Conectar
Walk-and-talk therapy integrates psychological support and physical activity conducted in outdoor environments, and has potential to better align with men’s preferences and masculine norms around emotional communication. Conventional indoor psychotherapy is effective for treating depression but can be less engaging for men, leading to less satisfaction and high rates of dropout. This trial aims to determine whether walk-and-talk therapy offers men with depressive symptoms clinically meaningful benefits over conventional indoor therapy.
This assessor-blinded, parallel group randomised controlled trial is comparing the efficacy of walk-and-talk therapy to conventional indoor therapy for men with depressive symptoms. After randomisation, all participants receive 10 fortnightly 1-hour individual psychotherapy sessions over 20 weeks as either: (1) conventional indoor therapy (sitting down indoors) or (2) walk-and-talk therapy (walking outdoors). Participants are assessed at ‘pre-intervention’ (baseline), ‘post-intervention’ (5 months post baseline) and ‘follow-up’ (12 months post baseline) time points. The primary outcome is change in overall psychological distress (21-item version of the Depression, Anxiety and Stress Scale (DASS-21)) at post-intervention. Secondary outcomes include male-type depression symptoms, mental well-being, suicidal ideation and quality of life. Costing data is being collected for cost-effectiveness analysis. Linear mixed models will be used to examine the impact of group (conventional indoor vs walk-and-talk), time (baseline, 5-month and 12-month) and the group-by-time interaction for primary and secondary outcomes.
This study is approved by the University of Newcastle Human Research Ethics Committee (H-2024-0090). Results will be published in an open access peer-reviewed journal and disseminated through conference presentations.
ACTRN12624000794505.
To identify and describe the medication information needs and preferences of caregivers of children with cancer, and the factors that support or impede those needs being met.
Qualitative descriptive study guided by reflexive thematic analysis.
Between November 2024 and July 2025, semi-structured interviews were conducted with 13 caregivers purposively recruited from a tertiary paediatric oncology centre in Australia. Data collection and analysis proceeded concurrently using reflexive thematic analysis.
Caregivers described receiving supportive medication information, yet their information needs persisted as responsibility for medication management shifted to families. Needs reflected the practical, emotional, and cognitive demands of translating clinical instructions into safe home-based care. Caregivers relied on visual tools, written schedules, and trusted clinicians to support medication management. High satisfaction with medication information coexisted with vigilance and uncertainty, highlighting a gap between information provision and the realities of home-based medication management.
Medication information needs in paediatric oncology are dynamic and linked to the transfer of responsibility to families. Phased, system-integrated approaches that support caregivers during care transitions and treatment are required.
Reconceptualising medication information as an iterative process rather than a discrete event is recommended. Transition support, decision aids, and standardised visual medication tools may reduce cognitive burden and enhance medication safety.
This study addresses the gap between providing medication information and how caregivers manage complex home-based regimens. Unmet needs stem from the demands of medication administration during care transitions and when managing ‘as required’ medicines. Findings offer practical insights for paediatric oncology nurses, pharmacists, and policymakers designing transition processes and medication safety strategies in family-managed cancer care.
Consolidated Criteria for Reporting Qualitative Research 32-item checklist.
Caregivers reviewed the interview guide prior to interviews and were invited to provide feedback; no changes were required.
by Hirotaka Eguchi, Kiyohito Hosokawa, Ryota Kawano, Yukinori Takenaka, Hiroshi Kato, Toshihiro Kishikawa, Masami Suzuki, Motoyuki Suzuki, Takeshi Tsuda, Ryohei Oya, Hidenori Inohara
BackgroundReduced skeletal muscle mass may impair outcomes of immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma. We evaluated whether temporal muscle thickness (TMT) on routine head computed tomography was associated with treatment response and survival.
MethodsWe retrospectively analyzed 109 patients treated with nivolumab or pembrolizumab between 2017 and 2023 (89 men [81.7%], 20 women [18.3%]; median age 69 years [range 21–88]). TMT was measured on CT images at the level where the Sylvian fissure was most clearly visualized, perpendicular to the temporalis muscle long axis, on both sides, and the mean of the bilateral values was used. Sex-specific cutoffs were defined by time-dependent receiver operating characteristic analysis for 12-month overall survival (5.53 mm for men; 3.92 mm for women). Associations with objective response and survival were assessed using logistic regression and Cox proportional hazards models.
ResultsObjective response was evaluable in 105 patients (complete response 12, partial response 30, stable disease 18, progressive disease 45), yielding a response rate of 40.0% and a disease control rate of 57.1%. High temporal muscle thickness was associated with response (univariable odds ratio 2.64, 95% confidence interval 1.18–5.90; p = 0.018) and remained significant after adjustment for chemotherapy (adjusted odds ratio 2.42, 95% confidence interval 1.05–5.58; p = 0.038). One-year progression-free survival was 36.5% in the high group versus 15.8% in the low group (absolute difference 20.7%; p = 0.010; adjusted hazard ratio 0.57, 95% confidence interval 0.36–0.90; p = 0.017). One-year overall survival was 73.1% versus 47.4% (absolute difference 25.7%; p = 0.001; adjusted hazard ratio 0.54, 95% confidence interval 0.34–0.86; p = 0.010).
ConclusionTemporal muscle thickness, obtainable from routine head computed tomography, was independently associated with response and survival in patients receiving immune checkpoint inhibitors and may serve as a practical host-related imaging marker for prognostic risk stratification.
by Dan Kambayashi, Shota Suzuki, Masayoshi Hirohara
BackgroundPharmacists are expanding their participation in veterinary healthcare teams and assuming roles beyond traditional dispensing duties. However, the scope of these collaborative practices and the degree of mutual recognition vary substantially across regions.
ObjectivesThis scoping review aimed to organize the existing literature on collaboration between veterinarians and pharmacists, clarifying current roles, practical applications, and professional perceptions within the veterinary field.
MethodsA scoping review was conducted to examine the roles, practices, and perceptions associated with veterinarian–pharmacist collaboration in veterinary medicine and related fields. Two researchers independently searched PubMed, Web of Science, the Cochrane Library, and Ichushi-Web, and additionally screened Google Scholar to identify gray literature (from database inception to August 2025, in English or Japanese). Records were independently screened at the title/abstract and full-text levels using predefined eligibility criteria, and relevant studies were identified.
ResultsThe search yielded 239 records, of which 16 studies published between 2007 and 2024 were included. Studies were conducted primarily in the United States (n = 7), New Zealand (n = 3), and Japan (n = 3); one study collected data from both Japan and Taiwan. Most studies employed cross-sectional survey designs. Pharmacist roles most frequently involved compounding and dispensing for animal patients (62.5%), followed by drug information (DI) and consultation (37.5%), inventory and supply management (25.0%), client education (18.8%), and safety and exposure control (12.5%).
ConclusionsThis scoping review demonstrates that veterinarian–pharmacist collaboration is described within a limited and regionally variable evidence base, with pharmacists most often contributing through compounding/dispensing and drug information support. Sustained and scalable implementation will require improved mutual understanding of professional roles, strengthened veterinary-specific education for pharmacists, and more robust empirical research to inform collaborative practice models.
To estimate the cost-effectiveness of immediate septoplasty compared with 6 months of medical management with the option for delayed septoplasty in individuals with nasal obstruction associated with septal deviation.
Economic evaluation alongside a multicentre, open label, randomised controlled trial.
17 otolaryngology clinics in the UK, recruiting from January 2018 to December 2019.
Adults aged≥18 years with symptoms of nasal obstruction associated with septal deviation with at least moderate symptoms of nasal obstruction (score>30 on the Nasal Obstruction and Symptom Evaluation scale).
Participants were randomised to receive either septoplasty within 12 weeks of recruitment or 6 months of medical management (nasal steroid and saline spray) with the option for delayed septoplasty.
Incremental cost per quality-adjusted life year (QALY) gained at 12 months. A UK National Health Service perspective was adopted, and surgery costs were estimated using a tariff and micro-costing. QALYs were estimated based on responses to the Short Form-36 (SF-36). Seemingly unrelated regression was used to estimate incremental costs and QALYs. A model-based analysis was used to extrapolate costs and effects to 24 months. Sensitivity analyses were used to illustrate uncertainty.
In the within-trial analysis, immediate septoplasty was on average more costly (mean difference (95% CI) £1193 (£1018 to £1368)) and more effective (mean difference (95% CI) 0.044 QALYs (0.03 to 0.06)) when compared with 6 months of medical management with the option for deferred septoplasty. Immediate septoplasty had an incremental cost per QALY gained of £27 114 in the base case analysis, which decreased to £16 682 when micro-costing was used to estimate surgery costs. Immediate septoplasty had a 15% and 78% probability of being considered cost-effective at a £20 000 threshold for an additional QALY, respectively. In the model-based analysis, immediate septoplasty remained more costly and more effective than 6 months of medical management with the option for deferred septoplasty but had a 99% probability of being considered cost-effective at a £20 000 threshold for an additional QALY.
Over a 24-month time horizon, immediate septoplasty would be cost-effective in the management of deviated nasal septum.
by Md. Jawadul Haque, A. K. M. Kamruzzaman, Rajendra Bohara, Chiranjit Das, Md. Tarjumanul Haque Sanij, Abul Fazal Md. Shahabuddin Khan, F. A. M. Anjuman Ara Begum, Nazim Uzzaman
IntroductionElectronic Immunization Registries (EIRs) are increasingly being implemented in low- and middle-income countries (LMICs) to support immunization tracking and data management. In Bangladesh, an EIR was introduced in Rajshahi City Corporation (RCC) to strengthen routine immunization services. However, evidence on user perceptions and operational implementation in this context remains limited. We assessed perceptions related to the feasibility and acceptability of the EIR among caregivers and healthcare providers (HCPs) in an urban pilot setting.
MethodsWe conducted a cross-sectional study between July and September 2024 in RCC, Bangladesh. Data were collected from caregivers of children receiving vaccinations and HCPs involved in immunization service delivery using a pretested semi-structured questionnaire. Perceptions of EIR-supported services were assessed using a 5-point Likert scale. Responses to open-ended questions were reviewed and summarized descriptively. This study was designed as a descriptive assessment and was not intended to evaluate the effectiveness or causal impact of the EIR system.
ResultsA total of 321 participants were included, comprising 305 caregivers and 16 HCPs. Electronic registration was conducted primarily at the Expanded Program on Immunization centers (87%), with additional outreach through house-to-house visits. Reported vaccination uptake among children registered in the EIR system was high within the study sample. Caregivers and HCPs reported generally positive perceptions of EIR-supported services. Most respondents selected ‘satisfied’ or ‘highly satisfied’ responses across assessed items. HCPs also reported positive experiences, particularly in relation to record management and data accessibility, while noting operational challenges such as intermittent internet connectivity and device-related limitations.
ConclusionsThe EIR was perceived as acceptable by caregivers and HCPs in this urban pilot setting. Further studies are needed to assess effectiveness, implementation challenges, and scalability across diverse settings.
Aboriginal women in the remote Northern Territory (NT) experience high rates of adverse pregnancy outcomes related to hyperglycaemia in pregnancy. Oral glucose tolerance test (OGTT) screening was recommended in early pregnancy but barriers to uptake exist.
To examine uptake of screening for hyperglycaemia in pregnancy among Aboriginal women in remote NT communities and explore adverse pregnancy outcome rates among women who did not have early OGTT screening compared with women who did undergo screening in early pregnancy and those with pre-existing diabetes.
Retrospective observational cohort study of pregnancies among Aboriginal women in remote NT clinics from January 2017 to December 2019. Screening for hyperglycaemia in pregnancy included having an early OGTT (
Among 1191 pregnancies in 52 remote communities, pre-existing type 2 diabetes (T2D) was diagnosed in 6.4% (n=76) and gestational diabetes mellitus (GDM) was diagnosed in 13% (154/1191). Excluding women with pre-existing diabetes, 226 (20%) had an early OGTT. Guideline-directed screening (with either (a) an early OGTT diagnosing GDM or (b) a negative early OGTT followed by a routine OGTT) occurred in 14% of pregnancies (n=158). Compared with women who had an early pregnancy OGTT, the combined adverse pregnancy outcome was more common among women with pre-existing T2D (89% vs 54%, adjusted OR 6.06 (95% CI 2.75 to 13.35)) and similar among women who did not undergo early OGTT (50%, adjusted OR 0.97 (95% CI 0.71 to 1.32)).
Uptake of guideline-directed screening in Aboriginal women in remote NT was low, although there was no difference in pregnancy outcomes for women who were and were not screened with an early OGTT. Rates of adverse pregnancy outcomes were concerningly high in women with pre-existing T2D, highlighting a need to strengthen diabetes care for these women.
Simulation-based interprofessional education (Sim-IPE) enables health professions students to collaborate in a realistic, safe, simulated clinical environment. Debriefing is a critical component of simulation, facilitating reflective learning and improvement in team performance. Instructor-led (IL) debriefing is considered the gold standard but is resource-intensive and may not be feasible in settings with limited faculty availability. Peer-led (PL) debriefing offers a potentially cost-effective alternative; however, its impact on debriefing quality, interprofessional competencies and professional identity in Sim-IPE remains underexplored. This study aims to compare PL and IL debriefing in terms of perceived quality and impact on interprofessional outcomes.
This manuscript reports a prospectively registered protocol for a single-centre, parallel-group, non-inferiority randomised controlled trial to be conducted at Qatar University Simulation Centre (Tamayuz). The trial consists of two arms: an IL debriefing arm (control) and a PL debriefing arm (intervention). A total of 120 students will undergo a comprehensive simulation experience, including pre-briefing and simulation, followed by random assignment to one of the debriefing arms. Outcome measures will include the Debriefing Assessment for Simulation in Healthcare Scale, Satisfaction with Simulation Experience tool, Modified McMaster Ottawa Scale for Teams and Extended Professional Identity Scale. At the time of the original submission, participant recruitment had not yet commenced.
This study was approved by the Institutional Review Board of Qatar University (QU-IRB 237/2025-EA). All participants in this study will provide informed consent prior to participation in the study. Findings of this study will be submitted to peer-reviewed journals and may be presented at conferences.
This study is prospectively registered on the International Standard Randomised Controlled Trial Number registry, a recognised clinical trial registry, prior to participant enrolment.
Early open fracture management aims to minimise the risk of complications. For the most severe open fracture wounds, multiple irrigation and debridement surgeries are required to overcome severe wound contamination, to reassess the evolving tissue injury or to temporise and plan further surgery. When multiple irrigation and debridement surgeries are needed, uncertainty remains about how the open fracture wound should be managed to best minimise complications. The primary aim of this trial is to compare the antibiotic cement bead pouch vs negative pressure wound therapy in the management of patients with severe open tibia fracture wounds.
BvV is a multicentre, pragmatic, parallel arm randomised controlled trial that aims to enrol 312 adult patients admitted to a participating centre with a severe open tibia fracture requiring multiple irrigation and debridement surgeries. Participants will be randomly allocated on a 1:1 basis to either antibiotic cement bead pouch or negative pressure wound therapy. The primary outcome will be a composite outcome to evaluate clinical status 6 months after randomisation. Using the win ratio approach, we will hierarchically assess the composite outcome in the following order: (i) all-cause mortality, (ii) injury-related amputation of the lower extremity, (iii) unplanned reoperation to manage wound complications, an infection or promote fracture healing and (iv) clinical fracture healing assessed using the Functional IndeX for Trauma (FIX-IT) instrument.
The BvV trial has been approved by a central institutional review board (IRB) (Advarra) for clinical sites in the USA, the ethics board at the coordinating centre at McMaster University (Hamilton Integrated Research Ethics Board), and participating sites not using the central institutional IRB (Fraser Health Research Ethics Board, The University of British Columbia Clinical Research Ethics Board, Newfoundland and Labrador Health Research Ethics Board, University of Manitoba Biomedical Research Ethics Board). Additional clinical sites who are in the start-up phase, as well as any new selected clinical sites, will obtain local approvals prior to initiating trial activities. This will include a clinical site in the UK who is in the process of obtaining the necessary approvals. Recruitment began in November 2023. Both interventions are frequently used to manage severe open fracture wounds, ensuring that the trial results can be easily transitioned into clinical practice. The results of this trial will be disseminated to national and international partners through peer-reviewed publications, academic conferences and stakeholder engagement activities.
by Azusa Kubota, Kentaro Kojima, Shinnosuke Koketsu, Takayuki Kannon, Takehiro Sato, Kazuyoshi Hosomichi, Yoshiaki Shinohara, Atsushi Tajima
Brain asymmetry is a fundamental feature of neural organization. However, the molecular basis of hippocampal lateralization in response to environmental stimuli remains poorly understood. Here, we examined the transcriptomic profiles of the left and right hippocampal CA1 regions in rats reared under isolated or enriched housing conditions to elucidate hemisphere-specific responses and shared molecular adaptations. RNA-sequencing analysis revealed lateralized differences in the number and identity of differentially expressed genes, accompanied by distinct biological themes, as indicated by overrepresentation and gene set enrichment analysis. The left CA1 region was prominently engaged in pathways related to synaptic organization and mitochondrial function, whereas the right CA1 region exhibited enrichment in transcriptional regulation and RNA metabolic processes. Despite these asymmetries, co-expression and protein–protein interaction network analyses revealed shared molecular architectures. Immediate early genes formed consistent central hubs across both hemispheres, and a common Mecp2–Grin2b–Cdkl5–Tet3 protein interaction cluster was identified as a potential integrative regulatory module. Additional enrichment analysis of differentially expressed genes shared between hemispheres further highlighted conserved responses, particularly in synaptic plasticity and cell–cell communication. Together, these findings demonstrate that the left and right CA1 regions employ distinct yet partially convergent transcriptional programs to adapt to environmental stimuli. This coordinated molecular asymmetry provides novel insights into hippocampal lateralization and its role in experience-dependent brain plasticity.
FreshRSS 