Extrapulmonary tuberculosis (EPTB) poses a significant diagnostic and economic challenge in HIV endemic, low-resource settings due to its complex presentation and current diagnostic tools limitations. While accurate and timely diagnosis is critical for reducing morbidity, mortality and health system costs, economic evaluations of EPTB diagnostics remain sparse and fragmented. This protocol aims to map existing evidence on the economic evaluation of diagnostic innovations for EPTB in low-resource settings.

This scoping review protocol follows the Joanna Briggs Institute (JBI) methodological framework and registered on the Open Science Framework. Peer-reviewed articles, grey literature and official reports published between 2000 and 2025 will be searched in PubMed, MEDLINE, Google Scholar, Scopus and Science Direct. The search strategy is structured using the Population, Intervention, Comparator, Outcome, Time, Study design and Setting (PICOTSS) framework, and will be peer-reviewed using the Peer Review of Electronic Search Strategies (PRESS) guideline. Study selection, data charting and extraction will be performed independently by two reviewers. Data will be charted iteratively, and the methodological quality of selected economic evaluations will be appraised using the Drummond checklist. Results will be synthesised in narrative summaries and tabular formats. Final reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline.

For review of previously published data, ethical approval is not required. Findings will be disseminated in professional networks, stakeholder meetings and a peer-reviewed journal.

OSF Registration DOI 10.17605/OSF.IO/BTCPG

Staphylococcus aureus (S. aureus) bacteraemia is a common and severe infection. With mortality rates ranging from 20–30% and long-term impairments in over a third of survivors, better treatments are urgently needed. Linezolid, a well-established treatment for pneumonia and complicated skin infections, has been shown in preclinical studies to strongly suppress S. aureus virulence factors critical to bacterial persistence and tissue damage. Hence, we aim to investigate whether the addition of linezolid to standard therapy in patients with S. aureus bacteraemia leads to an overall improvement in patient-relevant outcomes.

We will conduct a two-arm, parallel-group, multicentre, randomised controlled trial (Linezolid Plus Standard of Care) in 12 hospitals in Switzerland with blinded treating physicians, patients and outcome assessors. Hospitalised patients aged ≥18 years with S. aureus bacteraemia will be eligible. Patients will receive standard antibiotic treatment as prescribed by the treating physician. Within 72 hours of collection of the blood sample yielding the first positive blood culture, patients will be enrolled and randomised 1:1 to receive either adjunctive linezolid (600 mg orally two times per day for 5 days) or placebo. To determine patient-relevant outcomes, we implemented a comprehensive patient-representative consultation process. Consequently, we will use the desirability of outcome ranking (DOOR) established for S. aureus bacteraemia as the primary outcome at 90 days. The hierarchical composite DOOR outcome includes the following four components, ranked from most to least important: (1) survival, (2) return to level of function before S. aureus infection, (3) complications leading to treatment changes and serious adverse reactions; and (4) hospital length of stay. This approach will allow us to analyse the win ratio, that is, whether patients receiving linezolid have a better DOOR rank compared to patients in the placebo group. We calculated a target sample size of 606 patients providing 90% power at a two-sided significance level of 0.05.

Ethical approval was received from the Ethics committee for Northern and Central Switzerland (BASEC number 2025-00655). Eligible patients will be informed about the study by the local study team and asked for written consent if they wish to participate. For patients unable to provide informed consent, an appropriate substitute (ie, a close relative or a physician not involved in the research project) may make decisions based on the presumed wishes and the best interest of the patient. The patient’s own consent will be obtained as soon as their condition permits. Results will be published in peer-reviewed journals and in laymen's terms through various channels (social media, Swiss national portal HumRes).

NCT06958835.

Poor participant retention in randomised clinical trials, resulting in missing outcome data, can impact the validity, reliability and generalisability of results. While participants’ views on general non-retention issues have been reported elsewhere, a qualitative evidence synthesis specifically focusing on trial processes (ie, outcome data collection) impacting retention has not been undertaken to date. This is an important research question to inform targeted interventions to support retention. This review aims to address this by systematically searching and synthesising the evidence on participant reasons for trial non-completion, linked to outcome data collection.

We conducted a qualitative evidence synthesis of qualitative studies and mixed methods studies with a qualitative component, in Embase, Ovid MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Social Science Citation Index, Cumulative Index of Nursing & Allied Health Literature and Applied Social Sciences Index and Abstracts, up to February 2025. We used Thomas and Harden’s thematic synthesis approach. The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative framework was used to assess confidence in the review findings.

We identified 11 studies reporting qualitative data from 14 separate trials, with findings from 105 trial non-retainers. The studies were undertaken between 2007 and 2025.

There were three types of participant non-retention behaviours reported across the studies, where participants either: (1) missed at least one clinic visit; (2) did not complete a postal questionnaire or (3) did not complete online data collection. We developed four analytical themes outlining participant-reported influences on trial non-retention, specifically related to trial processes (ie, data collection for outcome measures): fluctuating health, balancing trial burdens, navigating life as a trial participant and managing expectations of participation.

This review generates important insights into participants’ reasons for trial non-completion linked to outcome data collection. The review highlights the need for further research into supporting trial recruitment discussions that provide clear, realistic expectations for potential trial participants, as well as strategies that recognise, and where possible, address some of the influences on participants to improve outcome data completeness and ultimately improve trial retention.

Despite its serious impact, anorexia nervosa (AN) remains one of the least understood mental illnesses, with significant gaps in effective treatment options. No medications have been deemed effective and only 50% of individuals respond to conventional psychotherapies. Gastrointestinal (GI) bacteria have been found to be altered in individuals with AN. While, Fecal microbiota transplantation (FMT) has shown potential for alleviating anxiety and depression, its effects remain understudied for individuals with AN. This study aims to determine whether oral capsular FMT is acceptable to adolescents with AN and results in clinical improvement in weight and/or psychological symptoms.

This study will randomise 20 adolescents with AN, ages 12–17 years, to receive either FMT or placebo capsules. These 20 youth, as well as an additional 10 youth who decline trial enrolment, will participate in qualitative interviews. We will track recruitment rates and collect psychological and biological measures (blood, stool, urine and saliva) at multiple timepoints to assess how gut microbiota and their metabolites may influence the symptoms of AN. Interviews with participants and caregivers will explore their experiences and views on FMT as a treatment approach.

This study has received ethics approval by the Hamilton Integrated Research Ethics Board (#17493) and investigational drug approval by Health Canada (Dossier ID: c292423). Informed consent will be obtained by research staff from all participants. Findings will be disseminated through academic conferences, clinical forums and partnerships with advocacy organisations to reach clinicians, researchers and individuals with lived experience.

NCT06593366.

To develop an empirically grounded, activity-based tariff framework for Hospital at Home (HaH) services using time-driven activity-based costing (TDABC) and micro-costing to support transparent and equitable reimbursement for acute elderly care delivered at home.

Microcosting study embedded within a randomised controlled trial (RCT) comparing HaH with conventional hospital admission in Denmark.

Three municipalities in the Central Denmark Region in collaboration with emergency department physicians at a regional hospital.

A consecutive subsample of 107 elderly acute patients enrolled in the RCT between June 2022 and February 2024. Resource use for HaH activities was measured prospectively using microcosting logs, time-motion observations and administrative records.

Empirically derived tariffs per HaH visit (first and subsequent) calculated using an eight-step TDABC framework incorporating process mapping, resource identification, capacity cost rates and time equations. Sensitivity analyses tested robustness to variation in key cost drivers.

The mean total tariff was 338.89 (95% CI 310.94 to 351.49) for first visits and 207.81 (95% CI 200.70 to 215.69) for subsequent visits, including treatment and transport components. Staff time was the principal cost driver, while equipment, overhead and travel reimbursement had smaller effects. The framework accommodates variation in staffing, geography and visit intensity and can be used to estimate total costs across diverse HaH pathways.

A transparent and reproducible tariff-development framework for HaH services was established using TDABC and microcosting. The model aligns reimbursement with actual resource use and care complexity and provides a transferable template for economic evaluation and operational planning.

NCT05360914.

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.

For critically ill patients requiring continuous renal replacement therapy, regional citrate anticoagulation is the preferred strategy to maintain extracorporeal circuit patency. Current clinical practice relies on two citrate-based protocols, with the widely used but complex 4% trisodium citrate solution posing a hypernatraemia risk and haemofiltration replacement fluid of sodium citrate offering procedural simplification and a more physiological electrolyte profile. Direct prospective comparison of their circuit lifespan efficacy is currently unavailable.

This single-centre, prospective, open-label, parallel-group randomised controlled trial will be conducted in China. 90 patients will be enrolled and randomly assigned (1:1) to receive anticoagulation with either citrate-based haemofiltration replacement fluid or 4% trisodium citrate solution, with all patients undergoing a standardised continuous venovenous haemofiltration protocol. The primary outcome is circuit lifespan, with a non-inferiority margin set at 2.43 hours. Secondary outcomes include the 72-hour circuit survival probability, duration of hospitalisation, and all-cause mortality rates at 28 and 90 days. The primary analysis will follow the intention-to-treat principle.

The study protocol has been approved by the Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Approval No. (2025)1157). Any subsequent amendments must be submitted to the same ethics committee for further review and approval prior to implementation. Furthermore, the findings of this trial will be disseminated through presentations at relevant national and international conferences and via publication in peer-reviewed scientific journals.

Chinese Clinical Trial Registry ChiCTR2500106991.

Over 50% of patients participating in cardiac rehabilitation (CR) experience poor sleep and/or, closely related, psychological stress. Although stress management interventions are generally available, they are typically underutilised in CR, and sleep remains an underaddressed component within CR. This is concerning, as poor sleep and stress not only reinforce each other but are also associated with poorer cardiovascular health and lower quality of life. Therefore, the primary aim of the OPtimising CArdiac REhabilitation by REfining Sleep and STress (RESST) study is to investigate the (cost-)effectiveness of adding a behavioural intervention targeted at improving sleep and managing stress during CR (RESST intervention) on sleep and psychological stress. Furthermore, the study aims to explore the (bidirectional) associations between sleep, stress and lifestyle behaviours.

This parallel-arm multicentre randomised controlled trial will include 200 CR patients across 3 major CR centres in the Netherlands who experience poor sleep and/or stress. Patients will be randomised in a 1:1 ratio to standard CR or standard CR with the RESST intervention. Standard CR is a structured programme combining exercise, lifestyle guidance and risk management. On top of standard CR, the RESST intervention consists of 5 in-person group sessions targeting sleep and stress and is based on Acceptance and Commitment Therapy and Cognitive Behavioural Therapy. Primary outcomes are accelerometer-assessed and self-reported sleep and perceived stress. Secondary outcomes include quality of life, psychosocial well-being, chronic stress biomarkers (hair cortisol and cortisone), momentary fatigue, momentary stress and physical activity. Linear mixed models will be used to assess changes in outcomes at 3-month (after intervention and/or CR completed) and 6-month follow-up. The momentary data collected with ecological momentary assessment and accelerometry will be analysed using multilevel linear mixed models to explore the (bidirectional) relationship between sleep, stress and other lifestyle components such as physical activity.

This study was approved by the ethics committee of Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands (MEC-2024-0238). The findings will be disseminated through publications in peer-reviewed journals, presentations at academic conferences and professional and patient publications.

NCT06505109.

Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence.

This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years.

The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences.

2023–5 08 316-27-00.

NCT06398028.

V.12, 18 March 2025

The global burden of cancer is increasingly concentrated in low-income and middle-income countries (LMICs), where health systems face significant challenges such as late-stage diagnosis, limited resources and restricted access to specialised care. Palliative care plays a vital role in improving symptom control and quality of life for patients with cancer, particularly as care delivery shifts toward ambulatory and community-based settings. In this context, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are crucial for capturing patients’ perspectives on the quality of care. However, the use and characteristics of these instruments in ambulatory palliative care settings within LMICs remain poorly understood. This systematic review aims to identify and map PROMs and PREMs used among adult patients with cancer receiving ambulatory palliative care in LMICs, and to examine their content, psychometric properties and alignment with key domains of quality palliative care.

This systematic review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) guidelines. The search will be conducted across seven databases from the database inception to December 2025. Two independent reviewers will screen titles, abstracts and full-text articles using Rayyan software to identify studies involving adults (≥18 years) with cancer in ambulatory palliative care settings. Data extraction will capture study characteristics, instrument content and psychometric properties. The final review will be reported in accordance with the PRISMA-COSMIN for Outcome Measurement Instruments. A narrative synthesis will be conducted, mapping the identified instruments against the eight domains of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care to identify measurement gaps and inform future instrument development. A meta-analysis will be conducted if sufficient homogeneity exists.

This review will include only published data; therefore, no approval is required. The findings of this review will be presented at conferences and published in an open-access peer-reviewed journal.

CRD420251273579.

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.

Youth vaping remains a global public health challenge. We will evaluate a pragmatic, theory-driven digital game-based learning intervention (VAPGAMO), delivered in public secondary schools to reduce adolescents’ intention to vape at 3-month follow-up.

Parallel cluster-randomised controlled trial with schools as clusters. Eight public secondary schools in an urban Southeast Asian district (Klang, Malaysia) will be randomised 1:1 to intervention or attention-matched online flash game. The intervention is a single 90 min, facilitator-led module grounded in the Theory of Planned Behaviour. Surveys at baseline, immediately postintervention and 3 months. The primary outcome is intention to vape at 3 months. Secondary outcomes are knowledge, attitudes, injunctive norms and refusal self-efficacy (perceived behavioural control). Prespecified implementation outcomes include acceptability, fidelity, reach, time-on-task and cost per student. Primary analysis will use generalised estimating equations with cluster-robust SEs, adjusted for baseline covariates; the intra-cluster correlation coefficient and design effect will be reported; intention-to-treat will be applied.

Universiti Putra Malaysia JKEUPM-2024-887; approvals from the Ministry of Education, Malaysia. Findings will be disseminated in peer-reviewed outlets and shared with education and health authorities to inform school-health programming. De-identified data and code will be made available on publication, subject to approvals.

Thai Clinical Trial Registry (TCTR20241222001).

This study aimed to determine the prevalence of fetal malnutrition (FM) among term singleton newborns at birth using clinical assessment of nutritional status (CAN) score. The study also compared the CAN score with selected anthropometric indices to describe their ability to identify FM. Furthermore, it sought to identify maternal and neonatal factors linked with FM among term infants delivered in four public hospitals in South Ethiopia.

Cross-sectional study.

The study was conducted at four public hospitals in South Ethiopia Regional State.

480 live-born full-term babies and their mothers delivered at four public hospitals between 6 June 2021 and 19 April 2022.

FM status at birth was the outcome variable. FM was assessed using both the CAN score and selected anthropometric indices. At birth, measurements of height, weight, head circumference (HC) and mid-arm circumference (MAC) were taken. The MAC/HC ratio, body mass index (BMI) and ponderal index (PI) were computed and contrasted with reference curves. By examining and calculating subcutaneous tissue and muscle loss, the CAN score was used to determine the newborn’s CAN status. A CAN score of

This study of 480 newborns found varying rates of FM depending on the diagnostic criteria used. The prevalence of FM was highest when assessed by CAN score (26.04%), followed by PI (17.29%), BMI (16.25%), MAC/HC ratio (13.54%) and birth size-for-gestational-age (11.25%). Not attending formal education (AOR 3.31 95% CI 1.14 to 9.64), age between 25–29 years (AOR 2.66 95% CI 1.19 to 5.98), primi-parity (AOR 9.63 95% CI 1.42 to 65.46), having

FM was prevalent among term neonates, with the CAN score showing higher prevalence than anthropometric indices. Education level of the mother, primi-parity, fewer ANC visits, maternal age between 25–29 years and PIH were significant risk factors. FM might be most effectively recognised using the CAN score, which can be done without advanced tools.

Patient awareness of their diagnosis and management plan is crucial for improving compliance, empowering patients and enhancing outcomes. We aimed to assess surgical patients’ awareness of their diagnosis, management plans and associated factors.

A cross-sectional study was conducted from December 2024 to March 2025 on 400 adult surgical inpatients who had undergone surgery in the general surgery, gynaecology and obstetrics, and orthopaedic wards at Debre Tabor Comprehensive Specialized Hospital, Ethiopia. Data were collected using a structured written questionnaire and analysed using the SPSS V.25. Bivariate and multivariate logistic regression were used to identify factors associated with patients’ awareness of their diagnosis and care plan, with significance determined using adjusted ORs and 95% CIs.

Overall, 52% of respondents had global awareness of their clinical conditions and management plans. Awareness was highest for clinical diagnosis (78.9%), necessity of admission (78.9%) and operations performed (72.0%). However, more than 50% of respondents did not seek information on the diagnosis, possible cause and investigation related to their condition. In multivariable analysis, patients with tertiary education were 7.12 times more likely to have global awareness than those without formal education (adjusted OR, AOR=7.12; 95% CI 1.95 to 25.95), and patients living in urban areas were 3.15 times more likely to have global awareness than those in rural areas (AOR=3.15; 95% CI 1.63 to 6.10; p

Awareness of various aspects of healthcare ranged from 35.5% to 78.9%, with about half of respondents demonstrating global awareness of their diagnosis and management plans. Implementing shared decision-making models may improve patients’ understanding of their care plans.

Haemorrhoidal disease affects 25–40% of adults worldwide and constitutes a primary reason for outpatient colorectal consultations. Surgical management is essential for grade III–IV or treatment-refractory cases. Numerous procedures have emerged, including Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty. However, randomised controlled trials and conventional meta-analyses report conflicting results on efficacy, postoperative pain, recurrence rates and complications such as bleeding, stenosis and incontinence. Although network meta-analyses exist, an updated synthesis is needed because outcomes and follow-up vary across trials. This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis, providing evidence-based guidance for clinical practice and guideline development.

The Cochrane Library, Web of Science, MEDLINE, Embase, China National Knowledge Infrastructure, VIP, SinoMed and Wanfang databases will be searched from inception to January 2025, limited to English or Chinese publications. Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included, with outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration. Risk of bias will be assessed using RoB 2. Pairwise meta-analyses will be conducted in RevMan; network meta-analysis will employ Bayesian frameworks in GeMTC or R, incorporating consistency evaluation, node-splitting and surface under the cumulative ranking curve for treatment ranking. Subgroup analyses (haemorrhoid grade, follow-up duration), sensitivity analyses and publication bias assessments will be performed. Evidence certainty will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Confidence in Network Meta-Analysis (CINeMA) framework.

As only published data will be used, ethical approval is not required. Results will be disseminated via peer-reviewed publication and conference presentations.

CRD420251053697.

To examine Australian General Practitioners’ (GPs) confidence in initiating oral anticoagulants (OACs) for patients with atrial fibrillation (AF), and their practices for monitoring treatment adherence.

Cross-sectional online survey.

GPs practising in metropolitan, regional and rural/remote locations in Australia.

1765 Australian GPs recruited through professional GP networks.

GPs’ self-reported confidence initiating OACs; practices monitoring patient adherence and persistence; and perceived barriers to adherence. Demographic data including clinical experience and geographic location were collected. ² analyses were used to examine associations between the key outcome variables and GP location and clinical experience.

Of 1765 respondents, 83.1% had practised for >10 years and 27.6% worked in regional or rural/remote areas. Overall, only 50.2% reported high confidence initiating OACs in patients with CHA₂DS₂-VA score ≥2 (a cumulative stroke risk score with a score of 1 for: congestive heart failure, hypertension, diabetes, vascular disease and age 65-74 years and 2 for: stroke/transient ischaemic attack, age ≥ 75 years). Unsurprisingly, confidence was higher among GPs with >10 years experience (51.5%) compared with 5–10 years (44.9%) and

Only half of GPs reported high confidence initiating OAC treatment, and approximately a quarter do not routinely monitor medication adherence or persistence. Targeted strategies to improve confidence and align practices with guideline recommendations are required. Appropriate education should be developed targeting the specific issues underlying lack of confidence in initiating OAC and the practice of referring newly diagnosed patients to cardiology. Further research into implementing systems for monitoring and improving adherence and persistence would be worthwhile in the context of these findings.

Ethnic communities provide an appropriate setting for examining patterns of pregnancy and childbirth. Policy-making aimed at improving maternal health will be rendered ineffective in the absence of knowledge and comprehension of the traditions and beliefs associated with childbirth. The objective of this study was to cross-ethnically compare childbirth experiences.

This research used a cross-sectional methodology and was conducted in 2023. The sampling in the cities of Tabriz (Azeri), Sanandaj (Kurdish), Babol (Mazani), Khorramabad (Lur), Ahvaz (Arab) and Tehran (Fars) was conducted using the cluster random approach. The data collection instruments included questionnaires of sociodemographic and obstetric characteristics and childbirth experience (Childbirth Experience Questionnaire 2.0). In bivariate analysis, a one-way analysis of variance test was employed. In contrast, a general linear model (GLM) was used in multivariate analysis to adjust for the influence of sociodemographic and obstetric characteristics. The data were analysed using SPSS V.24 software. The p value less than 0.05 was considered significant.

Health centres in cities with different ethnic groups all over Iran.

For this purpose, 1331 women from six ethnic groups who were referred to health centres were selected 4 to 6 weeks after giving vaginal birth.

The following are the mean (SD) scores (scoring range: 1–4) for the childbirth experiences of the participating women: Azeri 2.31 (0.32), Kurdish 2.14 (0.31), Fars 2.26 (0.42), Mazani 1.93 (0.38), Lur 2.14 (0.4) and Arab 2.06 (0.18). Results from GLM multivariate analysis showed that while Azeri (B: 0.25; 95% CI 0.16 to 0.35; p

Women of different Iranian ethnicities have varying childbirth experiences. Women of Azeri and Fars ethnic groups report higher satisfaction with childbirth than those of others. Mazeni women had the lowest mean scores for having a positive birth experience. To offer compassionate and effective treatment for their patients, healthcare providers must have a deep understanding of cultural diversity.

Emergency general surgery (EGS) decisions often occur under time pressure and with reduced patient involvement in comparison to the elective setting. Variation in decision-making in the field of EGS is partly attributable to patient and contextual factors, but clinician factors also likely shape decisions.

This scoping review aims to clarify which clinician factors have been investigated in relation to decision-making in adult EGS, which have been identified as influential, and the methods used to measure them.

Any studies reporting on individual clinician factors and decision-making in EGS will be eligible. Studies must be only in adult populations (patients aged 18 and over). This review will consider quantitative, qualitative and mixed-methods study designs.

This scoping review will be conducted in accordance with the methodology developed by the Joanna Briggs Institute and reported in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This protocol was prospectively registered with the Open Science Framework: https://osf.io/xcqp4. We will search MEDLINE, EMBASE, CINAHL, CDSR and CENTRAL. The search strategy will be adapted for each database, and no time or language restrictions will be applied.

Two independent reviewers will screen studies for eligibility and extract data using a purpose-designed data extraction form, with disagreements resolved by a third reviewer. Extracted data will be synthesised using a narrative approach to map key concepts, describe study characteristics and identify gaps in the literature.

Ethical approval is not required as this review will use publicly available data. Findings will be disseminated through peer-reviewed publication and conference presentations.

Invasive arterial blood pressure monitoring is critical for perioperative and critically ill patients, yet traditional radial artery cannulation near the wrist joint is prone to catheter dysfunction (eg, kinking, occlusion) due to positional changes, compromising accuracy and patient safety. This trial hypothesises that modifying the cannulation site to 1.5–2.5 cm proximal to the radial styloid process may enhance catheter stability.

This is a prospective, parallel-group, randomised, controlled, analyst-blinded trial. A total of 486 participants (243 per group) will be enrolled at the Sixth Affiliated Hospital, Sun Yat-sen University. Eligible patients (18–75 years, American Society of Anesthesiologists physical status I–III, requiring elective surgery with radial artery cannulation) will be randomised 1:1 to the modified group (1.5–2.5 cm proximal to the radial styloid process) or the conventional group (traditional site). The primary outcome is the incidence of arterial catheter dysfunction (defined by criteria such as blood sampling difficulty, position-dependent waveform or improved waveform post-square wave test). Secondary outcomes include frequency of catheter dysfunction, damping abnormality rate, first-puncture success rate, number of arterial punctures, arterial cannulation time, complication incidence and blood pressure measurement differences.

This study protocol (V.4.0) was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University in Guangzhou, China on 2 September 2025. The first participant was recruited on 15 September 2025, with an estimated completion date of 31 December 2025. Informed consent will be obtained from all participants. Findings will be published in peer-reviewed journals.

NCT06566456.

Artificial intelligence (AI)-driven chatbots have been rapidly adopted across research, education, business, marketing and medicine. Most interactions, however, come from non-experts using chatbots like search engines, including for everyday health and medical queries.

We conducted an original study to audit chatbot responses in health and medical fields prone to misinformation.

Five popular chatbots were assessed: Gemini (Google), DeepSeek (High-Flyer), Meta AI (Meta), ChatGPT (OpenAI) and Grok (xAI). In February 2025, each chatbot was prompted with 10 questions from five categories: cancer, vaccines, stem cells, nutrition and athletic performance. We deployed an adversarial-like framework, using open- and closed-ended prompts designed to strain models toward misinformation or contraindicated advice. Two experts from each category rated responses as ‘non-problematic’, ‘somewhat problematic’ or ‘highly problematic’ using a coding matrix based on objective, predefined criteria. Citations were scored for accuracy and completeness, and each response was given a Flesch Reading Ease score.

Nearly half (49.6%) of responses were problematic: 30% somewhat problematic and 19.6% highly problematic. Response quality did not differ significantly among chatbots (p=0.566) but Grok generated significantly more highly problematic responses than would be expected under a random distribution (z-score +2.07, p=0.038). Performance was strongest in vaccines (mean z-score –2.57) and cancer (–2.12), and weakest in stem cells (+1.25), athletic performance (+3.74) and nutrition (+4.35). Chatbot outputs were consistently expressed with confidence and certainty; from 250 total questions, there were only two refusals to answer (0.8%), both from Meta AI. Reference quality was poor, with a median completeness score of 40% (Q1–Q3: 20–67%). Chatbot hallucinations and fabricated citations precluded any chatbot from producing a fully accurate reference list. All readability scores were graded as ‘Difficult’ (30–50), equivalent to college sophomore–senior level.

The audited chatbots performed poorly when answering questions in misinformation-prone health and medical fields. Continued deployment without public education and oversight risks amplifying misinformation.