The National Health Service (NHS) faces mounting pressure from an ageing population and the backlog of care following the COVID-19 pandemic. The NHS Long Term Workforce Plan sets out a strategic framework to address these pressures through three priorities: train, retain and reform. The plan outlines a range of measures, including the doubling of medical school places over the next decade. Realisation of these ambitions is constrained by limited training capacity, as existing educators face significant pressures due to clinical demands. Clinical Teaching Fellow (CTF) programmes provide resident doctors with protected time for education and may help expand capacity and alleviate workforce pressures on established educators. Despite their rapid growth, CTF programmes remain under-described, and their contribution to NHS workforce priorities has not been systematically examined. To address this gap, this scoping review will map published and unpublished evidence on UK-based CTF programmes, engaging knowledge users to ensure findings are relevant to practice and workforce priorities.

The review will follow the Joanna Briggs Institute methodology for scoping reviews and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Evidence will be identified from academic databases (British Education Index, EMBASE, ERIC, MEDLINE, Scopus, Web of Science) and grey literature sources (Google Scholar, NHS and medical school websites, deanery pages and job-advertising platforms). Two reviewers will independently screen and extract data using a piloted form, with discrepancies resolved by discussion or a third reviewer. Extracted data will undergo descriptive analysis and narrative synthesis, guided by a Theory of Change framework to identify how CTF programme inputs, activities and outcomes relate to NHS workforce priorities. Knowledge users will be engaged throughout the review to refine research questions, inform source selection, interpret findings, and shape dissemination.

Ethical approval has been granted. All participants will provide informed consent. Participant contributions will be pseudonymised, and data will be managed in accordance with UK data protection legislation. Dissemination will be informed by knowledge users to ensure that findings on CTF programmes, including reported outcomes and identified gaps, are shared with those involved in delivering or supporting CTF programmes and with NHS stakeholders responsible for workforce priorities in training, retention and reform.

To systematically identify and synthesise dengue management strategies, levels of implementation, management dimensions, key challenges and proposed solutions across health systems worldwide.

A scoping review following the Arksey and O’Malley framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

PubMed, Scopus, Web of Science, Embase and the Cochrane Library were searched for studies published between January 2003 and December 2024. Reference lists of included studies were also manually screened.

English-language, peer-reviewed articles and reviews focusing on dengue management strategies, challenges and solutions at any health system level were included. Studies without full-text access or outside the scope of dengue management were excluded.

Two reviewers independently screened studies and extracted data using a structured form. Extracted data were charted and synthesised using an inductive thematic approach to identify core strategy domains, implementation levels, challenges and solutions.

Of 4822 records identified, 34 studies met the eligibility criteria. Dengue management strategies were categorised into six domains: vector and environmental control; surveillance and early warning systems; vaccination; enhancement of diagnostic and treatment services; community participation and education; and governance with intersectoral coordination. Implementation occurred at community, municipal, national, regional and international levels. Key challenges were grouped into five domains: structural and resource-related; sociocultural; governance and policy; scientific and technological; and climate- and urbanisation-related factors.

Global dengue management is increasingly adopting integrated, multi-sectoral approaches. Effective dengue control requires strengthening health system infrastructure, institutionalising community engagement and leveraging scientific and technological innovations. Sustained political commitment, stable financing mechanisms and coordinated governance across sectors are essential for resilient and sustainable dengue control.

To explore barriers and enablers to the implementation of the Global Initiative for Asthma (GINA) recommendations in Jordan, building on prior quantitative survey findings. We aimed to examine healthcare professionals’ experiences, perceptions and contextual challenges in translating guideline awareness into practice.

Qualitative descriptive study using semi-structured interviews. Analysis was inductive thematic, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Healthcare services in Jordan, including public hospitals, private hospitals, outpatient clinics and community pharmacies, spanning both urban and semi-urban areas.

28 healthcare professionals were purposively sampled to capture diverse roles, sectors and levels of experience. The sample included physicians (general practitioners and pulmonologists), pharmacists (community and hospital), nurses and Doctor of Pharmacy (PharmD) graduates. Eligibility required direct involvement in the management and counselling of adult patients with asthma within the preceding 12 months.

Perceptions of and experiences with implementing GINA recommendations in clinical practice, focusing on provider-level, system-level and patient-level barriers and enablers.

Eight interrelated themes were identified. A consistent ‘know–do gap’ emerged, whereby clinicians were aware of guidelines but reverted to habitual practice due to insufficient training, scepticism or lack of support systems. Limited diagnostic capacity, particularly the absence of spirometry in public settings, led to symptom-based management. Pharmacotherapy decisions were shaped by patient demand, entrenched short-acting β₂-agonist use and affordability concerns. Inhaler technique counselling and written action plans were infrequently provided, largely due to workload and unclear interprofessional roles. Patients’ beliefs (eg, steroid fears, avoidance of inhalers during Ramadan, low health literacy) further impeded adherence. Despite these barriers, participants proposed pragmatic solutions, including concise locally adapted tools, structured Continuing Medical Education (CME), digital decision support, pharmacy-based inhaler technique clinics and public awareness campaigns.

Asthma care in Jordan reflects a gap between GINA awareness and consistent application, driven by resource, organisational and cultural barriers. Improving outcomes will require system-level investment in diagnostic infrastructure, sustainable access to controller medications, interprofessional care models and culturally tailored patient education. These findings highlight the need for a coordinated national strategy to strengthen guideline implementation and provide a basis for developing policy and practice interventions across similar middle-income settings.

Sepsis is a global health priority with nearly 50 million cases annually. Cardiovascular dysfunction is common, frequently manifesting as hypotension that persists despite fluid resuscitation. Most affected patients require the use of intravenous (IV) vasoactive agents, typically necessitating intensive care unit (ICU)-level monitoring, invasive interventions and contributing substantially to healthcare costs. Midodrine, an oral alpha-1 agonist approved for orthostatic hypotension, has increasingly been used off-label as a vasopressor-sparing (reducing IV vasopressor use) strategy in sepsis, despite limited and inconsistent evidence. This pragmatic, randomised, open-label trial evaluates the efficacy and safety of midodrine in patients with sepsis-associated hypotension. We hypothesise that, compared with standard care, midodrine administration will reduce the duration of IV vasopressor use.

A total of 308 adult patients with sepsis-associated hypotension will be enrolled (154 per arm). The intervention group will, in addition to standard of care, receive enteral midodrine 10 mg three times daily. Outcomes will be ascertained pragmatically via electronic health record-based data retrieval and adjudicated by research coordinators blinded to treatment assignment. The primary outcome is time alive and off IV vasopressors in the first 28 days (in hours) after randomisation. Secondary outcomes include cumulative vasopressor exposure; use and duration of central venous access; cumulative fluid balance over the first 48 hours and up to 7 days of ICU stay; ICU and hospital length of stay; and ICU-, hospital-, and organ support-free days through day 28. Safety outcomes include adverse events potentially attributable to midodrine during hospitalisation including acute kidney injury. Primary analyses will follow an intention-to-treat framework, including all randomised participants according to their assigned treatment groups. Primary and secondary outcomes will be compared using a van Elteren test stratified by randomisation factors. A predefined secondary Bayesian analysis of the primary outcome will provide complementary estimates of treatment effect. Safety outcomes will be summarised descriptively without formal between-arm hypothesis testing.

The Mayo Clinic Institutional Review Board approved this protocol and required written informed consent from all participants (IRB# 24–0 00 121). Findings will be disseminated through peer-reviewed publications and international conference presentations.

NCT06319248.

Irritability represents one of the most common causes of referral to child and adolescent mental health services. Conceptually, tonic irritability (i.e., persistent grumpy mood) can be distinguished from phasic irritability (i.e., temper outbursts). The objective of this research project is to develop a fine-grained, ecologically valid and multimodal characterisation of tonic and phasic irritability to better understand the differential role of the two components in developmental psychopathology.

The study has a longitudinal observational and experimental design and involves two sites: (a) the Division of Child and Adolescent Psychiatry at the University Hospital of Lausanne and (b) the Division of Youth Mental Health at the Faculty of Psychology at the University of Basel. 220 help-seeking and healthy youths aged 8–14 years and their families will participate in the study consisting of a baseline assessment (i.e., self-report, interviews, cognitive assessments, autonomic measures, as well as in-situ experiments), an ecological momentary assessment (EMA) phase (over 2 weeks, including experience sampling method, cognitive assessment and passive monitoring) and a 1-year follow-up. Statistical analyses will include multilevel regression (e.g., linear mixed modelling).

We obtained ethical approval from the local ethics committees (Cantonal Research Ethics Commission on Human Beings, CER-VD, #2023-01846) and data collection began in January 2025. The results of the present study will be published in peer-reviewed scientific journals and will be presented at key conferences in the field of child and adolescent mental health, as well as at conferences focusing on EMA. Additionally, findings will be disseminated to practitioners, the educational sector and associations working with youths. We further intend to make the findings accessible to the general public through social media, for instance.

To systematically identify and synthesise the pedagogical mechanisms through which arts-based interventions (theatre, poetry, narrative medicine) may support empathy development in healthcare learners, while critically appraising the contextual implementation factors and methodological limitations of the existing evidence base.

Systematic review with narrative synthesis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

MEDLINE (via PubMed), Embase, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and CINAHL Plus, from inception to 31 August 2025.

Peer-reviewed empirical studies involving undergraduate or postgraduate healthcare students or professionals. Eligible studies reported on arts-based educational interventions designed to enhance empathy (including theatre, poetry or narrative medicine) and included quantitative or qualitative outcome measures of empathy or related constructs. No restrictions were placed on study design.

Two reviewers independently screened records, extracted data on intervention characteristics and outcomes, and assessed methodological quality using the Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme tools. A narrative synthesis was conducted to examine patterns across intervention modalities. Effect sizes (Cohen’s d) were calculated for quantitative pre-post or controlled designs; meta-analysis was precluded due to high heterogeneity in study designs, populations and outcome measures.

From 1094 records screened, 17 studies involving 835 participants (median sample size=28) met inclusion criteria. There were eight theatre-based, five poetry-based and four narrative medicine interventions. Theatre interventions, which emphasised embodied learning, showed patterns of large empathy effects (mean d=0.83). Poetry interventions, focusing on reflective practice, showed patterns of moderate effects (mean d=0.49). One study of narrative medicine demonstrated a pattern of sustained gains at 2-year follow-up (d=0.82). Key limitations of the evidence base include small sample sizes, substantial measurement heterogeneity (12 different empathy instruments), geographical bias (88% of studies from high-income, Western countries), and a predominance of pre–post study designs.

Arts-based interventions show mechanism-specific patterns of potential benefit for empathy in healthcare learners. However, significant methodological limitations in the current evidence constrain definitive practice recommendations. Educators may consider piloting brief, facilitator-led interventions based on local resources, while acknowledging the need for more robust evidence. Future research must prioritise standardised outcome measures, rigorous controlled and longitudinal trial designs, and studies in diverse cultural contexts.

CRD42025116174.

Funnel plots are used to identify intensive care units (ICUs) with a higher than expected risk-adjusted mortality. ICUs with a standardised mortality ratio (SMR) within pre-defined control limits (often the 99.8% CL) are regarded as ‘in control’ and not labelled as a potential outlier for a particular calendar year. However, increased mortality rates not due to random fluctuations within and across the calendar years may be overlooked. We examined whether statistically significant and relevant differences in mortality over time between ICUs regarded as ‘in control’ are present.

A longitudinal register-based study.

88 ICUs in the Netherlands registering the admissions of all critically ill patients in the National Intensive Care Evaluation registry in the Netherlands from 2013 to 2023.

Hospital death analysed in a multivariable logistic regression analysis with a random intercept for ICU. The random intercept variance was translated to the median OR (MOR).

877 ICU-calendar year combinations were included, covering 759 498 unique admissions. The MOR increased from 1.12 (95% CI 1.10 to 1.15) for ICU-calendar year combinations with an SMR within the narrowest 95% CL (N=677) to 1.20 (1.17 to 1.24) for combinations with an SMR within the expanded 99.8% CL (including adjustment for overdispersion) (N=194) and to 1.21 (1.17 to 1.25) when including all ICU-calendar year combinations. Similar results were found for separate calendar years and separate diagnostic groups.

These results show differences in mortality between ICUs that were not labelled as outliers. Assessment of mortality performance should integrate cross-sectional funnel plots, the MOR and longitudinal trends in the SMR to better capture persistent patterns of excess risk.

Emotional and behavioural problems (EBPs) are receiving increasing attention at the global level, and preschool children are no exception. These issues have a significant impact on future development. Preventive interventions in preschool age are effective in preventing more serious disorders by improving social skills, emotional regulation and resilience in children. Although various preventive interventions have been developed and their effectiveness demonstrated, the evidence remains fragmented. At present, there has been no comprehensive study mapping EBPs prevention interventions at the preschool age level using the Neuman Systems Model approach.

This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews.The completed scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). A systematic search will be conducted in four major databases, namely Scopus, PubMed, Web of Science, Cochrane Library, and online searches using Google Scholar, without language and publication year restrictions. Two reviewers will independently screen the literature according to the inclusion criteria and then extract the data. Any differences between the two reviewers will be resolved through discussion with a third reviewer. We will compile, summarise and analyse the extracted data and present the results in figures, tables and descriptive narratives to ensure clarity and facilitate comparison across studies.

Ethical approval is not required, as the review will use only published literature. Findings will be disseminated through publication in a peer-reviewed international journal and may inform policy and practice in early childhood preventive interventions.

Open Science Framework (https://osf.io/zg6ty).

To evaluate the feasibility and relevance of the LIFE-UP Day audit, a simple, 1-day benchmarking tool based on the multidisciplinary LIFE-UP bundle (Limit sedation, optimise nutritional Intakes, engage Families, promote Exercise and follow-UP the patients after discharge) and assessing the implementation of postintensive care syndrome (PICS) prevention strategies in daily practice.

Exploratory multicentre cross-sectional audit study.

Eight Belgian adult intensive care units (ICUs), between April and July 2024.

All patients present at 08:00 on the audit day and hospitalised for ≥24 hours.

An independent nurse collected data on sedation, analgesia, nutrition, family empowerment, physical exercise and post-ICU follow-up. A multidimensional LIFE-UP composite score (raw 0–10 points), normalised to a 5-point scale, was created to quantify adherence to PICS prevention practices based on current recommendations. Feasibility was evaluated through data accessibility, resource needs, cooperation of ICU teams and the ability to complete the audit within 1 day. Relevance was evaluated through adherence to the bundle, assessed by comparing LIFE-UP scores between ICUs. Quantitative results were expressed as median and IQR.

The audit was tested in 87 patients aged 68 (59–74) years, 9 (5–15.5) days after their admission. The audit was feasible across all ICUs: necessary data were available, resources required were minimal and cooperation was excellent. The LIFE-UP score highlighted significant variability between ICUs (2.5 (1.75–2.75), p

The LIFE-UP Day audit proved feasible and provides a first structured framework for benchmarking. Broader implementation will be essential to validate the LIFE-UP score, refine the model and ultimately determine whether it can translate into improved patient and family outcomes.

While there exist many individual and organisation-level initiatives aimed at reducing physician burnout and promoting wellness, there are no comprehensive frameworks or guidelines for evaluating initiatives targeted at physicians. To address this gap, we conducted a rapid review to understand the current state of initiative evaluation in this field and develop an evaluation framework for initiatives aimed at physician burnout and wellness.

A rapid review based on the Cochrane rapid review methods guidance.

MEDLINE, Embase and PsycInfo were searched from database inception to 2 May 2024 for concepts related to physicians, wellness initiatives and burnout, and organisational efforts.

We included studies with initiatives aimed at physician burnout, wellness or experience; targeted physicians, residents, fellows and/or physician faculty; were evaluated in some format; and took place within healthcare settings.

Two independent reviewers extracted data according to a standard template. For each study, we noted information related to the type of wellness initiative, evaluation approach, components measured in evaluations (‘evaluation indicators’) and gaps in evaluation. The same reviewers analysed the data quantitatively and thematically. Findings were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

The database search yielded a total of 3786 references, of which 105 were included based on predefined inclusion and exclusion criteria. Various types of wellness initiatives (eg, mindfulness, peer support programmes, communities of practice) were delivered multimodally, or via curriculums and workshops, among other formats. Common evaluation approaches included surveys (95%, n=100/105) and interviews or focus groups (17%, n=18/105). Evaluation indicators spanned five categories: impacts (94.3%, n=99/105), participants’ reactions (65.7%, n=69/105), perspective and behaviour changes (46.7%, n=49/105), implementation (45.7%, n=48/105) and continuous improvement (6.7%, n=7/105). Evaluation gaps included limited responses from participants, failure to capture certain indicators (eg, physician turnover) and limited longitudinal measures.

Based on the findings and existing models, we developed a physician-focused evaluation framework, constituting two domains: implementation and impacts. This framework can enable organisations to better understand, assess and improve initiatives aimed at physician well-being, which can have positive impacts on patient care and the healthcare system.

Patients with systemic autoimmune rheumatic disease (SARD) are at high risk of developing interstitial lung disease (ILD). We sought to gain insight into the pharmacological and non-pharmacological treatments being used by patients with SARD-associated ILD (SARD-ILD) following ILD progression.

This was a retrospective, observational cohort study.

Optum Clinformatics Data Mart administrative medical and pharmacy claims database in the USA.

Patients with SARD-ILD who had an incident ILD diagnosis and progression between January 2018 and March 2023.

Treatment patterns and healthcare services utiliation were descriptively summarised for baseline and follow-up periods.

We identified 6431 patients with SARD-ILD and evidence of ILD progression (mean age, 71.2 years; 75.3% female; 68.9% white). The mean (SD) time between the initial SARD-ILD diagnosis and the onset of ILD progression (index date) was 104 (201) days. On average, patients were followed for 936 (467) days.

Oral corticosteroids were the most common treatment post-progression (69.5%), followed by non-biologic disease-modifying antirheumatic drugs (non-biologic DMARDs) (41.6%), biologic DMARDs (15.5%) and immunomodulators (15.4%). Antifibrotics were received by 3.5% of patients. Supplemental oxygen was the most frequent non-pharmacological treatment (48.9%). For the baseline period, 53.0% and 42.1% of patients used inpatient and emergency department services, respectively. During the follow-up, 69.7% and 62.8%, respectively, used these services.

The high use of corticosteroids and limited use of DMARDs and antifibrotics post-progression in this descriptive study implies a significant gap between current practice and optimal management of patients with SARD-ILD.

To determine the prevalence of presbyopia and associated risk factors among Bangladeshi recipients of elderly social safety net payments who were not currently using mobile financial services (MFS) and demonstrated numeracy, dexterity and cognitive prerequisites for smartphone use during eligibility screening for the Transforming Households with Refraction and Innovative Financial Technology (THRIFT) trial. Accessing these payments requires use of online banking, as with a smartphone.

Cross-sectional analysis of trial eligibility screening data.

Community-based screening conducted in two rural subdistricts in Kurigram District, Bangladesh.

Among 13 944 Old Age Allowance and Widows’ Allowance (WA) beneficiaries screened, 953 met trial eligibility criteria, including passing a smartphone readiness assessment and completing near vision examinations.

Presbyopia, defined as binocular presenting near visual acuity of N6.3 or worse, correctable to at least N5 with near vision glasses and with distance vision of ≥6/12 in both eyes.

Among 953 participants (mean age 61.4±7.2 years, 62.6% women), presbyopia prevalence was 62.6% (95% CI 59.5 to 65.7). Presbyopia was significantly positively associated with female gender (adjusted prevalence ratio (APR)=1.19, 95% CI 1.02 to 1.41) and receiving WA (APR=1.20, 95% CI 1.04 to 1.38) in multivariable analyses.

This study highlights a substantial burden of uncorrected presbyopia among a prescreened, randomised control trial-eligible subgroup of social safety net beneficiaries in rural Bangladesh, who were not currently using MFS but demonstrated cognitive and functional capacity to use mobile phones, potentially hampering their ability to carry out online banking. Delivery of reading glasses may improve digital financial access and facilitate broader financial inclusion, a hypothesis currently being tested in the parent THRIFT trial.

NCT05510687.

While health research about persons of South Asian ancestry has been conducted for decades in Canada, it often uses pathologising approaches that fail to consider historical, social and political factors shaping health disparities. Further, this research rarely engages South Asian communities in meaningful ways, reinforcing feelings of disconnect and longstanding mistrust. Greater collaboration and transparency are needed to build trust and generate credible findings. The aims of this research protocol are to (1) examine how community engagement has been implemented in health research involving South Asian populations, (2) explore the experiences of both South Asian community members and academics involved in community-engaged research and (3) develop a framework guiding health research with and for South Asian communities in Canada, titled PRinciples to Operationalize Community Engagement, Equity, and Sustainability in South Asian Health Research in Canada (PROCESS).

This ongoing codesigned concurrent multimethods study is being conducted with community partners across Canadian provinces. First, the scoping review is examining how community engagement has been operationalised in health research involving South Asian populations in Canada. We are performing a search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Scopus and PsycINFO databases for articles published between 2003 and 2024 referring to the concept of community engagement in South Asian health research. Two reviewers are independently completing abstract and full-text reviews based on preselected eligibility criteria. Data are being extracted from peer-reviewed studies using a data extraction framework. Findings will be aggregated and synthesised using descriptive content analyses. Second, a qualitative descriptive study is being conducted to explore the experiences of diverse stakeholders, including academics and community partners who are partaking in academic health research focused on South Asians. Semistructured interviews are being analysed using an inductive thematic content analysis. Results from the scoping review and qualitative interviews will be triangulated to detect emerging themes and patterns, which will enable the identification of principles to be incorporated within a draft of the PROCESS framework. In the final phase, we will use a modified Delphi process to iteratively codevelop the PROCESS framework with community partners and researchers across Canada.

The Faculty of Medicine and Health Sciences Institutional Review Board at McGill University approved the study’s protocol (24-05-080). Results will be submitted for publication in peer-reviewed journals and presented in academic and community forums. Results will also be shared with diverse audiences across Canada through multiple formats, including articles, conferences, infographics and social media, with the aim of raising awareness and promoting the adoption of research principles and practices for engaging South Asian communities in health research. This research received funding from the Canadian Institutes of Health Research (Grant #507768).