Pancreatic cancer is diagnosed in approximately 1% of individuals with new-onset diabetes, increasing to 3% among those aged ≥60 years with weight loss. UK clinical guidelines recommend abdominal imaging to rule out pancreatic cancer in this high-risk group. In June 2025, National Health Service (NHS) England launched a case-finding pilot to test approaches to improve primary care referrals for imaging in these patients and improve the quality of body weight and diabetes-related data recorded in electronic healthcare records (EHRs). This study reports referral and imaging rates among the eligible group and the availability of body weight and glycated haemoglobin (HbA1c) measurements in people with diabetes, providing baseline data prior to implementation of the NHS England pilot.

Retrospective cohort study.

Primary care. The database of 8 million patients from 781 general practices from the Royal College of General Practitioners Research and Surveillance Centre.

Adults diagnosed with diabetes between 2015 and 2021.

Proportions of eligible individuals who received a referral and imaging within 12 months before or after diabetes diagnosis and the number of body weight and HbA1c measurements recorded for individuals with diabetes.

Among 180 815 individuals diagnosed with diabetes, 92 210 (51.0%) were aged ≥60 years (median age 71, 46% women). Overall, 152 300 (84.2%) had at least one body weight and 161 631 (89.4%) had at least one HbA1c measurement recorded in EHRs. Among the 1411 patients with new-onset diabetes and weight loss, 372 (26.4%) had a referral, 141 (10.0%) imaging and 40 (2.8%) had pancreatic cancer recorded.

This study demonstrated potential underutilisation of referral guidance and under-referral among the eligible population. The findings provide baseline data to support the launch of the NHS England pilot. Further research is needed to better understand current practice and support the implementation of cancer referral guidelines.

Calls to compensate patient partners for contributions to the health sector are increasing. The BMJ invites patients and the public (P&P) to review manuscripts alongside academic reviewers and recently introduced remuneration. We surveyed P&P reviewers to capture perspectives on remuneration and overall reviewing experience.

Two cross-sectional surveys administered via SurveyMonkey to P&P reviewers for The BMJ journal.

To capture views from those familiar with reviewing for The BMJ and views from those less familiar, we conducted two surveys. Survey 1 was sent to 267 reviewers who had completed a review in the past 3 years. Survey 2 was sent to 493 reviewers who had been invited to review but not completed a review within the past 3 years.

Survey 1 received 183/267 (69%) responses; survey 2 received 100/493 (20%) responses. Most respondents were based in the UK or the USA. Overall, 71% (202/283) rated their review experience as ‘very good’ or ‘good’. Half (51%, 143/283) said a £50 payment would make them more likely to review (48% survey 1, 56% survey 2). One-third (32%, 91/283) said a subscription to a selection of BMJ journals would make them more likely to review (32% survey 1, 33% survey 2). However, 29% (82/283) said £50 would not influence them (33% survey 1, 22% survey 2) and 40% (114/283) said the same about a subscription (39% survey 1, 43% survey 2). Views on remuneration varied—some saw it as recognition of value, others viewed it as unnecessary and some felt it was inadequate compensation. While 59% (166/283) had no concerns about introducing payment, 18% (52) had concerns, and 17% (49) were unsure. Concerns included potentially changing reviewers’ motivations and the quality of reviews, administrative burden and tax implications, impact on income received from benefits and a need to evaluate the initiative. Respondents emphasised the importance of offering optional incentives to accommodate individual preferences.

The BMJ’s P&P reviewers hold diverse views on remuneration. Flexible, optional incentives may help support broader engagement while respecting individual needs and values.

Pain remains difficult to manage due to limited efficacy and adverse effects of many existing analgesics, highlighting the need for safer non-opioid treatment strategies. Metformin is a widely prescribed oral antihyperglycaemic agent with emerging preclinical and early clinical evidence suggesting potential analgesic effects. Proposed mechanisms include activation of AMP-activated protein kinase with downstream inhibition of mammalian target of rapamycin and mitogen-activated protein kinase signalling pathways implicated in nociceptive sensitisation and chronic pain. This protocol describes a systematic review to evaluate the efficacy and safety of metformin for the treatment or prevention of pain in an adult population.

This systematic review will include randomised, double-blind, placebo or active-controlled trials evaluating orally administered metformin for the treatment or prevention of acute or chronic pain in adult human participants. Searches will be conducted in MEDLINE (Ovid MEDLINE ALL), EMBASE and the Cochrane Central Register of Controlled Trials from inception alongside ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and reference list screening. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane Risk of Bias 2.0 tool. Outcomes will include pain intensity, pain relief, responder outcomes, functional interference, analgesic use and adverse events. Where appropriate, random-effects meta-analyses will be performed. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics approval is not required as this study will synthesise published data. Findings will be disseminated through peer-reviewed publication and presentation in scientific conferences.

CRD420261296816.

Cancer literacy (CL) is essential for enabling informed decision-making, prevention, early detection and adherence to treatment. However, disparities in CL across Europe, coupled with the spread of disinformation, limit equitable access to cancer care. This protocol describes a collection of scoping reviews to document the state of CL, misinformation narratives and education and training initiatives and identify barriers and facilitators. This work is embedded within the activities of the Beating Cancer Inequalities through Literacy in Europe project and encompasses nine consortium countries across Europe: Romania, Portugal, Belgium, Bulgaria, Montenegro, Ukraine, Italy, Ireland and Moldova.

The protocol follows the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR) checklist, guided by the Population, Concept, Context framework. Searches will be conducted in PubMed, supplemented by grey literature, capturing results from January 2015 to December 2025. Eligible records will undergo full-text review. Data will be extracted into predefined categories reflecting the topics of interest, developed by the research team before extraction to include key study information. Then, sources in local languages are provided by the partners, included and validated by native-speaking team members, adding to the results found by the researchers.

No ethical approval is required. Findings will be disseminated via peer-reviewed publications, project reports and stakeholder workshops.

Open Science Framework (10.17605/OSF.IO/9AQSX).

Cannabis use is common in the USA and is associated with adverse outcomes across many domains, including sleep difficulties. Targeting insomnia with an evidence-based treatment could improve sleep and reduce frequent cannabis use. This randomised controlled trial (RCT) will compare evidence-based telemedicine-delivered cognitive-behavioural therapy for insomnia for adults with frequent cannabis use (CBTi-CB) against an active comparator, sleep hygiene education (SHE), for improving insomnia/sleep, associated daytime symptoms and cannabis use. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes.

This is a single-site RCT with planned enrolment of 200 adults (21+ years of age) who meet criteria for both chronic insomnia and frequent cannabis use. Eligible participants will be randomised 1:1 to six sessions of CBTi-CB or SHE with clinical assessments conducted at pre-treatment, post-treatment and at 3 and 6 months post-treatment. Overnight polysomnography (PSG) will be conducted before and after treatment. Primary outcomes will include the Insomnia Severity Index, 12-item Short-Form Health Survey Mental Composite Score and cannabis use frequency as assessed by the interview-administered Timeline Follow Back. Electroencephalogram delta activity, derived from overnight PSG, will be the primary end point to assess the sleep homeostasis mechanism.

Ethical approval for the study has been obtained from the Institutional Review Board of the University of Michigan Medical School (IRBMED #HUM00222302). The results of the investigation will be published in scientific papers. The data from the investigation will be made available through the National Institutes of Health (NIH) National Data Archive, which allows researchers on NIH grants to share and access raw data.

NCT05814822.

Older people living in care homes are at increased risk of harm during acute hospital admissions. In England, care home residents have more than twice as many emergency department (ED) attendances as people of the same age living at home. Up to 40% of emergency hospital admissions of older care home residents may be avoidable with different models of care within their homes.

In 2023, National Health Service England introduced the updated Enhanced Health in Care Homes (EHCH) framework, a set of recommendations to support ‘joined up’ and enhanced care for people living in care homes. A stated aim of the framework is to reduce ED attendances and inpatient admissions of residents. There is limited available evidence regarding how implementation of the EHCH framework differs regionally and whether variation in implementation may impact on hospitalisations of care home residents.

We aim to explore regional differences in care elements developed from the EHCH framework and assess how these differences may contribute to variation in hospitalisations of care home residents over the age of 65.

This is a comparative qualitative case study of six care home-containing postcode districts in England embedded within three Integrated Care Boards (ICBs). ICBs are regional organisations responsible for commissioning healthcare services in England. Case study districts and ICBs were selected due to contrasting case-mix adjusted admission rates and other characteristics (eg, deprivation). Data will be collected through semistructured interviews. We will interview health and social care professionals who are responsible for commissioning, overseeing and delivering enhanced care in care homes, care home professionals, residents over the age of 65 and their family and friends. Interview data will be analysed through a framework approach, with comparisons drawn within cases, across cases and across ICBs. Through our analysis, we will characterise the EHCH framework care elements and identify differences in implementation that may cause variation in hospital admissions. We will also identify perceived appropriate, effective and replicable enhanced care models.

Patients and the public have informed the design of this study, and will advise the research practice, support the analysis of data and guide dissemination plans.

This study has received Social Care Research Ethics and Health Research Authority Approval (25/IEC08/0014). All participants will be required to provide informed consent. The findings will inform a national survey of ICBs to map appropriate and effective enhanced care in England. Findings will be shared with key stakeholders and academic audiences.

This study aimed to identify the factors that influence access to diabetic retinopathy screening (DRS).

This is a qualitative case study.

Township health units in Shaoguan City, Guangdong Province, China.

This study included two representative patient groups (n=15) and five health-staff groups (n=42).

Focus group discussions were guided by a female ophthalmologist and other ophthalmology staff to determine the contextual factors influencing DRS uptake in people with diabetes mellitus in Qujiang District, Shaoguan City, southern China. Directly observed treatment and short-course (DOTS) components for the assessment of tuberculosis services were referred to for health structure when themes were extracted using deductive thematic analysis.

By referring to DOTS components related to the government, case detection, treatment, drug supply and recording system, we identified 31 factors associated with DRS uptake. Among these, six were from the perspective of service users whereas the remaining 25 were related to providers. From these factors, 10 modifiable themes pertained to policy, financing, interdepartmental coordination, hospital preparedness, primary healthcare staff training and public awareness through health education and quality enhancement of public health services. Two unmodifiable factors were also extracted: discomfort from pupil dilation during the examination and long travel distance to the facility.

This analysis identified contextual factors influencing DRS uptake, including policy, financing and public awareness, which, if addressed, could significantly enhance future screening uptake and disease management.