Patients’ sense of gain experience (PSGE) is the comprehensive feeling throughout the treatment process, which is a critical benchmark for evaluating comprehensive medical and health system reform in China. This study aims to assess the current status of PSGE in public hospitals and identify important associated factors, providing evidence-based recommendations for improving healthcare services.

This was a cross-sectional study conducted from October to November 2023.

A total of 14 public hospitals in Foshan, Guangdong Province, China.

There were 3223 responses, including 1592 from outpatients and 1631 from inpatients.

PSGE was assessed across five domains: time accessibility, service accessibility, cost affordability, patient participation and efficacy predictability. Participants were also asked to provide an overall rating of the PSGE.

The overall score for PSGE was 4.47±0.53 (mean±SD), with service accessibility receiving the highest score (4.68±0.50) and affordability the lowest (4.17±0.86). Secondary hospitals scored an overall PSGE of 4.55±0.50, while tertiary hospitals scored 4.42±0.54. Key factors associated with PSGE were overall satisfaction (β=0.164, p

This study found that patients reported a positive PSGE with service accessibility but reported a less positive PSGE with cost affordability. A tier-based disparity was evident, with secondary hospitals outperforming tertiary hospitals in overall PSGE outcome. Stronger PSGE was positively associated with higher scores in overall satisfaction, treatment satisfaction, satisfaction with medical reforms, patient loyalty and hospital reputation. Demographic and institutional factors, such as hospital level, patient type and household registration, were associated with the PSGE. Efforts can be focused on enhancing clinicians’ willingness and competence in discussing treatment costs during clinical encounters. It is essential for policymakers to address disparities in healthcare experiences among patient groups across hospital tiers to advance equitable, patient-centred systems.

The Validating Outcomes by Including Consumer Experience (VOICE) project is developing patient reported experience measure (PREM) tools to collect consumer feedback for Indigenous primary healthcare (IPHC) services’ accreditation and quality improvement processes. This study aimed to explore the views of health service staff about: (1) optimising the feasibility of collection, analysis and interpretation of findings; and (2) resourcing requirements for implementation of the PREM.

A participatory action research qualitative study design, guided by an Indigenous advisory group. Our team of Indigenous and non-Indigenous researchers conducted semistructured focus groups and individual interviews with IPHC staff. Focus groups and interviews were recorded, transcribed and thematically analysed. Multiple sense-making meetings were conducted with the Indigenous advisory group.

Eight partner IPHC services across four Australian states and territories.

All staff were eligible and invited to participate in the study via purposive and snowball sampling. Administrative staff (eg, receptionist, programme facilitator), clinicians/practitioners (eg, general practitioner, nurse, Aboriginal and Torres Strait Islander health workers and practitioners) and service managers (eg, CEO, practice manager) from partner health services participated.

63 staff participated; 44 attended across 13 focus groups, with the remainder participating in individual interviews. The majority of participants were between 35 years and 55 years old (52%), female (66%) and working in frontline IPHC service delivery roles (56%). Equal numbers identified as Indigenous (50%) and non-Indigenous (50%). Many had worked in the Indigenous health and well-being sector for over 10 years (40%). ‘Culturally safe care’ and ‘accountability’ were identified as primary themes and key reasons for gathering consumer feedback. Subthemes identified were ‘Relationships’, ‘trust and respect’, ‘communication about consumer feedback’, ‘timing and frequency of requesting consumer feedback’, ‘health service systems’, ‘health service and staff capacity’, ‘staff skills’ and ‘structure and administration of the PREM’. All themes and subthemes need to be considered for the successful design and implementation of PREMs in IPHC settings.

Many of the issues identified are not currently considered in the process of collecting PREM data for accreditation yet, if addressed, would likely improve the quality and relevance of data collected. The findings from this study will inform the co-design and validation of Indigenous-specific PREM tools to collect consumer feedback. Critically, service and community input will ensure the PREM tools meet service needs for continuous quality improvement and accreditation and reflect the priorities and values of Indigenous peoples.

As care needs increase in complexity, a shift to people-centred, integrated care is required to meet the full range of health and social care needs of clients. However, limited opportunities exist for care providers to develop interprofessional competencies as part of pre-licensing and/or continuing education. New learning models, such as case-based learning (CBL), that facilitate the development of interprofessional competencies and are aligned with practice realities of providers are needed. This scoping review will collate and codify leading practices and knowledge gaps in the development and delivery of CBL programmes in pre-licensing and continuing education for health and social care providers.

A scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. MEDLINE, CINAHL Plus, Scopus, ERIC Institute of Education Sciences, PsycINFO and Education Source will be searched for peer-reviewed literature; Google Scholar, ProQuest Dissertations and Web of Science will be searched for grey literature. Reference lists of full-text scholarly sources, key journals and authors will be searched manually. Study selection and extraction will be conducted by two independent reviewers. English sources published between 2014 and 2024 that discuss CBL epistemologies, characteristics, delivery mechanisms, programme limitations and/or programme evaluation in health and social care pre-licensing and/or professional training will be included. Data will be analysed using directed content analysis and synthesised as a narrative summary.

This scoping review protocol was reviewed by the Southlake Health Research Ethics Board and received ethics exemption. Findings will be disseminated through peer-reviewed publication, conferences, professional networks and social media, and used to inform the development of an evidence-based training programme for health and social care providers.

Open Science Framework https://doi.org/10.17605/OSF.IO/6YXHN

Telemedicine use has risen significantly since the COVID-19 pandemic. Evidence suggests that the quality of care in telemedicine could be as good as in-person care, but this is likely context-dependent. Expert guidelines have declared the appropriate medical conditions, but often without empirical evidence that grapples with the fundamental information limitations facing telemedicine. We draw on the task-technology fit theory and empirical evidence around human communication to examine how the medical and social contexts affect the efficiency and clinical quality of primary care.

We will use a population-based dataset from the Canadian province of British Columbia (BC) to inform a quasi-experimental study using propensity score matching (PSM). The treatment group will consist of telemedicine visits from April to December 2022. We will use PSM to create a control group of matched, in-person visits in the same period. We will then use cluster-robust linear regression to identify how specific medical conditions and social contexts are associated with higher rates of prescription, follow-up with primary care providers, emergency department visits and acute care admissions. We plan for the study to take place from 1 August 2025 to 1 August 2026.

The Research Ethics BC has granted approval for this study (H21-02244-A006). Our findings will be shared with patients, healthcare providers and policymakers and disseminated through conference presentations and peer-reviewed publications.

Patient-reported outcome measures are essential for assessing health-related quality of life (HRQoL) in both research and clinical practice. The Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire is a disease-specific instrument designed to measure HRQoL in patients with pulmonary embolism (PE). This study aimed to evaluate the psychometric properties of the Danish electronic version of the PEmb-QoL questionnaire.

Psychometric validation study.

Eligible patients received a digital mail 6 months after their diagnosis, with an invitation to complete an online questionnaire. A subset of patients completed a second time 7–10 days following the initial completion.

Adult patients diagnosed with PE in Denmark between March 2022 and May 2023 were included in the study.

The main outcome measure was the PEmb-QoL summary score. Validation procedures included assessments of targeting, internal reliability (IR), test–retest reliability, differential item functioning (DIF) and concurrent validity.

The study included 1017 patients. The Danish PEmb-QoL demonstrated robust IR (IR=0.95 for the total score) and adequate test–retest reliability for most domains (relative G-coefficients>0.7). However, DIF analysis revealed subgroup differences for some items, particularly those related to daily activity limitations and pain. Targeting analysis indicated moderate alignment between latent score distributions and item response distributions, with ceiling effects noted in several domains. The PEmb-QoL exhibited strong correlations with the Post-Venous Thromboembolism Functional Status Scale (r=0.82) and EuroQol-5 Domain (r=0.73), and moderate correlations with Generalised Anxiety Disorder Questionnaire (r=0.47) and Patient Health Questionnaire (r=0.57), confirming its concurrent validity.

While some items in the PEmb-QoL instrument performed inadequately on DIF and targeting, the expected overall score and the concurrent validity did not seem to be compromised by these issues. Thus, it is likely that a reduced version of the electronic Danish PEmb-QoL will possess suitable psychometric properties for measuring HRQoL in patients with PE.

Mobile diagnostic imaging services provided at home increase accessibility and convenience, particularly for older adults, people with disabilities and other vulnerable groups. These services can reduce the need for patient travel and support the routine monitoring of chronic conditions. However, current guidelines often overlook user acceptance and environmental considerations within the home setting.

To map studies that identify the models, barriers and facilitators for performing home-based diagnostic imaging/graph according to end users.

A scoping review was conducted following the methodological framework of the Joanna Briggs Institute and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.

Studies that addressed mobile or portable diagnostic imaging or graph examinations conducted in the home for individuals of any age or health status were included. Studies were eligible if they reported on barriers, facilitators or user experiences. Studies that focused on wearable technologies were excluded.

The search strategy was developed using terms related to home-based diagnostic imaging/graph, portability, home setting and user perceptions. Searches were conducted in PubMed, Web of Science, Scopus, Embase, The ACM Guide to Computing Literature and LILACS, without restrictions on publication date or language. Additional grey literature was identified through Google Scholar.

Two reviewers independently extracted data using a standardised form that captured study characteristics, types of procedures, target populations and reported barriers and facilitators. Quantitative data were summarised using absolute and relative frequencies. Qualitative findings were synthesised through basic content analysis to identify and categorise recurring themes.

Data were charted in tables to organise and visually map study contexts, methodological features and thematic patterns related to implementation and user experience.

Twenty-six studies published between 1998 and 2023 across 15 countries were included. The diagnostic examinations included mostly polysomnography, X-ray imaging and ultrasonography. Seven categories of barriers were identified, such as physical discomfort, equipment-related challenges and procedural limitations. Seven facilitators were also reported, including perceived comfort, patient satisfaction and equipment usability.

This review identifies key factors affecting the delivery and user experience of mobile diagnostic imaging at home, including logistical, technical and environmental aspects. It reveals gaps in the literature and provides a basis for future research to inform more inclusive and effective public health policies and service design.

Open Science Framework (DOI 10.17605/OSF.IO/7UV5D).

Heart failure clinics (HFCs) are associated with increased survival rates, lower hospitalisation and improved quality of life. This study investigated factors influencing patient access to multidisciplinary outpatient HFCs from the perspective of patients and cardiologists.

This was a qualitative study. A trained researcher conducted semistructured face-to-face interviews with patients and online interviews with cardiologists. Interviews, conducted between March and October 2023, were audio-recorded. Transcripts were cleaned (deidentification, translation verification) and analysed by two trained researchers independently using systematic text condensation in NVivo v12. Codes were derived from the transcripts and grouped and organised into themes. Two authors independently coded data, reconciling disagreements with the senior author, followed by respondent validation. Member checking ensued.

Outpatient multidisciplinary HFCs in Qatar.

A purposive sample of patients diagnosed with heart failure who had attended at least one HFC appointment at Qatar’s Heart Hospital were approached in person or via phone, and cardiologists with the authority to make referrals to these clinics via the electronic medical record system were emailed; interviews ensued until theme saturation was achieved.

26 individuals (14 patients and 12 cardiologists) participated in the interviews. Four major themes were identified: health system organisation (subthemes: benefits, HFC triage criteria, need/capacity), HFC referral processes (subthemes: electronic record system, patient communication and education), care continuity and communication (subthemes: patient navigators, clinician preferences) and access challenges (subthemes: transportation, costs).

Resources are needed to expand HFC capacity and coverage, leverage electronic medical record tools as well as telehealth, educate physicians and patients on referral guidelines and processes and engage primary care to ultimately improve patient outcomes.

To explore multiprofessional views about system-wide factors influencing (impeding or facilitating) the delivery of stroke mechanical thrombectomy (MT) services and/or improvements to this pathway in England.

A pragmatic exploratory qualitative study using online focus groups and semi-structured interviews with National Health Service (NHS) professionals and those working in a stroke strategic/policy lead role. We thematically analysed the data using the Framework Approach to understand participants’ views on the challenges to improving current and future MT implementation.

NHS trusts and other key stroke strategic/policy organisations covering 10 geographical regions in England and a national perspective.

A total of 29 professionals, working in an NHS clinical and managerial position and/or a stroke strategic national/regional clinical/policy lead role, participated in five focus groups and six individual semi-structured interviews between April and June 2024.

We identified five themes relating to MT implementation progress and challenges (1) workforce, (2) clinical care pathways, (3) service/system, (4) cross-cutting theme: communications and (5) cross-cutting theme: culture. Our analysis emphasised the increasing complexity and inter-related factors shaping the emergency stroke pathway for MT provision and a need to acknowledge key people-related, organisational and sociocultural factors during service planning.

Despite the challenges and complexity, professionals were optimistic that further progress would be made with MT delivery in England. However, ongoing improvement strategies are required, which also acknowledge wider cultural factors and system-wide relationships and are not just focused on care pathways and resources.

To evaluate an innovative approach to recruit 40 hospitals to a cluster randomised controlled trial (RCT) to improve discharge antibiotic prescribing.

This study describes the design, implementation and impact of a theory-informed recruitment approach for hospitals participating in the Reducing Overuse of Antibiotics at Discharge (ROAD) Home trial.

An inperson meeting of a quality improvement collaborative of acute care hospitals in the state of Michigan.

Representatives from acute care hospitals that are part of the Michigan Hospital Medicine Safety Consortium.

Small group recruitment sessions that combined deliberative participation and credible messengers to recruit hospitals to participate in a cluster RCT on a single date (1 November 2023).

The primary outcome was the number of hospitals which agreed to participate in the trial. We also assessed participant feedback, effectiveness of recruitment methods and resources required for implementation of this approach.

We recruited 51 (74%) of 69 eligible hospitals. Survey participants reported: sessions made clear the purpose of the trial (94%, 64/68) and time commitment required (87%, 59/68); agreed deliberative participation was helpful (82%, 56/68) and were ‘very satisfied’ with the session (82%, 56/68). Investigators largely reported credible messengers were a positive influence, though this varied across sessions. Hospital recruitment was time intensive, taking 179.5 total person hours. The recruitment process involved 3 months of preparation for the sessions and 2 months of follow-up prior to closing recruitment.

We demonstrated the feasibility and impact of a novel approach to recruit hospitals from an existing collaborative to a cluster RCT using the principles of deliberative participation and credible messengers. While the approach was time-consuming, we achieved success at over-recruiting hospitals in a relatively short period of time. Strategies presented here may assist future trial organisers in implementing hospital-based cluster RCTs.

The ROAD Home trial is registered on Clinical.Trials.gov (NCT06106204).

To examine health and social service use pre- and post-cochlear implant in adults.

A retrospective cohort study.

All public and private hospitals in Australia.

A total of 3033 adults aged ≥18 years who received a cochlear implant in Australia between 1 January 2014 and 31 December 2018 were included. Participants were followed for 3 years pre-implant date and 3 years post-implant date or until death. Data were sourced from the Person Level Integrated Data Asset.

The study examined the (i) number of visits to general practitioners (GPs), specialists and audiologists; (ii) fee charged, benefit paid and out-of-pocket (OOP) expenses for health services; (iii) personal income; (iv) completion of higher education and post-high school vocational education and training and (v) number of government benefits and concession cards received.

The mean age of adults at cochlear implantation was 63.3 years (SD 16.1). Over the 3 years period before and after implantation, the mean number of GP visits remained stable (24.5 pre-implant vs 24.7 post-implant), specialist visits decreased (6.4 pre-implant vs 5.3 post-implant) and audiologist visits increased (1.7 pre-implant vs 6.6 post-implant). Higher GP visit rates were observed both pre- and post-implantation among females (RR 1.13 vs 1.14), older adults (RR 1.06 vs 1.15), individuals needing assistance with daily activities (RR 1.11 vs 1.12), individuals with chronic health conditions (RR 1.25 vs 1.34), with ≥6 RxRisk comorbidities (RR 2.35 vs 2.22) and adults residing in socio-economically disadvantaged areas (RR 1.64 vs 1.19). Mental health conditions were associated with increased specialist visits pre- and post-implantation (RR 2.57 vs 2.53), while employed individuals had higher specialist visit rates post-implantation (RR 1.58). Average OOP costs for health services decreased by 31.4% post-implant. Government benefits were higher pre-implant (55.6%) than post-implant (44.4%). Females and adults needing assistance with activities of daily living were more likely to seek government benefits.

These findings highlight the need for tailored healthcare and social support services to address the diverse needs of cochlear implant users, ensuring comprehensive care and support throughout their healthcare journey.

The healthcare system is complex, involving multiple interactions among individuals, organisations and systems. Many patients, particularly those with limited health system literacy, struggle to navigate it. A reliable instrument is crucial for accurately measuring individuals’ navigational abilities. However, a systematic review of psychometric properties of existing instruments for measuring health system literacy has not been conducted. This review aims to provide a comprehensive assessment of methodological quality and measurement properties of these instruments.

A search was conducted in MEDLINE, EMBASE, CINAHL, APA Psyfor, SCOPUS, Web of Science and Google Scholar from the date the database was created to 14 December 2024. Eligible studies include those published in English and focusing on developing and validating an instrument for measuring the construct of health system literacy in adults aged 18 or older. Two researchers will independently review, select and extract eligible studies, while all members of the research team will be involved in assessing methodological quality and the quality of measurement properties. This systematic review will adhere to the Consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines for conducting systematic reviews of psychometric properties. We will provide summary tables of study characteristics and instrument characteristics used to measure health system literacy. Measurement properties and their quality will be assessed using the COSMIN standard criteria and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We will also evaluate methodological quality of measurement properties using the COSMIN Risk of Bias checklist.

This review does not collect original data, so obtaining ethical approval is not applicable. The findings will be disseminated through peer-reviewed journals, which can assist researchers and providers in choosing the appropriate instrument measuring health system literacy.

CRD420251004362.

Faced with the challenge of ageing populations and growing rehabilitation demands, misallocating healthcare resources may impede tiered service. This study aimed to (1) evaluate gaps between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and rehabilitation tiered service (RTS) tool results using the first-hand data from the field survey in China and (2) identify factors associated with these gaps across institution, doctor and patient levels.

Population-based, multicentre cross-sectional study.

41 medical institutions across 21 cities in China.

5856 participants were included in our study. The inclusion criteria of participants were (1) he/she had dysfunctional problems, (2) he/she had visited rehabilitation doctors, (3) he/she was outpatients, (4) he/she would complete all evaluation procedures and (5) he/she agreed to participate in our study.

Gaps between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and RTS tool results. The results included outpatient rehabilitation treatment, visiting other clinical departments, admission to primary healthcare, secondary hospitals, tertiary hospitals, nursing homes and other clinical departments.

The mean age of participants was 47.5 years (SD: 24.4), and half (53.6%) were male. Most were diagnosed with orthopaedic disorders (55.2%) and neurological disease (29.0%). The majority had mobility difficulty (81.8%), self-care ability (69.8%), controlled disease (89.5%) and stable vital signs (98.9%). The minority participants had an onset of over 1 year (8.5%). The first gap (the rate of misalignment between patients’ healthcare-seeking behaviour and doctors’ clinical judgement) was 21.0%; doctors with higher educational level (OR=4.89, 95% CI 1.35 to 17.73), those who majored in western medicine (OR=2.97, 95% CI 1.15 to 7.67), elder patients (OR=1.01, 95% CI 1.01 to 1.02) and patients with neurological disease (OR=2.11, 95% CI 1.34 to 3.30), geriatric diseases (OR=1.60, 95% CI 1.17 to 2.19) and childhood diseases (OR=2.72, 95% CI 1.04 to 7.13) were associated with the increased first gap, whereas doctors from public institution (OR=0.10, 95% CI 0.02 to 0.44), receiving more medical training (OR=0.94, 95% CI 0.88 to 1.00) and patients with cardiopulmonary disease (OR=0.44, 95% CI 0.29 to 0.67) were associated with reduced first gap. The second gap (the rate of misalignment between doctors’ clinical judgement and RTS tool results) was 49.3%; doctors from primary healthcare (OR=24.60, 95% CI 7.82 to 77.42), male doctors (OR=2.66, 95% CI 1.45 to 4.86), those who majored in western medicine (OR=1.91, 95% CI 1.04 to 3.51) or Chinese and western medicine (OR=4.19, 95% CI 1.47 to 11.91) and elder patients (OR=1.01, 95% CI 1.00 to 1.01) were associated with increased second gap, whereas doctors from public institution (OR=0.13, 95% CI 0.05 to 0.36) and having higher monthly income (OR=0.52, 95% CI 0.34 to 0.78) were associated with reduced second gap.

Gaps exist between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and RTS tool results. Target interventions such as enhancing training for private institutions, western medicine doctors and elderly patients diagnosed with neurologic, cardiopulmonary or childhood diseases may help reduce these gaps.

To assess factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 at primary healthcare (PHC) facilities in Nepal after healthcare workers received training.

Cross-sectional study.

PHC facilities across various provinces in Nepal.

A total of 180 healthcare workers trained in PEN, recruited from a random selection of 105 basic healthcare facilities.

The adoption of PEN Protocol 1 components: blood pressure measurement, blood glucose screening, 10-year cardiovascular disease (CVD) risk assessment using WHO/International Society of Hypertension risk charts and body mass index (BMI) assessment. Factors associated with protocol adoption were assessed using generalised estimating equations for ORs.

Among participants, 100% reported measuring blood pressure, while 56% measured blood sugar, 28% assessed CVD risk and 27% assessed BMI. The adoption of the CVD risk prediction chart was positively associated with the availability of amlodipine (adjusted OR (aOR) 3.00; 95% CI 1.09 to 8.27). The adoption of BMI assessment was positively associated with access to a stadiometer (aOR 3.23; 95% CI 1.26 to 8.30) and a glucometer (aOR 3.07; 95% CI 1.12 to 8.40), and negatively associated with lack of motivation/inertia of previous practice (aOR 0.60; 95% CI 0.42 to 0.87) and environmental factors such as lack of time and resources (aOR 0.57; 95% CI 0.37 to 0.89). Blood glucose level measurements were positively associated with being at a PHC centre (aOR 7.34; 95% CI 2.79 to 19.3) and the availability of metformin (OR 2.40; 95% CI 1.08 to 5.29).

Adoption of PEN Protocol 1 varied by component and was influenced by resource availability, provider motivation and system barriers. Addressing these factors is key to optimising implementation in low-resource settings.

To assess the prevalence of technostress among healthcare professionals (physicians and nurses) in Catalonia, Spain, and examine its association with sociodemographic characteristics and the contextual use of digital health tools.

Cross-sectional survey.

Healthcare institutions in Catalonia, including hospitals, primary care centres and social healthcare facilities.

A convenience sample of 587 healthcare professionals (423 physicians and 164 nurses) who responded to an anonymous online questionnaire.

The primary outcome was the level of technostress, assessed using the Technostress Creators Scale. Secondary outcomes included associations between technostress and sociodemographic factors, workplace context and the characteristics of digital technology usage.

Technostress levels were moderate overall (mean=2.93±0.60; observed range=1.00–4.78; theoretical range=1–5), with no significant differences between physicians and nurses. However, older professionals experienced significantly higher technostress. Key stressors included techno-overload and techno-uncertainty. Familiarity with digital health tools and voluntary usage was associated with lower technostress. Technical difficulties and lack of perceived usability increased stress levels.

Technostress is prevalent among healthcare professionals and particularly affects older staff. As digital health tools become essential in clinical practice, targeted strategies including training and technical support are needed to mitigate stress and promote well-being among healthcare workers.

To estimate the association between socioeconomic background (derived from household main earner occupation when the survey respondent was aged 14 years old) and likelihood of working as a doctor in adulthood in the UK, and estimate how associations varied over time for respondents who turned 18 years old in different decades.

Observational study of 10 years of pooled data from a nationally representative government survey.

The United Kingdom (UK).

358 934 respondents to the UK Office for National Statistics Labour Force Survey between July 2014 and September 2023. Respondents aged 22 years old or below or retired respondents aged 65 years old and above were excluded.

Whether the respondent was currently working as a medical practitioner (doctor).

2772 respondents were currently working as doctors (0.8% of respondents). 13% of doctors were from working-class backgrounds (National Statistics Socio-economic Classification 5–8), compared with 43% of non-doctor respondents, while 69% of doctors came from professional backgrounds (vs 32% of non-doctors) (unadjusted proportions). From multivariable Poisson regression models adjusting for year of survey, the year the respondent turned 18, sex, country of birth and ethnic group, the likelihood of being a doctor varied largely according to socioeconomic background, with those from professional backgrounds 3 times and 6 times more likely to become doctors than those from intermediate backgrounds and working class backgrounds, respectively (average predicted probability: 1.6% vs 0.5% vs 0.3%). Respondents growing up in households where the main earner was a doctor were by far the most likely to themselves report working as a doctor (average predicted probability: 10.1%), 15-fold more likely than all respondents with non-doctor backgrounds (risk ratio=15.0, 95% CIs 13.4 to 16.7), and between 3 times and 100 times more likely when compared with other specific occupation groups. Stratified analyses suggested socioeconomic inequalities were highly stable over time among respondents who turned 18 between the 1960s and the 2000s, and then weak evidence of decreasing diversity from 2010 to 2018.

There are large, persistent and potentially widening inequalities in the socioeconomic background of doctors working in the UK between 2014 and 2023, leading to doctors being highly socioeconomically unrepresentative of the general UK population. New data collections on the socioeconomic background of working doctors are needed to monitor this inequality and understand its effects on patient care. Increased and/or alternative efforts may be needed to address this entrenched inequality and improve social mobility into medicine.

Oral HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention for HIV prevention, but its access and utilisation are challenging, especially in high-burden settings such as Kenya. For potential PrEP users, long delays and repeated consultations with several providers are obstacles to both PrEP uptake and continuation. The One-Stop PrEP Care project aims to promote the use of PrEP among clients in the health system and enhance client satisfaction by reducing the waiting time.

We are conducting a 1:1 cluster-randomised trial to evaluate whether One-Stop PrEP Care achieves equivalent or better PrEP outcomes compared with the standard of care model in 12 high-volume HIV clinics in Kisumu County, Kenya. In the One-Stop model, all core PrEP components, including HIV risk evaluation, HIV testing and PrEP dispensing, are provided by one provider in a single consultation room. Programme data from ≥2400 new PrEP clients will be abstracted for 12 months each to obtain primary endpoints of PrEP initiation and continuation. Adherence will be assessed via blood drug level testing. A nested cohort of up to 300 PrEP clients will be enrolled and followed every 3 months to provide in-depth data on individual HIV prevention behaviour, risk perception and how they align PrEP use with perceived risk. We will also evaluate programme costs.

Ethical approval was obtained from the University of Washington Institutional Review Board (IRB) on 8 July 2022 (IRB ID: STUDY00015873) and the Kenya Medical Research Institute Scientific and Ethics Review Unit (SERU) with a letter dated 4 May 2023 (Ref: 4697). Project findings will be shared with stakeholders, including the Ministry of Health, County health officials and participants. Results will be disseminated through manuscripts, policy briefs and health meetings.

Plans for communicating important protocol modifications include timely notifications to all study team members and training on the changes, and updates to relevant stakeholders, including the two IRBs, through protocol amendment submissions.

V. 2.0 dated 21 May 2024.

NCT03194308.

This study aimed to examine the contextual barriers that may hinder the implementation of multiple family group therapy (MFGT) in Ghana’s Lower Manya Krobo District.

An exploratory, descriptive, qualitative study employing focus group discussions and in-depth interviews.

Atua Government Hospital in the Lower Manya Krobo District. Data were collected between February and March 2025.

12 young people living with HIV (YPLHIV; aged 12–22 years), 13 caregivers and five healthcare professionals were selected via purposive sampling.

Four major themes emerged: (1) resource and logistic constraints, including transportation challenges, programme sustainability concerns and inadequate physical facilities; (2) stigma and confidentiality concerns, encompassing public identification fears and community stigma; (3) implementation challenges, involving attendance reliability and organisational instability; and (4) participation barriers, including group setting anxiety and delayed HIV status disclosure. These barriers spanned multiple domains of the Consolidated Framework for Implementation Research (CFIR), highlighting the complex, multi-level nature of implementation challenges.

Successful implementation of MFGT for YPLHIV in Ghana requires addressing interrelated barriers across multiple ecological levels simultaneously. These findings largely underscore the importance of exploring the local context for potential barriers to inform the adaptation of evidence-based interventions to accommodate ecological concerns.

NCT06701942.

The COVID-19 pandemic has made long-standing nursing workforce challenges apparent on an international scale. Decision-makers must develop multi-pronged approaches to foster the development and maintenance of a strong nursing workforce to support health systems. These approaches require attendance to recruitment and retention initiatives that show promise for stabilising the nursing workforce now and into the future.

Searches were conducted across MEDLINE, Embase, CINAHL and Scopus from January 2014 up to 11 March 2024. This rapid umbrella review protocol is guided by the Joanna Briggs Institute scoping review methodology and adheres to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The research question guiding this review is: what structures have healthcare systems put in place to stabilise, support and sustain the nursing workforce? This review will include existing reviews of nursing workforce initiatives with outcomes that impact nursing recruitment and retention. Results will support local health transformation including the development of a jurisdictional nursing workforce stabilisation strategy. Findings from this review will be relevant for the design, refinement and implementation of nursing workforce sustainability strategies in countries around the globe and may apply to strategies for other healthcare workers.

Institutional research ethics board exemption was received. The research team is supported by an advisory group that includes provider and patient partners. The results from this study will inform the Nursing Workforce Strategy for the province of Nova Scotia as part of a larger Canadian Institutes of Health Research-funded project. They will also inform broader planning and strategy in Canada through integration with other evidence-generation activities such as comparative policy analyses and workforce planning exercises. Finally, the results will be published in a peer-reviewed journal.

Registered through Open Science Framework: https://doi.org/10.17605/OSF.IO/CUJYK

Guideline-based strategies to prevent chronic kidney disease (CKD) progression and complications are available, yet their implementation in clinical practice is uncertain. We aimed to synthesise the available evidence on the concordance of CKD care with clinical guidelines to identify gaps and inform future CKD care.

Systematic review and meta-analysis.

We systematically searched MEDLINE (OVID), EMBASE (OVID) and CINAHL (EBSCOhost) (to 18 July 2025) for observational studies of adults with CKD reporting data on the quality of CKD care. We assessed data on quality indicators of CKD care across domains that related to patient monitoring (glomerular filtration rate and albuminuria), medications use (ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), statins) and treatment targets (blood pressure (BP) and HbA1c). Pooled estimates (95% CI) of the percentage of patients who met the quality indicators for CKD care were estimated using random effects model.

59 studies across 24 countries, including a total of 3 003 641 patients with CKD, were included. Across studies, 81.3% (95% CI: 75% to 87.6%) of patients received eGFR monitoring, 47.4% (95% CI: 40.0% to 54.7%) had albuminuria testing, and 90% (95% CI: 84.3% to 95.9%) had BP measured. ACEIs/ARBs were prescribed among 56.7% (95% CI: 51.5% to 62%), and statins among 56.6% (95% CI: 48.9% to 64.3%) of patients. BP (systolic BP ≤140/90 mm Hg) and HbA1c (

Current evidence shows substantial variation in CKD care quality globally. Guideline-concordant care varied according to quality measures and across patient groups, with gaps in indicators like albuminuria testing. These findings underscore the need for effective quality improvement strategies to address gaps in CKD care, including increased albuminuria testing for risk stratification, together with systematic measures for monitoring care quality.

CRD42023391749.

Our aim is to develop a Framework of Measurement for people living with Long COVID and their caregivers for use in Long COVID research and clinical practice. Specifically, we will characterise evidence pertaining to outcome measurement and identify implementation considerations for use of outcome measures among adults and children living with Long COVID and their caregivers.

We will conduct a scoping study involving: (1) an evidence review and (2) a two-phased consultation, using methodological steps outlined by the Arksey and O’Malley Framework and Joanna Briggs Institute. We will answer the following question: What is known about outcome measures used to describe, evaluate or predict health outcomes among adults and children living with Long COVID and their caregivers? Evidence review: we will review peer review published and grey literature to identify existing outcome measures and their reported measurement properties with people living with Long COVID and their caregivers. We will search databases including MEDLINE, Embase, CINAHL, PsycINFO and Scopus for articles published since 2020. Two authors will independently review titles and abstracts, followed by full text to select articles that discuss or use outcome measures for Long COVID health outcomes, pertain to adults or children living with Long COVID and/or their caregivers and are based in research or clinical settings. We will extract data including article characteristics, terminology and definition of Long COVID, health outcomes assessed, characteristics of outcome measures, measurement properties and implementation considerations. We will collate and summarise data to establish a preliminary Framework of Measurement. Consultation phase 1: we will conduct an environmental scan involving a cross-sectional web-based questionnaire among individuals with experience using or completing outcome measures for Long COVID, to identify outcome measures not found in the evidence review and explore implementation considerations for outcome measurement in the context of Long COVID. Consultation phase 2: we will conduct focus groups to review the preliminary Framework of Measurement and to highlight implementation considerations for outcome measurement in Long COVID. We will analyse questionnaire and focus group data using descriptive and content analytical approaches. We will refine the Framework of Measurement based on the focus group consultation using community-engaged approaches with the research team.

Protocol approved by the University of Toronto Health Sciences Research Ethics Board (protocol #46503) for the consultation phases of the study. Outcomes will include a Framework of Measurement, to enhance measurement of health outcomes in Long COVID research and clinical practice. Knowledge translation will also occur in the form of publications and presentations.