To determine the prevalence of potentially inappropriate prescribing (PIP), potentially inappropriate medication (PIM), potential prescription omission (PPO), potentially harmful drug–drug interactions (PDDI) and identify associated factors among older Ethiopians.

Systematic review and meta-analysis

We searched PubMed, HINARI, Scopus and Web of Science databases to identify eligible studies published up to 31 October 2025.

Observational studies reported the prevalence of PIP, PIM, PPO and PDDI among older adults from any healthcare settings were screened.

Two independent reviewers selected studies, extracted data and assessed the risk of bias. The quality and risk of bias of the studies were assessed using the Newcastle-Ottawa scale and Hoy risk of bias tool, respectively, while the certainty of evidence of outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation based on Cochrane recommendations. We used a random-effects model for analyses to estimate the pooled prevalence and associated factors. All data analyses were done using Stata V.17 software.

The national prevalence of PIP, PIM, PPO and PDDI was estimated as main outcomes. Variations were estimated based on regions, age groups, outcome evaluation tool, disease type and healthcare setting.

The review included 25 studies (n=5662 participants) for PIP or PIM, 14 studies (n=2706 participants) for PDDI and 6 studies (n=1342 participants) for PPO. The pooled prevalence estimate was 41% (95% CI 33% to 48%), I²=96.87% for PIP, 37% (95% CI 31% to 44%), I²=96.33% for PIM, 55% (95% CI 36% to 73%), I²=99.00% for PDDI and 14% (95% CI 6% to 24%), I²=95.07% for PPO. The majority of the studies have very good quality (very good=13, good=1, satisfactory=11 for PIP and PIM; very good=11, satisfactory=3 for PDDI; very good=6 for PPO) and low risk of bias (low risk=18, moderate risk=7 for PIP and PIM; low risk=12, moderate risk=2 for PDDI and low risk=6 for PPO), while all studies for each outcome have low certainty of evidence. Subgroup analyses revealed significant regional and contextual variations. Polypharmacy was significantly associated with PIP (OR=3.72, 95% CI 2.53 to 5.46, p2=69.56%), PIM (OR=4.20, 95% CI 2.91 to 6.06, p2=57.83%) and PDDI (OR=4.51, 95% CI 3.05 to 6.69, p2=0.00%), while hypertension (OR=2.46, 95% CI 1.38 to 4.36, p2=0.00%) was associated with PIP.

This review found a high prevalence of PIP, PIM, PDDI and PPO among older adults in Ethiopia, with notable heterogeneity across regions. Polypharmacy was associated with PIP, PIM and PDDI, while hypertension showed association with PIP. Despite generally good study quality, the certainty of evidence was low for the included studies due to the cross-sectional design nature, with high heterogeneity. Therefore, these findings should be interpreted cautiously. This study indicates a high burden of inappropriate medication prescribing and its associated factors, underscoring the importance of further robust studies to clarify prescribing practices and associated factors.

CRD42024556744.

Stroke is one of the top causes of disability in Malaysia, yet caregivers have limited access to structured, culturally tailored education to support poststroke care.

To develop and validate the CaknaStrok Education Package (CEP), a blended learning intervention comprising a printed guidebook and a trilingual mobile health application for informal stroke caregivers in Malaysia.

Methodological study involving the development and validation of a caregiver education programme guided by the Analyse, Design, Develop, Implement, Evaluate (ADDIE) instructional design framework.

Development and validation were conducted in Malaysia between January 2022 and December 2023. Both experts and caregivers were recruited from two tertiary hospitals on the East Coast of Malaysia, with caregivers identified from inpatient wards and outpatient clinics at these hospitals.

Content validation involved 10 multidisciplinary experts. Face validation involved 14 informal stroke caregivers who met eligibility criteria, and all completed the study.

CEP was developed based on prior needs assessment and expert input. Content validation was undertaken using the Content Validity Index (CVI) and face validation using the Face Validity Index (FVI), both assessed on a four-point Likert scale. Qualitative feedback was also obtained from the participants.

CEP consists of six modules delivered via a printed guidebook and a trilingual app with videos, assessment tools and local resources. Experts rated the content highly valid (Scale-level (S)-CVI/the average method (Ave): 0.97–0.99 across domains). Caregivers reported strong acceptability (S-FVI/Ave: 0.95–0.99). Qualitative feedback from experts and caregivers informed refinements to content clarity, usability and presentation, including improved navigation, consistent language use and enhanced visual design. Suggestions requiring substantial structural changes were documented for future iterations.

The CEP shows strong content and face validity as a blended caregiver education tool. By combining printed and digital formats, CEP addresses cultural and access challenges and provides a scalable model for stroke caregiver education in Malaysia. Further pilot or feasibility studies are warranted to evaluate usability, engagement and implementation in real-world settings prior to effectiveness evaluation.

Artificial intelligence (AI) is rapidly evolving, offering an expanding suite of capabilities that go beyond the traditional focus on prediction and classification. Generative AI (GenAI) and agentic AI could create transformative practices to support real-world evidence (RWE) generation for health research by streamlining studies, accelerating insights and improving decision-making. However, there is no published overview available describing the range of applications in RWE generation. This review aims to describe where and how genAI and agentic AI are applied across the domains of healthcare research tasks for RWE generation. Additionally, to map applications by tasks and methods across the product lifecycle continuum, and to identify emerging gaps and opportunities.

This Living Scoping Review (LSR) will include studies reporting an application and/or evaluation of genAI or agentic AI applied to one or more RWE generation research tasks. Searches will be conducted in Embase, MEDLINE and additional sources (eg, grey literature). Citations will be independently screened by two human senior reviewers for a substantive training dataset and a commercially available screening algorithm (Robot Screener) will complete screening with a human reviewer. The LSR will include reports of studies (primary or reviews) describing and/or evaluating the application of any genAI model for RWE generation in healthcare, in English, published from 1 January 2025 to the date of search. Data will be extracted from all studies included in the LSR by one independent senior reviewer using a piloted template, with 10% quality check by a second senior reviewer. Descriptive statistics will be used to summarise the applications of genAI per RWE research task, and the results of genAI evaluations. Thematic analysis will be used to describe genAI application patterns, trends, gaps and opportunities. The LSR protocol and reports will be updated annually, and findings will be published on a publicly available website (eg, ISPE—the International Society for Pharmacoepidemiology).

Ethical approval is not required due to use of previously published data. Planned dissemination includes peer-reviewed publication, presentation and short summaries.

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.

Adults living with chronic conditions may need to access health programmes to mitigate health-related challenges that persist long after discharge from the hospital. Community physical activity programmes represent critical opportunities for health promotion and chronic disease self-management that can extend beyond hospital-based services. However, navigating the healthcare system and connecting to much-needed physical activity programmes can be challenging due to fragmentation of the health and social care system, especially for those who are transitioning between different healthcare providers, settings, stages of recovery and funding sources (eg, public, private). Patient navigation services can assist with this fragmentation by providing tailored support to individuals with chronic conditions. However, our understanding of patient navigation services in Canada is limited. This rapid review seeks to explore the landscape of patient navigation services supporting Canadians with chronic conditions in connecting to physical activity programmes in the community.

The rapid review will follow the recommendations published by Garritty et al in 2024. Integrated Knowledge Translation will be employed to facilitate meaningful engagement of people with lived experience of chronic conditions throughout the entire research process. Studies published in English that examine patient navigation services in physical activity for community-dwelling Canadians with chronic conditions will be included. Ovid MEDLINE, Embase, Emcare, CINAHL and Google Canada will be searched for articles published from 1990 to May 2025 to identify the characteristics, strengths and limitations, and prioritised features of patient navigation services for community physical activity programmes. The Mixed Methods Appraisal Tool will be used to assess the quality of included studies.

This protocol is a rapid review of published literature and does not require ethical approval. Review findings will be disseminated to various key interest groups through publications, presentations, infographics, social media posts and/or videos.

https://osf.io/gd2zm.

Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record accident and emergency attendances, persistent breaches of ambulance response targets and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as same-day emergency care, virtual wards and specialty hubs—to manage these pressures and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.

The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages: (1) National service mapping—outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders. (2) Quantitative analysis—quasiexperimental and longitudinal approaches will use National Health Service (NHS) England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance. (3) Qualitative case studies—up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use and the workforce. Findings will be integrated using the Consolidated Framework for Implementation Research to identify components of UEC models that are effective, scalable and sensitive to local context,

Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.

Research Registry (researchregistry11126).

To examine differences in physical health conditions among female veterans compared with male veterans and female civilians.

Cohort analysis using data from the UK Biobank, incorporating self-reported and hospital-derived health information.

Veteran status was identified using Standard Occupational Classification codes. The study included female veterans (n=546), male veterans (n=2722) and female civilians (n=66 305).

Physical health conditions were identified through self-report and hospital records. Multivariable logistic regression models estimated associations between veteran status and selected health conditions, adjusting for age, sociodemographic factors, time in service, body mass index and current smoking status.

Compared with female civilians, female veterans had increased odds of chronic obstructive pulmonary disease (adjusted OR (aOR) 1.79, 95% CI 1.04 to 3.08) and lower odds of hypertension (aOR 0.74, 95% CI 0.59 to 0.93), with no significant difference in musculoskeletal conditions or osteoarthritis. Compared with male veterans, female veterans had significantly higher odds of osteoarthritis (aOR 1.61, 95% CI 1.25 to 2.08), migraine (aOR 2.63, 95% CI 1.66 to 4.19) and thyroid disorders (aOR 4.42, 95% CI 2.83 to 6.89).

Female veterans have distinct physical health profiles, including a greater burden of musculoskeletal and respiratory conditions compared with male veterans and female civilians. These findings highlight the need for targeted prevention and clinical interventions for women with a history of military service.

International guidelines on breast cancer (BC) screening have differing recommendations leading to uncertainty on best practices for primary care providers. The purpose of this study was to create a Canadian best practices document on BC health and screening for primary healthcare providers through multidisciplinary consensus using Nominal Group Technique and Delphi method.

A 9-member multidisciplinary expert group and a patient advocate participated in the consensus methods and voting. Experts included those involved in BC management and two primary care physicians. Twenty-nine experts across BC disciplines participated in external review.

Two study objectives included (1) building consensus on key ‘best practice’ behaviours related to BC-related health and screening and (2) building consensus on specific definitions related to BC screening.

The final consensus document consists of 65 statements grouped in five categories with companion resources to support uptake of all best practices. Categories include identification and work-up for diagnostic imaging, risk factors and identifying individuals eligible for high-risk screening, shared decision-making, decisions and referrals for BC screening and screening outcomes. Special areas of focus were shared decision-making, age to initiate screening, and BC screening in special populations.

We created a comprehensive consensus document distilling the latest evidence to provide practical Canadian consensus-based advice on specific ‘best practice behaviours’ related to BC health and screening to serve as a resource for providers.

Non-communicable diseases (NCDs) are rapidly escalating in developing countries and social factors such as the dynamics of the family play an important part in the lifestyle choices that lead to the onset and maintenance of chronic illness. There remains a gap in Malaysia as the majority of the studies were focused on the normal population rather than directly towards persons having NCDs. This study aimed to examine emerging risk factors such as family functionality and its association with NCD.

A cross-sectional survey was conducted using a multistage random sampling method.

Urban residential areas in Selangor, Malaysia.

A total of 2542 adults residing in urban areas of Selangor were recruited.

Family functionality was measured using the APGAR (Adaptation, Participation, Gain or Growth, Affection and Resources) scale and multiple logistic regression was performed to measure the association between emerging risk factors and NCD.

The prevalence of diabetes mellitus and hypertension was 10.8% and 6.1%, respectively. Widowed/separated status (adjusted OR (AOR) 41.53, 95% CI 19.06 to 90.48, p value=0.001) was reported to be a predictor of diabetes. As for hypertension, familial functionality (AOR 4.2, 95% CI 1.11 to 14.50, p value

There is a growing concern that family functionality is an emerging risk factor for NCDs. Future family-centred health promotion programmes should be incorporated to improve self-management behaviours and health outcomes.

Clinical learning is central to undergraduate nursing education, with preceptors translating theoretical knowledge into practical competence. Preceptors’ clinical teaching behaviours (CTBs) shape students’ confidence, skill development and professional identity. While CTBs have been studied globally, evidence from Pakistan is limited, highlighting the need for research that offers a comprehensive, integrated perspective.

To investigate preceptors’ CTBs by evaluating students’ perceptions, exploring preceptors’ experiences, and integrating these insights to identify points of agreement and discrepancy for a thorough understanding of CTB.

Convergent mixed-methods study, with quantitative and qualitative data collected concurrently, analysed independently, and integrated using the Pillar Integration Process.

A tertiary teaching hospital in Islamabad, Pakistan, providing clinical placements for undergraduate nursing students.

All undergraduate nursing students (n=50) engaged in clinical practicum and their preceptors (n=14) were included through census sampling. Students completed the CTB Inventory (CTBI) following student-preceptor interactions. Preceptors participated in semistructured face-to-face interviews.

Quantitative data from 44 undergraduate nursing students, based on 88 student–preceptor encounter observations, showed generally positive ratings of preceptors’ CTBs across all six CTBI domains (mean scores range: 3.48–3.97 on a 5-point scale). The highest-rated domain was guiding interprofessional communication (M=3.97, SD=0.89), with 85.2% of students agreeing that preceptors demonstrated professional role modelling. The lowest-rated domain was showing concern and support (M=3.48, SD=0.89), with only 31.8% of students agreeing that preceptors expressed concern about students’ lives outside work. Qualitative interviews with 14 preceptors identified six categories reflecting clinical teaching practices, including commitment to teaching, learning environment creation, instructional strategies, communication facilitation, feedback and evaluation, and supportive behaviours. Integration of quantitative and qualitative findings yielded six overarching themes, demonstrating convergence in professional role modelling, structured teaching, scaffolded learning, feedback and communication practices. Divergence was observed in the area of personalised support, with qualitative findings explaining lower quantitative ratings through heavy workloads, competing clinical responsibilities and limited protected teaching time.

Preceptors play a critical role in shaping undergraduate nursing students’ clinical competence and professional identity. Enhancing preceptor training, institutional recognition and supportive policies can strengthen teaching effectiveness and optimise student learning outcomes.

Solid organ transplantation is a cornerstone of care for end-stage organ disease and a critical consideration for all doctors managing chronic conditions such as chronic kidney disease. Transplantation is wholly dependent on organ donation (both living and deceased), with shortages directly limiting access to life-saving therapy and resulting in preventable mortality for patients on waiting lists. Yet undergraduate exposure to organ donation and transplantation (ODT) across UK medical schools is anecdotally poor and not mapped nationally. The most substantive UK evidence is more than two decades old and demonstrates limited exposure and significant knowledge gaps among final-year medical students.

We here describe a protocol for two coordinated national surveys: U-KNOW-RT (Understanding and Knowledge of Renal Transplantation; final-year students) and U-TEACH-ODT (Undergraduate Teaching in ODT; educator leads). Together, these will provide the first UK-wide mapping of undergraduate ODT education, generating contemporary evidence on teaching provision, student exposure, knowledge, attitudes and career intentions. This work will directly inform the design of a standardised national ODT teaching module to ensure that all UK medical graduates attain a core level of literacy in ODT. Survey distribution is scheduled for January 2026, with completion expected by summer 2026.

We will conduct two parallel cross-sectional online surveys. U-KNOW-RT will recruit final-year medical students from all 44 UK medical schools via social media, institutional channels and student societies. U-TEACH-ODT will invite deans and senior curriculum leads. The student target is ~1200 responses (≥10 per school) to enable national mapping and triangulation with educator reports. Analyses will follow the Consensus-Based Checklist for Reporting of Survey Studies and the Checklist for Reporting Results of Internet E-Surveys reporting frameworks. Prespecified outcomes include student knowledge, exposure and attitudes alongside educator-reported curricular provision. Primary analyses will use mixed-effects regression with school-level clustering, agreement between student and educator reports will be quantified and selected items will be readministered to allow 20-year comparisons with legacy surveys.

This study involves human participants and was granted ethical approval by the University of Sheffield Ethics Department (reference 070914) on 25 November 2025. Participants provided informed consent before taking part. This manuscript reports a study protocol only; no results will be reported. Findings will be disseminated through peer-reviewed publications, conferences and feedback to medical schools and national bodies. De-identified data, questionnaires and analysis code will be shared openly on Open science framework.

OSF preregistration (DOI 10.17605/OSF.IO/38W5N).