Staff Publication

Practical Considerations in the Management of Frail Older People with Diabetes

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Type of publication:

Journal article

Author(s):

*Abdelhafiz, Dima; Abdelhafiz, Ahmed.

Citation:

Diseases. 13(8), 2025 Aug 06.

Abstract:

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients' views, wishes and preferences are in the heart of these plans.

DOI: 10.3390/diseases13080249

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Surgical Treatment of Wrist and Hand Deformity in Children with Cerebral Palsy (2025)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; *Khan, Muhammad Murtaza; *Gurukiran, Gurukiran; Carsi, Maria Belen; Singh, Rohit Amol.

Citation:

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 92(4):210-217, 2025 Aug.

Abstract:

Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this approach is to provide patients with this disorder the best quality of life. Although CP can affect both upper and lower limbs, the functional expectation of upper limb is much higher and complex. This implies particularly to hand and wrist based on complex functional movements expected of them. This puts orthopaedic surgeons in a unique position in managing these patients. It is worth mentioning here that it is not about offering them a surgical intervention the emphasis should lie on the entire process of selection, evaluation, and intervention. All these steps need to be considered very thoroughly so that the best outcome is achieved based on patients' expectation at present and keeping the future consideration in mind as well. This paper focuses only on children with hand and wrist deformity. Although children have a great healing potential, but they have high functional demand and longer-life expectancy in general so getting things right for the first time should be of paramount importance. This paper tries to address this issue by reviewing the literature to help orthopaedic surgeons in developing an algorithm in their mind when offering intervention. The consideration of inclusion and exclusion criteria along with review of literature has been considered with this background in mind. This paper primarily addresses the surgical aspect of disease and steps that are critical in this regard. Follow up planning, long-term outcome, rehabilitation planning, use of conservative treatment has not been considered in this review.

DOI: 10.55095/achot2025/011

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Is AI the Game-Changer for Polyp Detection in Colon Capsule Endoscopy? Insights from the CESCAIL Study (2025)

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Type of publication:

Conference abstract

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parson N.; Koulaouzidis A.; Robertson A.; Treceno P.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A9-A10), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon Capsule Endoscopy (CCE) provides a noninvasive alternative to colonoscopy for evaluating the lower gastrointestinal (LGI) tract. However, its widespread use has been limited by prolonged reading times and variability in diagnostic accuracy, often affected by factors such as bowel preparation quality and completion rates. In recent years, artificial intelligence (AI) has demonstrated potential in overcoming these limitations, particularly in small bowel CE, by enabling clinicians to achieve high diagnostic accuracy with significantly reduced reading times. The CESCAIL multi-centre study aims to evaluate a Computer-Aided Detection (CADe) system (AiSPEEDTM) to enhance polyp detection efficiency in CCE. Objective The primary aim is to assess AI-assisted CCE readings' diagnostic accuracy and non-inferiority in detecting polypoid lesions compared to standard readings using a per-patient analysis. The secondary objective focuses on mean reading time to evaluate the efficiency of each approach. Methods Patients aged 18 years or older, referred under urgent cancer or post-polypectomy surveillance pathway to one of the 14 CESCAIL participating centres across the UK, were prospectively enrolled in the study. Participants underwent CCE examinations, which were analysed using the AiSPEEDTM system, a convolutional neural network designed for automated polyp detection. Clinicians conducted initial manual readings, followed by AI-assisted readings, which involved an AI-automated first read, a review and annotation by a pre-reader, and a clinician assessment of selected images to create a report. Results Between February 2022 and September 2024, 673 patients were included in the final analysis. The overall completion rate was 77.1%, with adequate bowel preparation achieved in 78.1% of the standard pathway and 74.9% of the AI-assisted pathway (McNemar p=0.1). In the standard pathway, 403 patients (59.9%) required further investigation, including 243 (36.1%) colonoscopies and 138 (20.5%) flexible sigmoidoscopies. In the per-patient analysis, the diagnostic yield for polyp detection leading to a follow-up colonoscopy was 71.9% (484/673) for AI-assisted reading and 63.6% (428/ 673) for standard reading, confirming non-inferiority (p<0.0001). The diagnostic accuracy was 0.96 (95% CI: 0.95-0.98) for AI-assisted reading and 0.91 (95% CI: 0.89- 0.93) for standard reading (McNemar p<0.0001). The mean clinician reading time per video was 8.7 (SD=11.3) minutes for AI-assisted reading, compared to 47.3 (SD=24) minutes for standard reading, with a 5-fold reduction. Conclusion AI-assisted reading using AiSPEEDTM demonstrated significantly higher detection yield with improved diagnostic accuracy coupled with reduced reading time for polyp detection in CCE compared to standard clinician readings. These findings emphasise AI's potential to enhance efficiency and scalability in CCE, supporting its broader adoption for LGI investigations in clinical practice.

DOI: 10.1136/gutjnl-2025-BSG.14

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Decoding the Strength of AI-Assisted Reading in Colon Capsule Endoscopy: Factors Influencing Accuracy in Polyp Detection; CESCAIL Study's Interim Result (2025)

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Type of publication:

Oral presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shekhar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Robertson A.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A48-A49), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Artificial Intelligence (AI) assisted reading in Small Bowel Capsule Endoscopy (SBCE) has recently been shown to achieve comparable and potentially superior accuracy compared to standard clinician reading. In Colon Capsule Endoscopy (CCE), AI algorithms have also demonstrated some promising results.1 However, the extent of AI-assisted reading's advantage remains unclear, particularly regarding its performance across different polyp sizes, morphologies, locations, and non-polyp-related factors. Understanding this is essential for optimising AI performance and clinical integration. Objective(s) This CESCAIL sub-analysis evaluates the per-polyp diagnostic accuracy of AI-assisted versus standard clinician reads (pathways) and identifies key factors influencing AIassisted accuracy using AiSPEEDTM. Methods A total of 1,803 polyps from 673 patients were analysed at the per-polyp level to assess diagnostic accuracy in terms of sensitivity and PPV, as well as the factors influencing the improved accuracy of AI-assisted readings compared to standard clinician readings. Factors examined included polyp size, morphology, location, patient demographics (age and sex), bowel preparation quality, capsule excretion rates, comorbidities, medications, reading time, and video duration. Statistical methods included, McNemar's test, superiority and noninferiority analyses, Generalised Estimating Equations, and generalized linear models with interaction terms, were employed to identify key predictors of enhanced diagnostic accuracy in both AI-assisted and standard readings. Results AI-assisted reading demonstrated significantly higher sensitivity with clear superiority for smaller polyps (<10 mm) compared to larger ones (>=10 mm) (OR 2.27 vs 0.88, p<0.0001). While there was no observed difference in diagnostic accuracy between pathways for polyps >=10 mm, noninferiority was established. AI accuracy remained consistent between polyps measuring 6-9 mm and <=5 mm (p=0.64). The most notable improvement was observed with hyperplastic polyps (OR 5.4, p<0.0001), particularly in the rectal region (OR 5.7, p<0.0001). No significant differences were identified for pedunculated, subpedunculated, LST, or SSL polyps. Furthermore, AI-assisted readings were significantly more accurate for left-sided polyps compared to right-sided ones (OR 2.36 vs 1.66, p<0.0001), although AI-assisted reads outperformed standard reads in both locations. Conclusion This study highlights the strengths of AI-assisted reading, particularly for detecting smaller adenomas and hyperplastic polyps, with notable accuracy in the left colon. Next-generation AI should focus on distinguishing significant from diminutive polyps and enhancing polyp characterisation, especially for right-sided lesions.

DOI: 10.1136/gutjnl-2025-BSG.72

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From Capsule to Scope: Predicting Colon Capsule Endoscopy Conversion to Optical Endoscopy - Insights from the CESCAIL Study (2025)

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Type of publication:

Poster presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A269-A270), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon capsule endoscopy (CCE) has emerged as a non-invasive alternative to traditional colonoscopy for low-risk patients. However, its adoption is limited by low completion rates and the inability to perform biopsies or polyp removal, often resulting in CCE-to-conventional colonoscopy conversion (CCC). This conversion carries financial implications, contributes to patient dissatisfaction due to repeated procedures, and imposes a potential environmental burden from increased hospital visits. Objective(s) The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC. Methods In this prospective analysis of the CESCAIL study (November 2021-June 2024), 603 patients who underwent CCE were included. Predictive factors-including patient demographics, comorbidities, medications, and laboratory results-were analysed across symptomatic and surveillance groups. Statistical techniques such as LASSO regression, linear regression, and logistic regression were applied. Results Among the 603 participants analyzed, elevated f-Hb levels (OR=1.48, 95% CI: 1.18-1.86, p=0.0002) and smoking (OR=1.44, 95% CI: 1.01-2.11, p=0.047) were significantly associated with CCE-to-conventional colonoscopy conversion (CCC). However, an AUC of 0.62 after adjusting for confounders suggests f-Hb is a weak predictor of CCC. Diabetes was linked to poor bowel preparation (OR=0.40, 95% CI: 0.18-0.87, p=0.022). Alcohol use (p=0.004), smoking (p=0.003), and psychological conditions (p=0.001) were significantly associated with an increased polyp count, while haemoglobin levels (p=0.046) showed a marginal negative association with polyp numbers. Additionally, antidepressants (p=0.003) were associated with larger polyps, whereas betablockers (p=0.001) were linked to smaller polyps. Conclusion Non-smokers with lower f-Hb levels are less likely to require CCC. Effective patient selection criteria are essential for minimising conversion rates and improving the efficiency of CCE services. These findings highlight the need for validation across diver

DOI: 10.1136/gutjnl-2025-BSG.428

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Quantifying association of early proteinuria and estimated glomerular filtration rate changes with long-term kidney failure in C3 glomerulopathy and immune-complex membranoproliferative glomerulonephritis using the United Kingdom RaDaR Registry (2025)

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Type of publication:

Journal article

Author(s):

Downward L.; Proudfoot C.; Webb N.J.A.; Abat S.; Adalat S.; Agbonmwandolor J.; Ahmad Z.; Alejmi A.; Almasarwah R.; Annear N.; Araujo M.; Asgari E.; Ayers A.; Baharani J.; Balasubramaniam G.; Jo-Bamba Kpodo F.; Bailey L.; Bansal T.; Barratt A.; Barratt J.; Bates M.; Bayne N.; Bendle J.; Benyon S.; Bergmann C.; Bhandari S.; Bingham C.; Boddana P.; Bond S.; Braddon F.; Bramham K.; Branson A.; Brearey S.; Bridgett V.; Brocklebank V.; Budwal S.; Byrne C.; Cairns H.; Camilleri B.; Campbell G.; Capell A.; Carmody M.; Carson M.; Cathcart T.; Catley C.; Cesar K.; Chan M.; Chea H.; Chess J.; Cheung C.K.; Chick K.-J.; Chitalia N.; Christian M.; Chrysochou T.; Clark K.; Clayton C.; Clissold R.; Cockerill H.; Coelho J.; Colby E.; Colclough V.; Conway E.; Cook H.T.; Cook W.; Cooper T.; Coward R.J.; Crosbie S.; Cserep G.; Date A.; Davidson K.; Davies A.; Dhaun N.; Dhaygude A.; Diskin L.; Dixit A.; Doctolero E.A.; Dorey S.; Downard L.; Drayson M.; Dreyer G.; Dutt T.; Etuk K.; Evans D.; Finch J.; Flinter F.; Fotheringham J.; Francis L.; Gallagher H.; Game D.; Garcia E.L.; Gavrila M.; Gear S.; Geddes C.; Gilchrist M.; Gittus M.; Goggolidou P.; Goldsmith C.; Gooden P.; Goodlife A.; Goodwin P.; Grammatikopoulos T.; Gray B.; Griffith M.; Gumus S.; Gupta S.; Guzman R.; Hamilton P.; Hamrang-Yousefi S.; Harper L.; Harris T.; Haskell L.; Hayward S.; Hegde S.; Hendry B.; Hewins S.; Hewitson N.; Hillman K.; Hiremath M.; Howson A.; Htet Z.; Huish S.; Hull R.; Humphries A.; Hunt D.P.J.; Hunter K.; Hunter S.; Ijeomah-Orji M.; Inston N.; Jayne D.; Jenfa G.; Jenkins A.; Johnson S.; Jones C.A.; Jones C.; Jones A.; Jones R.; Kamesh L.; Kanigicherla D.; Frankl F.K.; Karim M.; Kaur A.; Kavanagh D.; Kearley K.; Kerecuk L.; Khwaja A.; King G.; Kislowska E.; Klata E.; Kokocinska M.; Koziell A.; Lambie M.; Lawless L.; Ledson T.; Lennon R.; Levine A.P.; Maggie Lai L.W.; Lipkin G.; Lovitt G.; Lyons P.; Mabillard H.; Mackintosh K.; Mahdi K.; Maher E.; Marchbank K.J.; Mark P.B.; Masoud S.; Masunda B.; Mavani Z.; Mayfair J.; McAdoo S.; Mckinnell J.; Melhem N.; Meyrick S.; Moochhala S.; Morgan P.; Morgan A.; Muhammad F.; Murray S.; Novobritskaya K.; Ong A.C.M.; Oni L.; Osmaston K.; Padmanabhan N.; Parkes S.; Patrick J.; Pattison J.; Paul R.; Percival R.; Perkins S.J.; Persu A.; Petchey W.G.; Pickering M.C.; Pinney J.; Pitcher D.; Plumb L.; Plummer Z.; Popoola J.; Post F.; Power A.; Pratt G.; Pusey C.; Pywell S.; Rabara R.; Rabuya M.; Raju T.; Javier C.; Roberts I.S.D.; Roufosse C.; Rumjon A.; Salama A.; Saleem M.; Sandford R.N.; *Sandu K.S.; Sarween N.; Sayer J.A.; Sebire N.; Selvaskandan H.; Shah S.; Sharma A.; Sharples E.J.; Sheerin N.; Shetty H.; Shroff R.; Simms R.; Sinha M.; Sinha S.; Smith K.; Smith L.; Srivastava S.; Steenkamp R.; Stott I.; Stroud K.; Swallow D.; Swift P.; Szklarzewicz J.; Tam F.; Tan K.; Taylor R.; Tischkowitz M.; Thomas K.; Tse Y.; Turnbull A.; Turner A.N.; Tyerman K.; Usher M.; Venkat-Raman G.; Walker A.; Walsh S.B.; Waters A.; Watt A.; Webster P.; Wechalekar A.; Welsh G.I.; West N.; Wheeler D.; Wiles K.; Willcocks L.; Williams A.; Williams E.; Williams K.; Wilson D.H.; Wilson P.D.; Winyard P.; Wong E.; Wong K.; Wood G.; Woodward E.; Woodward L.; Woolf A.; Wright D.; Wong E.K.S.; Gale D.P.

Citation:

Kidney International. 108(3) (pp 455-469), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction: C3 glomerulopathy (C3G) and immune-complex membranoproliferative glomerulonephritis (IC-MPGN) are rare disorders that frequently result in kidney failure over the long-term. Presently, there are no disease-specific treatments approved for these disorders, although there is much interest in the therapeutic potential of complement inhibition. However, the limited duration and necessarily small size of controlled trials means there is a need to quantify how well short-term changes in estimated glomerular filtration rate (eGFR) and proteinuria predict the clinically important outcome of kidney failure. Method(s): We address this using longitudinal data from the UK Registry of Rare Kidney Diseases (RaDaR) involving retrospective and prospective data collection with linkage to hospital laboratories via automated feeds of 371 patients. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression with eGFR slope estimated using linear mixed models. Result(s): In a median of 11.0 (inter quartile range 7.4-15.1) years follow-up, 148 patients (40%) reached kidney failure. There was no significant difference in progression to kidney failure between C3G and IC-MPGN groups. Baseline urine protein-creatinine ratio (UPCR), although high, was not associated with kidney failure in either group. Two-year eGFR slope had a modest association with kidney failure. In contrast, both 20%-50% and 50 mg/mmol reductions in UPCR between 0-12 months were associated with lower kidney failure risk in both groups. Notably, those with a UPCR under 100 mg/mmol at 12 months had a substantially lower risk of kidney failure (hazard ratio 0.10 (95% confidence interval 0.03-0.30). Conclusion(s): Overall, proteinuria a short time after diagnosis is strongly associated with long-term outcomes and a UPCR under 100 mg/mmol at one year is associated with a substantially lower kidney failure risk.

DOI: 10.1016/j.kint.2025.06.003

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Enhancing Sustainability in Endoscopically Assisted Naso-Jejunal Tube Insertion - A Novel Approach (2025)

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Type of publication:

Poster presentation

Author(s):

Bhargava K.; Bhargava C.; Dimitriadis S.; Sawyer M.; *Desai K.; Shekhar C.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A287), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction Due to the high caseload and heavy reliance on plastic predominant equipment in endoscopy, single use consumables remain a significant contributor to endoscopy related CO2 emissions (CO2e). Naso-jejunal tube (NJT) is a flexible tube that enables post-pyloric feeding. Conventionally, NJT insertion is performed endoscopically utilising consumables (e. g. single use laryngoscopes). We aimed to calculate and compare the CO2e of the standard NJT insertion process (SNIP) and a proposed innovative NJT insertion process (INIP). Method We dismantled each consumable used in the SNIP and INIP and calculated their associated CO2e by multiplying their weights by pre-established greenhouse gas emission factors published by the government of the United Kingdom. We further contacted relevant manufacturers to include emissions related to packaging, travel and transport, where possible. Results The SNIP emitted 1.327kg CO2e, while the INIP emitted 0.113kg CO2e – yielding an 11-times lower carbon footprint. The most significant contributor to SNIP emissions was the utilisation of the single use laryngoscope (0.838kg CO2e). In contrast, the INIP enabled NJT insertion, independent of conventional single-use instrumentation. Conclusion Implementing the INIP approach for NJT insertions for hospital and community-based patients would provide a sustainable alternative to existing procedural standards. Based on current data, utilising the INIP as standard practice would reduce 5827.2kg of NJT associated CO2e per year, in the UK. Further epidemiological research on populations receiving enteral feeding is required to more accurately evaluate the INIP's environmental impact.

DOI: 10.1136/gutjnl-2025-BSG.454

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Diagnostic Capabilities of MRI and CT in Evaluating Dizziness: A Systematic Review of Acute Cases in the ED (2025)

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Type of publication:

Journal article

Author(s):

Ali Mohammed, Elsuha Elgassim; Alzain Ali, Mohamed Almogtaba Mohamed; Eltayeb, Ethar; Saidahmed Ahmed, Lobaba Mubarak; *Ahmed Dafaalla, *Dalia Hamdan; Mohammed Elsheikh, Mohammed Omer; M Osman, Hanady Me.

Citation:

Cureus. 17(7):e88057, 2025 Jul.

Abstract:

Dizziness is a common reason for ED visits, posing diagnostic challenges due to its broad range of potential causes, from benign vestibular conditions to critical cerebrovascular events. Although CT scans are often used to quickly assess for intracranial hemorrhage, MRI provides greater accuracy for identifying strokes in the posterior circulation. Differences in imaging practices and uncertainty about the most effective approach highlight the need for a thorough evaluation of these modalities. This narrative systematic review examined the diagnostic performance of MRI and CT in assessing patients presenting with acute dizziness in ED settings, focusing on detection rates and clinical considerations. A comprehensive literature search was conducted, and eight relevant studies were included. The methodological quality of the studies was assessed, and findings were synthesized narratively due to variability in study designs. Overall, MRI showed a higher detection rate for underlying causes of dizziness compared to CT, particularly for posterior circulation strokes. CT was mainly useful for ruling out hemorrhage, while MRI offered superior detection of ischemic events. Using clinical factors such as age, vascular risk, and neurological findings may help prioritize MRI use in patients with higher stroke risk, supporting targeted imaging strategies to improve diagnostic outcomes and resource utilization.

DOI: 10.7759/cureus.88057

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Association Between Stone Composition and Recurrence Rates Following Ureteroscopy: A Scoping Review (2025)

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Type of publication:

Journal article

Author(s):

George, Althea O; Adefehinti, Mayowa; Lee, Minwook; Adebisi, Ajibola A; *Odedara, Ayodele; Omiko, Raymond; Akinwale, Mobolaji; Ndonga, Steven; Olalekan, Adeyeye; Yusuf, Abdulhameed; Ali, Sahar; Ononye, Reginald; Onobun, Daniel E.

Citation:

Cureus. 17(7):e87602, 2025 Jul.

Abstract:

Urolithiasis remains a significant global health burden, with high recurrence rates following intervention. Ureteroscopy is increasingly preferred due to its safety and efficacy; however, recurrence after ureteroscopy is common and may be influenced by stone composition. This scoping review aims to explore the relationship between stone composition and recurrence rates post-ureteroscopy and to identify gaps in current evidence that could inform clinical practice and research. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we conducted a structured literature search (2014-2024) across PubMed, Scopus, MEDLINE, and Google Scholar. Studies were eligible if they reported on adult patients (>=18 years) undergoing ureteroscopy for renal or ureteric stones, provided stone composition data, and reported recurrence (defined radiologically, symptomatically, or via reintervention). Retrospective/prospective cohort studies, clinical trials, and case series (n >10) in English were included. Non-English, paediatric-only studies, case reports, and those lacking recurrence or composition data were excluded. In total, 13 studies met the inclusion criteria. Calcium oxalate was the most frequently reported stone type and appeared to be associated with higher recurrence rates. Reported recurrence ranged from 25.8% at 32 months to nearly 60% at 36 months, particularly in patients without metabolic follow-up. Reporting of uric acid, struvite, and cystine stones was inconsistent, limiting firm conclusions. The majority of studies were retrospective, small-scale, and lacked standardised definitions of recurrence, often conflating residual fragments with true recurrence. Language restriction and lack of granular metabolic data further limited synthesis. Stone composition appears to influence recurrence risk post-ureteroscopy, particularly for calcium-based stones. However, variability in study design, recurrence definitions, and underreporting of metabolic data reduce the strength of current evidence. Future prospective research with standardised reporting and broader linguistic inclusion is essential.

DOI: 10.7759/cureus.87602

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Implementing Quick Response (QR)-Coded Patient Information Leaflets to Reduce Environmental Impact in Urology Outpatient Clinics: A Pilot Study (2025)

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Type of publication:

Journal article

Author(s):

Matei, Ana; *Chin, Yew Fung; Hughes, Thomas; Mahmalji, Wasim.

Citation:

Cureus. 17(7):e87891, 2025 Jul.

Abstract:

Background and aim Patient information leaflets (PILs) printed in paper form are a commonly used adjunct tool in urology clinics. These help to facilitate the information transfer between doctor and patient. They are detrimental to the environment and costly. Quick response (QR) codes can be used as another option for delivering the leaflets and would reduce the environmental burden. The aim of this paper is to evaluate patient response to the introduction of QR codes as a replacement for paper-based PILs. Methods This pilot study followed the introduction of QR codes of commonly used leaflets sourced from the British Association of Urological Surgeons (BAUS). The study was conducted in a urology clinic at the Hereford County Hospital over a one-month period. The acceptability of the QR codes was recorded. Data such as patient demographics and the type of leaflet were also documented and tabulated. Results Thirty-one patients required PILs, out of which 80% agreed to PILs via QR codes. The mean age of the participating patients was 76. The replacement of paper with QR codes for the one-month period reflects an average estimated saving of 1.88 kg of carbon dioxide emissions and around 238 sheets of paper. Discussion The introduction of QR codes has seen an increase in most sectors, including, more recently, the medical industry. They can be used with a wide range of functions within the industry ranging from medical education to patient identification. These can also be more easily distributed in various forms to cater to all needs. Limitations, such as the currently limited variety of urology PILs available, also need to be considered. Conclusion QR codes of the PILs are a generally accepted alternative. The widespread introduction of QR codes reduces the total environmental impact of paper documents while also reducing production costs.

DOI: 10.7759/cureus.87891

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