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Observational studies suggest that acid suppression may worsen outcomes among patients infected with SARS-CoV-2. The objectives of this embedded substudy of a randomised controlled trial evaluating pantoprazole in mechanically ventilated patients were to (1) describe the clinical characteristics of critically ill patients with SARS-CoV-2, (2) compare clinical outcomes with a propensity-matched non-infected cohort and (3) assess whether pantoprazole’s treatment effects differed by SARS-CoV-2 infection status.
A pre-planned substudy of the re-evaluating the inhibition of stress erosions (REVISE) trial, including a propensity-matched analysis of infected and non-infected patients comparing the effect of pantoprazole between patients with and without SARS-CoV-2.
68 intensive care units (ICUs) in eight countries.
From July 2019 to October 2023, 4821 eligible participants were enrolled in REVISE whether or not they had SARS-CoV-2 infection.
Participants enrolled in REVISE with SARS-CoV-2 infection had additional data collection, including biomarkers, venous thromboembolism, SARS-CoV-2 therapies and tracheostomy timing. The primary outcomes were clinically important upper gastrointestinal bleeding and 90-day mortality. Secondary outcomes included ventilator-associated pneumonia, Clostridioides difficile infection, patient-important upper GI bleeding, renal replacement therapy, ICU and hospital mortality and duration of mechanical ventilation, ICU and hospital stay.
Of the eligible trial cohort, 11.9% (540/4550) had SARS-CoV-2; 532 patients had additional SARS-CoV-2-specific data collection. Of these 532 patients, 87.8% received COVID-19-directed treatments—(dexamethasone 75.2%), 11.7% developed pulmonary embolism and 9.2% developed deep-vein thrombosis. After propensity matching, SARS-CoV-2 infection was not associated with clinically important upper gastrointestinal bleeding (adjusted HR 0.78, 95% CI 0.40 to 1.50) but was associated with significantly higher ICU, hospital and 90-day mortality, as well as longer duration of ventilation and ICU and hospital length of stay. The effect of pantoprazole on clinically important upper GI bleeding and 90-day mortality was consistent regardless of SARS-CoV-2 status.
SARS-CoV-2 infection was associated with higher mortality and longer duration of mechanical ventilation, ICU and hospital stays, without an increased risk of clinically important upper gastrointestinal bleeding. Pantoprazole reduced clinically important upper gastrointestinal bleeding without adversely affecting other outcomes.
REVISE trial (NCT03374800), SARS-CoV-2 cohort study (
Symptoms associated with vulvovaginal atrophy affect up to 73% of patients with breast cancer, whether menopausal or non-menopausal, because certain breast cancer treatments are responsible for oestrogen deprivation on the genital tract. These symptoms are currently underdiagnosed and undertreated but can significantly impair the quality of life and can be a cause of premature discontinuation of adjuvant hormone therapy. Treatment of vulvovaginal atrophy in patients managed for breast cancer should be the first-line treatment with non-hormonal local moisturising therapy. However, this treatment is often insufficient. Systemic menopause hormone treatment is not indicated and local oestrogen treatment is not a first-line treatment in this neoplastic context. Therapeutic alternatives, such as vaginal radiofrequency (RF) treatment, could be considered. Vaginal RF increases collagen synthesis by stimulating fibroblasts. However, the vaginal RF has not been sufficiently evaluated in the literature. We hypothesised that vaginal RF can improve a patient’s experience of vaginal dryness after breast cancer treatment when first-line local moisturising treatment is insufficient.
The RF-Vaginale trial will be a multicentre randomised phase III trial in two parallel groups until the 6-month assessment comparing a reference treatment with local moisturising (hyaluronic acid-based treatment, three times a week) versus the experimental treatment combining reference treatment+vaginal RF treatment. The vaginal RF treatment will consist of three sessions spaced 4–6 weeks apart (MATMATECH, GynWave 360). The primary outcome will be vaginal dryness, assessed at 6 months using a patient-rated 0–10 numerical scale. The secondary outcomes will be dyspareunia and Vaginal Health Index Score (VHIS). Dyspareunia will be assessed by the patient using a patient-rated 0–10 numerical scale, in patients reporting a sexual life with a male partner engaged in vaginal intercourse. The VHIS will be assessed by a physician blinded to the treatment group. All outcomes will also be evaluated at 3 and 12 months.
This trial will be proposed to a population receiving an adjuvant treatment for breast cancer with an aromatase inhibitor ±luteinising hormone-releasing hormone (LHRH) agonist.
The primary analysis will focus on the evaluation of the mean difference in vaginal dryness score at 6 months between arms, adjusted for baseline value, patient age (
The study protocol has been approved by the ethics committee (CPP Sud Est I, 12 November 2024), complied with the Declaration of Helsinki and French laws and regulations, and followed the International Conference on Harmonisation E6 Guideline for Good Clinical Practice (reference number EMA/CHMP/ICH/135/1995). The trial results, even if inconclusive, will be presented at international oncology congresses and published in peer-reviewed journals.
Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK.
OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3–18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3–18 months) during which OBS PPH care will be delivered.
The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation.
OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants.
There are many circumstances where individuals with limited mobility are exposed to prolonged postures increasing the risk of pressure ulcers. Technologies have been developed to monitor posture, mobility and pressure exposure; however, their effectiveness in different clinical settings is unknown. The aim of this scoping review was to assess clinical studies using continuous pressure monitoring for the prevention and/or treatment of pressure ulcers. A scoping review of the literature was conducted using the PRISMA-ScR framework. Clinical-based studies were included which used continuous pressure monitoring for assessment and treatment over a minimum of a 2-h period. The outcomes included quantitative measures such as pressure distribution and mobility data, qualitative insights relating to patient comfort and acceptability, and the perceptions of healthcare staff regarding usability and clinical integration of the technology. Twenty-four studies were identified and included in the scoping review, conducted across eight countries spanning three continents. Most studies were undertaken in a hospital setting (67%, n = 16). Following review of the included papers, five core themes were identified: clinical outcomes, pressure metrics, posture and mobility, nurse feedback and patient experience. There was high heterogeneity in study design, outcome measures and different risk of bias limited the scope to synthesise the outcomes. Collectively, the studies indicate that CPM can enhance awareness of interface pressures, support clinical decision-making and inform repositioning strategies for individuals at risk of tissue damage. Reported benefits include greater staff confidence and patient engagement. However, consistent reductions in ulcer incidence have yet to be demonstrated, with larger trials with standardised outcomes required.
Approximately 15 million people in the UK live with obesity and at least 5 million of these are people with severe obesity (PWSO). Severe obesity significantly compromises health, well-being and quality of life and reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Several studies suggest the potential of group-based intervention in Specialist Weight Management Services (SWMS), but PWSO remain underrepresented in research, and evidence on optimal design and outcomes is limited. The success of the PROGROUP feasibility randomised controlled trial (RCT) (ISRCTN22088800) informed the development of this study and additional adjustments have been made in response to the rollout of obesity management medication in the National Health Service (NHS). This study aims to assess the effectiveness and cost-effectiveness of PROGROUP in SWMS and primary care.
The RCT will be conducted in SWMS, alongside an implementation study in primary care. The RCT will recruit cohorts of 30 participants to be randomised 1:1 within-cohort to PROGROUP (intervention) or usual care (control). The implementation arm will recruit cohorts of 15 to PROGROUP. The primary objectives for the study are to undertake a process evaluation and economic evaluation of PROGROUP in the RCT and to assess its implementation in primary care. Baseline data and outcome differences at 6 months will be analysed. These will include weight, other clinical measures and patient-reported outcomes, including social and life-satisfaction measures.
This study is approved by an NHS Research Ethics Committee (REC reference: 23/WS/0101). Results will be reported in a manuscript that will be submitted to a peer-reviewed medical journal as open access. A lay summary of the findings will be published online, and participants and sites will be signposted to this.
The province of Khyber Pakhtunkhwa (KP), located in the northwestern region, is the third most populous province in Pakistan, with a population estimated at 41 million.
To determine the cancer counts and age-standardised incidence rates (ASIRs) per 100 000 population over a 4-year period for KP, 2020–2023, and to compare them with those available for two districts of Pakistan and nearby areas.
A retrospective, province-wide, multicentre observational study.
Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, as the collaborating centre, with data reported from leading cancer treatment and diagnostic facilities across the country entered into its hospital information system.
New cancer cases diagnosed from 2020 to 2023 among inhabitants of KP.
Primary measures were cancer counts, proportions and ASIRs per 100 000 population for children (0–14 years), adolescents/young adults (15–19) and adults (≥20 years) in KP. Secondary analyses compared ASIRs across regions.
A total of 57 852 malignancies were recorded in KP over a 4-year period: 51.6% in females and 48.4% in males. The ASIR per 100 000 persons was as follows: in pre-adolescent girls, 4.2; in pre-adolescent boys, 6.6; in adolescent females, 7.9; in adolescent males, 9.7; in adult females, 103.5; and in adult males, 90.1. Overall, breast cancer accounted for the highest proportion of cases (16.3%). In children, leukaemia had the highest ASIR in KP (1.9 in males, 1.0 in females) and in Lahore (3.3 in males, 2.1 in females), whereas in Karachi, the ASIR was high for bone tumours (8.6 in males and 5.6 in females). In adolescents, the ASIRs for leukaemia (0.8–2.0) were high in all three regions, as were those for ovarian cancer (0.8) in KP. In adults, the ASIRs for breast cancer among females were high in KP (32.6) and Lahore (76.7) but very high in Karachi (177.8). In adult males, the ASIR for prostate cancer was 9.1 in KP and 10.7 in Lahore, while in Karachi, it was 26.0 for colorectal/anal cancer. Overall, breast cancer had the highest ASIR in KP, Kabul in Afghanistan, and Iran among females, but in males, it was bladder cancer and non-Hodgkin lymphoma (NHL) in KP, and in Kabul and Iran, stomach cancer.
In KP, among children and young adults, haematologic malignancies; in adolescents, bone tumours and ovarian cancers; and in adults, breast and prostate cancers were frequently documented. There were similarities among the three regions (KP, Lahore and Karachi) in incidence rates. Differences were noted in the top three cancers among males in KP versus Kabul and Iran. This report lays the foundation for future comparative analyses and can guide the development of infrastructure for cancer prevention, diagnosis, and management within the province of KP.
The Healthy Early Life Moments in Singapore (HELMS) programme was developed by a multidisciplinary team to improve metabolic and mental health outcomes in women/mothers and to promote healthy growth and development in their children. Despite increasing interest in preventive life-course care, evidence on the long-term economic impact of these life-course interventions remains limited. This protocol outlines the economic evaluation of the HELMS integrated lifestyle intervention, supported by a mobile health (mHealth) app, across the reproductive continuum from preconception to postpartum.
The HELMS programme is conducted at KK Women’s and Children’s Hospital, recruiting overweight or obese women and planning to conceive. The economic evaluation comprises a within-trial costing study and a cost-effectiveness analysis. We will develop a Markov model for mothers and children to simulate maternal-child health outcomes over a 10-year horizon from the healthcare provider’s perspective. Primary data will be sourced from the HELMS programme and supplemented by local mother–child cohorts and published literature. The cost analysis will include direct medical, direct non-medical and programme-related costs incurred through the HELMS intervention. We will measure health outcomes in quality-adjusted life-years (QALYs) using the EuroQol-5 Dimension utility scores. We will conduct both deterministic and probabilistic sensitivity analyses to assess model uncertainty. The evaluation will estimate total and incremental costs, QALYs and incremental cost-effectiveness ratios for HELMS versus standard care. We will present cost-effectiveness acceptability curves and perform subgroup analyses to explore heterogeneity by maternal age, ethnicity and body mass index. A willingness-to-pay threshold appropriate for the Singapore context, based on recently published estimates, will be used to determine cost-effectiveness. We will also identify key cost drivers and examine the intervention’s scalability.
The study has been approved by the Centralised Institutional Review Board of SingHealth (2021/2247). Written informed consent will be obtained from all participants. The findings will be published in peer-reviewed journals and disseminated to international and national policy makers.
Glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have been shown to rule out CT-detectable intracranial lesions in patients with mild traumatic brain injury (mTBI) when assessed within the first 12 hours after injury. These biomarkers have been validated across different laboratory-based and point-of-care testing platforms. The combined biomarker test has been incorporated into several mTBI management algorithms in Europe. However, data regarding its real-world application, including patients with neurological comorbidities and its impact on reducing CT utilisation or emergency department (ED) length of stay, are lacking. This study will evaluate the performance of an automated laboratory-based assay for serum GFAP and UCH-L1 when integrated into a standardised clinical pathway for the diagnostic management of patients with mTBI. In addition, the study will assess its potential value in reducing CT scan prescription and ED time.
This single-centre observational study, with prospective data collection before and after the implementation of a combined test measuring GFAP and UCH-L1 in the clinical laboratory, will be conducted at Hospital Universitario 12 de Octubre, Madrid, Spain. Patients with clinically defined mTBI will be managed according to a newly implemented clinical pathway including biomarker testing. mTBI will be defined using predefined clinical criteria including a plausible traumatic mechanism, Glasgow Coma Scale score 13–15 assessed 30 min or more after injury, and compatible signs and/or symptoms of brain injury. Eligible patients must undergo blood sampling within 12 hours of injury and before imaging prescription. The effectiveness of this management approach will be compared with a previously established cohort of patients, prospectively enrolled under identical inclusion and exclusion criteria. A cohort of 1000 patients with mTBI, in whom biomarker testing was used in their management, will be included in the post implementation group. The pre-implementation cohort will be drawn from a comparable time period. The primary outcome measures are: the diagnostic performance of GFAP and UCH-L1, measured using an automated assay, for discriminating between patients with positive and negative findings on brain CT scans; the safety of the new clinical pathway in terms of complications such as unexpected surgery or deterioration, as well as the reduction in CT use after the implementation. Secondary objectives will be reduction in ED times and direct costs, as well as physicians’ compliance with the algorithms.
The study was reviewed by the Institutional Research Committee of Hospital 12 de Octubre, Madrid, Spain (Ref TP25/0144) and deemed exempt from formal ethical approval and informed consent requirements. This study’s results will be presented at national and international meetings, including meetings of patient associations, and published in peer-reviewed journals.
Pathology testing accounts for over half of non-labour costs in Australian Emergency Departments (EDs), yet up to one-fifth of tests are unnecessary. Despite national guidance from the Australasian College for Emergency Medicine (ACEM) and the Royal College of Pathologists of Australasia (RCPA), variation in test ordering persists across departments and across clinical presentations. The Unnecessary Tests in Emergency (UNTIE) study aims to evaluate whether audit and feedback using a novel indicator can reduce unnecessary pathology testing.
UNTIE is a multicentre, stepped-wedge cluster randomised trial conducted across five metropolitan EDs in New South Wales, Australia. All adult ED presentations that fall within the 29 clinical conditions covered by the 2023 ACEM–RCPA guideline will be included. Presentations were identified using routinely collected ED triage diagnoses. Because the ACEM–RCPA pathology guideline specifies clinical presentations rather than diagnostic codes, a mapping process was developed to align triage terms used in the electronic medical record with the guideline categories. Approximately 100 common triage diagnoses were reviewed by a panel of emergency physicians and mapped to the 29 eligible presentations. This mapping dictionary was used to automatically classify all ED encounters during data extraction. Ambiguous or unmapped triage terms were reviewed and assigned by consensus.
The intervention comprises a multifaceted audit-feedback programme—combining local champions, education sessions, visual prompts and electronic dashboards. Two automated indicators will be generated for every eligible ED encounter: UNTIE-U (Unnecessary Testing Index) representing the proportion of tests performed but not recommended and UNTIE-N (Necessary Testing Index) representing the proportion of guideline-recommended tests performed. The primary outcome is change in UNTIE-U before and after intervention; the secondary outcome is change in UNTIE-N.
Ethics approval has been granted by the Western Sydney Local Health District Human Research Ethics Committee (HREC/17/WMEAD/274, 2022/STE03249). All analyses will use de-identified data. Findings will be disseminated through peer-reviewed publication, conference presentation and feedback to participating EDs.
Australian New Zealand Clinical Trials Registry: ACTRN12623001130651, UTN: U1111-1297-0386
In current practice, fluid volumes administered to children following kidney transplant vary widely. Up to 52% of children experience fluid overload-related complications. Current fluid guidelines are not evidence-based and the optimal amount of fluid for children after transplant is not known. The aim of Randomised multiple centre trial of conservative versus LIberal fluid adMInisTration for children receiving a kidney tranSplant (LIMITS) is to determine whether relative limitation of fluid volume administered to children receiving kidney transplants is superior to liberal fluid volume administration.
LIMITS is a pragmatic, open-label, UK-based, multicentre randomised controlled trial, with an internal pilot phase and integrated economic evaluation. A total of 140 children receiving kidney transplants will be randomised to receive either conservative postoperative fluid administration (maximum of 150 mL/m2/hour for no longer than 18 hours, followed by a fixed daily target of maximum 1.5 L/m2/day thereafter) versus the comparator of liberal postoperative fluid administration (fluid volume administered to replace urine output and insensible losses for at least 48 hours with target urine output >2 mL/kg/hour). The primary outcome is mean days at home in the first 30 days after kidney transplant. The primary outcome will be analysed using a mixed linear regression model adjusted for donor type (living vs deceased donor) and participant weight (
The trial received Health Research Authority approval on 20 August 2025 (REC reference: 25/EE/0161, IRAS project ID: 354370). Findings will be presented to academic groups via national and international conferences and peer-reviewed journals. The patient and public involvement group will play an important part in disseminating the study findings to the public domain.
To estimate the prevalence of loneliness, social isolation, and their co-occurrence among people living with HIV and to explore factors explaining heterogeneity between estimates.
A systematic review and meta-analysis.
PubMed, Cochrane Library, SciELO Citation Index (via Web of Science), Scopus, Embase, PsycArticles, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception until November 1, 2024 for relevant studies.
Study eligibility, data extraction, and methodological quality assessment were conducted independently by two reviewers. Random-effects meta-analysis was used to estimate pooled prevalence. Subgroup analyses were performed.
A total of 66 studies were included. The pooled prevalence of loneliness was 46.9% and that of social isolation was 25.9%. However, heterogeneity was very high across studies, and these pooled estimates should therefore be interpreted cautiously. Subgroup analyses suggested regional variation in both loneliness and social isolation. Other subgroup findings should be interpreted cautiously because some subgroup estimates were based on small numbers of studies.
Loneliness and social isolation are highly prevalent among people living with HIV. Population-specific intervention strategies are needed to reduce this burden, and future studies should further examine contextual and demographic differences to guide intervention design.
Routine HIV services should include screening and referral pathways for loneliness and social isolation.
This systematic review identified the pooled prevalence of loneliness and social isolation among people living with HIV, highlighting a substantial and clinically relevant burden. The findings may influence HIV nurses' practice and inform care approaches for other clinical populations experiencing loneliness and social isolation.
This systematic review followed the PRISMA and MOOSE reporting guidelines.
No patient or public contribution.
To systematically evaluate associations between comorbidities and differences in treatment decisions, outcomes, health-related quality of life (HRQoL), healthcare resource utilisation and costs, in patients with colon or rectal cancer.
Systematic review.
PubMed (Medline) and Embase databases were searched for studies published from January 2000 until January 2024.
We included articles that compared the presence and absence of comorbidities, evaluated multiple comorbid conditions or used the Charlson Comorbidity Index, or variations such as the Charlson-Deyo Index. Primary and secondary outcome measures included cancer treatments, outcomes (including complications from treatments, survival and mortality rates), HRQoL, healthcare resource use and costs.
Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Joanna Briggs Institute checklists to ensure the quality of data. Findings were summarised narratively.
After duplicates were removed, 15 394 hits were screened and 31 studies were selected for inclusion in this systematic review. Comorbidities were associated with a lower likelihood of receiving treatment and lower survival rates and HRQoL, alongside a higher likelihood of complications following treatment, higher mortality rates and higher healthcare resource use. There were very limited studies that reported on HRQoL and resource use, and none reporting data directly relating to the impact of comorbidities on costs. These results were consistent across North America, Europe, Australia and New Zealand.
For patients with colon and rectal cancer, comorbidities are associated with a lower likelihood of receiving treatments and poorer health outcomes. With global populations ageing, there is likely to be an increase in patients with colon and rectal cancer with comorbidities. Therefore, further research is necessary, especially to inform decisions regarding patient management and treatment, and to understand the implications on healthcare resource allocation, costs and HRQoL.
To identify and describe the current literature on neurodivergence in nursing and to identify existing gaps in knowledge.
Scoping review guided by Joanna Briggs Institute scoping review guidelines and PRISMA-Scoping Review framework.
Comprehensive search with inclusion following Participants, Concept, and Context framework: nurses or nursing workforce; neurodiversity or neurodivergence defined as autism, attention deficit hyperactivity disorder, dyslexia; workplace environment. Articles were screened and data extracted by independent reviewers. Dates of inclusion were 1999–2025. Data analysed through descriptive categorisation.
MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO (Ovid) were searched in April 2025, followed by reference mining and citation cross-referencing. Inclusion criteria were set for empirical studies, reviews, or textual evidence (expert opinions or narratives).
Twenty-two sources met inclusion criteria. Most addressed dyslexia and neurodiversity. Sources described strengths of neurodivergent nurses (e.g., deep focus, relationality, novel perspectives), workable challenges (e.g., documentation and multitasking). Studies reported adaptations at multiple levels: individual, interpersonal, and intraprofessional, noting system influences of medical model framing and gender bias in diagnosis.
Literature on neurodivergent nurses in the workplace is scarce. Neurodivergence offers strengths and challenges, yet ableism and limited research restrict well-being and professional advancement.
Greater recognition of neurodivergence in nursing could enhance workforce retention, innovation, and inclusivity. Neurodivergent nurses' perspectives should inform research, workplace design, and professional development.
What problem did the study address?: Limited research on neurodivergence in nursing despite growing awareness of neurodivergence generally and overall challenges in nursing retention and well-being. What were the main findings?: Literature encompasses empirical studies and textual evidence presenting strengths and challenges for nurses. Adaptation centered on the individual. Where and on whom will the research have an impact?: Researchers to increase empirical studies on neurodivergent nurses, including participatory methods; Leaders interested in workplace inclusion, sustainable workplaces, and professional innovation; Neurodivergent nurses and policy-makers concerned with workforce rights and healthcare resilience.
No Patient or Public Contribution.
To explore perceptions of healthcare professionals' psychological wellbeing at work and patients' experiences of care.
Narrative interviews were undertaken as part of a wider experience-based co-design study.
Interviews were undertaken March to December 2022 with 19 participants (healthcare professionals n = 13 and patients n = 6) from a community hospital and analysed for emotional touchpoints using reflexive thematic analysis.
Ten themes were synthesised into five categories: (1) What is psychological wellbeing at work? (2) Barriers to psychological wellbeing at work (‘Misaligned NHS Culture’ and ‘Pressurised System’); (3) How negative psychological wellbeing at work impacts on staff and patients' experiences of care (‘Staff Struggle to Survive’ and ‘Patients Suffer’); (4) Enablers of psychological wellbeing at work (‘Nurturing Culture’ and ‘Teamwork’); and (5) How positive psychological wellbeing at work impacts staff and patients' experiences of care (‘Staff Thrive’ and ‘Patients Benefit’).
Poor psychological wellbeing negatively impacted healthcare professionals' health and their ability to provide care. In response, patients deliberately withheld requests for help, risking their recovery. Conversely, when psychological wellbeing was supported, staff provided more relational care with improved patient experience.
A nurturing culture and teamwork are positive enablers of staff psychological wellbeing and can be used to improve staff and patients' experience.
This is one of the first studies to demonstrate that patients modify their behaviour in response to perceptions of staff wellbeing, with implications for their recovery.
COREQ.
Members of the public advised on the patient-facing materials and the overarching study design.
This study aimed to explore culturally and linguistically diverse (CALD) fathers' early parenting support needs in the perinatal period in Australia.
A qualitative descriptive research study. Participant fathers were recruited using purposive and snowball sampling who self-identified as CALD.
Data were collected through semi-structured telephone interviews with 15 Australian fathers aged between 29 and 56 years in July–November 2022. Data were analysed using Braun and Clarke's six stages of thematic analysis to code, categorise and identify themes from the data.
Four major themes and six sub-themes emerged from the data, ‘Under pressure’, ‘Slipping through the cracks’, ‘Gaining knowledge and support by health professionals’, and ‘Path ahead: changed roles and being supported by peers’ that encompassed fathers' early parenting experiences and support needs in the perinatal period.
Culturally and linguistically diverse fathers experience challenges in navigating maternal health care settings and at times interactions with health professionals. However, findings from this study showed that fathers were determined to navigate resources, services and networks that supported their transition to fatherhood in the early postpartum weeks. There is a need for maternity settings to be a ‘father-inclusive’ environment where informational and practical support is readily available to them. Legislation reform is needed that recognises fathers as parents who require adequate ‘paid’ parental leave entitlements that foster family relationships and recognises the role fathers play in the development of their child.
This study provides insights into the support needs of CALD fathers in the perinatal period. Findings from this study have the potential to shape and design culturally appropriate health services and interventions tailored to CALD fathers that meet their nuanced needs through the lens of cultural competence and trauma informed maternity care.
What problem did the study address?: The study explored the support needs of CALD fathers in the perinatal period. What were the main findings?: The findings revealed CALD fathers feel a sense of responsibility and pressure to live up to socio-cultural expectations and support the family unit while engaging in paid employment to earn a living. At times fathers were not encouraged to be parenting partners by health professionals, and there was an expectation that they would be familiar and have knowledge about pregnancy, labour, birth and the transition to fatherhood. Some fathers struggled with their transition to parenthood either due to lack of paid parental support or limited to no family support. However, some fathers found alternatives to manage and adjust in the early weeks postpartum, which included peer support groups and online information. Where and on whom will the research have an impact?: The research has the potential to impact all fathers, as the findings may be transferrable across a number of communities. The research also has the potential to influence cultural competence training for health care professionals and inform policy development that employs a family centred model of maternity care inclusive of culturally diverse families.
The paper has adhered to the EQUATOR COREQ reporting guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
by Paola Ximena Gonzalez-Lerma, Crystal Lloyd, Scarlet J. Park, Ken Dawson-Scully
Chemotherapeutic agents used for most common cancers are frequently associated with neurotoxicity, which often include debilitating side effects such as seizures. Docetaxel, one of the most widely and effectively used chemotherapeutic drugs, is associated with an array of symptoms referred to as Docetaxel-Induced Peripheral Neuropathies (DIPNs), including motor neuropathy, tingling, muscle weakness, and numbness. In this study, we use the electroconvulsive assay to model DIPN-related muscle weakness in C. elegans, via shock induction. We show that acutely or chronically exposing nematodes to docetaxel increases time to recovery from shock-induced seizure-like behaviors. Additionally, we find that sildenafil citrate, a PDE-5 inhibitor, and a novel bicyclic bridge compound, Resveramorph-3 (RVM-3), are both effective at rescuing the animals from prolonged seizure-like movement duration following acute and chronic exposure to docetaxel. The results demonstrate that sildenafil citrate and RVM-3 are potential candidates for mitigating the neurological deficits resulting from DIPNs.by Ploy Khongrungjarat, Chonnikan Tothong, Chanyanut Pankaew, Suchada Phimsen, Nopawit Khamto, Nutthamon Kijchalao, Warissara Wongkham, Piyathida Wongkham, Wipaporn Chuaymaung, Adsadayu Thonnondang, Apinun Limmongkon
Prenylated stilbenoids, particularly trans-arachidin-1 (Ara-1) and trans-arachidin-3 (Ara-3), have gained attention for their notable bioactivities and potential health-promoting properties. This study presents the first comprehensive investigation into the stability and biological efficacy of these compounds in both peanut hairy root culture crude extracts (PCE) and partially purified fractions derived from elicited peanut hairy root cultures. PCE stored at –20 °C and 4 °C maintained higher antioxidant capacity, total phenolic content compared to samples stored at room temperature. In cytotoxicity assays using SW480 colon cancer cells, the extract stored at –20 °C retained bioactivity with only minor changes in IC₅₀ values over three months, demonstrating superior stability under frozen conditions. Over a six-month period, partially purified fractions of Ara-1 and Ara-3 showed a time-dependent decline in compound content. However, Ara-3 maintained strong cytotoxicity against KKU-100 cholangiocarcinoma cells, while Ara-1 exhibited a significant loss in activity. These findings demonstrate that low-temperature storage, particularly at –20 °C, is crucial for preserving the chemical integrity and bioactivity of stilbenoid-rich extracts. The study underscores the importance of optimizing storage conditions to ensure consistent bioactivity, supporting the potential application of these compounds in the development of stable and effective pharmaceutical or nutraceutical products.by Priscilla Kapombe, Choolwe Jacobs, Mark W. Tenforde, Kashala Kamalonga, Diane Morof, Terrence Lo, Mweene Cheelo, Lloyd Mulenga, Sombo Fwoloshi, Cordilia M. Himwaze, Patrick Musonda, Mpundu Makasa, Jonas Z. Hines
Zambia has achieved improvements in life expectancy among persons living with HIV (PLHIV) because of high antiretroviral therapy (ART) coverage, which should improve survival due to reductions in AIDS-defining conditions. However, recent estimates of the most common causes of death are not widely available. We utilized mortality surveillance data to report on common causes of death among persons with HIV who died in community settings in Zambia. The Zambian Ministry of Health conducted sentinel mortality surveillance of community deaths in 45 hospitals in 33 of 116 districts from January 2020 through December 2023. Verbal autopsies (VA) were conducted through interviews with relatives or close associates of deceased persons using the 2016 World Health Organization tool. HIV status was reported. A probable cause of death was assigned by a validated computer algorithm (InterVA5). We describe the top assigned causes of death stratified by HIV status. Verbal autopsies were conducted for 67,079 community deaths, of which 11,475 (17.1%) were persons with HIV. The mean age at death was 45 years among persons with HIV and 48 years for persons without HIV (T-test pby Caitlin D. October, Dzunisani P. Baloyi, Lario Viljoen, Rene Raad, Dillon T. Wademan, Megan Palmer, Juli Switala, Michaile G. Anthony, Karen Du Preez, Petra De Koker, Anneke C. Hesseling, Bronwyne Coetzee, Graeme Hoddinott
Children who are hospitalised for tuberculosis (TB) experience challenges that put them at risk of developing emotional, behavioural, and social difficulties. In this methodological paper, we showcase the development of a narrative intervention toolkit with key components of the resulting version 1.0 tool. The study design was participatory and pragmatic, with researchers working with the routine staff of TB hospital wards, children admitted and their caregivers, to iteratively understand and improve children’s experiences of hospitalisation. The project included three phases: (1) a situational analysis to map children and healthcare providers’ perspectives on priorities and potential intervention components, (2) co-development of a beta-version of the intervention, and (3) piloting and incremental refinement toward a version 1.0 of the intervention. The intervention toolkit combined a series of activities alongside the story of ‘Courageous Curly’ to facilitate children’s engagement with their own experiences of hospitalisation, including psychosocial and treatment challenges, captured, and described throughout data collection. We found that dividing the story into short chapters facilitated children’s engagement with the section of story that is being told on a specific day. Each chapter of the story follows/mimics a different stage children can expect during their treatment journey while hospitalised for TB care. Implementation and evaluation of such interventions can mitigate the psychosocial impact of TB in children and inform policies to improve their overall TB care.by Seung-Schik Yoo, Anvita Reddy, William Carroll, Kanyapat Ploypradith
Pharmacological removal of amyloid beta protofibrils has emerged as a promising therapeutic strategy to delay the onset of Alzheimer’s disease (AD) symptoms. As a non-pharmacological and noninvasive alternative, transcranial application of low-intensity ultrasound through intact skull can induce convective acoustic streaming, which has been shown to enhance cerebrospinal fluid solute transport and facilitate the clearance of interstitial solutes. This has led to the development of device-based approaches aimed at removing the precursors of amyloid beta (Aβ) plaques and mitigating cognitive decline in AD. We applied non-thermal, non-cavitational ultrasound (400 kHz frequency) in a pulsed mode (75 ms pulse duration, 2 Hz repetition rate) to the hippocampal region of male 5xFAD mice for 30 minutes weekly, starting at 10 weeks of age and continuing for 15 weeks (until 6 months of age). Spatial and recognition memory performance was assessed monthly using the Y-maze spontaneous alternation (SA) and novel object recognition (NOR) tests. A control group of age-matched mice underwent the same procedures with receiving zero acoustic output. Mice subjected to transcranial ultrasound (tUS) treatment maintained both SA and NOR performance throughout the entire experimental period, whereas mice that received sham tUS exhibited a progressive decline in memory beginning at 3–4 months of age. Congo Red staining of the brain sections revealed a significant (> 40%) reduction in Aβ plaques in the sonicated group. Histological analysis confirmed that repeated ultrasound exposure did not cause any detectable tissue damage. These findings suggest that low intensity tUS may serve as a novel, noninvasive therapeutic strategy to delay the onset of AD symptoms through the reduction of Aβ burden.
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