Walking, as a simple, low-cost and easily implemented form of exercise, offers multiple health advantages. The WalkLung trial aims to evaluate the efficacy of a home-based walking exercise and education intervention in promoting early functional recovery after lung cancer surgery.

WalkLung is a multicentre, parallel-group, randomised controlled trial conducted at three hospitals in China, with stratification by study centre. A total of 116 patients with postoperative lung cancer will be randomised in a 1:1 ratio to either the intervention group (home-based walking exercise and education for 4 weeks) or the control group (usual care). The primary outcome is the longitudinal walking difficulty score during the 4-week postdischarge, measured by the validated perioperative symptom assessment for lung surgery scale (0–10 scale), assessed at discharge and weekly for 4 weeks. Secondary outcomes are the 6-min walk test, pulmonary function, complications, physical activity level, quality of life, social functioning, exercise adherence and adverse events. Long-term outcomes (up to 6 months) will be analysed and reported separately. All analyses will use an intention-to-treat approach, with outcome measures analysed as appropriate using generalised estimating equations for repeated measures, and t-tests or ² tests.

Ethical approval was obtained from the Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital (No. SCCHEC-02-2025-091) and all participating subcentres. Written informed consent will be obtained from all participants. The manuscript is based on protocol V.1.0 (2 January 2025). The study findings will be disseminated through peer-reviewed journal publications and conference presentations.

ChiCTR2500103081.

Individuals experiencing moderate to severe mental illness have low rates of workforce inclusion, with a consequence of high welfare dependency, affecting both societal costs and health. Individual Placement and Support (IPS) is an approach to supported employment where the goal is to help people obtain jobs on the open rather than sheltered labour markets. Despite multiple randomised controlled trials (RCTs) indicating that the IPS model enables employment better than treatment as usual, with widespread adoption in some jurisdictions, the broader impacts of this large-scale implementation on mental health, quality of life and social functioning remain unknown.

Between 2012 and 2019, Norway introduced IPS through both local and national government projects. This study assesses the social and economic benefits of the implementation of IPS using Norwegian registry data, focusing on 18–45-year-old people receiving specialist mental healthcare, and who did not have steady employment at treatment start. Instead of assessing IPS efficacy in an RCT design, we use a naturalistic study design, evaluating IPS effectiveness by comparing aggregate population-level outcomes over time between areas where IPS was not available.

In work package (WP) 1, we mapped the availability and implementation of IPS across Norway. This involved analysing information on funding, resource and capacity levels to understand how IPS had been rolled out across the country. While completed, we include a description of WP1 here, as it informs WP2 and WP3. WP2 is an effectiveness evaluation investigating the population-level outcomes of implementing IPS, focusing on health, mortality, quality of life and social functioning. Finally, in WP3, we assess the financial implications of implementing IPS from a public purse perspective, synthesising data on resource use and costs of implementation with data from WP2.

Overall, we will examine the societal effects of IPS implementation on employment, welfare dependency, mental healthcare use, emergency care visits, self-harm and suicide, general mortality, crime and victimisation. Emphasis will be on long-term outcomes, and we will model the economic consequences of IPS. This study aims to inform policy making and strategies for implementing IPS at scale.

This is an effectiveness study using registry data. The Regional Committee for Medical Research Ethics Northern Norway, REK North has approved the use of registry data without informed consent for this project (approval number 134553).

The findings will be disseminated both in academic peer-reviewed journals, directly to informants in WP1, to the public through media and the project website, and at relevant conferences and seminars for specific relevant target groups.

Not applicable

Soft robotic gloves (SRGs) integrated with brain-computer interfaces (BCIs) have demonstrated potential in facilitating motor recovery after stroke by enabling active, intention-driven rehabilitation. Emerging evidence suggests that incorporating vibrotactile stimulation (VTS) into SRG-BCI systems may further enhance sensorimotor feedback. The objective of this study is to evaluate the therapeutic efficacy and underlying neural mechanisms of BCI-driven, intention-based glove activation compared with automated glove-assisted training, with VTS applied identically in both groups.

This multicentre, single-blind, randomised controlled trial will involve 48 post-stroke patients within 1 week to 3 months after stroke onset, with stratification by time since stroke during randomisation. Participants will be randomly assigned to either the BCI-SRG group (n=24) or SRG group (n=24). Both groups will receive identical VTS. Patients in the BCI-SRG group will actively initiate movements of the SRG through motor imagery, while those in the SRG group will receive automated glove-assisted training without BCI control. The intervention will be administered 5 days per week for 4 weeks. The primary outcome measure is the Fugl-Meyer Assessment of Upper Extremity. Secondary outcome measures include Wolf Motor Function Test, International Classification of Functioning, Disability and Health Generic Set, Barthel Index, Modified Ashworth Scale, Semmes-Weinstein Monofilament Test, as well as event-related spectral perturbation and event-related desynchronisation. All assessments will be conducted at both baseline and post-intervention.

Ethics approval of this study protocol has been obtained from the Ethics Committee of the First Affiliated Hospital with Nanjing Medical University (2025-SR-508). The findings will be disseminated through peer-reviewed journals, conference presentations and communication with scientific, professional and general public audiences.

ChiCTR2500106951.

During recovery from general anaesthesia with tracheal intubation, the tracheal extubation is a necessary step. 22% of anaesthesia-related complications occur after extubation. In a few patients, the hypoxic brain injury and death may occur. Inflation and suction techniques are two common techniques for tracheal extubation; however, it is unclear which technique is superior. In our practice, the suction tracheal extubation is typically performed via a suction catheter, and the tracheal and oropharyngeal secretions are often not completely cleared. Additionally, cough often occurs. When a suction catheter is substituted with a tracheal tube, the clearance of tracheal and oropharyngeal secretions seems to improve. In addition, even without prior tracheal and oropharyngeal suctions before tracheal extubation, the tracheal and oropharyngeal secretions can be effectively cleared when a tracheal tube is used as a suction catheter. This study was designed to investigate the use of tracheal tubes as suction catheters in awake suction tracheal extubation.

This single-centre, single-blinded, prospective, non-inferiority, randomised controlled trial will include 600 patients (aged 18–65 years, American Society of Anesthesiologists score suction catheter, Suction_{tracheal tube-1} and Suction_{tracheal tube-2} groups. In the Inflation group, a positive airway pressure will be given via the anaesthesia machine during awake tracheal extubation. In the Suction_{suction catheter} group, negative pressure suction will be implemented during awake tracheal extubation by inserting a suction catheter into the trachea. In the Suction_{tracheal tube-1} and Suction_{tracheal tube-2} groups, negative pressure suction will be applied during awake tracheal extubation by directly connecting the tracheal tube with a negative pressure suction device. In the Inflation, Suction_{suction catheter} and Suction_{tracheal tube-1} groups, the tracheal and oropharyngeal suctions under anaesthesia state will be carried out before cuff deflation and removal of the tracheal tube. In the Suction_{tracheal tube-2} group, the tracheal and oropharyngeal suctions will not be performed. The primary outcome is the incidence of blood oxygen saturation

This study was approved by the Ethics Committee of Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzho University of Chinese Medicine (Permit No. K2022-162-01, Chairperson Professor Mingzhen Xu) on 17 October 2022 and was registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/usercenter.aspx) on 18 November 2022 (identifier ChiCTR2200065904). The study results will be disseminated through peer-reviewed journals, professional societies and meetings.

ChiCTR2200065904.

Cystic fibrosis (CF) is a life-shortening genetic disorder traditionally mischaracterised as affecting only populations of European descent. This framing has contributed to under-recognition of CF in African populations, despite emerging evidence of both common and region-specific cystic fibrosis transmembrane conductance regulator mutations across the continent. Diagnostic barriers, structural inequities and lack of surveillance further exacerbate disparities in care and visibility.

This scoping review aims to characterise CF in African populations by synthesising evidence on clinical presentation, diagnostic practices, genotypic diversity, prevalence and structural barriers to care. We will include case reports, cohort studies, registry analyses and other primary data sources involving individuals of African descent with suspected or confirmed CF. Key outcomes include clinical phenotype, age at diagnosis, mutation profile, diagnostic testing access and mortality. Data sources include Ovid Medline, Embase, Ebsco Global Health, CAB Abstracts and Web of Science Core Collection. Multiple-reviewer screening and extraction will be conducted. We will use narrative synthesis, thematic analysis and meta-analysis for prevalence where feasible.

No ethical approval is required as the review uses published data. Results will be shared with clinicians, researchers and CF networks in Africa and globally to inform diagnostic strategies and policy.

Dementia contributes to the disease burden worldwide, and people with hypertension or type 2 diabetes are at an elevated risk of developing dementia. It is essential to prevent or delay cognitive decline in people at high risk within the community. Our trials aim to evaluate the effects of adaptive cognitive training on community-dwelling older adults with hypertension or type 2 diabetes but no dementia.

Two multicentre, double-blind, randomised, placebo-controlled trials, named COgNitive Training in community-dwelling older adults at high risk for demENTia and with Hypertension (CONTENT-Hypertension) and COgNitive Training in community-dwelling older adults at high risk for demENTia and with Diabetes (CONTENT-Diabetes), will be conducted to investigate the effects of adaptive cognitive training on participants aged 60 years or above who have been diagnosed with hypertension or type 2 diabetes but no dementia. Each trial will enrol 120 participants. Participants will be recruited from the local community in Shijingshan and Haidian Districts, Beijing, and allocated to either the intervention or control group using a 1:1 ratio. The intervention group will engage in 12 weeks of adaptive cognitive training, while the control group will receive 12 weeks of placebo cognitive training. A 24-week follow-up assessment will be conducted for all participants to evaluate the persistence of the effects. The primary outcome is the 12-week change in Montreal Cognitive Assessment (MoCA) Basic scores from baseline to the end of the intervention (12 weeks). Secondary outcomes include 6-week and 24-week changes in the MoCA from baseline; 6-week, 12-week and 24-week changes in Trail Making Test-A&B (TMT-A, TMT-B), Digit Symbol Substitution Test, the WHO/University of California at Los Angeles Auditory Verbal Learning Test and Boston Naming Test scores of cognitive functions; 6-week and 12-week changes in Geriatric Depression Scale, Generalised Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index and 12-week change in blood pressure (CONTENT-Hypertension) or fasting blood glucose and glycated haemoglobin (CONTENT-Diabetes) from baseline.

This study will adhere to the ethical principles outlined in the Declaration of Helsinki and comply with international standards for Good Clinical Practice. All participants will sign the informed consent at baseline. This study has been approved by the Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (approval numbers: 2023-139 and 2024-162). The findings of the trials will be disseminated through publications in peer-reviewed scientific journals and presented at academic conferences.

NCT06512922 and NCT06524388.

Tuberculosis (TB) remains a globally concerning infectious disease, and significant challenges persist in attaining the 2030 targets set by the WHO. With the rapid advancements in computer-aided detection (CAD) technology, CAD-assisted Chest X-Ray (CAD-CXR) has been applied in TB patients triaging, but the practical application value of the CAD-CXR system in real-world primary healthcare settings in China for TB prevention and control has not been fully elucidated. This protocol reports a design of a cluster randomised controlled trial (CRCT), which aims to evaluate the effectiveness and clinical pathway of CAD-CXR in enhancing TB diagnostic yield in primary healthcare settings, thereby contributing to global TB elimination strategies.

Scheduled for September 2025, this CRCT will recruit 22 townships in Yichang of Hubei Province, China. These townships will be randomly allocated at a 1:1 ratio to either the CAD-CXR system intervention group or the control group. In the intervention group, healthcare providers will use the CAD-CXR analysis system to assist in TB screening, whereas the control group will rely solely on conventional CXR interpretation by radiologists. The primary outcome of the study is the TB diagnostic yield; the secondary outcomes include diagnostic delay duration and the accuracy of the CAD-CXR system. These metrics will be comprehensively evaluated to assess the effectiveness of the CAD-CXR intervention. Findings from this study are anticipated to offer evidence-based recommendations regarding the optimal application scenarios and implementation pathways for CAD-CXR.

This study was approved by the Ethics Committee of the Peking Union Medical College (CAMS&PUMC-IEC-2025-044). Findings of this study will be disseminated through traditional academic pathways, including peer-reviewed publications and conference presentations.

NCT06963606.

Some intensive care unit (ICU) patients develop an extremely deep and sustained immunosuppression that increases the risk of secondary infections and can ultimately compromise survival. Thanks to an easily accessible and simplified immune monitoring to identify immunological failure, a personalised immune restoration approach is now feasible. Among the different therapeutic strategies in this field, interferon gamma (IFN-) is probably the most interesting drug to reduce the burden of secondary infections in the ICU.

This is a two parallel group multicentre blinded add-on randomised trial comparing immunorestoration by subcutaneous injection of IFN- to standard of care in targeted ICU patients. The study will be performed in 23 ICUs in France. Patients hospitalised in the ICU for a week, with multiple organ failure defined by a sequential organ failure assessment score ≥6 during this first week, will be enrolled. If within 96 hours after inclusion, these patients express immunosuppressed features defined by a low absolute lymphocyte count (x10⁹/L) and low expression of human leucocyte antigen-DR (HLA-DR) on monocytes (13 500 antibodies bound per cell and an absolute lymphocyte count >1200 x10⁹/L) at day 10, healthcare costs at day 90 and rate of serious adverse reactions and suspected unexpected serious adverse reaction at day 90. We plan to randomise 326 patients.

The study will be implemented in accordance with European regulations and was independently reviewed and approved by the French Ethics Committee Comité de Protection des Personnes Ile de France III (EUCT number: 2024-516780-93-00). The results will be reported in international peer-reviewed journals and presented at international and national conferences.

NCT06774235.

To identify risk factors and develop an early prediction model for bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age (GA) under 32 weeks.

A single-centre, retrospective case–control study.

A tertiary neonatal intensive care unit in Fujian Province, China.

762 infants (GA under 32 weeks, survived beyond the corrected GA of 36 weeks) who were hospitalised in our department between January 2018 and December 2023.

None.

The primary outcome was the diagnosis of BPD at 36 weeks of corrected GA, with diagnostic criteria based on the 2018 criteria established by the National Institute of Child Health and Human Development.

A total of 762 infants was enrolled in the study, including 572 in the training cohort, among whom 138 (24.13%) had BPD. Multivariate logistic regression identified the following as independent predictors for BPD development: birth weight (OR=0.997, 95% CI 0.996 to 0.998, p

Higher chest X-ray scores within 7 days of life and extended invasive mechanical ventilation to day 7 after birth were significantly associated with BPD. The model had good predictive performance for predicting BPD using birth weight, chest X-ray scores within 24 hours of birth and at day 7 after life, and the state of invasive mechanical ventilation at day 7 after birth.

Psychosocial safety climate (PSC) is increasingly recognised as an important organisational resource for promoting mental health at work and preventing psychosocial risks, which are aspects of work design, organisation and management that could threaten employees' psychological or physical well-being. While substantial theoretical and empirical evidence supports the role of PSC as a protective factor, limited research has explored how PSC can be deliberately and sustainably enhanced through organisational interventions. This scoping review aims to map PSC-related interventions, synthesise how PSC is conceptualised and operationalised, and identify elements that studies have reported as contributing to strengthening PSC.

This scoping review will follow established methodological frameworks and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to systematically identify and synthesise studies describing organisational interventions related to PSC. A comprehensive search strategy will be implemented across several databases, including MEDLINE, PsycINFO, Web of Science, ABI/INFORM and Business Source Premier. Eligible studies must describe, implement or evaluate interventions explicitly targeting PSC. Data on intervention types, mechanisms, outcomes and contextual factors will be extracted and narratively synthesised to address the descriptive research questions and map how PSC interventions have been conceptualised and implemented across organisational contexts. This protocol does not involve human participants. The review is not yet registered. Findings will inform future research and organisational practices related to PSC-focused interventions.

This review involves analysis of published literature only and does not require ethics approval. Findings will be submitted to a peer-reviewed journal and presented at relevant academic and professional conferences. Results will be reported in accordance with the PRISMA-ScR guidelines and will inform the development of future organisational interventions aimed at enhancing PSC.

To evaluate the performance of Ghana’s environmental surveillance (ES) system for poliovirus (PV) detection from 2018 to 2022 using standardised indicators developed by the WHO and the US Centers for Disease Control and Prevention.

A retrospective performance evaluation using 10 key indicators benchmarked against global targets for PV surveillance.

Seven regions across Ghana, participating in the national ES programme implemented under the Global Polio Eradication Initiative.

Wastewater sampling was conducted at designated ES sites, supported by field collection teams and laboratory personnel responsible for sample acquisition, processing and reporting of PV detection results.

Detection rates of PV and non-polio enteroviruses (NPEVs), timeliness of sample collection and reporting, data quality and system stability.

A total of 738 wastewater samples were collected. The system demonstrated high sensitivity, detecting circulating vaccine-derived PV type 2 in 51 (6.9%) of samples, Sabin PV types 1 and 3 in 61 (9.5%) and 114 (17.8%), respectively, and NPEVs in 491 (66.5%) of samples. Over 80% of samples met the recommended 21-day collection-to-reporting time frame. Data quality exceeded the ≥80% threshold, and workflows remained stable throughout the evaluation period.

Ghana’s ES system for PV was found to be flexible, stable and effective in generating high-quality data for early detection and public health response. These findings underscore the system’s critical role in supporting polio eradication efforts and highlight its potential as a model for surveillance in similar settings.