Despite efforts to implement lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) inclusive practices to address health disparities faced by LGBTQ+ individuals, factors that facilitate the uptake of these practices remain underexplored. Informed by the Consolidated Framework for Implementation Research (CFIR), this study explores nurse leaders’ perspectives across diverse US healthcare systems regarding the facilitators and barriers to implementing LGBTQ+ inclusive practices.

We used a qualitative descriptive design. Semistructured interviews guided by the CFIR framework were conducted from October to December 2023. The data were analysed using thematic analysis.

Diverse healthcare settings (eg, acute care hospitals and public health centres) across the USA.

We purposively recruited 21 nurse leaders, such as chief nursing officers or chief nurse executives, who oversee nursing strategy, staffing and quality across their organisations.

Consistent with prior frontline-focused studies, nurse leaders confirmed key inner setting and individuals facilitators (eg, LGBTQ+ specific training, electronic health record adaptation, visible executive engagement). Our findings add system-level detail from an executive perspective. Leaders identified actionable levers such as establishing LGBTQ+ clinical and social services, allocating protected time and budgets, and deploying dedicated implementation teams. We also identified a cross-cutting barrier: a reactive, crisis-driven organisational culture that hinders proactive inclusion efforts. Beyond the organisation, sociopolitical and legal climates shaped readiness and resourcing, with anti-LGBTQ+ laws influencing inclusion initiatives. Finally, nurse leaders highlighted the need for rigorous multilevel evaluation (eg, patient, staff, institution) and noted that common surveys inadequately capture LGBTQ+ inclusion, revealing measurement gaps that impede continuous improvement.

Implementing LGBTQ+ inclusive practices in healthcare is essential for optimal health outcomes and social justice. Understanding the context of implementation at multiple levels is crucial. Future research should focus on testing implementation strategies, developing inclusive healthcare surveys, and supporting the role of organisational culture and leadership in promoting LGBTQ+ inclusivity.

To determine progression in adult patients with early-stage chronic kidney disease (CKD) attending tertiary hospitals in Dodoma, Tanzania.

Prospective longitudinal study.

This study was conducted in two tertiary hospitals in Dodoma, Tanzania.

The population in this study was adult patients aged ≥18 years with early-stage CKD who were attending nephrology and medical outpatient clinics at Benjamin Mkapa Hospital and Dodoma Regional Referral Hospital, which are tertiary hospitals in Dodoma, Tanzania, from November 2020 to March 2022. Inclusion criteria included: patients aged ≥18 years of age, attending the clinic for at least 3 months with baseline clinical data on their files, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² and who gave a written informed consent. A total of 352 patients were enrolled, of whom 182 were males and 170 were females.

The dependent variable in this study was CKD progression, which was assessed after 12 months of follow-up.

A total of 352 participants with a median age of 54 (47–59) years were enrolled; the prevalence of progression of early-stage CKD was 28.0% (97/346). For patients with CKD progression, the baseline median eGFR was 43 (41–49) mL/min/1.73 m², urine protein creatinine ratio was 0.099 (0.025–0.158) mg/g, and haemoglobin was 11.7 (9.7–12.6) g/L. Of the patients with CKD progression, 75.3% (73/97) had diabetes mellitus, 72.2% (70/97) of the patients had hypertension, 58.8% (57/97) of the patients had significant proteinuria, and 58.8% (57/97) of the patients had anaemia. Variables associated with CKD progression after multivariate logistic regression analysis were; diabetes mellitus (OR=7.02, 95% CI 3.01 to 16.39, p=0.001), use of local herbs (OR=27.98, 95% CI 11.08 to 70.70, p=0.001), anaemia (OR=2.49, 95% CI 1.32 to 4.68, p=0.005), proteinuria (OR=7.51, 95% CI 3.49 to 16.19 p=0.001). Half, 52.5% (51/97) of the patients with CKD progression were found to have left ventricular hypertrophy (LVH), 26.8% (26/97) of the patients had evidence of coronary artery disease (CAD) on non-invasive testing, and 11.3% (11/97) of the patients died during the study period.

A substantial portion of adult patients with early-stage CKD were found to have progression after 12 months of follow-up. Diabetes mellitus, proteinuria, anaemia and use of local herbal medicines were significant predictors for CKD progression. Of the patients with CKD progression, more than half of the patients were found to have LVH, almost one third of the patients had evidence of CAD on non-invasive testing, and few patients died.

Osteoarthritis (OA) is a degenerative and progressive joint condition causing pain and disability. Physical exercise is recognised as the most effective intervention since individuals with this condition often experience muscle weakness, balance deficits and chronic pain. Additionally, knee osteoarthritis (KOA) is associated with central sensitisation, contributing to chronic pain conditions. Transcranial Direct Current Stimulation (tDCS), a non-invasive neuromodulation technique, has been employed to induce changes in pain perception by altering cortical excitability, potentially reducing chronic pain.

This is a protocol for a randomised controlled trial. Participants will be allocated to two groups: G1 (active tDCS combined with exercise) and G2 (sham tDCS combined with exercise). The intervention protocol will last for 5 weeks, with two sessions per week on non-consecutive days. Pain intensity will be assessed as the primary outcome using the Numeric Rating Scale (NRS). The sample size was calculated based on a minimum clinically important difference of 3 points on the NRS between groups, with a statistical power of 80% and a significance level of 5%. Secondary outcomes will include physical function and global perceived change.

This protocol was approved by the Research Ethics Committee of the Trairi School of Health Sciences, Federal University of Rio Grande do Norte (Approval Number: 6.801.827), and it is in accordance with the Declaration of Helsinki for human research. Results will be published in peer-reviewed journals and presented at scientific events. This trial is registered in the Brazilian Clinical Trials Registry.

Brazilian Clinical Trials Registry (RBR-5pb2g33).