To identify key factors influencing the implementation of technology-enabled virtual wards (VWs), also known as hospital at home, drawing on the qualitative accounts of stakeholders involved in implementation, using the updated Consolidated Framework for Implementation Research (CFIR) as a guiding analytical framework.

Qualitative semi-structured interviews with implementation leads. All interviews were conducted online, using MS Teams or Zoom, between January–June 2024, and audio-recorded with consent. Audio-recordings were transcribed, anonymised and exported to NVivo V.12 Pro software for data management. The updated CFIR was used to guide thematic analysis of interview data.

Adult VW services in one regional health and social care system in North West England, UK.

Service implementation leads from 11 hospital sites providing adult VW services. Job titles and roles varied across sites and included both operational and clinical service leads.

20 interviews were conducted with 22 participants. Four implementation themes were identified: (1) complexity and adaptability: the ability to adapt the service to local conditions was valued by leads, but also contributed to wide variation in operational, clinical, workforce and digital components of VW models; (2) resource and infrastructure: workforce capacity was identified as a key implementation challenge along with information technology system capability and interoperability; (3) performance demands: leads were concerned that an excessive focus on bed numbers and occupancy levels, without accounting for patient acuity, could negatively affect implementation, straining the service and staff capacity; and (4) readiness for change: organisational and professional readiness for change was considered crucial for increasing referrals and enabling successful implementation, yet leads reported that the level of behavioural and cultural change required had been underestimated.

Implementation of a national VWs programme has resulted in wide service variation in one UK region, which raises questions about service equity and poses challenges for wider programme evaluation. Despite this variation, common factors found to help or hinder implementation have been identified. This study provides greater understanding of the factors that influence the implementation of VW services and outlines actionable insights to help refine VW strategies. These insights can support future planning and sustainability of technology-enabled inpatient-level care at home more widely.

To systematically identify and synthesise the pedagogical mechanisms through which arts-based interventions (theatre, poetry, narrative medicine) may support empathy development in healthcare learners, while critically appraising the contextual implementation factors and methodological limitations of the existing evidence base.

Systematic review with narrative synthesis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

MEDLINE (via PubMed), Embase, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and CINAHL Plus, from inception to 31 August 2025.

Peer-reviewed empirical studies involving undergraduate or postgraduate healthcare students or professionals. Eligible studies reported on arts-based educational interventions designed to enhance empathy (including theatre, poetry or narrative medicine) and included quantitative or qualitative outcome measures of empathy or related constructs. No restrictions were placed on study design.

Two reviewers independently screened records, extracted data on intervention characteristics and outcomes, and assessed methodological quality using the Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme tools. A narrative synthesis was conducted to examine patterns across intervention modalities. Effect sizes (Cohen’s d) were calculated for quantitative pre-post or controlled designs; meta-analysis was precluded due to high heterogeneity in study designs, populations and outcome measures.

From 1094 records screened, 17 studies involving 835 participants (median sample size=28) met inclusion criteria. There were eight theatre-based, five poetry-based and four narrative medicine interventions. Theatre interventions, which emphasised embodied learning, showed patterns of large empathy effects (mean d=0.83). Poetry interventions, focusing on reflective practice, showed patterns of moderate effects (mean d=0.49). One study of narrative medicine demonstrated a pattern of sustained gains at 2-year follow-up (d=0.82). Key limitations of the evidence base include small sample sizes, substantial measurement heterogeneity (12 different empathy instruments), geographical bias (88% of studies from high-income, Western countries), and a predominance of pre–post study designs.

Arts-based interventions show mechanism-specific patterns of potential benefit for empathy in healthcare learners. However, significant methodological limitations in the current evidence constrain definitive practice recommendations. Educators may consider piloting brief, facilitator-led interventions based on local resources, while acknowledging the need for more robust evidence. Future research must prioritise standardised outcome measures, rigorous controlled and longitudinal trial designs, and studies in diverse cultural contexts.

CRD42025116174.

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.

We use new data and robust methods to estimate mortality levels and trends for US states and Washington DC and quantify cohort life expectancy for birth cohorts between 1941 and 2000.

Observational retrospective cohort study.

Mortality data and population estimates for cohorts born between 1941 and 2000 at the state, regional and national levels were obtained from the US Mortality Database.

We estimated cohort life expectancy at birth by sex and geographical level. We used the coefficient of variation to assess levels and trends in convergence in cohort life expectancy by geographical level.

In contrast to recent findings, estimates suggest that all states and regions experienced cohort life expectancy gains between the birth cohorts of 1941 and 2000 for both sexes, typically more than 5 years; the range included gains of 7–8 years in Oklahoma and Arkansas to over 14 years in Arizona, New Mexico and South Carolina (men). States sharply converged in the 1940s due to the South making substantial gains in under-five mortality, and since the 1960s there has been overall stability in geographical variation that is a combination of continued convergence by the South and modest divergence in the Midwest.

Cohort life expectancy estimates across US states over the birth cohorts born between 1941 and 2000 have shown important gains in all states and regions. The lack of progress estimated in other work is not replicated; for example, recent work estimated that between 1950 and 2000, at least 15 states’ female populations experienced cohort life expectancy losses; however, the use of better data and robust methods show no losses by any state. Our results also point to early life public health and medical interventions as key explanations for regional convergence in cohort life expectancy around 1950, however, the results suggest only modest additional convergence since then.

Non-communicable diseases (NCDs) have become the leading cause of mortality globally, with a sharp rise in Iran due to lifestyle changes and urbanisation. Although many NCD risk factors are modifiable, limited understanding of their determinants hinders effective prevention. To address this, the Prospective Epidemiological Research Studies in Iran (PERSIAN) Cohort was established in 2014 to study NCDs nationwide. The Sabzevar PERSIAN Cohort Study (SPECS) is the first in northeastern Iran, aiming to investigate environmental and social factors influencing NCDs in a unique regional context.

SPECS enrolled 5174 adults (aged 35–70 years) in northeastern Iran between January 2018 and January 2019 through a census and an online registration process. The baseline data collection included demographic verification, informed consent, health questionnaires, anthropometric measurements and biological samples (blood, urine, hair, nails). The annual follow-up began in April 2019, with full reassessments every 5 years over a 15-year period. The data is gathered via an active and passive follow-up, supported by trained staff and registry linkages.

Of the 5174 participants, 4241 (81%) remained in the study. Among the cohort, 54.5% were female, with a mean age of 50.5 years. The majority were married (93.5%), and nearly half had at least high-school education (46.5%) and moderate socioeconomic status (49.4%). Drug abuse history (smoking/drugs) was reported by about 15% of the sample. The mean body mass index was 26.9 kg/m², and the average blood pressure was higher in males (118.1/74.0 mm Hg) than in females (111.5/70.2 mm Hg). The common conditions included hypertension (22.8%), kidney stones (22.4%), fatty liver (15.4%) and diabetes (13.8%). Cancer had the highest treatment rate (100%), while fatty liver had the lowest (70.1%). Stroke had the highest mean age of onset (51.2 years), and epilepsy the lowest (23.7 years). All health data were self-reported.

SPECS, part of the national PERSIAN cohort initiative, is the only adult NCD-focused study in Khorasan Razavi. Its 15-year follow-up aims to generate region-specific insights into the incidence of NCDs and their risk factors. The ethnically homogeneous sample enhances statistical power, and the findings may inform culturally tailored health policies. While self-reported data have limitations due to bias, high initial participation and access to free healthcare support long-term engagement, especially among lower-income groups.

Management of heart failure (HF) is a challenge, with less than one-third of patients meeting physical activity recommendations.1 Existing cardiac rehabilitation programmes are designed to meet class 1A American Heart Association recommendations for physical activity.1 Benefits, facilitators and barriers to these programmes are described...

Vital signs such as heart rate (HR) and respiratory rate (RR), crucial for clinical assessment, are often challenging to measure in paediatric populations. Remote photoplethysmography (rPPG), a video-based measurement tool, has demonstrated accuracy in adults. The objective of this study is to compare HR and RR measurements obtained using rPPG with those from standard clinical monitoring in a paediatric population.

This is a monocentric, prospective study enrolling 600 paediatric participants. Each participant will have standard monitoring electrodes (ECG/impedance) placed on the chest while seated facing a camera for rPPG recording. Simultaneous HR and RR measurements will be recorded over periods of 30 and 60 s using both the standard monitor and the rPPG device. The intraclass correlation coefficient will be calculated to assess agreement between the rPPG and standard monitor measurements.

The study protocol has been approved by the French Agency for the Safety of Health Products (ANSM (Agence nationale de sécurité du médicament) registration no. IDRCB 2023-A02524-41) and by a French ethics committee (CPP Sud Méditerranée III at 29 August 2024, n°2024-A01324-43). The study’s findings will be published in peer-reviewed journals and disseminated at national and international conferences and through press releases.

Clinical Trials Registry (NCT06231654).

Cancer in adolescents and young adults (AYAs; ages 15–39 years) is a rising global epidemic. Yet, AYAs remain an understudied population, and little is known about what research topics should be prioritised according to those with lived experience. The AYA Cancer Priority Setting Partnership (PSP) was established to identify the top 10 research priorities for AYA cancer in Canada according to patients, caregivers, and clinicians.

This project followed the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology that included two national cross-sectional surveys and a final priority setting workshop following an adapted nominal group technique.

A national sample was recruited to participate from across Canada.

Participants were patients, caregivers, and clinicians with lived personal and/or professional experience of AYA cancer in Canada.

In the first survey, open-ended responses were collected from participants about questions they would like answered by research. Responses were collated into overarching summary questions and a literature search was undertaken to verify if questions were true uncertainties and not fully answered by existing evidence. Unanswered questions were ranked by participants in a second survey. The top-ranked questions were prioritised through consensus at the final priority setting workshop. The final outcome was the top 10 priorities for AYA cancer research in Canada.

In the initial survey, 1916 potential research questions were submitted by 275 patients, caregivers, and clinicians. Following data processing, summary question formation, and the evidence check, 58 questions were put forward for interim prioritisation in a second survey (n=285 patients, caregivers, and clinicians). The top 20 questions from the interim prioritisation were ranked at the final priority setting workshop attended by a diverse group of 23 patients, caregivers and clinicians from across Canada. The resulting top 10 priorities reflect topics across the cancer continuum including: diagnostic delays, screening and early detection, novel therapies, psychosocial impacts, end-of-life concerns, and survivorship issues.

This patient-directed research agenda will guide researchers, funding agencies, and policymakers to ensure that future research is aligned with what matters most to the AYA cancer community.

To explore the perceptions, challenges and strategies of caregivers in managing screen time among children younger than 5 years in the urban and rural areas of Tamil Nadu, India.

Qualitative study using focus group discussions (FGDs).

Rural Health and Training Centre in Vayalanallur, Thiruvallur district and Urban Health and Training Centre, Thiruvanmyur in Chennai district, Tamil Nadu, India.

54 caregivers (27 rural, 27 urban, 46 mothers, 6 grandmothers, 2 fathers) of children younger than 5 years whose screen time exceeded WHO age-specific recommendations participated. Six FGDs were conducted, each with 8–10 participants.

FGDs were conducted in familiar community locations near the participants’ homes to ensure comfort and accessibility. The audio recordings were transcribed verbatim in Tamil and translated into English and analysed using inductive thematic analysis. Coding was manually performed by two independent researchers.

Six major themes emerged: (1) circumstances leading to screen exposure, (2) perceived advantages, (3) perceived disadvantages, (4) challenges in reducing screen time, (5) methods adopted to reduce screen time and (6) strategies for sustaining reduction. Safety concerns, lack of play space and the need to manage household chores were commonly cited reasons for screen use. Although most caregivers were aware of the potential harms, screens were often used to feed or pacify children. Emotional resistance from children, inconsistent family norms and grandparents’ screen use were common barriers. Caregivers employed strategies, such as limiting access, engaging in outdoor play and enrolling children in structured activities. Urban–rural differences were minimal, and thematic saturation was achieved after six FGDs.

Caregivers face multiple, structural and family level challenges in managing screen time among young children. Awareness and interventions need to be tailored to address family dynamics, caregiver fatigue and lack of alternatives. Health providers, community workers and policymakers should collaborate to offer structured support, promote screen-free engagement and ensure child-friendly spaces in urban and rural communities.