Extrapulmonary tuberculosis (EPTB) poses a significant diagnostic and economic challenge in HIV endemic, low-resource settings due to its complex presentation and current diagnostic tools limitations. While accurate and timely diagnosis is critical for reducing morbidity, mortality and health system costs, economic evaluations of EPTB diagnostics remain sparse and fragmented. This protocol aims to map existing evidence on the economic evaluation of diagnostic innovations for EPTB in low-resource settings.

This scoping review protocol follows the Joanna Briggs Institute (JBI) methodological framework and registered on the Open Science Framework. Peer-reviewed articles, grey literature and official reports published between 2000 and 2025 will be searched in PubMed, MEDLINE, Google Scholar, Scopus and Science Direct. The search strategy is structured using the Population, Intervention, Comparator, Outcome, Time, Study design and Setting (PICOTSS) framework, and will be peer-reviewed using the Peer Review of Electronic Search Strategies (PRESS) guideline. Study selection, data charting and extraction will be performed independently by two reviewers. Data will be charted iteratively, and the methodological quality of selected economic evaluations will be appraised using the Drummond checklist. Results will be synthesised in narrative summaries and tabular formats. Final reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline.

For review of previously published data, ethical approval is not required. Findings will be disseminated in professional networks, stakeholder meetings and a peer-reviewed journal.

OSF Registration DOI 10.17605/OSF.IO/BTCPG

Staphylococcus aureus (S. aureus) bacteraemia is a common and severe infection. With mortality rates ranging from 20–30% and long-term impairments in over a third of survivors, better treatments are urgently needed. Linezolid, a well-established treatment for pneumonia and complicated skin infections, has been shown in preclinical studies to strongly suppress S. aureus virulence factors critical to bacterial persistence and tissue damage. Hence, we aim to investigate whether the addition of linezolid to standard therapy in patients with S. aureus bacteraemia leads to an overall improvement in patient-relevant outcomes.

We will conduct a two-arm, parallel-group, multicentre, randomised controlled trial (Linezolid Plus Standard of Care) in 12 hospitals in Switzerland with blinded treating physicians, patients and outcome assessors. Hospitalised patients aged ≥18 years with S. aureus bacteraemia will be eligible. Patients will receive standard antibiotic treatment as prescribed by the treating physician. Within 72 hours of collection of the blood sample yielding the first positive blood culture, patients will be enrolled and randomised 1:1 to receive either adjunctive linezolid (600 mg orally two times per day for 5 days) or placebo. To determine patient-relevant outcomes, we implemented a comprehensive patient-representative consultation process. Consequently, we will use the desirability of outcome ranking (DOOR) established for S. aureus bacteraemia as the primary outcome at 90 days. The hierarchical composite DOOR outcome includes the following four components, ranked from most to least important: (1) survival, (2) return to level of function before S. aureus infection, (3) complications leading to treatment changes and serious adverse reactions; and (4) hospital length of stay. This approach will allow us to analyse the win ratio, that is, whether patients receiving linezolid have a better DOOR rank compared to patients in the placebo group. We calculated a target sample size of 606 patients providing 90% power at a two-sided significance level of 0.05.

Ethical approval was received from the Ethics committee for Northern and Central Switzerland (BASEC number 2025-00655). Eligible patients will be informed about the study by the local study team and asked for written consent if they wish to participate. For patients unable to provide informed consent, an appropriate substitute (ie, a close relative or a physician not involved in the research project) may make decisions based on the presumed wishes and the best interest of the patient. The patient’s own consent will be obtained as soon as their condition permits. Results will be published in peer-reviewed journals and in laymen's terms through various channels (social media, Swiss national portal HumRes).

NCT06958835.

To examine the risk of severe cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD) across different time periods following COPD exacerbations and the incidence rate of cardiopulmonary events in a real-world setting in China.

Retrospective cohort study.

Regional electronic health records database from Yinzhou District of Ningbo City, China.

A total of 14 713 patients aged ≥40 years with a first COPD diagnosis between 1 January 2014 and 1 March 2022.

The risk of severe CV events (ie, hospitalisation and a primary or secondary discharge code for acute coronary syndrome, heart failure decompensation, cerebral ischaemia, arrhythmia and CV-related death) during different exposed time periods following a COPD exacerbation, the incidence rate of overall cardiopulmonary events (ie, severe exacerbation of COPD, all-cause mortality, inpatient CV events, inpatient ischaemic stroke and inpatient tachyarrhythmia/atrial fibrillation) and the incidence rate stratified by COPD exacerbation history.

We included a total of 14 713 patients. During a median (IQR) follow-up of 2.8 (4.0) years, 20.1% experienced severe CV events. Compared with the unexposed period, the risk of severe CV events was the highest in the first 10 days following a COPD exacerbation (adjusted HR 10.00, 95% CI 8.16 to 12.25). The risk of severe CV events decreased over time but remained significantly elevated up to 90 days post exacerbation. We found that 32.7% of COPD patients experienced cardiopulmonary events, with a crude incidence rate of 9.38 (95% CI 9.09 to 9.69) per 100 person-years.

This study is the largest retrospective cohort study investigating CV and cardiopulmonary events among patients with COPD in China. Our findings highlight an elevated risk of CV events closer to the time of COPD exacerbations and show that nearly one-third of COPD patients experience cardiopulmonary events.

Visual impairment is reported to affect 40%–50% of children with cerebral palsy (CP). Vision difficulties in the context of rehabilitation are often under-recognised, under-treated and therefore under-studied, pointing to an urgent need for the development of evidence-based vision interventions for infants and toddlers with cerebral vision impairment (CVI). We present the protocol of a multisite pragmatic pilot randomised controlled trial (RCT) of feasibility, acceptability and preliminary efficacy of an early vision-awareness and parent-directed environmental enrichment programme for infants with or at risk of CP under 7 months corrected age (CA) with vision impairment.

The main objective is to determine the feasibility and acceptability of the Vision Intervention for Seeing Impaired Babies: Learning through Enrichment (VISIBLE) intervention. We will estimate the preliminary effects of the programme on infants’ visual functions and early development, as compared with standard community-based care (SCC).

A two-group RCT will be conducted. Infants at 3–6 months at entry, with severe visual impairment and at high risk of CP, will be enrolled and randomised (n=16 per group) to receive the VISIBLE intervention compared to SCC. Randomisation will be completed through an independent automated process (Research Electronic Data Capture). VISIBLE intervention will be delivered by a therapist through home visits (90–120 min) once every 2 weeks. Completion of 10 visits (80% of the intervention target dose) within 6 months is required for adherence to the VISIBLE trial. Outcome will be assessed at 12 months CA. Visual function will be evaluated with the Infant Battery for Vision, motor outcomes with the Peabody Developmental Motor Scales, Second Edition. Developmental quotients, infant quality of life, parent well-being and parent-infant relationship will be also monitored through standardised tools.

The enrolling sites have historically demonstrated rapid and effective translation of successful evidence-based interventions into routine clinical practice, as well as the dissemination of the findings through local, national and international scientific meetings.

ACTRN12618000932268.

Poor communication between healthcare professionals is one of the main causes of medical errors. Many articles about interprofessional communication (IPC) do not define what communication is and often describe it only as a domain of competencies of interprofessional collaboration. Three communication paradigms coexist: the transmission model, the transactional model and the constitutive model. These models focus on different aspects of communication and are complementary. No review about IPC, including all healthcare professionals or all healthcare settings, has been found.

A scoping review protocol was developed to map the research on the topic of IPC, the paradigms of communication used by the researchers, as well as to clarify the definition of this concept. We will follow the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Eligibility criteria follow the Population, Concept, Context framework. Articles about health professionals, allied health professionals and social workers and students in these fields will be included. Articles evaluating IPC in healthcare, either quantitatively or qualitatively, will be included. Articles investigating IPC in any type of healthcare setting in any country will be considered. All types of published articles in scientific journals will be included. The databases that were searched are MEDLINE, CINAHL, APA PsycINFO, EMBASE and Web of Science. In October 2025, 22 798 citations were retrieved, of which 9722 duplicates were deleted. Two researchers will then independently assess the remaining 13 078 citations against the eligibility criteria. This step is scheduled for completion in May 2026. They will then chart the data using a standardised data extraction tool.

Formal ethical approval is not required, as primary data will not be collected in this study. Findings of the scoping review will be disseminated through professional networks, conference presentations and publication in a scientific journal.

Because the study is a scoping and not a systematic review, registration was not possible on PROSPERO. The study was registered on Open Science Framework: https://osf.io/dyh2a.

Poor participant retention in randomised clinical trials, resulting in missing outcome data, can impact the validity, reliability and generalisability of results. While participants’ views on general non-retention issues have been reported elsewhere, a qualitative evidence synthesis specifically focusing on trial processes (ie, outcome data collection) impacting retention has not been undertaken to date. This is an important research question to inform targeted interventions to support retention. This review aims to address this by systematically searching and synthesising the evidence on participant reasons for trial non-completion, linked to outcome data collection.

We conducted a qualitative evidence synthesis of qualitative studies and mixed methods studies with a qualitative component, in Embase, Ovid MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Social Science Citation Index, Cumulative Index of Nursing & Allied Health Literature and Applied Social Sciences Index and Abstracts, up to February 2025. We used Thomas and Harden’s thematic synthesis approach. The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative framework was used to assess confidence in the review findings.

We identified 11 studies reporting qualitative data from 14 separate trials, with findings from 105 trial non-retainers. The studies were undertaken between 2007 and 2025.

There were three types of participant non-retention behaviours reported across the studies, where participants either: (1) missed at least one clinic visit; (2) did not complete a postal questionnaire or (3) did not complete online data collection. We developed four analytical themes outlining participant-reported influences on trial non-retention, specifically related to trial processes (ie, data collection for outcome measures): fluctuating health, balancing trial burdens, navigating life as a trial participant and managing expectations of participation.

This review generates important insights into participants’ reasons for trial non-completion linked to outcome data collection. The review highlights the need for further research into supporting trial recruitment discussions that provide clear, realistic expectations for potential trial participants, as well as strategies that recognise, and where possible, address some of the influences on participants to improve outcome data completeness and ultimately improve trial retention.

Despite its serious impact, anorexia nervosa (AN) remains one of the least understood mental illnesses, with significant gaps in effective treatment options. No medications have been deemed effective and only 50% of individuals respond to conventional psychotherapies. Gastrointestinal (GI) bacteria have been found to be altered in individuals with AN. While, Fecal microbiota transplantation (FMT) has shown potential for alleviating anxiety and depression, its effects remain understudied for individuals with AN. This study aims to determine whether oral capsular FMT is acceptable to adolescents with AN and results in clinical improvement in weight and/or psychological symptoms.

This study will randomise 20 adolescents with AN, ages 12–17 years, to receive either FMT or placebo capsules. These 20 youth, as well as an additional 10 youth who decline trial enrolment, will participate in qualitative interviews. We will track recruitment rates and collect psychological and biological measures (blood, stool, urine and saliva) at multiple timepoints to assess how gut microbiota and their metabolites may influence the symptoms of AN. Interviews with participants and caregivers will explore their experiences and views on FMT as a treatment approach.

This study has received ethics approval by the Hamilton Integrated Research Ethics Board (#17493) and investigational drug approval by Health Canada (Dossier ID: c292423). Informed consent will be obtained by research staff from all participants. Findings will be disseminated through academic conferences, clinical forums and partnerships with advocacy organisations to reach clinicians, researchers and individuals with lived experience.

NCT06593366.

Deprescribing is important because inappropriate polypharmacy increases the risk of adverse drug events, treatment burden, reduced adherence and healthcare costs, while potentially compromising patient safety and quality of life. This study aimed to investigate the perceived barriers and enablers experienced by healthcare professionals (HCPs) in Indonesia regarding deprescribing in patients with type 2 diabetes (T2D) and polypharmacy.

A qualitative study using focus group discussions (FGDs) and thematic analysis.

Four FGDs were conducted with general practitioners, specialists (internists) and pharmacists from healthcare facilities in West Java Province, Indonesia. Each group included 3–4 participants from the same discipline, with one mixed group that included one participant of each profession. In total, 13 participants were included in the study.

HCPs across disciplines recognised the goals of deprescribing as optimising treatment, reducing polypharmacy risks and preserving treatment outcomes. However, implementation was hindered by the lack of clear guidelines, hierarchical dynamics, limited training and resource constraints, particularly in rural and high-volume settings. Enablers included clinical competence, effective communication, access to comprehensive clinical data and interprofessional collaboration. Patient education level, family support and community engagement were also key, underscoring the need for system-level support and shared decision-making to achieve effective deprescribing.

Deprescribing in T2D with polypharmacy is shaped by clinical competence, interprofessional collaboration, patient engagement and system-level resources. Improving practice in Indonesia requires clear guidelines, targeted HCP training, stronger interprofessional communication, better access to patient data and active involvement of patients and families. These strategies could provide context-specific insights to guide practice and policy on deprescribing initiatives.

766/UN6.KEP/EC/2024

To develop an empirically grounded, activity-based tariff framework for Hospital at Home (HaH) services using time-driven activity-based costing (TDABC) and micro-costing to support transparent and equitable reimbursement for acute elderly care delivered at home.

Microcosting study embedded within a randomised controlled trial (RCT) comparing HaH with conventional hospital admission in Denmark.

Three municipalities in the Central Denmark Region in collaboration with emergency department physicians at a regional hospital.

A consecutive subsample of 107 elderly acute patients enrolled in the RCT between June 2022 and February 2024. Resource use for HaH activities was measured prospectively using microcosting logs, time-motion observations and administrative records.

Empirically derived tariffs per HaH visit (first and subsequent) calculated using an eight-step TDABC framework incorporating process mapping, resource identification, capacity cost rates and time equations. Sensitivity analyses tested robustness to variation in key cost drivers.

The mean total tariff was 338.89 (95% CI 310.94 to 351.49) for first visits and 207.81 (95% CI 200.70 to 215.69) for subsequent visits, including treatment and transport components. Staff time was the principal cost driver, while equipment, overhead and travel reimbursement had smaller effects. The framework accommodates variation in staffing, geography and visit intensity and can be used to estimate total costs across diverse HaH pathways.

A transparent and reproducible tariff-development framework for HaH services was established using TDABC and microcosting. The model aligns reimbursement with actual resource use and care complexity and provides a transferable template for economic evaluation and operational planning.

NCT05360914.

Funnel plots are used to identify intensive care units (ICUs) with a higher than expected risk-adjusted mortality. ICUs with a standardised mortality ratio (SMR) within pre-defined control limits (often the 99.8% CL) are regarded as ‘in control’ and not labelled as a potential outlier for a particular calendar year. However, increased mortality rates not due to random fluctuations within and across the calendar years may be overlooked. We examined whether statistically significant and relevant differences in mortality over time between ICUs regarded as ‘in control’ are present.

A longitudinal register-based study.

88 ICUs in the Netherlands registering the admissions of all critically ill patients in the National Intensive Care Evaluation registry in the Netherlands from 2013 to 2023.

Hospital death analysed in a multivariable logistic regression analysis with a random intercept for ICU. The random intercept variance was translated to the median OR (MOR).

877 ICU-calendar year combinations were included, covering 759 498 unique admissions. The MOR increased from 1.12 (95% CI 1.10 to 1.15) for ICU-calendar year combinations with an SMR within the narrowest 95% CL (N=677) to 1.20 (1.17 to 1.24) for combinations with an SMR within the expanded 99.8% CL (including adjustment for overdispersion) (N=194) and to 1.21 (1.17 to 1.25) when including all ICU-calendar year combinations. Similar results were found for separate calendar years and separate diagnostic groups.

These results show differences in mortality between ICUs that were not labelled as outliers. Assessment of mortality performance should integrate cross-sectional funnel plots, the MOR and longitudinal trends in the SMR to better capture persistent patterns of excess risk.

With the proliferation of digital technology, the health sector, like other sectors of society, has increasingly adopted digital technologies, resulting in a dynamic landscape where the roles and impacts of digital health tools in different contexts are constantly evolving. This integration of digital technology into the health space has extended into the field of HIV prevention, ushering in new possibilities and challenges. However, review studies documenting the evolving use of digital health tools in HIV prevention are scant, particularly in regions with many low- and middle-income countries, such as in Africa, which have some of the highest HIV prevalence and incidence rates in the world.

This scoping review will follow the Joanna Briggs Institute (JBI) 2020 guidelines for methodological rigour and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Relevant published literature will be searched using a combination of keywords, Boolean terms and Medical Subject Headings in the following databases: CINAHL, Medline, Web of Science, Cochrane Library, Scopus, PubMed, WHO Digital Health ATLAS and Health Source with no date limits for the studies chosen. The Joint United Nations Programme on HIV/AIDS (UNAIDS) website and the reference lists of selected articles will also be used for backward searching, and Google Scholar will be used for forward citation tracking. The search strategy will be formulated following the guidelines provided by the Peer review of Electronic Search Strategies statement for peer assessment of electronic search strategies. Two reviewers will independently assess the references to ensure that they align with the predetermined eligibility criteria. Subsequently, the data from the included studies, published between January 2004 and January 2026, reflecting the period in which digital health innovations have rapidly expanded in Africa, will be extracted and any discrepancies resolved using a third reviewer. Thematic analysis will be used to analyse the data, and the findings will be reported using both tables and figures. The PRISMA-ScR will be followed to report this study’s results. Quality appraisal of the included studies will be done using the mixed methods appraisal tool V.2018.

This study does not involve human participants and only reviews existing literature in the public domain, and therefore ethical approval was not required. Our intention is to disseminate our research findings through a diverse range of channels, including peer-reviewed journals, conferences and webinars.

Metformin is the first-line treatment for type 2 diabetes mellitus (T2DM). Long-term use of metformin has been associated with vitamin B₁₂ deficiency, which may lead to serious complications such as anaemia and neuropathy. Although international bodies have recommended screening for vitamin B₁₂ deficiency in patients on long-term metformin, it is unclear how aware clinicians are of this adverse effect and to what extent such guidance is being followed in practice.

A scoping review was conducted using Joanna Briggs Institute (JBI) methodology. Databases searched included MEDLINE, Medical Literature Analysis and Retrieval System Online (PubMed), British Nursing Index (BNI), Google Scholar, Cochrane, Embase, Web of Science and CINAHL, Cumulative Index to Nursing and Allied Health Literature (EBSCO) alongside searching for grey literature such as EThOS (Electronic Theses Online Service), DART (Digital Access to Research Theses) European and Kings College London Research Portal. Studies published in English from 1990 onwards were included if they addressed clinician awareness or screening practices. Data were extracted and summarised using a structured tool, with themes mapped visually. The literature search was conducted between 1 August 2025 and 1 November 2025 and included studies published from January 1990 onwards.

23 sources were included in the review. 7 studies directly assessed clinician awareness of metformin-associated vitamin B₁₂ deficiency, all conducted outside the UK. Across 15 studies reporting screening practices, routine vitamin B₁₂ monitoring was uncommon, with annual testing rates in general below 20% of eligible patients (range 2.6%–19.8%). In a large retrospective cohort study of patients on long-term metformin, 44.9% underwent vitamin B₁₂ testing, with a mean delay of 990 days from treatment initiation. Screening was predominantly symptom-triggered rather than preventive, and older adults and other high-risk groups were consistently less likely to be tested. Reported barriers included lack of clinical prompts, competing priorities and testing costs.

Clinician awareness of the link between long-term metformin use and vitamin B₁₂ deficiency is present but inconsistently translated into practice. Screening practices remain suboptimal despite recent guideline updates. Interventions, such as checklists, prompts and updated training, may support improved adherence. However, no UK-based studies were identified, highlighting a gap in national evidence. Routine, risk-based screening in primary care could prevent significant morbidity associated with undiagnosed vitamin B₁₂ deficiency in this population.

Allergic rhinitis (AR) is a highly prevalent condition worldwide and imposes a substantial public health burden on adults. Although Traditional Chinese Medicine (TCM) therapies have shown potential therapeutic benefits in AR management, the lack of a standardised outcome evaluation framework limits evidence comparability and synthesis. Current studies commonly exhibit inconsistent outcome selection, heterogeneous measurement instruments and unclear assessment time points, reducing the applicability of findings to evidence-based practice and guideline development. Moreover, existing AR-related core outcome set (COS) studies generally target a broad population, with limited focus on adults (aged 18–75 years) and insufficient involvement of patients and other stakeholders. Therefore, this study aims to establish a standardised COS for clinical research in adult allergic rhinitis (COS-AR), with clearly defined outcomes, measurement instruments and recommended assessment time points. This COS-AR will provide a framework for outcome selection and measurement in clinical studies of TCM for adult AR.

The development of COS-AR will be conducted in four sequential phases: (1) A comprehensive review of randomised controlled trials and clinical trial registry entries related to adult AR from major domestic and international databases published between 1 January 2019 and 31 August 2025 will be performed. This phase will involve the systematic categorisation of all reported outcomes, including their definitions, measurement instruments and assessment time points. (2) An online survey will be administered to both clinicians and patients involved in AR management to identify outcomes considered most important by these stakeholders. (3) A modified Delphi process, consisting of two to three rounds of online surveys, will be conducted with over 100 key stakeholders to establish a COS. (4) One or two online consensus meetings will be convened with a representative group of 20–30 key stakeholders to reach final consensus on the outcomes, their definitions, measurement instruments and recommended assessment time points to be included in the COS-AR.

All activities conducted in this study have received ethical approval from the Medical Ethics Committee of Zhejiang Hospital (Ethics Approval Number: 2023 (9K)-X4). Written informed consent will be obtained from all participants prior to participation. The research findings will be disseminated through peer-reviewed publications and relevant academic and professional conferences.

China Clinical Trial Core Outcome Sets Research Centre (ChiCOS). Available at: https://www.chicos.org.cn/cos/1788748723768049665 (accessed 29 December 2025)

Self-injurious behaviour (SIB) consists of persistent, repetitive movements that can result in serious injury without suicidal intent. These behaviours are prevalent among children with neurodevelopmental disorders, including profound autism. Although many individuals benefit from currently available therapies, some exhibit treatment-refractory SIB that necessitates ongoing use of personal protective equipment and restraint, presumably due to stronger neurobiological drivers. We recently completed a phase I, open-label clinical trial demonstrating the safety, feasibility and preliminary efficacy of bilateral deep brain stimulation targeting the nucleus accumbens (NAc-DBS) in children with profound autism and severe, refractory SIB. The objective of the proposed study is to characterise the effectiveness of NAc-DBS in treating severe, refractory SIB in this unique and vulnerable population.

A single-centre, randomised double-blinded, crossover trial is proposed. Informed by the results of our pilot study, 25 subjects with autism spectrum disorder and severe, refractory SIB will undergo bilateral NAc-DBS. Following a 4-week recovery period, participants will be randomised to either group A (stimulation ON then OFF) or group B (stimulation OFF then ON). Each block will last 12 weeks, separated by a 2-week washout period. Following completion of the second block, all participants will enter a 6-month open-label phase with stimulation ON. The primary outcome is the difference in the Repetitive Behaviour Scale–Revised total score, between DBS-ON and DBS-OFF conditions. Secondary outcomes include measures of quality of life, caregiver burden, daily logs of SIB events and direct observation of SIB under structured analogues.

The proposed trial has been approved by the institutional Research Ethics Board (1000081171). Trial results will be disseminated through peer-reviewed publications and conference presentations.

NCT06529380

Guided by Straussian Grounded Theory, this study aimed to explore patients’ dynamic trade-off processes in evaluating bariatric surgery outcomes and to construct a patient-centred theoretical framework to inform clinical assessment and intervention.

Qualitative study using Straussian Grounded Theory, semi-structured, in-depth interviews were conducted. Data were analysed using open, axial and selective coding. Reporting followed the Standards for Reporting Qualitative Research guidelines.

This study was conducted at a tertiary hospital in China between June 2023 and August 2023.

A total of 11 patients who had undergone bariatric surgery were enrolled, aged 21–54 years, with postoperative follow-up durations ranging from 1 to 10 years.

A core category—Dynamic Trade-off Evaluation of Bariatric Surgery Outcomes—was identified, characterised by dynamism, trade-off and subjectivity. The framework comprises four inter-related components: trade-off basis, trade-off moderation, trade-off process and comprehensive evaluation. Outcome evaluation emerged as a non-linear process progressing through four stages: burden-dominant, contradiction-coexistence, contradiction-persistence and meaning-reconstruction stages. Individual goal orientation and psychological resilience served as key moderating factors shaping evaluative trajectories.

This study proposes a novel theoretical framework elucidating how patients dynamically evaluate bariatric surgery outcomes. By revealing stage-specific mechanisms and moderating factors, the framework provides a theoretical basis for improving preoperative expectation management and postoperative support.

To describe the normal heart rate (HR) of healthy newborns ≥35+0 weeks’ gestation in the first 10 min after caesarean delivery (CD) with extrauterine placental transfusion, using dry-electrode ECG (NeoBeat).

Single-centre, prospective observational study.

Norwegian County Hospital.

Newborns ≥35+0 weeks’ gestation delivered by CD under regional anaesthesia were eligible for inclusion. Newborns delivered by CD under general anaesthesia, or who needed medical intervention, were excluded.

NeoBeat was attached to the newborn’s chest immediately following delivery. The placenta was delivered without cord clamping after 60–90 s and transferred with the newborn to a resuscitation table. Modified physiology-based cord clamping (PBCC) was performed.

HR was recorded every second for 10 min. HR quartiles were calculated. Events possibly influencing HR were annotated using Liveborn Observation App.

89 newborns with a mean (SD) gestational age of 39+3 weeks (10 days) and birth weight of 3649 (536) g were included. Median (IQR) HR was 164 (117–176) and 169 (145–186) beats per minute at 20 s and 30 s, respectively, peaking at 169 (152–183) beats per minute at 4 min and then slowly decreasing to 157 (146–167) beats per minute at 10 min. HR was not significantly affected by intact-cord blood sampling (mean difference=5.4 (95% CI –1.4 to 12.1)), placental delivery (mean difference=0.7 (95% CI –3.5 to 4.9)) or cord clamping (mean difference =–0.6 (95% CI –2.1 to 0.9)).

This report describes, for the first time, HR quartiles for healthy newborns ≥35⁰ weeks’ gestation from 15 s to 20 s and up to 10 min after CD with extrauterine placental transfusion and PBCC.

To investigate the risk factors for primary non-central malposition of peripherally inserted central catheter (PICC) tip in neonates admitted to the neonatal surgical department, compare the malposition rates across different insertion sites in disease types, and explore whether different diseases affect PICC tip malposition.

A retrospective case–control study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

A 3A women’s and children’s hospital in South China (Guangdong Province).

A total of 558 neonates aged ≤28 days who underwent PICC insertion between January 2019 and November 2024 were enrolled. Neonates with congenital circulatory system malformations, incomplete clinical data and death or treatment withdrawal before tip positioning were excluded.

The primary outcome was the incidence of primary non-central PICC tip malposition confirmed by X-ray or ultrasound within 24 h after insertion. Secondary outcomes included comparison of primary non-central PICC tip malposition rates across different insertion sites and comparison of primary PICC tip malposition rates by insertion sites across different disease groups.

558 neonates were included in this study, including 460 cases with PICC tip in place and 98 with PICC tip malposition. In binary logistic regression analysis, the PICC insertion site was considered an independent risk factor (OR 2.908, 95% CI 1.748, 4.840, p

Medical staff can choose appropriate upper or lower limb veins for PICC insertion without worrying about the impact of abdominal diseases or thoracic diseases on non-central PICC tip malposition. PICC insertion via the head and neck veins should be performed with caution in neonates, as these sites carry a high risk of primary non-central tip malposition compared with other insertion sites.

Domestic sex trafficking is a major health and human rights concern associated with profound social, physical and psychological harms, including complex trauma. People who are being/have been sex trafficked often present to emergency departments (EDs) with unmet health needs and in contexts shaped by coercion, control and fear of authority. ED encounters represent an important setting for identifying sex trafficking, building trust, making referrals to specialised resources and facilitating an exit out of sex trafficking. This scoping review will explore the care experiences and processes for sex trafficked persons in EDs by synthesising existing evidence on the barriers and facilitators to providing high quality, equitable and effective emergency care. This review represents the first phase of a multi-stage study to develop quality indicators (QIs) for ED clinicians providing care for people experiencing domestic sex trafficking in Canada.

This scoping review will follow Arksey and O’Malley’s framework, as updated by Levac and colleagues, which consists of: (1) identifying a research question(s); (2) identifying relevant literature; (3) selecting studies; (4) charting/extracting data; (5) collating, summarising and reporting results; and (6) consulting with community partners. Five databases will be systematically searched to find scholarly, empirical studies describing emergency care experiences and processes for people being sex trafficked. Data will be extracted using a standardised charting tool developed by the lead author and research team.

Research Ethics Board (REB) approval is not required for this study as it involves an analysis of published literature only. Findings will be synthesised into a set of candidate QIs to be disseminated.

To describe the Knowledge–Attitude–Practices (KAP) of community pharmacy professionals regarding chemsex prevention in the Auvergne-Rhône-Alpes region of France, and to identify associated determinants.

Regional, cross-sectional, web-based, self-administered KAP survey collecting quantitative and qualitative data, analysed using multivariable linear regression and inductive content analysis.

Primary care, community pharmacies in the Auvergne-Rhône-Alpes region of France, February–March 2025.

Of the 276 respondents entering the survey, 261 community pharmacy professionals fully completed it. Inclusion criteria were: (1) age ≥18 years; (2) pharmacists, pharmacy technicians or students in training and (3) employment in a community pharmacy in the Auvergne-Rhône-Alpes region. Exclusion criterion was non-consent.

KAP domain scores derived from survey items; thematic categories identified through qualitative content analysis of open-ended responses; and factors associated with KAP scores.

Participants were predominantly female (69.6%), pharmacists (64.5%), aged 18–29 (41.7%) and working in urban areas (61.6%). Overall, 67.4% were able to define chemsex. Mean (SD) KAP domain scores were 13.8 (4.4) (range 3–27) for knowledge, 9.6 (2.9) (2–16) for attitudes and 9.6 (2.9) (5–16) for perceived resource adequacy/need. Qualitative analysis identified insufficient knowledge or training (28.7%) and the taboo and intimate nature of the topic (21.1%) as the main barriers to discussing chemsex. The most frequently suggested levers for improving care were professional training (57.1%) and broader prevention efforts (36.4%).

Higher knowledge scores were associated with more positive attitudes (p=0.015), male gender (p=0.004) and prior chemsex-related advice requests (p=0.027), while increasing age was negatively associated with knowledge (p=0.029). Positive attitudes were associated with urban practice settings (p

To explore existing qualitative research on patients’ experiences from the onset of symptoms to the diagnosis of sarcoma, with the purpose of identifying patient-perceived barriers at both patient and healthcare system levels and to highlight opportunities for improvement.

Systematic review of qualitative studies using thematic synthesis.

We systematically searched Medline [Ovid], Embase [Ovid], PsycINFO [EBSCOhost] and CINAHL [EBSCOhost] from database inception to 11 April 2025 for qualitative studies reporting sarcoma patients’ experiences during their diagnostic trajectory. The final search was conducted on 11 April 2025. All articles were screened against predefined inclusion and exclusion criteria and methodological quality was appraised using the Critical Appraisal Skills Programme qualitative checklist. Six studies conducted in Australia, the Netherlands and the UK were included. Data were analysed using a thematic synthesis approach guided by Thomas and Harden (2008). Confidence in the synthesised findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERqual) approach.

Four overarching themes emerged: patients’ experience and interpretation of symptoms, diagnostic pathways, healthcare system factors, and reflections and recommendations. Key contributors to delayed diagnosis were symptom normalisation, misattribution by both patients and healthcare professionals, limited continuity of care and communication challenges. These findings were consistent across multiple countries, indicating relevance and validity in many settings. Patients emphasised the importance of disease awareness, persistence of patients and coordinated care.

Diagnostic delays in sarcoma are influenced by both patient and healthcare systemic factors. Addressing these factors requires increased disease awareness among healthcare professionals and the public, improved coordination within the healthcare system, and targeted research to guide future interventions. This review provides cross-country insights into barriers to early sarcoma diagnosis, informing future priorities in clinical practice and research.

CRD420251030726.