Longitudinal studies provide insights into the outcomes of medical training curriculum. However, few educational cohort studies have been conducted in Iran. This study aims first to evaluate the impact of the current curriculum on medical students' medium- and long-term academic and career outcomes and, second, to identify medical students' characteristics and how they change through the doctor of medicine programme.

This protocol outlines a multi-phase, prospective cohort study that will take place in Mashhad, Iran. The study will implement the Kirkpatrick model, investigating medical students' knowledge, skills, behaviour and professionalism development over 10 years. Approximately 1000 medical students will be recruited through peer invitations and social networks. Data will be collected through baseline and follow-up questionnaires, academic performance records and comprehensive test scores throughout the Doctor of Medicine (MD) programme.

The data from the questionnaires will be reported using a Likert scale. Quantitative data will be described using means and SD, while qualitative variables will be presented as frequencies and percentages. We will evaluate the relationship between quantitative variables using correlation coefficients and the relationship between qualitative variables via the ² or Fisher exact test. All tests will be two-sided, with a significance level set as p

All participants will complete written informed consent before data collection. All students can withdraw from the study at any time with no consequences. Results of this study will be presented at relevant conferences and will be submitted for publication in peer-reviewed journals. This study was approved by the Ethics Committee of Mashhad University of Medical Sciences.

IR.MUMS.REC.1400.311.

Non-adherence to tuberculosis (TB) treatment remains a major challenge in high-burden regions. However, few studies have qualitatively examined the sociocultural and emotional barriers to adherence, particularly among Afghan refugees in Pakistan. This study explores the patient-related, sociocultural and treatment-related barriers to treatment adherence among patients with TB of Pakistani and Afghan origin living in Pakistan.

We conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) and in-depth interviews (IDIs) with purposively selected multisectoral stakeholders. The data were analysed thematically using a combination of inductive and deductive approaches.

We employed a qualitative study design in the TB DOTS (Directly Observed Treatment Short course) centres in the Haripur and Peshawar districts of Khyber Pakhtunkhwa province, Pakistan.

We conducted IDIs (n=29) and FGDs (n=11) with three categories of participants: TB healthcare providers, patients with TB and their carers.

We identified several contributors to lower treatment adherence. These included patient-related barriers (eg, lack of awareness about TB and its treatment), sociocultural barriers (eg, stigma, refugee status of Afghan patients, gender roles and reliance on traditional and spiritual healing) and treatment-related barriers (eg, demanding treatment regimen and TB-induced depression).

Several personal, sociocultural and treatment-related barriers contribute to lower treatment adherence in patients with TB. A significant contributing factor to treatment non-adherence in patients is the high prevalence of anxiety and depression related to TB and its treatment, for which there is no treatment or counselling available at the DOTS level in Pakistan, warranting the need for mental health interventions that could improve adherence and treatment outcomes for both TB and depression.

ISRCTN10761003.

To evaluate temporal trends in the epidemiology of hip osteoarthritis (OA) in the USA from 1990 to 2019, with stratification by sex and geographic region.

Cross-sectional time-series analysis using secondary data from the Global Burden of Disease (GBD) study.

US population-based analysis, stratified by the four US Census Bureau regions: Northeast, Midwest, South and West.

De-identified, aggregate population-level data representing all adults in the USA from 1990 to 2019, drawn from the GBD database.

Age-standardised rates per 100 000 population for years lived with disability (YLDs), prevalence and incidence of hip OA. Outcomes were stratified by sex and region. Statistical significance was defined as p

Between 1990 and 2019, hip OA in the USA increased by 23.91% in YLDs, 24.67% in prevalence and 25.22% in incidence. In 2019, the mean YLDs were 28.30 in women versus 25.48 in men; prevalence was 49.55 versus 41.08; and incidence was 919.29 versus 818.10 (all p

There has been a substantial rise in the burden of hip OA in the USA over the past three decades. Women and residents of the Northeastern USA are disproportionately affected. These findings underscore the need for targeted public health strategies that account for geographic and sex-based disparities in hip OA burden.

Lower gastrointestinal symptoms attributed to colorectal disease are common. Early diagnosis of serious colorectal disease such as colorectal cancer (CRC), precancerous growths (polyps) and inflammation is important to ensure the best possible outcomes for a patient. The current ‘gold standard’ diagnostic test is colonoscopy. Colonoscopy is an invasive procedure. Some people struggle to cope with it and require intravenous sedation and/or analgesia. It is also resource-intensive, needing to be performed in specialist endoscopy units by a trained team. Across the UK, the demand for colonoscopy is outstripping capacity and the diagnosis of colorectal disease is being delayed. A colon capsule endoscope (CCE) is an alternative colorectal diagnostic. It is a ‘camera in a pill’ that can be swallowed and which passes through the gastrointestinal tract, obtaining visual images on the colon. There is now established experience of CCE in the UK. CCE might provide a less invasive method to diagnose colorectal disease if found to be accurate and effective and provide a means by which to increase the National Health Service (NHS) diagnostic capacity.

The aim of this study is to determine the diagnostic accuracy of CCE when compared with colonoscopy in representative and clinically meaningful cohorts of patients. An evaluation of the experiences of CCE for the patient and clinical team and an assessment of cost effectiveness will be undertaken.

We will undertake three research workstreams (WS). In WS1, we shall perform a paired (back-to-back) study. Each participant will swallow the CCE and then later on the same day they will have a colonoscopy. The study has been designed in collaboration with our Patient Advisory Group and as closely mirrors standard care as is possible. 973 participants will be recruited from three representative clinical contexts; suspected CRC, suspected inflammatory bowel disease and postpolypectomy surveillance. Up to 30 sites across the UK will be involved to maximise inclusivity. Measures of diagnostic accuracy will be reported along with CCE completion rates, number of colonoscopy procedures potentially prevented and adverse events, such as capsule retention. A nested substudy of intraobserver and interobserver agreement will be performed. WS2 will develop models of cost-effectiveness and WS3 will evaluate the patient and clinician experience, with reference to acceptability and choice.

The study findings will provide the evidence base to inform future colorectal diagnostic services.

The study has approval from the North East—Tyne and Wear South research ethics committee (REC reference 24/NE/0178, IRAS 331349). The findings will be disseminated to the NHS, National Institute for Health and Care Excellence, other clinical stakeholders and participants, patients and the public.

ISRCTN16126290.

This systematic review examined the prevalence of postpartum family planning (PPFP) uptake and its association with spousal discussion and husband’s support.

Systematic review and meta-analysis.

A comprehensive literature search was conducted across PubMed (NLM), Scopus (Elsevier), Web of Science (Clarivate) and Cochrane Library (Wiley).

The review included primary observational studies published in English between January 2014 and March 2024. Eligible studies reported prevalence and association between spousal discussion, support, approval or contraceptive use by the husband in PPFP within 12 months of childbirth.

Two reviewers independently screened the articles, performed data extraction and assessed the risk of bias using the Newcastle-Ottawa Scale and Appraisal Tool for Cross-Sectional Studies. Discrepancies were resolved through consensus. Random-effects meta-analysis estimated pooled prevalence, and pooled ORs of log odds were reported for the association between spousal discussion and partner approval and PPFP uptake.

Six cross-sectional studies involving 2856 postpartum women were included. The pooled prevalence of PPFP uptake was 35% (95% CI 19% to 52%). Meta-analysis showed that spousal discussion was associated with PPFP uptake (log OR=1.39 (95% CI 0.65 to 2.13), however, partner’s approval was not associated with PPFP uptake (log OR=1.49, 95% CI –0.08 to 3.06). Two studies assessed partner support, with one reporting a significant association (log OR: 1.45); joint decision-making was assessed in two studies but showed no significant association with PPFP.

In conclusion, the overall prevalence of PPFP uptake is low. Spousal discussion plays a critical role in enhancing PPFP uptake. These findings highlight the need for policy initiatives and programmatic interventions that promote couple communication for PPFP decision-making to improve reproductive health outcomes in low–middle-income countries.

CRD42024505801.

Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern among the elderly, especially in low-income and middle-income countries such as Iran. This study aims to explore the prevalence and patterns of polypharmacy among the elderly in Iran, using health insurance claims data to identify common drug classes and coprescribed medications, with a focus on informing policy decisions and improving medication management.

Retrospective population-based observational study.

Nationwide data from the Iran Health Insurance Organization (IHIO) across 24 provinces.

1 876 527 individuals aged 65 years and older, insured by the IHIO from 2014 to 2017. Individuals with incomplete demographic information or lacking medication records in the database were excluded from the analysis.

Prevalence and patterns of polypharmacy, demographic factors associated with polypharmacy, and common drug classes used. Medications were classified using the Anatomical Therapeutic Chemical system. Polypharmacy was defined as the use of five or more medications, with cumulative polypharmacy considering total drug use over time, and consecutive polypharmacy focusing on the frequency of monthly drug use. Logistic regression and association rule mining were applied to explore demographic factors and medication patterns associated with polypharmacy.

Of the study population, 74.9% experienced cumulative polypharmacy over 6 months and 64.6% over 1 month, with 7.6% experiencing consecutive polypharmacy. Females and those aged 75–79 were more prone to polypharmacy. Systemic glucocorticoids were the most commonly used medications (50.02%), followed by HMG-CoA reductase inhibitors (42.73%) and platelet aggregation inhibitors (41.92%). Polypharmacy was most strongly associated with medications related to the alimentary tract and metabolism, cardiovascular system, nervous system and blood and blood-forming organs.

Polypharmacy is highly prevalent among the elderly in Iran, with significant variations by gender, age, insurance fund and region. The findings highlight the need for targeted interventions to manage polypharmacy and improve medication safety in this population.

Transitions from the emergency department (ED) to home are high-risk periods for medication-related harm. Pharmacist-led interventions during this period may improve medication safety and care continuity, yet co-design approaches to develop such interventions remain underused. The aim of this study is to co-design a pharmacist-led transition of care programme for patients discharged from the ED.

This study will be conducted at a 371-bed secondary-care teaching hospital in Qatar and will follow two sequential phases using qualitative and participatory methods. Phase I will involve focus groups and semistructured interviews with key stakeholders (clinical pharmacists, physicians, nurses and patients or patient representatives). Phase II will consist of an intervention co-design workshop with decision makers (leaders, policymakers and representatives from Phase I). Participants will be recruited using purposive and snowball sampling. Interviews will be audio recorded and transcribed verbatim. Data will be analysed using an inductive-deductive approach, guided by the Theoretical Domains Framework, the Care Transitions Framework and the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria for evaluation of intervention feasibility.

The anticipated outcome is a prototype intervention detailing target recipients, core components, workflow, implementation strategies and supporting tools. This prototype will be pilot-tested to assess feasibility and inform further refinement.

The study was approved by the Medical Research Centre of Hamad Medical Corporation-Qatar (MRC-01-24-699) and Qatar University Institutional Review Board (QU-IRB 009/2025-EM). Written informed consent will be obtained from all study participants prior to participation. Research findings will be disseminated through institutional stakeholder briefings, presentations at national and international scientific conferences and publication in peer-reviewed journals. Patient representatives will contribute throughout the intervention development process.

Admission to a surgical intensive care unit (ICU) following major surgery is associated with a number of discomforts, not only related to the disease itself but also to the care provided or the ICU environment itself (lights, sounds, pain, sleep deprivation, thirst, etc). This discomfort is real and can be associated with psychological consequences. We hypothesised that the use of immersive virtual reality (IVR) with HypnoVR is feasible and can help reduce discomfort in intensive care.

The ZION trial is a prospective, monocentric trial randomising 194 patients admitted to a surgical ICU after a major surgery. The inclusion criterion is patients admitted to a surgical ICU for at least 48 hours following major surgery (cardiac, thoracic or major abdominal surgery). Patients will be allocated to the intervention group (n=97) or the control group (n=97). In the intervention group, patients will receive IVR using HypnoVR two times a day during the ICU stay (2–5 days). In the control group, postoperative care will be conducted according to standard care without IVR. The primary endpoint will be the 18-item IPREA (Inconforts des Patients de REAnimation) questionnaire on the day of ICU discharge. The secondary endpoints will include intensity of discomfort symptoms (anxiety, pain, dyspnoea, thirst and sleep deprivation); the 18-Item IPREA Questionnaire assessed daily from randomisation to the V1 follow-up visit (ICU discharge); incidence of delirium; cumulative morphine consumption at ICU discharge; length of ICU stay and anxiety or depression at 1 month after discharge from intensive care and patient experience of device use.

Ethical approval was obtained from the institutional review board of the University Hospital of Amiens (Registration number ID: 2024-A01528-39) in January 2025.

NCT06830369.

Osteoporosis is a skeletal condition with decreased bone mass and structural deterioration, increasing fracture vulnerability. Several studies have found a correlation between prostate cancer in men and an increased risk of osteoporosis. This study aims to determine the prevalence of osteoporosis in patients with prostate cancer.

The primary objective of this study will be to estimate the prevalence of osteoporosis in prostate cancer survivor patients. An extensive search will be conducted on PubMed, Scopus, Embase, Web of Science, CINAHL and ProQuest databases to ensure comprehensive coverage. The search will encompass the timeframe from 1 January 1994 to 24 September 2024. Furthermore, we will not impose any limitations on the language or geographical location of the published studies. In order to assess the potential bias in the included studies, the Joanna Briggs Institute critical appraisal checklist for prevalence studies will be employed. The analysis of data will be performed using STATA V.17. The prevalence of osteoporosis or osteopenia will be calculated for each study by dividing the number of participants with these conditions by the total number of patients diagnosed with prostate cancer. A subgroup analysis will examine prevalence regarding geographical location, age groups, ethnicity, definitions and measurements of osteoporosis or osteopenia, risk of bias in the included studies, type and duration of androgen deprivation therapy, and site of osteoporosis diagnosis. We will employ multiple methods to detect publication bias, including funnel plot analysis, Begg’s and Egger’s tests, and the Trim and Fill method. If we have enough data, we will conduct a sensitivity analysis using the leave-one-out-remove method.

No ethical approval or patient consent is required as this study synthesises only published aggregate data. Results will be disseminated via a peer-reviewed publication.

CRD42024600884.

Marginalised populations—such as racialised groups, low-income individuals, newcomers and those in rural areas—disproportionately experience severe diabetes-related complications, including diabetic foot ulcers, retinopathy and amputations, due to systemic inequities and limited access to care. Although community-based programmes address cultural and accessibility barriers, their isolation from mainstream healthcare systems leads to fragmented care and missed opportunities for early intervention.

Artificial intelligence (AI)-powered technologies can enhance accessibility and personalisation, particularly for underserved populations. However, integrating AI into community settings remains underexplored, with socioethical concerns around inclusion, diversity, equity and accessibility requiring urgent attention.

This realist review aims to examine how, why and under what circumstances AI applications can be effectively integrated into community-based diabetic care for marginalised populations. The review will develop a programme theory to guide ethical, inclusive and effective AI implementation to ensure AI-driven innovations address health disparities and promote culturally sensitive, accessible care for all.

Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) extension for Reviews guidelines, this realist review will systematically search MEDLINE, Embase, CINAHL, Cochrane library, Google Scholar and Scopus, alongside grey literature. A two-stage screening process will identify eligible studies, and data extraction will use a developed tool. Synthesis will employ realist logic, analysing relationships between contexts (eg, organisational capacity), mechanisms (eg, AI functionalities) and outcomes (eg, reduced disparities).

Ethics approval is not required for conducting this realist review. Ethics approval will be obtained from the University of Toronto; however, following the completion of the realist review for patients and community members’ engagement to support knowledge mobilisation and dissemination to ensure practical application and reciprocity.

This protocol was registered at PROSPERO (CRD42025636284).