To examine how clinicians’ scepticism regarding patients’ self-reports of subjective symptoms can be internalised, leading to psychosocial and medical harms.

In-depth, semi-structured qualitative interviews with the resulting data analysed using reflexive thematic analysis.

43 individuals with Ehlers-Danlos syndrome (EDS) from Europe and North America completed a pre-survey, and 39 of those participants completed interviews for this study. Purposive sampling was used to obtain approximately equal numbers of participants with hypermobile EDS and the molecularly defined types of EDS.

Patients with both hypermobile and molecularly defined types of EDS reported high levels of self-doubt, with 73% of survey respondents questioning the extent—and even reality—of their private experiences of pain. Participants attributed much of their self-doubt to repeated dismissal and minimisation of their symptoms in healthcare settings, especially during childhood. Ultimately, self-doubt transformed not merely how they communicated their symptoms but also how they recognised, evaluated and even experienced them at a phenomenological level. While some participants developed coping strategies, others withdrew from the conventional medical system altogether.

These findings have important implications for clinicians, who may inadvertently reinforce self-doubt through discussion of diagnostic uncertainty. Doubt need not be delegitamising. Recognising and mitigating these potential harms requires epistemic humility and attention to the psychosocial dynamics of patient-provider interaction.

The use of data science for health research produces complex ethical, legal and social challenges that traditional ethical oversight mechanisms struggle to address. In Nigeria, the current ethical guidelines were not designed for these challenges which include pervasive data environments, consent for secondary data use, algorithmic decision-making and bias, privacy risks, involvement of commercial entities, data colonisation, inequitable benefit-sharing and commercial data holdings. To address these gaps, we developed a draft guideline incorporating principles like trust, veracity, global justice and alternative ethical approval mechanisms. Here, we describe the protocol for a study aimed at validating the guideline through stakeholder consensus on the content, feasibility and acceptability of this subcode for national implementation.

We describe the use of a modified e-Delphi approach to iteratively synthesize expert opinions about ethical oversight for data science health research (DSHR) led by a multidisciplinary working group from the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI) team. We will invite 65 experts, including health researchers, ethics committee members, data scientists, health policymakers, funders and key opinion leaders in Nigeria to participate. Participants will rate 13 core principles, including global justice, algorithmic bias, data governance and related governance provisions on importance, desirability for inclusion in national guidelines, feasibility and confidence in implementation, using 5-point Likert scales, with optional free-text comments. We will summarise responses using descriptive statistics, assess consensus and polarity using pre-specified thresholds for the mean and IQR, and iteratively refine statements between rounds using qualitative content analysis of comments.

Ethical approval was obtained from the Nigerian National Health Research Ethics Committee and the University of Maryland IRB, and participants will provide informed consent. Results will be shared with the expert panel and national regulators and disseminated via publications and conferences.

Moral distress is a significant challenge in contemporary nursing practice, posing a substantial threat to nurses’ well-being and patient safety. Nurses in the emergency department are considered a high-risk group for experiencing this distress due to their unique working environment. Although numerous qualitative studies have explored this issue, a systematic synthesis of this fragmented evidence is notably absent. This qualitative meta-synthesis aims to integrate existing evidence to construct a comprehensive conceptual framework of the experiences, processes and coping mechanisms related to moral distress among emergency nurses.

This study will be a qualitative systematic review and meta-synthesis, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and the Joanna Briggs Institute (JBI) methodology. A systematic search will be conducted in international and Chinese databases, including PubMed, CINAHL, Embase, CNKI, etc. All peer-reviewed qualitative studies exploring the first-person experiences of emergency nurses will be included. Two independent reviewers will perform study selection, data extraction and methodological quality appraisal using the JBI Critical Appraisal Checklist for Qualitative Research. Data synthesis will employ a theory-integrated meta-aggregation approach, systematically mapping findings onto the Stress, Appraisal, and Coping Theory to construct a nuanced conceptual framework that explains the dynamic process of moral distress. Confidence in the synthesised findings will be assessed using the ConQual approach.

As this study is a secondary analysis of published data, ethical approval is not required. The findings will be disseminated through publication in a peer-reviewed journal and presentations at academic conferences.

CRD420251041396.

The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.

A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.

An ED in a tertiary hospital in western China.

2001 patients (aged ≥18 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.

The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.

Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p

Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.