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Healthcare professionals working in busy hospital environments are expected to make multiple back-to-back critical decisions related to patient assessment and treatment. Fatigue from a combination of complex decision-making over multiple patients can lead to less efficient care and an increased risk of error and harm. Artificial intelligence (AI) risk recommendation systems, hereafter referred to as AI risk recommenders, have the potential to reduce the impact of decision fatigue by prompting healthcare professionals with appropriate recommendations for patient care and management. A key barrier to the effective usage of such systems is the establishment of trust and subsequent acceptance among healthcare professionals. However, little is currently known about how trust and acceptance can be engendered. The aim of this review is to develop a theory explaining what influences healthcare professionals’ usage of AI risk recommenders and how trust and acceptance, facilitate their usage of such systems.
We will conduct a rapid realist review to develop a programme theory exploring how trust and acceptance of AI risk recommenders are established among healthcare professionals and how these mechanisms influence system usage. We will use the following databases—MEDLINE (Ovid), EMBASE (Elsevier), the Cumulative Index to Nursing and Allied Health Literature (CINAHL (EBSCOhost)), PubMed, The Cochrane Library, The Institute of Electrical and Electronics Engineers (IEEE) Xplore, The Association for Computing Machinery Digital Library, Scopus (Elsevier), Web of Science (Clarivate) and ProQuest Dissertation and Theses. The review will focus on identifying the resources and processes that stimulate trust and acceptance, leading to the actual use of the system in clinical practice. The review will be guided by the four steps of realist review described by Rycroft-Malone. Article searching and retrieval was conducted on 15 November 2025; full-text screening is ongoing and the review is expected to be completed by May 2026.
This study does not require formal ethics approval, as it does not involve primary research. Findings will be shared in peer-reviewed publications, conference presentations and engagement with relevant policy-makers involved in the development and integration of AI risk recommenders within hospital settings. Through these efforts, we aim to support the effective utilisation of such systems, leading to improved decision-making and patient care outcomes.
CRD420251155251
Anaphylaxis is a sudden onset multiorgan allergic reaction that infrequently but regularly causes fatalities which may be preventable with appropriate organ support. There is limited data about the type of organ failure leading to death or near-fatal episodes resulting in permanent neurological disability. To assist clinicians facing anaphylaxis in diverse clinical settings, we aimed to quantify the frequency of organ failure type contributing to death or neurological disability from anaphylaxis according to allergen trigger.
Systematic review of published peer-reviewed literature.
Three databases were searched to January 2025: MEDLINE from 1946, Embase from 1947 and Web of Science from 1900.
Studies were eligible if they contained data about the type of clinical deterioration during anaphylaxis resulting in death or permanent neurological disability. No language restriction was implemented. Exclusion criteria were: hydatid anaphylaxis; five or more stings from an insect; death from acute atheromatous myocardial infarction and where anaphylaxis was only a differential diagnosis.
We extracted information using pre-specified criteria to determine the primary organ failure involved: either upper airway obstruction, lower respiratory obstruction (bronchospasm) or cardiovascular failure. Baseline demographics including age and asthma status were collected along with the allergen trigger, time course and treatment. We reported frequencies according to allergen trigger for case reports and a narrative analysis of case series weighted by risk of bias assessment.
277 case studies and 14 case series were identified reporting 896 deaths and 28 disabilities. There were no other study types. Separate case series and case report analyses produced similar findings despite varying quality of published clinical data. Respiratory failure was the most common primary organ failure in case reports (73.4%), whereas primary cardiovascular failure was reported in 26.6% of case reports. Primary organ failure type differed in frequency by allergen trigger and was primarily caused by: respiratory failure when food was the allergen trigger (95%); respiratory failure in 65% of cases of drug allergen triggers; cardiovascular failure in 65% venom allergen triggers.
In this review, respiratory failure (primarily bronchospasm) is the most common primary physiological event leading to decompensation in fatal anaphylaxis, particularly for food and drug allergen deaths. Emphasising the significance of respiratory involvement, particularly from bronchospasm, in both patient and clinician facing anaphylaxis treatment guidelines may help further reduce the risk of fatalities. Prospective anaphylaxis management registries or whole population data are needed to better capture primary organ failure present in fatal anaphylaxis to validate this finding.
CRD42023434206.
by Jordan Bellis, Lydia Monk, Ritika Jhawar, Galia Pollock, Angela Liu, Charleen Jacobs-McFarlane, Brittany McCrary, Jeffrey Glassberg, Susanna Curtis
Sickle Cell Disease (SCD) is a hemoglobinopathy affecting millions of people globally. Pain, both acute and chronic, affects over half of those living with SCD, but treatment of chronic pain is an ongoing challenge. While opioid treatments are widely used for chronic pain, it’s efficacy is limited, so alternatives must be explored. This protocol outlines a procedure for investigation of dronabinol, an FDA-approved synthetic tetrahydrocannabinol (THC), for the treatment of pain in patients living with SCD and chronic pain. The study is an 8-week, randomized, double-blind placebo-controlled study which aims to assess both the efficacy and safety of this opioid alternative to pain treatment. The study will also track biomarkers of inflammation as THC has demonstrated anti-inflammatory properties, and inflammation is a driver of SCD pain and disease severity. Results from this study have the potential to further clinical understanding of cannabinoids for pain management in Sickle Cell Disease treatment and spark new questions for research.Although breastfeeding is associated with lower postnatal depression and anxiety, limited research exists regarding long-term maternal mental health outcomes. This study examined the association between breastfeeding and depression and anxiety in women of later reproductive age (mid 30s to menopause).
This was a 10-year prospective longitudinal cohort study. Self-reported questionnaires were used to collect lifetime breastfeeding behaviour at 10 years, and health history including depression, anxiety and medication use was collected at each study timepoint.
A tertiary level maternity hospital in Dublin, Ireland.
168 parous women from the ROLO Longitudinal Cohort with lifetime breastfeeding behaviour and health history data available at 10 years were included (22% of total cohort). Women currently pregnant or breastfeeding at 10-year follow-up were excluded.
Mean (SD) age at study end was 42.4 (3.8) years. 72.6% (n=122) of women reported ever breastfeeding. Median lifetime exclusive breastfeeding was 5.5 weeks (IQR 35.8, range 0–190). 37.5% of women (n=63) breastfed for ≥12 months over their lifetime. 13.1% (n=22) reported depression or anxiety at 10 years, and 20.8% (n=35) reported depression or anxiety over the whole study period. Ever breastfeeding was associated with less depression and anxiety at 10 years (OR 0.34, 95% CI 0.12 to 0.94, p=0.04). Ever breastfeeding, longer exclusive breastfeeding and lifetime breastfeeding ≥12 months were associated with lower depression and anxiety over the whole study period (ever breastfeeding OR 0.4, p=0.03; exclusive breastfeeding OR 0.98/week, p=0.03; lifetime breastfeeding ≥12 months OR 0.38, p=0.04).
There may be a protective association between breastfeeding and self-reported depression and anxiety. Further studies are required to confirm the findings.
To evaluate the impact of a participatory, action-oriented implementation study, guided by the integrated Promoting Action on Research Implementation in Health Services framework, for optimising pain care processes in a tertiary paediatric emergency department.
Hybrid type 3 implementation effectiveness.
A collaborative appraisal of the context and culture of pain care informed two interdependent action cycles: Enabling nurse-initiated analgesia and involving families in pain care. The Kids Pain Collaborative, an authentic clinical–academic partnership, was central to facilitating successful implementation. Summative evaluation explored the impact of implementation on processes of pain care using an interrupted time series analysis and emotional touchpoint interviews with families.
Staff achieved clinically important and sustained improvements in the rate of nurse-initiated analgesia and pain assessment. Family involvement in pain care shifted from task-orientated practices towards more person-centred ways of working and decision-making. As capacity for collective leadership developed, frontline staff found ways to integrate the KPC approach into ED systems to lead pain care innovation beyond the life of the research project.
The Kids Pain Collaborative, as the overarching implementation strategy, created a practitioner-led coalition for change. Successful implementation was facilitated by working with four interdependent principles: Collaborative and authentic engagement; enabling context for cultural transformation; creating safe spaces for critical reflection and workplace learning; and embedding sustainable practice change.
A multi-level model of internal–external facilitation enabled sustained improvement in pain care practice. An embedded researcher was pivotal in this process.
Authentic engagement of clinicians and families was pivotal in transforming systems of pain care and enabling a culture where "it is not ok for children to wait in pain"
The principles underpinning the Kids Pain Collaborative are transferable to other emergency department and acute care contexts.
Standards for Reporting Implementation Studies checklist.
FreshRSS 