Tea-tribe communities in Assam face a substantial and under-recognised burden of stroke, shaped by socioeconomic marginalisation, limited access to formal healthcare and distinct cultural practices.

We estimated the prevalence of physician-diagnosed stroke, described associated functional and psychological disabilities, characterised gaps in diagnosis and care, and developed a logistic regression-based classification score for prevalent stroke among tea-tribe adults in Cachar district, Assam, Northeast India.

We conducted a community-based cross-sectional door-to-door survey (July 2024–August 2025) across five tea estates among permanent tea-tribe residents aged ≥18 years. Trained community health workers collected data on sociodemographics, vascular risk factors, healthcare utilisation and poststroke functional and psychological outcomes using a structured questionnaire, the Modified Rankin Scale and a symptom inventory. Stroke was identified through community symptom screening and confirmed by teleconsultation with a senior neurologist, supported by neuroimaging where available. A multivariable logistic regression model with stepwise selection identified factors associated with prevalent stroke and regression coefficients were converted into an additive point-based classification score. Internal validation used 1000 bootstrap samples and a 70:30 train–test split. The model performance was assessed using the area under the receiver operating characteristic curve and Brier score.

Among 3818 participants, 164 had a history of stroke (prevalence 4.3%), with a higher prevalence in older adults, men, unemployed or semiskilled or skilled workers and households below the poverty line. Hypertension was the strongest risk factor and its combination with daily tea containing added salt was associated with markedly higher odds of stroke. Alcohol consumption, smoking and previous heart disease were also associated with stroke. Stroke survivors had high functional and psychological burdens and fewer than half reached a health facility within 4.5 hours or underwent CT/MRI. The final model showed good discrimination (area under the curve 0.84) and calibration (Brier score 0.037). The derived classification score (0–19 points) identified a highly associated group (scores >13) with a stroke prevalence of 14.5%.

The tea-tribe community in Assam faces a high stroke burden, substantial disability and major gaps in timely diagnosis and care. A simple, internally validated classification score based on demographic, socioeconomic and vascular factors may help target community screening and prevention but requires external validation and cautious interpretation given the cross-sectional design and self-reported exposures.

Implementing integrated One Health surveillance of antimicrobial resistance (OH-AMR) remains a challenge globally, particularly in developing countries. Resource limitations, infrastructural gaps and inadequate technical capacity often hinder adherence to standardised antimicrobial resistance (AMR) surveillance guidelines, resulting in suboptimal data coverage and quality in resource-constrained settings. Moreover, considerable disparities exist in the design and execution of OH-AMR surveillance systems across regions, further complicating global data harmonisation and comparative analyses. Therefore, considering the complex ecosystem of OH-AMR and its effective implementation in the low- and middle-income countries (LMICs), a consensus-based multidisciplinary research agenda should be prioritised. In recent years, the Delphi method has become a popular tool in systematic and bias-free consensus building on a certain research domain or complex topics. Therefore, with the overarching objective of setting an operational standard for OH-AMR surveillance in LMICs, we aim to perform a Delphi study by engaging the experts from relevant domains.

To streamline the traditional time-consuming Delphi technique, we plan to implement a real-time Table-Top Delphi exercise for rapid consensus building. Moreover, to capitalise on the convention of experts from diverse fields in real-time, we propose to conduct the study during an international conference on AMR. With systematic modification in the Delphi technique, the study will be conducted in two rounds where the first round will be performed in real-time followed by a second round online. For this purpose, a set of questions being prepared based on the identified gaps in existing scientific literature, evidence and guidelines for OH-AMR will be used. The questionnaire will be dispatched on an electronic platform to accumulate the responses from the experts in real-time while ensuring the anonymity and controlled feedback. Consensus will be defined as 70% or more of respondents selecting the same option for a given question. Considering the engagement of stakeholders from multiple domains of the trifecta, a total of 50 participants will be recruited in the study to have 70% replicable consensus where responses from at least 40 participants are expected in both rounds. The outcome of this Delphi study will pave the way for the implementation of an optimised OH-AMR surveillance strategy, especially in the global south, leading to actionable outcomes.

The study will be conducted in accordance with the guidelines of the Ethics Advisory Board, Leipzig University, Germany. The Ethics Advisory Board has no concern on the study protocol (2025.08.27_eb_348) in terms of research ethics. Before participating in the survey, individuals will be required to provide informed consent through the Welphi electronic platform (Yes/No options). Participation will be entirely voluntary, and participants may withdraw their consent and discontinue participation at any stage of the study. The findings of the study will be shared with the major stakeholders including the quadripartite organisations, global and regional networks on AMR and presented in international conferences and social media forums on AMR. The outcome of the study will be published in a peer-reviewed journal.

Methamphetamine use has risen dramatically in North America, contributing to increased emergency department (ED) visits marked by agitation and complex psychosocial needs. While clinical consequences of methamphetamine use are well-documented, there is a paucity of research capturing the perspectives of people who use methamphetamines (PWUM) when accessing emergency care. This study aimed to explore the lived experiences of PWUM in ED settings to identify service gaps and inform patient-centered care strategies.

A qualitative exploratory study was conducted using semi-structured interviews with PWUM who accessed ED services in Calgary, Alberta within the past five years. Participants were recruited through community-based organizations and professional networks. Interviews were audio-recorded, transcribed, and analyzed using Braun and Clarke’s six-phase thematic analysis approach. A member-checking session was conducted with individuals with lived/living experience to validate findings.

Five interviews were included in the final analysis. Three major themes emerged including: first, experiences of stigma in which participants described feeling judged, dehumanised and often received differential treatment following disclosure of methamphetamine use. This led to avoidance behaviours including leaving against medical advice and withholding substance use histories. Second, many highlighted the need for care beyond acute needs. While acute medical concerns were addressed, participants perceived a lack of attention to underlying psychosocial and addiction-related issues. Opportunities for deeper engagement and referral to supportive services were frequently missed. Lastly, participants provided recommendations for care delivery, namely enhanced integration of acute, mental health and community services; inclusion of peer support workers with lived experience; and creation of alternative care settings tailored to the needs of PWUM.

PWUM experience significant stigma and perceive ED care as focused solely on acute stabilisation rather than holistic, person-centred support. Their recommendations call for systemic changes that address both clinical and psychosocial dimensions of care. Integrating peer navigators, expanding service linkages and establishing alternate care environments may improve patient trust, engagement and health outcomes. Future work should incorporate these perspectives to develop more compassionate and effective emergency healthcare responses for PWUM.

To evaluate the feasibility, safety and acceptability of arm crank ergometry cardiopulmonary exercise testing (CPETarm) in patients with chronic limb threatening ischaemia (CLTI).

Prospective feasibility single-arm cohort study.

A tertiary vascular surgery referral centre in Greater Manchester, UK.

Adult inpatients admitted with CLTI and scheduled for non-elective vascular intervention.

Participants underwent bedside CPETarm using an incremental ramp protocol. Cardiopulmonary parameters measured included peak oxygen uptake, anaerobic threshold (AT), ventilatory equivalent for carbon dioxide at AT, peak work rate, oxygen pulse, maximum heart rate and respiratory exchange ratio.

Primary outcomes were feasibility domains including eligibility, recruitment, test completion, safety, practicality, implementation and patient acceptability. Secondary outcomes included the ability to obtain clinically relevant CPET variables for perioperative risk stratification.

60 patients underwent CPETarm. 74% of CLTI inpatients met eligibility criteria and 71% of eligible patients consented to testing. CPETarm was completed to volitional exhaustion by 95% of participants, with anaerobic threshold identified in 68%. No major adverse events occurred during testing or within 24 hours post-test. 90% of CPETarm assessments were completed within 48 hours of the decision to proceed with intervention, without delaying surgery. The procedure was well tolerated and acceptable to patients.

CPETarm is a feasible, safe and acceptable method for preoperative assessment in patients with CLTI who are unsuitable for conventional lower-limb CPET. Further research is required to establish modality-specific thresholds, evaluate prognostic value for postoperative outcomes and evaluate integration into perioperative care pathways.

NCT06404229.

Frostbite is a common reason for emergency department (ED) presentations in Canada. Iloprost, a prostacyclin analogue, has been investigated to reduce the risk of amputation with its use expanding. Two Canadian cities implemented iloprost over different times leading to a practice variation that allowed for treatment comparison. Our objective is to evaluate the effectiveness of iloprost compared with non-iloprost treatment. Secondary objectives include assessing the impact of iloprost dosage and homelessness.

A retrospective cohort study was conducted on adult severe frostbite cases presenting to EDs in Calgary and Edmonton between November 2021 and April 2024. Data were abstracted from clinical databases and analysed for demographic and injury characteristics, treatment and amputation outcomes.

Of 1812 total ED encounters for frostbite, 257 patients with grades 2–4 extremity frostbite were included for analysis. Logistic regression found that overall patients receiving iloprost were associated with reduced likelihood of any amputation (OR=0.49, 95% CI 0.25 to 0.96) and fewer digit amputations (p

Iloprost infusion was associated with a reduction in amputation rates in grade 3 and 4 frostbite with the greatest association seen in grade 3 cases. Greater iloprost dosage was associated with improved digit salvage. Homelessness was associated with delayed ED presentation.

Chronic and life-limiting illnesses require coordinated care beyond hospital settings, with increasing emphasis on continuity of care in community and out-of-hospital environments. Respite care plays an important role in supporting both patients and caregivers; however, its delivery is often variable and lacks structured clinical guidance. While several frameworks exist to support chronic and palliative care, these have been primarily studied in broader care settings and have not been systematically examined within out-of-hospital respite care. This scoping review aims to map clinical guidance frameworks used in respite care, describe their components and implementation and identify reported patient-level, caregiver-level and system-level outcomes.

This scoping review will be conducted in accordance with Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be undertaken across the electronic databases PubMed, Scopus, Embase, CINAHL, Web of Science, PsycINFO and Global Health, along with grey literature sources (ProQuest). Studies of any design including quantitative, qualitative, mixed-methods, implementation studies and service evaluations, published in English from database inception to 31 December 2025 will be included. Two reviewers will independently screen studies, extract data using a structured data-charting form and resolve discrepancies through discussion. Extracted data will be synthesised using descriptive mapping and thematic analysis. Findings will be integrated to identify gaps and implications for low and middle-income country settings.

Ethical approval is not required for this review, as it will use publicly available data. Findings will be disseminated through peer-reviewed publication, conference presentations and integration into the ongoing mixed-methods doctoral project.

Open Science Framework, osf.io/avyzp.