Socioeconomic inequalities in neonatal mortality are observed globally but gaps remain in the evidence from current reviews, specifically: a wider range of socioeconomic indicators at the individual, household and area level than previous reviews, and alternative time frames to define neonatal mortality. Thus, a comprehensive updated review of the literature is required, focusing on multiple measures of socioeconomic status and alternative time frames, to assess the relationship between maternal socioeconomic status and neonatal mortality in high-income countries.

Three different search approaches will be used: electronic searching of three databases, grey literature searching and reference list checking. First, the three databases Medline, Scopus and Web of Science will be searched using relevant synonyms and adapted terms from medical subject heading terms (MeSH) in Medline for maternal socioeconomic status and neonatal mortality identified from previous systematic reviews on inequalities in adverse pregnancy outcomes. Second, grey literature will be searched by entering the relevant terms into Google. Title, abstract and full text screening will be conducted by the review team against the inclusion and exclusion criteria, with at least 10% checked by a second reviewer to assess for any bias and errors. We will also conduct the kappa statistic for inter-rater reliability. Third, the reference lists of included studies will be reviewed for any additional studies that meet the criteria. Data will be extracted using a data extraction form and extracted studies will be assessed using the Liverpool Quality Assessment Tool. A narrative synthesis will be conducted and, where appropriate, meta-analysis will be performed. If the data allow, subgroup analysis by neonatal care population and specific gestational ages will be performed.

Ethical approval is not required as all studies in this systematic review will be publicly available. The findings of this review will be presented at conferences and disseminated in peer-reviewed publications.

CRD42022315407.

Sympathetic activation is the hallmark of cardiac disease, driving disease progression and triggering ventricular arrhythmia (VA). Despite optimal medical therapy, many patients experience recurrent VAs refractory to medical therapy, leading to repetitive implantable cardioverter defibrillator (ICD) therapy, worse quality of life and adverse outcomes. Cardiac sympathetic denervation (CSD) through surgical removal of the stellate ganglia is an effective treatment for refractory VAs but carries a high complication rate. We hypothesise that high precision image guided radiotherapy can be used to target the stellate ganglia to achieve CSD non-invasively.

RADIO-STAR (hypofractionated radiotherapy to the stellate ganglia for ventricular arrhythmia) is a first-in-human, phase 1 safety and dose finding study of radiotherapy to the stellate ganglia in patients with recurrent VAs. Patients with structural heart disease requiring recurrent ICD therapy for VAs are invited to undergo radiotherapy bilaterally to their stellate ganglia with a predetermined sample size of n=13. Radiotherapy dose will be determined by a prespecified dose escalation protocol. The primary outcome is safety defined as any treatment-related grade 3–5 toxicity occurring within 6 months of radiotherapy treatment, as defined by the Common Terminology Criteria for Adverse Events or any treatment-related side effects detected on patient symptom questionnaires and clinical examination during study visits. Secondary outcome measures to evaluate feasibility and efficacy include ability to safely deliver radiotherapy and consequent changes in circulating catecholamines and neuropeptide-Y, heart rate variability, structural changes in the stellate ganglia on MRI imaging and ICD therapy burden.

This study has received ethical approval by the South Central—Oxford B Research Ethics Committee (REC/SC/0005). Study findings will be submitted for publication in peer-reviewed scientific journals and presented at national and/or international scientific conferences.

ISRCTN49861434.

Hyperkalaemia (HK) is common in the emergency department (ED) and can cause life-threatening arrhythmias. Patiromer is a potassium binder whose role in acute HK management is uncertain; therefore, we investigated the efficacy and safety of patiromer as an adjunct to the standard of care treatment of HK in the ED.

A prospective, randomised, double-blind, placebo-controlled study.

16 ED sites across the USA.

Patients aged ≥18 years treated at a participating ED who were found to have serum potassium ≥5.8 mEq/L.

Participants were randomised 1:1 to standard combination therapy (25 g intravenous dextrose, 5 units intravenous insulin and 10 mg albuterol) with either patiromer or placebo. The initial dose was given within 1 hour of the potassium result, and the second dose 24 hours later.

The primary endpoint was net clinical benefit (NCB) at 6 hours, defined as the change in number of potassium-lowering interventions minus change in serum potassium. Adverse events (AEs) were also recorded.

The study was terminated early and did not reach the prespecified sample size. Overall, 111 patients (53 patiromer and 58 placebo) were analysed. Mean (SD) age was 61.34 (15.21) years, 34% were female, 48% white and 22.5% received chronic haemodialysis. Mean baseline potassium was 6.5 mmol/L. NCB at 6 hours was similar between patiromer and placebo (–0.6 vs –0.4; p=0.44). Potassium levels at 2, 4 and 6 hours were similar between the groups (5.50 vs 5.70, 5.45 vs 5.65, 5.50 vs 5.60; patiromer and placebo (all p>0.05)). The number of interventions per patient was similar (p>0.05) between groups at each time point. The proportion of patients experiencing AEs was not significant between the patiromer and placebo groups (16.98% vs 32.76%; p=0.08).

No differences in efficacy were reported in this study, which was underpowered to detect statistical efficacy of patiromer over placebo.

NCT04443608.

Palliative care supports the physical, emotional, social and spiritual needs of people with serious life-limiting illness. Future research must align with the priorities of people approaching the end of their lives, and those close to them.

To undertake a refresh of the James Lind Alliance Palliative and End of Life Care Priority Setting Partnership, to identify and prioritise areas for future research.

The James Lind Alliance process was applied, between May 2023 and February 2025. An initial online survey collected areas for future research from participants. These were synthesised into a long list of questions and shortlisted through a second online survey. Final ranking of priorities was achieved using an adapted Nominal Group Technique within a prioritisation workshop.

People living with serious life-limiting illnesses, carers, friends and family members supporting them, bereaved people, health and social care professionals, volunteers working in palliative and end-of-life care and members of the public.

1032 and 626 responses were received to survey 1 and 2, respectively. 20 people with lived and professional experience attended the prioritisation workshop. An updated list of 24 priorities for palliative and end-of-life care research was produced.

The priorities reflect the range of issues shaping end-of-life experiences and serve as a call to action for researchers and funders.

Recent research indicates that around 8% of older people living in prison have signs or symptoms of dementia or mild cognitive impairment (MCI), yet the care they receive is not equivalent to care in the community and this means their needs may not be met. We co-developed an intervention specifically for older people living in prison with dementia/MCI (Dementia and Mild Cognitive Impairment in prison care pathway and training package–DECISION). To date, this has not been implemented or evaluated. This paper presents our protocol for a study to assess the feasibility and acceptability of DECISION.

This is a non-randomised, realist-informed mixed-methods feasibility study with integrated process evaluation, which will take place in two prisons in England. The intervention was codeveloped with experts with lived experience. Participants will include older people living in prison, staff working in prison and peer supporters. We will assess the feasibility and acceptability of the intervention (eg, numbers eligible; rates of recruitment and retention), and the evaluation design (eg, completion rates of standardised outcome measures). Methods will include semistructured, realist-informed interviews; an audit to assess implementation fidelity; focused ethnography; training questionnaires; and collection of resource use data. We will refine the DECISION programme theory using realist-informed methods to examine and refine how contexts and mechanisms interact to produce the intervention’s outcomes.

This study received a favourable ethical opinion from the Wales REC 3 Research Ethics Committee in January 2025 (reference number 24/WA/0323). HMPPS National Research Committee approval was also granted in January 2025 (reference number 2024-1451). Findings will be disseminated through a range of avenues, including stakeholder engagement events, open-access papers, conference presentations, evidence briefings for commissioners, providers and practitioners, and newsletters for service users.

Tongxinluo capsule (TXL) is widely used in China as an adjunctive therapy for patients with acute coronary syndromes (ACS) who underwent percutaneous coronary intervention (PCI), collectively referred to as ACS-PCI. However, current evidence on its therapeutic effects and safety remains limited and insufficiently synthesised. This review aims to evaluate the therapeutic effects and safety of adding TXL to Western medical therapy (WM) in this population.

A systematic literature search was performed in PubMed, the Cochrane Library, CNKI, VIP and Wanfang from inception to August 2024; a rapid supplemental search was conducted up to November 2025, without language restrictions, to identify randomised controlled trials (RCTs) evaluating the therapeutic effects and safety of adding TXL to WM in patients with ACS-PCI. Dichotomous outcomes were summarised using risk ratios (RRs) with 95% CIs; absolute risk reductions (ARRs) were estimated as risk differences, and corresponding numbers needed to treat (NNTs) were calculated. Continuous outcomes were summarised using mean differences (MDs) with 95% CIs. All meta-analyses were performed using a random-effects model. The included studies generally had limitations in methodological quality, heterogeneity across analyses was low to moderate and the potential for publication bias could not be excluded. The evidence certainty for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Eighteen RCTs involving 1800 participants were included. Low-certainty evidence indicated that adding TXL to WM may reduce the risks of restenosis (RR=0.30, 95% CI 0.10 to 0.91; ARR=0.056, NNT=18), revascularisation (RR=0.28, 95% CI 0.10 to 0.80; ARR=0.069, NNT=15), myocardial infarction (RR=0.44, 95% CI 0.20 to 0.98; ARR=0.033, NNT=31), angina (RR=0.32, 95% CI 0.17 to 0.61; ARR=0.076, NNT=14) and other cardiovascular events (RR=0.41, 95% CI 0.24 to 0.71; ARR=0.075, NNT=14). It also improved Seattle Angina Questionnaire scores (MD=8.82, 95% CI 6.58 to 11.05) and quality of life (qualitative synthesis). However, no statistically significant reductions were observed for sudden cardiac death (RR=0.39, 95% CI 0.12 to 1.27; ARR=0.022, NNT=45), or non-cardiovascular adverse events (RR=0.67, 95% CI 0.32 to 1.40; ARR=0.043, NNT=24) when TXL was added to WM.

Current evidence suggests that adjunctive TXL may reduce key cardiovascular events and improve symptoms and quality of life in patients with ACS-PCI, without increasing the risk of non-cardiovascular adverse events. However, all findings are based on low-certainty evidence. These results provide preliminary support for the use of TXL as an adjunctive therapy, but high-quality, multicentre RCTs are needed to confirm these effects and inform clinical guidelines.

CRD42024509453.

The COVID-19 pandemic accelerated telehealth adoption, offering remote consultations via phone and video. Allied health services are one part of the healthcare system where telehealth, in specific teleconsultations, has been applied and has shown promising results in improving healthcare access by breaking down financial, logistical and geographic barriers. However, more insight is needed into the consumer’s perspective. A consumer is anyone who has used, currently uses or will use telehealth for allied health services. Therefore, this study explores consumer experiences and preferences, identifying barriers and facilitators to telehealth for allied health services.

This qualitative study used focus group discussions to evaluate consumers’ experiences with telehealth for allied health services. Allied health was defined as healthcare professionals distinct from medical, dental and nursing fields. Eight focus groups with 57 participants were conducted. The participants were recruited from the general public as well as seldom represented communities such as a support service focused on improving and maintaining members’ mental health, the deaf and hard-of-hearing community, young disabled people and the Pacific Islander community. An inductive thematic analysis was used to analyse the data.

Five main themes were identified. First, the consumer with their individual characteristics and context played a major role in the suitability of telehealth. Second, the allied health practitioner and their skills influenced the quality and therefore the success of remote consultations. Further, the relationship between consumer and practitioner contributed to the success of telehealth. The appointment itself was equally often discussed. While telehealth improved access to care, remote appointments were seen as more suitable for questions and verbal exchanges. Lastly, the technology was an important factor with the availability of necessary technology and the accessibility of it playing a central role.

The findings reinforce existing research while highlighting new insights from often under-represented groups, emphasising the importance of telehealth choice, accessible technology and quality standards.

Patient safety is a central pillar of healthcare quality. However, with repeated examples of failure emerging across healthcare, there is an ongoing need to better understand how the safety of care can be improved for patients. Evidence suggests that some population groups are more likely to inequitably experience healthcare harm. This review will look at what evidence exists on understanding patient safety harm and its causes and impact on different population groups and particularly those from marginalised backgrounds. It will also focus on what actions can be taken to address patient safety disparities and service improvements, including with patient and public involvement.

A scoping review of empirical and grey literature will be conducted following the Joanna Briggs Institute guidance. Medical databases such as Medline, EMBASE, PsycINFO will be searched for peer-reviewed articles and grey literature sources such as BASE, institutional and government repositories will be searched for reports, independent reviews, confidential enquiries, etc. These will be searched from 2001 to present for publications in English. Title and abstract and full text screening will be undertaken by one or more people acting as first reviewers and validated by a second reviewer. A data extraction form will be used to extract data including equity considerations following the PRO EDI framework. Data will be grouped thematically and analysed using a narrative approach.

Ethics approval is not required for this work as the information used is publicly available. The findings of the review will be disseminated through stakeholder meetings, a peer-reviewed publication and conference presentations.

osf.io/4mfus.

To explore the experiences of clinicians providing pastoral and mental health services to racially and ethnically minoritised students (REMS) at UK universities, aiming to understand the challenges REMS face in accessing support and to identify ways to improve service inclusivity.

Qualitative study using semi-structured interviews.

Student health and well-being services at five universities in the North East of England, a region with comparatively low racial diversity.

Ten clinicians (nine female, one male; nine White British, one other ethnic background; mean age 42.8 years) working in therapeutic roles with experience supporting REMS. Participants were recruited via opportunity sampling.

Semi-structured interviews, averaging 44 min, were video-recorded, transcribed verbatim and analysed using thematic analysis to identify key themes.

Six overarching themes were identified: (1) the chokehold of layered systemic challenges, (2) dynamics of power, (3) lack of safety for REMS, (4) "Am I really getting it?", (5) psychological therapies for white people by white people and (6) the thirst for expertise. Clinicians were enthusiastic about providing culturally responsive care but reported limited access to reflective spaces and training. Contextual factors—including racism, Brexit and the marketisation of higher education—were perceived to affect service delivery and REMS’ engagement with mental health support. Business-model approaches to service provision were sources of frustration.

Clinicians face structural and systemic challenges in providing culturally sensitive mental health support to REMS. Enhancing staff training, reflective practice and service adaptation may improve access and efficacy. Findings offer practical insights for universities aiming to strengthen equity in student mental health services, and future work could evaluate interventions to increase clinician preparedness and REMS engagement.

The treatment of tobacco dependence in patients admitted to hospital is a priority for the National Health Service in England. We aimed to conduct an economic analysis of a pilot ‘opt-out’ tobacco dependence treatment intervention adapted from the Ottawa Model of Smoking Cessation.

Observational cost analysis of an inpatient tobacco dependence treatment intervention, and matched cohort study comparing readmission costs between patients who received the intervention and benchmarked equivalents who did not.

11 acute inpatient wards in a major teaching hospital in London, England.

673 patients who smoked, admitted between 1 July 2020 and 30 June 2021.

The intervention consisted of the systematic identification of smoking status, automatic referral to tobacco dependence advisors, provision of pharmacotherapy and behavioural support throughout the hospital stay and telephone support for 6 months after discharge.

The primary outcomes were cost-per-patient, cost-per-quit and incremental cost effectiveness ratio among patients who received the intervention. The secondary outcomes were patient-level readmission costs and bed-days from 6 months after discharge, compared between the intervention group and a group of matched benchmark patients who smoked but did not receive the intervention.

The total cost of the intervention was £178 105. On the basis of 104 patients who reported not smoking at 6 months, the cost-per-quit was £1712.55, equating to an estimated age-adjusted incremental cost per life year gained of £3325. Among 611 patients who were successfully matched to a benchmark cohort, readmissions for patients in the intervention group cost £492 k less than their benchmark equivalents over 21 months from 1 January 2021 to 30 September 2022 (£266 k vs £758 k), incurred 414 fewer bed days (303 vs 717) and readmitted at a lower rate (5% vs 11%). There were reduced readmission rates and costs among all patients who received the intervention compared with their benchmarked equivalents, regardless of smoking status at 6 months, except among those who opted out.

A pilot ‘opt-out’ tobacco dependence treatment intervention implemented in an acute hospital setting in London demonstrated value for money through reduced readmission rates and costs among all patients who received it.

To determine age-specific and age-standardised incidence trends of acute rheumatic fever (ARF) or rheumatic heart disease (RHD) among Indigenous Western Australians aged less than 35 years of age.

A population-based retrospective cohort study with linked data analysis.

Western Australian hospital admissions (1996–2022) and RHD notifications to the state-based register (2011–2015).

Patients, both Indigenous and non-Indigenous aged

Of 1746 incident ARF/RHD cases, 1526 (87%) were Indigenous peoples, with the highest rates observed in patients aged 5–14 years, with an annual estimated increase of 4.3% (95% CI 3.2% to 5.2%). The 0–4 years age group experienced an annual increase in incidence rates of 4.8% (95% CI 1.4% to 8.2%). Overall, Indigenous patients experienced an annual increase of 1.9% (95% CI 1.3% to 2.6%) from 1996 to 2022. However, most cases (n=894) were identified after multiple significant policy developments (2011–2022) with an annual increase of 5.7% (95% CI 3.7% to 7.5%) for this period.

Increasing trends of incident ARF/RHD were observed in Indigenous patients aged under 15 years, with the greatest annual increments observed after policy implementation for disease reporting and awareness in the period from 2011 to 2022. Improvement in case ascertainment of ARF/RHD may be contributing towards increasing trends with improved reporting and monitoring of incident cases in very young Indigenous Australians more recently.

Streptococcus pneumoniae serotype 3 (SPN3) remains a significant contributor to invasive pneumococcal disease globally, despite its inclusion in widely administered vaccines. The next generation of pneumococcal vaccines may confer better protection against this serotype, reducing disease burden. We describe an ethically approved protocol for a double-blind randomised controlled trial assessing the impact of VAXNEUVANCE (15-valent pneumococcal conjugated vaccine (PCV15)) and 0.9% saline (placebo) on the acquisition, density and duration of SPN3 carriage using a controlled human infection model.

Healthy adults aged 18–50 years will be randomised 1:1 to receive PCV15 or placebo. Participants will be considered enrolled on the trial at vaccination. One month following vaccination, all participants will be intranasally inoculated with SPN3. Following inoculation, participants will be followed up on days 2, 7, 14 and 28 to monitor safety, SPN3 colonisation status, density and duration, as well as immune responses. The primary endpoint of the study is to assess the rate of SPN3 acquisition between vaccinated and unvaccinated participants defined by classical microbiological methods. Secondary endpoints will determine the density and duration of SPN3 colonisation and compare the immune responses between study groups. An exploratory cohort of 5 participants will be asked to consent to a nasal biopsy procedure during a screening visit and a second nasal biopsy 28 days after PCV15 vaccination. This cohort will only receive PCV15 and will not be challenged. Through this exploratory cohort, we will explore gene expression changes induced by PCV15 vaccination and their visualisation (spatial location) within the nasal tissue.

This protocol has been reviewed by the sponsor, funder and external peer reviewers. The study is approved by the NHS Research and Ethics Committee (Reference: 24/SC/0388) and by the Medicines and Healthcare Products Regulatory Agency (Reference: CTA 21584/0485/001-0001).

NCT06731374 – ISRCTN91656864.

To estimate the sociodemographic and geographical variation in prescribing selective serotonin reuptake inhibitors (SSRIs) and medications for attention-deficit/hyperactivity disorder (ADHD) to children and young people (CYP) in North West London, UK.

Cross-sectional population-based study.

General practices in North West London, UK, with data for the period 2020–2022 obtained from the Discover Now platform, which covers approximately 95% of the local population.

762 390 CYP aged 5–24 years in the year 2022.

Primary outcome: Prescription rates of SSRIs and ADHD medications. Secondary outcomes: Associations between prescription rates and sociodemographic factors, including age, gender, geographical area (local authority), ethnicity and socioeconomic deprivation (measured using the Index of Multiple Deprivation).

The total sample comprised 762 390 CYP. 2.20% of the sample were prescribed an SSRI (95% CI 2.17% to 2.24%) and 0.50% an ADHD medication (95% CI 0.49% to 0.52%) in years 2020–2022. High deprivation was associated with the highest rates of an SSRI prescription (2.5%). In contrast, low deprivation was associated with the highest rates of an ADHD medication prescription (0.70%). This divergent pattern was evident in some London boroughs and not in others. The relationship between level of area deprivation and prescription rates also differed by borough. Overall, the sociodemographic factors could not explain most of the variation in prescription rates (Pseudo R² 0.18 for SSRI and 0.06 for an ADHD medication).

Prescriptions for common mental disorders and ADHD for CYP from North West London varied by sociodemographic characteristics and London borough of residence, potentially exacerbating mental health inequalities. To monitor and address these inequalities, more extensive use of linked electronic health records should be undertaken; for example, data on mental health diagnosis and service utilisation are needed to investigate the relationship between diagnosis and treatment over time.

Addressing physical inactivity is a promising dementia risk reduction strategy due to its direct benefits for brain health, and indirect benefits for other modifiable dementia risk factors. A potential limitation of previous interventions is that they often overlook how increasing physical activity affects other behaviours throughout the 24-hour day, such as sleep and sedentary behaviour, which are also important for brain health. Further, interventions are rarely tailored to the individual, considering their needs, preferences and constraints that may serve as barriers or facilitators to behaviour change. The current phase I randomised controlled trial, Small Steps, aims to investigate feasibility, acceptability and preliminary effectiveness of a personalised 24-hour time-use intervention to improve lifestyle and cognitive health in older adults.

Participants aged ≥65 years from Adelaide, South Australia will be recruited and randomised to either the Extended or Condensed programme. During the first 12 weeks, participants in the Extended programme will use a tailored website to set personalised weekly goals to move towards their ‘optimal’ 24-hour day for brain health, facilitated by weekly website ‘check-ins’ and weekly phone calls with a research staff member. Participants randomised to the Condensed programme will have access to the website educational resources only but will not undergo personalised goal setting or telephone calls. Following the introductory phase (first 12 weeks), phone calls will be gradually withdrawn for the Extended programme. Primary (feasibility and acceptability) and secondary outcomes (changes in time use, cognitive function and behaviour change metrics) will be assessed 12, 24 and 36 weeks after the beginning of the intervention.

Ethics approval has been obtained from the University of South Australia’s Human Research Ethics Committee (205989). Study findings will be disseminated through peer-reviewed journal articles, conference presentations, media releases and community engagement.

NCT06291909).