• A deep learning approach to case prioritisation of colorectal biopsies.

  Dada, Mahomed

  AIMS: To create and validate a weakly supervised artificial intelligence (AI) model for detection of abnormal colorectal histology, including dysplasia and cancer, and prioritise biopsies according to clinical significance (severity of diagnosis). MATERIALS AND METHODS: Triagnexia Colorectal, a weakly supervised deep learning model, was developed for the classification of colorectal samples from haematoxylin and eosin (H&E)-stained whole slide images. The model was trained on 24 983 digitised images and assessed by multiple pathologists in a simulated digital pathology environment. The AI application was implemented as part of a point and click graphical user interface to streamline decision-making. Pathologists assessed the accuracy of the AI tool, its value, ease of use and integration into the digital pathology workflow. RESULTS: Validation of the model was conducted on two cohorts: the first, on 100 single-slide cases, achieved micro-average model specificity of 0.984, micro-average model sensitivity of 0.949 and micro-average model F1 score of 0.949 across all classes. A secondary multi-institutional validation cohort, of 101 single-slide cases, achieved micro-average model specificity of 0.978, micro-average model sensitivity of 0.931 and micro-average model F1 score of 0.931 across all classes. Pathologists reflected their positive impressions on the overall accuracy of the AI in detecting colorectal pathology abnormalities. CONCLUSIONS: We have developed a high-performing colorectal biopsy AI triage model that can be integrated into a routine digital pathology workflow to assist pathologists in prioritising cases and identifying cases with dysplasia/cancer versus non-neoplastic biopsies.
• Presenting Symptoms Define Time to Diagnosis in Degenerative Cervical Myelopathy: Process Mapping From a Musculoskeletal Triage Unit in the UK.

  Foulds, Stephanie (Wiley, 2025-03)

  STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Tackling delayed diagnosis in degenerative cervical myelopathy (DCM) is a global research priority. On average, it takes 2-5 years, leading to worse outcomes from surgery and greater disability. Many countries in the UK use interface triage units run by specialist physiotherapists that sit between primary and secondary care termed musculoskeletal services. Their role in the efficient diagnosis of DCM is unknown. The aim of this study was to map the journey of the patient in the musculoskeletal service and to establish the presenting signs and symptoms. METHODS: A retrospective review of 2.5 years of clinical notes was performed in a musculoskeletal service. Process mapping was utilised to visualise the patient's journey and identify delays to diagnosis and presenting signs and symptoms. RESULTS: Twenty-seven cases were reviewed. Patients spent an average of three months in the service. There was a wide variety of presenting symptoms. DCM was more often suspected if patients had both upper limb symptoms and gait disturbance or pathological reflexes. Delays occurred when patients had no gait disturbance or a normal or incomplete neurological assessment. Longest delays occurred when patients received electrophysiology tests for differential diagnosis of peripheral neuropathies. Delays were also seen with incorrect triaging of MRI results. CONCLUSIONS: Where DCM is the principal differential diagnosis, diagnosis was faster. Incomplete examination, misinterpretation of MRI findings or delays in other investigations contributed to delays. Improved awareness and protocols of care within musculoskeletal services represent an opportunity to accelerate diagnosis in DCM.
• An exploration of the utilisation and impact of restraint practices in acute paediatric settings: A narrative review of global literature

  Holden, Victoria

  Purpose: The purpose of this paper will be to ascertain the underpinning reason for restraint use in the acute paediatric setting. In the UK, presentations for mental health-related needs within paediatric settings have increased. These admissions can be associated with patients with significant mental health and trauma histories who present with behaviours that challenge, risking exposure to higher levels of restrictive practice. Design/methodology/approach: A literature review was conducted across five databases, PsychINFO, EMCARE, EMBASE, MEDLINE and CINAHL. Search terms related to “paediatrics” and “restraint” were used. In all, 116 studies were screened with 78 studies being retrieved for analysis. A total of eight studies were included for review. All studies were quality assessed using the appropriate tool that adhered to each respective design. Findings: Five themes were extracted from the analysis and presented. These themes were identified as “restraint as part of the role of paediatric nursing”, “culture and attitudes”, “lack of guidance and agreed terminology”, “lack of other alternatives” and “training”. Restraint in paediatrics is unregulated not only in the UK but also globally. Positive behaviour support is highlighted as an approach for restraint reduction in paediatric settings. Originality/value: This literature review identifies a significant lack of research regarding restraint for young people with mental health presentations in the paediatric setting. This paper sets forth the need for future research both in the UK and globally.
• One year of gluten free diet impacts gut function and microbiome in celiac disease

  Costigan, Carolyn; Spiller, Robin C.; Marciani, Luca; Hoad, Caroline L.; Lewis, Nina; Hill, Trevor; Crooks, Colin J.; Morgan, Paul S.; Gowland, Penny A. (Clinical Gastroenterology and Hepatology, 2024)

  BACKGROUND & AIMS Currently, the main treatment for celiac disease (CD) is gluten free diet (GFD). This observational cohort study investigated the impact of CD and 1 year of GFD on gut function and microbiome. METHODS 36 newly diagnosed patients and 36 healthy volunteers (HVs) were studied at baseline and at 12 months follow up. Small bowel water content (SBWC), whole gut transit time (WGTT) and colon volumes were measured by MRI. Stool samples DNA was subjected to shotgun metagenomic sequencing. Species level abundances and gene functions, including carbohydrate active enzymes (CAZymes) were determined. RESULTS SBWC was significantly higher in people with CD 157±15 mL versus HVs 100±12 mL (P = .003). WGTT was delayed in people with CD 68±8 hours versus HVs 41±5 hours (P = .002). The differences reduced after 12 months of GFD but not significantly. Wellbeing in the CD group significantly improved after GFD but did not recover to control values. CD faecal microbiota showed high abundance of proteolytic gene functions, associated with Escherichia coli, Enterobacter and Peptostreptococcus. GFD significantly reduced Bifidobacteria and increased Blautia wexerelae. Microbiome composition correlated positively with WGTT, colonic volume and Akkermansia municphilia but negatively with B.wexerelae. Following GFD the reduction in WGTT and colonic volume significantly associated with increased abundance of B.wexerelae. There were also significant alterations in CAZyme profiles, specifically starch and arabinoxylan degrading families. CONCLUSIONS CD impacted gut function and microbiota. GFD ameliorated but didn’t reverse these effects, significantly reducing Bifidobacteria associated with reduced intake of resistant starch and arabinoxylan from wheat.
• Implementing Mental Practice in Postgraduate Surgical Training for Minimally Invasive Surgery: A Systematic Review and Thematic Analysis.

  Liu, Paul Zhaobo

  BACKGROUND: Unprecedented pressure on the National Health Service (NHS) has meant that there are increasing obstacles to surgical training. Simulation training is an option to improve surgical performance but is limited due to availability, accessibility and financial constraints. Mental practice (MP) has been proposed as a potential solution to supplement the traditional method of apprenticeship-style learning. Despite increasing evidence that MP may be a useful tool to improve surgical performance and reduce surgeon anxiety, it is not widely adopted. This systematic review and thematic analysis aims to identify key themes that would allow for the successful implementation of MP in postgraduate surgical training. METHODS: Medline, Embase and PsycINFO databases were systematically searched to identify articles that investigate the role of MP in improving surgical performance amongst surgical trainees. Retrieved papers were studied to inform thematic analysis of their content and studies were assessed for bias. RESULTS: A total of 321 studies were retrieved, of which 11 met the inclusion criteria. Overall risk of bias was assessed to be between critical and moderate for seven nonrandomized studies and between fair and good for four randomized studies. Key themes were identified and discussed using a thematic analysis approach. CONCLUSION: This study has identified that attaining high quality mental imagery is fundamental to success in mental practice and this can be augmented by the use of relaxation therapy and/or motivational imagery. Future research should focus on the application of MP in real-world surgical practice and breaking down complex procedures into fewer operative steps.

View more