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To explore healthcare professionals’ perspectives on the potential role of molecular breast imaging (MBI) for breast cancer imaging and to inform future clinical study design and implementation.
Qualitative interview study.
UK National Health Service (NHS) breast screening and diagnostic pathways.
Purposively sampled stakeholders.
Semistructured interviews with key professional stakeholders explored potential MBI pathways and routes to adoption, including barriers and facilitators. Data were analysed thematically.
22 participants were recruited between January 2020 and October 2021. Barriers to MBI adoption were identified at three levels: scan-related, system-level, and cultural within the screening programme. Overcoming these is likely necessary for implementation. A further theme highlighted the potential for MBI to improve screening in selected patient groups, contingent on addressing these barriers. Specifically, adoption would require advances in next-generation MBI systems, particularly reductions in radiation dose and scan time, alongside prospective clinical studies in UK populations to assess diagnostic accuracy.
Once identified barriers are overcome, participants perceived that MBI could improve screening pathways, particularly for women with dense breast tissue.
Although evidence on whether particular birthing positions offer advantages over others remains inconclusive, the majority of women give birth in the supine position. Earlier research associates maternal satisfaction with autonomy and active participation in choosing positions, irrespective of the clinical outcome. In practice, however, autonomy may be limited by the dynamics of labour, insufficient information and sociocultural norms. Against this background, the intervention aims to enhance maternal autonomy in childbirth through the provision of activating information materials and psychological nudges. Women shall be encouraged to explore various positions enabling them to autonomously choose positions that best align with their individual needs.
Using an exploratory pre-post design, this controlled intervention is carried out as a multicentre study in six German obstetrics departments. The intervention will include various ways to inform and nudge women to move and try out various positions autonomously during childbirth. Due to its minimally invasive character, it should easily integrate into organisational processes and everyday care. The primary endpoint of the study is the proportion of mothers who indicate that their final birthing position felt appropriate. Secondary endpoints include the proportion of upright positions as final birthing positions and maternal and neonatal health outcomes among others. Data sources include maternal longitudinal data, birth companions’ and midwives’/physicians’ perspectives as well as clinical sheets and aggregated comparisons.
This study obtained ethical approval from the Ethics Committee of the Medical Faculty of the University of Bonn and the Medical Chamber of Nordrhein (2025–325 BO). All study procedures will adhere to relevant data protection regulations. Dissemination of project information, materials and results will take place through the project homepage, social media and peer-reviewed journals.
DRKS00036899; (https://drks.de/search/en/trial/DRKS00036899/entails).
To explore women’s expectations and experiences of care and support from pregnancy to childbirth in Burkina Faso, with a focus on the role and impact of companions and providers.
An exploratory qualitative study based on in-depth interviews with purposively sampled participants and employing reflexive thematic analysis.
Two public hospitals in urban Burkina Faso having implemented the ‘QUALIty DECision-making by women and providers for appropriate use of caesarean section’ intervention.
24 purposively selected postpartum women with variation in terms of parity, mode of birth, labour companionship experiences, education level and occupation were interviewed before discharge from the hospital.
The two themes generated from the analysis elucidate how women rely on providers and companions to navigate uncertainty and vulnerability experienced during pregnancy and childbirth. Women viewed providers as essential for managing the biomedical risks of childbirth and voiced their need for care at critical moments. They expected companions to enhance the non-clinical aspects of their experiences by providing spiritual support and alleviating feelings of loneliness. However, participants also expressed ambivalence about companions witnessing intimate aspects of their birth experience and valued the ability to choose a companion as means to preserve personal integrity.
Both providers and labour companions play an essential role in enhancing women’s experiences of pregnancy and childbirth in Burkina Faso. Additional research and programmatic efforts are needed to support women’s equitable participation in patient–provider interactions and operationalise the notion of choice of a labour companion in a contextually appropriate manner.
Ear, nose and throat (ENT) conditions are highly prevalent in primary and secondary care, yet patients frequently face prolonged waits for specialist review. In England, over half of ENT patients wait beyond the NHS 18-week referral-to-treatment target. Many of these cases can be effectively managed with advice and non-surgical interventions, presenting an opportunity for remote service innovation.
This study aims to evaluate the clinical effectiveness, cost-effectiveness, acceptability and environmental sustainability of a digitally enabled remote ENT clinic model compared with traditional face-to-face pathways.
This single-centre, mixed-methods, prospective cohort study will be conducted at University Hospitals Birmingham NHS Foundation Trust. Remote clinics will use trained staff to collect diagnostic data (including endoscopic imaging and boothless hearing tests) for consultant review via secure cloud-based software. Quantitative analysis will assess patient outcomes, costs, waiting times, carbon footprint and satisfaction. Qualitative data from semi-structured interviews with patients, clinicians and managers will explore acceptability, scalability and barriers to implementation. The qualitative data will be analysed using the framework methodology, according to the non-adoption, abandonment, scale-up, spread and sustainability framework, while the strengthening the reporting of observational studies in epidemiology framework will be used to guide the reporting of quantitative data. Cost-effectiveness analyses will follow NICE guidelines, while environmental impact will be measurement will be informed by the sustainability in quality improvement framework. Recruitment will be aiming for 300 completed datasets and 30–35 interviews.
Ethical approval has been granted (IRAS 350908; REC 25/SW/0116). Findings will be disseminated via conferences, peer-reviewed journals and institutional communication channels.
To explore nursing professionals' perceptions of the intersectional positioning of their profession within healthcare and society, examining how axes of oppression shape healthcare responses and resource management.
A qualitative study framed in critical theory paradigm employing constructivist grounded theory, as outlined by Charmaz.
The study was conducted in Catalonia, Spain, between 2022 and 2023. A total of 26 nursing professionals participated, representing a range of professional roles and settings. Theoretical sampling guided participant recruitment and was saturated after 17 in-depth interviews and 2 thematic focus groups. Interviews and focus groups were transcribed verbatim. Thematic analysis, informed by Charmaz's approach, was applied to identify key dimensions and themes. Intersectionality theory was used as a critical analysis framework.
A predominant theme emerged from data identified as ‘intersectional disempowerment of nursing profession’. Four categories shape this positioning: (1) symbolic and historical undervaluation of care, rooted in nursing's feminization and patriarchal norms; (2) patriarchal influence on professional leadership, manifested by men disproportionately occupy leadership roles, reinforcing vertical segregation; (3) intra-professional hierarchies and technocratic influence, forcing prestige disparities within nursing and promoting horizontal segregation; and (4) internalised barriers among nurses regarding professional prestige, authority and recognition which combined undermine nursing's visibility, legitimacy and influence within healthcare.
Nursing cannot be understood as a neutral profession. Its societal positioning is deeply shaped by structural inequities, gendered assumptions and entrenched hierarchies, which collectively undermine its potential for autonomy and recognition.
This study highlights the need to challenge intersectional hierarchies in nursing, promoting equitable recognition, policy reforms and leadership opportunities to enhance nurses' authority, visibility and professional empowerment within healthcare systems. Addressing these challenges requires systemic policy reforms and a critical re-evaluation of societal perceptions. What problem did the study address? Nursing's social image is strongly shaped by biomedical, technocratic and social views. The gap between nursing's public image and identity limits professional growth and recognition. Analysing how power relations intersect in nursing's social position is essential. What were the main findings? Nursing's role is shaped by the intersection of gender, prestige, socioeconomic status and social recognition. Nurses' empowerment must be tied to transforming unjust institutions and systemic structures. Where and on whom will the research have an impact? This study provides a critical analysis of the intersectional positioning of the nursing profession. The findings have implications at multiple levels: micro, by offering nurses a critical perspective on their professional positionality; meso, by providing healthcare managers with insights into the underlying factors contributing to nursing's undervaluation; and macro, by fostering reflection within the broader healthcare community on the power dynamics shaping interprofessional relationships.
This study did not include patient or public involvement in its design, conduct, or reporting.
The manuscript is based on the Consolidated Criteria for Reporting Qualitative Research (COREQ).
To review the evidence on the experiences and perceptions of culturally and linguistically diverse informal carers supporting older adults during transitions from hospital to home, including their interactions with transitional care interventions.
Scoping review guided by Arksey and O'Malley's framework.
We searched CINAHL, MEDLINE, Embase, Emcare, AMED, PsycINFO, Global Health, Social Work Abstracts, JBI EBP, Scopus, Web of Science Core Collection, ProQuest and Informit for studies published between January 2010 and November 2024.
Two reviewers independently screened studies and extracted data. Analysis followed the Patterns, Advances, Gaps, Evidence for Practice and Research recommendations framework.
Seventeen studies involving 1275 carers were included. Carer experiences were summarised into four themes: (1) cultural and communication barriers; (2) role ambiguity and practical challenges; (3) limited involvement in discharge planning and (4) barriers to accessing support and services. Perceptions of transitional care interventions were mixed. While some interventions improved carer preparedness and reduced stress, most lacked cultural tailoring and did not address carers' psychosocial and communication needs.
Culturally and linguistically diverse informal carers face challenges navigating transitional care. While involving them in care planning improves outcomes, implementation remains inconsistent. Emotional support and culturally tailored services are insufficient.
There is a need for culturally and linguistically tailored transitional care programmes that prioritise carer education and communication support. Key areas for improvement include: (1) health literacy and system navigation; (2) involvement in care planning; (3) communication with providers; (4) psychosocial and emotional support and (5) culturally appropriate services. Future research should explore the unique emotional and psychosocial needs of these carers to inform targeted support strategies.
This review follows the PRISMA guideline for reporting.
No patient or public contribution.
Food retail outlets in sports and recreation facilities often fail to support healthy eating, despite aligning with healthy lifestyles and goals of local governments (LGs) that often own or manage them. LGs face barriers to implementing facility changes including inadequate staffing, training and incentives. The Promoting CHANGE initiative was co-designed to support LGs in improving and sustaining healthier food and drink offerings in these settings.
A 3-year, type 2 effectiveness-implementation hybrid cluster randomised controlled trial will evaluate the Promoting CHANGE capacity-building and support package in three Intervention and four Control LGs in Victoria, Australia (August 2023–July 2026). The co-designed initiative includes human resource support, training, tools, technical assistance, community-of-practice groups, feedback based on food outlet audit and sales data and small grant incentives. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework, the trial’s co-primary outcomes are the percentage of least healthiest food and drinks (1) displayed (implementation) and (2) sold weekly (effectiveness). Key secondary outcomes are effectiveness (sales and revenue); facility-level adoption, implementation, maintenance of healthy changes; cost-effectiveness (within-trial modelled economic evaluation). Findings will provide evidence of the initiative’s effectiveness and scalability, informing recommendations for advancing healthier food environments in over 6000 community-based food outlets across 500 Australian LGs, with implications globally.
This study has received approval from the Deakin University Human Research Ethics Committee (reference number HEAG-H 92_2023). The results will be published in scientific peer-reviewed journals along with plain language summaries for participants.
ACTRN12621001120864.
The Windrush Generation describes a group of individuals who migrated, primarily from the Caribbean to the UK between 1948 and 1971, many of whom are now entering older age. Now entering later life, many face ongoing health inequalities shaped by systemic racism and cultural marginalisation. Despite a growing number of ethnic minority residents in UK care homes, little is known about the lived experiences of Black African Caribbean people in these settings, particularly at the end of life.
This qualitative study explores the experiences of Black African Caribbean care home residents and their families, focusing on how race, identity and marginalisation shape care. Guided by the Silences Framework, semistructured interviews will be conducted with up to 16 participants across diverse care home settings. Data will be analysed thematically, with attention to under-represented narratives. A Patient and Public Involvement group of African Caribbean community members has codeveloped the study and will support analysis and dissemination to ensure cultural relevance.
Ethical approval has been secured (REC: 24/WM/0151; protocol number: RG_21087; IRAS project ID: 302629), and the study will follow rigorous consent and capacity procedures, including caregiver affirmation and UBACC assessment where needed. Given the sensitive, potentially distressing focus on racism, marginalisation and end-of-life experiences, the research will be conducted by an experienced clinician-researcher using a reflexive, ethically grounded approach that safeguards both participants and researcher. Interviews will be held in private, accessible settings with appropriate advocacy, safeguarding concerns will follow care home and national protocols, and all data will be securely stored, anonymised and managed under General Data Protection Regulation and university governance, with the University of Birmingham as sponsor and data controller.
The experiences of people from ethnic minority backgrounds living in care homes—A qualitative systematic review.
Despite the increasing need for older people from ethnic minority backgrounds to be able to access good quality, culturally competent care home provision, globally, there is an absence of literature exploring care home residents' perspectives. This study conducted a systematic review, identifying and synthesising qualitative evidence, which explored the experiences of residents', and their families, from ethnic minority backgrounds, who live in care home settings.
A qualitative systematic review.
Nine electronic databases, MEDLINE, Nursing and Allied Health, CINAHL, ASSIA, AMED, Sociological Abstracts, PsycINFO, Web of Science, SCOPUS, were systematically searched for research published after 2005 until 2025.
This systematic review of qualitative studies was conducted in accordance with The PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Studies were appraised for quality based upon validated critical appraisal tools from the Joanna Briggs Institute. Qualitative data were extracted and synthesised using reflexive thematic analysis.
Sixteen studies were identified from the international literature that explored care home experiences from the resident's and families' perspectives. Three key themes were extrapolated: Patter, which includes how cross-cultural communication skills and language affect care experiences; Place, which includes the care home environment, the multi-ethnic environment, and quality of care; and Person, which encompasses the individual's culture, values, beliefs, food, and family.
There is limited literature from the UK and low-to-middle income countries exploring care home residents' perspectives on care provision. Key components of culturally competent care include culturally sensitive communication, adaptable environments that support residents' chosen lifestyles, and inclusive, family-centred approaches to living well.
For nurses within the adult social care sector, to recognise the need for further research, education, and policy initiatives aimed at enhancing the care home provision for people from ethnic minority groups.
There was no patient or public contribution.
Depression and sub-diagnostic depressive syndromes are prevalent and associated with suffering and reduced life expectancy. Access to care is limited even in countries with developed healthcare systems. In this context, it is important to strengthen the self-management expertise of people suffering from depressive symptoms. Smartphones offer the possibilities for improved self-management based on long-term monitoring of symptoms.
The present multicentre randomised controlled trial (the Protecting mental health in times of change (MENTINA) trial) aims to evaluate whether (1) daily smartphone-based monitoring and automatic rule-based feedback+smartphone-based outcome evaluations versus (2) smartphone-based outcome evaluations alone will improve depressive symptoms and other clinically relevant outcomes in participants with current depressive symptoms and/or one or more prior depressive episodes during a 12-month trial period.
The MENTINA trial is a multicentre randomised controlled parallel-group trial conducted in Denmark, Germany and Spain. Participants with current depressive symptoms and/or one or more previous depressive episodes are invited to participate. The included participants will be randomised to (1) daily smartphone-based monitoring and automatic rule-based feedback+outcome evaluations via smartphone (intervention group) or (2) outcome evaluations via smartphone alone (control group). All participants can continue with ongoing treatment in case they receive it. The trial started in May 2025 and has currently included 115 participants. The outcomes are differences between the intervention group and the control group in (1) Patient Health Questionnaire 9-items (PHQ-9) measured every 14th day during the 12-month trial period (primary), (2) WHO Quality of Life-BREF, Generalised Anxiety Disorder-7, monthly change in PHQ-9, proportion of participants with ≥50% reduction in PHQ-9, remission rate defined as PHQ-9≤9 and ≥5-point improvement, PHQ-9 scores after 6 months, area under the curve for PHQ-9 over the 12 months trial period, subgroup analyses in PHQ-9 in participants with or without lifetime depression, Perceived Stress Scale, user-reported healthcare contacts, usability of the app and negative effects, number of depressive episodes+duration and depressive-free days based on PHQ-9. A total of 660 participants will be included in the MENTINA trial.
The MENTINA trial is funded by the European Union under Grant Agreement No. 101 080 651. Ethical approval and approval from Medical Agencies have been obtained from Denmark (CIV-25-02-051094), Germany (CIV-25-02-05109) and Spain (CIV-25-02-051094). The results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patients’ organisations and media outlets.
Version 6, January 2026.
The commercial determinants of health (CDoH) are a rapidly growing field of research and global health priority. Despite being disproportionately affected, Indigenous Peoples’ voices and perspectives are conspicuously absent from CDoH research and policy. This article outlines the protocol for Addressing Commercial Health determinants: Indigenous Empowerment and Voices for Equity (ACHIEVE), an Aboriginal and Torres Strait Islander-led project in Australia.
ACHIEVE integrates four research streams, using a novel combination of methods. The first three streams will (i) conceptualise the CDoH using Indigenous yarning methodology, (ii) evaluate the effectiveness and cost-effectiveness of policies to reduce exposure to harmful marketing and (iii) assess the impacts of specific commercial entities on Aboriginal and Torres Strait Islander health using case studies. The final stream will consolidate findings from streams 1–3 and work with Aboriginal Community Controlled Health Organisations (ACCHOs) to co-create strategies for addressing the commercial determinants of Aboriginal and Torres Strait Islander health.
Ethical approval for streams 1–3 has been granted by Deakin University Human Research Ethics Committee. ACHIEVE is guided by a governance model that prioritises Indigenous data sovereignty, community and ACCHO partnerships, capacity building and knowledge translation. Findings will be shared with participants, ACCHOs and policymakers to maximise research impact.
Outcome from large vessel occlusion stroke can be significantly improved by time-critical thrombectomy but treatment is only available in regional comprehensive stroke centres (CSCs). Many patients are first admitted to a local primary stroke centre (PSC) and require transfer to a CSC, which delays treatment and decreases the chance of a good outcome. Access to thrombectomy might be improved if eligible patients could be identified in the prehospital setting and selectively redirected to a CSC. This study is evaluating a new specialist prehospital redirection pathway intended to facilitate access to thrombectomy.
This study is a multicentre cluster randomised controlled trial with included health economic and process evaluations. Clusters are ambulance stations (or teams) which are work bases for ambulance practitioners. Intervention allocated ambulance practitioners use the Specialist PrE-hospital rEDirection for ischaemic stroke thrombectomY (‘SPEEDY’) pathway which comprises initiation according to specific criteria followed by contact with CSC staff who undertake a remote assessment to select patients for direct CSC admission. Control allocated ambulance practitioners continue to provide standard care which comprises admission to a local PSC and transfer to a CSC for thrombectomy if required. A co-primary outcome of thrombectomy treatment rate and time from stroke symptom onset to thrombectomy treatment will evaluate the impact of the pathway. Secondary outcomes include key aspects of emergency care including prehospital/hospital time intervals, receipt of other treatments including thrombolysis, and performance characteristics of the pathway. A broad population of all ambulance practitioner suspected and confirmed stroke patients across participating regions is being enrolled with a consent waiver. Data about SPEEDY pathway delivery are captured onto a study case record form, but all other data are obtained from routine healthcare records. Powered on a ‘primary analysis population’ (ischaemic stroke patients with pathway initiation criteria), 894 participants will detect an 8.4% difference in rate and data from 564 thrombectomy procedures will detect a 30 minute difference in time to treatment. The full study population is estimated to be approximately 80 000. Regression modelling will be used to examine primary and secondary outcomes in several analysis populations. The economic analyses will include cost-effectiveness and cost–utility analyses, and calculation of willingness to pay at a range of accepted threshold values. The process evaluation involves semi-structured interviews with professionals and patient/family members to explore views and experiences about the SPEEDY pathway.
This study has ethical, Health Research Authority and participating NHS Trust approvals.
Dissemination of study results will include presentations at national and international conferences and events, publication in peer-reviewed journals, and plain English summaries for patient/public engagement activities.
To explore and describe registered nurses' perceptions of the patient and clinician characteristics, healthcare systems, and processes that contribute to deterioration resulting in a Medical Emergency Team (MET) review.
An exploratory descriptive qualitative study using semi-structured interviews.
A purposive sample of experienced registered nurses from acute medical and surgical wards in a large teaching hospital in Melbourne, Australia was recruited from July to August 2018. Semi-structured interviews were conducted, guided by a semi-structured interview schedule. Interviews were analysed using the 7 steps of Framework Method analysis: transcription, familiarisation, coding, developing a working analytical framework, applying the analytical framework, charting data into the framework, and interpreting the data.
Twenty-one interviews were conducted with participants who had a median of 5.5 years' total nursing experience and 2 years' experience in their current ward. The major finding was The Downward Spiral of Clinical Deterioration theme characterised by a worsening spiral of clinical deterioration risk culminating in MET review. The Downward Spiral comprised four sub-themes: Physiological Age, not Chronological Age Matters; Delirium Demands Attention; Unclear Therapeutic Goals; 24/7 Risk in a 9-to-5 Service.
This integrates existing knowledge to explain how patient characteristics and healthcare systems and processes interact to contribute to clinical deterioration risk in the time between admission and MET review.
Identifying patients at increased risk of deterioration may assist with earlier, proactive intervention and improve patient outcomes associated with clinical deterioration in acute healthcare.
Recognising and responding to clinical deterioration remains a challenge in acute healthcare, associated with poor patient outcomes and consuming substantial resources. To date, registered nurses' perceptions of the factors leading to Medical Emergency Team review have not been described. The Downward Spiral of Clinical Deterioration describes how patient and clinician characteristics and healthcare systems and processes interact to increase clinical deterioration risk, culminating in Medical Emergency Team review. These findings may help researchers integrate disparate clinical deterioration models and concepts. Insights into how the safety of healthcare systems can be improved may assist administrators and clinicians in reducing the incidence of clinical deterioration in the future.
The study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ).
This study did not include patient or public involvement in its design, conduct, or reporting.
Binge drinking in the previous month was reported in 23.5% of US adults, and 28.1 million adults met criteria for Alcohol Use Disorder (AUD) in 2023. Individuals with AUD face increased risks of oral health problems, including caries, periodontal disease and mucosal lesions. Poor oral hygiene, nutrition and dental care all contribute to these conditions, but individuals with AUD are often under-represented in oral health surveys. Understanding relationships between oral health behaviours, attitudes and general health is crucial for designing future interventions. This pilot aims to explore the relationship between oral and systemic health in subjects with AUD, focusing on oral health behaviours, salivary biomarkers and clinical phenotype, including systemic biomarkers of inflammation, to inform future research on oral–systemic interactions in AUD.
This protocol has two parts. Part 1 involves cognitive interviews to assess the content validity and interpretability of the Oral Health Behaviours Assessment (OHBA) questionnaire. Part 2 will collect biological and behavioural data from treatment-seeking patients with AUD and matched controls (age, sex and smoking status), including saliva, blood, dental exams, and health behaviour and symptom measures. Inpatients with AUD will provide biospecimens and answer symptom severity questionnaires at admission and again at the dental exam visit (7–12 days later), while controls will provide a single set of measures at their dental exam visit. Oral health will be assessed through structured dental and periodontal examinations, radiographs and validated questionnaires (including the OHBA). Additional data will include alcohol use history, psychiatric and medical history assessments, dietary recall, and measures of stress, sleep and mood to capture potential moderators of oral–systemic relationships. Biomarkers of inflammation and stress will be quantified from saliva and blood using immunoassays. Primary outcomes will compare oral health, salivary biomarkers and clinical measures between AUD and controls, while secondary outcomes will evaluate within-subject changes in patients with AUD during inpatient treatment and early abstinence.
This clinical protocol was approved by the National Institutes of Health Institutional Review Board (IRB #002005). Prior to enrolling, participants will be informed of the study purpose, risks and benefits, and study procedures, and evaluated for understanding prior to signing consent. Part 1 of the protocol is currently active and recruiting participants for cognitive interviews. The study findings will be disseminated through journals and conferences related to addiction medicine, psychology, immunology, neuroscience and dentistry. We expect the results of the pilot study will inform future research on oral health and salivary bioscience while also providing treatment-seeking patients with AUD targeted information on the importance of oral health behaviours for maintaining oral and systemic health.
NCT06684483; preresults.
Artificial intelligence (AI) in healthcare often requires large, confidential clinical datasets. However, a recent UK government survey revealed that 20–40% of the public remain sceptical of its use in health research due to concerns about data security, patient–practitioner communication and commercialisation of data. A greater understanding of public attitudes is therefore needed, particularly in the context of stroke research.
In this article, we describe the patient and public involvement work undertaken for the AI-Based-Stroke-Risk-fActor-Classification-and-Treatment (ABSTRACT) project, which aims to train AI models to predict future stroke risk from the electronic health records of 1 18 736 patients.
We aimed to evaluate the opinions of stroke/transient ischaemic attack (TIA) patients, caregivers and members of the public on the following themes: (1) the acceptability of using AI to predict stroke from electronic health records, (2) obtaining these data using an opt-out model of consent and (3) allowing access to this dataset from members both within and outside of the routine clinical care team.
A total of 83 participants were recruited via the National Health Service social media and by approaching hospital inpatients. Participants were first provided with background information on stroke, AI in medical research and ABSTRACT’s proposed data handling protocol. A mixed methods approach was then used to explore each of the above themes using online survey, semistructured focus groups and one-to-one interviews.
Nearly all participants felt that it was appropriate to use patient data to train AI models to predict stroke risk and that it was acceptable to obtain these data via an opt-out model of consent. Almost all participants also agreed that data could be shared within and outside of the routine clinical care team, provided it was General Data Protection Regulation compliant and used for medical research only.
The public and those with lived stroke/TIA experience appeared to support using deidentified medical datasets for AI-driven stroke risk prediction under an opt-out consent model. However, this is provided that the research conducted is transparent, for a clear medical purpose and adheres to strict data security measures.
Transoral robotic surgery (TORS) is a minimally invasive technique for surgical removal of tumours of the tonsil and lateral oropharynx. Surgical defects after TORS lateral oropharyngectomy are traditionally left open to heal by secondary intention, resulting in significant postoperative pain and secondarily resulting in delayed swallowing and discharge. Although multimodal analgesia can improve postoperative pain control, no studies to date have assessed the impact of adjunct surgical interventions for reducing postoperative pain after TORS. Buccal fat rotation flap is a regional reconstruction option after TORS lateral oropharyngectomy and provides immediate coverage of the open surgical wound. However, the impact of buccal fat rotation flap reconstruction on postoperative pain and swallowing remains unclear. This trial aims to compare postoperative pain outcomes in patients who undergo TORS lateral oropharyngectomy with and without buccal fat rotation reconstruction.
This protocol outlines a single centre, parallel, unblinded, phase II, randomised control trial. Inclusion criteria include adult patient (≥18 years) undergoing TORS lateral oropharyngectomy for early to intermediate stage tonsillar squamous cell carcinoma (T1-2N0-1 p16+/–) or early to intermediate stage salivary gland tumours of the palatine tonsils. Exclusion criteria include a history of prior head and neck squamous cell carcinoma, prior head and neck radiotherapy, retropharyngeal lymphadenopathy, bilateral lymphadenopathy, need for bilateral neck dissection, baseline trismus, opioid use or drug addiction, need for open surgery (transcervical lateral oropharyngectomy), free tissue transfer, or alternative regional flap, and pregnancy. All patients are planned for a TORS lateral oropharyngectomy. The intervention group will have a buccal fat rotation flap reconstruction, and the control group will be allowed to heal via secondary intention. The allocation sequence will be created using a computer-generated random sequence with a permuted block strategy. The allocation sequence will be concealed until the time of assignment. The primary outcome is postoperative pain intensity during rest and swallowing using the visualised analogue scale. Secondary outcomes include postoperative complications, other adverse events, patient-reported speech and swallowing, opioid usage, length of hospital stay, feeding tube dependence and blood glucose levels. The trial has a target sample size of 40 patients. Statistical analysis of the primary outcome will be analysed in an intention to treat analysis using a linear mixed effects model.
The study was approved by the University Health Network Coordinated Approval Process for Clinical Research. Study number CAPCR ID: 24-5894. All participants will be required to provide written informed consent to participate. Findings will be presented at national conferences and published in medical journals.
Police are frequently dispatched to a wide range of 911 calls, including mental and behavioural health crises, despite lacking the training, resources and time to respond effectively. In particular, people with serious mental illness are at elevated risk of experiencing excessive use of force, arrest and continued criminal legal involvement following police contact. Following the murder of George Floyd and other highly publicised police killings, Community Safety Response (CSR) programmes, staffed by unarmed peers, mental health professionals and other trained responders, have proliferated to provide non-police responses to mental and behavioural health and other quality-of-life concerns. CSR programmes have expanded rapidly, yet the evidence base remains fragmented and largely outside the peer-reviewed literature.
This scoping review will synthesise peer-reviewed and grey literature from 2020 to present on CSR programmes operating in North America. Guided by Joanna Briggs Institute methodology and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards, we will search multiple databases (Medline, PsycINFO, Embase, SocIndex, Web of Science, Policy Commons) and employ complementary grey literature search strategies, including targeted website searches, reference tracking and review of internal and external reports and evaluations. Inclusion criteria require that programmes provide non-police first response to calls traditionally served by law enforcement and include information on programme operations or outcomes. Two reviewers will independently screen and extract data on process metrics including operational characteristics, dispatch, funding, services provided and outcomes such as populations served, diversion from police, service linkage and use of force.
No ethical review for this study is required as it will not include human subjects or any identifiable information. Findings will provide the first national synthesis of CSR programme models, operations and outcomes. Results will inform policy-makers, practitioners, researchers and community members. Findings will be disseminated through peer-reviewed publications and public-facing products to support implementation, scale-up and sustainability of CSR programmes.
In low-income and middle-income countries, significant geographical and socioeconomic inequalities affect access to eye care. This study explores an equity-focused approach to improve access to eye care services provided by a community-based eye care organisation in northern India.
A sequential exploratory mixed-method approach.
A high-volume eye screening programme in north Indian villages. Individuals identified with eye care needs during the screening were referred to the six nearby primary eye care centres.
7578 individuals identified with eye needs through a community-based eye screening programme. Of these, 4431 (58.6%) were women and 3137 (41.4%) were men.
Socioeconomic questions, developed by experts and lay representatives, were integrated into an ongoing digitally supported (Peek Vision) eye screening programme in north Indian villages. Data from referred individuals identified with eye needs were analysed using logistic regression with a mixed-effect model to identify socioeconomic characteristics most strongly associated with poor access to care after referral. A sequential exploratory mixed-method approach, including in-person interviews and follow-up telephonic surveys of individuals with these characteristics, was used.
To identify barriers and gather suggestions for improving attendance from groups least likely to attend services.
Of 7627 individuals referred for eye care, 7578 (99.3%) participated in the study. Of those, 2937 (38.5%) attended the Vision Centre, to which they were referred. The least likely to attend were individuals aged >16, those with dependents, and those referred for non-cataract conditions. Among the 3939 individuals with all three characteristics, the attendance rate was 35.3% compared with 42.5% (p
Suggested programme improvements, including better counselling, reminder calls and transportation, could increase access among those least likely to access services after referral. This study demonstrates a two-step approach for identifying solutions from individuals facing the most significant barriers to care. We will go on to conduct trials of these suggested interventions.
To co-develop storyboards and scripts for multimedia resources to support the information needs of informal carers (carers) of older adults from Greek, Italian and Chinese (Cantonese- and Mandarin-speaking) Australian backgrounds during hospital-to-home transitions.
A modified experience-based co-design methodology was used to co-develop four storyboards and scripts with Greek, Italian and Chinese Australian carers and advocates from multicultural community-aged care organisations. To promote relevance, a Carer Advisory Group guided the research. The Carer Advisory Group, comprising 10 people, included carers and advocates from participating multicultural community-aged care organisations, a social worker from a large public health service, and policy representatives. Twenty-nine participants took part from June 2023 to April 2024. Data collection involved two rounds of co-development including 2 workshops, 9 small group interviews and 11 individual interviews. Round 1 focused on understanding participants' experiences of older adult care transitions, information needs and advice for other carers. This information was used to develop categories and example quotes to draft four storyboards reflecting participants' descriptions of the carer and patient journey during care transitions. Round 2 involved draft storyboards being presented to the same participants who advised on their acceptability. Certified interpreters and translators were used throughout data collection.
The co-developed categories, four storyboards and scripts are presented. Participants and the Carer Advisory Group agreed that the findings would be used to develop multimedia resources to support the information needs of carers and older adults from Greek, Italian and Chinese Australian backgrounds in care transitions.
The storyboards and scripts for multimedia resources are expected to improve access to information and services for carers and older adults from culturally and linguistically diverse backgrounds. The storyboards and scripts are examples to guide policymakers and leaders in improving transitional care in Australia and internationally.
The reporting of the study has adhered to the COREQ guidelines.
Informal carers were involved in the Carer Advisory Group which provided guidance and consultation to each phase of the project. Their contributions included reviewing the ethics application prior to submission for ethical review, and reviewing storyboards and scripts to optimise the relevance for informal carers and older adults.
Implementation science research increases the uptake of evidence-based interventions, which may improve health equity among racial and ethnic minorities. However, it is unclear how anti-racism and anti-colonialism practices have been integrated into implementation science research. The objectives of this scoping review are to describe the current conceptualisations of racism and colonialism within the USA, examine racism or colonialism-conscious approaches and analyse gaps in the operationalisation of anti-racism or anti-colonialism within implementation science studies.
This scoping review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guidelines. The Center for Chronic Disease Reduction and Equity Promotion Across Minnesota conceptual framework and an implementation science anti-racism lens will guide the study design and analysis. To determine study eligibility for the scoping review, articles will undergo abstract and full-text screening by two independent reviewers and discrepancies will be settled together. Data charting will be extracted from included articles by eight independent reviewers. The search strategy will use controlled vocabulary and natural language keywords related to health equity, health disparities and anti-racism/colonialism on six databases. The scoping review will include studies that applied implementation science theories, models or frameworks among US-based populations. Additionally, included studies will report any of the following implementation activities: implementation strategies, implementation outcomes, adaptations to evidence-based interventions, or evaluations of pre-implementation or implementation context.
No ethical approval was required for the scoping review. Dissemination will be through publication in a peer-reviewed journal and conference presentations.
FreshRSS 