While health services leaders rely heavily on information gathered via environmental scans (ESs) to guide strategic decision-making, formal guidance on how to conduct these scans is notably absent. The purpose of this study was to determine the level of agreement on essential components of a definition and a methodological framework for ESs. The goals were to (1) advance our working definition to a concept definition for ESs and (2) develop a methodological framework to guide health service researchers conducting ESs.

We used a real-time, modified Delphi survey in a virtual platform setting to seek perspectives on statements related to ESs from individuals who were recruited based on having verifiable experience designing or conducting ESs in health services delivery research. Surveylet, an online software, was used to facilitate asynchronous data collection and to determine the level of agreement on the statements with an a priori threshold of 75% set for agreement on each statement.

21 panellists provided opinions on 59 statements related to a proposed ES definition and on 69 statements specific to components of a methodological framework for ESs.

Panellists from four countries participated in the survey representing 2 to ≥11 years of experience with ESs and having completed 1 to ≥7 ESs. Agreement was achieved in 28 of the 59 statements related to the ES definition and for 51 of 69 statements related to a methodological framework.

The agreement on many elements deemed essential for a definition of ES support development of a proposed concept definition of ES in health service delivery research. As well, the agreement on components deemed necessary for a methodological framework will help in future development of such a framework to guide stakeholders in the planning and implementation of ESs. These results provide a starting point for a common understanding of ESs in the field of health services delivery research.

To develop and validate a concise, physician-specific quality-of-life scale (Afya MedQol) Index, and to examine sociodemographic and occupational correlates of physician well-being in Brazil.

Nation-wide, cross-sectional, web-based survey employing split-sample psychometric validation: exploratory factor analysis, confirmatory factor analysis (CFA), multidimensional graded-response item-response theory calibration and post-stratification weighting to the 2025 Brazilian medical demographic census.

Physicians practising in all five Brazilian macro-regions and 27 state medical councils (2 July 2024–6 August 2024).

A total of 2005 fully responding physicians (56% women; mean age 38.5±12.6 years).

Domain scores—F1: Quality of Life, F2: Institutional Support, F3: Perceived Stress—and a Fisher-information-weighted global score. Convergent validity with WHOQOL-Bref; subgroup differences (Cohen’s d, partial ²).

CFA supported a three-factor, 13-item solution (Comparative Fit Index=0.987; Root Mean Square Error of Approximation=0.050) with strict invariance across sex and graduation-year quartiles. Item-response modelling showed marginal reliability =0.82. Convergent validity with WHOQOL-Bref domains was strong (r=0.55–0.73). Weighted mean (95% CI) scores were: Global 67.2 (66.5–67.9), F1 69.5 (68.9–70.2), F2 64.1 (63.4–64.8) and F3 62.5 (61.8–63.2).Women scored higher on Perceived Stress (F3) than men by 5.6 points (weighted mean difference 5.6, 95% CI 4.0 to 7.2; Cohen’s d 0.28). Physicians working ≥60 hours/week scored higher on Perceived Stress than those working ≤44 hours/week by 8.8 points (weighted mean difference 8.8, 95% CI 6.7 to 10.9; Cohen’s d 0.40). Well-being increased with income up to ~BRL 25 000 per month and plateaued thereafter.

Afya MedQoL Index is a psychometrically robust, 13-item instrument capturing personal, organisational and stress dimensions of physician well-being. Perceived Stress—shaped by workload, institutional climate and gender—was the most discriminative domain, while additional income beyond an upper-middle-class threshold conferred negligible benefit. Findings support policies aimed at capping duty hours, fostering ‘just-culture’ environments and expanding flexible work models.

To explore public perceptions of COVID-19 vaccine acceptance and hesitancy in India, and to identify underlying factors influencing attitudes toward vaccination during the second wave of the pandemic.

A cross-sectional qualitative study based on a grounded theory approach.

Community-based interviews conducted in Mumbai, a densely populated metropolitan city in India, during the second COVID-19 wave (April–June 2021).

Twenty purposively selected adults (men and women aged 22–87 years) from varied educational and occupational backgrounds. Inclusion criteria were willingness to participate and the ability to provide informed consent; individuals directly involved in COVID-19 vaccine policy or administration were excluded.

In-depth semi-structured interviews were conducted using an interview guide exploring perceptions of COVID-19 vaccination. Interviews were audio-recorded, transcribed verbatim and analysed inductively following grounded theory principles. Reflexivity was maintained throughout data collection and analysis.

Key emergent themes relating to vaccine acceptance, hesitancy and influencing factors such as safety concerns, efficacy perceptions, media influence and social determinants of vaccine choice.

Attitudes toward vaccination ranged from strong acceptance to hesitancy driven by concerns about safety, side effects and the speed of vaccine development. Media coverage, peer and healthcare professional opinions, and personal experiences shaped the decision of the participants. Cost considerations and lack of vaccine choice influenced uptake. Many participants favoured vaccination being voluntary rather than mandatory for the general population.

Trust in authorities, transparent risk communication and culturally sensitive engagement are critical to improving vaccine confidence. Public health strategies should address safety concerns, ensure equitable access and promote consistent messaging to enhance vaccine acceptance in current and future pandemic contexts.

There is a global rise in the burden of childhood obesity, increasing the risk of early onset adult obesity. Most developing countries face the double burden of malnutrition; overnutrition as overweight/obesity and undernutrition.

To determine the current burden and determinants of childhood thinness, overweight and obesity using national survey data.

Data from a cross-sectional survey conducted in 2022 were used.

Data from the seventh Demographic Health Survey conducted in Ghana were used.

The participants included 4417 children ≤59 months.

The seventh Ghana Demographic Health Survey in 2022 employed a two-stage stratified cluster sampling design, selecting 618 clusters to create a nationally representative sample. Weight and height were measured using the SECA 874U scale and Shorrboard, respectively. Children’s heights were measured recumbent (24 months). Multivariate logistic regression was used to assess the relationship between thinness and obesity, as well as the independent factors.

The outcome variable was obesity, determined by a WHZ of >+2SD.

The weighted prevalence of overweight/obesity and thinness in children under 5 years is 9.9% and 5.2%, respectively. Children who were overweight or obese had a mean age of 23.11 months, those who were thin or severely thin had a lower mean age of 21.02 months, and those with normal nutritional status were relatively older, with a mean age of 28.41 months. The Upper West, Northeast and Northern regions had the lowest densities of obesity. In the multivariate logistic regression model, children residing in Ashanti, Oti, Northern, North East and Upper East regions had significantly reduced odds of being obese compared with those in the Ahafo region. The average haemoglobin for those overweight/obese was 10.8 g/dL, and 10.7 g/dL for those who were normal and marginally reduced, 10.5 g/dL for those who were thin.

Regional disparities, maternal nutritional status, socioeconomic conditions and unsafe water sources were significant determinants of child nutrition outcomes. These findings call for targeted, multipronged interventions that integrate maternal-child nutrition, safe water, sanitation and regional context.

The ‘time-limited trial’ for patients with critical illness is a collaborative plan made by clinicians, patients and families to use life-sustaining therapies for a defined duration. After this period, the patient’s response to therapy informs decisions about continuing recovery-focused care or transitioning to comfort-focused care. The promise of time-limited trials to help navigate the uncertain limits and benefits of life-sustaining therapies has been extensively discussed in the palliative and critical care literature, leading to their dissemination into clinical practice. However, we have little evidence to guide clinicians in how to conduct time-limited trials, leading to substantial variation in how and why they are currently used. The overall purpose of this study is to characterise the features of an optimal time-limited trial through a rich understanding of how they are currently shaping critical care delivery.

We are conducting an observational, multicentre, focused ethnography of time-limited trials in patients with acute respiratory failure receiving invasive mechanical ventilation in six intensive care units (ICUs) within five hospitals across the US. Study participants include patients, their surrogate decision makers and ICU clinicians. We are pursuing two complementary analyses of this rich data set using the open-ended, inductive approach of constructivist grounded theory and, in parallel, the structured, deductive methods of systems engineering. This cross-disciplinary, tailored approach intentionally preserves the tension between time-limited trials’ conceptual formulation and their heterogeneous, real-world use.

This study has been reviewed and approved by the University of Wisconsin Institutional Review Board (IRB) as the single IRB (ID: 2022-1681; initial approval date 23 January 2023). Our findings will be disseminated through peer-reviewed publication, conference presentations, and summaries for the public.

NCT06042621.

Substance use among adolescent expectant mothers is a significant public health concern due to its adverse effects on both maternal and fetal health. Despite this, there is limited evidence regarding the patterns and factors influencing substance use among pregnant adolescents in Ghana.

This study aimed to explore the psycho-social and cultural factors that influence substance use among adolescent expectant mothers attending the antenatal clinic at the Upper East Regional Hospital in the Bolgatanga municipality.

A qualitative, descriptive exploratory design was employed. 17 adolescent expectant mothers were purposively recruited and interviewed using a researcher-developed semistructured guide. Interviews were audio-recorded, transcribed verbatim and analysed using a six-step thematic analysis guided by a deductive approach. The study was underpinned by the socioecological model, which allowed for the exploration of knowledge, social and cultural factors influencing substance use during pregnancy.

The study was conducted at the antenatal clinic of the Upper East Regional Hospital in Bolgatanga and involved adolescent expectant mothers attending the clinic.

Analysis revealed three major themes: knowledge of substance use, social factors and cultural factors influencing substance use. Participants demonstrated understanding of substance use, including its definition, causes and potential consequences. Social influences, particularly peer pressure and family dynamics, were reported as motivating factors for substance use. Cultural factors, including local beliefs, practices and community attitudes, also played a significant role in shaping substance use behaviours among these adolescents.

The findings indicate that while adolescent expectant mothers possess knowledge about the risks and consequences of substance use during pregnancy, many continue to engage in such behaviours. Peer and family influences, alongside cultural beliefs and community attitudes, were identified as key drivers of substance use. These results highlight the need for targeted, culturally sensitive substance use education and intervention programmes within antenatal clinics and the broader community to support adolescent mothers in reducing substance use during pregnancy.

Curable sexually transmitted infections (STIs) heavily rely on laboratory testing methods. Unfortunately, these diagnostic tools are infrequently used in certain regions of the country, which often results in suboptimal treatment for these infections. This study aimed to assess the prevalence of selected curable STIs among pregnant women.

Cross-sectional study.

The study was conducted in an antenatal care (ANC) unit in one of Southern Ethiopia’s general hospitals.

A total of 244 consecutive pregnant women attending the ANC follow-up were recruited for the study. All pregnant women have equal opportunity to participate; however, women who declined to be interviewed or give a sample were excluded. Pregnant women on antibiotic treatments were also excluded.

The study assessed the prevalence of selected curable STIs and associated factors. Neisseria gonorrhoea was diagnosed by culture, trichomoniasis by microscopic examination and syphilis by serological testing using a rapid diagnostic test cassette. Test results for trichomoniasis and gonorrhoea were obtained from vaginal and endocervical swabs. Factors associated with curable STIs were evaluated by bivariable and multivariate logistic regression.

The overall prevalence of curable STIs was 16.4% (40/244), with prevalence of 2% for gonorrhoea, 15.2% for trichomoniasis and 1.2% for syphilis. Alcohol intake (adjusted OR (AOR)=3.0; 95% CI 1.1 to 8.3; p=0.030), symptomatic treatment (AOR=3.6; 95% CI 1.4 to 8.6; p=0.004), residency (AOR=3.2; 95% CI 1.2 to 9.1; p=0.022) and pain while urinating (AOR=4.0; 95% CI 1.6 to 9.7; p=0.002) were all found to be associated with the existence of these STIs. This study has limitations; the cross-sectional study design and small sample size would provide limited information about factors associated with curable maternal STIs.

The study reveals a high prevalence of curable STIs among the participants, highlighting the need for further research aimed at improving their management during pregnancy.

To explore the experiences of different stakeholders on the balance of package training and deployment of highly skilled Human Resources for Health for specialised services in Tanzania.

An exploratory qualitative case study was used as part of a larger tracer study conducted by Muhimbili University of Health and Allied Sciences (MUHAS) for its postgraduate programmes being a requirement for quality assurance. Semi-structured interview guides were used for in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted to analyse the data.

The trace study was carried out in all seven geopolitical zones of the Tanzania mainland and Unguja in Zanzibar.

We conducted 14 FGDs and 301 IDIs. Participants included alumni, immediate supervisors at employment sites, MUHAS faculty, continuing students at MUHAS and management of professional councils in Tanzania.

Key findings revealed variations in demands and recognition within the scheme of services, even after registration by professional councils. Five main themes emerged from the qualitative interviews: Package training to improve service provision, Unprofessional collegial relationships or issues related to professionalism within interdisciplinary teams, Silence of scheme services on super specialisation in the medical cadre, Silence of scheme services on specialisation in the nursing cadre, Integrated scheme of services for specialties in pharmacy.

The findings highlight the demand for specialised training, challenges with professionalism and inconsistencies in the recognition and remuneration of specialists across medical, nursing and pharmacy cadres within existing service schemes. There is a need for harmonisation between specialisation/super specialisation and the scheme of services. This harmonisation is crucial to ensure the provision of quality healthcare services. Furthermore, harmonisation requires multistakeholder engagement to realise universal health coverage strategies.

Photobiomodulation (PBM) has shown promising effects in managing postoperative pain following conventional periapical surgery, although current evidence remains limited. This study aims to assess the effect of PBM on postoperative pain 24 hours after periapical surgery.

A randomised, controlled, double-blind trial will include 34 patients undergoing periapical surgery in the maxillary region, randomly assigned to an experimental group (n=17) or control group (n=17). The experimental group will receive PBM (GaAlAs diode laser, 808 nm, 100 mW, 4 J/cm², applied at five vestibular points) and placebo ibuprofen immediately and 24 hours postoperatively. The control group will receive simulated PBM and active ibuprofen. The primary outcome is postoperative pain assessed by the visual analogue scale at 24 hours. Secondary outcomes include pain at the seventh day, paracetamol intake, oedema, ecchymosis, soft tissue status and temperature at 24 hours and 7 days. Radiographic evaluation of healing will be performed at 1 and 3 months. Statistical analysis will be conducted based on data distribution, using repeated measures ANOVA (Analysis of Variance) or non-parametric equivalents for longitudinal outcomes, and appropriate tests for categorical variables. Significance will be set at p

The study was approved by the Human Research Ethics Committee of Universidad Católica del Uruguay (process no. 220914). Results will be disseminated to participants, healthcare professionals, the public and scientific communities.

NCT05935306.

Concussion is an acute injury that may contribute to short-term limitations and potential long-term risks.

To test whether a past concussion is associated with the risk of a subsequent serious motor vehicle crash.

Population-based longitudinal cohort analysis.

Ontario, Canada, from 1 April 2002 to 31 March 2022 (178 emergency departments).

Adults diagnosed with a concussion (cases) or an acute ankle sprain (controls), excluding individuals with a disqualifying illness (blindness, dementia, delirium), severe cases resulting in hospitalisation or those who died within 90 days.

Subsequent motor vehicle crash requiring emergency medical care.

We identified 3 037 028 patients, including 425 158 with a concussion and 2 611 870 with an ankle sprain. A total of 200 603 patients were injured in a subsequent motor vehicle crash over a median follow-up of 10 years, equal to an absolute risk of 1 in 15 patients (6.64 per 1000 patient-years). Patients with a concussion had a 49% higher motor vehicle crash risk compared with those with ankle sprain (adjusted relative risk=1.49, 95% CI 1.47 to 1.50, p

This study suggests a significant increased risk of a motor vehicle crash after a concussion that may justify a safety warning from clinicians.

To ascertain the clinical impact, prevalence and associated determinants of delayed treatment intensification, defined as delaying the escalation of treatment plans for individuals with type 2 diabetes mellitus who fail to attain ideal glycaemic control, at the University of Gondar Comprehensive Specialised Hospital in Northwest Ethiopia.

A mixed-methods study.

University of Gondar Comprehensive Specialised Hospital.

420 patients with type 2 diabetes mellitus with poor glycaemic control after the index date were included in this study. A simple random sampling technique was employed to select the required sample size. Data were collected retrospectively and entered into EpiData V.4.6 and exported to Stata V.14.2 for analysis.

Multivariable logistic regression was used to identify factors associated with delayed treatment intensification. A p value of 0.05 in the multivariable analysis was considered statistically significant. Qualitative data were collected through in-depth interviews with eight selected healthcare providers, and thematic analysis was undertaken to identify the underlying barriers to timely treatment intensification.

Delayed treatment intensification.

The prevalence of delayed treatment intensification was 51.4% (95% CI 46.6% to 56.2%), with a median delay of 14 months (IQR: 7.5–42 months) from the index date. Among those experiencing delayed treatment intensification, 43.1% developed new chronic diabetic complications, including retinopathy (18.1%), neuropathy (14.4%) and nephropathy (6.0%). Other complications (hypertension, stroke, heart failure and diabetic foot ulcer) accounted for 4.64% of the cases. Significant predictors of delayed treatment intensification included longer duration of diabetes (adjusted ORs (AOR) 1.68; 95% CI 1.13 to 2.5), presence of comorbidities (AOR 1.83; 95% CI 1.04 to 3.2) and use of cardioprotective medications (AOR 1.59; 95% CI: 1.04 to 2.43). The qualitative findings revealed additional barriers contributing to delayed treatment intensification, including financial limitations, insufficient patient awareness and non-adherence among patients. Additionally, healthcare provider-related factors, including professional fatigue and knowledge gaps, as well as health institution-related factors such as inadequate healthcare infrastructure.

This study found a high prevalence of delayed treatment intensification (51.4%), associated with comorbidities, longer disease duration, low patient awareness, cardioprotective drug use and barriers related to the system and providers. To address these gaps, priorities should include strengthening patient education, scheduling regular reviews for high-risk patients and improving clinical decision support tools for timely treatment intensification. Enhancing healthcare infrastructure, such as medication supply and diagnostic services, and offering refresher training to reduce provider fatigue, are also crucial for improving the delivery of diabetes care.

Antibiotic self-medication and home storage are two common behaviours that can result in inappropriate drug use. This study elucidated their prevalence and associated factors among university students in Vietnam.

Cross-sectional study.

Vietnam.

2230 university students.

Antibiotic storage was evaluated at the time of the survey, while self-medication was assessed for 1 year preceding this time. Associated factors were determined via multivariable logistic regression models.

Among 2230 participants, 418 (18.7%) reported self-medicating with antibiotics. The three main reasons for this behaviour included saving time (48.6%), mild diseases (45.0%) and the ease of purchasing antibiotics from community pharmacies (43.8%). Community pharmacies (88.3%) and home storage (36.4%) were the primary sources of antibiotics for self-treatment. Students mainly selected antibiotics based on community pharmacists’ consultation (59.8%) and their knowledge/experience (37.8%). They commonly read the patient information leaflet (64.6%) and asked for the community pharmacist’s advice to obtain information about antibiotic usage (52.9%). Besides, 296 students (13.3%) stored antibiotics at home. Over two-thirds had antibiotic leftovers from previous treatment and stored them for future use (69.3%), while 46.3% purchased antibiotics from community pharmacies without a prescription. Amoxicillin/clavulanic acid was the most commonly used antibiotic for self-medication (59.8%) and home storage (54.4%). Antibiotic self-medication was significantly associated with older age (adjusted odds ratio (aOR)=1.25; 95% CI 1.15 to 1.35), non-healthcare students (aOR=0.47; 95% CI 0.34 to 0.63), higher knowledge score (aOR=1.05; 95% CI 1.02 to 1.07) and storing antibiotics at home (aOR=7.12; 95% CI 5.34 to 9.51). Factors associated with home storage of antibiotics included non-healthcare students (aOR=2.77; 95% CI 2.01 to 3.83), region (north: aOR=6.50; 95% CI 3.49 to 13.54; south: aOR=5.92; 95% CI 3.06 to 12.65), having a family member working in the medical field (aOR=1.70; 95% CI 1.29 to 2.25), higher knowledge score (aOR=1.05; 95% CI 1.02 to 1.08) and antibiotic self-medication (aOR=7.58; 95% CI 5.69 to 10.14) (p values

The prevalence of antibiotic self-medication and home storage among students was relatively low but still raises public health concerns. Some interventions, such as integrating targeted health education programmes into university curricula, orientation sessions, extracurricular activities and campus campaigns, may help effectively promote rational antibiotic use.

The development of the target trial emulation (TTE) methodology has enhanced the conduct of non-randomised studies. By leveraging readily available routinely collected data, TTEs offer opportunities for complementing randomised controlled trials (RCTs), providing more precise estimates and improving the external validity of RCTs. To explore this potential, we selected a successfully completed RCT as a case study. In the FIRST-line support for Assistance in Breathing in Children (FIRST-ABC) step-up RCT, high flow nasal cannula (HFNC) was found to be non-inferior to continuous positive airway pressure (CPAP) in terms of time to liberation from respiratory support in the paediatric critical care setting. We will emulate the FIRST-ABC step-up trial using routinely collected data from the Paediatric Intensive Care Audit Network (PICANet) database.

This is a protocol for a TTE that will use longitudinally collected data from the PICANet database. The study aims to emulate the FIRST-ABC step-up RCT using an observational study design in a frequentist framework. We will benchmark the results against the published trial. The study will apply a new-user design by selecting children admitted to paediatric intensive care units that started HFNC or non-invasive ventilatory support (as a surrogate for CPAP). The eligibility criteria and selected outcomes will reflect those of FIRST-ABC within the constraints of the available routinely collected data. We will use advanced quantitative doubly robust methods to minimise the impact of confounding by indication and allow for heterogeneity according to child characteristics. The analysis will be repeated using a Bayesian approach for follow-up research.

The research received ethics approval from the London School of Hygiene & Tropical Medicine Research Ethics Committee. This study will expand the findings from the FIRST-ABC step-up RCT, providing additional insight from a large representative sample using real-world data. The frequentist and Bayesian approaches will enable a discussion about the advantages and drawbacks of the two strategies. The results will be disseminated to the research and clinical community and made accessible to the public. In addition, the study results will be used in future research, which aims to supplement RCTs with additional evidence from a TTE.

Surrogacy has become a vital reproductive option for individuals and couples who are unable to conceive naturally. This study explores the experiences of surrogate mothers in Ghana, focusing on recruitment pathways, eligibility criteria, societal stigma and postnatal care experiences.

Qualitative phenomenological research design was used, and data were collected through semi-structured interviews and analysed using thematic content analysis.

Three private agencies that source surrogate mothers for assisted reproduction facilities in Accra, Ghana. Data were collected between December 2020 and June 2021.

Twenty-one surrogate mothers aged 20–40 years who were either pregnant (gestational age ≥16 weeks) or had delivered within the past 2 years were recruited from three private agencies in Accra.

Thematic analysis generated four themes: (1) recruitment pathways into surrogacy, (2) eligibility criteria and assessments, (3) experiences of stigma and concealment and (4) postnatal care and recovery. These themes illustrate how surrogate mothers in Ghana navigate recruitment processes, psychosocial and medical evaluations, societal stigma and challenges with discharge and follow-up care.

These findings underscore the need for systemic changes, including enhanced postnatal care, structured psychological evaluations and culturally sensitive interventions to reduce stigma.

This study aimed to assess the psychosocial determinants of psychological distress among people with disabilities in Ethiopia.

A cross-sectional study was conducted at an institution from 01 to 30 May 2021, using a census sampling approach.

A total of 269 individuals aged 18 and older with disabilities were present at the University of Gondar in Ethiopia.

The Kessler psychological distress scale (K10), the multidimensional scale of perceived social support, the actual help-seeking behaviour and the stigma scale for chronic illness-8 were used to assess the dependent and independent variables, respectively. Binary logistic regression analyses were performed; a p value less than 0.05 was considered statistically significant at a 95% CI.

In this study, the prevalence of psychological distress was 34.6% with a 95% CI (29.40 to 40.10). Factors, such as older age (adjusted ß=1.09; 95% CI 1.04 to 1.15), low perceived social support (adjusted OR (AOR)=1.83; 95% CI 1.16 to 2.89), experiencing stigma (AOR=2.50; 95% CI 1.12 to 5.61) and cognition problems (adjusted ß=0.73; 95% CI 0.62 to 0.85), were significantly associated with increased psychological distress. Of the participants with psychological distress, professional help-seeking behaviour was 7.5%.

Psychological distress was notably high among individuals with disabilities, while professional help-seeking remained very low. This underscores the urgent need for targeted mental health interventions to reduce stigma, strengthen social support and improve access to appropriate psychological care.

This study aims to assess how implementing a checklist for managing extremely preterm or extremely low birth weight infants can reduce mortality rates and morbidities.

A quasi-experimental, before-and-after study.

Neonatal intensive care unit at Dr. Cipto Mangunkusumo National General Hospital, a national referral hospital in Indonesia.

86 infants were born at

Implementation of a modified Canberra Health Services extremely preterm-early management checklist during the initial management of extremely preterm or low birth weight infants, including humidified gas resuscitation, thermal management, early surfactant administration and standardised first-hour care protocols.

The primary outcome was the mortality rate. Secondary outcomes included comorbidities such as hypothermia, hypoglycaemia, acidosis, intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP).

A total of 86 extremely premature and/or extremely low birth weight infants were enrolled, 48 neonates prior to and 38 neonates after the use of the checklist. Baseline characteristics were comparable between groups (median gestational age 27 weeks in both groups, median birth weight 795 g vs 868.5 g, p=0.09). Mortality at discharge showed a non-significant reduction from 52.1% to 47.4% (p=0.664, 0.91, 95% CI 0.64 to 1.30). Significant reductions were observed in IVH (79.2% to 28.9%, p

Implementation of a systematic checklist was associated with significant reductions in IVH and ROP, though mortality reduction was not statistically significant. These findings suggest potential benefits of structured early care protocols, but the observational design limits causal inference.

Multiple sclerosis (MS) is a common autoimmune illness that causes inflammation, demyelination and neurological damage. Symptom relief and immunotherapy are part of the treatment, but several healthcare barriers significantly influence outcomes and quality of life.

This study aimed to assess different aspects among patients with MS, such as their knowledge of the disease, access to care, medications’ beliefs and depression, and to evaluate any correlations between these variables and their impact on the presence of depression.

A cross-sectional study was conducted from May 2024 to October 2024 at Al-Basheer Hospital, King Abdullah University Hospital (KAUH), Princess Basma Teaching Hospital and the Multiple Sclerosis Society of Amman. 200 participants were recruited after confirming consent. Data were collected through face-to-face interviews using validated instruments, covering sociodemographics, beliefs about medicines, knowledge about MS, access to care and levels of depression.

This study involved 200 patients with MS with a median age of 36 years, mostly women (70.5%), non-smokers (65%) and insured (77.5%). The majority had high education (58%) but low income (67%), with a mean duration of MS disease of 7.8 years after diagnosis. The majority (79.5%) were unaware of their MS type. Beliefs about medications varied, with 22% accepting, 48.5% ambivalent, 14.5% sceptical and 15% indifferent. Disease knowledge was high, with patients recognising MS as an immune, non-contagious and non-curable disease that affects women more than men. Despite good access to care, a percentage of patients needed to travel long distances for care. Depression affected 58% of participants, and it was influenced by access to care, concerning beliefs, income and education. Other variables such as gender, health insurance, the duration of the disease and the necessity of medications had no significant influence.

In conclusion, patients with MS deal with various challenges, such as difficulties in accessing care, associated with psychological factors such as depression. Addressing these barriers by optimising patients' beliefs about medications, enhancing access to care and focusing on the level of knowledge of the disease is crucial for ensuring better and optimal treatment outcomes, as well as decreasing the risk of depression development.

Paediatric hospitalisation, encompassing the period from admission to discharge, often involves feelings of pain, fear and anxiety, primarily due to clinical diagnoses and, more significantly, discomfort and stress-inducing procedures. Numerous methodologies and interventions have been investigated and implemented to alleviate these phenomena during paediatric hospitalisation. Virtual reality (VR), for example, has demonstrated efficacy in pain relief for hospitalised children in recent studies. This systematic review, therefore, aims to identify and evaluate the effectiveness of VR in alleviating pain, fear and anxiety in hospitalised children undergoing painful procedures.

This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. A systematic search will be conducted in March and April 2025 across the following databases, with no restrictions on language or publication year: PubMed, Embase, Scopus, Web of Science, Cumulated Index in Nursing and Allied Health Literature, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Eligible studies will include randomised and quasi-randomised clinical trials involving children (aged 2–10 years) and adolescents (aged 10–18 years) who received VR interventions during painful procedures. Data will be managed and analysed using Review Manager software (RevMan 5.2.3). In cases of significant heterogeneity (I² > 50%), a random-effects model will be employed to combine studies and calculate the OR with a 95% CI. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias 2.0 tool, and the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework.

This study will solely review published data; thus, ethical approval is not required. This systematic review is expected to provide subsidies, evidence and insights into the use of VR. It is also anticipated that the results will directly impact the improvement of care for these patients and the qualification of professional care.

CRD42024568297.

Millions of patients receive general anaesthesia every year with either propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA). It is currently unknown which of these techniques is superior in relation to patient experience, safety and clinical outcomes. The primary aims of this trial are to determine (1) whether patients undergoing (a) major inpatient surgery, (b) minor inpatient surgery or (c) outpatient surgery have a superior quality of recovery after INVA or TIVA and (2) whether TIVA confers no more than a small (0.2%) increased risk of definite intraoperative awareness than INVA.

This protocol was co-created by a diverse team, including patient partners with personal experience of TIVA or INVA. The design is a 13 000-patient, multicentre, patient-blinded, randomised, comparative effectiveness trial. Patients 18 years of age or older, undergoing elective non-cardiac surgery requiring general anaesthesia with a tracheal tube or laryngeal mask airway will be eligible. Patients will be randomised 1:1 to one of two anaesthetic approaches, TIVA or INVA, using minimisation. The primary effectiveness endpoints are Quality of Recovery-15 (QOR-15) score on postoperative day (POD) 1 in patients undergoing (1) major inpatient surgery, (2) minor inpatient surgery or (3) outpatient surgery, and the primary safety endpoint is the incidence of unintended definite intraoperative awareness with recall in all patients, assessed on POD1 or POD30. Secondary endpoints include QOR-15 score on POD0, POD2 and POD7; incidence of delirium on POD0 and POD1; functional status on POD30 and POD90; health-related quality of life on POD30, POD90, POD180 and POD365; days alive and at home at POD30; patient satisfaction with anaesthesia at POD2; respiratory failure on POD0; kidney injury on POD7; all-cause mortality at POD30 and POD90; intraoperative hypotension; moderate-to-severe intraoperative movement; unplanned hospital admission after outpatient surgery in a free-standing ambulatory surgery centre setting; propofol-related infusion syndrome and malignant hyperthermia.

This study is approved by the ethics board at Washington University, serving as the single Institutional Review Board for all participating sites. Recruitment began in September 2023. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media.

NCT05991453.

Osteoarthritis (OA) is a degenerative and progressive joint condition causing pain and disability. Physical exercise is recognised as the most effective intervention since individuals with this condition often experience muscle weakness, balance deficits and chronic pain. Additionally, knee osteoarthritis (KOA) is associated with central sensitisation, contributing to chronic pain conditions. Transcranial Direct Current Stimulation (tDCS), a non-invasive neuromodulation technique, has been employed to induce changes in pain perception by altering cortical excitability, potentially reducing chronic pain.

This is a protocol for a randomised controlled trial. Participants will be allocated to two groups: G1 (active tDCS combined with exercise) and G2 (sham tDCS combined with exercise). The intervention protocol will last for 5 weeks, with two sessions per week on non-consecutive days. Pain intensity will be assessed as the primary outcome using the Numeric Rating Scale (NRS). The sample size was calculated based on a minimum clinically important difference of 3 points on the NRS between groups, with a statistical power of 80% and a significance level of 5%. Secondary outcomes will include physical function and global perceived change.

This protocol was approved by the Research Ethics Committee of the Trairi School of Health Sciences, Federal University of Rio Grande do Norte (Approval Number: 6.801.827), and it is in accordance with the Declaration of Helsinki for human research. Results will be published in peer-reviewed journals and presented at scientific events. This trial is registered in the Brazilian Clinical Trials Registry.

Brazilian Clinical Trials Registry (RBR-5pb2g33).