate students’ perceived knowledge acquisition and awareness of the Holocaust, after visiting Auschwitz concentration camp in Poland. The qualitative study (focus groups & semi-structured questionnaires) involved three cohorts of students and lecturers from a university in the North West of England. The participants visited the Holocaust-related sites in Poland from 2016 to 2019. Findings indicate that students’ who actively engaged in visits to Holocaust related sites developed knowledge and awareness of the Holocaust. For many participants, this knowledge and awareness was facilitated via a reflective process that enabled empathic connection between these historical events and the students. The study also highlighted practical strategies that could be implemented to enhance the experience for future cohorts of undergraduate students visiting holocaust related sites. By adding to the limited literature on Holocaust education with undergraduate students, the study highlighted the importance and directions for future research in this area to inform future pedagogic practice.
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Efficacy and safety of allogeneic hematopoietic stem cell transplantation in curing Sickle Cell Disease: A systematic review and meta-analysis of single-arm studiesSickle cell disease (SCD) is a life-threatening hemolytic genetic disorder affecting approximately 20 to 25 million people globally. Conventional treatment, like hydroxyurea, is supportive but not a cure. Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) has gained popularity recently as it offers a potential cure for SCD. Although several independent studies exist supporting this, there is a lack of consolidated evidence for a more comprehensive analysis of clinical outcomes. In this systematic review and meta-analysis, we assessed the safety and efficacy of allo-HSCT in SCD, offering information on results for various age groups, donor types, conditioning procedures/regimens, and stem cell sources. A systematic literature search was carried out in PubMed and Scopus for articles published between January 2010 and March 2025. Articles that satisfied the inclusion requirements were subjected to quality assessment using the Newcastle-Ottawa Scale (NOS). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed throughout. Statistical analyses were performed using meta, an R package. The meta-analysis of 58 studies (n = 7931) revealed allo-HSCT to have 94%, 86%, 20%, 14%, 9%, 6% for overall survival (OS), event-free survival (EFS), acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), graft-failure (GF), and mortality, respectively, in SCD. Subgroup analysis demonstrated that clinical outcomes varied based on the type of donors, conditioning procedures/regimens and stem cell sources. The findings of this study show that allo-HSCT is safe and efficacious in curing SCD with an OS of 94%. GF and GVHD issues could be reduced by following personalized conditioning regimens/post-transplantation prophylaxis.
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The acceptability of the Fire and Rescue Service working with primary care to improve identification of mental health problems in older adults. A mixed-method qualitative studyBackground: Mental ill-health in older adults (aged 60 years and over) is often underdiagnosed and undertreated. Older adults are less likely to access mental health services owing to perceived stigma and fear of being a burden. Non-traditional providers of health care, such as the Fire and Rescue Services (FRS), provide a possible solution to facilitate early detection of problems and help-seeking among older adults, especially in the context of pressured statutory services. Aim: To examine whether and how FRS Home Fire Safety Visits (HFSV) could be optimised to include detection and signposting for mental health problems — particularly anxiety and depression — in older adults. Design & setting: This mixed-method qualitative study took place in the West Midlands, UK in 2022. Method: This study involved focus groups (n = 24) and interviews with FRS staff (n = 4) to develop an in-depth contextual understanding of he acceptability and feasibility of expanding HFSV to include identification of anxiety and depression. Results: FRS staff were open to expanding their HFSVs to include mental health, provided they had sufficient training and support from partner agencies in primary and social care settings to accept referrals for service users presenting with symptoms of anxiety and/or depression. Conclusion: The positive reputation of FRS staff and engagement with older adults suggests that HFSV could support the detection of anxiety and depression in older adults, and appropriate signposting to other services including primary care.
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Gestational low-protein diet impairs mitochondrial function and skeletal muscle development by inducing immune responses in male offspringMaternal nutrition is essential for proper fetal and postnatal organ maturation and is linked to the future risk of developing metabolic syndrome, cardiovascular disease, and muscle loss. There is still limited understanding how a low-protein intake during gestation influences skeletal muscle development, inflammation, and the related pathways. This study aimed to investigate the impact of gestational low-protein diet in mice on skeletal muscle development and inflammatory responses in male offspring. Pups born from mothers fed a low-protein diet (LPD) were lactated by normal protein diet (NPD)-fed mothers and maintained on NPD post-weaning (LNN group). Offspring born from mothers fed an NPD and maintained on an NPD during lactation and beyond were used as controls (NNN group). In 21-day-old offspring from protein-restricted mothers, RNA-Seq analysis showed upregulation of immune response–related genes, enriching adaptive immunity pathways. Additionally, LNN group exhibited elevated markers of inflammation, along with disruptions in antioxidant defence balance and macrophages infiltration in gastrocnemius muscle at 3 months of age. Energy metabolism was impaired, as indicated by changes in related proteins and enzymes involved in mitochondrial function. We conclude that gestational LPD adversely affects skeletal muscle development in male offspring.
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Impact of vaccination on pertussis-related hospital admissions in children in Scotland from January 2013 to July 2024: a cohort studyBACKGROUND: In Scotland, the number of pertussis infections recorded in children in 2024 was the highest of any year in the last decade. The protective role of vaccination against severe infection and associated hospitalisations has not been assessed. AIM: To investigate the effect of vaccination and sociodemographic factors on pertussis-related hospitalisations in Scottish children aged under 18 years. METHODS: In a retrospective cohort study, laboratory-confirmed pertussis cases from January 2013 to July 2024 were extracted from the national electronic surveillance system and linked to hospitalisation data from Scottish Morbidity Records and vaccination data from the national immunisations database. The outcome was a pertussis-associated hospitalisation. Multivariable logistic regression was used to calculate odds ratios (OR) for the association between vaccination status and hospitalisation, adjusted for age, sex, ethnicity and deprivation status. RESULTS: There were 3,982 laboratory-confirmed cases of pertussis during the study period. Children fully vaccinated for age had significantly lower odds of hospitalisations than unvaccinated children (adjusted OR (aOR): 0.31; 95% CI: 0.21–0.46). Being partially vaccinated for age did not significantly reduce hospitalisations relative to unvaccinated children (aOR: 0.80; 95% CI: 0.47–1.33). In the univariable analysis, children living in the most deprived areas had significantly more hospitalisations than those in the least deprived areas (OR: 3.90; 95% CI: 2.41–6.56). This association was not significant when adjusted for the effect of vaccination (aOR: 1.47; 95% CI: 0.84–2.66). CONCLUSIONS: Fully vaccinated children had significantly lower odds of hospitalisation, indicative of less severe disease. This emphasises the importance of fully vaccinating children according to the childhood immunisation schedule.
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‘We’re not daft, we’re not stupid, we can still learn’ – the impact of informal science learning on wellbeing in acquired brain injuryScience engagement centres offer interactive, hands-on experiences that foster curiosity and public engagement with science. This pilot study explores the integration of a UK science engagement centre, Oriel Science, into social prescribing for individuals with acquired brain injury (ABI). A ten-week structured intervention was delivered through science-based workshops. Quantitative wellbeing outcome measures were combined with qualitative reflections from participants, caregivers and academic presenters. Findings showed consistent improvements in wellbeing, with participants reporting enhanced cognitive engagement, motivation and social connection. The sessions provided a stimulating environment that helped participants reconnect with cognitive skills they felt had been lost after injury. Academic presenters also found the experience unexpectedly rewarding themselves, noting strong participant engagement and a renewed sense of purpose. This is the first study to link a science engagement centre with healthcare delivery, offering science-based social prescribing as part of ABI rehabilitation. Results highlight the potential of curiosity driven learning to support recovery, promote wellbeing and strengthen scientific literacy. The study underscores the role of universities in public engagement, particularly in an age where science communication and critical thinking are vital for societal resilience.
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Long-term efficacy and safety of a low-carbohydrate diet in Type 2 Diabetes remission: A systematic reviewType 2 diabetes mellitus (T2DM) is a major global health concern with increasing prevalence and healthcare costs. Despite the availability of pharmacological interventions, sustained glycemic control and disease remission remain challenging. Dietary strategies such as low-carbohydrate diets (LCDs) and ketogenic diets (KDs) are gaining attention for their potential to improve metabolic parameters and induce T2DM remission. The objective of this review is to evaluate the long-term efficacy and safety of low-carbohydrate and ketogenic diets in the management and remission of type 2 diabetes mellitus. The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched using predefined keywords and filters. Studies included randomized and non-randomized clinical trials published in English within the last 24 years. Eligible studies involved adult T2DM patients on LCDs/KDs with a follow-up period of at least 12 months. The primary outcomes were T2DM remission, changes in glycated hemoglobin (HbA1c), body weight, body mass index (BMI), and secondary outcomes included blood pressure, lipid profiles, and adverse effects. Out of 124 initially identified studies, six studies met the inclusion criteria, with follow-up durations ranging from one to eight years. Low-carbohydrate and ketogenic diets led to significant reductions in HbA1c, body weight, BMI, and systolic blood pressure. In terms of long-term studies, remission rates were highest at one year (up to 62%) and declined to 13% by year five. Participants in the intervention groups also experienced reduced dependency on glucose-lowering and antihypertensive medications. Despite some weight regain and glycemic relapse over time, the overall metabolic improvements suggest a beneficial role of dietary intervention in T2DM management. Low-carbohydrate and ketogenic diets appear to be effective in improving metabolic outcomes and inducing remission in T2DM. These dietary interventions may serve as viable alternatives to pharmacological treatments or bariatric surgery, provided that long-term adherence and support mechanisms are in place. Further research is needed to address long-term safety, sustainability, and individualized dietary approaches.
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Identification of candidate synovial fluid biomarkers for the prediction of patient outcome after microfracture or osteotomyBACKGROUND: Biomarkers are needed to predict clinical outcomes for microfracture and osteotomy surgeries to ensure patients can be better stratified to receive the most appropriate treatment. PURPOSE: To identify novel biomarker candidates and to investigate the potential of a panel of protein biomarkers for the prediction of clinical outcome after treatment with microfracture or osteotomy. STUDY DESIGN: Descriptive laboratory study. METHODS: To identify novel candidate biomarker proteins, we used label-free quantitation after liquid chromatography-tandem mass spectrometry of dynamic range-compressed synovial fluids (SFs) from individuals who responded excellently or poorly (based on change in Lysholm score) to microfracture (n = 6) or osteotomy (n = 7). Biomarkers that were identified in this proteomic analysis or that relate to osteoarthritis (OA) severity or have predictive value in another early OA therapy (autologous cell implantation) were measured in the SF of 19 and 13 patients before microfracture or osteotomy, respectively, using commercial immunoassays, and were normalized to urea. These were aggrecanase-1 (ADAMTS-4), cartilage oligomeric matrix protein (COMP), hyaluronan (HA), lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1), matrix metalloproteinase 1 and 3, soluble CD14, S100 calcium binding protein A13, and 14-3-3 protein theta (YWHAQ). Levels of COMP and HA were also measured in the plasma of these patients. To find predictors of postoperative function, multivariable regression analyses were performed. RESULTS: Proteomic analyses highlighted YWHAQ and LYVE-1 as being differentially abundant between the clinical responders/improvers and nonresponders after microfracture. A linear regression model after backward variable selection could relate preoperative concentrations of SF proteins (HA, YWHAQ, LYVE-1), activity of ADAMTS-4, and patient demographic characteristics (smoker status and sex) with Lysholm score 12 months after microfracture. Further, a generalized linear model with elastic net penalization indicated that lower preoperative activity of ADAMTS-4 in SF, being a nonsmoker, and being younger at the time of operation were indicative of a higher postoperative Lysholm score (improved joint function) after osteotomy surgery. CONCLUSION: We have identified biomarkers and generated regression models with the potential to predict clinical outcome in patients treated with microfracture or osteotomy of the knee. CLINICAL RELEVANCE: Candidate protein biomarkers identified in this study have the potential to help determine which patients will be best suited to treatment with microfracture or osteotomy.
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Assessing stroke survivors’ knowledge: A scoping review of tools and influencing factorsBackground: Stroke survivors’ knowledge of their condition is essential for self-management and adherence to secondary prevention strategies. However, current methods for assessing stroke knowledge are not consistent. This scoping review aimed to review existing assessment tools, evaluate their characteristics, and identify factors associated with stroke knowledge to inform the development of more effective, patient-centred educational strategies. Review design and methods: A scoping review was conducted to evaluate existing methods used to assess stroke knowledge and the factors influencing patients’ knowledge among stroke survivors. Systematic searches of PubMed, Cochrane, and CINAHL were performed from inception to June 2025. Studies assessing stroke survivors’ knowledge were included. Data were extracted on tool characteristics, assessed themes, administration methods, readability, validation, and knowledge-associated factors. Findings were qualitatively synthesised. Results: Thirty-nine studies were included. Most studies assessed mixed cohorts of ischaemic, haemorrhagic, and TIAs. Stroke symptoms and risk factors were the most frequently assessed themes, while rehabilitation, medications, and lifestyle behaviours were less explored. Tools were primarily self-administered questionnaires, typically completed in under 15 min, but often lacked standardised cut-off values and demonstrated limited reporting of development processes. Factors positively associated with knowledge included higher education, younger age, and healthier lifestyles. Conclusion: Existing assessments of stroke survivors’ knowledge have considerable variability, limited validation, and inconsistent alignment with survivors’ information needs. Developing standardised, validated, and patient-centred assessment tools that are tailored to stroke type and accessible across literacy levels is essential for advancing stroke education and supporting long-term recovery. These findings can inform policymakers in tailoring education efforts and designing interventions that directly address knowledge gaps across diverse stroke survivor populations. Future research should prioritise longitudinal evaluation of knowledge and its impact on clinical outcomes.
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Efficacy and safety of lentivirus gene therapy in the correction of sickle cell diseaseBackground and objective: Lentivirus gene therapy (LGT) is an emerging therapy for sickle cell disease (SCD), although its efficacy and safety are under evaluation in clinical trials. This review assessed the efficacy and safety of LGT in relation to hydroxyurea (HU). Materials and methods: A systematic review was conducted using The Preferred Reporting Items for Systematic Review and Meta-analysis protocol. Following a set of inclusion criteria, 10 studies were selected for quality assessment, extraction, and meta-analysis from 499 studies pooled from PubMed, ScienceDirect and Sematic Scholar. Data obtained were described and subjected to random effect meta-analysis using RevMan software. Results: There was a significant increase (p-value<0.00001) in haemoglobin (Hb) level after LGT and production of HbAT87Q and foetal haemoglobin (HbF). Clinical outcome decreased significantly, and no hospitalization was required following LGT. A significant age-related difference in the LGT outcome was observed. Mode 1 treatment had significantly higher (p=0.004) outcome compared to mode 2 treatment. There was a significant increase (p<0.00001) in treatment outcome in SCD patients treated with LGT compared to those treated with HU. Gastroenteritis and leucopenia were the most reported adverse effects. Conclusion: The review has demonstrated that LGT has a promising efficacy in the treatment of SCD although there are existing safety concerns.
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ACPGBI position statement on robotic‐assisted colorectal surgical trainingThe uptake of robotic-assisted colorectal surgery (RACS) across the UK and Ireland has increased exponentially over the last 5 years. It is anticipated that most 'conventional' laparoscopic procedures will eventually move to a robotic approach within a National Health Service that is committed to embracing robotic-assisted surgery. Working in collaboration with the surgical Royal Colleges, a more structured framework is necessary for robotic training. Inequality in robotic access and the impact that RACS is having on current colorectal surgical trainees need to be addressed, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) has set out a framework to help support training in RACS at basic, advanced and trainer levels. Safer, better-trained robotic surgeons will ensure improved patient outcomes, which is the overriding goal of the ACPGBI.
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The ACPGBI AI taskforce report: A mixed‐methods roadmap for AI in colorectal surgeryAim: The ACPGBI has commissioned a taskforce to devise a strategy for integrating artificial intelligence (AI) into colorectal surgery. This report aims to (i) map current AI adoption amongst UK colorectal surgeons; (ii) evaluate knowledge, attitudes, perceptions and experience of AI technologies; and (iii) establish priority recommendations to drive innovation across the specialty. Methods: A prospective 45‐item questionnaire was circulated to the ACPGBI membership. Questionnaire findings were explored at a multidisciplinary round table of surgeons, allied professionals, computer scientists and lawyers. Strategic recommendations were then generated. Results: 122 members responded (75.4% consultants; 72.1% male; modal age 41–50 years). Although 43.5% used AI daily, only one third said they could explain key concepts within AI. 86.9% anticipated routine future‐AI use, with documentation and imaging ranked highest. 88.5% endorsed formal AI training. Major obstacles were unclear regulation, cost, medicolegal liability and professional or patient distrust. The round table generated 17 recommendations across clinical, educational and research domains and a ten‐point action plan, including the establishment of a Colorectal AI Committee and the creation of an open‐source colorectal foundational data initiative. Conclusion: This taskforce report combines questionnaire insights from the ACPGBI membership and expert debate into 17 key recommendations and a ten‐point action plan that will set the direction of future colorectal AI practice. The objective is to establish a framework through which colorectal surgical practice can be augmented by safe, trustworthy AI.
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Global anaesthesia practice using inguinal hernia surgery as a tracer condition: A secondary analysis of an international prospective cohort studyINTRODUCTION: Restoration of surgical capacity is essential to post-COVID-19 recovery. This study explored the use and safety of anaesthesia options for inguinal hernia surgery, a common tracer condition, to describe current global practice and highlight opportunities to build the capacity of health systems. METHODS: This is a secondary analysis of an international prospective cohort study of consecutive patients who underwent elective inguinal hernia surgery. We used a consensus process to define generalisable outcomes to measure patient selection, utilisation of hospital capacity and peri-operative safety in patients who received locoregional, spinal or general anaesthesia for their surgery. RESULTS: In total, 16,554 patients from 83 countries were included. Locoregional anaesthesia was performed in 1536 (9.2%) of patients, compared with 9165 (55.4%) who had general and 55,853 (35.4%) who had spinal anaesthesia. Patient selection outcomes were comparable across anaesthesia groups. As a measure of hospital capacity, adjusted day-case rates were higher for locoregional anaesthesia (OR 6.62, 95%CI 5.13-8.54, p < 0.001) but not for spinal anaesthesia (OR 0.97, 95%CI 0.84-1.12, p = 0.68) compared with general anaesthesia. Complications were lower in patients who underwent locoregional anaesthesia (OR = 0.67, 95%CI 0.52-0.87, p = 0.001) but not for spinal anaesthesia (OR = 0.90, 95%CI 0.77-1.05, p = 0.167) compared with general anaesthesia after risk adjustment. DISCUSSION: This study has filled knowledge gaps of anaesthesia practice in common surgeries across the world. Locoregional and spinal anaesthesia could be adopted as safe options to increase surgical volume when there is limited access to general anaesthesia.
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SBO ACTION: Conservative Small Bowel Obstruction management in the absence of standard ConTrast agents ON outcomesBowel obstruction is a common condition, accounting for 12–16% of acute surgical admissions1. Small bowel obstruction (SBO) is the most frequent site, comprising half of all emergency laparotomies performed in England and Wales between 2019 and 20202. The leading cause of SBO is intra-abdominal adhesions, with adhesional small bowel obstruction (aSBO) accounting for approximately 60% of cases3. Optimal management of aSBO remains a subject of ongoing debate.
