Risk screening for pre-eclampsia relies on accurate gestational age assessment, but routine access to ultrasound-based gestational dating remains challenging in many low- and middle-income countries. As part of the formative work for the ‘Preventing pre-eclampsia: Evaluating AspiRin Low-dose regimens following risk Screening’ (PEARLS) platform, we aim to validate and implement an artificial intelligence (AI)-based algorithm for estimation of gestational age, using blind sweeps done with a handheld ultrasound device. This study protocol outlines the accuracy cohort for AI-based gestational age estimation in participating facilities in Ghana, Kenya and South Africa.

This multicountry prospective cohort study will recruit 969 pregnant women at 13 health facilities across Kenya, Ghana and South Africa. The eligible population is pregnant women presenting for antenatal visits from 11⁺⁰ to 13⁺⁶ weeks’ gestation. Eligible women will have a gestational age assessment by a trained sonographer using fetal biometry (reference standard), followed by gestational age estimation conducted by a trained midwife using the AI-based Intelligent Ultrasound ScanNav FetalCheck system (experimental). Both conventional and AI-based gestational age scans will be conducted with the General Electric VScan Air platform. Women will return for a second visit between 14⁺⁰ and 27⁺⁶ weeks’ gestation (week of visit is randomly selected) for an assessment with both conventional and AI-based ultrasound. The primary objective is to determine the accuracy and precision of gestational age estimation using an AI ultrasound system in first and second trimesters, as compared with gestational age estimation using crown-rump length measurement by conventional ultrasound in first trimester (11⁺⁰ to 13⁺⁶ weeks’).

This study has received or sought ethics approval from the following entities: Australia: University of Melbourne, Office of Research Ethics and Integrity (Reference Number: 2024–28489-49438-3) and the Alfred Hospital Ethics Committee (Reference: Project 727/23); Ghana: Ghana Health Service Ethics Review Committee (GHS-ERC Number 002/01/24); Kenya: Kenyatta National Hospital, University of Nairobi ERC (Ref: KNH-ERC/01/MISC/20); South Africa: University of Cape Town, Faculty of Health Science, Human Research Ethics Committee (HREC Ref: 138/2024). Key findings will be disseminated to research teams to inform future scale-up of AI-based pregnancy dating and pre-eclampsia risk screening. Findings from this pilot work will be published in peer-reviewed open-access journals, conferences and meetings to maximise reach of our findings.

To examine associations of overall, healthy and unhealthy low-carbohydrate diet (LCD) scores with all-cause mortality in general and chronic disease populations. Healthy and unhealthy subtypes were compared with assess whether the observed associations depend on macronutrient quality rather than carbohydrate restriction alone.

Systematic review and pairwise category meta-analysis.

PubMed, MEDLINE, ProQuest Medical Database and Web of Science Core Collection were searched from inception to 12 May 2026.

Prospective cohort studies of adults assessing LCD adherence using a validated three-macronutrient composite score and reporting HRs for all-cause mortality were eligible.

Two reviewers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale (NOS). Random-effects meta-analyses compared each higher reported LCD category with the lowest category, stratified by LCD score subtype and population type. Certainty of evidence was assessed using NutriGrade.

18 prospective cohort studies included 779 158 participants and 219 457 deaths; all scored 7–9/9 on the NOS. In chronic disease populations, the highest healthy LCD category was associated with lower mortality than the lowest category (HR 0.72, 95% CI 0.69 to 0.76; I²=0%; high certainty), as was the highest overall LCD category (HR 0.85, 95% CI 0.75 to 0.96; I²=68%; high certainty). In the general population, the highest healthy LCD category was not associated with lower mortality than the lowest category (HR 0.93, 95% CI 0.85 to 1.01; I²=69%; moderate certainty), and neither was the highest overall LCD category (HR 0.96, 95% CI 0.90 to 1.03; I²=87%; low certainty). Unhealthy LCD scores were not associated with mortality in either population.

Healthy LCD adherence was associated with lower all-cause mortality, particularly among individuals with chronic diseases. Unhealthy LCD scores were not associated with mortality in either population, suggesting that macronutrient quality and source may matter more than carbohydrate reduction alone.

Depression is a prevalent mental health condition often occurring after traumatic brain injury (TBI) in both children and adults. Sex, gender and other social determinants of health (SDoH) (e.g., race/ethnicity or socio-economic status) play an important role in depression-related and TBI-related healthcare utilisation (e.g., diagnosis, treatment and management of the conditions). Despite this, no reviews have examined how sex and gender, along with other SDoH, influence depression-related healthcare utilisation among individuals who sustained a TBI ≤19 years of age. The review’s objective will be to synthesise evidence on sex-based and/or gender-based findings, along with other SDoH, in depression-related healthcare utilisation among individuals who sustained a TBI ≤19 years of age.

Searches will be conducted on Ovid Medline, Embase, American Psychological Association PsycINFO and Cumulative Index of Nursing and Allied Health Literature from database inception to the search date. The review will follow the Joanna Briggs Institute evidence synthesis framework for knowledge synthesis and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)-P, PRISMA-Equity guidelines and PROGRESS-Plus for reporting results. Included studies will be peer-reviewed articles published in any language that examined individuals who sustained a TBI at ≤19 years of age, reported depression-related healthcare services and provided sex-stratified and/or gender-stratified results. Studies will be excluded if they were grey literature, included individuals who sustained a TBI at >19 years without age-stratified results, reported healthcare services for conditions other than depression without depression-specific stratification or did not provide sex-stratified or gender-stratified results. A narrative synthesis will be conducted to identify themes and attributes describing how sex, gender and other SDoH influence depression-related healthcare utilisation. Methodological quality will be assessed using the National Heart, Lung and Blood Institute Quality Assessment Tool.

No institutional ethics approval will be required as this study will not conduct primary data collection. The review will be disseminated as a peer-reviewed publication.

CRD420261301669.

This study aimed to evaluate the validity and reliability of the Postpartum Sleep Quality Scale (PSQS) for assessing sleep quality among postpartum women in Vietnam during the COVID-19 pandemic. The major hypothesis is that the PSQS will provide a reliable and valid measure of postpartum sleep disturbances and their correlation with mental health outcomes, particularly postpartum depression (PPD).

A cross-sectional, observational study was conducted from May to December 2023.

The study was carried out at a leading maternal healthcare centre in Vietnam, located in Hanoi, Vietnam.

A total of 223 postpartum women participated in the study, with inclusion criteria specifying women aged 18–45 years, who had delivered within the past 3 months, and were capable of completing the survey. Participants with severe psychiatric or neurological disorders or those experiencing postpartum complications affecting sleep were excluded.

The primary outcome was the psychometric evaluation of the PSQS, including internal consistency (Cronbach’s α), construct validity (through exploratory factor analysis) and concurrent validity (via correlation with the Edinburgh Postnatal Depression Scale and the Perinatal Infant Care Social Support Scale). Secondary outcomes included the relationship between sleep quality and PPD as well as the role of social support in moderating sleep disturbances.

Exploratory factor analysis identified a three-factor structure for the PSQS: (1) sleep efficiency and satisfaction, (2) sleep disruptions and infant-related disturbances and (3) postpartum sleep impairment and daytime fatigue. The PSQS demonstrated strong internal consistency (Cronbach’s α=0.839–0.875). Poor sleep quality was significantly correlated with higher PPD scores (r=0.6890, p

The PSQS is a reliable and valid tool for assessing postpartum sleep quality in Vietnamese women. Its multidimensional structure provides valuable insights into postpartum sleep disturbances. Enhancing social support may improve maternal sleep and mental health. Further research is needed to explore the long-term impact of sleep quality on postpartum recovery and mental well-being.

The DEVT and DIRECT-MT trials showed that endovascular thrombectomy (EVT) alone is non-inferior to intravenous thrombolysis (IVT) followed by EVT in achieving 90-day functional independence for stroke patients with large-vessel occlusion (LVO). However, it is unclear whether EVT alone is non-inferior to IVT followed by EVT among patients with acute basilar artery occlusion (BAO). Therefore, additional studies are needed to explore the potential benefits of EVT alone in these patients.

The ATTENTION IV trial is a prospective, multicentre, non-inferiority, blinded endpoint assessment, randomised controlled clinical trial to assess the effect of EVT alone compared with IVT plus EVT in acute BAO patients within 4.5 hours of symptom onset. Patients will be randomised in a 1:1 ratio to either the EVT-alone group or the IVT-plus-EVT group. A score of 0–2 on the 90-day modified Rankin Scale (mRS) was designated as the primary outcome for this study. Primary analysis will follow the intention-to-treat principle with a 15% non-inferiority margin. Secondary outcomes encompass functional status (mRS shift, excellent/good/fair outcomes), quality of life, early neurological recovery and radiological outcomes alongside safety endpoints of intracerebral haemorrhage and mortality.

This study has been approved by the Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (2023KY-055) and will be conducted following the Declaration of Helsinki. Study results will be published in peer-reviewed academic journals.

ClinicalTrials.gov (NCT05827042).

We recently showed that 65% of medical specialists’ guidelines in the context of chronic disease management in the Netherlands contain recommendations on lifestyle. However, it remains unclear how these recommendations are perceived and implemented in clinical practice.

To analyse (1) the level of implementation of these recommendations and (2) the knowledge, attitudes and needs to further facilitate the implementation of lifestyle recommendations in chronic disease management within specialist care from both patient and healthcare professional perspectives.

Mixed-methods cross-sectional study using two surveys.

Hospital care in the Netherlands.

Medical specialists affiliated with the Dutch Association of Medical Specialists (n=193) and patients who had visited a medical specialist within the previous 6 months, recruited via the Dutch Patient Federation (n=1057).

Lifestyle recommendations embedded in clinical practice guidelines for chronic disease management.

The level of implementation is assessed by the self-reported frequency of lifestyle discussions and familiarity with lifestyle recommendations in clinical practice guidelines.

Patients and medical specialists report different levels of implementation. While 72% of medical specialists reported discussing lifestyle topics during consultations, only 37% of patients recalled such discussions. Guideline familiarity among medical specialists was significantly associated with applying lifestyle advice in clinical practice (Fisher’s exact test, p=0.02). Both groups expressed positive attitudes toward addressing lifestyle as part of medical specialist care consultations. Although medical specialists considered the lifestyle recommendations applicable, they identified key factors for successful implementation, including the framing of recommendations, patient motivation and capacity to make lifestyle changes and the organisational and societal contexts in which lifestyle recommendations are delivered.

Although both medical specialists and patients recognise the importance of addressing lifestyle in healthcare, implementation in clinical practice can still be improved. Strengthening implementation requires institutions to allocate adequate resources to support these consultations, including protected time, targeted training and clearly defined referral pathways. Broader societal and political commitment, ensuring that prevention becomes a priority and shared responsibility across the healthcare ecosystem.

Primary liver cancers, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma, are one of the leading causes of cancer-related mortality. Transarterial chemoembolisation (TACE) and radioembolisation (TARE) are established palliative treatments yet they are traditionally performed during inpatient hospitalisation. Recent technical and organisational advances allow for safe same-day ambulatory procedures. In particular, the extent to which ambulatory intra-arterial therapy aligns with patients’ expectations, comfort and quality of life remains poorly documented. The Care pathway for Hepatic intra-arterial Oncology in an ambulatory Context study (CHOC) trial aims to evaluate the implementation and effectiveness from both patient-centred and clinical perspectives of an ambulatory care pathway for intra-arterial treatment of primary liver cancer in a multicentre randomised hybrid type 1 trial.

CHOC is a pragmatic, multicentre, randomised controlled hybrid type 1 trial comparing ambulatory versus conventional inpatient care for patients undergoing TACE or TARE for primary liver cancer. A total of 206 patients (103 per arm) will be randomised 1:1 and followed for 7 months. The primary outcome is the patient’s global satisfaction score, measured 3 days post-procedure using the EORTC PATSAT-C33 questionnaire. Secondary outcomes include quality of life, safety, clinical outcomes, cost analysis and an embedded qualitative implementation study assessing acceptability, adoption, feasibility and sustainability across centres. Economic analyses will estimate both per-patient costs and the 5-year budget impact for the French national health insurance.

The study has received ethical approval from the Protection of Persons Committee and adheres to the Declaration of Helsinki, good clinical practice and French regulatory requirements. Findings will be disseminated through peer-reviewed publications, conferences and participating centres to guide broader implementation of ambulatory interventional radiology care.

NCT06990659.

Unintentional weight loss is prevalent in advanced cancer and maintaining weight is critical to improve clinical outcomes. Body image plays a significant role in how weight loss is perceived. A previous Swedish study showed that men with advanced cancer had a negative perception of cancer-induced weight loss whereas women perceived the weight loss more positively.

The aim of the GRACE study (Global Research on Appearance in Cancer) is to study gender differences in the perception of body image during cancer-induced weight loss. Second, we aim to explore cross-country differences in perceptions of body image.

This is a study protocol for a multi-centre, cross-sectional study across six countries (Sweden, Chile, New Zealand, Switzerland, the United States and Vietnam) spanning five continents. We aim to recruit 50 women and 50 men with advanced cancer from each country, targeting 600 people in total. Data will be collected through a structured digital questionnaire covering perceived body image measured with the Body Image Scale (BIS), demographics, anthropometrics, weight history, disease-related symptoms and dietary intake. Data collection started in 2025. Patients are enrolled at each site following ethical approval. The primary endpoint is difference in BIS-score between men and women. A difference of 3 BIS points between groups will be considered clinically significant. For statistical analysis, multivariable linear regression will be used, including country as a fixed effect to account for between-country differences. We will also perform secondary, exploratory analyses examining between-country variation in the gender difference in BIS.

Ethical approval has been obtained from all of the participating countries. Results will be disseminated through peer-reviewed publications and conference presentations.

ClinicalTrials.gov (NCT07195448).

Shared decision making (SDM) in healthcare is an ethical imperative and essential to patient-centred care. SDM is particularly useful when several preference-sensitive treatment options exist and in the setting of chronic conditions or longitudinal management. Chronic pain management embodies these characteristics, yet SDM often remains insufficient in this population. Decision aids are designed to facilitate SDM by helping patients and clinicians understand treatment options, clarify patient values, and guide collaborative decision processes. Despite their importance, the use of decision aids in pain management is inconsistent and their reported effectiveness has been variable. However, the current landscape of decision aids for pain management has not been described. This lack of understanding of what tools exist, how they are structured, what decisions they address and how they were developed makes it difficult to advance implementation efforts or identify meaningful gaps in available resources. As such, the purpose of this systematic review is to identify and characterise decision aids for pain management across the lifespan. Specifically, this review will describe the clinical decisions addressed, decision aid structures and delivery formats, development processes and outcomes used to evaluate the impact of existing decision aids.

Electronic searches were performed in PubMed, CINAHL and Ovid Embase from inception through January 2026. Studies will be assessed for quality using the Mixed Methods Appraisal Tool. Data will be extracted and presented with the aim of describing the: (a) content and structures of pain-related decision aids, (b) development processes used to create existing pain-related decision aids and (c) outcome measures used to evaluate the impact of decision aids in clinical care.

This review does not require ethics approval. Findings will be disseminated to clinicians, researchers and patients through journal publications, conference presentations and in collaboration with patient partners.

CRD420251085288

Children born extremely preterm (EP;

This is a follow-up of the VICS 2016–2017 cohort, a prospective longitudinal cohort study of children born EP/ELBW and a contemporaneous group of term-born controls born in the state of Victoria, Australia. Children were previously assessed at 2 years’ corrected age.

Follow-up at 8–9 years’ corrected age includes a comprehensive assessment of cognitive, motor, social and behavioural development and lung function.

Follow-up at 8–9 years’ corrected age includes a comprehensive assessment of cognitive, motor, social and behavioural development and lung function.

The study has approval from the Royal Children’s Hospital Human Research Ethics Committee, Melbourne, Australia. The findings will be disseminated via peer-reviewed journal publications, conference presentations, digital and print media and through parent support/network groups.

Adolescent pregnancy remains a significant public health and social challenge in sub-Saharan Africa, including Tanzania. The study aimed to explore contextual reasons and determinants of adolescent pregnancy among girls using a mixed-methods approach.

A convergent mixed-methods study integrating a community-based cross-sectional survey with qualitative in-depth interviews and focus group discussions. Quantitative and qualitative data were analysed separately and integrated during interpretation using triangulation and comparative joint analysis.

Community-based study conducted in Korogwe District, Tanga Region, northeastern Tanzania.

A total of 418 adolescent girls aged 15–19 years were selected through multistage sampling for the quantitative survey. The qualitative component purposively recruited pregnant and parenting adolescents, parents/guardians and community stakeholders.

The primary outcome was adolescent pregnancy, defined as ever having been pregnant, including current pregnancy. Secondary variables included sociodemographic, educational, economic, relational and contraceptive factors associated with adolescent pregnancy.

The prevalence of adolescent pregnancy in Korogwe District was 16%. In multivariable analysis, older age (18–19 years), school discontinuation, marital union and economic vulnerability were independently associated with adolescent pregnancy. Current contraceptive use was more commonly reported among adolescents who had experienced pregnancy, a finding likely reflecting post pregnancy uptake rather than a protective effect, given the cross-sectional design. Qualitative findings revealed that poverty, transactional relationships, early unions, gendered power imbalances and misconceptions about contraception constrained adolescents’ reproductive autonomy. Integrated analysis demonstrated convergence between statistical associations and lived experiences, showing that economic precarity and educational limitations operated as structural pathways influencing early union formation and limiting contraceptive decision making.

Adolescent pregnancy among girls aged 15–19 years in Korogwe District is shaped by interrelated socioeconomic, educational and gendered factors. The identified factors and contextual reasons suggest that adolescent pregnancy is a socially patterned outcome rather than solely an individual behavioural issue. Multisectoral interventions addressing school retention, economic insecurity and gender power relations are essential to reduce vulnerability.

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