First post-contrAst SubtracTed (FAST) MRI, an abbreviated breast MRI scan, has high sensitivity for sub-centimetre aggressive breast cancer and short acquisition and interpretation times. These attributes promise effective supplemental screening. Until now, FAST MRI research has focused on women above population-risk of breast cancer (high mammographic density or personal history). DYAMOND aims to define the population within the population-risk NHS Breast Screening Programme (NHSBSP) likely to benefit from FAST MRI. The study population is the 40% of screening clients aged 50–52 who have average mammographic density (BI-RADS (Breast Imaging Reporting and Data System) B) on their first screening mammogram. DYAMOND will answer whether sufficient numbers of breast cancers, missed by mammography, can be detected by FAST MRI to justify the inclusion of this group in a future randomised controlled trial.

Prospective, multicentre, diagnostic yield, single-arm study with an embedded qualitative sub-study: all recruited participants undergo a FAST MRI. An internal pilot will assess the willingness of sites and screening clients to participate in the study. Screening clients aged 50–52, with a clear first NHSBSP mammogram and BI-RADS B mammographic density (by automated measurement) will be invited to participate (recruitment target: 1000). The primary outcome is the number of additional cancers detected by FAST MRI (missed by screening mammography). A Fleming’s two-stage design will be used as this allows for early stopping after stage 1, to save participants, funding costs and time continuing to the end of the study if the question can be answered earlier.

The NHSBSP Research and Innovation Development Advisory Committee and the Yorkshire and Humber–Sheffield Research Ethics Committee (23/YH/0268, study ID (IRAS): 330059) approved this research protocol. Participation involves a two-stage informed consent process, enabling screening for eligibility through automated mammographic density measurement. Patients with breast cancer helped shape the study design and co-produced participant-facing documents. They will disseminate the results to the public in a clear and meaningful way. Results will be published with open access in international peer-reviewed scientific journals.

ISRCTN74193022

This qualitative study aimed to address the following central research question: what are the key factors and behavioural trajectories influencing delayed medical care-seeking among participants with breast cancer-related lymphoedema (BCRL), and how do these factors operate across the stages of symptom perception, alertness and decision-making?

This qualitative study employed a phenomenological approach, with semistructured interviews conducted to explore participants' experiences.

A tertiary hospital located in North China.

18 patients with BCRL were recruited through purposive maximum variation sampling and interviewed in person between January and June 2023.

10 themes emerged and were categorised into three stages: (1) the perception stage (lack of disease knowledge, risk underestimation and symptom avoidance); (2) the alertness stage (failed self-management, negative coping and exposure to misinformation) and (3) the decision-making stage (financial burden, limited healthcare access, insufficient social support and fatalism). The average delay was 10.2 months, with prolonged delays (>12 months) linked to severe lymphoedema progression.

Delayed care seeking in BCRL is a multifactorial behavioural trajectory shaped by knowledge gaps, systemic barriers and psychosocial factors. Clinicians should prioritise early patient education and context-sensitive interventions to mitigate delays.

To investigate the educational value of combining intraoperative explanations with laparoscopic surgical video reviews for teaching the local anatomy of the stomach.

Thirty resident physicians undergoing standardised training in our hospital, including undergraduate resident physicians and clinical-type postgraduates in surgery who had not participated in radical gastrectomy for gastric cancer, were selected as study subjects. They were randomly divided into an experimental group and a control group, with 15 participants in each group. The experimental group received instruction through intraoperative explanations combined with laparoscopic surgical video reviews, while the control group participated in surgery without additional instructional methods. After the teaching sessions, both groups underwent clinical practice assessments, theoretical examinations and evaluations of teaching satisfaction. The distribution of the data was assessed using the Shapiro-Wilk normality test along with Quantile-Quantile plots. Two-way analysis of variance was employed to evaluate the main effects and interaction effects of clinical practice scores across different groups and student types. Statistical power was examined through post hoc power analysis.

The clinical practice assessment results, theoretical examination scores and teaching satisfaction ratings of the experimental group were significantly higher than those of the control group, with all differences reaching statistical significance (p

Combining intraoperative explanations with laparoscopic surgical video reviews for teaching local anatomy during distal gastrectomy is more effective than participation in surgery alone. This approach allows students to review surgical videos at their convenience, enhancing their understanding and mastery of local anatomical structures and significantly improving the quality of local anatomy education for resident physicians.

Adolescents and young adults (AYAs) represent a significant proportion of the global population, yet they face persistent barriers to accessing HIV services. In Sub-Saharan Africa, nearly 90% of AYA HIV cases occur within the region, with young women disproportionately affected. In Chad, while the overall HIV prevalence has declined, the risk remains high among AYA, accounting for 26.3% of all new infections. Stigma, lack of confidentiality, negative provider attitudes and structural barriers continue to hinder service utilisation, underscoring the urgent need for evidence-based, AYA-centred interventions. However, little is known about which attributes of HIV services AYA prioritise when accessing HIV care. This study applies a discrete choice experiment in Chad to systematically quantify AYA preferences for HIV services to inform the design of youth-responsive interventions.

The study employs a D-efficient fractional factorial design, developed through extensive qualitative research and pilot testing. The final design comprises 80 choice scenarios, divided into 10 blocks to reduce participant burden. The study will recruit 1000 AYA living with HIV aged 15–24 years across eight provinces, ensuring geographical and epidemiological representativeness. Participants will be randomly assigned to one of the blocks and complete eight choice tasks. Choice data will be analysed using conditional logit, mixed logit and latent class models to estimate trade-offs and preference heterogeneity.

Ethical approval was obtained from the National Committee on Bioethics of Chad (#010/MESRS/SE/SG/2024). In addition to disseminating findings through scientific publications, policy briefs and stakeholder engagements, the study will incorporate a codesign process with AYA, healthcare providers and policymakers to translate research findings into actionable interventions that align with AYA preferences and improve HIV service delivery.

Premature acute coronary syndrome (PACS) presents with a poor prognosis and significant risks. This study aimed to investigate the association between small-dense low-density lipoprotein cholesterol (sdLDL-C) levels and the severity of coronary lesions, as well as its potential role in risk stratification for PACS patients with multivessel disease (MVD).

Retrospective cross-sectional study.

First Affiliated Hospital of Xinjiang Medical University in China, between May 2022 and November 2023.

900 PACS patients with MVD confirmed by coronary angiography (CAG) and 600 age-matched and sex-matched controls with normal CAG results.

Patients with PACS and MVD were stratified by the Global Registry of Acute Coronary Events (GRACE) score, and sdLDL-C levels were compared among the different GRACE score groups. The association between sdLDL-C and the GRACE score was evaluated using Pearson’s correlation analysis. Multivariate logistic regression analysis was employed to identify factors associated with PACS and MVD. The discriminatory ability of sdLDL-C for PACS with MVD was assessed using receiver operating characteristic (ROC) curve analysis. Restriction cubic spline (RCS) analysis was used to examine the potential nonlinear association between sdLDL-C levels and the high-risk groups of PACS with MVD.

Patients with PACS and MVD exhibited significantly higher sdLDL-C levels compared with control group (p

Elevated sdLDL-C levels demonstrated a significant association with the risk of PACS and MVD. These findings indicate sdLDL-C may serve as a potential biomarker for risk stratification in this high-risk population. However, causal inferences require validation in prospective studies.

ChiCTR2300074166

To provide bottom-up guidance on improving post-COVID care using patients’ experiences with received care and their perceived health

Qualitative study design using focus group interviews

30 patients with post-COVID condition recruited through purposive sampling based on patient complexity and diversity

Three dimensions for potential improvements of post-COVID care were identified: (1) building, supporting and maintaining patient resilience, (2) redesigning healthcare pathways to meet patient needs and (3) embedding post-COVID care in health systems and organisations. A conceptual framework that could guide improvements in post-COVID care was developed.

This study revealed several opportunities for improving and implementing post-COVID care following a person-centred approach in multidisciplinary integrated care pathways with an integrative vision of health.

Acute decompensated heart failure (ADHF), characterised by rapid deterioration of cardiac function, imposes substantial clinical and economic burdens due to high mortality (10%), frequent rehospitalisations (30% within 3 months) and impaired health-related quality of life. While exercise-based cardiac rehabilitation (ExCR) is a guideline-recommended intervention for stable heart failure, its utilisation remains critically low (11%) in ADHF populations, particularly during the vulnerable period spanning 90 days post-discharge—a high-risk phase marked by elevated mortality and morbidity. Current evidence gaps persist regarding optimal ExCR timing, dosage and efficacy during this critical window. This randomised controlled trial investigates the feasibility and impact of early ExCR initiation in the ADHF vulnerable period, evaluating outcomes in physical capacity, cardiac function and quality of life to inform evidence-based exercise protocols for this high-risk population.

This prospective, non-inferiority, randomised controlled trial will recruit 88 patients with ADHF. Participants will be randomised 1:1 to a 12-week personalised ExCR group or a traditional health education-based CR control group. Assessments will occur at baseline and 1, 2 and 3 months. The primary outcome is the change in 6 min walk distance post-intervention. Secondary outcomes include changes in grip strength, New York Heart Association Classification(NYHA class), brain natriuretic peptide, left ventricular ejection fraction, hospital stay, Short Physical Performance Battery score, Activities of Daily Living, Minnesota Living with Heart Failure Questionnaire score, and frailty status. Safety measures include all-cause readmission and mortality within 3 months post-discharge, as well as adverse events during the trial.

The study protocol was approved by the Peking University First Hospital Ethics Committee (Approval No. 2024yan180-002) in accordance with the Declaration of Helsinki. All participants will provide written informed consent prior to enrolment. The findings will be disseminated via peer-reviewed publications and conference presentations.

This study protocol was registered at ClinicalTrials.gov (Identifier: NCT06795737, https://www.clinicaltrials.gov/.) on 26 January 2025.

The purpose of this article is to share insights from the National Institute for Health and Care Research Clinical Research Network (NIHR CRN) in delivering research for Multiple Long Term Conditions (MLTC) and to highlight lessons of wider relevance across the research ecosystem.

Designing health and care systems to be more responsive to the needs of people living with MLTC requires a considerable evidence base. When compared with research focused on a single disease area, research relating to MLTC raises unique considerations at the stages of planning, placing, and delivering research studies. Our article describes challenges associated with MLTC research outcomes and outlines different types of interventions to target MLTC, along with related research delivery considerations. Our article also raises important considerations for placing research in the most appropriate setting and highlights the vital role of robust feasibility studies, informed by the lived experience of patients and carers with MLTC, for ensuring that studies are conducted, recruited to, and completed in a timely and appropriate way.

Increasing the evidence base for the prevention and management of MLTC is a necessity for our health and care system. This presents novel challenges that require collaboration between multiple stakeholders. The UK benefits from a unique research infrastructure, including support for the stages of planning and delivery of health and care research. As the health and care system moves towards bringing care closer to patients and service users, the appropriate selection of the health and care settings and research sites in which to deliver MLTC research, in addition to understanding and removing barriers to recruitment and participation for people with MLTCs, are important considerations to enable us to collectively respond to this challenge.

Although emerging evidence supports the short-term efficacy of transcranial magnetic stimulation (TMS), including repetitive TMS (rTMS) and theta-burst transcranial magnetic stimulation (TBS-TMS), and transcranial direct current stimulation (tDCS) for managing patients with chronic musculoskeletal pain (CMP), their clinical utility in managing CMP remains inconclusive. This uncertainty may arise from methodological limitations, including heterogeneity in treatment parameters such as stimulation targets and dosages. Additionally, safety profiles for these non-invasive brain stimulation interventions in patients with CMP remain insufficiently reported, with limited data on adverse events, cumulative risks and long-term safety outcomes. Hence, in this scoping review protocol, we aim to systematically (1) identify and map the stimulation targets and dosages of TMS and tDCS used in previous studies to treat patients with CMP; (2) summarise the rationale for using the stimulation targets and dosages of TMS and tDCS; and (3) summarise the reports on the safety of TMS and tDCS in managing patients with CMP, including whether safety was reported and how it was described.

We will adopt Arksey and O’Malley’s methodological framework and report findings according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two authors will independently screen articles and extract data from PubMed, Scopus, Web of Science and Embase, including publications from inception to 1 August 2025. Discrepancies regarding study inclusion will be resolved through consultation with a third author. We will synthesise results using descriptive statistical methods.

This scoping review does not require ethical approval. The findings will be disseminated through presentation at national or international conferences and peer-reviewed publication.

Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/8HFBZ).

The choice of anaesthetic agents may influence specific aspects of postoperative recovery, such as haemodynamic stability, recovery times and the incidence of adverse events, in patients undergoing day-case laparoscopic cholecystectomy. Propofol is widely used in total intravenous anaesthesia (TIVA) for its favourable recovery profile, while etomidate, valued for its haemodynamic stability, is less commonly used due to concerns about adrenal suppression. This study aims to compare etomidate-based and propofol-based TIVA on postoperative quality of recovery in patients undergoing day-case laparoscopic cholecystectomy, hypothesising that etomidate is non-inferior to propofol.

A multicentre, double-blind, randomised controlled non-inferiority trial was conducted to compare the effects of etomidate vs propofol for TIVA on postoperative quality of recovery in patients undergoing day-case laparoscopic cholecystectomy. A total of at least 336 participants were enrolled and randomly assigned to either the etomidate or propofol group in a 1:1 ratio, stratified by site. The primary outcome was quality of recovery on postoperative day 1, quantified by the Quality of Recovery-15 questionnaire. Non-inferiority between the groups was determined using a margin of –6 points and a 95% CI. Secondary outcomes included perioperative haemodynamic stability, recovery times (eg, response to verbal commands, time to extubation and duration of postanaesthesia care unit stay), postoperative complications (eg, hypoxaemia, nausea/vomiting, delirium) and patient-reported outcomes such as pain, satisfaction and quality of sleep. Long-term outcomes included quality of life at 6 and 12 months, assessed using the 36-Item Short Form Health Survey.

This study was approved by the Ethics Committee of Nanjing University Medical School, Drum Tower Hospital (No. 2024-371-04) and registered in the Chinese Clinical Trial Registry.

ChiCTR2400087413.

To investigate the knowledge, attitudes and practices (KAP) regarding deep vein thrombosis (DVT) among patients presenting with lower limb swelling and pain and their accompanying family members. A secondary objective was to compare KAP levels between these two groups and identify predictors of higher KAP.

A cross-sectional survey study.

The study was conducted in various hospital wards and outpatient clinics at a single tertiary academic hospital (Zhongshan Hospital, Xiamen University) in Xiamen, China, from October 2023 to May 2024.

A total of 725 participants were recruited using convenience sampling, comprising 358 patients presenting with lower limb swelling and pain and 367 accompanying family members. Key inclusion criteria were age of ≥18 years and the ability to provide informed consent.

Primary outcomes were KAP scores measured by a validated, self-designed questionnaire. Scores ≥70% of the maximum possible score for each domain were defined as adequate knowledge (≥16.8/24), a positive attitude (≥19) and proactive practice (≥30.4). Secondary outcomes included the comparison of KAP scores between patients and family members and the identification of factors associated with higher overall KAP levels using multivariate logistic regression analysis.

Of 725 participants, both patients and family members demonstrated inadequate mean knowledge scores (10.62±4.71 and 11.88±4.95, respectively, below the adequacy threshold of 16.8), though mean attitude and practice scores were above the positive/proactive thresholds. Family members had significantly higher scores than patients across all domains: knowledge (mean difference: 1.26, p

Patients presenting with lower limb symptoms and their families possess inadequate knowledge about DVT, despite generally positive attitudes and proactive practices. Family members represent a key resource with significantly better KAP than patients. Targeted educational interventions, focusing on individuals with lower educational levels and non-medical backgrounds, are crucial to improve DVT awareness and facilitate timely medical consultation.

Neonatal death and later disability remain common sequelae of hypoxic-ischaemic encephalopathy (HIE) despite the now standard use of therapeutic hypothermia (HT). New therapeutic approaches to brain protection are required. Melatonin is an indolamine hormone with free-radical scavenging, antiapoptotic, anti-inflammatory and gene regulatory neuroprotective properties, which has extensive preclinical evidence of safety and efficacy. Pharmacokinetic (PK) data suggest it is necessary to reach melatonin levels of 15–30 mg/L within 6–8 hours of hypoxia-ischaemia for brain protection. We developed a novel Good Manufacturing Practice (GMP) grade melatonin in ethanol 50 mg/mL solution for intravenous use. In preclinical studies, ethanol is an adjuvant excipient with additional neuroprotective benefit; optimised dosing protocols can achieve therapeutic melatonin levels while limiting blood alcohol concentrations (BACs).

The Acute High Dose Melatonin for Encephalopathy of the Newborn (ACUMEN) Study is a first-in-human, international, multicentre, phase 1 safety study of intravenous melatonin in babies with moderate/severe HIE receiving HT. Sixty babies will be studied over two phases: a dose escalation study including four dose levels to establish the recommended phase 2 dose (RP2D), followed by a 6-month cohort expansion study of RP2D to further characterise PKs and affirm safety. Participants will receive a 2-hour intravenous infusion of melatonin within 6 hours of birth, followed by five maintenance doses every 12 hours to cover the period of HT. Plasma melatonin and BACs will be monitored. The RP2D will be based on the attainment of therapeutic melatonin levels while limiting BACs and the frequency of dose-limiting events (DLEs). A Bayesian Escalation with Overdose Control approach will be used to estimate the risk of DLE per dose level, with a target level of

Approval has been given by the London Central National Health Service Health Research Authority Ethics Committee (25/LO/0170) and UK Clinical Trials Authorisation from the Medicines and Healthcare products Regulatory Agency. Separate approvals have been sought in Ireland and Australia. Dissemination will be via peer-reviewed journals, conference presentations, public registries and plain language summaries for parent/legal guardian(s), in accordance with national requirements.

ISRCTN61218504. EU CT: 2025-520538-49-00.

Publication based on the UK protocol V.3.0, 08 May 2025

To identify the factors influencing professionals’ implementation of the National Institute for Health and Care Excellence (NICE) guidelines on self-harm.

A rapid review evidence synthesis

Five electronic databases (ASSIA, CINAHL, EMBASE, MEDLINE, PsycINFO) and five indexing databases (Science Citation Index Expanded (SCIE), Social Sciences Citation Index (SSCI), Arts and Humanities Citation Index (AHCI), Emerging Sources Citation Index (ESCI) and Conference Proceedings Citation Index (CPCI)), using the Web of Science platform, were searched in December 2023 and repeated in July 2024.

We included quantitative and qualitative studies that investigated professionals’ knowledge and implementation of NICE guidelines on self-harm, that were in English language and published between 2004 and July 2024.

One reviewer used standardised methods to search, screen, select, quality assess and synthesise the included studies, to accelerate the review. Quality assessment was conducted using the Mixed Methods Appraisal Tool. Data were extracted and synthesised thematically using NICE guidance implementation priorities.

The review included 10 studies. Six were conducted in accident and emergency (A&E) settings, two in general practice, one in a burns and plastic surgery hospital department and one involved cross-sectoral health professionals. Key findings indicate that awareness and implementation of self-harm guidelines is low among health professionals. Systemic barriers include lack of staff training, negative staff attitudes towards people who self-harm and lack of resources.

There is a need to develop and implement regular training on self-harm, incorporating NICE guidance and measures, to integrate knowledge and mobilise practice changes. Further research into the implementation of NICE guidelines in children who self-harm is needed, and in a wider variety of health and social care settings. The absence of studies from the social care sector into professionals’ awareness and implementation of NICE guidelines on self-harm is a key limitation.