Geriatric transition care between acute hospital and residential healthcare settings: scoping review of current models and proposed conceptual framework.

Advancing Neuropediatric Rare Disease Diagnosis Through Clinical Genome Sequencing.

Abdominal aortic aneurysm (AAA) is less common in women than in men; however, when present, women appear to follow a more aggressive disease course, rupturing at smaller diameters and experiencing worse operative outcomes. The United Kingdom provides a unique environment in which to evaluate sex-specific outcomes, as national screening invitations are extended to men only and National Institute for Health and Care Excellence guidance applies a uniform 5.5 cm threshold for elective repair irrespective of sex. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, EMBASE, and the Cochrane Library were searched to September 2025. Eligible studies reported sex-stratified outcomes for AAA in the United Kingdom. Gray literature was included through review of the National Vascular Registry, National Health Service AAA Screening Program reports, and National Institute for Health and Care Excellence guidance. Where sex-stratified numerators and denominators were available, crude odds ratios (ORs) were calculated and pooled using Der Simonian-Laird random-effects models. A separate adjusted-effects meta-analysis was performed using the generic inverse-variance method for studies reporting multivariable-adjusted ORs (adjORs). Five peer-reviewed studies met inclusion, supported by national reports. Women had significantly higher perioperative mortality after elective endovascular repair (pooled OR 1.61, 95% confidence interval [CI] 1.31-1.97) and elective open repair (pooled OR 1.37, 95% CI 1.16-1.63). After ruptured repair, mortality was similar between sexes following endovascular aneurysm repair (EVAR) (pooled OR 1.11, 95% CI 0.89-1.39), but higher in women after open surgery (pooled OR 1.53, 95% CI 1.24-1.89), although with substantial heterogeneity. Adjusted-effects synthesis confirmed higher mortality for women after elective EVAR (summary adjOR ≈1.55, 95% CI 1.25-1.80) and open repair (adjOR 1.39, 95% CI 1.25-1.56). Women were less likely to undergo surgery following rupture, more likely to be readmitted after elective EVAR, had longer hospital stays, and higher long-term aortic-related mortality. Women with AAA in the United Kingdom remain disadvantaged at every stage of care: they are less likely to be screened, rupture at smaller diameters, less often selected for repair, and when treated, face higher perioperative and long-term mortality. These disparities reflect a combination of anatomical and biomechanical differences, together with systemic factors. Current UK policy, based on male-only screening and a sex-neutral 5.5 cm threshold, does not reflect this reality. Sex-specific thresholds for repair, targeted female screening, and the development of devices optimized for female anatomy are needed to address inequity.

Assessment and management of dry eye disease (DED) in the UK is increasingly taking place outside of specialist ophthalmology settings. While comprehensive, evidence-based international guidance exists, much of it does not reflect the realities of practice in the UK. A panel of experts was brought together to identify areas of consensus on assessment, management, and appropriate referral of DED in the UK National Health Service (NHS). A questionnaire was circulated to a panel consisting of 15 optometrists, ophthalmologists, and corneal specialists with experience and expertise in DED. Based on their responses, consensus statements were developed and underwent two rounds of voting, in which respondents indicated to what extent they agreed with each statement. A core steering panel of seven experts discussed the results and provided further context for the statements. Strong or very strong consensus was reached for 57/62 statements. Statements with very strong consensus included guidance on the minimum symptoms and signs to be assessed on initial presentation and simple guidance for grading the severity of the disease. Statements regarding initial treatment were divided by setting (primary and secondary care), and a strong or very strong consensus was reached on 17/20 statements relating to treatment options in these settings. Statements specific to referral included approximate target timelines, where possible, as well as guidance on key supporting information to help improve the efficiency of patient care. This consensus provides a UK-focused resource to support consistent and effective care for patients with DED within the NHS.

Fatigue is a common problem that significantly affects intensive care unit (ICU) survivors' physical, psychological, and social functioning. ICU survivors often experience a loss of self-worth and identity, struggle to return to their normal roles, and face ongoing challenges with cognitive and emotional recovery. Despite its profound impact, there are limited rehabilitation interventions targeting this population. This research aims to evaluate the acceptability of implementing the Fatigue After CriTical illness (FACT) self-management intervention into usual care for patients experiencing fatigue after critical illness and the feasibility of the intervention for a future clinical trial. This is a multicentre, open-label, feasibility randomised controlled trial (RCT) with an embedded qualitative evaluation, conducted across. Seventy participants recruited from three United Kingdom (UK) National Health Service (NHS) Trusts will be randomised either to the FACT self-management intervention following hospital discharge, which focuses on fatigue management, goal setting, and personal action planning, in addition to usual care, or to a control group receiving usual care alone. The intervention will be accessible for six months and will include a 30-min phone or video call with an ICU follow-up healthcare professional (HCP) in the third month. HCPs will attend an online training session and follow a protocol to guide patients in goal setting. Outcome assessments will occur at baseline, three months, and six months post-randomisation to evaluate feasibility and acceptability. Semi-structured interviews with patients and HCPs will explore their experiences and acceptability outcomes at 6months. This study aims to provide insights into the feasibility and acceptability of the FACT intervention, with the goal of improving fatigue management among survivors of critical illness. Preliminary findings will inform the design of a larger-scale RCT to evaluate its effectiveness in enhancing recovery from critical illness in patients who are experiencing fatigue. Study ID: ISRCTN1381359. Date registered: 01/04/2025.

This article investigates the historical roots of green prescriptions, which are a form of social prescribing. It seeks to establish when and why they began to be used in Britain to inform practice in the present. Social prescriptions are a broad range of interventions for patients for whom standard medical treatments may not be effective. Many social prescription programmes are delivered by charities in partnership with the National Health Service. 'Green prescriptions' are a subset of these interventions, and the term now refers specifically to environmental and nature-based interventions such as forest bathing and gardening. The article uses the historical method and brings together a range of primary sources (including digitised newspaper articles, medical journals and medical handbooks) to examine the use of horticulture as part of medical regimes in Britain in the 19th and 20th centuries. Academic research on green prescriptions tends to locate the history of nature-based health interventions in either the ancient world or in non-Western medical traditions. However, the use of horticulture as therapy is better situated in its use in medical institutions from the late-18th century onward. Though recast as medical therapy, horticultural activities for patients often began as a cost-saving measure. Focusing on tuberculosis sanatoria, the article draws analogies between the institutional use of horticulture as therapy and green prescriptions to provide a critical framework for understanding modern social prescription programmes.

With Complex Post Traumatic Stress Disorder (CPTSD) as a new diagnostic category, there is a diversity of interventions and influences on clinical practice, it is prudent that we gather information about current 'treatment as usual'. This study aims to address this need by describing the current clinical landscape of CPTSD treatments offered in NHS services in Scotland. An online survey was distributed via heads of service managers to clinicians working with adults. The survey posed questions about psychological therapy models, professional experience and, for the clinicians' latest 3 discharged cases, the length of therapy and perceived patient outcomes. Forty-nine clinicians, most of whom were clinical psychologists, took part and provided data about 139 clinical cases. Twenty-three different therapeutic models were cited by clinicians, with phase-based approaches described by 64% of clinicians. The modal number of sessions was 21-30. Most cases were described as completed, with 28% ending before therapy was completed, and a further 7% dropped out. Of those who completed therapy, 86% were judged to have improved after therapy, with 11% judged to have deteriorated. There is a wide variety of treatments available for complex PTSD, and innovative interventions and trials are required to support future clinical decision-making about the optimal treatment components and therapy length.

This study aims to evaluate the real-life efficacy and safety of a biosimilar to reference product (RP) ustekinumab for the treatment of plaque psoriasis in different patient scenarios. The cohort included ustekinumab-switched patients, who switched from the RP to the biosimilar, and ustekinumab-naïve patients, never treated with ustekinumab. Ustekinumab-naïve patients were subdivided into bio-naïve (no prior biologic therapy) and bio-experienced (previous non-ustekinumab biologic therapy). Adult patients with chronic plaque psoriasis treated with AVT04 were followed up to 28weeks. Efficacy of the biosimilar was assessed by improvement of the Psoriasis Area Severity Index (PASI) 75, 90, and 100 responses from baseline to weeks16 and 28. A cost-minimisation analysis over a 1-year time horizon was performed to estimate costs and potential savings with AVT04 versus RP across the Italian National Health Service (NHS). Throughout the observation period, a sustained improvement in PASI was observed in the overall cohort of 183 patients, encompassing both the ustekinumab-switched and ustekinumab-naïve groups. Within the ustekinumab-naïve group, a trend toward more favourable PASI75/90/100 responses was observed in bio-naïve patients compared to bio-experienced patients. By 28weeks of treatment, a higher proportion of bio-naïve patients compared to the bio-experienced group achieved PASI75 (72.7% vs. 56.2%), PASI90 (72.7% vs. 50.0%), and PASI100 (54.5% vs. 37.5%), respectively (p > 0.05). No adverse events were reported during the study. Furthermore, the cost-minimisation analysis suggested that compared to the RP, AVT04has the potential to generate approximately €5200 in annual savings per patient for the Italian NHS, representing around €20million in nationwide savings. AVT04 biosimilar shows consistent efficacy results in both ustekinumab-switching and ustekinumab-naïve patients, supporting its integration into real-world practice as an effective and cost-saving therapeutic option. Further studies are warranted to confirm and expand these preliminary findings across a broader bio-naïve cohort.

To explore the experiences of South Asian female healthcare professionals in the UK National Health Service (NHS) during COVID-19, examining how the pandemic conditions exposed the ways in which race, gender and professional identity intersect to shape risk, silence and discrimination. A qualitative study using semi-structured interviews. 27 South Asian female doctors and nurses, employed across NHS trusts in London, Greater Manchester and Liverpool, were recruited through purposive snowball sampling between 2021 and 2022. This study was conducted during the COVID-19 pandemic, a period when existing workplace inequality became more visible and consequential. Although the research was initially motivated by evidence of disproportionate COVID-19 risk among ethnic minority healthcare staff, participants consistently foregrounded experiences of voice, silence and power within the NHS. It was through these accounts, situated in the heightened pressures and uncertainties of the pandemic, that four key themes emerged: (1) how discrimination and ethnic bias suppress voice; (2) fear of retaliation and the consequences of speaking out; (3) internalised cultural norms and the emotional labour of adaptation; and (4) finding voice through experience and action. Participants reported microaggressions, disproportionate disciplinary scrutiny and informal silencing tactics that left them feeling vulnerable and voiceless. For many, cultural expectations around hierarchy and respect inhibited confrontation, even in the face of unfair treatment. Some women engaged in self-reflexive strategies, learning to interpret institutional codes, recalibrating their behaviour or selectively speaking out. For many, this process of adaptation-learning, recalibrating and navigating institutional expectations-was less a path to upholding their agency and more a survival mechanism within a system they perceived as structurally biased. While a few participants described finding ways to speak out and support others through union membership and legal awareness, most described adaptation as emotionally taxing and ineffectual in the face of structural barriers. Silence (eg, withdrawing, transferring departments, leaving their roles altogether) remained the dominant strategy. COVID-19 did not create these dynamics, but it did expose and intensify pre-existing constraints on voice in the NHS. Drawing on South Asian women's accounts, this study provides insight into how institutional and cultural dynamics constrain voice and inclusion, particularly under conditions of heightened organisational pressure. We argue that voice is not just a personal capacity but a structural condition that can either reinforce silence or enable change. Our study highlights the need for structural reforms that strengthen psychological safety, ensure clarity around rights and protections and address the persistent gap between inclusion rhetoric and lived experience.

To evaluate the National Health Service (NHS) Federated Data Platform (FDP) Inpatient (IP) Care Coordination Solution (CCS) digital scheduling tool on elective theatre utilisation. An interrupted time series assessed changes in theatre utilisation and cancellations following tool adoption (January 2022). Weekly data spanned 90 weeks (April 2021-December 2023). Outcomes included weekly median theatre utilisation (actual, booked and bookings per session) and the percentage of cancelled bookings. Models incorporated a 5-week lag and estimated level (step-change) and trend (slope) effects. Postintervention level and trend increases were observed for booked (β=4.40, p=0.045; β=0.26, p=0.002) and actual (β=3.98, p=0.064; β=0.23, p=0.006) utilisation. Bookings per session showed a significant level increase (β=0.34, p=0.002) with no trend change (β=0.00, p=0.790). Across the postintervention period, compared with counterfactual estimates, booked and actual utilisation were 15.0% (95% CI 13.4% to 16.5%, p<0.0001) and 12.2% (95% CI 10.8% to 13.5%, p<0.0001) higher, while bookings per session were 10.9% (95% CI 9.5% to 12.4%, p<0.0001) higher. Significant positive effects were observed for urology, general surgery, gynaecology, plastic surgery and ophthalmology. A significant upward trend in cancellation rates was associated with the introduction of the tool (β=2.1, p=0.001). Findings suggest that centralised digital scheduling tools can improve theatre capacity by enabling more efficient use of existing capacity through improved scheduling visibility. Future research should explore differences in specialty-level usage and long-term sustainability of gains. The introduction of the NHS FDP IP CCS product was associated with improved elective theatre utilisation.

Appendicitis is one of the most common emergency surgical pathologies in childhood. This study used data from the Children's Acute Surgical Abdomen Programme study to describe compliance with published standards of care and the relationship between care delivery and 30-day postoperative morbidity for children aged 1-16 y undergoing appendicectomy. Data were collected from 80 hospitals and this included the type of care delivered, the setting in which care was provided and patient level factors. Bivariable and multivariable analysis was undertaken to identify associations between care delivery and outcome. Data collected from 2799 children highlighted variation in care provision related to the use of pre-operative imaging, multimodal analgesia and the proportion of children undergoing surgery within 24 h of presentation; compliance with these standards was 42.6%, 70.8% and 72.8%, respectively. Children managed in specialist paediatric centres were younger, with a higher burden of chronic disease and higher rates of complicated appendicitis. They were also less likely to have a negative appendicectomy but more likely to experience postoperative complications. Despite a high compliance with published recommendations for several aspects of care, deficiencies were identified. A focused effort is needed to improve diagnostic accuracy, optimise analgesia management and reduce the duration of time for which children are waiting for surgery. Similarly, further work is required to better understand the increased rates of postoperative morbidity seen in specialist paediatric centres. Addressing these factors may lead to discernible improvements in experience and outcomes for children with suspected appendicitis.

Eritrean women face a difficult tension between the cultural context in which they experienced female genital mutilation (FGM) in their country of origin, where it was seen as social and moral protection, and the perspective in the UK, where it is considered harmful and a crime. This dissonance may create psychological stress and barriers for women in accessing FGM-related healthcare in the UK. While artificial intelligence (AI) is used widely in healthcare, little attention has been paid to how it could help women navigate these complex cross-cultural and emotional realities of FGM. This paper presents the first exploration of how AI could support Eritrean women who have experienced FGM and are living in the UK in accessing healthcare.As the UK National Health Service promises to become the 'most AI-enabled health system in the world', this conceptual paper argues that AI could create a 'third space' for survivors: an environment existing between these conflicting cultural frameworks, offering a safe and culturally sensitive way for women to disclose their experiences, access support and regain a sense of agency over their health. However, AI interventions also carry significant risks, including the potential for reproducing a new form of medical colonialism in digital spaces, amplifying existing harmful biases in algorithms and raising privacy concerns that could deter survivors from seeking support. Ultimately, this paper calls for urgent co-design of culturally responsive AI interventions with FGM survivors and deeper explorations of how AI can be conceptualised as a 'third space' in cross-cultural healthcare.

Integrated care for children and young people in England represents a transformative shift towards holistic, person-centred health services tailored to the needs of local communities. In this first part of a series of three, we describe what we mean by integrated care, and why it is needed now, setting the context for the subsequent parts that detail integrated care's core components and practical implementation.Integrated care addresses multidimensional needs-physical health, mental wellbeing, education and social development-while reducing fragmentation and inefficiency. This approach enables early intervention and improves health equity. Key benefits include streamlined access for families, reduced hospital admissions and better outcomes for vulnerable groups, such as children with complex conditions or those facing social and economic challenges.The evolution of UK child health policy, from the 1959 Platt Report to the 2025 National Health Service 10-Year Health Plan for England, underscores the growing emphasis on multidisciplinary, community-based models. By adopting a whole-population approach-segmenting children by health and social needs rather than rigid pathways-integrated care enables every child to be supported and cared for.Ultimately, integrated care is not just an improvement but a necessity, addressing rising demand, workforce pressures and persistent inequities. It fosters proactive, collaborative systems that prioritise children's wellbeing, offering a sustainable future for child health and care services in England.

To evaluate whether QR (Quick Response) code-linked digital patient information leaflets (PILs) improve documentation of shared decision making (SDM) and patient experience in elective hip and knee replacement clinics. A two-cycle quality improvement project (completed audit loop) comparing preintervention and postintervention outcomes. Elective orthopaedic clinics in a UK district general hospital (secondary care). Patients listed for elective hip or knee replacement during two 6-week periods (25 in cycle 1; 43 in cycle 2). Patients with incomplete records or not assessed face-to-face were excluded. Introduction of QR code-linked digital PILs between audit cycles, provided at clinic appointments. The resource included procedure information, anaesthetic options, recovery expectations and links to translation services. Primary outcomes were documentation rates of PIL provision and key SDM domains in line with NICE NG157 (National Institute for Health and Care Excellence Guidance) and GIRFT (Getting it Right First Time) standards. Secondary outcomes were patient-reported measures of clarity, usability, accessibility and preference, obtained through an anonymous Likert-scale survey. Documentation that a PIL had been offered increased from 7% (hip) and 9% (knee) in cycle 1 to 24% and 36% in cycle 2. Documentation of patient understanding rose from 79% to 90%, and recovery expectations from ≤9% to 36%. Survey results showed 100% of respondents found the digital information clear, 86% preferred it over paper and 71% reported greater engagement with the digital format. QR code-linked digital PILs improved documentation, engagement and accessibility in elective orthopaedic clinics. This low-cost, scalable intervention supports national guidance on SDM, aligns with NHS (National Health Service) Green Plan sustainability goals and has potential for spread to other surgical pathways.

Access to National Health Service (NHS) dental care in the UK, particularly in rural and coastal regions such as the South West, remains a significant concern. Increasing socio-economic diversity in the dental workforce has previously been reported to improve access to care in underserved areas. Widening Participation (WP) initiatives aim to address this by encouraging applications from underrepresented groups. This study analysed admissions data from the University of Plymouth's Bachelor of Dental Surgery (BDS) programme for cohorts between 2014 and 2021. Metrics included entry qualifications, age, gender, ethnicity, disability and socio-economic markers. Statistical analyses included chi-squared tests and ANOVA to identify demographic shifts over time. Data from 512 students revealed significant changes in entry profile (p < 0.001), gender distribution (p = 0.003), school type (p = 0.003) and age at entry (p < 0.001). The proportion of students applying with predicted grades increased, while graduate applicants declined. Socio-economic diversity remained limited, with most students from areas of high participation in higher education and low deprivation. Over the study period, the demographic profile of dental students remained largely unchanged, even though this period coincided with enhancements to widening participation initiatives. Without greater representation from diverse backgrounds, the dental workforce may struggle to meet the needs of underserved communities.

The Faricimab Real-World Evidence (FARWIDE) studies are evaluating real-world outcomes of eyes with neovascular age-related macular degeneration (nAMD) or diabetic macular oedema (DMO) treated with faricimab in the UK. Here, we present results from FARWIDE-nAMD for eyes with 12 months of follow-up after faricimab initiation. nAMD patient-eyes that received ≥1 faricimab injection after May 2022 at one of 35 participating UK National Health Service retinal clinics with ≥12 months of follow-up after faricimab initiation as of July 2024 were included. Treatment-naïve (TN) eyes had no prior anti-VEGF treatment. Previously treated (PT) eyes switched from an anti-VEGF to faricimab. Baseline characteristics, VA, and injection frequency were assessed. Intraocular inflammation (IOI) and presumed infectious endophthalmitis (PIE) rates were pooled for nAMD and DMO eyes with any follow-up duration on faricimab. Analyses are descriptive. 5854 nAMD patients (6991 eyes; 26.5% TN, 73.5% PT) were included. 83.3% of PT eyes switched from aflibercept 2.0 mg. TN eyes received a mean (SD) of 4.7 (0.7) faricimab injections in months 1-6 and 2.2 (1.1) injections in months 7-12. PT eyes received 4.5 (1.0) injections in months 1-6 and 3.0 (1.2) in months 7-12. In TN eyes, mean (SD) VA increased from 56.4 (16.3) Early Treatment Diabetic Retinopathy Study letters at baseline to 60.1 (19.4) at 12 months (mean [SD] change 3.6 [14.7] letters). PT eyes had stable VA. IOI and PIE rates were consistent with faricimab phase 3 trials. These 1-year data support real-world faricimab effectiveness, durability, and safety in nAMD.

Purpose The purpose of this study is to understand the clinical and demographic factors of these patients to understand if treatment could be provided earlier and prevent the need for hospital admission. Design/methodology/approach A retrospective cohort analysis was conducted using secondary data in a large multi site National Health Service Trust in the Northwest of England. The sample comprised of 905 patients over a 12-month period. Findings A high proportion of patients (n = 362, 40%) admitted to inpatient wards were not under community services at the time of admission. Nearly half (n =170, 47%) of these had been discharged from community services previously. This cohort of 362 patients were significantly more likely to be male (n = 202, p &amp;lt;0003), younger (p &amp;gt; 0001), have shorter length of stay (n =17, p &amp;lt; 0.001) and be discharged directly to community services (n = 116, p &amp;lt; 0.001). Practical implications The findings call into question critical elements of the current design of secondary mental health services and support the need for further exploration of access to services. A focus on case load management and continuity of care principles is recommended. Originality/value The authors are not aware of other published work examining previous community involvement for patients admitted to hospital.

Objective This study aimed to investigate the experiences of children/young people and families living with microtia and hearing loss. Design Interviews and focus groups were conducted with children and young people (n = 11) with microtia and parents (n = 12). A constant comparative approach consistent with Grounded Theory was used. Study sample Participants included children and young people with microtia aged 7 to 20, recruited from across England, UK. They engaged in individual semi-structured interviews, whilst parents participated across five online Focus Groups. All participants spoke English and received care from the National Health Service (NHS). Results Children, young people and parents actively assess the child’s hearing needs. Other microtia considerations change over time, and ongoing information-seeking is important. This information is drawn from multiple sources, contributing to an understanding of microtia as an integral aspect of the individual’s identity. Conclusions This study highlights the evolving information needs of children and young people with microtia, including hearing support, ear reconstruction options, managing daily challenges such as school and social situations, and learning about the experiences of peers with similar conditions. The findings show how these needs change over time, emphasising the value of accessible, age-appropriate information to support children as they grow and navigate these experiences.

Studies investigating the relationship between gender, sexual identity and pay have increased in number and scope over the last three decades, enabling a greater understanding of the outcomes facing LGB+ workers in the labour market. Pay gap studies that also allow for the disclosure of sexual identity in the workplace are, however, very rare. Using a rich survey of employees from the National Health Service in England, this article considers the relationship between relative pay, LGB+ identity, and disclosure for both men and women. While the findings reveal substantial heterogeneity within the LGB + , disclosure is shown to be related to higher pay from larger returns on the endowments of LGB+ employees (men or women), especially so for men.

The United Kingdom's National Health Service has a workload which is increasingly moving from secondary to primary care. The proportion of Foundation Year 2 (F2) doctor specialty training applicants appointed to General Practitioner (GP) training programmes has historically been in decline. Though recent figures show an increase in applications, the pattern of high competition and many F2s not progressing directly into GP training is ongoing. To explore the features of F2 GP placements that influence career choice DESIGN & SETTING: A retrospective mixed methods study using an on-line survey followed by semi-structured interviews. A survey of 77 F2 doctors from 3 Health Education England regions was completed, of which 20 took part in interviews following their 4-month GP placement. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis. This study found considerable variation between practice placements in terms of F2s' workload, the quality of supervision and support, whether they encountered inspiring GP role models, the degree of isolation, educational opportunities and the culture of the practice. F2 doctors consider that their GP placements are invaluable for their learning. However, placement experiences were mixed, with F2 doctors being attracted and "put off" a GP career in equal numbers. There is a need to ensure consistently high-quality GP placement experiences for F2 doctors' that can best inform their career choice. F2 doctors made several recommendations following their GP placement which, if implemented, may help to increase the attractiveness of GP as a career.