Tetralogy of Fallot is the most common cyanotic CHD and is ideally repaired during infancy. However, delayed diagnosis and limited access to congenital cardiac care may result in presentation during adolescence or adulthood. This study evaluated outcomes of tetralogy of Fallot repair in patients aged ≥ 13 years.

This retrospective cohort study included patients aged ≥ 13 years undergoing primary tetralogy of Fallot repair between June 2016 and June 2025. Demographic, operative, and post-operative data, including early mortality and reintervention, were analysed.

Ninety-four patients underwent repair at a median age of 15 years (interquartile range: 3) and weight of 36.5 kg (interquartile range: 12.2). Pre-operative coil embolisation of aortopulmonary collaterals was required in 26.6%. Mean cardiopulmonary bypass and aortic cross-clamp times were 114.8 ± 49.8 and 82.4 ± 35.6 minutes, respectively. Mean ventilation duration was 7.7 ± 7.1 hours, ICU stay 3.9 ± 1.0 days, and post-operative hospital stay 4.6 ± 1.3 days. Transannular patch repair was performed in 65 patients (69%), while 29 (31%) underwent pulmonary valve-preserving repair, with comparable early outcomes. Thirty-day mortality was 1.06%, and reintervention occurred in 2.1% during a mean follow-up of 38.4 months.

Primary repair of tetralogy of Fallot in late-presenting adolescents and adults can be performed with low early mortality and acceptable morbidity. Careful pre-operative assessment, including identification and management of significant aortopulmonary collaterals, and individualised right ventricular outflow tract reconstruction are important components of management. These findings support definitive repair in appropriately selected late-presenting patients.

Depression trials typically use symptom-based outcomes to determine treatment efficacy. Qualitative work with service users and clinicians indicates that other outcomes may be equally or more important. Quantitative investigations are needed to assess the relative importance of outcomes to key stakeholders.

To examine how stakeholders (service users with minimal symptoms (Beck Depression Inventory Second Edition (BDI-II) score ≤18), those who were currently symptomatic (BDI-II score ≥19) and clinicians working with people with depression) prioritise outcome domains drawn from two completed trials of cognitive behavioural therapy (CBT) for depression. This was from a new sample of stakeholders in order to explore similarities, differences and predictors of domain importance.

An online survey using a novel point-allocation method examined stakeholder priorities for outcome domains from two completed UK trials of CBT for depression. Stakeholder free-text responses explaining point allocations were thematically analysed. Multivariate analysis of covariance explored differences in domain importance across groups, and exploratory multivariate general linear models investigated predictive variables.

In total, 229 participants completed the survey (57 with minimal symptoms, 108 who were currently symptomatic and 64 clinicians). Median point allocations suggest that all three participant groups assigned similar importance to depression symptoms, quality of life, anxiety symptoms and impact on activities. Sociodemographic factors significantly predicted domain importance within the currently symptomatic group, and age was a predictor both across and within this subgroup.

Stakeholders valued several outcome domains with similar importance. While depression symptoms are not unimportant to stakeholders, they are balanced with other outcomes, such as quality of life, that are rarely measured in depression trials. These findings demonstrate the need to incorporate stakeholder-important outcomes into trial design, with stakeholder-weighted composite outcomes offering a potential method to capture this broader judgement of benefit.

Many autistic adolescents receive in-patient psychiatric care from services that are ill-equipped to meet neurodivergent needs. However, the outcomes for autistic adolescents accessing in-patient care remain poorly understood.

To document the demographics and clinical outcomes of autistic adolescents referred to in-patient psychiatric services over a 5-year period and compare these with those of their allistic peers accessing the same services.

We conducted a retrospective cohort study involving all adolescents (aged 12–17 years inclusive) referred for in-patient psychiatric care through the Thames Valley Provider Collaborative between 1 April 2019 and 31 March 2024. Clinical characteristics and outcomes of referrals for autistic and allistic adolescents were collected and summarised from routine service data. Inferential statistics (including t-tests and chi-squared tests) were used to compare characteristics between the autistic and allistic groups.

Autistic adolescents were more likely than their allistic peers to be referred in an emergency (24.6 v. 16.6%) and for risk management (53.7 v. 33.5%). Autistic adolescents without an eating disorder had longer average length of stay than their peers (146.1 v. 97.5 days) and were more likely to be discharged to more secure settings following admission (12.9 v. 7.7%). Emerging evidence from routine outcome measures suggests less positive progress during in-patient care and greater impairment among autistic adolescents at both admission and discharge.

There are important differences in outcomes from psychiatric in-patient admissions between autistic and allistic adolescents. Greater work is needed to understand these differences and the factors influencing treatment success for autistic adolescents.

Adults with repaired tetralogy of Fallot represent a growing clinical population at risk for long-term cardiovascular complications. Characterising their postoperative course and late outcomes is essential to guide surveillance and management.

To describe the clinical characteristics and long-term outcomes of adult patients (≥18 years) with repaired tetralogy of Fallot who received care at a quaternary-care institution between January 2000 and December 2024.

We performed a retrospective cohort study. Adult patients with a diagnosis of repaired tetralogy of Fallot who had undergone complete surgical repair either during the study period or before it were included. Clinical and sociodemographic data were obtained.Variables related to prior palliative procedures, type of surgical repair, reinterventions (surgical or catheter-based), and long-term outcomes were analysed.

A total of 56 patients were included; 31 (55.4%) were women. The median duration of follow-up after repair was 23 years; twenty patients (35.7%) had undergone a palliative or prior intervention before complete repair. The most common type of outflow tract reconstruction was a transannular patch (37.5%), followed by homograft implantation (25.0%). Reinterventions occurred in 29 patients (51.8%), most commonly pulmonary valve replacement (23 patients, 41.0%), mainly due to progressive pulmonary regurgitation and right ventricular dilation. Arrhythmic complications included premature ventricular contractions in 35.7% of patients. Long-term mortality was 3.6%.

Adults with repaired tetralogy of Fallot demonstrate high long-term survival; however, late complications are common and frequently require surgical or catheter-based reintervention. These findings underscore the need for lifelong specialised follow-up in adult CHD programmes.

Studies assessing the effect of preoperative iron supplementation in paediatric cardiac surgery are limited and yield conflicting data.

The study aimed to evaluate the effect of preoperative oral iron supplementation on allogeneic blood transfusion after cardiac surgery for acyanotic CHD.

This was a prospective, open-label, outcome assessor-blinded, randomised clinical trial performed in a large tertiary care centre in India. Children (haemoglobin <13 gm/dl) with acyanotic CHD were recruited for the study. Children in the intervention arm received colloidal iron (3 mg/kg), folic acid, and cyanocobalamin according to body weight for at least 7 days before cardiac surgery. The primary outcome was the amount of allogeneic blood transfusion, while secondary outcome measures were the duration of mechanical ventilation and ICU stay.

A total of eighty-six children (43 in each arm) completed the trials. A total of 43 children received iron supplementation for a minimum of 1 month. The haemoglobin level improved by 1.3 gm/dl immediately before the cardiac surgery in the intervention arm. The allogeneic blood transfusions (ml/kg) median (IQR) were significantly lower in the intervention group (5 (0–8) vs 10 (8–12); p < 0.01). Furthermore, total cumulative allogeneic blood transfusion was also significantly lower in the intervention arm (60 ml; (0–100) vs 100 ml; (70–140); p < 0.001). The duration of mechanical ventilation, ICU stay, and hospital stay was significantly lower in the intervention arm.

Preoperative oral iron supplementation significantly reduces the need for allogeneic blood transfusion in children undergoing cardiac surgery for acyanotic heart disease.

Although acute type A aortic dissection (ATAAD) is a recognised complication of Turner syndrome, population-level data describing its prevalence and outcomes remain limited.

We queried the National Inpatient Sample (2002–2020) and generated three groups: TS + ATAAD+, TS + ATAAD−, and TS−ATAAD+ in our retrospective observational cohort study. Primary outcomes were ATAAD hospital admission rate and in-hospital mortality; secondary outcomes included length of stay. Sampling weights were applied to all analyses.

A total of 51,426 Turner syndrome hospitalisations were identified. Median ages were 40 years (interquartile range 31–50) for TS + ATAAD+ and 32 years (interquartile range 9–49) for TS + ATAAD− (p < 0.001). Overall, 0.27% of Turner syndrome hospitalisations presented with ATAAD. Compared with TS + ATAAD−, those with ATAAD had higher mortality (13.1% vs 2.1%, p < 0.001) and longer length of stay (median 8 vs 3 days, p < 0.05). Rates of bicuspid aortic valve (34.3% vs 3.5%, p < 0.001), hypertension (46.0% vs 25.7%, p < 0.05), and complete heart block (14.6% vs 0.8%, p < 0.001) were also higher. Multivariable analysis showed bicuspid aortic valve (adjusted odds ratio 24.31, 95% CI 8.8–67.3) and age (adjusted odds ratio 1.02, 95% CI 1.01–1.04) predicted ATAAD. Compared with TS−ATAAD+ patients, those withTS + ATAAD+ were younger (40 vs 68 years, p < 0.001), while mortality, length of stay, hypertension, and bleeding rates were similar.

ATAAD is highly lethal in patients with and without Turner syndrome. In Turner syndrome, ATAAD is associated with higher mortality, longer hospitalisation, and higher rates of bicuspid valve disease and hypertension.

Lasoo Health is an e-software in the early stages of development, designed to generate a consult report with the most probable headache diagnosis and treatment plan from direct patient input. A patient accesses the program with their consent and a referral from primary care. Digital consult is then reviewed by a medical specialist and then sent to the primary care provider to initiate care. This early health technology assessment (eHTA) assesses the potential impact of Lasoo Health on timely access to effective headache management, cost savings, and health outcomes compared to the current standard of care (SOC) in Alberta, Canada.

We developed a discrete event simulation (DES) of headache diagnostic pathways for Albertan patients suffering from headaches. The model was parameterized using secondary data sources identified via relevant published literature and subject matter expert opinion. Cost-effectiveness was expressed from a societal perspective using the incremental net monetary benefit (iNMB) of Lasoo Health incorporated with the SOC compared to SOC alone over an analytical time frame of five years.

Our analysis suggests that incorporating Lasoo Health into the SOC may reduce specialist assessment wait times by 70 percent and total per-patient costs by 7 percent. Using a willingness-to-pay (WTP) threshold of Canadian dollars (CAD) 50,000 (U.S. dollars (USD) $35,240), the iNMB per patient was estimated to be CAD 1,069 (USD $753).

The benefits of implementing Lasoo Health over a 5-year period could translate to improved patient outcomes, reduced wait times for specialists, and lower productivity losses among headache patients.

This study aimed to analyse respiratory infection rates (RI) in a representative cohort and evaluate if tumour size, pre-existing respiratory co-morbidities, smoking history, and tracheostomy predicted postoperative infection.

A retrospective observational study at a London tertiary head and neck oncology centre reviewed six years of patient data. BMJ Best Practice guidelines for hospital-acquired pneumonia (2022) were applied to medical records alongside postoperative RI prescriptions.

RI occurred in 32% of patients, more often in those with tracheostomy (36%) than intubation (12%). Infected patients were older (p=0.025), had tracheostomy (p=0.045), and underwent bilateral neck dissection (p<0.001). ICU (p=0.008) and hospital LOS (p<0.001) were significantly higher. Age, smoking, respiratory disease, tumour stage, and airway type were not predictors.

RI were more frequent in tracheostomised patients, though assessed risk factors were not predictive. Further research should explore additional contributors and evaluate targeted interventions to reduce incidence.

A clinic to assess and treat mental health (MH) within a community substance use disorder (SUD) service has been implemented with the aim to facilitate engagement, progress, and completion of substance use treatment.

This study was completed to assess the effectiveness of such an integrated service. The records of individuals seen within the clinic during 2022 and 2023 were assessed for the reason for referral, diagnosis, and treatment offered, and outcome of MH and SUD.

A total of 118 individuals were assessed. The majority (58%) were referred due to a lack of progress in treatment. The most frequent MH diagnosis was bipolar disorder (57%), followed by smaller numbers of diagnoses of psychosis, PTSD, anxiety and depression. Seventy-four (63%) individuals improved in MH, and eighty (68%) in SUD.

Despite the limitations due to the naturalistic methodology, this early work suggests that an integrated type of provision of MH treatment within a SUD service might have a beneficial complementary role within the existed parallel treatment model implemented in England.

Transcatheter closure of secundum atrial septal defects is well-established, but data on very large defects requiring 40–50 mm occluders remain limited. This multicenter retrospective study evaluated the safety and efficacy of percutaneous closure using large atrial septal occluders.

Patients undergoing atrial septal defect device closure with 40–50 mm occluders from June 2015 to May 2025 at two tertiary centres were analysed. Patients were grouped by device size: Group A (40–42 mm; n = 34) and Group B (44–50 mm; n = 28).

The cohort (n = 62) had a mean age of 42.07 years with female predominance (70.96%). Mean atrial septal defect size was 33.03 mm (thick-to-thick: 38.71 mm), with mean pulmonary artery pressure of 22.33 mmHg and left ventricular end-diastolic pressure of 12.59 mmHg. Aneurysmal septum with thin or deficient posteroinferior rim was common (77.4% and 19.4%, respectively). Procedural success was 93.5%. Device instability or residual flow led to surgical closure in three cases; one had intraprocedural embolisation. Procedural assistance (balloon/device, etc.) was needed in 93.5%. Fenestrated devices were used in four (6.5%) patients—due to severe pulmonary stenosis, diastolic dysfunction, or pulmonary hypertension. “Cobra” configuration and device bulkiness were noted in 9.7% and 6.5%, respectively. Arrhythmias occurred in 25.8%, mostly transient. One patient developed device-related endocarditis, and one late, unrelated death occurred due to intracranial haemorrhage. At a mean follow-up of 29.29 months, outcomes were satisfactory.

Transcatheter closure of large atrial septal defects with 40–50 mm devices is safe and effective with proper anatomical assessment, procedural planning, and vigilant follow-up in selected patients.

This study aimed to investigate whether seasonal epistaxis patterns differ between cases manageable in emergency departments versus those requiring hospital admission and to examine weather parameter correlations by severity category.

A retrospective severity-stratified analysis of 2,201 epistaxis presentations across two UK hospitals (January 2023–December 2024) with comprehensive weather correlation analysis was used.

Emergency department cases (1,762 presentations, 80.1 per cent) peaked in winter (475 cases, 27.0 per cent), while hospital admissions (439 cases, 19.9 per cent) peaked in spring (130 cases, 29.6 per cent). A critical 10°C temperature threshold effectively separated severity categories with high predictive accuracy.

Epistaxis demonstrates opposing seasonal patterns by clinical severity with distinct weather correlation profiles. Emergency departments should prepare for winter volume surges during cold, humid periods, whilst specialist ENT services require enhanced spring capacity during moderate temperature conditions.