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Abstract Introduction Virtual wards (VWs) and Hospital-at-Home (HaH) services are increasingly used in the UK to support acute care delivery. While clinical outcomes are often comparable to conventional inpatient care, the success of these models also depends on patient and carer experiences, including quality of life (QoL), satisfaction, and caregiver burden. Evidence synthesising these patient-centred outcomes within the UK context is needed to inform service implementation. Aim To systematically synthesise evidence from UK-based randomised controlled trials (RCTs) evaluating patient and carer satisfaction, QoL, and caregiver burden in VWs/HaH compared with traditional inpatient care. Methods Following PRISMA guidelines, PubMed and CINAHL databases were searched for UK-based randomised controlled trials (RCTs) (inception-October 2024) reporting QoL measures, patient/carer satisfaction, or caregiver burden, comparing VWs/HaH to traditional inpatient care for patients with acute illness. Validated tools (e.g. EQ-5D and custom surveys) were prioritised in data extraction. Risk of bias was assessed using the Cochrane RoB2 tool. Meta-analysis employed a random-effects model; heterogeneity was assessed using the I2 statistic. Results Fourteen RCTs (n = 3416 participants) met the inclusion criteria. Patient satisfaction was consistently high across studies. For example, one RCT reported very good/excellent satisfaction ratings of 91.7% for HaH compared with 88.1% for inpatient care.[1] Meta-analysis of satisfaction outcomes (five studies) showed no significant difference between groups (OR 0.67; 95% CI 0.29–1.54) with substantial heterogeneity (I2 = 78%). Carer outcomes varied; some studies found high satisfaction and no additional workload, while moderate-to-severe caregiver burden in 25% of carers was reported in one RCT.[2] QoL outcomes measured by various tools like the Euro Quality of Life EQ-5D-5L showed no clinically meaningful differences between groups. Some studies indicated better outcomes for home-treated patients in specific domains, including significantly lower depression scores (p < 0.001) and slightly higher social activity, and lower rate of select medical complications, although overall QoL remained comparable. Conclusion UK virtual health care services offer patient experiences that are comparable to traditional hospital care, with consistently high satisfaction and similar QoL outcomes. Carer experiences are more variable, highlighting a need for improved caregiver support within VW/HaH models. A key limitation of this review is the heterogeneity in the QoL and satisfaction measures used across included RCTs, which restricted the scope of quantitative synthesis. Future UK research should adopt standardised, validated outcome sets to strengthen comparability and inform evidence-based implementation.

ABSTRACT Background Electrical storm (ES) is a life‐threatening manifestation of recurrent ventricular arrhythmia. While anti‐arrhythmic drugs (AADs) have historically been the first‐line treatment, the role of catheter ablation (CA) as an initial therapy in ES remains incompletely defined. This meta‐analysis evaluates the efficacy and safety of radiofrequency CA compared to escalating medical therapy in patients with ES. Methods A systematic search of PubMed, Science Direct, and Cochrane databases was conducted for studies published from 2010 to 2025 that compared CA with medical therapy as first‐line treatment for ES. Outcomes of interest included ES recurrence, ventricular arrhythmia recurrence, in‐hospital mortality, procedural complications, and follow‐up survival. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random‐effects models. Results Six studies encompassing 963 patients (473 CA, 490 medical therapy) were included. The mean age was 67.8 years, and 87.7% were male. The mean left ventricular ejection fraction was 33%, and ischemic cardiomyopathy was present in 77.5% of CA and 72.1% of MT patients. CA reduced the risk of ES recurrence by 71% compared to medical therapy (OR: 0.29; 95% CI: 0.15–0.53; p < 0.001; I ² = 53%). Recurrence of any ventricular arrhythmia, in‐hospital mortality, and long‐term survival were also significantly improved with CA. Conclusion This meta‐analysis suggests that CA is associated with lower ES and VA recurrence and in‐hospital mortality and improved survival compared to medical therapy alone. These findings support consideration of catheter ablation as a first‐line strategy. Larger prospective trials are needed to confirm these findings and guide patient selection.

Aim To evaluate the clinical effectiveness, cost‐effectiveness, quality of life (QoL) and patient/caregiver satisfaction associated with VWs/HaH vs . traditional inpatient care in adults with acute or post‐acute illness. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), following PRISMA 2020 guidelines, registered with PROSPERO (CRD42024508457). Major databases were searched until October 2024. Primary outcomes were mortality, readmission, emergency attendance and length of stay. Secondary outcomes were quality of life (QoL), cost‐effectiveness, patient satisfaction and caregiver burden. Meta‐analyses employed random‐effects models; heterogeneity was assessed using the I 2 statistic. Results A total of 47 reports of RCTs (9749 patients) were included. Meta‐analyses showed no statistically significant differences in mortality over 1 to 12‐month periods (OR 0.82‐1.11, 95% CI 0.54‐1.43), readmission rates (OR 0.93‐1.16, 95% CI 0.80‐1.67) or emergency attendance rates (3‐month OR 0.86, 95% CI: 0.6–1.25). Narrative synthesis indicated VWs/HaH had higher patient satisfaction and potential cost savings. Quality of life outcomes were comparable, with some improvements in pain and emotional well‐being noted in home care settings. Conclusion VWs/HaH models demonstrated non‐inferior clinical safety and cost‐effectiveness compared to inpatient care for select adult populations. High satisfaction and comparable clinical outcomes were observed. Findings support the continued, regulated integration of virtual care into routine practice. Future research should focus on service standardization, patient/caregiver satisfaction and support and specific economic evaluations.

The translation of AI-generated brain metastases (BM) segmentation into clinical practice relies heavily on diverse, high-quality annotated medical imaging datasets. The BraTS-METS 2023 challenge has gained momentum for testing and benchmarking algorithms using rigorously annotated internationally compiled real-world datasets. This study presents the results of the segmentation challenge and characterizes the challenging cases that impacted the performance of the winning algorithms. Untreated brain metastases on standard anatomic MRI sequences (T1, T2, FLAIR, T1PG) from eight contributed international datasets were annotated in stepwise method: published UNET algorithms, student, neuroradiologist, final approver neuroradiologist. Segmentations were ranked based on lesion-wise Dice and Hausdorff distance (HD95) scores. False positives (FP) and false negatives (FN) were rigorously penalized, receiving a score of 0 for Dice and a fixed penalty of 374 for HD95. The mean scores for the teams were calculated. Eight datasets comprising 1303 studies were annotated, with 402 studies (3076 lesions) released on Synapse as publicly available datasets to challenge competitors. Additionally, 31 studies (139 lesions) were held out for validation, and 59 studies (218 lesions) were used for testing. Segmentation accuracy was measured as rank across subjects, with the winning team achieving a LesionWise mean score of 7.9. The Dice score for the winning team was 0.65 ± 0.25. Common errors among the leading teams included false negatives for small lesions and misregistration of masks in space. The Dice scores and lesion detection rates of all algorithms diminished with decreasing tumor size, particularly for tumors smaller than 100 mm3. In conclusion, algorithms for BM segmentation require further refinement to balance high sensitivity in lesion detection with the minimization of false positives and negatives. The BraTS-METS 2023 challenge successfully curated well- annotated, diverse datasets and identified common errors, facilitating the translation of BM segmentation across varied environments and providing the tools for future development of personalized volumetric reports to patients undergoing BM treatment.

Background: Coronary in-stent restenosis (ISR) secondary to neointimal hyperplasia or neoatherosclerosis remains a significant challenge following percutaneous coronary interventions (PCI), with no consensus on the optimal revascularization strategy. We compared the outcome of PCI for ISR using drug-coated balloons (DCB) and drug-eluting stents (DES) and investigated the time trends in their clinical outcomes. Methods: PubMed, Embase, Scopus, and the Cochrane Library databases were searched through May 2024. We included randomized controlled trials (RCTs) comparing DCB versus DES among patients with coronary ISR. The primary outcome was target lesion revascularization (TLR). Secondary outcomes included all-cause mortality, myocardial infarction (MI), stent thrombosis, and late lumen loss (LLL). Random-effects models were employed to analyze outcomes within 1-year and beyond 1-year intervals. Meta-regression analysis was used to investigate the effect of age, sex, history of diabetes, hypertension, dyslipidemia, smoking, and ejection fraction on all outcomes by applying mixed-effect models. Results: We included 10 RCTs (1034 patients in the DCB group and 943 patients in the DES group). We found similar incidence of 1-year TLR (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.86, 2.14; P 0.194; I 2 43.3%) and >1-year TLR (OR 0.94; 95% CI 0.57, 1.56; P 0.817; I 2 0%) with the use of DCB versus DES. The risks of all-cause mortality, MI, and stent thrombosis were comparable between DCB and DES in 1-year and beyond 1-year follow-ups. At 6-9 months angiographic follow-up, DCB was associated with non-significantly lower LLL compared to DES (standardized mean difference [SMD] -0.12 millimeters; 95% CI -0.29, 0.05; P 0.170; I 2 71.7%). Meta-regression indicated that higher prevalence of diabetes was associated with an increased risk of 1-year revascularization after DCB compared to DES (Estimate 0.07; P 0.003; I 2 0%). Additionally, male sex was associated with an increased LLL in DCB versus DES (Estimate 0.034; P 0.001; I 2 41.8%). No association was found between other baseline characteristics and measured clinical outcomes. Conclusion: DCB demonstrated comparable PCI outcomes compared to DES in patients with coronary ISR.

Abstract Objectives Healthcare institutions implement antimicrobial stewardship (AMS) programmes to optimize the use of antibiotics. The focus is often on inpatient rather than outpatient settings. We aimed to explore perceptions of AMS stakeholders on effective interventions for appropriate antibiotic use in outpatient settings, and the role of clinical pharmacists in the AMS multidisciplinary team. Methods A qualitative semi-structured interview study using thematic analysis by two researchers independently. Participants that practice AMS programmes were recruited from healthcare facilities in the United Arab Emirates (UAE). Interviews were conducted face to face or online and transcribed verbatim. Results Four themes emerged: (i) Perceived factors leading to unnecessary or inappropriate antibiotic prescribing and their impact on patients and the community; (ii) current outpatient AMS activities and perceived barriers and facilitators for their sustainability; (iii) suggested outpatient AMS strategies to be implemented in outpatient settings; and (iv) perceived future AMS implementation barriers and suggested mitigation strategies. Conclusions Several AMS interventions, together with the presence of a clinical pharmacist, may be effective in improving antibiotic use in UAE outpatient settings. Future research should investigate the most appropriate AMS strategy considering barriers and possible mitigation strategies to ensure sustainability.

ImportanceLip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.ObjectiveTo analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence ReviewThe incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.FindingsIn 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and RelevanceIn this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

Antimicrobial resistance (AMR) is a well-known global threat due to the subsequent increase in antimicrobial usage. Several antimicrobial stewardship (AMS) strategies have been implemented to curb irrational prescribing and reduce the AMR burden. However, since the beginning of the COVID-19 pandemic, it has enormously impacted the healthcare system and jeopardized public health, causing millions of deaths globally. Our semi-structured qualitative study aimed to explore the impact of COVID-19 on AMS activities in the UK hospitals. Seventeen interviews were conducted with health care professionals who were part of AMS teams (consultant medical microbiologists, infectious disease consultants, antimicrobial pharmacists). Interviews were audio-recorded and transcribed. An inductive thematic framework was adopted to analyse and create the themes. After agreement of the hierarchical framework definition, all transcripts were coded accordingly. Four main themes and 15 sub-themes were identified. These main themes were: (1) AMS activities or strategies before and during the pandemic; (2) challenges to implementing AMS activities before and during the pandemic; (3) information from public authorities on AMS during the pandemic; and (4) new AMS activities/strategies adopted during the pandemic. Staff vacancies, redeploying of AMS staff to other duties and meeting the burden related to the COVID-19 and lack of resources were the most frequently identified contributing factors to withheld AMS activities during the pandemic. However, modifications to the hybrid working environment, i.e., remote or flexible working, allowed for resumption of AMS activities including virtual ward rounds, virtual meetings and other activities. Further research needs to assess the impact of the hybrid delivery system on AMS activities.

Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: −0.99; 95% CI: −2.38, 0.39) and a significant reduction in antibiotics’ days of therapy (MD: −2.73; 95% CI: −3.92, −1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.