Oligoprogressive disease (OPD) is a clinically significant pattern of progression observed in patients with oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer treated with endocrine therapy (ET) and cyclin-dependent kinase (CDK) 4/6 inhibitors. Stereotactic ablative body radiotherapy (SABR) is an emerging strategy that may ablate resistant subclones and prolong the benefit of systemic therapy. The AVATAR-II trial investigates whether the addition of SABR to continued systemic therapy can delay the need to change treatment strategy.

AVATAR-II is a multicentre, randomised, open-label, phase II randomised controlled trial enrolling 74 patients with histologically confirmed ER-positive, HER2-negative advanced breast cancer and 1–5 sites of extracranial OPD. Eligible patients must have demonstrated clinical benefit (stable disease or partial response) from ET and CDK4/6 inhibitors for at least 6 months prior to randomisation. Participants will be randomised 1:1 to either SABR to all OPD sites with continuation of current systemic therapy (Arm A) or physician’s choice of systemic therapy (Arm B). The primary endpoint is time to treatment failure, defined as progression not amenable to SABR, cessation of systemic therapy or death. The secondary endpoints include progression-free survival (PFS), PFS2, overall survival, treatment-related adverse events and patient-reported quality of life using the Functional Assessment of Cancer Therapy–Breast score.

This study received ethical approval from the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC), under approval number 25/45 and HREC reference HREC/105165/PMCC. Results of the study will be disseminated via peer-reviewed presentation at scientific conferences and open-access publication.

NCT06882499.

To examine the prevalence and disease-combination patterns of multiple long-term conditions (MLTCs) among adults in India and their associations with quality of life and healthcare utilisation.

Cross-sectional analysis of two nationally representative survey waves.

Community-based household survey conducted across six Indian states (Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal), part of the WHO Study on global AGEing and adult health.

9116 adults aged 18 years and older in Wave 2 (2015) and 7885 adults in Wave 3 (2019–2020).

Quality of life, assessed with the 8-item WHO Quality of Life scale (WHOQoL-8, range 0–100), was the primary outcome. Outpatient visits and hospitalisations in the preceding 12 months were the secondary outcomes. Associations with MLTC were estimated using Tobit regression for quality of life and Poisson regression for healthcare utilisation, adjusting for sociodemographic, socio-economic and behavioural factors.

MLTC prevalence rose from 19.2% to 24.4% between waves and was highest among adults aged 60 years and older, women, urban residents and the wealthiest quintile. Hypertension–cataracts, hypertension–arthritis and hypertension–diabetes were the most prevalent dyads. Depression–chronic obstructive pulmonary disease (COPD) and depression–stroke combinations had the poorest quality of life. Physical and functional domains declined most as MLTC increased, while the financial domain remained stable. Compared with adults without chronic conditions, WHOQoL-8 scores fell in a stepwise pattern with one, two and three or more conditions (–2.6, –5.1 and –6.7 points in 2015; –3.3, –5.6 and –7.9 in 2019–2020; all p

MLTC are rising in India and are associated with poorer quality of life and higher healthcare use. High-burden combinations, particularly depression–COPD, depression–stroke, COPD–stroke and depression–angina, warrant targeted interventions to improve quality of life and manage rising healthcare demands.

Breast cancer is the most common cancer in women in the UK. For women who have early-stage oestrogen-receptor positive (ER+ve) disease, daily oral adjuvant endocrine therapy reduces risk of recurrence. Recently, CDK4/6 inhibitors, a form of biological therapy, have been approved for use alongside endocrine therapy. However, trial data suggest there may be challenges with adherence to CDK4/6 inhibitors. This study aims to explore the experiences of adherence and support needs of women who have been prescribed CDK4/6 inhibitors for early ER+ve breast cancer. It will also co-develop an intervention to support women with adherence to these drugs alongside endocrine therapy through an evidence-based, theory-informed and patient-centred approach.

The SWEET-PLUS study has three phases. Phase I uses semi-structured interviews or focus groups to explore the experiences of women with early breast cancer who have been prescribed CDK4/6 inhibitors. It will also explore their support needs and experiences of adherence. Phase II involves interviews or focus groups with healthcare professionals who support CDK4/6 inhibitor prescription and associated care to understand the existing support and unmet needs. Phase I and II findings will inform phase III, which comprises workshops and user testing interviews to co-develop an intervention to support women with adherence to CDK4/6 inhibitors alongside endocrine therapy. This will be delivered as an additional module prototype designed for future integration into the existing HT&Me intervention, which supports women with adherence to endocrine therapy.

Data from phases I and II will be analysed using a framework approach-based thematic analysis. Phase III data will be analysed through content analysis.

SWEET-PLUS received ethical approval from the National Health Services (NHS) Health Research Authority (Cambridge East Research Ethics Committee (25/EE/0220)). Research findings will be disseminated through peer-reviewed journal articles and via international and national conferences. Further dissemination will be guided by patient and public involvement.

Very preterm infants (

Australasian multicentre, two-arm, parallel-group, prospective, randomised, open, blinded-endpoint superiority trial in 868 infants born less than 32 weeks’ gestation. Infants are randomised to cycled environmental light and noise or routine care in a non-cycled hospital environment from soon after birth until discharge home. The intervention comprises wearing eye-masks and ear plugs from 20:00 to 6:00, followed by removal of these devices and exposure to normal environmental noise and 300-600 lux light from 6:00 to 20:00. The primary outcome is composite cognitive score on Bayley-4 developmental assessment at 2 years corrected postnatal age.

The trial is approved by the Child and Adolescent Health Service Human Research Ethics Committee under the National Mutual Acceptance Scheme in Australia. Infants are randomised to intervention or control group after informed parental consent is obtained. Results of the CIRCA DIEM Study will be disseminated widely via presentations at local, national and international conferences, publication in international peer-reviewed journals and inclusion on the study website. Information about trial findings will also be communicated directly to the parents/guardians of trial participants through the regular study newsletter. The trial investigators will seek opportunities to communicate study results to the lay public through media and social media avenues.

ANZCTRN12618000371291.

Musculoskeletal (MSK) conditions affect over 20 million people in the UK and account for one in seven General Practitioner (GP) consultations. To address capacity challenges, First Contact Physiotherapists (FCPs) now manage MSK patients in primary care. However, FCPs working in isolation from physiotherapy teams exhibit broad variation in decision-making that could pose risks to care quality. PRimary Care Individual Social Norms MSK Data Dashboard (PRISM) is a clinician-facing behaviour change digital dashboard that provides individualised social norms feedback such as, ‘you are in the top 10% of those referring to secondary care’ or ‘in the bottom 10% of those referring to social prescribing’. It aims to nudge FCPs towards evidence-based norms, including more effective and cost-efficient treatments, thereby reducing unwarranted variation in care and improving patient outcomes. Social norms interventions have been shown to positively influence clinician behaviour, but their application in MSK services remains unexplored.

To determine the feasibility of evaluating PRISM’s effectiveness and cost-effectiveness in a future clinical trial.

A pragmatic feasibility cluster randomised controlled trial will be conducted across four UK primary care sites with FCP services. Sites will be allocated 1:1 to intervention (PRISM dashboard, guidebook and structured clinical supervision) or control (usual care). Data on clinical decision-making will be collected monthly and anonymised for dashboard generation and compared to an existing dataset of over a million FCP consultations. Patients seen by FCPs will be invited to provide patient-reported outcome measures and experience measures. Feasibility outcomes include recruitment and retention of sites, FCPs and patients; dashboard engagement and completeness of data collection.

The primary outcome is recruitment feasibility. Secondary outcomes include retention, dashboard usage, patient-rated outcome measure/experience measure (patient-rated outcome measures/patient-rated experience measures) completion and supervision engagement. Descriptive analyses will summarise feasibility metrics and missing data. Health economic and carbon reduction data collection will also be assessed for future trial planning.

IRAS number 361 359. REC reference: 25/EM/0256, Approved: 10 December 2025 based on PRISM Protocol V.9. Dated 25 November 2025.

NCT07112508.

Findings from the PRISM feasibility trial will be disseminated through peer-reviewed publications, conference presentations and stakeholder engagement. Results will also be shared with participating sites, patient and public involvement representatives and professional bodies such as the Chartered Society of Physiotherapy to inform clinical practice and policy. Additionally, lay summaries will be produced for patients and the public and digital channels will be used to maximise reach.

Young men’s mental health is a continuing concern but remains underrepresented in both mental health services and research. Engaging young men in mental health research has proven difficult, but creative, strength-based and participatory methods may help overcome barriers and enhance understanding of how best to involve them. This study aims to explore young men’s perceptions of how healthcare and academic settings can better engage them in mental health research, and to examine whether participatory, strength-based approaches themselves foster greater engagement.

This convergent mixed-methods participatory-informed study integrates photovoice with appreciative inquiry (AI) within a four-phase AI cycle: Discovery (photovoice-led exploration of ‘what works’ in engaging with research), Dream (co-imagining desirable engagement experiences), Design (co-creating practical engagement resources and practices) and Deploy (planning how to test and refine these practices). Participants will be young men aged approximately 18–25 years, recruited through community organisations and primary-care-adjacent networks.

Data will include photographs with captions and written captions (Discovery), workshop transcriptions (Dream/Design/Deploy). Qualitative data will undergo reflexive thematic analysis, incorporating participatory sense-making through member reflections. Quantitative data will analyse pre–post changes on engagement and empowerment measures, which will be summarised with means, medians and bias-corrected bootstrapped 95% CIs, with exploratory non-parametric tests where appropriate. Feasibility and acceptability will be assessed through recruitment, retention, data completeness and satisfaction metrics. Adverse events and distress responses will be monitored and reported.

Ethical approval has been granted by the University of Exeter Ethics Committee (Ref 10981599). Safeguards include staged written consent, image ownership and usage agreements, anonymisation and a distress and safeguarding protocol with supported signposting. All participants will provide informed consent, and data will be managed in accordance with GDPR and university information governance policies. Findings will be shared with participants and community partners, published in peer-reviewed outlets and developed into a replicable engagement toolkit for wider use.

The objectives were to evaluate if a novel self-triaging and self-scheduling emergency department (ED) service, the Minor Ailment Patient Pathway (MAPP), can safely reduce ED wait times for low-acuity patients presenting with either cold and influenza or musculoskeletal ailments.

Prospective cohort study including all consecutive ED patients from 1 June 2023 to 31 March 2024. Outcomes for MAPP patients were compared with contemporaneous, matched ED patients who followed the usual care (UC) ED intake and evaluation process.

Single acute care hospital, Royal Victoria Regional Health Centre, located in Ontario, Canada.

Of 73 132 ED visits during the study period, 2766 (3.8%) used the MAPP. Low-acuity patients, defined by the Canadian Triage and Acuity Scale (CTAS) 3 or 4–5, comprised 59.4% and 34.1%, respectively, of all ED patients.

Most MAPP visits were for cold and influenza symptoms (63.6%) or musculoskeletal ailments (18.4%). Compared with CTAS-matched UC patients, MAPP users had a shorter mean length of stay (LOS) and faster mean physician initial assessment (PIA) time (adjusted LOS: –0.44 hours, 95% CI –0.84 to –0.05 and adjusted PIA: –1.22 hours, 95% CI –1.42 to –1.01). 7-day return visits occurred in 3.2% of MAPP patients compared with 4.4% of UC patients (p=0.002), with fewer admissions on return (1.8% vs 13.2%; p

MAPP was associated with shorter LOS, faster PIA, lower rates of return visits and hospital admissions, and high patient satisfaction, all suggestive of a safe, efficient and patient-centred ED service. Despite these benefits, MAPP was underused with only 9.3% of all cold and influenza and musculoskeletal ED patients self-triaging and self-scheduling an ED MAPP visit during this cohort period.

Strong evidence signals that maternal mental health issues significantly contribute to overall maternal morbidity and mortality. With emerging scholarly innovation to address these concerns, it has become clear that meeting the mental healthcare needs of women from minority ethnic groups will require the development of appealing and culturally responsive approaches. This study by Gardner et al1 proposes four themes of women from minority and ethnic groups’ experiences with receiving National...

To explore the acceptability of the Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS) intervention and trial procedures for participants.

A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone.

Primary care.

Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30–60 min.

COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes.

Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally.

Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions.

These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial.

Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.

To develop a core information set for induction of labour. Rates of induction of labour for childbirth are rising in many high-income countries. In England, a third of women have their labours induced. National guidelines recommend women receive information to make informed decisions about induction.

Two-stage consensus study using modified Delphi.

UK.

Pregnant people, parents and professionals.

Stage 1: A long list of information points was identified through a systematic review of reviews, reviewing patient leaflets, qualitative interviews and a stakeholder survey, with ongoing patient, public and professional involvement. Stage 2: Think-aloud interviews were undertaken to refine the Delphi survey before a two-round modified Delphi process where participants voted on the importance of the information items. Pre-specified criteria were used to select items taken forward to a consensus meeting.

199 information points were identified through systematic review (110), patient information leaflets (162), qualitative interviews (58) and a survey (93). 46 unique information items entered the first Delphi round after four think-aloud interviews, 2 items were added following round 2. 368 people (310 parents/58 professionals) participated in round 1 and 177 people (154 parents/23 professionals) in round 2. 44 items met inclusion criteria; one item excluded, and three items were carried forward for consensus meeting discussion where 12 overarching information points were agreed on.

This study has established a consensus-based core information set for induction of labour from a sample of the birthing population and staff providing their care. The resultant set has been populated with evidence in line with national guidelines. It can be used by women and clinicians as a standardised starting point from which to personalise discussions about birth.

COMET Initiative registration 2600: Developing a core information set for induction of labour.

This qualitative study aims to explore the experiences and preferences of Hispanic men participating in the National Diabetes Prevention Program (NDPP), an intensive lifestyle change intervention that effectively reduces diabetes risk, considering Hispanic men experience diabetes disproportionately yet remain underrepresented in the NDPP.

Individual semi-structured interviews were conducted over the phone in English or Spanish between June 2023 and February 2024. Transcripts were analysed using a framework analysis.

17 Hispanic men engaged in the NDPP for ≥4 sessions. The majority were foreign-born (n=11) and self-identified as English proficient (n=11).

Through three major themes, Hispanic men reflected on their experiences: (1) Going into the NDPP: despite not knowing what to expect from the NDPP, their fear of diabetes motivated them to enrol in the programme; (2) During the NDPP: they felt relief from gaining critical knowledge about diet, exercise and diabetes prevention; and finally (3) Impressions of the NDPP: they appreciated the NDPP’s informational resources, personalised coaching, group format and acknowledgement of traditional cultural diets and found men-only groups often offered additional emotional safety but had mixed feelings about the programme’s virtual format.

Findings suggest that Hispanic men appreciate the knowledge and skills attained from the NDPP and value its resources, group format, culturally-tailored content and gender-tailored structure. Recruitment efforts may benefit from emphasising how the programme reduces uncertainty about prediabetes and from more clearly conveying the structure of the programme. Strategies to improve sustained engagement should consider how to feasibly offer delivery formats that accommodate diverse preferences.

Deficiencies in non-technical skills—including communication and leadership—are well-established causes of clinical errors in healthcare. Healthcare students and professionals increasingly use high-fidelity and virtual reality (VR) simulation to replicate clinical practice, through immersive and realistic scenarios in a risk-free teaching setting. However, there is no up-to-date, high-quality synthesis of the effects of high-fidelity and VR simulation on non-technical skills for healthcare students and professionals. A systematic review and meta-analysis of this literature is required to enhance the current knowledge.

This protocol has been reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. We will include randomised trials and other controlled studies that report differences in non-technical skills between high-fidelity and VR simulation. We will search MEDLINE, Scopus, EMBASE, ERIC and CINAHL, from database inception. We will also search reference lists and contact experts to identify additional studies. Two independent reviewers will screen titles and abstracts, review full texts, and extract data. Discrepancies will be resolved through discussion, with a third reviewer if necessary. For randomised trials, we will use the Cochrane Risk-of-Bias 2.0 (RoB2) tool to evaluate the risk of bias in the included studies. For non-randomised studies, we will use the Risk Of Bias In Non-randomized Studies (ROBINS-1) assessment tool. If appropriate, meta-analysis will be performed. We will analyse continuous outcomes using weighted mean differences (with 95% CIs) or standardised mean differences (with 95% CIs) if different measurement scales are used. We will use subgroup and sensitivity analyses to explore heterogeneity. The overall certainty of evidence will be assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) tool.

Ethical approval is not applicable for this study because no primary data have been collected. This review will be disseminated through peer-reviewed publication and presented at conferences to inform ongoing educational practises.

CRD420251136479.