Inside CKD aims to assess the burden of chronic kidney disease (CKD) and the cost-effectiveness of screening programmes in Belgium.

Microsimulation-based modelling.

Data derived from national statistics and key literature from Belgium.

Virtual populations of ≥10 million individuals, representative of Belgian populations of interest, were generated based on published data and cycled through the Inside CKD model. Baseline input data included age, estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR) and CKD status.

Outcomes included the clinical and economic burden of CKD during 2022–2027 and the cost-effectiveness of two different CKD screening programmes (one UACR measurement and two eGFR measurements or only two eGFR measurements, followed by renin-angiotensin-aldosterone system inhibitor treatment in newly diagnosed eligible patients). The economic burden estimation included patients diagnosed with CKD stages 3–5; the screening cost-effectiveness estimation included patients aged ≥45 years with no CKD diagnosis and high-risk subgroups (with cardiovascular disease, hypertension, type 2 diabetes or aged ≥65 years).

Between 2022 and 2027, CKD prevalence is estimated to remain stable and substantial at approximately 1.66 million, with 69.9% undiagnosed. The total healthcare cost of patients diagnosed with CKD is expected to remain stable at approximately 2.15 billion per year. The one UACR, two eGFR measurement screening programme was cost-effective in all populations, with an incremental cost-effectiveness ratio of 3623 per quality-adjusted life year (QALY) gained in those aged ≥45 years, well below the estimated willingness-to-pay threshold of 43 839 per QALY gained.

Without changes to current practice, the disease burden of CKD in Belgium is predicted to remain substantial over the next few years. This highlights the need for timely diagnosis of CKD and demonstrates that, in line with guideline recommendations, implementing a CKD screening programme involving UACR and eGFR measurements followed by treatment would be cost-effective.

Sodium-glucose cotransporter-2 inhibitors have demonstrated cardiorenal protective effects in adults with chronic kidney disease (CKD), but their efficacy and safety in paediatric CKD remain uncertain. Treatment for hereditary kidney disease in children is limited. This DAPA-PedHKD study aims to evaluate the effectiveness and safety of combining renin-angiotensin-aldosterone system inhibitors (RAASi) with dapagliflozin compare to RAASi alone in children with hereditary kidney disease accompanied by proteinuria.

DAPA-PedHKD is a multicentre, randomised, crossover, open-label clinical trial. Patients aged 6–18 years with hereditary kidney disease will be eligible. All patients must have received stable RAASi therapy for at least 4 weeks, with a baseline estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m², and either a 24-hour urinary protein level of >0.2 g or a urinary protein-to-creatinine ratio (UPCR) of >0.2 mg/mg. Participants will be randomised in a 1:1 ratio to receive either dapagliflozin in addition to standard RAASi therapy or RAASi therapy alone for 12 weeks. After a 4-week washout period with continued RAASi therapy, participants will crossover to the other treatment for another 12 weeks. Outcome assessments will be conducted at baseline and at weeks 2, 6, 12, 16, 18, 22 and 28. The primary outcome is the change in 24-hour urinary protein excretion from baseline to week 12. Secondary outcomes include changes in the UPCR, urinary albumin-to-creatinine ratio, serum albumin, eGFR, blood pressure and body weight from baseline to week 12. Neither participants nor investigators are blinded to treatment allocation, and placebo control is not used.

This study has been approved by the Ethics Committee of the Children’s Hospital of Fudan University and 11 local ethics committees. We will publish results in peer-reviewed journals and present at international conferences.

NCT06890143.

This study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.

Retrospective cohort study with multivariable regression analysis.

A tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.

A total of 8072 patients were included. The cohort was randomly divided into a derivation cohort (75%) and a validation cohort (25%).

The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.

Several factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124–5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p

The validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.

Many pregnant women have a history of trauma, such as abuse or violence, which can significantly impact their mental and physical health. Discussing these experiences in maternity care presents an opportunity to support women, reduce stigma and connect them with resources. However, concerns persist about stigmatisation, re-traumatisation and unwarranted safeguarding referrals.

The objective of this study was to explore how trauma discussions should be approached in maternity care, drawing on the perspectives of women with lived experience, voluntary sector representatives and healthcare providers in the UK. Findings aim to inform the development of a future intervention.

Semistructured interviews were conducted with women with trauma histories (experts by experience; n=4), representatives of voluntary sector organisations (n=7) and healthcare providers (n=12). Reflexive thematic analysis was used to analyse the data. A qualitative content analysis approach was employed, supported by a Patient and Public Involvement and Engagement group (named as the ‘Research Collective’ for this study) comprising experts by experience, maternity care professionals and voluntary sector practitioners. The group contributed to both study design and data analysis.

Five descriptive categories emerged: (1) Rationale for discussions—whether and why trauma should be addressed; (2) Professionals and settings—who should lead discussions and in what environment; (3) Timing considerations—when discussions should occur; (4) Communicating about trauma—strategies to sensitively explore prior trauma; and (5) Supporting care providers—training and emotional support needs. Participants highlighted both the benefits of trauma discussions and the practical, emotional and systemic challenges involved.

Trauma discussions in maternity care are complex but essential. Findings provide practical, UK-specific insights into timing, communication and staff support considerations, highlighting the need for culturally sensitive, co-designed approaches to facilitate safe and effective trauma-informed care.

This study aims to review case reports/series on West Nile virus (WNV) infection-associated cranial nerve (CN) neuropathy to explore the associated patterns and characteristics.

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.

We reviewed the literature in PubMed/Medline, Google Scholar and ScienceDirect databases to retrieve relevant case reports.

Case reports published in the past 25 years on CN neuropathy in WNV-infected patients, with no language or geographic restrictions.

Retrieved data included patient demographics, disease presentation and treatment outcomes. Descriptive statistical analyses were performed to describe frequency and characteristics of CN neuropathies. Cross tabulation was performed to calculate statistical significance of association between patient characteristics, disease factors and treatment outcomes. Risk of bias was assessed using the JBI Critical Appraisal Tool for case reports.

A total of 30 case reports satisfied inclusion criteria. These studies described 42 cases that developed CN neuropathies as an outcome of WNV infection. Patients were in the main males (54.8%) and had a mean age of 52.5±15.5 years. The most frequently affected CNs were, in descending order, optic (n=21, 50.0%), facial (n=14, 33.3%) and abducent nerves (n=8, 19.0%). Age was significantly associated with optic nerve neuropathy (≥51 years) and facial palsy (

CN neuropathy represents an important subset of neuroinvasive disease caused by WNV. There is a slight male preponderance among the patient population who are mostly middle aged. Optic and facial nerves are mostly affected. Most patients show complete recovery, particularly in the absence of chronic diseases. The role of systemic antivirals in improving disease outcomes should be further investigated. Early detection of CN neuropathies is recommended by routine CN screening and use of specific tools such as MRI and neurophysiological tests.

Post-induction hypotension (PIH) is a critical concern in elderly surgical patients and is associated with adverse postoperative outcomes. This trial aims to compare the effects of propofol, etomidate and remimazolam on the incidence of PIH in older adults undergoing non-cardiac surgery.

In this single-centre, triple-arm, randomised controlled trial, 210 patients aged ≥80 years with American Society of Anaesthesiologists physical status I–III undergoing elective non-cardiac surgery will be recruited. All patients will receive general anaesthesia with endotracheal intubation. Patients will be randomised (1:1:1) to receive propofol, remimazolam or etomidate for anaesthesia induction (n=70 per group). The primary outcome is the incidence of PIH (mean arterial pressure (MAP) 30% from baseline, vasopressor requirements, bradycardia, injection pain, myoclonus, postoperative delirium, and cardiac, cerebral and renal complications during hospitalisation.

This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University (Approval No. 2024-380). The results will be peer-reviewed for publication in a scientific journal.

ChiCTR2400090800.

It has been reported that pregnant women used more cosmetics daily than non-pregnant women. Phenoxyacetic acid is the main metabolite of phenoxyethanol, the most frequent preservative in cosmetics used in Europe, previously associated with reproductive effects (longer time to conception, endocrine disruptors in newborns and poorer verbal comprehension in children). In France, specialised platforms (PREVention ENvIronment Reproduction (PREVENIR)) in university hospital maternity wards are dedicated to evaluating environmental and occupational exposures in patients with pregnancy-related pathologies and supporting targeted prevention efforts. These platforms are composed of occupational health physicians, obstetrician-gynaecologists, midwives, occupational health nurses, and occupational health and environmental engineers. To assess the efficacy of these platforms, we developed a randomised clinical trial, the protocol for which is presented in this paper. The primary objective of the PREVENIR-G Study is to compare the change in urinary phenoxyacetic acid concentrations from baseline to 3 months postintervention between an intervention group and a control group. To date, the intervention has been integrated into routine care in certain facilities; however, its efficacy remains unproven. It is therefore essential to assess the relevance of this intervention, considering both its potential benefits and any adverse effects, such as increased stress or anxiety.

This study is an unblinded, randomised clinical superiority trial with two parallel groups (intervention vs no intervention) in four university maternity hospitals in France. We will include 300 pregnant women (aged 18 years or older) who are under 24 weeks of gestation (150 per group) referred to the participating PREVENIR platforms for management. The intervention will consist of clinical prevention management through the PREVENIR platforms, involving a consultation with an environmental health expert for an assessment of environmental and occupational exposures. During the consultation, targeted prevention messages will be provided based on identified exposures. The no intervention comparator will be a waiting-list control group. At the inclusion visit, patients will receive urine collection vials for samples to be collected at baseline and again at 3 months. Urine samples will be collected twice in a single day, on three separate days, during the collection week at home. In the week following the urine collection period, only participants in the intervention group will engage with the PREVENIR platforms. The primary outcome will be the difference in the urinary phenoxyacetic acid concentration between baseline and 3 months postintervention, compared between the intervention and control groups.

The study has been approved by the hospital ethics committee (CCP Ouest 2, no. 2023-A00941-44). All participants will provide written informed consent. Results will be shared through presentations and publications.

NCT06642818

Health-related quality of life (HRQoL) of metastatic colorectal cancer (mCRC) in Jordan has been previously evaluated using disease-specific HRQoL tools. Meanwhile, data on HRQoL utility scores for calculating Quality-Adjusted Life Years for economic evaluations are lacking. In this study, we aim to describe, measure and identify predictors of HRQoL utility scores in patients with mCRC.

This was a cross-sectional, non-interventional, observational study.

A specialised cancer centre in Jordan.

A cross-sectional questionnaire survey was conducted on 164 mCRC adult patients.

Using the five-level EuroQol-3-dimension (EQ-5D-3L) instrument, patients’ health profiles were described and then valued using the EQ-5D-3L value set for Jordan to generate a single utility score. The Kruskal-Wallis test assessed differences in mean utility scores across patient characteristic categories. A Tobit regression model was used to identify potential predictors of HRQoL in mCRC patients.

A total of 164 patients were enrolled with a mean age of 59 years, a mean utility score of 0.78 (SD±0.25) and visual analogue scale score of 68.78 (SD: ±19.9). 19% of patients had a stoma, and most of the patients reported health problems (72%); pain and discomfort were reported by (55%), followed by mobility (32%), usual activities (29%), anxiety/depression and self-care (13%). Analysis revealed that patients with more than one metastatic site, those who received more than one line of systemic treatment, were currently on chemotherapy, received systemic therapy in the last year or had peritoneal metastasis were found to have significantly lower utility scores (p

Utility scores measured in this study could be valuable for future economic evaluations of mCRC treatments. Pain and discomfort were the most reported problems among patients, highlighting the need for further evaluation to improve pain management strategies. Additionally, our regression analysis identified significant predictors of HRQoL.

Patients with acute myocardial infarction (AMI) and multivessel disease are at elevated risk of recurrent events. Radial wall strain (RWS), a novel indicator derived from angiography, has emerged as a potentially useful adjunct to optical coherence tomography (OCT) for assessing plaque vulnerability. The NASCENT trial is a prospective, multicentre cohort study designed to assess the natural history of coronary plaque in this high-risk AMI population and investigate the predictive value of angiography-based RWS for lesion progression, compared with OCT-assessed vulnerable plaque.

Following successful culprit lesion revascularisation for AMI patients with multivessel disease, we assessed eligible non-culprit lesions (30%–80% diameter stenosis) in non-flow-limiting, non-infarct-related arteries (Murray law-based quantitative flow ratio >0.80) using OCT and offline RWS analysis. The primary endpoint is lesion progression at 1 year, defined as a ≥20% increase in diameter stenosis percentage measured by quantitative coronary angiography. Between April 2024 and April 2025, 131 patients were enrolled. The 1-year angiographic and OCT follow-ups will be completed by May 2026. Clinical follow-ups are planned at 1 month, 6 months, 1 year and annually up to 3 years. As the first prospective trial comparing angiography-based RWS with OCT for predicting lesion progression in the AMI population, this study may provide crucial evidence for RWS as a valuable tool for risk stratification and clinical decision-making.

The protocol has been approved by the Institutional Review Board and Ethics Committee (Fuwai Hospital Approval No. 2023-2039) and will be conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants. The study results will undergo peer-reviewed publication.

NCT06040073.

Community health workers (CHWs) are trained lay people and trusted members of communities worldwide who play crucial roles in bridging healthcare gaps in low–middle-income countries yet remain underused and not well integrated within high-income countries like Canada. The objective of this scoping review is to map out available evidence on the integration of CHWs in high-income countries with universal healthcare systems.

This scoping review will include all available literature involving CHWs, or similar designations, and their integration into universal health systems within high-income countries. Literature will be excluded if it does not involve CHWs, universal healthcare systems, address integration or is conducted in low–middle-income countries. This review will include all available literature (including those that show null or negative results) that examines the integration of CHWs in high-income countries with a universal healthcare system. Documents describing integration may include, but are not limited to: tools, policies, models, frameworks, programmes or organisational features that seek to promote positive integration. Peer-reviewed and grey literature examining CHW integration in high-income countries with universal healthcare systems will be eligible for inclusion. Databases/sources to be searched (from inception until November 2025) will include: Medline (Ovid), Embase (Elsevier), Scopus (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Business Source Complete (EBSCO), ProQuest Dissertations and Theses Global. Retrieval of full-text, all language studies (and other literature), data extraction, synthesis and mapping will be performed independently by two reviewers, following Joanna Briggs Institute methodology. Findings will be organised and presented according to the Levesque conceptual framework for healthcare access.

Ethics approval is not required for this scoping review and literature search will start in October 2025 or on acceptance of this protocol. The findings of the scoping review will be available (February 2026) and will be published in a peer-reviewed journal.