To develop predictive models for early and overall tuberculosis (TB) deaths for prospective use at TB diagnosis in resource-constrained TB programme settings.

Statewide cohort study using routinely captured secondary data.

With the majority of TB deaths being early (within 2 months), India’s TB programme’s information management system (Ni-kshay)-dependent death prediction models (using age, gender, TB site, previous treatment, microbiological confirmation, HIV, diabetes and bank account availability) are not feasible for prospective use, as few variables are captured at diagnosis. Utilising routinely captured triage variables for severe illness at diagnosis (body mass index, pedal oedema, respiratory rate, oxygen saturation and ability to stand without support) from an ongoing statewide and state-specific differentiated TB care initiative to reduce TB deaths in Tamil Nadu state (southern India, 80 million population with 0.1 million annual notifications), robust models for prospective use were developed.

Adults (aged ≥15 years) with TB (not known to be drug-resistant at diagnosis) that were notified from public facilities of Tamil Nadu from July 2022 to June 2023.

Early and overall (within 12 months of notification) TB deaths. Area under the receiver operating characteristic curve (AUC) was used to assess accuracy of models built using modified Poisson regression.

Among 55 971 adults, the overall death rate was 7.4%, and 67.9% of the deaths were early. In predicting overall deaths, accuracy of the model using all Ni-kshay variables (AUC 0.716 (95% CI 0.707 to 0.725)) was as good as the model using triage variables for severe illness only (AUC 0.701 (95% CI 0.691 to 0.711)). To the latter, adding potentially capturable Ni-kshay variables at diagnosis (age, gender, TB site, previous treatment and microbiological confirmation) significantly improved model accuracy (AUC 0.754 (95% CI 0.745 to 0.763)). Further addition of remaining Ni-kshay variables did not improve accuracy significantly. Death prediction equations were generated for these models.

Simple and easily measurable triage variables for severe illness should be routinely captured at TB diagnosis. A death prediction calculator (http://44.208.93.99/) based on these variables (specifically triage variables for severe illness combined with age, gender, TB site, previous treatment and microbiological confirmation) may be used by Indian states and high TB burden countries seeking scalable, data-driven interventions to reduce TB deaths.

To assess the diagnostic accuracy of contrast enema for Hirschsprung disease in children when preoperative rectal suction biopsy was unavailable and to examine age-related diagnostic performance and the utility of individual radiographic signs.

Retrospective diagnostic accuracy study.

A high-volume tertiary paediatric surgical centre in Hanoi, Vietnam, during a period of COVID-19 related service disruption from May 2020 to October 2021.

354 consecutive children aged 0 to under 16 years who underwent contrast enema for suspected Hirschsprung disease. Final diagnosis was established by intraoperative frozen section and postoperative histopathology for operated patients and by clinical follow-up for non-operated patients.

Not applicable.

Primary outcome was diagnostic accuracy of contrast enema versus the reference standard, expressed as sensitivity, specificity, positive predictive value and negative predictive value with 95% CIs. Secondary outcomes were age-stratified accuracy and the performance of individual radiographic signs.

Among 354 children, contrast enema yielded 131 true positives, 19 false positives, 20 false negatives and 184 true negatives. Overall sensitivity was 86.75% (95% CI 80.43 to 91.26), specificity 90.64% (95% CI 85.85 to 93.93), positive predictive value 87.33% (95% CI 81.06 to 91.74) and negative predictive value 90.20% (95% CI 85.34 to 93.56). Sensitivity was higher in children aged 1 month or less than in those older than 1 month, 96.00% vs 75.71%, whereas specificity was lower, 80.00% vs 97.67%. Of the individual radiographic signs, the inverted rectosigmoid index was the most sensitive, while the irregular mucosal pattern was the most specific.

Contrast enema showed moderate to high diagnostic accuracy for Hirschsprung disease in this biopsy-constrained setting and may be useful as a triage tool within a limited diagnostic pathway. However, its false negative rate indicates that it should not be used as a standalone rule-out test when histological confirmation is available.

Intravenous injection is one of the most frequently performed invasive nursing procedures in hospitals. However, patients may experience pain and anxiety during this procedure, which can affect patient satisfaction.

To assess the prevalence and associated factors of dietary practices among antenatal women in Colombo district, Sri Lanka.

This descriptive cross-sectional study examined dietary practices among antenatal mothers in four Medical Officer of Health areas in Colombo, Sri Lanka. A total of 422 participants were selected using stratified random sampling. Data were collected via a validated Food Frequency Questionnaire and analysed using SPSS V.26. Dietary diversity, food variety and animal-source food consumption were assessed. Poisson regression identified predictors of dietary practices, adjusting for socio-economic and pregnancy-related factors. The statistical significance was set at p

Of the 380 antenatal mothers (mean age: 30.72±3.96 years), most were married (98.2%) with 73.7% living in urban areas. Regarding dietary practices, 64.7% had high dietary diversity, while 35.3% had low diversity. Of the sample, 52.1% had a high food variety score and 64.7% had a high animal-source food score. More than half (64.7%) had appropriate dietary practices. Fruits, vitamin A-rich vegetables and rice were the most consumed foods. Key factors influencing dietary practices included age, religion, education, employment and geographical location.

This study highlights the prevalence and factors influencing dietary practices among antenatal mothers. Although the predominant mothers had fair dietary diversities, a considerable number were found to have poor dietary practices. Better dietary practices were associated with major educational attainment, formal employment status and selected residential areas, while younger age, low educational qualification and housewife status were associated with poorer nutrition. The findings indicate that there is an urgent need for interventions related to nutrition for specific vulnerable groups so that they can improve their maternal nutrition and produce better pregnancy outcomes through education and support programmes.

Accurate identification of adverse events after colonoscopy is essential for quality assurance in colorectal cancer (CRC) screening. Review of medical records is labour intensive as adverse events are infrequent. The object of this study was to investigate the accuracy of claims data in identifying adverse events after colonoscopy in CRC screening.

Cross-sectional, retrospective.

Males and females aged 50–74 years were randomised to once-only sigmoidoscopy or biennial faecal immunochemical test in a CRC screening trial at two screening centres in Norway. Participants in the present study underwent follow-up colonoscopy from 2012 to April 2020 after initial positive screening test. We reviewed medical records for adverse events within 30 days following 11 205 colonoscopies.

The primary outcome of the study was to assess the sensitivity of claims data from the Norwegian Patient Registry to identify lower gastrointestinal bleeding using emergency contact International Statistical Classification of Diseases and Related Health Problems 10th Revision diagnostic code sets under two definitions: a stringent definition (codes explicitly identifying bleeding) and a broad definition (including suggestive codes). Secondary outcome measures included the sensitivity to identify perforation using a stringent and a broad definition. Additionally, we assessed whether incorporating procedure codes and non-emergency contacts improved accuracy.

87 cases of lower gastrointestinal bleeding and eight perforations were confirmed. Sensitivity for bleeding differed between the centres (p

Use of claims data underestimated adverse event rates following colonoscopy. Difference in coding practice across hospitals underscores the need for standardised reporting in screening programmes.

NCT01538550.

To evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO₂/FiO₂) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.

A retrospective observational study.

A central hospital in Vietnam.

Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO₂/FiO₂>300 mm Hg) to 4 (PaO₂/FiO₂≤100 mm Hg).

All-cause hospital mortality.

Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0–66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO₂/FiO₂ ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO₂/FiO₂ ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic 2/FiO₂ values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.

In this study of ARDS patients in Vietnam, the PaO₂/FiO₂ ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO₂/FiO₂ ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.

Dietary modification, particularly low-carbohydrate diet, and diabetes self-management education (DSME) have shown promise in improving glycaemic control among persons with type 2 diabetes mellitus (T2DM). However, real-world evidence from India is limited. This protocol describes the methods of a cluster randomised trial to determine the effectiveness and feasibility of adopting a low-carbohydrate diet among persons with T2DM.

Our cluster-randomised trial with a mixed-method process evaluation will use computer-generated block randomisation sequence to randomise Urban Primary Health Centres (UPHCs) (n=16) to either continue delivering the usual guideline-based care under the National Programme for Prevention and Control of Non-Communicable Diseases (NPNCD) or our study intervention. The study intervention will comprise a personalised nutrition counselling focusing on (i) low-carbohydrate diet (

We will include persons with T2DM, over the age of 30 years and above, irrespective of comorbidities, registered in the selected UPHC under care for diabetes for at least a month and with an glycated haemoglobin (HbA1c) level ≥6.5% during the screening test. We will collect data electronically using semistructured questionnaires and measure HbA1c, blood pressure, lipid profile, serum creatinine and body weight at baseline, 3, 6, 9 and 12 months after enrolment. We will use a difference in difference analysis, adjusted for clustering, to compare the change in HbA1c at the follow-up visits compared with baseline across the two study arms. We will conduct both intention-to-treat and per-protocol analysis, exploring reasons for differences in effect size.

The study protocol was reviewed and approved by the Scientific Advisory Committee/Institutional Human Ethics Committee of the research institution (NIE/IHEC/202302-03). The findings of this study will be disseminated through publication in peer-reviewed journals.

Clinical Trials Registry-India (CTRI/2024/02/062202).

Digital therapeutics (DTx) show promise in bridging mental healthcare gaps. However, treatment selection often relies on availability and trial-and-error, prolonging suffering and increasing costs. Personalised prediction models could help identify individuals benefiting most from specific DTx.

The aim of this secondary analysis was to establish a machine learning-based prediction model for positive treatment outcomes in patients with depressive or anxiety symptoms after 8 weeks of internet-delivered cognitive behavioural therapy (iCBT).

We analysed a large real-world dataset of patients from the online therapy unit iCBT programme in Saskatchewan, Canada (2013–2021). Clinically significant changes in depressive symptoms or anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7). We trained six prediction models using sociodemographic and mental health-related factors at baseline, compared model performances and calculated Shapley values for feature importance.

Data from 4175 patients using 34 features for prediction, identified by least absolute shrinkage and selection operator regression, showed the Gradient Boosted Model (gbm) and logistic regression (log) performed best, with balanced accuracies of 0.76, 95% CI (0.70 to 0.83) and 0.70, 95% CI (0.63 to 0.77). Shapley values indicated GAD-7 scores at baseline as the most important predictor of clinically significant improvement, along with mental health history and sociodemographic variables.

The gbm and log models achieved comparable accuracy in predicting clinically significant improvement after iCBT, supporting the use of simpler, interpretable methods in clinical practice.

These findings could help improve mental health treatment selection, iCBT assignment, enhance effectiveness and optimise treatment for patients.

NCT05758285.