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Publication Febrile Rash, Shock, and Hyperferritinaemia in A Young Woman: Navigating the Diagnostic Overlap of Hemophagocytic Lymphohistiocytosis, Toxic Shock, and Viral Exanthema(SMC Media, 2025-11-04) Srinivasaiah, Pavankumar Hulikere; Surabhi, Kasi Vishwanath; Surabhi, Kasi Vishwanath; Medical and DentalBackground: Fever, rash, and shock in adults pose diagnostic and therapeutic challenges. Markedly elevated ferritin often raises suspicion for hemophagocytic lymphohistiocytosis (HLH), yet hyperferritinaemia is also encountered in sepsis, adult-onset Still's disease (AOSD), and viral infections. Case report: We describe the case of a 27-year-old woman who developed a high fever, diffuse erythematous rash, hypotension, and markedly elevated ferritin levels. The initial differential diagnoses included toxic shock syndrome, HLH, AOSD, and viral exanthema. Extensive evaluations for infectious, autoimmune, and malignant diseases were negative. Imaging demonstrated gallstones with gallbladder wall inflammation, which was likely the trigger for the systemic inflammatory response. With supportive care and early multidisciplinary input, the patient made a full recovery without the need for immunosuppressive therapy. Conclusion: This case highlights the importance of contextualising ferritin elevation and maintaining a broad differential diagnosis. Serial laboratory trends, careful use of HLH scoring systems, and multidisciplinary collaboration prevented premature immunosuppression and ensured a favourable outcome. Learning points: Hyperferritinaemia is a useful biomarker but highly non-specific and must be interpreted within the broader clinical context.Serial trends in inflammatory markers and use of scoring tools such as the HScore guide safe decision-making in suspected hemophagocytic lymphohistiocytosis.Early multidisciplinary review helps prevent unnecessary immunosuppression and ensures timely supportive care.Publication WTP6.02 Assessing the Accuracy of Claude 3 Opus in Predicting Outcomes of Breast Multidisciplinary Team Meetings(Oxford University Press, 2025-09-28) Oliver-Blaney, Ciara; Badenoch, Thomas; Massey, Eleanore; Oliver-Blaney, Ciara; Badenoch, Thomas; Massey, Eleanore; Medical and DentalAims Multidisciplinary team meetings are key to providing optimal care to breast cancer patients. However, increasing caseloads and complexity have lengthened these meetings. Large language models (LLM) can efficiently process large amounts of information and respond with conversational prose (Gokul 2023). This study aims to evaluate the ability of LLMs, specifically Anthropic’s Claude 3 Opus, to accurately predict MDT outcomes within Breast MDT. Methods A prospective diagnostic concordance and validation study, assessing Claude’s ability to interpret clinical information and provide guideline-based recommendations for management. We will provide Claude with the same clinical information that is presented at MDT and prompt it to generate treatment plans based on current Association of Breast Surgery and National Institute of Health and Care Excellence guidelines. We will review and generate a concordance score comparing Claude’s output with the MDT decision, marked against critical elements of patient care and validated by the MDT. Results Preliminary results demonstrate that Claude outputs well-structured recommendations and signposts its use of the guidelines to justify its proposed treatment plans. In addition, its conversational nature enables it to provide clear clinical reasoning for decisions. We anticipate our results to demonstrate good concordance between Claude and actual MDT outcomes. Conclusion If LLMs such as Claude can generate accurate, guideline-based treatment plans, this could significantly reduce the time required to discuss each case at Breast MDT. This could allow the team to allot more time to discuss complex cases, resulting in enhanced overall patient care.Publication SP8.06 Assessing the Accuracy and Accessibility of Patient Correspondence Produced by Claude 3 Opus Using Breast MDT Decisions(Oxford University Press, 2025-08-28) Oliver-Blaney, Ciara; Badenoch, Thomas; Massey, Eleanore; Oliver-Blaney, Ciara; Badenoch, Thomas; Massey, Eleanore; Medical and DentalAims Breast cancer multidisciplinary team (MDT) meetings are vital to providing optimal patient care. Discussions are complex and produce patient-individualised treatments, which can be difficult to effectively translate into patient correspondence. Due to the ability to process complex information efficiently and respond with conversational text (Gokul 2023), large language models (LLMs) represent a potential aid for patient communication. This study aims to evaluate the accuracy and accessibility of patient letters generated by Claude 3 Opus using clinical decisions from the MDT. Methods Claude will be provided with Breast MDT outcomes and prompted to summarise the decision and generate a patient letter. The letters will be evaluated by two reviewers scoring against a rubric and generating qualitative feedback. Assessments will focus on accuracy, fluency and accessibility, using a readability test (such as automated readability index). Results Initial pilot outcomes demonstrate well-structured patient letters with clear summaries of intended treatment plans. Claude outlined clinical reasoning to justify MDT decisions and suggested specific lifestyle advice and guidance on self-monitoring between appointments. As conversational dialogue is a strength of LLMs, we predict strong performance with the use of coherent and patient-friendly language. Conclusion We expect our results to support the use of Claude to assist clinicians in writing patient communication. Expected advantages include streamlining the patient correspondence process and improving patient satisfaction. Despite anticipated results, we expect that using LLMs in this way should only enhance clinicians’ efficiency in written patient communication rather than replace this aspect of their role.Publication The role of RCP chief registrars in the COVID-19 pandemic response(Elsevier, 2021-03-31) Gaunt, Victoria; Sayer, Georgia; Bassett, Jacqueline; Ellis, Lucy; Gaunt, Victoria; Sayer, Georgia; Bassett, Jacqueline; Ellis, Lucy; Medical and DentalNo abstract availablePublication Re-Examining the idea of internal morality in medicine(Taylor and Francis Group, 2021-08-01) Ng, Christopher; Saad, Toni; Saad, Toni; Medical and DentalThis article considers the idea of medicine’s internal morality as it is understood by its various proponents. Although the use of the phrase ‘internal morality’ in relation to medicine predates Edmund Pellegrino, he can be credited with cementing its place in the vocabulary of medical ethics. Yet, while ‘internal morality’ and its related terms are now readily recognizable, they are used to denote irreconcilable ideas. Our aims, therefore, are to, firstly, clarify and, secondly, evaluate the different uses of ‘internal morality’, showing that there is little agreement on its definition. Thirdly, we argue that the terminology relating to ‘internal morality’ requires substantial revision, and that the term itself should be jettisoned. Finally, we briefly set out our own account of how morality should be understood in relation to the practice of medicine along similar but clearer lines to Pellegrino.Publication P125 The advancement of digital health technology in the outpatient setting, is speech recognition software useful?(Oxford University Press, 2022-04-23) Crawshaw, Helena; Jamal, Safwan; Andev, Rajinder; Crawshaw, Helena; Jamal, Safwan; Andev, Rajinder; Medical and DentalNo abstract availablePublication A comparison of in-person versus telephone consultations for outpatient hospital care(Elsevier, 2022-07-31) Crook, Rebecca; Iftikhar, Hina; Moore, Steven; Lowdon, Phillipa; Modarres, Pedram; Message, Simon; Crook, Rebecca; Iftikhar, Hina; Moore, Steven; Lowdon, Phillipa; Modarres, Pedram; Message, Simon; Medical and DentalThe SARS-CoV-2 pandemic has triggered a transition towards telemedicine for delivering outpatient care. The evidence base for telemedicine is heterogeneous and its efficacy remains debated. We, therefore, designed a mixed-methods semi-structured survey to evaluate patients' and clinicians' experiences of outpatient telemedicine clinics during the pandemic. One-hundred and eighty-eight patients and 69 clinicians from two hospitals in Gloucestershire completed the survey. The quantitative results for patients rated in-person and telemedicine appointments similarly in all areas except communication (p<0.001) and overall quality (p=0.004), both in favour of in-person consultations, while clinicians rated all aspects of telemedicine appointments as inferior, with the exception of convenience (p=0.643). Qualitative analysis highlighted themes of communication and relationship building difficulties, confidentiality concerns, loss of visual inspection as a clinical tool and debatable time efficiency associated with telemedicine. Significant adaptation of current telemedicine services is required before it will be integrated into current practice.Publication Enhancing Equity in a Widening Participation Scheme for School Students(SAGE Publications, 2023-11-21) Kirkham, Emily; Rozwadowski, Sophie; Wijeyaratne, Manuk; Ferris, Lisa; Bennett, Joanne; Coyle, Margaret; Kirkham, Emily; Rozwadowski, Sophie; Wijeyaratne, Manuk; Ferris, Lisa; Bennett, Joanne; Coyle, Margaret; Medical and Dental; Admin and ClericalObjectives: The Royal College of Surgeons (RCS) Diversity Review 2021 found that premedical school students from ethnic minority backgrounds were dissuaded from pursuing a surgical career. Gloucestershire is in the bottom 20% of disadvantaged counties; there is no widening participation (WP) scheme in the county. We implemented a fully inclusive WP scheme in Gloucester, with means of accessing virtual and face-to-face work experience, to enhance the equity of work experience. Methods: A three-stage project was conducted. Stage 1; two separate virtual Q and A sessions, to allow students to ask questions about life as a doctor. Stage 2; conversation between student and patient held virtually, to gain insight into working as a doctor to help determine whether medicine is the career for them. Stage 3; face-to-face work experience. Distribution sent to all 58 schools (state and private) in the county, targeted at secondary school children. Results: One hundred twenty-nine people attended the Q and A; 70 feedback responses received. Of the total, 86% female and 56% of ethnic minority background. 26% did not have an immediate family member that attended university, 10% had care-giving responsibilities. Eighty-one percent rated the session >8/10 for usefulness. Twenty-seven undertook the virtual conversation, feedback from 11; 91% female, 45% of ethnic minority background, and 27% did not have an immediate family member that attended university. All rated the session 10/10 for usefulness. 10 attended the face-to-face experience, 50% from an ethnic minority background. Conclusion: The RCS Report identified barriers to aspiring students from less-privileged backgrounds pursuing a medical career. More needs to be done with WP schemes to promote equity. Targeted distribution of WP schemes to all schools, utilization of a variety of means of offering work experience, and accessibility to any school-aged student were aspects of our WP to improve exposure to the medical profession.Publication Investigating the Impact of Automation on the Health Care Workforce Through Autonomous Telemedicine in the Cataract Pathway: Protocol for a Multicenter Study(JMIR Publications, 2023-05-26) Khavandi, Sarah; Zaghloul, Fatema; Higham, Aisling; Lim, Ernest; de Pennington, Nick; Celi, Leo; Khavandi, Sarah; Medical and DentalBackground: While digital health innovations are increasingly being adopted by health care organizations, implementation is often carried out without considering the impacts on frontline staff who will be using the technology and who will be affected by its introduction. The enthusiasm surrounding the use of artificial intelligence (AI)-enabled digital solutions in health care is tempered by uncertainty around how it will change the working lives and practices of health care professionals. Digital enablement can be viewed as facilitating enhanced effectiveness and efficiency by improving services and automating cognitive labor, yet the implementation of such AI technology comes with challenges related to changes in work practices brought by automation. This research explores staff experiences before and after care pathway automation with an autonomous clinical conversational assistant, Dora (Ufonia Ltd), that is able to automate routine clinical conversations. Objective: The primary objective is to examine the impact of AI-enabled automation on clinicians, allied health professionals, and administrators who provide or facilitate health care to patients in high-volume, low-complexity care pathways. In the process of transforming care pathways through automation of routine tasks, staff will increasingly "work at the top of their license." The impact of this fundamental change on the professional identity, well-being, and work practices of the individual is poorly understood at present. Methods: We will adopt a multiple case study approach, combining qualitative and quantitative data collection methods, over 2 distinct phases, namely phase A (preimplementation) and phase B (postimplementation). Results: The analysis is expected to reveal the interrelationship between Dora and those affected by its introduction. This will reveal how tasks and responsibilities have changed or shifted, current tensions and contradictions, ways of working, and challenges, benefits, and opportunities as perceived by those on the frontlines of the health care system. The findings will enable a better understanding of the resistance or susceptibility of different stakeholders within the health care workforce and encourage managerial awareness of differing needs, demands, and uncertainties. Conclusions: The implementation of AI in the health care sector, as well as the body of research on this topic, remain in their infancy. The project's key contribution will be to understand the impact of AI-enabled automation on the health care workforce and their work practices.Publication Psychophysiological fidelity: A comparative study of stress responses to real and simulated clinical emergencies(Wiley, 2023-07-01) Peek, Russell; Moore, Lee; Arnold, Rachel; Peek, Russell; Medical and DentalIntroduction: Experiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real-world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real-world clinical practice. Methods: In this within-subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real-world emergencies in a 6-month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (SD) participant age was 33 (8) years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20 min after simulated and real-world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State-Trait Anxiety Inventory, respectively. High-frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings. Results: Simulation was associated with greater likelihood of threat appraisal and higher state anxiety. High-frequency HRV reduced from baseline in simulated and real-world emergencies but recovered further towards baseline 20 min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post-simulation debrief and feedback. Discussion: This study identifies important differences in psychophysiological stress responses to simulated and real-world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real-world clinical practice.Publication Improving 24-Hour Medication Reconciliation Through Audit and Feedback: A Multicycle Quality Improvement Study at a Scottish District General Hospital(Springer, 2025-05-20) Stanley, William; Falconer, Kate; Hume, Megan; Falconer, Kate; Medical and DentalIntroduction Medication reconciliation (MR) is a key patient safety process during hospital admission. MR ensures an accurate list of a patient’s medications is compiled on hospital admission, enabling safe downstream prescribing and reducing adverse events. This responsibility falls primarily to the admitting clinician in paper-based systems with limited pharmacy input at the point of admission. This study aimed to assess local compliance with the national benchmarks and evaluate whether a structured audit-feedback intervention could improve MR documentation and the recording of reasons for withholding medications. Methods This quality improvement project was conducted over four 1-week periods: an initial audit, a pre-intervention baseline, a post-intervention follow-up, and a reaudit 10 days later. The medical records and prescription charts of 305 acute admissions were reviewed within 24 hours of presentation. The primary process measures were (i) the proportion of patients with a documented MR and (ii) the proportion of withheld medications with a documented reason, recorded in the clinical notes, drug chart, or MR sheet. The intervention included personalized compliance feedback to admitting doctors and consultants, public recognition of high performers, and educational posters placed in clinical areas. Two-proportion Z-tests were used to assess significance. Results The proportion of patients with a documented MR increased from 55 of 73 (75.3%) pre-intervention to 50 of 65 (89.3%) post-intervention (p = 0.044), and further to 64 of 69 (92.8%) at reaudit (p = 0.0049). The proportion of withheld medications with a documented reason rose from 23 of 39 (59.0%) to 30 of 37 (81.1%) post-intervention (p = 0.036) and remained elevated at 35 of 44 (79.6%) during the reaudit (p = 0.041). The most commonly withheld medication classes were diuretics (n = 27, 14.5%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (n = 24, 12.9%), and statins (n = 16, 8.6%). The most frequent reasons for withholding were acute kidney injury or dehydration (n = 39, 27.8%), hypotension (n = 15, 11.5%), and medications deemed not indicated (n = 15, 11.5%). Conclusion A targeted, low-cost audit-feedback intervention directed at admitting clinicians significantly improved compliance with MR standards and the documentation of withheld medications. These findings suggest that, even in resource-limited, paper-based settings, behavioral strategies can deliver meaningful improvements in prescribing safety and move practice closer to national standards.