Open access

Artificial Intelligence and Digital Therapy for Adolescent Mental Health in the UK; Opportunities, Barriers, and Ethical Consideration (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Adindu K.N.; Akubue N.; Jude N.O.; Onakoya A.; Chukwunonye C.; Odion O.; *Okengwu C.G.; Uchechukwu N.; Osita-Obasi P.Z.; Ezike A.; Bello I.; Olenloa E.; Eruteya O.O.; Oyewole S.A.

Citation:

SSRN. (no pagination), 2025. Date of Publication: 20 May 2025.

Abstract:

Background: Adolescence constitutes a critical developmental stage marked by the onset of mental health difficulties, yet timely access to effective mental health care remains a significant challenge for many adolescents in the United Kingdom (UK). Artificial intelligence (AI)-enabled digital therapies present innovative opportunities to address these gaps. Objective(s): This systematic review critically assesses current evidence on AI-driven digital interventions for adolescent mental health within the UK, highlighting their potential opportunities, barriers to implementation, and pertinent ethical considerations. Method(s): Employing a mixed-methods design, a systematic literature review adhering to PRISMA guidelines was combined with thematic analysis of semi-structured interviews. Comprehensive database searches (MEDLINE, PsycINFO, Web of Science; 2013-2023) targeted studies involving UK adolescents (ages 11-19) using AI-based mental health technologies. Included studies underwent rigorous quality appraisal (Cochrane RoB 2.0, ROBINS-I, CASP). Additional insights were gathered through stakeholder interviews (clinicians, AI developers, adolescent users). Result(s): Twenty-seven studies met inclusion criteria, investigating interventions such as AI chatbots, predictive analytics, mobile apps, and virtual environments targeting anxiety and depression. Key opportunities identified include enhanced accessibility for underserved populations, personalization through adaptive algorithms, proactive early-risk detection, scalability, cost-efficiency, and improved engagement via interactive interfaces. Significant implementation barriers encompassed technical infrastructure limitations, data security concerns, insufficient longitudinal efficacy data, socioeconomic disparities, and clinician scepticism. Ethical challenges emphasized informed consent, algorithm transparency, potential biases, unclear accountability, and clinician deskilling risks. Conclusion(s): AI-driven digital interventions offer substantial promise for augmenting adolescent mental health services in the UK. However, realizing their full potential necessitates addressing infrastructural, ethical, and evidentiary challenges through robust governance frameworks and continued rigorous research.

DOI: 10.2139/ssrn.5253224

Link to full-text [open access - no password required]

Carbapenem-resistant Enterobacterales across the UK: A nationwide study of carbapenemase testing and novel antimicrobial activity (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Baltas I.; Drury K.; Harrison T.; Moore N.; Lester R.; Chattaway M.A.; England B.; Cattrall J.W.S.; Donaldson C.J.; Jamal Khan D.P.; Carroll A.; Ball D.; Wareham D.W.; Pahalage R.; Banavathi K.; Drazho B.; Shorrocks R.E.; Hlaing W.; Adhikaree N.; Ryan F.; Thompson J.V.; Connolly G.; Shibu P.; Ale E.; Mirfenderesky M.; Jain S.; Fowler S.; Beard K.; Hughes G.; Bonnici G.; Mohammed T.; Brown K.; Drazich-Taylor S.; Martinez A.S.; Lipworth S.; Crawford-Jones D.; Elnour M.; Moore J.; Democratis J.; McCormick J.; Hussain A.; Islam J.; Jenkins D.; Stoesser N.; Hopkins K.; Demirjian A.; Hatcher J.; Soares A.L.; Kirby A.; Grandjean L.; Riley U.; Stephens J.; Joseph A.; Winzor G.; Jackson K.E.; Kandil H.; Barker B.; Planche T.; Jawad S.; Merrick B.; Snell L.B.; Subbaraj K.P.; Munthali P.G.; Clayton J.J.; Varghese R.; Jones C.R.; Hardman N.L.; Komosa M.M.; Heppell B.M.; Halstead F.D.; Qaiser S.; Mavrogiorgou E.; Nye C.; Bamber S.; Locke T.E.; Whatmore J.; Mohamed F.; Adobah E.; Knox K.; Campbell O.; Carson A.A.; North P.; Albur M.; Tickell-Painter M.; Mooney H.; Coward A.; Shah A.; Choudhury R.Y.; Sughayer H.M.; Graham C.; Mutch C.P.; Dewar S.; Hesing S.C.; Khan S.; Garcia-Mingo A.; Garcia D.M.; Penciu F.; Kosaraju K.; Davey E.; Vazquez A.M.; Qazzafi Z.; *Anand M.; Navalan H.; Roberts S.; Mermerelis D.; Read A.; Rangaiah J.; Austin-Hutchison R.; Price J.R.; Peters J.; Stevens M.; Knapper F.; Merchant N.; Davies F.; Vanstone G.L.; Allen D.; Prior-ong M.; Tuharska Z.; Soper I.; Tsui R.; Watts A.; Kakkar N.; Patel M.; Townsley H.; Saajan P.; Claxton A.P.; Burns P.J.; Jeppesen C.A.; Lee M.; Tudor A.; Macnaughton E.; McKeating C.; Dhillon R.; Okoliegbe I.; Sakka N.E.; Scott K.S.; Wang D.B.; Wilson B.; Laing-Herridge K.; Diver-Hall E.

Citation:

International Journal of Antimicrobial Agents. 67(10) (no pagination), 2026. Article Number: 107898. Date of Publication: 01 Oct 2026. [epub ahead of print]

Abstract:

Background Carbapenem-resistant Enterobacterales (CRE) are increasing in the UK, but the drivers of this rise and effective treatment options remain uncertain. Methods Ninety-seven acute National Health Service Trusts, including 192 UK hospitals, submitted data on 8840 consecutive, non-duplicate CRE (October 2023 to September 2024) and local laboratory methods. Results Predominant CRE species were Klebsiella pneumoniae (30.6%, 2709/8840), Escherichia coli (29.3%, 2592/8840), Enterobacter cloacae complex (22.2%, 1966/8840). Overall, 21.8% (1927/8840) of CRE were collected in outpatient settings. Overall, 85.5% (7279/8513) of CRE underwent carbapenemase detection testing, with significant variation depending on species, specimen type, and baseline antibiogram. Carbapenemases detected were OXA-48-like (22.3%, 1967/8840), NDM (18.6%, 1645/8840), KPC (9.2%, 817/8840), IMP (2.0%, 178/8840), VIM (0.7%, 62/8840), multi-carbapenemase producers (4.0%, 351/8840). Overall, 51.2% (4526/8840) of CRE were tested against >=1 novel agent. In-house antimicrobial susceptibility testing availability was common for ceftazidime-avibactam (90.7%, 88/97) and cefiderocol (73.2%, 71/97), while less common for meropenem-vaborbactam (41.2%, 40/97), imipenem-relebactam (21.6%, 21/97), aztreonam-avibactam (11.3%, 11/97). OXA-48-like- (97.6%, 1138/1166) and KPC producers (96.2%, 429/446) remained susceptible to ceftazidime-avibactam; KPC producers to meropenem-vaborbactam (99.4%, 160/161) and imipenem-relebactam (98.4%, 62/63). Cefiderocol resistance was 32.4% overall and higher among NDM- (58.4%) and multi-carbapenemase producers (50.3%). Ceftazidime-avibactam plus aztreonam synergy was performed for 17.2% (286/1658) of aztreonam-resistant metallo-beta-lactamase-producers; synergy was observed in 78.7% (225/286) of cases. Colistin resistance was 10.6% (153/1445) among non-intrinsically resistant species. Conclusions Whilst most UK CRE are tested for carbapenemases, coverage gaps persist. The community burden of CRE is increasing. Cefiderocol resistance is concerningly high, particularly among metallo-beta-lactamase-producers.

DOI: 10.1016/j.ijantimicag.2026.107898

Link to full-text [open access - no password required]

Understanding the Nuanced Concept of Hemodynamic Incoherence and Its Underlying Physiology (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Rola P.; *Miller A.; Haycock K.; Spiegel R.; Rikhraj K.; Kattan E.; Hernandez G.

Citation:

Journal of Clinical Medicine. 15(15) (no pagination), 2026. Article Number: 5811. Date of Publication: 01 Aug 2026. [epub ahead of print]

Abstract:

Hemodynamic incoherence is commonly defined as a dissociation between normalization of macrocirculatory variables and persistent impairment of tissue perfusion. However, this phenomenon is not physiologically homogeneous. We propose a conceptual distinction between two forms of macro-microcirculatory incoherence. Type 1 incoherence represents primary microcirculatory dysfunction, in which intrinsic alterations in microvascular regulation and flow distribution lead to heterogeneous capillary perfusion despite apparently adequate upstream hemodynamics, as observed in sepsis. In contrast, Type 2 incoherence reflects secondary impairment of microcirculatory flow resulting from hemodynamic constraints elsewhere in the circulation, including excessive vasoconstriction, limited cardiac forward flow, or venous congestion. In this setting, impaired perfusion arises from ineffective transmission of flow across the system rather than primary microvascular failure. The four-interface model of the circulation provides a unifying physiological framework to interpret these mechanisms as failures of energy transfer across sequential hemodynamic domains. Recognizing these distinct forms of incoherence may improve not only physiologic interpretation of shock and help avoid conflating fundamentally different mechanisms under a single conceptual entity, but also be key in individualizing therapeutic interventions to the proper phenotypes of tissue malperfusion

DOI: 10.3390/jcm15155811

Link to full-text [open access - no password required]

Variation in antenatal anaemia guidelines across the NHS in the United Kingdom: A cross-sectional study (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Haynes S.; Balboula I.; Collins P.; *Parry-Smith W.; Fye H.; *Elsmore A.; Collis R.; De Lloyd L.; Churchill D.; Bell S.F.; Stanworth S.J.

Citation:

British Journal of Haematology. (no pagination), 2026. Date of Publication: 2026. [epub ahead of print]

Abstract:

Antenatal anaemia affects up to 30% of pregnant women in the United Kingdom and is a recognised clinical priority. National management guidance is published by the British Society of Haematology (BSH), but the extent to which local National Health Service (NHS) guidelines align with it is unknown. We conducted a cross-sectional document analysis of antenatal anaemia guidelines from 49 NHS sites across the United Kingdom, obtained through two national research programmes. Two reviewers independently extracted data on screening, diagnosis, treatment and monitoring, using the 2020 BSH guideline as the national reference standard. The included guidelines represented approximately 33% of annual UK births. Screening and diagnostic haemoglobin thresholds were broadly consistent with BSH guidance, whereas substantial variation was concentrated in treatment and monitoring: oral iron indications, dosing and duration; haemoglobin thresholds and clinical criteria for intravenous iron; and the timing, biomarkers and response definitions used after treatment. Ferritin thresholds, reassessment intervals and response criteria were frequently absent or divergent. Variation was greatest in domains where the underlying evidence base is least resolved. These findings characterise the nature and extent of guideline-level variation across NHS maternity care and identify priority areas for future research and national guideline development.

DOI: 10.1111/bjh.70780

Link to full-text [open access - no password required]

Temporal Trends and Demographic and Geographic Disparities in Stroke Mortality Among US Adults Aged 25-64 Years (1999-2020): A CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Analysis (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Farahmandian, Ronit; Kananyan, Mariam; Alonso, Jorge E; Saro-Naenwi, Naomi; Ajibade, Tolulope; Kaurani, Purvi; Gudapati, Vamsi Krishna; Gomez-Sauceda, E Lucano; Clarke, Cleve; Arra, Srihitha; Imam, Bashir; *Gupta, Anchal R; Makkieh, Yahya.

Citation:

Cureus. 18(8):e113934, 2026 Aug.

Abstract:

BACKGROUND: Stroke remains a major contributor to mortality in the United States. Understanding long-term temporal changes and demographic and geographic disparities in stroke mortality is essential for identifying high-risk populations and guiding targeted prevention strategies.

METHODS: This retrospective observational study analyzed stroke mortality among US adults aged 25-64 years from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Deaths with stroke recorded as the underlying cause were identified using International Classification of
Diseases, 10th Revision (ICD-10) codes I60-I64 and were analyzed collectively as overall stroke mortality. Age-adjusted mortality rates per 100,000 population were assessed overall and stratified by sex, race, US Census region, and urbanization level. Joinpoint regression was used to identify temporal changes and estimate the annual percent change (APC) for each temporal segment and the average annual percent change (AAPC) across the complete study period.

RESULTS: A total of 382,253 stroke deaths were identified. The overall age-adjusted mortality rate (AAMR) decreased significantly from 1999 to 2012 (APC, -2.41%; 95% CI, -2.77 to -2.21), remained statistically unchanged from 2012 to 2018, and increased significantly from 2018 to 2020 (APC, 4.36%; 95% CI, 1.51 to 6.06). The full-period AAPC was -1.23% (95% CI, -1.42 to -1.11). Men had higher AAMRs than women and experienced a significant increase during 2018-2020. Black or African American adults had the highest race-specific AAMR, the South had the highest regional AAMR, and noncore counties had the highest urbanization-specific AAMR. Full-period AAPCs were significantly negative across all examined subgroups; however, significant later-period increases occurred among men, American Indian or Alaska Native adults, White adults, residents of the
West, large fringe metropolitan counties, and noncore counties.

CONCLUSION: Premature stroke mortality declined substantially over the complete study period, but progress was uneven across demographic and geographic groups. Persistently elevated mortality and recent reversals in selected populations highlight the need for targeted prevention and continued surveillance.

DOI: 10.7759/cureus.113934

Link to full-text [open access - no password required]

Impact of surgical timing on wound complications following ankle fracture fixation: A 22-year retrospective cohort study (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Zahra, Wajiha; Gomaa, Abdul-Rahman; Babatunde, Jubril; Seifo, Mina; *Cool, Paul; *Pickard, Simon.

Citation:

Journal of Clinical Orthopaedics & Trauma. 76:103405, 2026 May.

Abstract:

Background: Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections.

Methods: A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48 h), Intermediate (48 h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates.

Results: There was no significant association between surgical timing and the incidence of superficial wound infections (p = 0.274). However, a significant difference was observed in deep wound infection rates (p = 0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p < 0.001) and deep infections (p = 0.019). Patients over 60 years had an increased risk of superficial infections (p = 0.016) but not deep infections (p = 0.261). Superficial wound infections required longer hospital stay (p < 0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p < 0.001) and deep infections (p < 0.001).

Conclusion: In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections.

Level of evidence: IV.

DOI: 10.1016/j.jcot.2026.103405

Link to full-text [open access - no password required]

Consensus Statements on the Definition of Surgical Success Following Obstetric Urinary Pelvic Floor Fistula Repair: An IUGA-ICS Proposal (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Maljaars LP; Corcos J; Ghoniem G; Goh JTW; Greenwell TJ; Kupualor D; Pope R; *Rachaneni S; Regmi MC

Citation:

International Urogynecology Journal. 2026 Mar 18.

Abstract:

INTRODUCTION: Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries.

MATERIALS AND METHODS: A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement.

RESULTS: Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life.

DISCUSSION: The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of "incurable" fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective.

CONCLUSION: The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.

DOI: 10.1007/s00192-025-06413-6

Link to full-text [open access - no password required]

Correlation Between Cycle Threshold Value and CT Severity Score During COVID-19 Pandemic (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Udayakumar C.; M V.; Kumar K.; *Jayaram A.

Citation:

International Journal of Pharmacy Research and Technology. 16(1) (pp 391-397), 2026. Date of Publication: 01 Jan 2026.

Abstract:

Introduction: The novel SARS CoV-2 was declared as a public health emergency in January 2020. Patients infected with this virus show different severity of disease symptoms ranging from mild disease to that requiring intensive care and death. Therefore, it is important to have a test with the ability to predict the prognosis of patients at diagnosis and can aid in management decisions. Material(s) and Method(s): This study is a hospital based prospective observational study. The study includes the patients who are tested RTPCR positive within 72 hours of onset of symptoms. Patient who underwent Chest CT between 5th-7th day after the onset of symptoms were included in the study. Patients with RTPCR negative, RTPCR positive without Chest CT, asymptomatic RTPCR positive patients were excluded from the study. Viral RNA will be extracted by using extraction kits, and RTPCR performed in VRDL laboratory, SIMS, Shimoga. Using primers and probes targeting the RNA-dependent RNA polymerase (RdRp) gene fragment will be detected in the sample. A positive and a negative control were included in each run to generate a valid result. A Ct value of 15-35 was defined as a positive result. Computed tomography images of the chest will be obtained using 64 Slice Phillips CT machine. CT severity score will be calculated by looking for the presence of inflammatory abnormalities (like ground-glassopacities, mixed ground-glass opacities, or consolidation) in each lobe. Each lobe will then be awarded 0 to 4 points, depending on the percentage of involvement in each lobe: 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%), or 4 (76-100%. Total severity score will then be calculated with cut off being 7 for mild disease. Result(s): The mean age in the mild COVID-19 group was 49.52 years and in the moderate COVID-19 group was 51.84 years. The gender distribution showed that 68% (68/100) of the subjects were males while 32% (32/100) of them were females. On comparison of the haematological parameters, there was a statistically significant difference in the mean platelet count between the mild and moderate COVID-19 group (3.04 L versus 2.19 L, respectively, p-value=0.01). Among the biochemical parameters, a statistically significant difference between the mild and moderate COVID-19 groups were found in the following parameters- mean AST, mean ALT, mean D-dimer and mean serum ferritin. Conclusion(s): Viral load can be used as an early prognostic marker to assess severity. The utility of CT severity score, RT-PCR Ct value and other various clinical, radiological and immunological indices for supplementing the clinical diagnosis of COVID-19 cannot be overemphasized especially in a pandemic situation. CT chest severity score correlates with cycle threshold values in assessing severity of disease. However since the sample size is small further studies are required to prove the same.

DOI: 10.48047/ijprt/16.01.43

Link to full-text [open access - no password required]

National multi-specialty robotic surgery training curriculum and implementation for UK surgical residents: a delphi consensus (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Francis N; Shakir T; McLarty E; Haddad F; *Farquharson A; Garnham A; Siddiq S; Bannon A; Collins J; Yassin N

Citation:

Journal of Robotic Surgery. 20(1), 2026 Aug 29.

Abstract:

Robotic-assisted surgery is now established across multiple surgical specialties in the United Kingdom, yet training for surgical residents remains variable, resource-dependent, and insufficiently standardised at national level. This study sought multispecialty expert consensus on the essential components of a national robotic surgery training curriculum for UK surgical residents. A four-round modified Delphi study was conducted between September and December 2025 under the RaDaR network of the Royal College of Surgeons of England. Round 1 used open-ended questionnaires with independent dual-coder thematic analysis; Round 2 was a hybrid face-to-face and online meeting with live anonymous electronic voting; Rounds 3 and 4 were online questionnaires addressing statements not yet reaching the pre-defined consensus threshold of 70% agreement or greater. The panel comprised consultant surgeons, surgical trainees, curriculum and training authorities, and industry representatives with deliberately bounded, non-clinical input. 25 participants completed the final round. Of 26 statements, 22 (84%) reached consensus. A three-tier framework of device, basic skills, and procedural training was endorsed, with device training introduced during Phase 1 (76%) and basic skills and procedural training introduced after Phase 1 (96% and 88% respectively). Competency assessment integrated within the Annual Review of Competence Progression was supported (84%), alongside multi-source funding; trainee self-funding was not endorsed. This consensus offers a pragmatic foundation for standardising robotic surgery training for UK residents, contingent on coordinated investment in platform access, simulation infrastructure, and faculty development.

DOI: 10.1007/s11701-026-03864-x

Link to full-text [open access - no password required]

Obstetric Bleeding Study UK (OBS UK): protocol for a stepped wedge cluster randomised trial investigating the clinical and cost-effectiveness of a maternity quality improvement programme to reduce excess bleeding and need for transfusion after childbirth (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Kotecha S.J.; Potter C.; Hope-Bell J.; Riddell N.S.; Munnery K.; Onyimadu O.; Liberty C.; Taylor H.; Dop C.; De Lloyd L.; *Parry-Smith W.; Townson J.; Pallmann P.; Moody G.; Moriarty Y.; Deere R.; Barlow C.; Dhadda A.; *Elsmore A.; Willson S.; *Millward H.; *Siddall K.; Sanders J.; Stanworth S.J.; Black M.; Petrou S.; Rai T.; Slade P.; Hinton L.; Fye H.; Gur Geden A.; Collis R.E.; Collins P.; Bell S.

Citation:

BMJ open. 16(8) (pp e118723), 2026. Date of Publication: 20 Aug 2026.

Abstract:

INTRODUCTION: Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK. METHODS AND ANALYSIS: OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3-18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3-18 months) during which OBS PPH care will be delivered.The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation. ETHICS AND DISSEMINATION: OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants. TRIAL REGISTRATION NUMBER: ISRCTN17679951

DOI: 10.1136/bmjopen-2026-118723

Link to full-text [open access - no password required]