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Oligoprogressive disease (OPD) is a clinically significant pattern of progression observed in patients with oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer treated with endocrine therapy (ET) and cyclin-dependent kinase (CDK) 4/6 inhibitors. Stereotactic ablative body radiotherapy (SABR) is an emerging strategy that may ablate resistant subclones and prolong the benefit of systemic therapy. The AVATAR-II trial investigates whether the addition of SABR to continued systemic therapy can delay the need to change treatment strategy.
AVATAR-II is a multicentre, randomised, open-label, phase II randomised controlled trial enrolling 74 patients with histologically confirmed ER-positive, HER2-negative advanced breast cancer and 1–5 sites of extracranial OPD. Eligible patients must have demonstrated clinical benefit (stable disease or partial response) from ET and CDK4/6 inhibitors for at least 6 months prior to randomisation. Participants will be randomised 1:1 to either SABR to all OPD sites with continuation of current systemic therapy (Arm A) or physician’s choice of systemic therapy (Arm B). The primary endpoint is time to treatment failure, defined as progression not amenable to SABR, cessation of systemic therapy or death. The secondary endpoints include progression-free survival (PFS), PFS2, overall survival, treatment-related adverse events and patient-reported quality of life using the Functional Assessment of Cancer Therapy–Breast score.
This study received ethical approval from the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC), under approval number 25/45 and HREC reference HREC/105165/PMCC. Results of the study will be disseminated via peer-reviewed presentation at scientific conferences and open-access publication.
by Dulam Devee SivaPrasad, Azees Maria
Vehicular Ad Hoc Networks (VANETs) have been developed as an important technology for improving road safety and traffic efficiency in intelligent transport systems. However, due to the increase in the number of cyberattacks, they have become vulnerable to several security threats that must be addressed. Although several works related to authentication and key agreement protocols have been proposed in the past, there is a significant overhead in both communication and computation. To overcome this burden, a Chebyshev chaotic map-driven anonymous authentication scheme with a key agreement scheme is proposed in this work. This work shows integrates a chaotic map with anonymous authentication, thereby balancing security and efficiency. The proposed scheme removes the bilinear pairing operations, thereby reducing the time required for cryptographic operations, which leads to a significant reduction in computation overhead. Moreover, Quantitative evaluation shows that the proposed scheme achieves a total execution time of only 0.9494ms representing a (49.7%−71%) reduction compared to existing schemes (1.8878-3.7756 ms) and a communication overhead of 264 bytes, which is (13.2%−57.4%) lower than most related works (84–620) bytes. Furthermore, the security analysis section addresses the secure nature of the proposed protocol in contrast to different types of security attacks. The efficiency of the proposed schema is validated against similar works based on the computation time of cryptographic operations using the Cygwin platform and is proven to be noteworthy.Patients with lacunar ischaemic strokes are at risk of substantial long-term disability and cognitive impairment. However, uncertainty remains surrounding the use of intravenous thrombolysis or antithrombotic medications acutely in this subpopulation, as no trials have been dedicated to specifically studying acute lacunar strokes. To address this knowledge gap, we will conduct a systematic review and meta-analysis of existing literature examining the comparative effectiveness and safety surrounding the use (or non-use) of thrombolytic agents in lacunar strokes.
MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) will be searched with librarian assistance. Eligible studies will include randomised controlled trials (RCTs) and post-hoc analyses of RCTs investigating the use of an intravenous thrombolytic agent and report outcomes in adult patients with lacunar ischaemic stroke as a population or subgroup. The primary outcome will be the proportion of patients achieving a modified Rankin Scale (mRS) score of 0–1 at 90 days. Data on participant characteristics, study design, interventions, comparators and outcomes will be extracted. Study quality will be assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool for RCTs and post-hoc analyses; heterogeneity will be assessed using the I2 statistic. The primary quantitative synthesis will be a pairwise meta-analysis comparing intravenous thrombolysis with non-thrombolytic standard of care. An exploratory Bayesian network meta-analysis will also be performed if there is adequate direct or indirect evidence and no significant concerns regarding transitivity, homogeneity and consistency.
CRD420261355006
Formal ethics is not required as no primary data will be collected. Findings will be disseminated through peer-reviewed publications and scientific conference presentations. This review will aid healthcare teams in decision-making on the choice of intravenous thrombolysis and non-thrombolytic standard care in patients with ischaemic lacunar stroke and may guide the development of future treatment trials and guidelines.
Cardiovascular disease is a leading cause of death worldwide, of which coronary artery disease is the most common form. Sudden cardiac death (SCD) is a serious complication following acute myocardial infarction (MI), accounting for the highest percentage of all deaths in this population. Currently implantable cardioverter-defibrillators (ICDs) provide an acceptable method of primary prevention of SCD. However, the current literature is heterogeneous with regard to studies evaluating the benefits of ICDs for the primary prevention of SCD after MI, particularly relating to the timing of ICD implantation, risk stratification of patients for ICD implant selection and reporting non-rhythmic deaths after ICD implantation.
A meta-analysis will be performed to estimate the pooled effect size of randomised controlled trials (RCTs) examining the relationship between prophylactic transvenous ICD (TV-ICD) implantation and other medical therapies for primary prevention of SCD after MI. A comprehensive literature search and review will be performed using electronic medical databases including Scopus, Ovid MEDLINE, EMBASE (Ovid Platform), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ProQuest (Health and Medicine) and CINAHL (EBSCO) from January 1980 to June 2025. The literature search will be limited to peer-reviewed original studies carried out in human subjects and published in English. Type of study design will be limited to RCTs. The systematic review and meta-analysis will be developed according to the Joanna Briggs Institute Manual for Evidence Synthesis (2024 edition) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Data analysis will be performed according to a structured and predetermined analysis plan. The primary outcome of the study will be all-cause-mortality, for which Hazard Ratios (HRs) will be reported as a measure of effect with 95% CI. Based on data availability, subgroup analysis will be carried out. The effect sizes will be reported based on a random effects model.
This systematic review and meta-analysis will evaluate and provide primary evidence for the effectiveness of prophylactic implantation of TV-ICDs on all-cause mortality in patients who experienced MI, aiming for primary prevention of SCD after MI. The primary prevention of SCD after MI is an important goal to reduce community incidence of out-of-hospital cardiac arrests, improving patient survival rates and their quality of life after MI. Out-of-hospital cardiac arrests currently have a survival rate of less than 10% and could result in long-lasting neurological damage in those who survive.
CRD42023456995.
Atrial fibrillation (AF), a common arrhythmia, is associated with impaired quality of life and increased stroke risk and mortality. Clinical guidelines recommend leveraging digital technologies to support patient education and AF self-management. Conversational artificial intelligence (AI) technologies may support patient engagement with self-management by enabling human-like conversations. This study aims to evaluate the effectiveness of a conversational AI intervention (Conversational artificial intelligence HeAlth supporT in Atrial Fibrillation Self-Management (CHAT-AF-S)) in improving quality of life in patients with AF.
CHAT-AF-S is a 3-month randomised controlled trial with 1:1 allocation and embedded process evaluation. We will randomise 480 adults (aged 18 years and older) with documented AF to the CHAT-AF-S intervention or usual care. Primary outcome is the Atrial Fibrillation Effect on QualiTy-of-life overall score. We will follow the intention-to-treat principles and data analysts will be blinded. Intervention participants will be invited to complete a user experience survey and take part in an interview to explore the feasibility, acceptability, perceived use and barriers and enablers to implementing the intervention. Qualitative data will be analysed thematically.
Ethics approval was obtained from the Western Sydney Local Health District Human Ethics Research Committee (2023/ETH00765). Written and informed consent will be obtained from all study participants before commencing any study procedures. Results will be disseminated via peer-reviewed publications and presentations at international conferences.
Australian New Zealand Clinical Trials Registry (registration number: ACTRN12623000850673).
by Mohamad Zulfikrie Abas, Norshahiratul Atiqah Mohd Zaidi, Pei Jia Lee, Xin Rou Teh, Kim Sui Wan, Azah Abdul Samad, Huan Keat Chan, Sheamini Sivasampu, Swee Hung Ang
BackgroundDiabetes is a major health concern in Malaysia, yet no comprehensive review has assessed the quality of care for these patients. This study aims to systematically review published evidence on type 2 diabetes mellitus (T2DM) management in Malaysian primary health care (PHC), focusing on the achievement of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL-C) targets (ABC control).
MethodsA scoping review was conducted, involving a comprehensive search of four databases (PubMed, Embase, Scopus, and MyMedR) and grey literature for publications up to December 2024. Studies were included if they reported on at least one ABC indicator among the general adult T2DM population in Malaysian PHC settings. The scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. EndNote was used for deduplication, and Rayyan was utilised for the screening process. Data were extracted and synthesised narratively.
ResultsA total of 109 publications were included. Publications increased post-2010 but remained geographically concentrated in urban states. Large-scale studies heavily relied on the National Diabetes Registry. HbA1c was the most reported indicator. Findings revealed no evidence of improvement in HbA1c and BP control over two decades; achievement rates were 30–45% for HbA1c ( Conclusion
Despite a substantial increase in research, the HbA1c and BP control for T2DM in Malaysian PHC has remained static and suboptimal, highlighting a persistent gap between clinical guidelines and real-world outcomes. The modest improvement in LDL-C suggests that progress is achievable. These findings underscore the need for a balanced policy focus on all three ABC indicators, strategies to overcome systemic barriers, and continued investment in the national registry to guide evidence-based improvements in diabetes care.
Primary healthcare (PHC) systems in Sub-Saharan Africa (SSA) continue to prioritise reactive, curative models of care, despite the region’s pressing need for health-promotive and preventative strategies. Instead of disrupting the existing curative model, the expansion of digital health often automates old, treatment-oriented systems with a limited focus on creating new tools for preventive and health-promoting functions. While there is no shortage of reviews on digital health and telemedicine in SSA, these predominantly focus on curative care and service delivery within the walls of healthcare facilities. An understanding of how remotely provided preventive and health-promoting services can be implemented by PHC facilities to strengthen the PHC overall is currently lacking. Addressing this gap is critical for guiding research, policy and practice towards designing more preventive and proactive PHC service models.
This protocol details a scoping review that will identify and establish what is currently known about the implementation and feasibility of remote preventive and digital health-promoting services as potential levers to strengthen PHC in SSA. The review will consolidate evidence on digital health initiatives for prevention and identify key opportunities, barriers and gaps in the current knowledge. Results will be analysed using quantitative summaries and qualitative thematic analysis.
Ethical approval is not required as this study uses publicly available literature. The findings could guide policymakers, programme implementers and researchers in reorienting PHCs towards more preventive approaches. The findings of the proposed scoping review will be disseminated through publication in a peer-reviewed journal.
The protocol is registered with the Open Science Framework (OSF: https://osf.io/8whkc/) to comply with methodological transparency and accountability.
To examine the effectiveness of Internet-delivered Cognitive Behaviour Therapy (ICBT) in improving psychosocial well-being and promoting weight-loss in adults ≥ 18 years with BMI ≥ 25 kg/m2.
Global obesity engenders significant physical and psychosocial health consequences. Second-wave ICBT focused on restructuring negative thoughts and behaviours has been explored as a potential intervention for elevated BMI and mental health concerns, but its effectiveness remains to be fully established, making further evaluation essential.
Eight databases were searched from inception to January 2025 for randomised controlled trials (RCTs), including participants ≥ 18 years with BMI ≥ 25 kg/m2 and second-wave ICBT evaluating BMI, weight, depression, eating behaviours, and self-esteem. This review followed PRISMA 2020. Study quality was assessed using the Cochrane Risk of Bias (ROB 2) and GRADE. Data were extracted using a modified Cochrane form. Random-effects meta-analysis calculated Standardised Mean Differences (SMD) with 95% confidence intervals, with subgroup analyses exploring heterogeneity.
Nine trials with 2278 participants were included. Significant improvements were seen in BMI, weight, and depressive symptoms while self-esteem effects were small and non-significant. Compared with passive controls, ICBT showed greater improvements in BMI and weight, whereas differences versus active control were smaller and inconsistent. Face-to-face CBT demonstrated superior outcomes for depression and self-esteem. Male-tailored interventions showed greater improvements. Shorter programmes yielded larger short-term weight loss, while longer programmes supported more sustained effects. Narrative synthesis indicated improvements in emotional and external eating, with increased mindful and restrictive eating behaviours.
ICBT improved weight, BMI, and depressive symptoms, with limited evidence for self-esteem. Male-tailored interventions and longer programmes may enhance sustainable outcomes.
Future ICBT programs should integrate strategies targeting sustainable weight loss and psychosocial well-being to support long-term outcomes.
Patients or members of the public were not involved, as this study synthesised previously published data.
PROSPERO registration number: CRD42024497961
The COVID-19 pandemic disrupted healthcare delivery worldwide, beginning in early 2020. While cardiac non-invasive testing (NIT) plays a critical role in the evaluation and management of cardiovascular disease, the population-level association of pandemic-related public health measures on cardiac diagnostics remains unclear.
To compare the rates and patterns of cardiac NIT before and after the implementation of the first and subsequent provincial COVID-19 lockdown measures.
A population-based and registry-based retrospective time series analysis conducted in Ontario, Canada, a single-payer healthcare system.
All individuals receiving transthoracic echocardiography, stress echocardiography, nuclear imaging, cardiac CT or cardiac MRI between 17 March 2018 and 16 March 2022.
Standardised weekly testing rates compared across pre-pandemic and pandemic intervals using ARIMA (autoregressive integrative moving average) modelling.
Among 5 269 897 cardiac tests performed, the cumulative rates decreased from 228.8 (95% CI 228.5 to 229.0) tests per 100 000 person-weeks in the pre-pandemic period to 204.3 (95% CI 204.0 to 204.5) tests per 100 000 person-weeks in the pandemic period (p
During the COVID-19 pandemic in Ontario, cumulative cardiac NIT rates declined significantly and did not fully recover by early 2022. The magnitude and patterns of these declines raise concerns about delayed cardiovascular diagnoses while also signalling a possible shift in diagnostic strategies. Efforts should prioritise preserving access to essential diagnostic testing during future health crises.
by Robin Devey-Burry, Julia Lukewich, Dana Ryan, Myuri Sivanthan, Maria Mathews, Marie-Eve Poitras, Cheryl Etchegary, Shabnam Asghari, Margot Antle
BackgroundFamily Care Teams were introduced in Newfoundland and Labrador (NL) as a strategy to strengthen primary care through team-based models that optimize interprofessional collaboration. Nurses, including nurse practitioners (NPs), registered nurses (RNs), and licensed practical nurses (LPNs), play critical roles in these models; however, little is known about nurses’ transition to these settings or the supports shaping their integration and effectiveness. To address this gap, we explored nurses’ experiences transitioning into Family Care Teams, including supports for integration and the barriers and facilitators influencing this process.
MethodsAs part of a qualitative descriptive study, we conducted semi-structured interviews with 25 nurses (6 NPs, 13 RNs, 6 LPNs) employed in Family Care Teams across five NL health zones. During the interviews, nurses described their experiences working in Family Care Teams, available practice supports, current roles, and barriers and facilitators to maximizing scope of practice. Interviews were transcribed and analyzed using qualitative content analysis and constant comparison.
ResultsParticipants described their transition to Family Care Teams in two stages: 1) orientation and 2) supportive learning relationships. Orientation was highly variable, ranging in length and structure. Learning in this area was often self-directed, technology-focused, and asynchronous, with limited emphasis on clinical preparation or role expectations. Mentorship and shadowing opportunities were inconsistently available, with many nurses lacking access to experienced role models within the newly established teams. These gaps contributed to role ambiguity, underutilization of nursing scope of practice, and prolonged adjustment periods.
ConclusionsOur findings reveal gaps in orientation and mentorship during nurses’ transition into Family Care Teams in NL. A common yet adaptable transition framework, expanded student placements, and structured mentorship are critical to optimizing nursing roles in team-based care. Strengthening practice supports and clarifying nursing contributions can improve access and care quality while informing broader initiatives to support nurses’ transition into primary care.
Introducción. Los planes de cuidados en enfermería (PCE) son instrumentos para documentar e informar las actividades de enfermería. Actualmente existen varias herramientas digitales totalmente de PCE (softwares y/o aplicaciones móviles).
Objetivo: Comprender los significados de las experiencias vividas por los profesionales de enfermería que laboran en servicios de hospitalización de unidades de segundo y tercer nivel de atención de Sevilla y Alicante (España) con el uso de herramientas informáticas de PCE.
Metodología: Se realizó un estudio fenomenológico en unidades de segundo y tercer nivel de atención en salud de Sevilla y Alicante (España). Mediante muestreo intencional se incluyeron 9 profesionales de enfermería de servicios de hospitalización. Los datos se obtuvieron en septiembre y octubre de 2023 mediante una entrevista semiestructurada y fueron analizados mediante un enfoque fenomenológico interpretativo.
Resultados: Se comprendieron las siguientes categorías descritas por los profesionales de enfermería: experiencias positivas tales como generación de Planes de Cuidados Estandarizados de Enfermería, experiencias negativas como ambigüedad de las herramientas informáticas e inadecuada accesibilidad a las herramientas y la propuesta ideal para desarrollar un software de Planes de Cuidados Individualizado de Enfermería (PCIE).
Conclusiones: Se lograron comprender los significados de las experiencias vividas de los profesionales de enfermería acerca del uso de las herramientas informáticas de PCE, las cuales posteriormente sirvieron para generar un software de PCIE que permita responder a las necesidades actuales en salud de individualizar el cuidado de enfermería.
FreshRSS 