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Breast cancer screening attendance in the UK has fallen, and London has the lowest uptake nationally. This study tested the impact of a behavioural science-informed reminder SMS, and animated video intervention on screening uptake. This three-armed randomised controlled trial took place in two screening services in London (each service operated across a range of static sites such as hospitals, and mobile sites). We included participants who were registered with GP as female, aged 50–70 years, and not screened in the past 3 years. We excluded those who had opted out of screening messages or were in care. Participants were assigned into three groups via the final two digits of their NHS number (ratio 34:33:33): control group (received usual care reminder), behavSMS group (behavioural science-informed SMS reminder addressing reducing negative emotions and information on health consequences), or behavSMS+video group (behavioural SMS plus link to animation). Researchers were masked to allocation. The SMS and video were co-designed with stakeholders using the Behaviour Change Wheel. Invitation processes changed during the COVID-19 pandemic, and therefore, we did separate analyses for those receiving a timed appointment (n=9027), and an open invitation to book an appointment (n=25 020). Messages were sent 7 days and 1 day before the appointment, plus 7 days after the open invitation letter. Group differences in the primary outcome of attendance within 3 months of invitation (and secondary outcome of booking for open invites) were assessed using χ2, and logistic regression controlling for age, ethnicity, deprivation, and first invitation. This trial is registered with ClinicalTrials.gov , NCT05395871. Recruitment took place between July 18, and Oct 21, 2022. For timed invitations, 3094 participants were assigned to the control group, 2952 to the behavSMS group, and 2981 to the behavSMS+video group. For open invitations groups sizes were 8654, 8095, and 8271 respectively. Median age was 59 years for participants who received a timed appointment, and 58 years for those who received an open invitation. There were no attendance differences for timed appointments (intention-to-treat analysis): 71·9% (2225/3094) in control group; 69·9% (2064/2952) in behavSMS group; 71·7% (2137/2981) in behavSMS+video group (χ2(2)=3·47, p=0·176), even when controlling for covariates. There were no attendance differences for open invitations either: 7·4% (4104/8654) in control group, 8·3% (3909/8095) in behavSMS group, 48·1% (3978/8271) in behavSMS+video (χ2(2)=1·40, p=0·497), including when controlling for covariates. However, in the per-protocol analysis (of those with valid mobile numbers), intervention groups were more likely to book an appointment: 44·7% (3238/7274) in control group, 46·3% (3121/6744) in behavSMS group, and 46·3% (3199/6910) in behavSMS+video group (χ2(2)=6·01, p=0·050). Despite positive stakeholder feedback during co-design, the SMS or SMS+video interventions did not increase breast screening attendance compared with the usual SMS reminder. A limitation is that only 5·8% participants followed the video link. Links within SMS are unlikely to be an effective way to disseminate video content, and alternative options are being explored. NHS England and National Institute for Health and Care Research (NIHR). [ABSTRACT FROM AUTHOR]

In their Perspective, Ara Darzi and Hutan Ashrafian give us a tour of the future policymaker's machine learning toolkit. [ABSTRACT FROM AUTHOR]

The article discusses historical restrictions on federal funding for research on firearm violence by the Centers for Disease Control and Prevention (CDC). The Parkland shooting reportedly occurred despite repeated notifications to the Federal Bureau of Investigation and law enforcement about the threat posed by a student who had stated his violent intent.

The burden of cancer on public finances is a serious concern for policy makers. More people are developing cancer, and as standards of care have risen, more are surviving and requiring longer-term care. Precision medicine promises better outcomes but demands commensurately higher payments for care. As both incidence and per case costs rise, we suggest that the task of expanding access to high-quality cancer care poses a "value challenge" that policies in many countries are inadequate to meet. Policy makers should respond with a new approach. We explore questions that policy makers will need to consider regarding objectives, barriers, and levers for policy development. We use transparency and accountability as cornerstones of a new approach to promote value-based decision making. Although barriers to advancing this agenda are formidable, we recommend that governments define common standards for value-based accounting; serve as information brokers for evidence development; pioneer value-based procurement of goods and services; engage in deliberative democracy in cancer care; and educate communities to facilitate knowledge sharing between communities of patients, their caretakers, and researchers. [ABSTRACT FROM AUTHOR]

Background: Global health will increasingly be determined by cities. Currently over half of the world's population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations. Methods: We conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210). Results: The search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited. Conclusion: The collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term 'The Vital 5'. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These 'Vital 5' are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these 'Vital 5'. [ABSTRACT FROM AUTHOR]

The article offers information on the transformative innovations in care delivery. It focuses on shared medical appointments, in which patients receive one-on-one physician consultations. It mentions that shared appointments are used for routine care of chronic conditions, patient education, and physical examination.

BACKGROUND: Ward-based care of surgical patients is a complex and variable process, centered on the surgical ward round (WR). The authors describe the development of an evidence-based curriculum to improve ward-based care in the form of surgical WRs. METHODS: A modular, simulation-based curriculum was developed according to validated methods, incorporating the most recent evidence in the design of each educational module. RESULTS: A predevelopmental analysis questionnaire identified themes of patient assessment and management, communication skills, and teamwork as areas to be addressed. Curricular development incorporated knowledge and confidence assessment, lecture-based teaching, and simulated WR, followed by individualized assessment, debriefing, and feedback. Each module is evidence based and assesses trainees using validated tools. CONCLUSIONS: A comprehensive and cost-effective simulation-based curriculum, developed according to a validated framework, has been developed for surgical WRs and ward-based care. This may improve trainees' WR performance, improving patient care and surgical outcomes in turn. [ABSTRACT FROM AUTHOR]

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. [ABSTRACT FROM AUTHOR]

Many factors combine to drive the growth in health spending worldwide, but the introduction of new technologies, drugs, and therapies is probably the most important. However, in contrast to other industries, innovations in health care have not tended to reduce the need for labor. In fact, labor still accounts for the largest proportion of expenditures in many health systems. But labor-saving technologies, workforce innovations, and patient self-care approaches are now emerging and altering health care's labor structure. For example, in Mexico more than one million households pay $5 per month to access a health advice hotline before setting foot in a physician's office. In India assembly line-style eye surgery has dramatically reduced cost without sacrificing quality. Policy makers should focus on such labor-saving innovations; reform reimbursement systems to encourage them; tackle professionals' resistance; and remove regulatory barriers. Bold experiments to redesign health services around patient self-care approaches are also warranted. [ABSTRACT FROM AUTHOR]

The process and consequences of change to a health care system can have unintended, detrimental effects. Various types of simulations have been developed in order to try to predict the effects of change in a health care system. Such methods are in widespread use in industrial, military and higher educational institutions. This review essay focuses on participatory behavioural simulations, in which multiple participants are placed into a realistic, interactive simulation environment and asked to respond to a given set of circumstances, such as a change in policy. The processes and outcomes are driven by the actions and interactions of the participants and not by chance, allowing participants to see the consequences of their actions in a safe environment. The use of simulation in health care policy is presented, together with the evidence for its contribution to policy prediction, education and behaviour change among those designing and implementing health care policies. A method based on best evidence for design, implementation and evaluation of future simulations and participants is proposed. [ABSTRACT FROM PUBLISHER]

The article presents information on a report which discusses how the health technology can be of benefit worldwide not just to those who live in high-income countries. It reflects that technology can improve global health. It recommends that increased funding and support are required for development of more frugal technologies, technology should be combined with other innovations, and there should be a multi-disciplinary approach to develop and introduce a new technology.

The aim of this paper is to define a strategy for the development and organisation of a surgical skills centre. The areas of interest can be divided into decisions about who, what and where to teach, the importance of an approach which is competency‐based, definition of staff to run the centre, and also the use of the centre for the purposes of assessment, as well as training. The efficient delivery of this service will be augmented by adopting a multi‐disciplinary and multi‐professional approach, and must also be malleable enough to adopt future developments, such as web‐based learning. Simulation is now the preferred mode of practice for commencement of surgical training. Surgical skills centres must be able to supply users with tools in a suitably designed environment, which enables them to move along a curriculum which is delivered in a competency‐based manner. [ABSTRACT FROM AUTHOR]

Presents an overview of advances in minimal access surgery, concentrating on procedures that have become established in everyday surgical practice. Development of minimally invasive surgery which was facilitated by miniature video cameras with good image reproduction; Methods; Topic of laparoscopy; Minimally invasive abdominal surgery; Sentinal lymph node biopsy; Robotics in surgery.

Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta-analysis. However, we believe that the authors' conclusion that "the presented meta-analysis provides current evidence for the use of stapler closure in laryngeal cancer patients undergoing total laryngectomy" cannot be supported based on their meta-analysis. We read with interest the systematic review and meta-analysis on stapler closure vs manual closure in total laryngectomy for laryngeal cancer.1 The authors should be congratulated for attempting to answer this important question. [Extracted from the article]

Features the development of digital cameras that could be used in medicine. Immediate production of digital images; Taking of routine clinical photographs; Picture archiving and communication system; Integration with management systems.

Background: Cervical screening saves approximately 5000 lives annually in England. However, screening rates have been falling continuously, and coverage in London is particularly low (64.7%). While demographic predictors of uptake have been well researched, there has been less thorough investigation of the individual barriers and facilitators which predict cervical screening attendance. Understanding modifiable factors influencing attendance can guide the design of effective interventions to increase cervical screening uptake. The aim of this study was to understand the demographic, and individual factors associated with self-reported attendance at cervical screening in London. Methods: The study used an online survey of 500 women in London (June-July 2017). The survey included self-reported measures of past attendance, demographic variables (including age, household income, ethnicity), past experience variables, and individual variables (list of potential barriers and facilitators developed based on the Theoretical Domains Framework and existing literature, which included: environmental context and resources, perceived risk, anticipated pain/embarrassment). Participants were categorised into regular attenders and non-regular attenders. Backwards stepwise logistic regression investigated the barriers and facilitators predicting past attendance. Demographic variables with significant differences between regular and non-regular attenders were added to the final regression model. Results: Of women who had previously been invited (n = 461, age range: 25–65), 34.5% (n = 159) were classified as non-regular attenders, and 65.5% (n = 302) as regular attenders. The individual barriers and facilitators predicting attendance were: cervical screening priority, memory, environmental context and resources, and intention. The only demographic variables related to regular attendance were relationship status (married/civil partnership having higher rates than single) and higher household income. Relationship status was not significant when adjusting for barriers and facilitators. Those who have ever been sexually active or who have had an STI in the past were significantly more likely to be regular attenders. Conclusions: The study shows the importance of individual barriers and facilitators in predicting self-reported cervical screening attendance. Household income was the only significant demographic variable when combined with the individual variables. Interventions targeting priority, memory, and practical barriers affecting environmental context may be expected to be effective an increasing attendance. [ABSTRACT FROM AUTHOR]

In recent years England has introduced a number of initiatives to promote more integrated care. Two contrasting examples are the GP-led health centres and the Integrated Care Pilots announced in the interim and final reports, respectively, of the NHS Next Stage Review in 2007-2008. The GP-led health centres were proposed as a very centralised, prescriptive approach where the aim was that all the NHS should adopt the same model of facilitating integration through co-location. Integrated Care Pilots, on the other hand, looked to the NHS to suggest their own solutions to improve integration, resulting in a variety of solutions tailored to the needs of localities. Although the results of the evaluation of the Integrated Care Pilots have been equivocal, this bottom-up approach must be the right way to foster integrated care. Long-term commitment to integrate care is needed, as well as more exploration of integration between primary care and hospitals. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to article about the use of recombinant activated factor VII in patients with ventricular assist devices.

Background: There is significant health inequity in the United Kingdom (U.K.), with different populations facing challenges accessing health services, which can impact health outcomes. At one London National Health Service (NHS) Trust, data showed that patients from deprived areas and minority ethnic groups had a higher likelihood of missing their first outpatient appointment. This study's objectives were to understand barriers to specific patient populations attending first outpatient appointments, explore systemic factors and assess appointment awareness. Methods: Five high-volume specialties identified as having inequitable access based on ethnicity and deprivation were selected as the study setting. Mixed methods were employed to understand barriers to outpatient attendance, including qualitative semi-structured interviews with patients and staff, observations of staff workflows and interrogation of quantitative data on appointment communication. To identify barriers, semi-structured interviews were conducted with patients who missed their appointment and were from a minority ethnic group or deprived area. Staff interviews and observations were carried out to further understand attendance barriers. Patient interview data were analysed using inductive thematic analysis to create a thematic framework and triangulated with staff data. Subthemes were mapped onto a behavioural science framework highlighting behaviours that could be targeted. Quantitative data from patient interviews were analysed to assess appointment awareness and communication. Results: Twenty-six patients and 11 staff were interviewed, with four staff observed. Seven themes were identified as barriers – communication factors, communication methods, healthcare system, system errors, transport, appointment, and personal factors. Knowledge about appointments was an important identified behaviour, supported by eight out of 26 patients answering that they were unaware of their missed appointment. Environmental context and resources were other strongly represented behavioural factors, highlighting systemic barriers that prevent attendance. Conclusion: This study showed the barriers preventing patients from minority ethnic groups or living in deprived areas from attending their outpatient appointment. These barriers included communication factors, communication methods, healthcare the system, system errors, transport, appointment, and personal factors. Healthcare services should acknowledge this and work with public members from these communities to co-design solutions supporting attendance. Our work provides a basis for future intervention design, informed by behavioural science and community involvement. [ABSTRACT FROM AUTHOR]

• Two messaging strategies invoking a sense of ownership were tested to evaluate their impact on COVID-19 vaccination uptake. • The behavioural science informed text messages in our study did not improve the rates of vaccination. • This may highlight the effectiveness of public health campaigns during a pandemic. • Our analysis highlighted that different population subgroups respond variably to vaccination offers. • This study highlights the importance of creating accurate data records to facilitate delivery of vaccination offers. Behavioural science constructs can be incorporated into messaging strategies to enhance the effectiveness of public health campaigns by increasing the occurrence of desired behaviours. This study investigated the impact of behavioural science-informed text message strategies on COVID-19 vaccination rates in 18–39-year-olds in an area of low uptake in London during the first vaccination offer round in the United Kingdom. This three-armed randomised trial recruited unvaccinated residents of an urban Central London suburb being offered their first vaccination between May and June 2021. Participants were randomised to receive the control (current practice) text message or one of two different behavioural science-informed COVID-19 vaccine invitation strategies. Both intervention strategies contained the phrase "your vaccine is ready and waiting for you", aiming to evoke a sense of ownership, with one strategy also including a pre-alert message. The main outcome measures were vaccination rates at 3 and 8 weeks after message delivery. A total of 88,820 residents were randomly assigned to one of the three trial arms. Each arm had a vaccine uptake rate of 27.2 %, 27.4 % and 27.3 % respectively. The mean age of participants was 28.2 years (SD ± 5.7), the mean index of multiple deprivation was 4.3 (SD ± 2.0) and 50.4 % were women. Vaccine uptake varied by demographics, however there was no significant difference between trial arms (p = 0.872). Delivery was successful for 53.6 % of text messages. Our choice of behavioural science informed messaging strategies did not improve vaccination rates above the rate seen for the current practice message. This likely reflects the wide exposure to public health campaigns during the pandemic, as such text messages nudges were unlikely to alter existing informed decision-making processes. Text message delivery was relatively low, indicating a need for accurate mobile phone number records and multi-modal approaches to reach eligible patients for vaccination. The protocol was registered at clinicaltrials.gov (NCT04895683) on 20/05/2021. [ABSTRACT FROM AUTHOR]

Introduction: Clinical decision support (CDS) systems (CDSSs) that integrate clinical guidelines need to reflect real-world co-morbidity. In patient-specific clinical contexts, transparent recommendations that allow for contraindications and other conflicts arising from co-morbidity are a requirement. In this work, we develop and evaluate a non-proprietary, standards-based approach to the deployment of computable guidelines with explainable argumentation, integrated with a commercial electronic health record (EHR) system in Serbia, a middle-income country in West Balkans. Methods: We used an ontological framework, the Transition-based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR-based implementation of the Assumptions-Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed-methods evaluation was conducted with 20 simulated cases and five pulmonologists. Results: Pulmonologists agreed 97% of the time with the GOLD-based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co-morbidities was suggested in the future along with customisation of the level of explanation with expertise. Conclusion: An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long-term condition. Extension to other guidelines and multiple co-morbidities is needed to test the approach further. [ABSTRACT FROM AUTHOR]

Introduction: With the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use. Methodology: An online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. Results: Respondents (n = 6326) reported an increased use of telephone consultations (+ 6.3%, p <.001), patient-initiated services (+ 1.5%, n = 98, p < 0.001), video consultations (+ 1.4%, p <.001), remote triage (+ 1.3, p < 0.001) and secure messaging systems (+ 0.9%, p =.019). Experience rates using virtual care technologies were higher for men (2.4 ± 1.0 vs. 2.3 ± 0.9, p <.001), those with higher literacy (2.8 ± 1.0 vs. 2.3 ± 0.9, p <.001), and participants from Germany (2.5 ± 0.9, p <.001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n = 1802), safety (45.5%, n = 1822), patient-centredness (45.2%, n = 45.2) and equity (42.9%, n = 1726). Interest in future use was highest for telephone consultations (55.9%), patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%) and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. Discussion: Future work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally. [ABSTRACT FROM AUTHOR]

Significance: The integrity of the intestinal barrier is gaining recognition as a significant contributor to various pathophysiological conditions, including inflammatory bowel disease, celiac disease, environmental enteric dysfunction (EED), and malnutrition. EED, for example, manifests as complex structural and functional changes in the small intestine leading to increased intestinal permeability, inflammation, and reduced absorption of nutrients. Despite the importance of gut function, current techniques to assess intestinal permeability (such as endoscopic biopsies or dual sugar assays) are either highly invasive, unreliable, and/or difficult to perform in certain patient populations (e.g., infants). Aim: We present a portable, optical sensor based on transcutaneous fluorescence spectroscopy to assess gut function (in particular, intestinal permeability) in a fast and noninvasive manner. Approach: Participants receive an oral dose of a fluorescent contrast agent, and a wearable fiber-optic probe detects the permeation of the contrast agent from the gut into the blood stream by measuring the fluorescence intensity noninvasively at the fingertip. We characterized the performance of our compact optical sensor by comparing it against an existing benchtop spectroscopic system. In addition, we report results from a human study in healthy volunteers investigating the impact of skin tone and contrast agent dose on transcutaneous fluorescence signals. Results: The first study with eight healthy participants showed good correlation between our compact sensor and the existing benchtop spectroscopic system [correlation coefficient ðr Þ > 0.919, p < 0.001]. Further experiments in 14 healthy participants revealed an approximately linear relationship between the ingested contrast agent dose and the collected signal intensity. Finally, a parallel study on the impact of different skin tones showed no significant differences in signal levels between participants with different skin tones (p > 0.05). Conclusions: In this paper, we demonstrate the potential of our compact transcutaneous fluorescence sensor for noninvasive monitoring of intestinal health. [ABSTRACT FROM AUTHOR]

Background Despite advances in understanding and reducing the risk of endoscopic procedures, there is little consideration of the safety of the wider endoscopy service. Patient safety incidents (PSIs) still occur. We sought to identify nonprocedural PSIs (nPSIs) and their causative factors from a human factors perspective and generate ideas for safety improvement. Methods Endoscopy-specific PSI reports were extracted from the National Reporting and Learning System (NRLS). A retrospective, cross-sectional human factors analysis of data was performed. Two independent researchers coded data using a hybrid thematic analysis approach. The Human Factors Analysis and Classification System (HFACS) was used to code contributory factors. Analysis informed creation of driver diagrams and key recommendations for safety improvement in endoscopy. Results From 2017 to 2019, 1181 endoscopy-specific PSIs of significant harm were reported across England and Wales, with 539 (45.6%) being nPSIs. Five categories accounted for over 80% of all incidents, with "follow-up and surveillance" being the largest (23.4% of all nPSIs). From the free-text incident reports, 487 human factors codes were identified. Decision-based errors were the most common act prior to PSI occurrence. Other frequent preconditions to incidents were focused on environmental factors, particularly overwhelmed resources, patient factors, and ineffective team communication. Lack of staffing, standard operating procedures, effective systems, and clinical pathways were also contributory. Seven key recommendations for improving safety have been made in response to our findings. Conclusions This was the first national-level human factors analysis of endoscopy-specific PSIs. This work will inform safety improvement strategies and should empower individual services to review their approach to safety. [ABSTRACT FROM AUTHOR]

At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI − 0.482; − 0.167, p < 0.001), and speed by 25% (ES − 0.25, CI − 0.399; − 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education. [ABSTRACT FROM AUTHOR]

Details a prospective evaluation of laparoscopic colectomy in 40 patients requiring elective colonic excision mainly for malignant disease. Number of operations that were unsuccessful and required conversion to conventional open laparotomy; Study conclusions; Operation according to diagnosis; The issue of tumor clearance; Discussion.

The author discusses the transforming opportunity of global health-care workers shortage. Topics discussed include improving the investments in health workers and health, private medical education increases concerns about underfunding as well as poor quality education and offerings of the universal health coverage (UHC) for the health workforce development.

The authors discuss aspects of a study conducted by John Yaxley and colleagues which unveiled the outcomes of the randomised controlled trial comparing robotic-assisted laparoscopic prostatectomy with open radical retropubic prostatectomy. Topics include the assessment of robotic innovation, oncological outcomes for robotic-assisted laparoscopic prostatectomy, and improvement in surgical quality assurance.

Instantaneous, continuous, and reliable information on the molecular biology of surgical target tissue could significantly contribute to the precision, safety, and speed of the intervention. In this work, we introduced a methodology for chemical tissue identification in robotic surgery using rapid evaporative ionisation mass spectrometry. We developed a surgical aerosol evacuation system that is compatible with a robotic platform enabling consistent intraoperative sample collection and assessed the feasibility of this platform during head and neck surgical cases, using two different surgical energy devices. Our data showed specific, characteristic lipid profiles associated with the tissue type including various ceramides, glycerophospholipids, and glycerolipids, as well as different ion formation mechanisms based on the energy device used. This platform allows continuous and accurate intraoperative mass spectrometry-based identification of ablated/resected tissue and in combination with robotic registration of images, time, and anatomical positions can improve the current robot-assisted surgical platforms and guide surgical strategy. [ABSTRACT FROM AUTHOR]

Data System. The UK Department of Health and Social Care funded the REal-time Assessment of Community Transmission-2 (REACT-2) study to estimate community prevalence of SARS-CoV-2 IgG (immunoglobulin G) antibodies in England. Data Collection/Processing. We obtained random cross-sectional samples of adults from the National Health Service (NHS) patient list (near-universal coverage). We sent participants a lateral flow immunoassay (LFIA) self-test, and they reported the result online. Overall, 905 991 tests were performed (28.9% response) over 6 rounds of data collection (June 2020–May 2021). Data Analysis/Dissemination. We produced weighted estimates of LFIA test positivity (validated against neutralizing antibodies), adjusted for test performance, at local, regional, and national levels and by age, sex, and ethnic group and area-level deprivation score. In each round, fieldwork occurred over 2 weeks, with results reported to policymakers the following week. We disseminated results as preprints and peer-reviewed journal publications. Public Health Implications. REACT-2 estimated the scale and variation in antibody prevalence over time. Community self-testing and -reporting produced rapid insights into the changing course of the pandemic and the impact of vaccine rollout, with implications for future surveillance. (Am J Public Health. 2023;113(11):1201–1209. https://doi.org/10.2105/AJPH.2023.307381) [ABSTRACT FROM AUTHOR]

Cancer is one of the leading causes of high mortality worldwide, affecting most of the body organs including the breast and colon. Triple‐negative breast (TNBC) and colorectal cancers (CRC) usually present the poorest clinical outcomes and lowest disease‐free survival rates among the different cancer types. Novel biomarkers for early detection of TNBC and CRC have been proposed throughout the years, although the rate of success remains limited. Herein, a dual method for detection of cancer‐derived exosomes based on the measurement of the Raman spectra in graphene field‐effect transistors (GFETs) is proposed, thereby obtaining electrical signal metrics related to the variation of the Dirac point in graphene and optical features corresponding to representative bio‐molecular cancer structures in an orthogonal way. This pioneering method and classification routine can potentially be extended to other types of cancer, thus creating a unique and universal tag‐free diagnostic template for early cancer diagnostics. [ABSTRACT FROM AUTHOR]

Background: European countries face fiscal pressure regarding the long-term sustainability of their healthcare system due to increasing levels of public health expenditures and mounting demographic pressures. The promotion of generic drugs is considered to be an efficient means to tackle these challenges; however, market diffusion remains slow. The aim of this study was to investigate the impact of price and brand cues on purchase intentions by means of Direct-to-Consumer (DTC) advertising, and to build on the market cue evaluation model by Dodd et al. Methods: Participants rated purchase intentions on six DTC adverts varying in price and brand information, followed by self-reports on purchase intentions, attitudes towards generics, brand loyalty, price consciousness, as well as perceptions of quality, risk and value. Open-ended questions explored attitudes toward generic drugs. Results: Brand information and purchase intentions were mediated by perceived risk and perceived quality, while price information influenced purchase intention through perceptions of quality, risk and value. Consumers' purchase behaviour was furthermore influenced by unawareness and misconceptions, past experiences, and advertising as a decision-making tool. Conclusions: Advertisements, including price and brand information, are an important tool to improve consumers' awareness of the availability of different OTC drugs. Practical and theoretical implications are discussed. [ABSTRACT FROM AUTHOR]

The article looks at the state of the health care industry in Great Britain as of March 2015. Topics include the need for the government to address threats to the innovation and improvement of health care quality, effects of National Health Service's fiscal scrutiny of health care and increasing population of older people with chronic diseases on health care quality, and ways to improve health care services and outcomes such as optimizing health care market and redesigning of service.

The article discusses a positive reaction regarding the implementation of a smoking ban in parks and outdoor spaces in Great Britain. Topics covered include the efforts in promoting healthy living in Great Britain, policies created to protect people from the detrimental effects of passive smoking, and the Smoke-Free Air Act of 2002 implemented in New York. It discusses details relating to the reduced number of smokers after implementing policies and legislation relating to smoking ban.

Background: In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs). Objective: Our study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail. Methods: Semi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes. Results: Fifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging inter-organisational collaboration. Conclusion: Tackling poor interoperability will require solutions both at the technical level and in the wider policy context. This will involve demanding interoperability functionalities from the outset in procurement contracts, fostering greater inter-organisation cooperation on implementation strategies, and encouraging systems vendors to prioritise interoperability in their products. Only by comprehensively addressing these challenges would the full potential promised by the use of fully interoperable EHRs be realised. [ABSTRACT FROM AUTHOR]

The article offers the author's insights regarding his experience of being an under undercover hospital porter in Saint Mary's Hospital in London, England. The author mentions his affiliation with the National Health Services in Great Britain. Moreover, he discusses the importance of doing tasks as team to achieve particular goal and the essence of harmonious interaction among other workers.

The authors reflects on the proposals issued by the British government to improve the country's medical education and training system and ensure that the National Health Service (NHS) has high-quality doctors. They argued that Great Britain can become a destination for doctors who want to enhance their skills and knowledge. However, the authors claimed that sustained effort and funding are needed for the country to lead global medical education and training.

This article focuses on the quality of health care. The article explains that the error rate for medical care is higher than any other industry within developed economies. The author explains what practices would make England's National Health Service safer including measures of clinical outcomes and patient choice.

Information about the Symposium on Surgical Simulation for Training and Certification in the U.S. is presented.

This article comments on a report from the British National Health Service (NHS) called "Our NHS, our future." The report identified four dimensions of good-quality medical care: fairness, responsiveness, safety and effectiveness. While the NHS is a leader in fairness, medical service disparities are being seen. One of the biggest challenges for the NHS is the need to improve responsiveness. Safety issues need to address the spread of hospital-based infections.

The authors reflect on the difficulty in detecting the spigelian hernia, a rare abdominal wall defect in spigelian fascia. They stress that this condition go unrecognized due to the lack of specific physical findings. They emphasize that its unspecific clinical presentation, small size, and intramural location can make its detection extremely difficult. They assert that diagnosis of an incarcerated spigelian hernia is challenging because the symptom suggest many other diagnoses.

The article presents a letter to the editor in response to the article "Risk in primary care of colorectal cancer from new onset rectal bleeding: 10 year prospective study," by Du Toit et al.

Comments on the evolving professional roles of surgeons. Impact of a shortage of physicians on the changing roles of surgeons; Potential benefits and disadvantages of training medical personnel to complete surgery-related procedures; Discussion of the importance of expertise in clinical medicine; View that clinicians in specialized training programs must be trained and monitored to ensure quality of care.

Simple Summary: Breast-conserving surgery (BCS) is an oncological procedure that allows for the excision of breast cancer with a clear margin of healthy tissue whilst optimising the cosmetic appearance. However, BCS is associated with up to a 19% re-excision rate due to incomplete excision ("positive margins") in the United Kingdom. Optical spectroscopy and the optical imaging of BCS specimens could be a potential intraoperative margin assessment tool to help reduce re-excision rates. Hyperspectral sensing is based on the premise that light illuminating biological tissues undergoes several processes that reflect the composition of tissue, thus helping to differentiate between normal and malignant tissues. This review assesses the current literature on the use of hyperspectral sensing in breast cancer. We divide the techniques into either point-based (spectroscopy) or whole field-of-view (imaging) methods. A comparison is made of the effectiveness of these modalities in discriminating between normal and malignant tissue, and we reflect on the usability of these modalities in the intraoperative setting. Up to 19% of patients require re-excision surgery due to positive margins in breast-conserving surgery (BCS). Intraoperative margin assessment tools (IMAs) that incorporate tissue optical measurements could help reduce re-excision rates. This review focuses on methods that use and assess spectrally resolved diffusely reflected light for breast cancer detection in the intraoperative setting. Following PROSPERO registration (CRD42022356216), an electronic search was performed. The modalities searched for were diffuse reflectance spectroscopy (DRS), multispectral imaging (MSI), hyperspectral imaging (HSI), and spatial frequency domain imaging (SFDI). The inclusion criteria encompassed studies of human in vivo or ex vivo breast tissues, which presented data on accuracy. The exclusion criteria were contrast use, frozen samples, and other imaging adjuncts. 19 studies were selected following PRISMA guidelines. Studies were divided into point-based (spectroscopy) or whole field-of-view (imaging) techniques. A fixed-or random-effects model analysis generated pooled sensitivity/specificity for the different modalities, following heterogeneity calculations using the Q statistic. Overall, imaging-based techniques had better pooled sensitivity/specificity (0.90 (CI 0.76–1.03)/0.92 (CI 0.78–1.06)) compared with probe-based techniques (0.84 (CI 0.78–0.89)/0.85 (CI 0.79–0.91)). The use of spectrally resolved diffusely reflected light is a rapid, non-contact technique that confers accuracy in discriminating between normal and malignant breast tissue, and it constitutes a potential IMA tool. [ABSTRACT FROM AUTHOR]

The relationship between prevalence of infection and severe outcomes such as hospitalisation and death changed over the course of the COVID-19 pandemic. Reliable estimates of the infection fatality ratio (IFR) and infection hospitalisation ratio (IHR) along with the time-delay between infection and hospitalisation/death can inform forecasts of the numbers/timing of severe outcomes and allow healthcare services to better prepare for periods of increased demand. The REal-time Assessment of Community Transmission-1 (REACT-1) study estimated swab positivity for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in England approximately monthly from May 2020 to March 2022. Here, we analyse the changing relationship between prevalence of swab positivity and the IFR and IHR over this period in England, using publicly available data for the daily number of deaths and hospitalisations, REACT-1 swab positivity data, time-delay models, and Bayesian P-spline models. We analyse data for all age groups together, as well as in 2 subgroups: those aged 65 and over and those aged 64 and under. Additionally, we analysed the relationship between swab positivity and daily case numbers to estimate the case ascertainment rate of England's mass testing programme. During 2020, we estimated the IFR to be 0.67% and the IHR to be 2.6%. By late 2021/early 2022, the IFR and IHR had both decreased to 0.097% and 0.76%, respectively. The average case ascertainment rate over the entire duration of the study was estimated to be 36.1%, but there was some significant variation in continuous estimates of the case ascertainment rate. Continuous estimates of the IFR and IHR of the virus were observed to increase during the periods of Alpha and Delta's emergence. During periods of vaccination rollout, and the emergence of the Omicron variant, the IFR and IHR decreased. During 2020, we estimated a time-lag of 19 days between hospitalisation and swab positivity, and 26 days between deaths and swab positivity. By late 2021/early 2022, these time-lags had decreased to 7 days for hospitalisations and 18 days for deaths. Even though many populations have high levels of immunity to SARS-CoV-2 from vaccination and natural infection, waning of immunity and variant emergence will continue to be an upwards pressure on the IHR and IFR. As investments in community surveillance of SARS-CoV-2 infection are scaled back, alternative methods are required to accurately track the ever-changing relationship between infection, hospitalisation, and death and hence provide vital information for healthcare provision and utilisation. This study investigates how the severity of effects of the SARS-CoV-2 virus in England was affected by the mass vaccination campaign and emergence of Alpha, Delta and Omicron variants between May 2020 and March 2022. [ABSTRACT FROM AUTHOR]