Some cancers are diagnosed late, making them harder to treat. People with an undiagnosed cancer may use over-the-counter medications to manage non-specific cancer-related symptoms that often mimic other more common, easily treatable conditions. Results from the original Cancer Loyalty Card Study (CLOCS) suggest there may be an increase in purchases of pain and indigestion medication 8–9 months before an ovarian cancer diagnosis. We aim to validate the CLOCS findings by exploring whether a significant change in medication purchases could be an indication for early signs of the following cancer types: oesophageal, stomach (gastric), colorectal (bowel), pancreatic, liver, bladder, endometrial, uterine sarcoma, ovarian and vulval, using data collected through store loyalty cards.

Using a retrospective case-control design, we aim to recruit 1450 participants with one of the cancers of interest (cases) and 1450 participants without cancer (controls) in the UK who (or whose household members) hold a loyalty card with at least one participating high street retailer. We will use pre-existing loyalty card data to compare past purchase patterns of cases with those of controls. To assess cancer risk in participants and their purchasing patterns, we will collect information on demographic characteristics, health risk factors, lifestyle habits and behaviours, family history of cancer and any symptoms experienced prior to diagnosis (cases) and in the last year prior to study recruitment (controls). In addition, cases will be asked about their cancer diagnosis.

CLOCS-2 was reviewed and approved by the East Midlands-Leicester South Research Ethics Committee (23/EM/0224). Study outcomes will be disseminated through peer-reviewed publications, conferences, presentations to the research communities as well as patients and the public, the study website and other social media outlets.

NCT06447064, CPMS58679; pre-results.

Many older people experience Mild Cognitive Impairment (MCI), which may compromise the effectiveness of health promotion programmes.

We explored engagement with behaviour change among participants scoring 18-25 on the Montreal Cognitive Assessment receiving HomeHealth, a health promotion intervention supporting older adults with mild frailty to maintain independence in England ().

Of the 46 semistructured process evaluation interviews, 29 participants scored in the MCI range, purposively selected for demographic characteristics and degrees of cognitive impairment and the seven support workers.

Thematic analysis resulted in three themes: Navigating the impact of MCI; Addressing memory as a goal in the intervention; and Adapting Behaviour Change Interventions for MCI. Participants had varied opinions about whether their memory was problematic and whether anything could be done to help. Many reported not discussing memory concerns with support workers. Barriers to engagement in behaviour change included limited social support and not acknowledging memory problems. Facilitators included setting goals which increased or were linked to existing health behaviours, using reminders/prompts and actively involving family members.

Implementing these facilitators into existing and new health promotion interventions delivered to older adults, with suspected but unacknowledged MCI, could overcome the current barriers people with MCI face when trying to engage and benefit from interventions.

ISRCTN54268283

Pressure injuries (PIs) pose a substantial global healthcare challenge, with their prevalence ranging from 0% to 72.5% across settings.1 In the UK, over 700 000 individuals are affected annually, with community settings prevalence of 0.40–0.70 per 1000 adults in Northern England.2 Early detection of PIs presents unique challenges in individuals with darker skin tones (DST), accentuating a critical gap in nursing education and...

Management of heart failure (HF) is a challenge, with less than one-third of patients meeting physical activity recommendations.1 Existing cardiac rehabilitation programmes are designed to meet class 1A American Heart Association recommendations for physical activity.1 Benefits, facilitators and barriers to these programmes are described...

Refugees experience significant health needs and well-being inequities. Smoking tobacco, nutrition disorders, alcohol use and physical inactivity are potential contributors to developing non-communicable diseases and mental health conditions. This study aims to explore refugees’ health promotion needs in a regional town in New South Wales (NSW), Australia, suggest appropriate health promotion methods, and co-design a health promotion intervention. Privileging refugees’ voices and experiences is central to co-designing appropriate health promotion interventions.

We will employ a two-phase participatory qualitative co-design method. As there is a lack of knowledge about refugees’ health needs, a participatory research design has the potential to explore the topics holistically. The social–ecological model and the behaviour change wheel model will guide this study. During Phase 1, a semistructured interview guide will be used for in-depth interviews and focus group discussions with refugees. A deductive reflexive thematic analysis will be applied to analyse data using NVivo. In Phase 2, two workshops will be conducted with refugees and health professionals. A reflexive thematic analysis will be performed to identify the top health promotion strategies.

Ethical approval was obtained from the Human Research Ethics Committee (HREC) of the North Coast NSW Local Health District (HREA370 2023/ETH00444). The Human Research Ethics Committee approved a minimisation of duplication at a regional university in Australia (SCU HREC 2024/106). Study findings will be disseminated through embedding chapters in the PhD thesis, publishing high-quality papers and presenting at conferences, lay reports, newsletters and media.

Over 777 million COVID-19 infections have occurred globally, with data suggesting that 10%–20% of those infected develop Long COVID. Fatigue is one of the most common and disabling symptoms of Long COVID. We aim to assess the feasibility and safety of a new, remotely delivered, multimodal rehabilitation intervention, paced to prevent post-exertional malaise (PEM), to support the conduct of a future, definitive randomised trial.

We will conduct a randomised, two-arm feasibility trial (COVIDEx intervention vs usual care). Sixty participants with Long COVID will be recruited and randomised prior to giving informed consent under a modified Zelen design using 1:1 allocation with random permuted blocks via central randomisation to receive either the COVIDEx intervention or usual care. The 50-minute, remotely delivered, COVIDEx intervention will occur twice weekly for 8 weeks. All participants will wear a non-invasive device throughout their entire study participation, to track heart rate, blood oxygen saturation, steps, sleep and monitor PEM. The primary feasibility objectives will be recruitment rates, intervention fidelity, adherence, acceptability (intervention and design), retention, blinding success and outcome completeness. Secondary objectives will include refined estimates for the standard deviation and correlation between baseline and follow-up measurements of fatigue. Feasibility and clinical outcomes will be collected at baseline, 4, 8, 12 and 24 weeks. Qualitative interviews with participants and physiotherapists will explore intervention acceptability and barriers/facilitators.

Ethical approval for this study was obtained by the Western University Health Sciences Research Ethics Board (REB# 123902). Dissemination plans include sharing of trial findings at conferences and through open access publications and patient/community channels.

NCT06156176

Access to general practice in England is a challenging issue of enduring importance. COVID-19 precipitated various abrupt changes, exposing and compounding existing problems. The access as human fit conceptualisation provides a nuanced understanding of access that extends beyond a limited focus on appointment numbers and speed. This qualitative study explored the pandemic’s impact on access to general practice and the experiences of patients and healthcare staff in England using access as human fit as an analytical framework.

A community-based participatory approach underpinned by qualitative semi-structured interviews and focus groups, and observations.

The following were conducted in Northwest England (December 2021—August 2022): interviews (10 participants) with patients, general practice staff and professionals; seven focus groups (42 participants) with patients from general practice patient groups and underserved groups; and twenty observation sessions of non-clinical access encounters (seven general practice and Primary Care Network premises; 45 hours total).

A rapid qualitative analysis methodology facilitated an abductive thematic approach, applying the dimensions of access as human fit to the data.

The access as human fit framework highlighted key areas where there is a lack of fit between patients and staff. Patients expressed that the array of access options and changes made it hard to know how to be a patient; some thought general practice should be ‘back to normal’ and the pandemic was an excuse to restrict access. Providers reported working harder than ever with insufficient resources.

The pandemic created greater distance between staff and patient realities of access. Access as a human fit facilitated in-depth exploration of patient and staff experiences, improving understanding and identifying key issues. Broader adoption and application of this framework, within policy and practice, could focus improvement efforts, optimise access fit and improve patient satisfaction and staff retention.

To identify and understand the barriers and enablers influencing medical students’ engagement with research and consideration of academic careers.

This was a mixed-methods explanatory sequential study comprising two surveys (Phase 1 and Phase 2), followed by semistructured interviews (Phase 3).

The School of Medicine at Newcastle University.

All students from all year groups at The School of Medicine, Newcastle University (UK) were invited to participate, with data collected from 343 survey respondents and 25 students in semistructured interviews.

Survey responses from 188 students in Phase 1 (exploratory survey) and 155 students in Phase 2 (general student survey) identified barriers which reflect personal experience (eg, lack of knowledge and confidence), practical constraints (eg, time constraints and academic pressures) and institutional contexts (eg, insufficient research teaching and lack of formal opportunities). Enablers included mentors and other sources of information about research.

Interview data emphasised that academic mentoring relationships are often emergent rather than planned. The limited visibility of research opportunities and of mentors was a significant barrier and perpetuated a culture where research was not normalised within the curriculum. Conversely, enablers included intrinsic motivations (eg, intellectual curiosity and desire to contribute to knowledge) and extrinsic motivations (eg, career advancement). Social dynamics between peer groups emerged, whereby these could act as either a barrier or an enabler, depending on the normalisation of research within their networks.

To enhance engagement with research and promote the attractiveness of a clinical academic career, research should become a ‘normal’ part of undergraduate medical education. Visible integration of research into the undergraduate curriculum, providing structured mentorship programmes and ensuring equitable access to research opportunities will aid this. Addressing these factors may sustain the pipeline of students pursuing clinical academic careers.