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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.

Lung transplantation presents numerous intraoperative challenges, particularly related to pulmonary artery and vein anastomotic integrity and hemodynamic stability. We present 3 cases where intraoperative transesophageal echocardiography (TEE) provided real-time diagnostic insights that directly altered surgical decision-making. Case 1 highlights pulmonary vein flow acceleration initially concerning for ostial stenosis, ultimately diagnosed as external compression from a retractor. Case 2 demonstrates true right pulmonary vein stenosis requiring immediate revision. Case 3 illustrates severe right pulmonary artery narrowing, detected by TEE and corrected intraoperatively to prevent early graft dysfunction. These cases underscore the critical role of intraoperative TEE in detecting subtle anastomotic abnormalities, distinguishing functional from structural stenosis, and guiding timely surgical correction. Incorporating comprehensive 2D and 3D TEE evaluation into routine lung transplant protocols enhances diagnostic accuracy, reduces postoperative complications, and contributes to improved long-term allograft function. Intraoperative 3D TEE should be considered an essential imaging modality in cardiothoracic transplantation and an invaluable educational tool for perioperative teams.

Abstract Aims Infective endocarditis (IE) is a serious and potentially fatal complication of mitral valve (MV) intervention. There are limited data comparing the incidence of IE after MV repair compared with bioprosthetic MV replacement. The aim of this study was to analyse the incidence and timing of IE after MV repair compared with bioprosthetic valve replacement, in both surgical and transcatheter patient populations. Methods and results A literature search of Medline, Embase, and Cochrane Library (January 2000—September 2025) was conducted. Pooled IE incidence rates were derived using random-effects models. Eighty-two studies (80 939 patients, total follow-up 350 252 patient-years) were included. The overall incidence rate of IE was 0.97 per 100-patient-years (95% confidence interval [CI] 0.71–1.34). IE was more common after surgical MV replacement (SMVR) than surgical MV repair (SMVr): incidence rate 0.93 (95% CI 0.41–1.81) vs 0.39 (95% CI 0.25–0.62) per 100-patient-years, incidence rate ratio (IRR) 2.34 (95% CI 1.06–5.18), P = .035. The incidence of IE after transcatheter MV replacement (TMVR) was comparable to transcatheter MV repair (TMVr) (2.88 [95% CI 1.91–4.33] vs 1.70 [95% CI 0.84–3.43] per 100-patient-years), IRR 1.56 (95% CI 0.73–3.34), P = .250. The cumulative incidence of IE following SMVR was significantly higher than following SMVr at 1- and 2-years post-procedure, but not at 6 months. Conclusions IE is an infrequent complication of mitral valve intervention. The incidence of IE following SMVR is significantly higher than following SMVr, while the incidence of IE following TMVR is numerically but not significantly higher than following TMVr. Reducing IE risk after mitral intervention is a clinical and research priority.

Background: Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship. Methods: A prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for THA. Results: tThe cohort included 362 hips with a mean patient age of 32.1 years; 53% were in females, and 95.6% were in Caucasian patients. The THA-free survivorship of the cohort was 90.6% at a mean of 10.4 ± 1.6 years postoperatively. Risk factors for THA were older age at surgery (p = 0.01), male sex (p = 0.02), body mass index of ≥30 kg/m 2 (p = 0.009), and femoral head chondromalacia (p < 0.001). Conclusions: This study demonstrates that FAI surgery yielded durable 10-year THA-free survivorship of 90.6%. Older age at surgery, obesity, male sex, and femoral head chondromalacia were key predictors of conversion to THA. Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Background: Idiopathic intracranial hypertension (IIH) is commonly linked to obesity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and bariatric surgery may improve outcomes beyond conventional therapy, but comparative evidence is limited. Methods: We systematically searched MEDLINE, EMBASE, and Cochrane from inception until June 2025. Eligible randomized and observational studies compared GLP-1RAs or bariatric surgery (each plus conventional care) against conventional management. Primary outcomes were the change in papilledema, visual acuity, and visual field. Secondary outcomes included body mass index (BMI), retinal nerve fiber layer (RNFL) thickness, monthly headache days, and risks of papilledema, visual disturbance, and headache. Pairwise random-effects meta-analyses and frequentist network meta-analysis ( P -scores) were performed. Results: Out of 429 records, 8 studies were included. Versus conventional therapy, GLP-1RAs reduced BMI (mean difference −1.55 kg/m 2 ; 95% confidence interval [CI]: −2.13 to −0.97) and lowered risks of papilledema (relative risk [RR]: 0.47; 95% CI: 0.34–0.65), visual disturbance (RR: 0.48; 95% CI: 0.24–0.98), and headache (RR: 0.78; 95% CI: 0.69–0.88). Changes in papilledema severity and RNFL thickness were not different; visual acuity favored GLP-1RAs at the end of follow-up, whereas visual field values were worse at some time points. In indirect comparisons with bariatric surgery, no significant differences were detected across outcomes. Conclusions: Adjunctive GLP-1RA therapy may be associated with weight loss and improved clinical/ophthalmic outcomes in IIH relative to conventional care, with a signal for worse visual fields at certain time points. Indirect comparisons suggest comparable efficacy to bariatric surgery. High-quality randomized trials are needed to define comparative effectiveness, safety, and optimal use.

Introduction With the rapidly changing landscape of rectal cancer treatment, it is becoming increasingly challenging for clinicians to interpret and synthesise the vast amount of high-quality evidence being generated. A core outcome set (COS) for clinical trials in rectal cancer would help address issues surrounding outcome selection and reporting. The purpose of this research project is to develop a COS to be used in research comparing different treatment paradigms in the management of rectal cancer. Methods and analysis This will be a mixed-methods project, including a systematic review, semi-structured interviews and a Delphi consensus process. The project was designed in accordance with the COMET (Core Outcome Measures in Effectiveness Trials) Handbook, which provides a framework for COS development based on existing evidence. A multidisciplinary Study Advisory Group, composed of rectal cancer providers, methodologists and patients, will oversee the project. A systematic review will be performed to identify an inclusive list of outcomes reported by researchers in previous rectal cancer trials. Outcomes will be collapsed into various core areas and domains according to the OMERACT Filter V.2.0. Semi-structured interviews with rectal cancer survivors and their partners/caregivers will help identify additional patient-centric outcomes not captured in the systematic review. Finally, after a final list of outcomes is generated, patients and healthcare professionals will be invited to participate in a Delphi process to develop the final COS. Ethics and dissemination The study has received full approval with the Research Ethics Committee at the Integrated Health and Social Services Network for West-Central Montreal (health network responsible for the Jewish General Hospital) (REC: 2025-4377) and the Institutional Review Board of the Mount Sinai School of Medicine (IRB: STUDY-25-00515). The results of this study will be presented at national and international meetings and a manuscript will be submitted for publication in a high-impact surgery and/or oncology peer-reviewed journal. Trial registration number The study was registered in the COMET database in December 2023 ( https://www.comet-initiative.org/Studies/Details/2941 ). The full systematic review protocol, along with the search strategy and inclusion/exclusion criteria, was registered online in September 2023 (researchregistry.com; reviewregistry1705).