To investigate changes in lateral hip pain following a 3-month, physiotherapist-led, education and exercise programme in patients with clinically and MRI-verified hip abductor tendon pathology.

Prospective cohort study.

Secondary care, Danish public teaching hospital.

From May 2024 to July 2025, 60 patients (100% women) with lateral hip pain duration of >6 months, aged 18–75 years (mean age 58.2), MRI-verified hip abductor tendon pathology were included; 55 patients completed the intervention.

Patient education on load management and modification of daily activity was provided through seven physiotherapist-led sessions over 3 months. Additionally, patients followed an individually progressed daily home-based exercise programme.

The primary outcome was change in the subscale pain of the revised Copenhagen Hip and Groin Outcome Score (HAGOS). Secondary outcomes included hip-related patient-reported outcomes and health-related quality of life, isometric hip muscle strength and a 30-second Chair Stand Test (30s-CST).

Adherence to the exercise protocol was 85%. The mean (95% CI) score in the revised HAGOS pain improved from 46.4 (41.5 to 51.2) to 60.1 (54.4 to 65.7) at 3 months follow-up. Clinically relevant improvements were observed in secondary hip-related patient-reported outcomes, alongside improvements in generic patient-reported outcomes. Minor strength improvements were observed, while the 30s-CST improved from 11.7 (10.6 to 12.9) to 14.2 (12.8 to 15.6) repetitions.

Following 3 months of physiotherapist-led, combined patient education and exercise therapy, patients with clinically and MRI-verified hip abductor tendon pathology, seen in secondary care, experienced clinically relevant changes in lateral hip pain measured by the revised HAGOS pain.

NCT06418217.

To estimate uptake of obstructive sleep apnoea (OSA) screening and initiation and long-term use of positive airway pressure (PAP) treatment in a middle-aged and older general population cohort.

Prospective population-based cohort study.

Icelandic arm of the multinational Burden of Obstructive Lung Disease follow-up study II (2019–2021)

378 non-institutionalised adults aged 54–91 years were invited from a general population cohort. 26 with prior OSA diagnosis were excluded. Of the remaining participants, 334 (88.4%) completed a technically adequate home sleep apnoea test.

Those with an apnoea–hypopnoea index (AHI)≥15 events/hour were invited for clinical evaluation and when appropriate, referred for PAP treatment. Adherence was assessed 2 years after PAP initiation.

Primary outcomes were screening uptake and PAP initiation. Secondary outcomes included long-term PAP use and objective adherence 2 years after referral.

AHI≥15 was identified in 132/334 participants (39.5%). Of these, 123 (93.2%) attended clinical evaluation and 99 (75.0%) were referred for PAP treatment. Of those not referred, six declined PAP and the remainder were advised alternative management or reassessment. At 2-year follow-up, 53/99 (53.5%) were long-term PAP users, 43/99 (43.4%) had discontinued and 3/99 (3.0%) never initiated PAP. Objective adherence data were available for 47/53 long-term users; 21/47 (44.7%) met adherence criteria (≥4 hours/night on ≥70% of nights in the preceding 30 days).

Most adults accepted OSA screening when offered. Among those with moderate-to-severe OSA identified through population screening, most accepted evaluation and PAP treatment, with approximately half becoming long-term users. These findings suggest that population-based detection of OSA followed by routine clinical management is feasible. Future studies should identify subgroups most likely to benefit and evaluate alternative treatment strategies.

Fracture misdiagnosis is a common diagnostic error in emergency departments (EDs) and minor injury units (MIUs), leading to poor patient outcomes, unnecessary treatments and significant healthcare costs. Artificial intelligence (AI)-assisted fracture detection tools are now available for use in radiology workflows; however, the impact of these technologies on patient outcomes, experiences and overall care pathways in the real-world clinical setting is limited.

We will conduct a prospective cluster randomised cross-over trial over a 6-month period, assessing the impact of an AI-assisted fracture detection tool in EDs and MIUs across 4 healthcare Trusts in the UK. Patients aged over 2 years old undergoing a plain film radiography for a suspected fracture as part of routine clinical care will be eligible for study enrolment. The trial will deploy Radiobotics’ RBfracture, a CE-approved AI-assisted medical device software for fracture detection at each site for 6 months. Randomisation will be at a cluster-level; a site will be randomised to begin with ‘AI on’ or ‘AI off’ for a month, followed by alternating active status each month for the remaining 5 months. The primary outcome will evaluate the incidence of ‘inappropriate healthcare contacts’ among patients receiving imaging for suspected fractures. This composite metric encompasses inappropriate referrals to fracture clinics, repeated hospital attendances and subsequent follow-up communications regarding missed fractures. The rates of these measures will be compared in the ‘AI on’ versus ‘AI off’ stages. Secondary outcomes will include patient-reported outcomes, clinician surveys, a predefined health economic evaluation assessing cost-effectiveness and budget impact and the diagnostic performance of the algorithm.

The study has received ethical approval from the South Central—Oxford Research Ethics Committee (Reference: 25/SC/0252, approval date: 23 October 2025), and subsequently from the Health Research Authority (IRAS 3 57 391-A). The results of this study will be presented at relevant scientific conferences and peer-reviewed publications will be disseminated on wider public forums such as traditional and social media.

This is an ongoing, actively recruiting trial (ISRCTN23087950). Recruitment began in January 2026 and will run for 6 months at each site, with per-patient follow-up of 30 days and subsequent data analysis. This manuscript describes protocol version 1.1. The full protocol and statistical analysis plan are available from the corresponding author on request and will be deposited on the study’s public repository (https://github.com/Jason-L-Oke/SAMURAI) prior to publication of results.

ISRCTN23087950.

User involvement is important for improving accessibility, quality and equity in health and social care research. However, the specific mechanisms by which it contributes to, or detracts from intervention outcomes are unclear, particularly for populations experiencing exclusion and health and social inequities in high-income countries. This realist review aims to understand and describe key mechanisms of user involvement in complex interventions in health and social care research among populations experiencing exclusion in high-income countries. Specifically, we will explore how, why, for whom and under what circumstances user involvement contributes to complex interventions in health and social care research among populations experiencing exclusion.

We will conduct a six-step realist review: (1) clarifying the scope, (2) searching for evidence, (3) selecting and appraising sources, (4) extracting and organising data, (5) synthesising data and (6) refining the synthesis. We will systematically review and synthesise relevant sources from academic databases and grey literature. Workshops will be held with experts who have lived experience of exclusion and/or professionals working in inclusion health to gather feedback and refine the findings. A group of external academic experts in the field will also be consulted. Following Pawson and Tilley’s iterative approach, data will be extracted, analysed and synthesised into explanatory theoretical findings and reported in accordance with the Realist And Meta-narrative Evidence Syntheses Evolving Standards.

Formal ethical approval is not required for this study as it is a review of published literature. Our overall dissemination strategy will be developed in collaboration with the experts who have lived experience of exclusion, as well as three professionals working in inclusion health. Findings will be shared with these expert contributors and disseminated through various channels, including a peer-reviewed publication, lay summary report and conference presentations.

CRD420251046835.

Parosmia is a qualitative olfactory disorder characterised by a distorted perception of smell, often experienced as unpleasant or offensive. Although parosmia has multiple aetiologies, post-viral parosmia has become increasingly prevalent following the COVID-19 pandemic. In the UK, post-viral parosmia affects an estimated 637 836 individuals and has a substantial negative impact on quality of life and mood. At present, there is no licensed or standardised treatment for this condition. Gabapentin, a gamma-aminobutyric acid analogue with neuromodulatory properties, has shown potential benefits at low doses in small, non-randomised studies; however, its efficacy requires further evaluation.

Use of Gabapentin in the Management of Post-Viral Parosmia: A Double-Blind, Randomised, Placebo-Controlled, Multi-Site Trial (COPANOS) is a phase III, double-blind, randomised, placebo-controlled trial comparing gabapentin with placebo in adults aged 18–65 years with post-viral parosmia persisting for ≥6 months and

The results will provide robust preliminary evidence on the efficacy and safety of low-dose gabapentin for managing post-viral parosmia and will inform the feasibility and design of targeted treatment guidelines. Defining effective treatment for post-viral parosmia is essential given the significant impact on patient well-being and the absence of current evidence-based interventions.

The trial protocol has been reviewed and approved by Health Research Authority (HRA) and Health and Care Research Wales (HCRW): 25/WA/0298, 21/10/2025. Results will be analysed and published as soon as possible following trial completion. Findings will be summarised on the study webpage and shared with trial participants in plain English. Trial results will also be uploaded to relevant trial registries within 12 months of trial completion. The Rosetrees Trust will be acknowledged in all publications. Publications will follow International Committee of Medical Journal Editors authorship guidelines, and professional medical writers will not be used.

ISRCTN82171427, IRAS 1012783.

To investigate the association between attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic risk profile at the time of type 2 diabetes (T2D) diagnosis and examine longitudinal changes in cardiometabolic measures following T2D diagnosis.

A nationwide cohort study using linked Swedish health registers.

Adults aged 18–65 years with a first recorded diagnosis of T2D between 1996 and 2020. ADHD, treated as a lifetime condition, was identified through diagnostic and prescription records.

The cardiometabolic risk profile, comprising nine clinical parameters and two behavioural factors, was assessed at T2D diagnosis and was tracked for up to 5 years post-diagnosis. Linear regression (β_ADHD) and Poisson regression models with robust variance (risk ratios (RRs)) compared cardiometabolic risk factors at diagnosis between individuals with and without ADHD. Generalised estimating equations (β_ADHD*t) assessed longitudinal changes in clinical parameters following the diagnosis.

Among 80 607 individuals with T2D, 1204 (1.5%) had an ADHD diagnosis. At T2D diagnosis, individuals with ADHD were younger and had statistically significantly higher body mass index (BMI) (β_ADHD: 1.93 (95% CI 1.54 to 2.32)), triglycerides (β_ADHD: 0.31 (95% CI 0.17 to 0.45)) and smoking prevalence (RR: 1.58 (95% CI 1.44 to 1.74)) compared with those without ADHD. Other cardiometabolic risk factors did not differ significantly. Over the subsequent 5 years, trajectories in cardiometabolic risk factors were broadly similar, except for a greater reduction in BMI in individuals with ADHD (β_ADHD*t: –0.26 (95% CI –0.34 to –0.17)), independent of baseline BMI and glucose-lowering medications. After inverse probability of treatment weighting, the BMI reduction was substantially reduced and not significant (β_ADHD*t: –0.05 (95% CI –0.17 to 0.07)).

Among adults with newly diagnosed T2D, those with co-occurring ADHD had broadly similar cardiometabolic profiles to those without ADHD but presented at a younger age with a modestly higher BMI, triglycerides and smoking prevalence. Individuals with ADHD also showed a slightly greater reduction in BMI over time following T2D diagnosis. Despite modest overall cardiometabolic differences, incorporating ADHD status into preventive diabetes care may help identify a younger, more vulnerable subgroup who could benefit from targeted risk factor management.

Time Together (TT) is a nursing intervention designed with a focus on increasing the possibility of patients and staff engaging in joint activities. Previous research points towards implementation difficulties but there are no studies specifically investigating the process of implementing TT in psychiatric inpatient care (PIC). Therefore, the aim of this study is to explore mid-level leaders’ and implementation leads’ perspectives on implementing TT in PIC, analysed through the Consolidated Framework for Implementation Research (CFIR).

This qualitative study used semistructured interviews with 11 mid-level leaders and implementation leads who took part in implementing TT. The interviews were analysed using deductive qualitative content analysis, with the CFIR applied as a structured matrix in the analysis.

The study was conducted in PIC settings at three wards within secondary care healthcare services in northern Sweden.

Participants were 11 mid-level leaders and implementation leads involved in the implementation of TT in PIC.

TT is scheduled for 1 hour, 5 days a week. During this hour, nursing staff and patients engage in joint activities, while one or two staff members oversee administrative duties. No meetings, visits or other ward-related activities are scheduled during this hour.

Deductive content analysis resulted in 15 categories sorted into 4 domains and 11 constructs. TT was perceived as advantageous and aligned with the wards’ mission. However, one key finding was that mid-level leaders and implementation leads found implementation challenging as they perceived that some innovation deliverers viewed joint activities within TT as lacking value and not being ‘proper work’. Furthermore, there was a need for more information and a clearer rationale for the intervention in order to improve implementation and delivery.

The findings indicate a discrepancy in values and attitudes between leaders and innovation deliverers regarding what constitutes meaningful care in psychiatric inpatient settings. Implementation was further influenced by challenges related to leadership and motivating others. Barriers to implementing TT may not be addressable through implementation and intervention training alone. Instead, implementation planning should also consider intervention deliverers’ values and beliefs.

To identify profiles of compositional movement behaviour patterns among children and examine cross-sectional and 12-month associations with adiposity markers and health-related quality of life (HRQoL).

Secondary analysis of data from the TransformUs cluster randomised controlled trial with cross-sectional and 12-month follow-up analyses.

Primary schools in metropolitan and regional areas of Victoria, Australia.

Children aged 7–11 years with valid accelerometer at baseline, regardless of demographic, adiposity and HRQoL data available (n=792), were included in the analytical sample for the latent profile analysis.

Sedentary time, light-intensity physical activity (LPA) and moderate- to vigorous-intensity physical activity (MVPA) along with their respective mean bout lengths were derived from raw acceleration data. Latent profile analysis used these measures (total times, as isometric log ratios and mean bout lengths) as input variables to classify distinct profiles for us as a categorical exposure variable in regression models. Primary outcomes were age- and sex-standardised body mass index, waist circumference and parent-reported HRQoL at baseline. Secondary outcomes were the same measures assessed at 12-month follow-up.

Four distinct profiles were identified. The high MVPA-short sedentary bout profile (n=184) was characterised by the highest levels of MVPA, moderate sedentary time and the shortest mean sedentary bout duration. The low sedentary-high LPA profile (n=54) had the lowest sedentary time, the highest LPA and the longest mean LPA bout duration. Two profiles were characterised by high sedentary time: the high sedentary-long sedentary bout profile (n=149), which had the longest mean sedentary bout durations, and the high sedentary-shorter bouts profile (n=405), which also had high sedentary time but shorter bout durations for all intensities. While the omnibus Wald test for differences across profiles indicated uncertainty in the overall profile effect, the high MVPA-short sedentary bout profile had favourable adiposity levels cross-sectionally compared with the high sedentary-long sedentary bout reference profile in pairwise comparisons. No longitudinal associations were detected.

Four distinct movement profiles were identified. Few pairwise differences between health outcomes were observed. While MVPA remains a key factor for promoting healthy body weight, our findings suggest that a variety of movement patterns - including those characterised by lower sedentary time and higher LPA - may also support health in children.

This study is a secondary analysis of the TransformUs effectiveness-implementation trial, registered with the Australian Clinical Trials Registry (ACTRN12617000204347; 1 April 2017).

Worldwide, billions of children and young people live in areas affected by war. Suicide remains one of the three leading causes of death worldwide among people aged 15–29 years. However, little is known about the effect of war on suicidal behaviours in this group. This review aims to assess suicides, suicide attempts and suicidal ideation among children and young people exposed to war or armed conflict.

A scoping review of studies was conducted using Web of Science, PubMed, Embase and PsycINFO databases from their inception to 18 November 2025, without any restrictions on geographical location. We included only observational studies with full-text, peer-reviewed English articles reporting any suicides, suicide attempts and suicidal ideation of children and young people aged 0–24 years exposed to war. The quality of the included articles was assessed using the Quality Assessment with Diverse Studies. The protocol of the review was registered with the Open Science Framework on 29 March 2022 (https://osf.io/7kszh/).

Of the 3229 articles retrieved, 37 studies were eligible for review, providing data from 24 countries and covering a period of almost a hundred years (1921–2025). Most studies (>20) focused on conflicts ongoing during or until the 2000s, whereas only three focused on World War II. The reported outcomes were suicides (n=9), suicide attempts (n=15) and suicidal ideation (n=21). Included studies spanned six continents, from Latin America (n=5, Colombia only) to Europe (n=10). We assessed the suicide rates during and after wars. There was some evidence of a decrease in suicide rates during war, but no clear trend in suicide rates post-war was observed. The prevalence rates of suicide attempts and suicidal ideation varied widely, without uniformity in the definitions used. War-related trauma, mental health problems, substance abuse and exposure to suicide or suicide attempts were identified as risk factors, while protective factors included family and social support.

There is a need for more methodologically consistent and rigorous research on suicidal thoughts and behaviours in children and young people exposed to war or armed conflicts. Future research should identify mediator/moderating factors influencing suicidal behaviours and their links to mental health.

Microbiome composition across multiple body sites, including the vagina, gut, urinary tract and semen, has been implicated in reproductive health and infertility. Vaginal dysbiosis and reduced Lactobacillus abundance have previously been associated with poorer outcomes in assisted reproductive technologies, yet few studies have simultaneously characterised microbiomes of both partners or compared infertile couples with healthy population controls. The BIOME study, a prospective cohort study, aims to characterise multisite microbiomes in infertile and healthy Danish couples and examine their association with long-term fertility outcomes.

The BIOME study is a multicentre, prospective observational cohort study including 100 couples undergoing fertility treatment following ≥12 months of unsuccessful pregnancy attempts and 100 healthy control couples. Participants provide biological samples from multiple body sites (vaginal swab or semen, faeces, urine and blood) prior to initiation of fertility treatment. Samples will undergo microbial sequencing, quantitative PCR, culture-based analyses, proteomics, metabolomics and microRNA profiling. Questionnaire data, clinical information and electronic medical record data will be collected. Participants will be followed for 5 years after sample collection to assess fertility outcomes. No intervention, randomisation or blinding is performed. Recruitment is planned over 24 months.

The study has been approved by the Danish Ethics Committee (#SJ-1033), and all participants provide written informed consent. Data are processed according to the General Data Protection Regulation and the Danish Data Protection Act, with pseudonymisation and restricted-access procedures. Results will be disseminated through peer-reviewed publications and scientific conferences. Sequencing data will be deposited in a public repository (eg, European Nucleotide Archive) with personal identifiers removed, and curated metadata will be available on reasonable request.

One-third of patients operated for degenerative conditions in the lumbar spine do not report substantial improvement after 12 months. Most previous outcome prediction models are classifiers. This constrains nuances in prediction and use for decision support.

To develop and test models for the prediction of continuous outcome scores and retrieval of similar patients’ outcomes, and to evaluate the models’ fairness.

Norwegian public and private specialist healthcare.

All cases recorded with an elective operation for lumbar disc herniation (LDH, n=18 377) or lumbar spinal stenosis (LSS, n=24 540) in the Norwegian Registry for Spine Surgery from 1 January 2007 to 23 May 2023.

All outcomes were patient-reported 12 months after the operation. The primary outcome was the Oswestry disability index (ODI), modelled on a scale ranging from 0 to 100. Numeric Rating Scale scores (range 0–10) for back and leg pain were secondary outcomes.

We selected 22 predictors recorded preoperatively by patients and clinicians based on Shapley Additive Explanations values. Data were split into 80%/20% training/test samples for LDH and LSS. Six machine learning methods for regression, that is, with a continuous outcome (extreme gradient boosting (XGBoost), Gaussian process regression, gradient boosting regression, artificial neural networks and linear regression), were trained for both conditions using fivefold cross-validation. We report the magnitude and distribution of errors as mean absolute error (MAE) with 95% CIs, and explanatory power as the coefficient of determination (R²). Fairness and calibration were assessed with violin and calibration plots of error. We developed a patient-similarity function that uses a K-nearest neighbour model to retrieve the individual outcomes of the 50 most similar patients and evaluated it by calculating L1 distances (Manhattan distances) across subgroups.

XGBoost regression performed best for both conditions. The models showed good calibration and predicted ODI with MAE 11.32 (95% CI 11.00 to 11.63) and R² 0.27 (95% CI 0.24 to 0.29) for LDH and MAE 12.05 (95% CI 11.76 to 12.32) and R² 0.31 (95% CI 0.28 to 0.34) for LSS. The MAEs for back and leg pain were 2.09 (95% CI 2.04 to 2.15) and 1.95 (95% CI 1.90 to 2.00) for LDH and 2.33 (95% CI 2.28 to 2.38) and 2.13 (95% CI 2.08 to 2.16) for LSS. All models were fair with differences in error between subgroups for sex, age, education level and native language. In the patient-similarity function, distances at baseline were evenly distributed across subgroups.

Our machine learning models predicted continuous outcomes with MAEs close to the SEs of measurements. The models were fair across sociodemographic subgroups. We succeeded in developing a patient-similarity function which supplements the predictions.

To co-develop the Stay-At-Work (SAW) intervention, a person-centred, interdisciplinary, cross-sectoral vocational rehabilitation (VR) programme for individuals on, or at risk of, sick leave due to chronic low back pain (CLBP) and to advance methodological understanding of how evidence, qualitative insights, stakeholder input and programme theory can be systematically integrated and operationalised into concrete intervention components.

A three-stage intervention development study, guided by the Medical Research Council framework for complex interventions, involving evidence review and stakeholder consultation (previously reported); multistakeholder co-design; and prototyping in clinical settings.

The intervention was developed within a Danish public healthcare and welfare context, involving a secondary care spinal service, municipal employment services (n=3), municipal rehabilitation services (n=3) and general practice.

Stage 1: 17 individuals on long-term sick leave due to CLBP participated in interviews and focus groups. Stages 2 and 3: The co-design group included individuals living with CLBP (n=2); clinicians from a secondary care spine service (n=2) and municipal rehabilitation services (n=6); general practitioners (n=2); municipal employment service professionals (n=3) and local managers (n=3); and employer and employee representatives (n=2). Participants were purposively recruited based on their roles and experience in VR and return-to-work processes and contributed across different stages of intervention development.

The SAW intervention consists of eight structured activities, developed through multistakeholder co-design and underpinned by a programme theory with four core mechanisms: (1) strengthened interprofessional and cross-sectoral understanding and collaboration; (2) stronger alignment around functional capacity and work ability; (3) addressing psychological vulnerability through systematic screening and support; and (4) enhanced coordination of care and rehabilitation efforts across services.

Stakeholder input from the co-design group informed the intervention’s content and procedures, thereby improving alignment with local contexts and strengthening cross-sector collaboration. Some proposals were excluded due to inconsistency with clinical guidelines.

This study demonstrates how a structured, theory-informed co-development process can be used to integrate evidence, stakeholder input and programme theory into a coherent, cross-sectoral VR intervention. The approach enhanced transparency, supported alignment with real-world practice, and provides methodological insight to strengthen the reproducibility and transferability of complex interventions.

Registration number: The Region of Southern Denmark’s Research Registry (journal no. 23/44927).

Robot-assisted laparoscopic surgical procedures are commonly perceived to result in fast recovery; however, the postoperative course can be challenging for many patients. We have previously found severe pain and a significant decrease in the patient-reported outcome measure Quality-of-Recovery 15 (QoR-15) in a cohort of patients undergoing robot-assisted upper urinary tract surgery. In similar settings, intrathecal analgesia is sometimes used to improve recovery; however, its benefits have not been established. Therefore, this study aims to examine the effects of intrathecal analgesia in this setting compared with an active comparator intravenous lidocaine.

In this randomised, assessor-blinded multicentre trial, 220 patients scheduled for robot-assisted upper urinary tract surgery under general anaesthesia are recruited after obtaining informed consent. They are randomised to receive either intrathecal analgesia or an intraoperative infusion with lidocaine. The primary study outcome is the decrease in QoR-15 from baseline to postoperative day 1. Other outcomes of interest include postoperative pain, length of stay and postoperative complications. Differences in intraoperative haemodynamics and postoperative inflammatory parameters will also be analysed.

This study has been approved by the Swedish Medical Products Agency (5.1.1-2023-69740 and 5.1.2-2025-030145). The results of this study will be presented at national and international meetings and submitted for publication in peer-reviewed international medical journals.

NCT06349668.