Health Education North West

Objective To evaluate the current practice of diagnosing and managing Helicobacter pylori infection in children across UK centres and compare to European and North American Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)-North American Society For Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines. Design/method We conducted a retrospective, multicentre audit across nine National Health Service (NHS) trusts between April 2023 and June 2024 on stool antigen tests performed in children ≤16 years. Information collected included test indication, demographics, treatment regimens and follow-up. Practices were compared with international guideline recommendations. Further data were collected from one of the trusts with regards to symptoms when tests were performed, and primary care data were gathered from a single-practice retrospective audit. Results From over 1900 stool antigen tests, 249 (13%) were positive, with a mean age of the patients investigated of 9.6 years. Of the 249 positive tests, 209 (84%) were for initial diagnosis and 38 (15%) for eradication confirmation. Empirical eradication therapy was common; however, 88% of primary treatment and 60% of re-treatment courses deviated from ESPGHAN-NASPGHAN guidance, particularly in treatment duration. Follow-up stool antigen testing was performed in only 53% of initial diagnosis cases and 64% of eradication therapy cases, often outside the recommended timeframe. Symptom profiles varied between primary and secondary care referrals, but abdominal pain remained the most frequent indication for testing. Conclusion UK paediatric practice in managing H. pylori infection frequently diverges from international guidelines. The findings underscore the need for harmonisation of national guidance with international paediatric-specific recommendations and to improve clinician education in order to promote consistent, evidence-based care and responsible antibiotic use.

Abstract Introduction Surgical treatment of erectile dysfunction (ED), particularly inflatable penile prosthesis (IPP) implantation, is a key intervention for patients unresponsive to conservative therapies. Delivering this care efficiently within elective services is essential, especially as surgical backlogs and resource constraints challenge healthcare systems. Centralised tertiary centres often struggle with emergency care pressures, potentially impacting elective surgery throughput. This study evaluates theatre efficiency and patient outcomes in IPP surgery across two hospital models: a large tertiary centre and a dedicated elective “cold-site”. The standalone “cold-sites” were designed to deliver high-volume elective surgical care while being insulated from the demands of emergency care pressures. Objective To compare surgical delivery of inflatable penile prosthesis implantation and other andrology surgeries using theatre efficiency metrics between a tertiary and cold-site hospital setting, with emphasis on theatre utilisation, patient experience, and system-based delays. Methods A retrospective observational study analysed all full-day urology theatre sessions led by two high-volume andrology surgeons over two 18-month periods: Period 1 (Oct 2018–Feb 2020, tertiary centre) and Period 2 (Oct 2023–Feb 2025, cold-site hospital). These timeframes were selected to minimise COVID-19-related bias. Metrics included theatre utilisation, case volume, proportion of IPP/andrology cases, delays, cancellations, day-case rates, 30-day readmissions, and IPP-specific patient satisfaction scores. Results In Period 1 (tertiary centre), 71 theatre sessions were conducted with 202 cases and 67.3% being andrology-related. Theatre utilisation averaged 34.61%. In Period 2 (cold-site), 82 sessions were recorded with 340 cases, of which 79.9% were andrology procedures. Theatre utilisation improved to 81.2%, with a day case rate of 73.5%. Delayed starts occurred in 30 sessions (mean 21.8 minutes), and 19 sessions overran (mean 36.9 minutes). There were 32 on-the-day cancellations, and the 30-day readmission rate was 1.18%. Patient experience survey data for 61 IPP implantation patients during 2024 revealed strong satisfaction levels: * Pre-operative: 4.81 / 5 * Day of surgery: 4.73 / 5 * Post-operative: 4.58 / 5 These outcomes reflect a patient-centred care model enhanced by the cold-site's dedicated elective infrastructure. Conclusions Cold-site elective surgery delivery for erectile dysfunction, mainly IPP implantation, demonstrated markedly improved efficiency and patient satisfaction compared to a tertiary hospital setting. Higher throughput, better theatre utilisation, and reduced disruption from emergency pressures underpin these findings. The results support broader adoption of ring-fenced elective surgical pathways to improve access, efficiency, and patient experience in surgical management of erectile dysfunction. Disclosure No

With growing interest in applying artificial intelligence (AI) to population breast cancer screening, the evidence base has expanded rapidly. This systematic review aims to systematically review and summarise the published evidence on the use of AI in breast cancer screening. We conducted a systematic review of primary studies assessing AI for screening mammography, extracting test-accuracy metrics (sensitivity, specificity, recall and cancer detection rates) and workflow outcomes. We searched the Cochrane Breast Cancer Group Specialised Register, Cochrane CENTRAL, PubMed, Embase (Elsevier), Scopus, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from January 2012 to June 2025; we also screened reference lists of included studies and relevant reviews. No language restrictions were applied. Primary studies evaluating AI for screening mammography (digital mammography or digital breast tomosynthesis) in asymptomatic women, assessing AI as a standalone reader or AI-assisted radiologist workflows versus radiologists alone. Eligible designs included randomised trials, prospective paired reader studies, real-world implementation/registry cohorts, retrospective cohorts and multireader-multicase reader studies conducted in population-based or opportunistic screening settings. Key outcomes included diagnostic accuracy metrics (eg, sensitivity, specificity, Area Under the Curve (AUC) and/or programme metrics (cancer detection rate (CDR), recall/abnormal interpretation rate, positive predictive value, arbitration/workload). We excluded protocols, pilot/feasibility studies, case reports, editorials and studies without relevant accuracy or screening outcomes. Two independent reviewers extracted data and assessed risk of bias. Study quality was appraised with Quality Assessment of Diagnostic Accuracy Studies-2 and an AI-specific critical appraisal tool, and findings were synthesised narratively with stratification by study design and AI integration role. 31 studies met the inclusion criteria, encompassing randomised controlled trials, prospective paired-reader studies, registry-based implementations and retrospective simulations, representing more than two million screening examinations across Europe, Asia, North America and Australia. When used as a second reader or within double-reading workflows, AI generally maintained or modestly increased sensitivity (up to +9 percentage points (PP)) while preserving or improving specificity. Triage and decision-referral configurations delivered the greatest operational benefit, reducing reading volumes by 40-90% while maintaining non-inferior cancer detection when thresholds were conservatively calibrated. Stand-alone AI achieved AUC values comparable to radiologists and similar cancer detection in real-world, non-enriched cohorts, although interval-cancer follow-up remains incomplete in several datasets. In prospective randomised evidence, including the Mammography Screening with Artificial Intelligence trial (MASAI) trial, AI-supported screening achieved higher CDRs (6.4 versus 5.0 per 1000; p=0.0021) with stable or reduced false-positive and recall rates. Across implementation and simulation settings, integration of AI reduced radiologist workload substantially, with triage and band-pass approaches reducing the number of reads by approximately 40-90%. Overall certainty is limited by heterogeneity across study designs, reliance on enriched datasets for some accuracy estimates and incomplete interval-cancer follow-up in several major studies. Contemporary AI systems show diagnostic performance that is broadly comparable to radiologists and can substantially reduce reading workload, particularly when used as a second reader or triage tool. Emerging prospective evidence supports their safe integration in these roles, although transparent reporting, standardised evaluation and long-term population studies are still required before considering AI as a stand-alone reader. AI may improve workflow efficiency and possibly cancer detection, but definitive evidence on safety, especially interval cancer outcomes, remains essential.

Hand hygiene is one of the most significant components of standard infection control precautions. This study aimed to assess local hand hygiene technique and the effectiveness of an instructional video plus adding a seventh step to the Ayliffe technique. Adherence of practitioners to the six-step Ayliffe technique and its effectiveness were assessed using a lotion that shows areas not cleansed adequately under ultraviolet light. This was followed by a short instructional video plus an added step to improve cleansing of the dorsal hand. Technique was re-evaluated immediately and 3-4 weeks later. 43% of participants correctly performed all six steps of the Ayliffe technique during the initial assessment; this rose to 97% after watching the video. A majority (59%) of participants initially missed the dorsal hands, which improved to 13% at the third assessment. An instructional video is an effective tool for improving hand hygiene technique. Adding the seventh step to the Ayliffe technique improves coverage of the dorsal hand so will increase the effectiveness of hand hygiene protocols.

We present an uncommon case of atraumatic spontaneous renal hemorrhage in a 72-year-old woman with a background of atrial fibrillation on edoxaban who presented with a sudden onset of left abdominal pain, nausea, vomiting, lethargy, and dizziness. Cross-sectional imaging was performed and confirmed an ongoing renal bleed. She had a trial of conservative management; however, repeated imaging showed an ongoing, slow but active renal arterial bleed; hence, she underwent an embolization procedure. On-table angiogram revealed pseudoaneurysms in the upper and lower poles of the kidney, for which she underwent successful renal artery embolization.

The ejaculatory reflex consists of emission and expulsion, with the latter involving rhythmic muscular contractions that propel seminal fluid. Botulinum toxin, through its inhibitory effects, has been hypothesized to improve premature ejaculation (PE). This study evaluates high-quality evidence on botulinum toxin-A injections into the bulbospongiosal muscle as a treatment for PE. We conducted a systematic review and meta-analysis of randomised-controlled trials (RCTs) following PRISMA guidelines. Outcomes included intravaginal ejaculatory latency time (IELT), Premature Ejaculation Profile (PEP) scores, and complications. Data were analysed using Microsoft Excel and R. ROB-2, Eggers test, and GRADE assessed risk of bias, publication bias, and certainty of evidence (CoE). Three RCTs were eligible, and covered data from 228 patients with (1:1) randomisation into intervention and control arms (100 units of botulinum toxin-A in 10 mLs versus 10 mLs of 0.9% NaCl). IELT increases were noted with averages of 39.6, 11.5, and 2.4 s at 1, 3, and 6 months of follow up, respectively. Likewise, PEP scores demonstrated improvements of 1.54, 1.08, and 0.36 units at the same follow up intervals. however, statistical significance was not achieved in both outcomes of interest. Post-procedural complications were recorded in 11 patients (9.6%) with 10 in the intervention group. The majority of patients had voiding difficulties (n = 5) & mild erectile dysfunction (n = 4), however, all adverse events (AEs) were self-resolving and did not require active treatment. Given our findings, current high-quality evidence does not support using Botulinum Toxin-A in the management of PE. Larger scale & standardised RCTs are recommended to conclusively outline its clinical benefits.