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Gram negative bloodstream infections (GN BSI) are a leading cause of mortality worldwide, and antibiotic treatment approaches remain understudied. BALANCE+ is a perpetual Bayesian adaptive platform trial to test multiple treatment questions for hospitalised patients with GN BSI. The vanguard phase objective was to test the feasibility of the main trial.
Adaptive platform trial with five initial domains of investigation, each with open label 1:1 randomisation.
Ten hospitals across four Canadian provinces.
Individuals admitted to hospital with blood cultures yielding Gram negative bacteria.
The five initial domains of investigation included: antibiotic de-escalation versus no de-escalation; oral transition to beta-lactam versus non-beta-lactam treatment; routine versus no routine follow-up blood cultures (FUBCs); central vascular catheter replacement versus retention; and, ceftriaxone versus carbapenem treatment for low risk AmpC organisms.
Domain-specific recruitment rates and protocol adherence.
During the vanguard phase, 719 patients were screened, of whom 563 (78.3%) were eligible, with 179 (31.8%) enrolled into the platform. The platform recruitment rate was 1.37 patients/site-week. Recruitment varied by domain: routine versus no FUBC domain 1.23 patients/site-week; oral beta-lactam versus non-beta-lactam domain 0.48; de-escalation versus no de-escalation domain 0.28; low risk AmpC domain 0.02; catheter replacement versus retention domain 0.01. Domain specific protocol adherence rates were 145/158 (91.8%) for routine versus no routine FUBC, 53/60 (88.3%) for oral beta-lactam versus non-beta-lactam, 26/33 (78.8%) for de-escalation versus no de-escalation, 3/3 (100%) for low risk AmpC, and 0/1 (0%) for line replacement versus retention. There was complete ascertainment of all study outcomes in hospital 170/170 (100%) and near complete ascertainment at 90 days 162/170 (95.3%).
The vanguard phase demonstrated overall trial feasibility by recruitment rate and protocol adherence, with differences across interventions, leading to a transition to the main BALANCE+ platform trial with minimal protocol modifications.
Ebola disease stigma hinders outbreak control and recovery by deterring care-seeking and driving social exclusion. Although this phenomenon is well recognised, gaps remain in understanding how stigma emerges and operates in outbreak settings, limiting the development of effective reduction strategies. The objective of this study was to examine the drivers, manifestations and public health impacts of stigma following the 2022–2023 Sudan ebolavirus outbreak in central Uganda.
We conducted a cross-sectional, mixed-methods survey to assess Ebola disease stigma in June 2024.
The study was conducted in the Ugandan districts of Mubende, Kassanda and Kyegegwa, which were heavily affected by the outbreak.
A total of 302 respondents completed the survey. Respondents included all 51 eligible adult Ebola survivors in the districts known to the research team, as well as household members, healthcare workers, outbreak support staff and the general public.
The interviewer-administered survey explored personal experiences of stigma, community attitudes and impacts on outbreak control. We used a pillar integration process to identify themes across quantitative and qualitative data in three domains (drivers, manifestations and impacts of stigma).
Participants identified several perceived drivers of stigma, including fear, hygiene-focused public health messaging, distrust in public services and criminal connotations inferred from the outbreak response. Manifestations, including self-stigma and associative stigma, endured beyond the outbreak and across contexts. Nearly all survivors interviewed (n=48, 94%) reported multiple experiences of stigmatisation since discharge, with almost half (n=25, 49%) reporting physical harm or threats. Stigma was reported to affect care-seeking, healthcare worker morale and community socioeconomic well-being.
Stigma remains a major barrier to Ebola disease outbreak control and recovery. The high levels of stigma reported by survivors and anticipated by community members highlight the urgent need for targeted interventions in future outbreaks. We specifically show there are opportunities to address misinformation, avoid criminal connotations in outbreak control efforts and enable peer support.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
Interprofessional co-debriefing, whereby facilitators from different healthcare professional backgrounds jointly facilitate debriefings, is increasingly common in simulation-based education. This approach can enhance learning by incorporating diverse perspectives and distributing cognitive workload, but it may also expose tensions linked to professional identity, hierarchy and power dynamics between debriefers. While learner outcomes and debriefing strategies in general are well studied, little is known about faculty experiences of interprofessional co-debriefing or how sociocultural factors influence this practice. Addressing this gap is crucial to optimise faculty development and support effective interprofessional education. This study will qualitatively explore the experiences and perceptions of simulation educators engaged in interprofessional co-debriefing, with a focus on the influence of sociocultural factors on their practice.
This UK-based qualitative study will recruit up to 30 healthcare simulation educators with experience of interprofessional co-debriefing. Participants will be purposively sampled from simulation networks, centres and academic institutions, with snowball sampling to broaden reach. Semistructured interviews will be conducted online via Microsoft Teams, guided by a topic framework developed by the research team. Interviews will be audio-recorded, transcribed verbatim and anonymised. Underpinned by constructivist and constructionist paradigms, data will be analysed using reflexive thematic analysis following Braun and Clarke’s six-phase approach. Three researchers will independently code transcripts, with themes refined through iterative team discussions to ensure rigour and transparency.
Ethical approval has been granted by the University of Glasgow School of Medical and Life Sciences Ethics Committee (Ref No: 200240285). All participants will provide informed written consent, and data will be handled in accordance with data protection regulations. Findings will be disseminated via peer-reviewed publications, conference presentations and professional networks, with a summary provided to participants. This study will offer novel insights into the underexplored area of interprofessional co-debriefing, specifically how sociocultural dynamics may influence and shape practice, potentially informing faculty development and best practice moving forward.
To examine the extent of adherence to high-level principles in remote prescribing and investigate how medical and non-medical prescribers comply with these principles.
Scoping Review.
A systematic search of CINAHL, PubMed, Medline, the Cochrane Database of Systematic Reviews, the Web of Science, and the Ovid Emcare databases was performed. A grey literature search was conducted on relevant professional websites and Google Scholar. Literature was searched from January 2007 to March 2025.
Research results were uploaded to Raayan for management and selection of evidence. Two reviewers independently scored and appraised papers using a structured data extraction form. The ‘United Kingdom High-level Principles for Good Practice in Remote Consultations and Prescribing’ served as a coding framework for deductive manifest content analysis.
Searches identified 6870 studies. After screening the title and abstract, 54 full texts were reviewed, and 14 studies were identified for analysis. Adherence to high-level principles was limited and inconsistent. Data categories were developed into 5 themes: (1) Patient privacy and vulnerability, (2) Adequate assessment, (3) Guidelines and evidence-based prescribing, (4) Investigations and safety netting, and (5) Organisational safety and creating safe systems.
This review provided insight into the challenges that medical prescribers face when adhering to governance principles during remote prescribing practice. However, no research about how non-medical prescribers integrate remote prescribing governance into their practice was found.
Remote prescribing has become firmly embedded within the current healthcare system and robust governance is required to safeguard patient outcomes. Further research exploring how non-medical prescribers integrate the high-level principles into practice will inform prescribing governance for this group.
No patient or public contribution was sought as the scoping review focused solely on the existing literature.
Our aim is to develop a Framework of Measurement for people living with Long COVID and their caregivers for use in Long COVID research and clinical practice. Specifically, we will characterise evidence pertaining to outcome measurement and identify implementation considerations for use of outcome measures among adults and children living with Long COVID and their caregivers.
We will conduct a scoping study involving: (1) an evidence review and (2) a two-phased consultation, using methodological steps outlined by the Arksey and O’Malley Framework and Joanna Briggs Institute. We will answer the following question: What is known about outcome measures used to describe, evaluate or predict health outcomes among adults and children living with Long COVID and their caregivers? Evidence review: we will review peer review published and grey literature to identify existing outcome measures and their reported measurement properties with people living with Long COVID and their caregivers. We will search databases including MEDLINE, Embase, CINAHL, PsycINFO and Scopus for articles published since 2020. Two authors will independently review titles and abstracts, followed by full text to select articles that discuss or use outcome measures for Long COVID health outcomes, pertain to adults or children living with Long COVID and/or their caregivers and are based in research or clinical settings. We will extract data including article characteristics, terminology and definition of Long COVID, health outcomes assessed, characteristics of outcome measures, measurement properties and implementation considerations. We will collate and summarise data to establish a preliminary Framework of Measurement. Consultation phase 1: we will conduct an environmental scan involving a cross-sectional web-based questionnaire among individuals with experience using or completing outcome measures for Long COVID, to identify outcome measures not found in the evidence review and explore implementation considerations for outcome measurement in the context of Long COVID. Consultation phase 2: we will conduct focus groups to review the preliminary Framework of Measurement and to highlight implementation considerations for outcome measurement in Long COVID. We will analyse questionnaire and focus group data using descriptive and content analytical approaches. We will refine the Framework of Measurement based on the focus group consultation using community-engaged approaches with the research team.
Protocol approved by the University of Toronto Health Sciences Research Ethics Board (protocol #46503) for the consultation phases of the study. Outcomes will include a Framework of Measurement, to enhance measurement of health outcomes in Long COVID research and clinical practice. Knowledge translation will also occur in the form of publications and presentations.
FreshRSS 