HPV self-sampling has the potential to improve early detection of cervical cancer among women living with HIV (WLHIV), but its acceptability varies, creating implementation challenges, especially in sub-Saharan Africa. This study aims to assess the acceptability of HPV self-sampling among WLHIV. We searched PubMed, Web of Science, CINAHL, Academic Medical Ultimate, Cochrane databases, and Google Scholar. The review protocol was registered with PROSPERO (CRD42022299781). Inclusion criteria were based on population, intervention, comparison, and outcome. Statistical analysis was done with R Studio version 4.3.2, and data abstraction was performed in Microsoft Excel. The analysis included 14 studies on the acceptability of HPV self-sampling among WLHIV. The overall acceptability rate was 73%. The pooled data showed that 94% felt comfortable with self-sampling, 72% found it easy to use, 10% reported pain, 14% felt embarrassed, and 41% felt confident about the process. The study found that a majority of WLHIV accepted HPV self-sampling, a higher rate than in the general female population. Many participants had concerns about the method's efficacy. This indicates that while WLHIV generally views self-sampling positively, additional education and support are needed to improve their confidence in its accuracy and reliability.

Background: Colon capsule endoscopy (CCE) is increasingly used as an alternative to optical endoscopy (OE), particularly in Europe. However, challenges like low completion rates, inadequate bowel preparation, high conversion to OE, and discrepancies in findings remain. Accurate polyp size measurement in CCE is essential to avoid unnecessary procedures due to size overestimation.

Objective(s): This retrospective study analysed real-world data to compare polyp size measurements between CCE, OE, and histopathology (HP) and assess the impact on the need for further procedures.

Methods: Data from 2508 participants across 12 UK centres were analysed, with 4898 polyps identified via CCE. Polyps were matched with OE and HP reports based on size, location, morphology, sequence, and count, including those meeting ≥3 criteria. Regional data from Scotland and England were compared.

Results: Half of the CCE patients required follow-up OE, with 29 % undergoing colonoscopy. Among these, 32 % required OE for polypectomy, and 18 % due to incomplete CCE. In these cases, CCE overestimated polyp size by an average of 2.5 mm compared to HP and 2.7 mm compared to OE, leading to 17.3 % of potentially deferrable procedures.

Conclusion: one in six participants had a further procedure reflecting the overestimation of polyp size. AI advancement could enhance polyp measurement accuracy and reduce unnecessary procedures whilst improving the cost-effectiveness of CCE.

Background and objective: Uncertainty regarding the diagnostic accuracy of ultrasound for testicular torsion (TT) and a lack of high-level evidence to inform international guidelines have led to significant global variation in its use. The objective of this study was to assess the diagnostic accuracy of ultrasound for TT.

Methods: This systematic review was undertaken in accordance with the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A comprehensive electronic search strategy was applied up to January 4, 2024. Colour Doppler sonography (CDS) was the primary index test, with surgical scrotal exploration or clinical follow-up as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the risk of bias and applicability. Meta-analyses were performed using bivariate models.

Key findings and limitations: Sixty-three studies met the inclusion criteria; 54 (85.7%) assessed CDS, and the others assessed spectral doppler sonography (n = 6), contrast enhanced ultrasound (n = 1), or an alternative combination of ultrasound technologies (n = 2). The summary sensitivity (95% confidence interval [CI]) and specificity (95% CI) of CDS for the diagnosis of TT were 95.3% (91.4-97.5) and 98.3% (96.2-99.3), respectively (42 studies, 4422 participants). Patient selection (related to the risk of bias and applicability concern) was identified as the domain of the greatest methodological concern on QUADAS-2 assessment.

Conclusions and clinical implications: CDS has high diagnostic accuracy for TT. The ideal patient pathway for suspected TT should integrate timely access to ultrasound alongside clinical assessment, with careful patient counselling.

Background/ Introduction: Around 80% of breast cancers are oestrogen receptor positive (Cancer Research UK, 2023). Endocrine treatment is given to these patients that may cause menopausal type side-effects. In the last year 338 patients were diagnosed with oestrogen receptor positive breast cancer requiring endocrine treatment in our hospital. It is known that menopause can have a great impact on quality of life (BMS, 2021). Intolerability to endocrine treatment was the reason for setting up a clinic and is a field of breast cancer treatment that is often neglected without patient support.

Objectives: This systematic review aimed to identify and categorise racial bias in healthcare and education; evaluate their impact on healthcare practitioners, students, and patients; and explore strategies to reduce these biases and improve health equity.

Method: A systematic review was conducted following PRISMA guidelines to investigate racial bias in healthcare and healthcare education. Databases searched included PubMed, Cochrane, EMBASE, and CINAHL. Identification of additional papers was completed by employing backward and forward snowballing techniques. Rigorous interprofessional multi-reviewer screening and data extraction processes were performed. Thematic analysis was conducted inductively and collaboratively refined, with disagreements resolved through discussion and a third reviewer confirming resolutions as an additional quality assurance measure.

Results: From an initial pool of 1634 records, 45 studies were included in the final review. The studies employed various designs, primarily cross-sectional, with most conducted in the United States of America. Five themes emerged: disparities in healthcare access and/or provision, perceived discrimination and/or medical mistrust, provider bias and/or stereotyping, disparities in education and training, and healthcare literature disparities.

Conclusions: The findings suggest significant racial disparities across multiple medical specialties, including maternal and infant healthcare, chronic disease management, and emergency care. The review also highlights the underrepresentation of racial minorities in medical imagery and educational materials, contributing to implicit bias and inadequate training for healthcare providers. Overall, the five identified themes appear interconnected, forming a self-reinforcing cycle of racial bias in healthcare and education.

No abstract available

Ultrasound contrast agents (UCAs) are microbubbles comprising an inert gas core stabilized by an encapsulating shell, which serves to increase the signal-to-noise ratio of blood-to-tissue in diagnostic ultrasound imaging. More recently, research has investigated the use of UCAs to combine both diagnostics and therapeutic outcomes in an amalgamated approach, designated 'theranostics.' Two examples of theranostic based approaches include the use of super-resolution imaging with ultrasound localized microscopy (ULM) and ultrasound-mediated drug delivery (UMDD). Both ULM and UMDD have been shown to have the potential to improve both patient care and clinical outcomes. Currently, there are 4 commercially available global UCAs licensed for clinical use. The physico-chemical properties of each of these UCAs influence its potential theranostic efficacy. Because of differences in their composition and/or manufacturing processes, each UCA has different characteristics that contribute to different in vivo resonance behavior, which in turn influences their effective clinical applications. This review highlights the key physico-chemical characteristic differences of the 4 commercially available contrast agents, with specific emphasis on their gaseous core, shell composition, and microbubble volume distribution, while providing novel insights into their benefits for supporting emerging clinical technologies, specifically ULM and UMDD.

Background: Prehospital Extra-Corporeal Membrane Oxygenation Cardiopulmonary Resuscitation (ECPR) has the potential to improve survival from out of hospital cardiac arrest (OHCA). This study aims to estimate the potential caseload for an airborne ECPR service for refractory cardiac arrest in adults in North West England.

Methods: A retrospective analysis was carried out on cardiac arrest patients attended by The North West Air Ambulance Charity (NWAA) team, examining the time taken from the 999 call to emergency services, to team arrival at patient, this was used to create a mathematical model for travel times.Secondly, a retrospective review of cardiac arrest cases attended by The North West Ambulance Service (NWAS) was performed. Two sets of criteria were applied to examine if prehospital cardiac arrest patients would be eligible for ECPR; a locally defined set (LIC), and an in-hospital criteria (AIC). Combined with our travel time model, we estimated the number of patients the service might see.

Results: Time taken for the NWAA team to reach cardiac arrest patients was given by the formula y = 0.2237x + 20.135 and there was a moderate linear distance and time correlation. 85 and 78 patients per annum would have been eligible, using the LIC and AIC, respectively. Using an estimated 30% survival rate 21.6-23.1 lives could be saved annually.

Conclusion: The two different criteria produced similar estimates of caseload. An ECPR service in this region would expect to treat to 1.4-1.5 patients per week, depending on the criteria used.

Background: Early diagnosis of metastases is crucial but routine staging with contrast-enhanced multidetector computed tomography (ceMDCT) is suboptimal. A total of 20% will have indeterminate or too small to characterize (TSTC) liver lesions on CT, requiring formal characterization by magnetic resonance imaging (MRI). This UK cross-sectional study reports our experience undertaking routine abbreviated liver MRI (MRI).

Patients and methods: A total of 99 patients with rectal cancer had ceMDCT, abbreviated liver MRI, and rectal MRI at diagnosis. Liver imaging was scored for liver metastases, benign or indeterminate/TSTC lesions on a per patient basis. Primary rectal cancer was risk scored on MRI.

Results: A total of 42/99 (42%) had liver lesion(s) on ceMDCT versus 55/99 (56%) by MRI, and 46/99 (46%) had high-risk rectal cancer. ceMDCT showed 5 patients with liver metastases, 14 with benign lesions, and 23 with indeterminate/TSTC lesions. MRI showed 6 with liver metastases, 45 with benign lesions, and 4 with indeterminate/TSTC lesions. All liver metastases were in high-risk rectal cancer, OR 17.18 (p = 0.06), with 12.5% conversion rate of TSTC lesions to metastases in high-risk rectal cancer and 0% in low-risk rectal cancer. Diagnostic certainty of the liver findings was achieved in 93% of patients by MRI compared with 45% by ceMDCT (p < 0.0001).

Discussion: Abbreviated liver MRI diagnosed fewer indeterminate/TSTC lesions and provided greater diagnostic certainty than ceMDCT, p < 0.0001. High-risk rectal cancer is associated with a higher conversation rate of TSTC lesions to metastases than low-risk rectal cancers. Risk stratified; routine abbreviated liver MRI sequences should be investigated as part of the patient pathway for high-risk rectal cancer.

Background: Stroke is a major cause of mortality and permanent disability worldwide. Precise prediction of post-stroke mortality is essential for guiding treatment decisions and rehabilitation planning. The ability of Machine learning models to process large amounts of data, offer a promising alternative for improving mortality prediction in stroke patients. In this review, we aim to evaluate the risk of bias in different machine learning models used for predicting post-stroke mortality.

Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Relevant articles were retrieved from Cochrane Library, Scopus, PubMed, and Web of Science databases.

Results: A total of 9 studies were included, with an aggregate patient population of 669,424. Six studies used publicly available datasets, and four used hospital data with a follow up duration ranging from 7 days to 18 months. The range of area under the curve (AUC) for mortality prediction across the studies ranged from 0.81 to 0.95. All studies were determined to have a high overall risk of bias.

Conclusion: Machine learning models demonstrated great potential in predicting post-stroke mortality. However, implementation of these models in clinical practice is limited by high risk of bias. Future studies should focus on reducing this bias and enhancing the applicability of these models to improve the reliability of stroke mortality predictions.

Background: People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding QoL in dementia.

Aims: To conduct the first comprehensive systematic review of all studies that investigated efficacy of any pharmacological or non-pharmacological intervention for improving QoL of PwD.

Method: Our review team identified eligible studies by comprehensively searching nine databases. We completed quality assessment, extracted relevant data and performed GRADE assessment of eligible studies. We conducted meta-analyses when three or more studies investigated an intervention for improving QoL of PwD.

Results: We screened 14 389 abstracts and included 324 eligible studies. Our meta-analysis confirmed level 1 evidence supporting the use of group cognitive stimulation therapy for improving QoL (standardised mean difference 0.25; P = 0.003) of PwD. Our narrative data synthesis revealed level 2 evidence supporting 42 non-pharmacological interventions, including those based on cognitive rehabilitation, reminiscence, occupational therapy, robots, exercise or music therapy. Current evidence supporting the use of any pharmacological intervention for improving QoL in dementia is limited.

Conclusions: Current evidence highlights the importance of non-pharmacological interventions and multidisciplinary care for supporting QoL of PwD. QoL should be prioritised when agreeing care plans. Further research focusing on QoL outcomes and investigating combined pharmacological and non-pharmacological interventions is urgently needed.

Newborn babies are examined at around 6 to 72 hours after their birth to rule out major congenital abnormalities and reassure the parents that their baby is healthy. This practical text is a step-by-step guide for all practitioners who undertake this clinical examination. It is particularly valuable for midwives and nurses undertaking Examination of the Newborn modules as well as a useful reference work for those already performing this role. It provides midwives and other practitioners involved in neonatal examination with a comprehensive guide to the holistic examination of the newborn infant.

Examination of the Newborn encourages the reader to view each mother and baby as unique, taking into account their experiences preconceptually, antenatally and through childbirth. The text covers:

• the role of the first examination as a screening tool;

• normal fetal development;

• parents’ concerns and how to respond to them;

• the impact of antenatal diagnostic screening;

• the events of labour and birth;

• the clinical examination of the neonate;

• the identification and management of congenital abnormalities;

• accountability and legal issues.

This new edition is thoroughly revised throughout to meet current Nursing and Midwifery Council (NMC), General Medical Council (GMC) and National Screening Committee standards. It reflects the new standards and key performance indicators (KPIs) from Public Health England (2016b). Case scenarios, model answers, questions and further reading help the reader to apply the content to their own practice.