Healthcare workers (HCWs) have been disproportionately affected by the COVID-19 pandemic, both as carers and as patients. Many individuals developed persistent symptoms following an acute SARS-CoV-2 infection, known as post-COVID-19 syndrome (PCS). Previous research indicates that a significant proportion of HCWs experience long-lasting and debilitating symptoms of PCS. The aim of this study is to investigate the longitudinal symptom burden as well as the care pathways and treatment experiences of PCS-affected HCWs insured by the German Social Accident Insurance Institution for Health and Welfare.

The study uses a mixed-methods approach. The longitudinal survey will extend a cohort study of n=2436 HCWs (started in 2023) affected by PCS, adding two measurement points, set in 2025 (T₃) and 2026 (T₄). Additionally, interviews on care pathways and treatment experiences will be conducted with a subsample of n=60 PCS-affected HCWs. Another subsample of n=30 HCWs will be asked to participate in ecological momentary assessments of symptom burden, emotional well-being and coping strategies. Analyses of routinely collected data by the insurance company will complement the study data. The study is supported by an advisory board comprising PCS-affected HCWs who assist with the content of both qualitative and quantitative surveys.

This study was approved by the Local Ethics Committee of the University Medical Center Hamburg-Eppendorf, Germany (LPEK-0909, 1 May 2025; amendment: LPEK-0954, 18 September 2025). The results of the study will be presented at conferences and published in peer-reviewed journals.

https://drks.de/search/de/trial/DRKS00035957

Integrated care represents a transformative approach to delivering person-centred healthcare, aiming to reduce health inequalities, improve outcomes and boost system efficiency. The WHO advocates integrated care, which is also a central pillar of the UK government’s National Health Service (NHS) 10-year plan. However, there remains a significant evidence gap regarding optimal organisational strategies for designing and delivering integrated care services. Multiple long-term conditions (MLTCs) refer to the coexistence of two or more chronic physical and/or mental health conditions in a person. This complex need requires coordinated support from multiple healthcare services, and individuals with MLTCs may particularly benefit from integrated care services. This review aims to identify and synthesise evidence regarding the organisational structures (care set-up) and processes (care delivery) that support integrated care models for adults with MLTCs.

An information specialist and research team will co-develop a search strategy and search databases (MEDLINE, EMBASE and PsycINFO) for empirical articles between January 1990 and December 2025. Date restrictions reflect the establishment of integrated care as a concept for organising and delivering health services. Screening, data extraction and methodological assessment using the Mixed Methods Appraisal Tool will be independently conducted by two researchers. Eligible studies include any empirical studies, including all study designs that investigate adults (aged 18+ years) with MLTCs in high-income countries. This review aims to identify the way integrated care services are designed and delivered. As such, studies must identify and explain the organisational structures and processes involved in implementing and delivering integrated care services to be eligible for inclusion. Extracted data will be categorised according to the two integrated care mechanisms: vertical and horizontal integration. Data will then be examined in relation to how these mechanisms function and/or interact across the macro (system-wide structures and policies), meso (organisational arrangements) and micro (clinical practice and patient-level interactions) levels of integrated care. Review findings will be reported narratively.

Ethical approval is not required. This work may directly inform health policy by providing evidence-based understanding of how to organise and deliver integrated care for people living with MLTCs. The findings will be disseminated through publication in a peer-reviewed journal and shared with relevant stakeholders.

CRD420251143298.

To evaluate variation in nurse staffing ratios in intensive care unit (ICU) and medical-surgical units in Chilean public hospitals and the extent to which nurse staffing is associated with patient mortality and length of stay.

Cross-sectional.

Out of a population of 45 general high-complexity Chilean public hospitals, 43 participated in the study.

514 ICU and 1850 medical-surgical bedside nurses answered an online survey to provide data on their working conditions, including staffing. Patient outcomes were measured using the 2023 national discharge database from the Ministry of Health containing data from 344 567 adult patients admitted to an ICU or a medical-surgical unit.

Primary patient outcomes were mortality within 30 days after admission and length of stay. The association between nurse staffing and the primary outcomes was tested using mixed logistic regression models for mortality and mixed zero-truncated negative binomial regression for length of stay.

The analytical sample represented 95.6% of public Chilean hospitals. In the average hospital, ICU nurses cared for 3.0 patients at a time (range: 1.1–4.5); nurses on medical-surgical units cared for 10.1 patients (range: 6.9–13.6). Each additional patient in a nurse’s workload was associated with a statistically significant higher odds of death and longer length of stay in medical-surgical units (OR 1.043, 95% CI 1.042 to 1.043; incidence rate ratio 1.032, 95% CI 1.007 to 1.058, respectively) and higher odds of death in ICU (OR 1.12, 95% CI 1.112 to 1.128).

There is considerable variation in nurse staffing among Chilean public hospitals with negative consequences for patient outcomes. Regardless of the unit type, patients in hospitals where nurses care for more patients at a time are more likely to die; in medical or surgical units, they are more likely to have longer lengths of stay. Systematically reducing the numbers of patients in a nurses’ workload has the potential to decrease inequalities across the public healthcare system by decreasing preventable deaths and decreasing the length of patient stays to thereby improve access for patients on waitlists.

This project will establish a nationally consistent and ethically defensible approach to embed genomic testing in Australian primary care. Many non-genetic health professionals (eg, general practitioners (GPs) and other specialists) have limited experience with such testing. Current tests—both subsidised and consumer-paid—target a range of genes and conditions, making appropriate selection challenging. A structured implementation approach is therefore crucial. We will develop, test, refine and evaluate internationally relevant tools to support GPs and consumers in using genomics effectively.

Aims of the project are to (1) develop, implement and evaluate key supports for GPs offering tests through three interventions: primary health point-of-care resources, a practical guide to dealing with ethical issues affecting clinicians and established recommendations for a national approach for genetic counsellors to support GPs providing genetic testing; (2) develop and evaluate consumer resources and plan the implementation strategies; (3) evaluate real-world utilisation and equity of access to genetic testing in primary care using linked Medicare and population data.

This project will focus on two genomic applications recently made available in Australia on the universal insurance scheme (Medicare): a reproductive genetic carrier screen (an example of the role of genetics in reproductive testing) and genetic testing for familial hypercholesterolaemia (an example of a condition-specific test). Both tests can be complex for GPs to understand and explain to consumers and have potential implications beyond the purpose of the test (eg, personal health implications for carriers and results are also relevant to genetic relatives). Developing a robust clinical pathway and process for these tests will prepare GPs for future more complex applications of clinical genomics. The study will take place from January 2024 to December 2026.

Ethical approval for this work has been received from the Macquarie University Human Research Ethics Committee (Ref: 520241849560183) and the Royal Children’s Hospital Research Ethics and Governance (HREC/112451). Findings will be disseminated via publications, conferences and engagement with primary care networks and policymakers.

This study aimed to estimate the spatial accessibility of inpatient mental health services in Kerala, India. We also aimed to calculate bed-to-population ratios for these services for each district in the state.

We used a Geospatial Information System (GIS)-based travel time isochrone analysis to estimate potential spatial accessibility.

Kerala, India.

A list of all mental health facilities licensed to admit patients was obtained from data published by the Kerala State Mental Health Authority in 2025. The facilities were geocoded and mapped. Population data were also obtained using satellite-based estimates from 2020 at a resolution of 100 m. Information on Road Networks was obtained using OpenStreetMap through the OpenRouteService plugin in 2025.

We calculated the proportion of people who could access facilities within 15 min, 30 min and 45 min. We also calculated beds per population for each of the 14 districts.

Kerala has an average of 21 mental health beds per 100 000 people, ranging from 0.75 in Kasargod to 68 in Idukki. In terms of bed-to-population ratios, one district was ideal, three met the basic requirements, two experienced slight shortages, four faced moderate shortages and four encountered severe shortages. Across the state, 67.95% of the population could access psychiatric services within 15 min, increasing to 96.85% within 45 min.

GIS-based isochrone analysis indicated that 96.85% of the population could reach a facility by car within 45 min. Bed-to-population ratios varied substantially between districts.

To investigate the impact of patient-held medication records (PHMRs) on identifying and/or resolving medication discrepancies and other drug-related problems (DRPs) before, during or after care transition.

A systematic review and narrative synthesis.

Medline, Embase, PubMed, Cochrane via Ovid and CINAHL were searched from 1990 to 2025.

Any study design investigating the impact of PHMRs in isolation or in combination with other interventions on medication discrepancies and other DRPs was included.

Quality of studies was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. One reviewer screened the titles and abstracts, assessed full texts and extracted data from all papers with three additional reviewers collectively reviewing 10% at each stage.

A total of 31 studies were included: 13 reported data related to the impact of PHMRs on medication discrepancies, 10 on other DRPs and eight on both. 12 studies explored use of PHMRs integrated into routine clinical flows, with 10 showing that they contributed to the detection and resolution of discrepancies. Seven studies explored use of PHMRs enabling patients to independently complete reconciliation at home (eg, via patient portals). Five of these showed favourable findings in detecting and resolving discrepancies. The remaining two compared their use against standard medication reconciliation: one showed their non-inferiority, while the other favoured the standard process but noted similarities between them. 18 studies reported on other DRPs where PHMRs contributed to detecting and improving problems such as non-adherence (n=7), adverse drug events (ADEs) (n=4), therapeutic duplications or drug-interactions (n=3) and indication without medications (n=2). Two studies evaluating the rate of ADE (per patient) did not find significant findings.

PHMRs can engage patients in their medication safety and contribute to improving medication management. Further large-scale studies are needed to better understand their effectiveness as well as their unintended consequences.

PROSPERO registration number

(CRD42022309343) - An amendment was made to update the search end date.

Our aim was to compare the incidence and outcomes of civil legal cases in Canada involving international medical graduate (IMG) physicians to physicians who graduated from medical schools in Canada or the US.

We conducted a retrospective cohort study with multilevel, multivariate modelling of civil legal cases against physicians licensed to practise in Canada.

We used the Canadian Medical Protective Association’s national repository of medicolegal case data.

We extracted data on physicians’ demographic characteristics, geographical characteristics and undergraduate medical education.

Outcomes included physician medicolegal case rates (the number of civil legal actions a physician is involved in per year) and case outcomes (when a case proceeds and is either dismissed, settled or proceeds to trial). Our multilevel models examined associations between physician factors and the rate of civil legal actions and the distribution of civil legal outcomes.

The case rate model included 433 038 physician-year observations from 98 960 physicians (2015–2019), with 7657 civil legal cases (mean case rate per physician-year 0.0221; 98% had no cases). Case rates did not differ significantly between IMGs and Canadian/US graduates (p=0.0516). The case outcome model included 8046 cases (2016–2023). Unadjusted, cases favoured the plaintiff slightly more often for IMGs (39.1% vs 36.6%, ² (2, N=8046)=14.03, p

Our study suggests that where physicians receive their medical degree has no effect on their level of medicolegal risk in civil legal actions in Canada.

Proactive deprescribing is the process of stopping a medicine and comprises four steps: (1) identify a patient for potential stop of a medicine, (2) evaluate a patient for potential stop of a medicine, (3) stop a medicine and (4) monitor after stopping.

The CHARMER (CompreHensive geriAtRician-led MEdication Review) trial is a stepped-wedge design to evaluate the effectiveness and cost-effectiveness of a behaviour change intervention to increase proactive deprescribing in hospitals. The CHARMER intervention comprises a deprescribing action plan, deprescribing briefings, videos of successful deprescribing consultations, deprescribing case studies workshop and a deprescribing performance dashboard. The process evaluation will explore trial processes, CHARMER intervention implementation, CHARMER behavioural mechanisms of action and contextual factors influencing these aspects.

The convergent parallel design process evaluation will follow the UK Medical Research Council guidance. We will interview: staff involved in CHARMER implementation, geriatricians and pharmacists who receive the intervention and research delivery staff involved in patient/carer recruitment and data collection. We will also interview patients/carers and primary care practitioners. Interviews will be supplemented with recordings of implementation activities and completed implementation manuals. Questionnaires will capture the extent to which the four proactive deprescribing steps are enacted by intervention recipients, measure the behavioural mechanisms by which the CHARMER intervention operates and capture the patient experience of proactive deprescribing. Qualitative data will be analysed thematically and then mapped to Normalisation Process Theory to explore implementation and the Theoretical Domains Framework to explore behaviour change. Most quantitative data will be analysed descriptively; however, changes in staff questionnaire responses preintervention and postintervention will be analysed using a Mann-Whitney test. We will triangulate qualitative and quantitative findings to explain intervention effects.

Ethical and governance approvals have been obtained by the Wales 2 Research Ethics Committee and the Health Research Authority, respectively. The dissemination strategy will be underpinned by the evidence-based Guide to Disseminating Research (GuiDiR) targeting healthcare practitioners, policy makers and patient-facing organisations.

ISRCTN13248281.

Patient safety is crucial in healthcare, especially in home-based settings where unregulated environments and limited supervision pose unique challenges. With the expansion of home healthcare due to an ageing population and healthcare workforce shortages, there is a pressing need for tools to assess patient safety culture in this context. Current instruments, developed for hospitals, do not adequately address the specific dynamics of home healthcare, such as patient autonomy and caregiver involvement. This protocol outlines the development and validation of the Patient Safety Culture in Home Health Care Centers Instrument (PSCHCI), using a sequential exploratory mixed-methods approach.

This sequential exploratory mixed-methods protocol consists of three phases. Phase 1 fieldwork (semi-structured interviews with 15 participants, 3 participant observations and field notes) has been completed. Qualitative data are currently being analysed using conventional content analysis. The scoping review component of Phase 1 is planned but has not yet been conducted. Phase 2 (instrument development) is planned to include item generation from qualitative results followed by expert panel review. Phase 3 (psychometric evaluation), scheduled for late 2026, will employ a cross-sectional study to assess face, content and construct validity; reliability; interpretability; and feasibility. This phase features pilot testing (n=30–50), face and content validity assessment (n=10 each), test-retest reliability (n=15) and exploratory and confirmatory factor analyses (n=300–400).

Ethical approval was obtained from the Ethics Committee of Iran University of Medical Sciences. All participants will provide written informed consent. Confidentiality, voluntary participation and withdrawal rights are guaranteed. Findings will be published in peer-reviewed journals, presented at conferences and shared with participating home healthcare centres, policymakers and stakeholders.

Despite growing evidence and specific guidelines, people with knee and hip osteoarthritis often do not receive appropriate care. This review aims to identify healthcare utilisation and its predictors to optimise existing services and identify unmet needs across different healthcare systems using Andersen’s Healthcare Utilisation Model as a reference.

We conducted a scoping review and included studies published between 2010 and 2023 that assessed the healthcare utilisation in people with osteoarthritis. We examined general practitioner and orthopaedist consultations, physiotherapy, medication, hospitalisation and emergency department visits.

PubMed, Livivo, Cochrane Library, CINAHL Complete and Web of Science were searched from January 2010 until November 2023. An updated literature search was conducted in December 2025.

We analysed the included studies by means of thematic analysis and descriptive representation of quantitative data.

The literature search identified 4228 articles, of which 2380 articles were included in the title/abstract screening after excluding duplicates. After the full-text screening of 97 articles, we included 39 (n=4 233 566) publications for data extraction and data synthesis. Most studies were conducted in the USA, Australia, Germany and the UK—few from Asia, Middle and South America and other European countries. Utilised healthcare services are general practitioner consultations (mean use: 43% of participants, n=6), opioid (36%, n=8) and non-steroidal anti-inflammatory drug use (42%, n=7), emergency department visits (27%, n=3), orthopaedic surgeon consultations (26%, n=4), total joint replacement surgery (26%, n=3), physiotherapy (14%, n=8), hospitalisation (11%, n=7) and psychotherapy (6%, n=2). Among predisposing characteristics, older age, female gender, ethnicity, high socioeconomic status, social support and fear of certain treatment options were related to higher healthcare utilisation. In those, gender (n=8 studies) and age (n=6 studies) were primarily discussed. Regarding enabling and need factors, increased healthcare utilisation is associated with urban residence and being insured as well as having pain and comorbidities.

Results vary between countries. Against the background of existing guidelines, there is a need for promoting the utilisation of non-surgical and non-pharmacological treatments, such as physiotherapy, which have proven to be effective. Special attention should be given to predictors when promoting appropriate healthcare utilisation. Addressing the identified predictors associated with healthcare utilisation may lead to more appropriate osteoarthritis care. Further research is needed to address healthcare stakeholders’ (physiotherapists, insurers, patients and practitioners) needs and roles in the process.

Protocol registration on PROSPERO (CRD42023475803).

To update the rurality index for Japan (RIJ) using the most recent national data and to test and evaluate the updated RIJ variants that incorporate alternative distance metrics and a modified classification of remote islands, thereby providing methodological guidance for their use in research and health policy.

Nationwide methodological study.

Japan.

All postal code areas in Japan; analyses were aggregated into municipalities and secondary medical care areas for evaluation.

Six RIJ variants (‘RIJ family’) constructed by combining three distance metrics (direct distance, road-based distance and travel time by car) and two island classifications (original RIJ and modified RIJ), standardised to a continuous 0–100 scale using percentile ranks.

Concordance among RIJ variants was assessed using Spearman’s rank correlation coefficients, quintile reclassification matrices and rank-difference analyses; convergent validity was evaluated using the national physician distribution index. Criterion-related validity was assessed using municipal-level life expectancy for men and women.

All RIJ variants had extremely high concordance (Spearman’s ≥0.99 across all pairwise comparisons). Compared with the previous RIJ classification, >98% of the geographic units remained in the same rurality quintile and

Despite differences in distance metrics and island classification, all RIJ variants captured highly similar underlying dimensions of rurality and demonstrated comparable validity. These findings indicate that rurality measurement in Japan is stable regardless of methodological refinements, allowing RIJ variants to be flexibly selected according to specific research or policy purposes without materially affecting conclusions.

To develop and evaluate a standardised, fully automated assessment procedure for patient treatment preferences suitable for use in randomised controlled trials (RCTs) with remote or digital health interventions.

Multiphase developmental study followed by implementation in a fully randomised preference trial (FRPT).

University and outpatient cancer care settings in Switzerland; implementation in RCTs with a remote digital health intervention.

50 medical students for pilot testing; 11 patients with cancer for qualitative testing; 124 adult patients with cancer experiencing fatigue or sleep problems in an FRPT with a remote digital health intervention.

Primary outcome: feasibility and applicability of a standardised digital preference assessment procedure. Secondary outcomes: distribution and strength of treatment preferences, reasons for preference.

A procedure with three items for assessing treatment preferences was developed and refined based on pilot testing, stakeholder meetings and patient interviews. The stepwise procedure ensured that study participants with an initially unclear preference were finally able to report their preference. The majority of students (91.7%) indicated their preference already in the first assessment step. Similar in the RCT phase, 110 of 124 participants (88.7%) indicated their preference in the first step. Preference drivers included interest, perceived ease and conceptual appeal in addition to expected treatment benefits.

Our fully automated standardised preference assessment with three items appears feasible in trials with digital health interventions. Future trials with two active treatment conditions should consider implementation of such a preference assessment to evaluate non-specific treatment effects driven by the match of patients’ preferences with the respective treatment.

DRKS00035596; DRKS00035541; SNCTP000006209.

The overall aim of the present project is to increase healthcare professionals’ ability to ask about exposure and to identify individuals exposed to intimate partner violence (IPV). The project will evaluate the effects of three different interventions that can be assumed to increase healthcare professionals’ ability to ask and identify individuals who have been or are exposed to IPV.

This project has a quasi-experimental design. After a 2-month baseline period, participating care units (primary health centres, maternal health clinics and youth guidance clinics) will be assigned to one of three interventions to potentially increase the ability to enquire and identify patient exposure to IPV: (1) healthcare professionals’ use of a standardised questionnaire about exposure to IPV in patient meetings, (2) training through the use of a virtual patient case tailored to health professionals and (3) a combination of (1) and (2) earlier. Preintervention (baseline) and postintervention measurements of the health professionals’ enquiry and identification of patients exposed to IPV will be used to explore the effect of the interventions. Focus group interviews with the participating health professionals will be used as a qualitative method, applying thematic analysis, to explore which intervention they perceive as most effective in increasing their ability to identify victims of IPV.

Data analysis will focus on a comparison of pre- and post-measurements regarding the number of patients asked about and identified patients in each intervention arm that have been or are exposed to IPV. Measurements will be carried out per care unit at the group level. Qualitative data from focus group interviews will be analysed using thematic analysis.

All participants will sign a written consent form and the study has been approved by the Swedish Ethical Review Authority (Dnr 2023-03399-01). The study will be conducted according to good clinical practice and the Declaration of Helsinki. The results of this study will increase knowledge about how identification of violence in close relationships can be improved in the clinical setting through publications in peer-reviewed journals and presentations at national and international scientific conferences.

Recruiting since May 2024. Expected trial termination December 2026.

NCT06322251.

Gender, sex and ethnicity-sensitive approaches to psychosocial interventions for behavioural and psychological symptoms of dementia have been under-represented in the literature. Although the initial findings have revealed relevant differences with regard to sex, gender and ethnicity-sensitive approaches to those interventions. The GenderDem study aims to identify the top-10 research priorities in this context for future dementia care research.

The methodological approach in GenderDem is based on the James Lind Alliance Guidebook and the concept of priority setting partnerships. In this participatory research approach, people living with dementia, their caregivers (and/or their loved ones) and healthcare professionals will be actively involved in the study. As members of a steering group, they act as coresearchers in the GenderDem study. We aim to recruit a diverse group of people for the steering group by considering different factors, eg, gender identity, sex, ethnicity and age. Future research priorities will be identified through two rounds of online surveys to collect and rank research topics from additional participants (eg, people with dementia, caregivers and/or loved ones and healthcare professionals). Additionally, a literature review and a workshop will be carried out in parallel to consider the current state of the research and to finalise the top-10 research priorities.

An ethics application for conducting the two surveys and the workshop for this study has been approved by the German Society of Nursing Science (No. 25-029). Study participants will be informed in detail about the voluntary nature of their participation. Together with the coresearchers from the steering group, we will develop a dissemination plan that considers the different media consumption forms of the various groups. Additionally, we will disseminate our project results on an ongoing basis.

To explore administrators’ and clinicians’ views on the factors that influence their use and adoption of a machine learning clinical decision support system (ML-CDSS) to predict patients’ risk of hepatic and renal deterioration during chemotherapy.

This was a qualitative study that used purposive sampling. 18 participants with administration and clinical backgrounds working in cancer care in England were recruited. Qualitative data were collected by conducting semi-structured interviews and a focus group. Data were analysed thematically using the framework method to identify key themes.

Participants acknowledged that monitoring blood chemistry is a core component of chemotherapy as it helps clinicians assess patient fitness and treatment response. The ML-CDSS was perceived as a potentially valuable tool for identifying patients at increased risk of hepatic and renal deterioration, supporting clinical decision-making and enhancing care efficiency. However, several concerns were raised regarding its potential implementation in practice. Participants questioned clinicians’ willingness and capacity to integrate the tool into their existing workflows. Participants also believed it was important to demonstrate the ML-CDSS’s sensitivity, specificity and validity in accurately predicting patients’ risk to build clinicians’ trust in the tool, demonstrating evidence of its efficacy and effectiveness in practice.

Administrators and clinicians recognised the potential benefits of the ML-CDSS to enhance the delivery of chemotherapy by identifying patients at risk for hepatic and renal deterioration. Successful adoption in practice depends on building trust with the tool by being transparent in its development, its effectiveness and impact. Future work should demonstrate the ML-CDSS being used in practice to generate real-world evidence.

Despite limited evidence of efficacy, opioid analgesics are frequently used by patients for chronic pain while awaiting total hip or knee arthroplasty (THA or TKA). Preoperative use of opioids is problematic as it increases the likelihood of postoperative opioid-related adverse drug events and postoperative complications and is the strongest predictor of persistent opioid use post surgery. Opioid tapering prior to elective surgery has been proposed as a strategy for mitigating harms and improving postoperative outcomes. This protocol describes a randomised clinical trial, which aims to determine the effectiveness of a preoperative pharmacist-partnered opioid tapering programme compared with standard care for patients awaiting elective THA or TKA on postoperative outcomes including persistent opioid use.

Eligible participants must be aged ≥18 years; awaiting elective unilateral or bilateral THA or TKA; speak and read English; use prescription opioid analgesics at least 4 days a week and have access to internet or telephone. The participants will be excluded if they are undergoing a repeat surgery (same procedure within 6 months), are using opioids for cancer, palliative care or substance use disorder; have previously or are currently undergoing an opioid tapering programme or active medication review or have cognitive impairment. Enrolled participants will be randomised in a 1:1 ratio in permuted blocks of two and four to: (1) intervention or (2) standard care. A total of 314 participants will be recruited into the study. The intervention will include a pharmacist-partnered opioid tapering programme in which a pharmacist will work with participants to reduce their opioid dose over a 3-month period before surgery. Standard care will involve review by the hospital preadmission clinic multidisciplinary team to assess medical, physical and psychological health prior to surgery and education sessions for preoperative and postoperative care. The primary outcome assessed is persistent opioid use 3 months post surgery. The key secondary outcome is total Western Ontario and McMaster Universities Arthritis Index score. Data analysis will be performed using an estimand framework, with a generalised estimating equation model for the primary outcome from 1 day to 3 days presurgery to 3 months post surgery and a multilevel model for the main secondary outcome from baseline to 3 months after surgery. Cost-effectiveness and cost-utility analyses will be conducted to determine whether the intervention is cost-effective from the healthcare system perspective.

Ethics approval for this study was granted by a Human Research Ethics Committee (approval number: 2023/ETH01042). Results will be disseminated in peer reviewed journals, at international scientific meetings as well as meetings with key stakeholders and via the media.

ACTRN12623000685617.

This study aimed to identify the factors that influence access to diabetic retinopathy screening (DRS).

This is a qualitative case study.

Township health units in Shaoguan City, Guangdong Province, China.

This study included two representative patient groups (n=15) and five health-staff groups (n=42).

Focus group discussions were guided by a female ophthalmologist and other ophthalmology staff to determine the contextual factors influencing DRS uptake in people with diabetes mellitus in Qujiang District, Shaoguan City, southern China. Directly observed treatment and short-course (DOTS) components for the assessment of tuberculosis services were referred to for health structure when themes were extracted using deductive thematic analysis.

By referring to DOTS components related to the government, case detection, treatment, drug supply and recording system, we identified 31 factors associated with DRS uptake. Among these, six were from the perspective of service users whereas the remaining 25 were related to providers. From these factors, 10 modifiable themes pertained to policy, financing, interdepartmental coordination, hospital preparedness, primary healthcare staff training and public awareness through health education and quality enhancement of public health services. Two unmodifiable factors were also extracted: discomfort from pupil dilation during the examination and long travel distance to the facility.

This analysis identified contextual factors influencing DRS uptake, including policy, financing and public awareness, which, if addressed, could significantly enhance future screening uptake and disease management.

Cancer care involves multiple healthcare providers across various settings. Each time the responsibility of care is transferred from one healthcare provider or setting, referred to as transitions in care (TiC), there is an increased risk of medical error, patient dissatisfaction with care and poor outcomes. The objective of this study is to explore patient perspectives and experiences with TiC during cancer care, and to identify perceived gaps in care during TiC among individuals living with and beyond cancer.

A qualitative study using the interpretive descriptive approach was used to generate clinically relevant insights. Participants were recruited between 1 September 2022 and 9 September 2023, using purposive sampling to obtain a diverse sample. Semi-structured interviews were conducted and analyzed with thematic analysis.

This study was conducted in Alberta, Canada. Cancer care in Alberta is provided through a publicly funded, single-payer healthcare system.

31 interviews were conducted, with three themes emerging: (1) Communication as a key driver of continuity and quality during TiC, (2) Complexity and fragmentation create variation and confusion in care and (3) From system to person: how system failure and strengths shape individual experiences of TiC.

The study highlights the multifaceted nature of TiC among individuals living with and beyond cancer and emphasizes the need for patient-centred, coordinated approaches to improve the quality of care for individuals living with and beyond cancer. The findings highlight the emotional strain during TiC, which can be eased when patients feel informed, supported and involved in decision-making. Survivors can apply this by preparing questions in advance and engaging with support networks. Whereas providers can offer check-ins and clear next steps during TiC.

For priority populations, such as Indigenous children, school-based screening programmes can increase equitable access to care. However, current traditional economic measures evaluating the effectiveness of many screening programmes in Australia do not capture the value perceived by those at the intersection of the benefits, including children and families, communities, health workers and teachers or the differences between Western-Anglo and Indigenous conceptualisations of health. This mixed-methods study aims to develop and validate a Community Reported Outcome Measure (CROM) of school health screening programmes based on concepts of value of health and healthcare and school screening programmes from the perspective of Indigenous peoples. The purpose of the tool is to provide a robustly developed and validated tool to assess the experiences of school health screening programmes from the perspective of Indigenous stakeholders including families, communities, health workers and teachers.

This mixed-methods study will be conducted in three stages in accordance with regulatory and international consensus guidance: (1) concept elicitation to construct a conceptual framework of value in school screening; (2) item generation and mapping to the conceptual framework and (3) a psychometric evaluation of the CROM. Phase 1 concept elicitation: this involves an umbrella review (phase 1.1); yarning circles with communities in New South Wales (phase 1.2); concept integration of the umbrella review and yarning circles data (phase 1.3) and an online e-Delphi study to ensure the framework of value is nationally representative (phase 1.4). Phase 2 item generation and mapping: this involves item generation (phase 2.1) and cognitive testing of the item pool (phase 2.2). Phase 3 psychometric evaluation: this involves field testing (phase 3.1) and assessing the structural validity of the CROM via Rasch analysis (phase 3.2).

This study was reviewed and approved by the Australian Institute of Aboriginal and Torres Strait Islander Studies (Ref: REC-0397) and State Education Research and Partnerships (Ref: SERAP 6500). The results of this study will be presented at relevant academic and non-scientific conferences and meetings and published in high-impact peer-reviewed journals.

Active patient involvement is a core principle of patient-centred care, yet public experiences of medical decision-making in non-Western settings remain underexamined. In South Korea, nationwide evidence on how adults experience, perceive and prefer medical decision-making is limited. This study, therefore, examined Korean adults’ experiences, perceptions and preferences regarding medical decision-making.

A cross-sectional study was conducted between March and April 2025 using online data collection for adults aged 19–59 years and face-to-face interviews for those aged 60 years or older.

This nationwide survey was conducted in South Korea.

A total of 1081 Korean adults were recruited using proportional quotas for sex, age group and region. After excluding withdrawals and invalid responses, 1000 were included (response rate 92.5%).

Overall, 70.4% of respondents reported at least one significant health-related decision in the past 2 years. Although 34.1% reported making their most recent decision independently, a larger proportion preferred collaborative decision-making involving clinicians and/or family members. The clinician’s explanation was the most influential factor (77.4%). Preferences for primary decision-maker varied by clinical context: patient-led decisions were favoured for low-risk interventions such as vaccination (78.5%), whereas physician involvement was preferred for life-threatening illness (86.2%). Communication ratings were highest for presentation of treatment options (mean score 3.56±0.79 on a 5-point scale) and lowest for explanation of potential treatment risks (mean score 3.20±0.89). Participants satisfied with decision outcomes reported higher communication quality (p

Medical decision-making was common, but respondents’ experiences did not always match their preference for collaborative involvement. The findings suggest that strengthening patient-centred care in South Korea will require not only improvements in patient–clinician communication, but also attention to family involvement and structural conditions such as limited consultation time and current reimbursement arrangements.