Postextubation swallowing disorders (SD) are common in the intensive care unit (ICU) and are associated with severe complications, including aspiration pneumonia, a three-fold increase in reintubation risk and higher mortality. While fibreoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy are gold standards for diagnosis, they are often impractical or impossible to perform on intubated patients. The use of ultrasound offers a non-invasive, bedside alternative to evaluate the musculoskeletal structures involved in swallowing. The Echographie Identifier les troubles de Déglutition Acquis en Réanimation (EIDAR) study aims to evaluate the diagnostic performance of pre-extubation ultrasound in identifying patients at risk of SD following mechanical ventilation.

This prospective, monocentric diagnostic study conducted at the Dijon University Hospital ICU will include 100 adult patients ventilated for ≥48 hours. The primary outcome is the presence of SD, defined as a Penetration-Aspiration Scale score >2 during a FEES procedure performed 3 to 24 hours postextubation and independently assessed by an otolaryngologist blinded to index test results. Pre-extubation cervical ultrasound (Index Test) will be performed within 3 hours prior to extubation and measure hyoid bone ascension (primary variable of interest), geniohyoid muscle surface area and digastric muscle cross-sectional area. The diagnostic performance of cervical ultrasonographic parameters will be assessed using their discriminative capacity via a receiver operating characteristic curve. The feasibility of the ultrasound procedure in a critical care setting will also be assessed.

The study received a favourable opinion from the independent ethics committee CPP Ouest III and is registered with the French health authority ANSM (national agency on safety in medicine and health products). It is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Participants or their proxies provide free and informed oral consent. Results will be submitted for publication in peer-reviewed medical journals and presented at international conferences.

RCB 2023-A00461-44 and NCT05922085

To characterise engagement across the diabetic retinopathy (DR) care continuum in the USA using a cascade-of-care framework and identify gaps contributing to preventable vision loss.

Systematic review.

From September to November 2025, with an updated search in March to April 2026 using the same eligibility criteria, we systematically searched Ovid MEDLINE and Ovid Embase supplemented by reviewing reference lists of relevant articles and opportunistic searches of the Centers for Disease Control and Prevention publications.

We included English-language US-based cross-sectional, cohort and case–control studies and systematic reviews containing US-based data published between 1 January 2018 and 31 December 2025 relevant to one of the defined DR cascade stages: (1) diagnosis of diabetes, (2) adherence to DR screening, (3) diagnosis of DR, (4) adherence to DR care and (5) DR-related blindness. We included systematic reviews only to inform DR-related blindness, where primary data were limited and excluded them from other stages to avoid double-counting. Exclusion criteria included studies not relevant to one of the defined DR cascade stages and editorial, perspective or commentary pieces.

Two reviewers independently screened studies, extracted data and assessed risk-of-bias using the Newcastle-Ottawa Scale and Risk of Bias in Systematic Reviews tool. We synthesised data narratively and organised via the DR treatment cascade framework.

Of 14 893 studies screened, 46 met the inclusion criteria. Cascade analysis revealed substantial losses in patient engagement at three stages: (1) only 15.5%–78.7% (median 59.4%, IQR 33.9%–74.0%) of individuals with diabetes obtain biennial DR screening; (2) a substantial 54.9%–88.5% (median 70.1%, IQR 62.5%–79.3%) of individuals with DR are unaware of their diagnosis; (3) only 30.9%–62.7% (median 52.0%, IQR 40.9%–59.1%) of individuals diagnosed with DR are initially linked to care and 55.3%–77.8% (median 70.3%, IQR 59.2%–77.7%) have a lapse in DR follow-up.

This review identifies major gaps in the DR care continuum, particularly in diagnosis awareness, linkage to care and follow-up adherence. The cascade framework highlights key points of disengagement and provides a basis for prioritising future research.

To explore healthcare professionals’ perspectives on the potential role of molecular breast imaging (MBI) for breast cancer imaging and to inform future clinical study design and implementation.

Qualitative interview study.

UK National Health Service (NHS) breast screening and diagnostic pathways.

Purposively sampled stakeholders.

Semistructured interviews with key professional stakeholders explored potential MBI pathways and routes to adoption, including barriers and facilitators. Data were analysed thematically.

22 participants were recruited between January 2020 and October 2021. Barriers to MBI adoption were identified at three levels: scan-related, system-level, and cultural within the screening programme. Overcoming these is likely necessary for implementation. A further theme highlighted the potential for MBI to improve screening in selected patient groups, contingent on addressing these barriers. Specifically, adoption would require advances in next-generation MBI systems, particularly reductions in radiation dose and scan time, alongside prospective clinical studies in UK populations to assess diagnostic accuracy.

Once identified barriers are overcome, participants perceived that MBI could improve screening pathways, particularly for women with dense breast tissue.

To examine virtual health service (VHS) device usage patterns and identify factors associated with VHS engagement among Indigenous Australian adults with chronic conditions.

Cross-sectional survey.

An Aboriginal Community Controlled Health Organisation providing primary healthcare services across rural and remote Queensland, Australia.

74 consenting Indigenous Australian adults with at least one chronic condition who were registered VHS users.

Participants completed surveys assessing their use of four Bluetooth-enabled monitoring devices (pulse oximeter, blood glucose monitor, blood pressure monitor, weight scale) over a 2-week recall period. The primary outcome was VHS device usage status, categorised as active versus inactive users. Active users were defined as participants who reported any frequency of device use, while those reporting no use were classified as inactive users. All participants had access to Indigenous health coach support as part of the VHS model. Binary logistic regression was used to identify sociodemographic and geographical factors associated with VHS engagement.

Sixty-four per cent (n=47) were active users, with 73% of these using all four devices concurrently. Among active users, blood pressure monitors showed the highest utilisation (98%), followed by weight scales (91%), blood glucose monitors (89%) and pulse oximeters (86%). Three factors were significantly associated with VHS usage using binary logistic regression: residing in medium rural towns (adjusted OR 4.71, 95% CI 1.23 to 17.94, p=0.02), age 18–65 years (adjusted OR 3.59, 95% CI 1.05 to 12.22, p=0.04) and having multiple chronic conditions (adjusted OR 10.95, 95% CI 1.25 to 95.87, p=0.03) compared with those in more remote areas, aged ≥66 years and with single condition, respectively.

Indigenous-led VHS achieve substantial engagement through culturally grounded health coach support. However, addressing digital connectivity in remote areas, age-appropriate support for older adults and Indigenous workforce development is essential to ensure equitable access and sustained engagement

Doxycycline as post-exposure prophylaxis (doxy-PEP) has emerged as an efficacious strategy to reduce Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae) and syphilis (sexually transmitted infections (STIs)) among gay, bisexual and other men who have sex with men (GBM). There is a need to identify prescribing criteria that maximise the number of STIs averted while minimising excessive use.

In this prospective longitudinal cohort study with repeated measures and biobehavioural data collection, participants completed a questionnaire and tested for STIs at each visit.

Community-based, population-level study conducted in three large Canadian cities between February 2017 and July 2023.

2449 GBM were recruited through respondent-driven sampling (RDS); 1998 had ≥1 follow-up visit, contributing 7551 person-years of observation. Eligible participants were aged ≥16 years, cis- or transgender men, reported sex with another man in the past 6 months and resided in Montreal, Toronto or Vancouver.

Adjusted rate ratios (aRR) of STIs, accounting for RDS recruitment, loss to follow-up and confounding were estimated using generalised estimating equations (GEE) Poisson regression. For identified STI risk factors, the proportions of STIs averted through doxy-PEP prescription (based on the efficacy of doxy-PEP for each bacterial STI) and the number needed to treat (NNT) for 1 year to avert one STI, assuming 100% adherence, were calculated.

Among 1998 participants, the combined incidence rate of any C. trachomatis, N. gonorrhoeae and syphilis infection was 29.5 (95%CI 27.3 to 31.9) per 100 person-years. STI risk factors that had the most impact as doxy-PEP criteria were history of any of the three STIs in the past 12 months (P12M) (aRR=2.0, 95% CI 1.8 to 2.2, 36% STI averted, NNT=2.1); ≥10 male sexual partners in the past 6 months (P6M) (aRR=3.8, 95% CI 3.0 to 4.9, 41% STI averted, NNT=2.4); HIV-pre-exposure prophylaxis (PrEP) use P6M (aRR=1.7, 95% CI 1.5 to 2.0, 29% STI averted, NNT=2.5); use of any chemsex-related substance P6M (aRR=1.2, 95% CI 1.1 to 1.4, 28% STI averted, NNT=2.6); and group sex event attendance P6M (aRR=1.2, 95% CI 1.1 to 1.3, 27% STI averted, NNT=2.3). Reporting≥10 male sex partners P6M represented the most useful criterion for syphilis prevention (52% syphilis infections averted, NNT=20). Prescribing doxy-PEP to GBM having any of the following STI risk factors, namely, ≥1 bacterial STI P12M, ≥10 male sex partners P6M, or HIV-PrEP use P6M, would substantially increase the proportion of all STI diagnoses potentially averted (60%) with minimal increase of the NNT (2.7).

This work informs on the impact of various doxy-PEP clinical prescribing criteria and demonstrates the benefit of focusing on any of the following three criteria: ≥1 bacterial STI P12M, ≥10 male sex partners P6M or HIV-PrEP use P6M.

Parenting an infant in the neonatal intensive care unit (NICU) can be highly stressful, undermine parental confidence and minimise involvement in infant care. Enhancing parental self-efficacy is therefore crucial to promoting active engagement and supporting positive child outcomes. This study aims to identify the psychosocial needs (emotion regulation and stress management) of NICU parents and examine the factors that influence their engagement in infant care. It also seeks to determine whether higher levels of parental self-efficacy are associated with greater engagement and collaboration with healthcare providers (HCPs) and a shorter NICU stay.

A mixed-methods study will be conducted at the Montreal Children’s Hospital’s Level III NICU located in Quebec, Canada. Parents (ie, mothers and, when available, their partners) will be recruited during their infant’s hospitalisation. Participants will complete a set of self-report questionnaires measuring parental engagement, self-efficacy, parent-infant attachment, mental health, perceived stress and social support. Additionally, one parent per family will be invited to participate in a qualitative interview to discuss their experience in the NICU. Qualitative data will be analysed thematically using NVivo 12 to identify key themes, and statistical analyses will be conducted using RStudio to determine which factors are most strongly associated with parental engagement and their interactions with the clinical team. Finally, HCPs will be invited to assist and participate in a qualitative interview regarding their perspectives on the NICU environment and the study’s impact on the unit (ie, reduction in HCP burden due to increased parental engagement). Findings from this study will offer valuable insights to inform future clinical strategies aimed at enhancing parental engagement and self-efficacy in the NICU. These outcomes may contribute to improved neonatal outcomes, parental mental health and the advancement of evidence-based, family-centred care policies.

The protocol was approved by the Montreal University Health Centre’s (MUHC) Research Ethics Board (2025-9392). Findings derived from this study have the potential to optimise parental engagement in the NICU to promote family resilience and child well-being.

Our study protocol aims to underscore the critical role of self-efficacy and other key psychosocial factors, such as lower parental stress and higher emotion regulation, in promoting parental engagement and collaboration within the NICU. We anticipate that higher levels of self-efficacy will correlate with parental well-being, increased caregiving engagement (ie, basic baby care, improved communication with NICU staff) and enhanced parent-infant bonding. These findings may support the development of structured interventions that empower parents and streamline provider-parent collaboration. In clinical practice, these insights can guide the integration of tailored parental support programmes to optimise discharge preparation and reduce provider burden by promoting shared caregiving responsibilities. Future initiatives could build further on this model to guide institutional policies that aim to prioritise parental empowerment (ie, greater self-efficacy and engagement) as a fundamental pillar of neonatal care.

We designed the Optimising Care in Critically Ill at the UCHealth by Liberalising the Target O₂ in Mechanically ventilated intensive care unit (ICU) Patients to determine the effectiveness of a multimodal educational and electronic health record order panel intervention in limiting occult hypoxaemia and hyperoxaemia in patients receiving invasive mechanical ventilation by targeting a prespecified oxygen saturation (S_pO₂ 90%–96%) range.

This trial is a pragmatic electronic health record-embedded, multisite, cluster-randomised, stepped-wedge implementation of a multimodal educational and electronic health record order panel intervention aimed at achieving a standardised intermediate target range of S_pO₂ (90%–96%) or partial pressure of oxygen (P_aO₂ 60–100 mm Hg) in mechanically ventilated adult patients admitted to the ICU across a 10 hospital health system that includes a large academic centre and smaller community hospitals.

The primary endpoint is ventilator-free days to day 30, defined as the number of days alive and not receiving support through invasive mechanical ventilation following the first initiation of invasive mechanical ventilation in a participating ICU during the hospitalisation. Secondary outcomes include a variety of clinical endpoints: hospital-free days to day 30, all-cause mortality to day 90, need for supplemental oxygen at discharge and incidence of occult hypoxaemia and hypoxaemia. We will analyse primary and secondary endpoints using a mixed effects modelling framework, with specific distributions chosen depending on the type of outcome (eg, binary, count, ordinal, time-to-event).

Research is performed under a waiver of informed consent for minimal-risk research, as approved by Colorado Multiple Institutional Review Board (24-0065). Results will be disseminated in peer-reviewed publications and at national and international conferences.

NCT06501118.

Each year, suicide claims approximately 700 000 lives worldwide and generates a significant financial burden. Integrating genomic data, exposomic factors and digital phenotypes can enhance the development of short-term predictive models. Current knowledge and available tools provide the basis for designing personalised treatment strategies that incorporate real-time interventions to prevent suicide attempt recurrence cost-effectively. This study aims to develop a predictive algorithm for suicidal behaviour integrating psychiatric assessments, genetic risk markers, digital phenotypes and exposomic data.

This protocol describes a retrospective multicentre study that will recruit participants with a clinical history of suicide across 25 hospitals across Spain with a catchment area of 8.6 million people (17.8% of Spain’s population). Our sample target is over 5000 participants, aged over 12 years old, ensuring 93.5% statistical power for genetic analysis. Eligible participants must be over 12 years old. Data collection will include psychiatric assessments, biospecimen collections (DNA, RNA, plasma and serum), Google Takeout data for digital phenotyping, and a standardised set of administrative and clinical data registered for each patient. Genotyping will be performed with the Axiom Spanish array (>750 000 markers), and genome-wide association studies (GWAS) will be performed after genetic imputation in a whole sample of >10 000 individuals (5000 suicide attempters; 5000 controls). Prescription and clinical history will also be retrospectively integrated, and codified data statistics forms will periodically be sent to the Government. Statistical analyses will combine traditional regression models and AI-based algorithms to identify predictive behavioural, genomic profiles, and digital markers of suicidal behaviour. Cost-effectiveness analyses of pharmacogenomic markers for antidepressant response will also be conducted.

By successfully implementing this project, we aim to help reduce suicide reattempts and lessen the emotional and economic burden on families and the healthcare system.

This study has been approved by the Ethics Committee of the Fundación Jiménez Díaz (PIC301-24_FJD) and complies with the Declaration of Helsinki. It adheres to the GDPR (EU Regulation 2016/679), Spain’s Organic Law 3/2018 on Personal Data Protection and Digital Rights, and Law 41/2002 on patient autonomy. All required data protection measures will be implemented, including those under Real Decreto 1718/2010 on prescriptions and treatment adherence. Underaged participants will require parental consent for participation. The results will be disseminated through publication in peer-reviewed scientific journals and presentations at psychiatric conferences.

NCT07422090.

Adolescent mothers are at increased risk of rapid repeat pregnancy during the postpartum period, particularly in low-and middle-income countries where unmet need for contraception remains high. Stigma, limited autonomy and inadequate youth-friendly services contribute to low uptake of postpartum contraception. Digital health interventions have been proposed as scalable approaches to improve access to contraceptive information and support. However, evidence specifically focusing on digital interventions to enhance postpartum contraception among adolescent mothers has not yet been comprehensively mapped. This scoping review aims to identify and describe the available evidence in this area.

This review will follow the Arksey and O’Malley framework, with refinements by Levac et al and guidance from the Joanna Briggs Institute. Reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, Scopus and Web of Science along with relevant grey literature sources will be searched. Studies involving adolescent mothers (10–19 years) within 12 months after childbirth and evaluating digital interventions for postpartum contraception will be included. Two reviewers will independently screen and extract data using a standardised charting form. Findings will be synthesised descriptively to map intervention types, outcomes and research gaps. No formal quality appraisal will be undertaken.

Ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and engagement with relevant stakeholders to inform research, policy and programme development.

Chronic musculoskeletal pain often extends beyond pathology alone. Augmented central pain processing is linked to pain severity, persistence and treatment outcomes. A practical clinical tool is needed to identify individuals likely to have persistent or worsening pain, likely due to augmented central pain mechanisms. Quantitative Sensory Testing (QST) offers mechanistic insight, while the Central Aspects of Pain (CAP) Questionnaire captures symptom profiles that potentially reflect central mechanisms. Combining a brief clinical QST protocol with CAP may support early risk stratification and guide personalised pain management.

This prospective observational study will recruit 250 individuals with inflammatory arthritis, osteoarthritis, chronic low back pain or fibromyalgia from existing cohorts, primary or secondary care. Participants will complete validated patient-reported outcomes at baseline, 6 and 12 weeks, with no additional intervention. The risk stratification tool completed at baseline will include clinical QST (Pressure Pain Threshold, Temporal Summation of Pain, Conditioned Pain Modulation), tender point count and the CAP questionnaire. Baseline laboratory versions of the clinical QST, plus Heat Pain Threshold, Offset Analgesia and the Central Sensitisation Inventory short form-9 questionnaire, will provide pain profiling to evaluate the predictive validity and psychometric properties of the tool. Data collection will include demographics, medical history, cognitive and neurological assessments and sleep quality via actigraphy (Actigraph wGT3X-BT). Interviews with patients and healthcare professionals will inform refinement, feasibility and acceptability of the tool.

Ethical approval was obtained from the Yorkshire & The Humber—South Yorkshire Research Ethics Committee (reference number: 24/YH/1062). Findings will be disseminated through peer-reviewed publications, conference presentations and patient-facing summaries and podcasts. The study aims to develop a clinically feasible tool to identify individuals at risk of persistent or worsening pain due to augmented central pain processing, enabling targeted treatment strategies.

NCT06518278.

The goal of this study was to identify strategies and assess priorities to increase human papillomavirus (HPV) vaccination among unvaccinated young adults using a concept mapping approach.

The concept mapping process was conducted in two phases. In phase 1, eligible participants generated qualitative statements in response to a topic prompt. In phase 2, participants organised and grouped the statements by perceived similarity, and then rated each statement on a scale of perceived effectiveness. Multidimensional scaling and hierarchical cluster analysis were conducted to develop a conceptual map of the data.

This study was conducted at a university in the southwestern USA.

Eligibility criteria for participation included individuals (1) aged 18–26, (2) who had not received any dose of the HPV vaccine or were unsure if they had received the vaccine and (3) who were enrolled students at the study site institution. 24 participants engaged in the concept mapping process; five participated in phase 1 only, five participated in phase 2 only and 14 participated in both phases.

The 41 statements generated were organised into five cluster concepts: media and messaging, information and education, promotion, legal and accessibility. Accessibility was the highest-rated cluster for effectiveness followed by information and education. Exploratory trends across participant demographics were also identified. Differences in perceived effectiveness of the cluster concepts were observed by gender, race, political affiliation and vaccination status.

This study provides valuable preliminary insights into strategies and factors perceived influential in enhancing HPV vaccination from the perspective of unvaccinated young adults. Using concept mapping, multiple factors were identified that varied in their degree of perceived effectiveness across different groups. Future HPV vaccination interventions should consider multi-component elements to ensure their success and reduce the burden of HPV-related disease.

Rates of mental health difficulties among girls and young women in the UK have risen sharply, and disproportionately so for those from marginalised groups. My Story and Me is a new digital public mental health intervention that uses storytelling to reduce stigma, increase awareness and support early help-seeking among girls and young women aged 14–18. The feasibility study aims to determine the acceptability of the intervention and future full trial, including assessing optimal settings and meaningful changes in the primary outcome measure (anxiety and depression).

This is an 18-month mixed-methods, uncontrolled feasibility study conducted in secondary schools, further education colleges and community organisations across the UK. We will recruit 120–180 participants. Quantitative data will be collected at baseline and 7-month follow-up. The primary outcomes are anxiety and depression, and secondary outcomes are social support, mentalising, stigma, quality of life, loneliness, empowerment, intervention acceptability, resource use and randomisation acceptability. Platform-level engagement data will assess adherence and fidelity. Qualitative interviews with young women and staff will explore acceptability, feasibility, mechanisms of change and views on trial procedures, including randomisation in a future full trial. Analysis will be descriptive and exploratory, including comparisons across settings and priority groups (LGBTQIA+, neurodivergent and those experiencing digital poverty). A framework and reflexive thematic analysis approach will be used for qualitative data. Prespecified progression criteria will inform decisions about advancing to a full cluster randomised trial.

The University College London Research Ethics Committee (0692) has approved the My Story and Me protocol. Interested participants will be required to complete an expression of interest and consent form to take part in the study, and young people under 16 years old will be required to obtain parent/carer informed consent. Results will be disseminated through peer-reviewed publications, lived experience summaries, a policy briefing and academic conference presentations.

ISRCTN12191423.