Diagnosing venous thromboembolism (VTE) in primary care is challenging due to non-specific symptoms and competing clinical demands. Although clinical decision support (CDS) tools are often proposed to improve diagnostic accuracy, their adoption remains inconsistent. This study aims to explore primary care providers’ (PCPs’) perspectives on diagnosing VTE and identify factors influencing the design, implementation and potential use of a VTE-specific CDS system in primary care.

Qualitative interview study using directed content analysis.

Primary and urgent care settings across two academic health systems in urban and rural regions of the USA.

Eight PCPs, including physicians and physician assistants, were purposively sampled from two health systems. Participants practised in primary or urgent care settings and completed semistructured interviews focused on diagnosing VTE and CDS use.

PCPs described diagnosing VTE as challenging because symptoms are often non-specific and encountered in time-constrained clinical environments. Participants viewed a VTE-specific CDS as potentially valuable, particularly if integrated seamlessly into the electronic health record and capable of supporting risk stratification using existing clinical data. However, clinicians also identified substantial concerns regarding alert fatigue, workflow burden, limited specificity and disruption of clinical autonomy. Medico-legal concerns are constructed as a prominent theme, with participants expressing apprehension that ignoring CDS recommendations could increase liability risk, while following alerts could contribute to unnecessary diagnostic testing and downstream consequences. Participants emphasised that CDS tools should be actionable, context-aware, minimally disruptive and supportive of rather than directive to clinical reasoning.

PCPs viewed diagnostic CDS for VTE as potentially beneficial but also potentially burdensome depending on how it is implemented within clinical workflows. Acceptance of CDS appears to depend not only on technical performance but also on its effects on workflow efficiency, clinician autonomy and perceived legal risk. Future CDS development for diagnostic decision-making in primary care should prioritise usability, workflow integration and minimisation of unintended consequences such as alert fatigue and over-testing.

Document review is a qualitative research method that enables educators in higher education to systematically examine and interpret materials related to teaching, curriculum design and institutional policy.1 While traditionally applied to archival and policy documents, its scope has expanded to include institutional reports, digital learning resources and educational media.2 3 For nursing educators, particularly those engaged in pedagogical research, document review offers a practical, non-intrusive means of examining curriculum alignment, teaching practices and administrative processes without direct participant involvement. In an era of growing demands for accountability, quality assurance and evidence-based teaching, document review serves as a valuable tool for critically exploring how institutional documents reflect broader pedagogical trends and priorities.4 Therefore, this paper provides a practical guide for nursing educators on applying document review as a qualitative research method to support pedagogical research using student evaluation of teaching...

Inflammation is causally related to cancer progression and cardiovascular toxicities of anticancer treatments. Fine particulate matter (PM_2.5) air filtration lowers interleukin-6 and C reactive protein (CRP) levels in high-risk cardiopulmonary groups, though potential synergistic or confounding effects with routine medications—statins, cyclo-oxygenase-2 inhibitors, beta-blockers—remain poorly understood. Whether overnight in-bedroom PM_2.5 air filtration effectively reduces inflammation and prothrombotic biomarkers in survivors of adult-onset cancer at high cardiovascular toxicity risk is unknown.

BREATHS is a series of randomised, adaptive, blinded, placebo-controlled N-of-1 trials conducted in densely populated urban areas of Valencia, Spain, during winter when PM_2.5 concentrations historically exceed WHO guidelines. Eligible participants are aged ≥18 years with a history of breast, colorectal, prostate, lung or haematological cancer, prior cardiotoxic cancer therapy and CRP ≥3 mg/L. Each participant will undergo up to three cycles, each comprising two 14-day periods of advanced submicron air filtration (clean air delivery rate: 275 m³/hour nightly) or placebo (sham filtration), in random order. Sequence duration ranges from 4 weeks to 12 weeks, depending on whether a clinically meaningful CRP reduction (

The trial protocol was approved by the research ethics committees of University College London (REC UCL: 22105/001), Doctor Peset University Hospital (CEIm: 044/25) and General University Hospital of Valencia (CEIm: 1/2026 EO-PS), Spain. Results will be presented at relevant conferences and published in peer-reviewed journals.

NCT06778122.

Many older people experience Mild Cognitive Impairment (MCI), which may compromise the effectiveness of health promotion programmes.

We explored engagement with behaviour change among participants scoring 18-25 on the Montreal Cognitive Assessment receiving HomeHealth, a health promotion intervention supporting older adults with mild frailty to maintain independence in England ().

Of the 46 semistructured process evaluation interviews, 29 participants scored in the MCI range, purposively selected for demographic characteristics and degrees of cognitive impairment and the seven support workers.

Thematic analysis resulted in three themes: Navigating the impact of MCI; Addressing memory as a goal in the intervention; and Adapting Behaviour Change Interventions for MCI. Participants had varied opinions about whether their memory was problematic and whether anything could be done to help. Many reported not discussing memory concerns with support workers. Barriers to engagement in behaviour change included limited social support and not acknowledging memory problems. Facilitators included setting goals which increased or were linked to existing health behaviours, using reminders/prompts and actively involving family members.

Implementing these facilitators into existing and new health promotion interventions delivered to older adults, with suspected but unacknowledged MCI, could overcome the current barriers people with MCI face when trying to engage and benefit from interventions.

ISRCTN54268283