Approximately 96% of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) cases in Rwanda result from direct transmission rather than acquired resistance. However, the nationwide spatial distribution and transmission dynamics of RR/MDR-TB remain poorly characterised. This study aims to analyse spatial patterns of RR/MDR-TB in Rwanda and explore relationships between spatial proximity and RR/MDR-TB strains’ genetic relatedness.

We conducted a retrospective analysis of 249 confirmed RR-TB cases across Rwanda from 2017 to 2024, using the known geolocations of patients’ residences. Spatial and space-time clustering was assessed using Kulldorff’s scan statistics. Demographic and socioeconomic determinants were evaluated using multivariable regression. For 201 cases with whole-genome sequencing data, we performed transmission analysis using a 5-SNP threshold to define recent transmission clusters and investigated spatial relationships within genetically related strains.

Significant spatial clustering of RR/MDR-TB was identified in 21 sectors, mainly in Nyarugenge, southern Gasabo and western Kicukiro (relative risk: 10.06; p

RR/MDR-TB in Rwanda shows significant spatial clustering with transmission occurring through both localised and regional networks. Integrating genomic and spatial data reveals transmission patterns that extend beyond household contacts and administrative boundaries. These findings underscore the need to implement geographically targeted interventions that address community-level transmission to control RR/MDR-TB in Rwanda effectively.

Mixed-methods observational implementation and economic evaluation study.

Perioperative care bundles have the potential to improve patient outcomes but their successful implementation depends on staff engagement and the resources required. Data on implementation costs and staff perceptions are limited for perioperative brain health initiatives.

To estimate the resource use and costs of implementing a perioperative brain healthcare bundle in a Swiss hospital and to explore staff perceptions relevant to sustainable adoption.

Retrospective mixed-methods study combining semi-structured interviews with economic modelling.

Single tertiary-level Swiss hospital. Cost estimates were expressed in 2024 Swiss Francs (CHF).

Five anaesthesiologists and five nurses involved in perioperative care and bundle implementation were interviewed using semi-structured interviews. Postoperative delirium incidence was assessed in patients admitted to the post-anaesthesia care unit (PACU).

Implementation of a perioperative brain healthcare bundle, including staff training, workflow adaptation and routine postoperative delirium screening.

Primary outcomes were total implementation time and costs, and postoperative delirium incidence in the PACU measured using the Nursing Delirium Screening Scale. Secondary outcomes included staff perceptions of workload and feasibility, hospital length of stay and net cost impact.

Staff perceptions of the care bundle were generally positive, with initial concerns about workload decreasing over time. Implementation required an estimated 803 hours (695–912) and cost CHF 326 612 (275 370–374 781). The economic model estimated a reduction of 300 (270–330) PACU-detected postoperative delirium cases, corresponding to 421 (341–509) hospital days saved and net cost savings of CHF 389 523 (159 209–688 988) within 12 months. Scenario and probabilistic sensitivity analyses projected cumulative net savings exceeding CHF 2 million over 5 years, with a breakeven point at approximately 2 months.

Implementation of a perioperative brain healthcare bundle was well accepted by staff and associated with substantial cost savings in this single-centre model-based analysis, supporting its potential scalability as a perioperative quality improvement intervention.

To examine whether exposure to anti-herpetic drugs (AHDs: acyclovir, valacyclovir, famciclovir) is associated with reduced risk of Alzheimer’s disease (AD) treatment initiation.

Population-based retrospective matched cohort study.

University Groningen community pharmacy database IADB.nl, covering approximately 125 Dutch pharmacies (1994–2024).

262 757 adults aged 50–80 years without prior dementia or AD treatment. Exposed individuals with antiherpetic prescriptions (n=23 887) were matched 1:10 to unexposed controls (n=238 870) by age, sex and calendar time.

AHDs: acyclovir, valacyclovir, famciclovir.

Initiation of AD drug treatment, defined as at least two prescriptions for rivastigmine, donepezil, galantamine or memantine within 1 year. Cox proportional hazards models estimated HRs with 95% CIs, adjusted for comorbidities and medications. Analyses were stratified by period (1994–2018 vs 2019–2024) and drug type.

During follow-up, 2495 participants initiated AD treatment. The age of the participants was 65 (SD 9), and 59% were female. Any AHD exposure was associated with 90% reduced hazard of AD treatment (HR 0.09, 95% CI 0.07 to 0.13, p

AHD exposure was consistently associated with markedly lower risk of AD treatment initiation, with similar findings observed in recent years. These findings support the hypothesis that herpesvirus reactivation may contribute to AD pathogenesis and suggest antiviral therapy could have preventive implications. Confirmation through prospective studies and randomised trials is needed.

A core screening, assessment and outcome set is needed in cancer prehabilitation to standardise what is measured in both research and services. Currently, there is significant variation in measures used, which limits comparability between studies and evidence synthesis. Standardising measures will improve the quality, comparability and impact of research by reducing heterogeneity between studies, minimising reporting bias, improving trial efficiency, enabling data synthesis into large datasets, supporting international collaboration and data sharing, and accelerating the implementation of best practices.

An international Delphi consensus process will be conducted involving patients, healthcare professionals and researchers to identify screening, assessment and outcomes and their corresponding measurement instruments, to be included in a core set. The study consists of three phases: (1) A scoping review to identify screening, assessment and outcomes and associated measurement instruments currently used in cancer prehabilitation. (2) At least two rounds of a modified Delphi survey to prioritise the identified screening, assessment and outcomes using a 1–9 Likert scale. Consensus will be defined across stakeholder groups using prespecified thresholds. A consensus meeting will be held if agreement is not reached. (3) Measurement instruments corresponding to each retained screening, assessment and outcome will be assessed for quality for measurement properties and feasibility. Further Delphi rounds will be conducted to reach consensus on the most appropriate measurement instrument for each core screening, assessment and outcome.

The study has ethical approval (Ref: 25/NW/0159). Findings will be disseminated through peer-reviewed publications, conference presentations, stakeholder networks and made publicly available via the Core Outcome Measures in Effectiveness Trials database.