To identify and prioritise research uncertainties regarding the assessment, management and rehabilitation of patients with problematic hip replacements through a national Priority Setting Partnership (PSP).
A national PSP using the James Lind Alliance (JLA) methodology.
UK.
Patients, carers and healthcare professionals (HCPs) involved in the care of patients with problematic hip replacements.
A steering group was established. The James Lind Alliance methodology was followed throughout. A nationwide survey was conducted to collect unanswered questions. These were refined, prioritised through an interim survey and ranked at a final consensus workshop.
The initial survey yielded 201 questions, refined to 32. The interim survey had 191 respondents, leading to 19 questions at the final workshop. The top 10 research priorities were agreed on.
This PSP identified key research priorities for problematic hip replacements, focusing on diagnosis, pain management, perioperative optimisation and infection. These priorities can inform researchers and funders to improve outcomes for affected patients.
by Jeanette Alcaraz, Charlotte Keyse, Charles Hall, David W. Walker, David P. Doupé, Rebecca I. Clark
Inflammaging is considered a driver of age-associated pathology across tissues. Similarly, intestinal permeability is a feature of ageing and underlies a range of inflammatory and age-related diseases. Increased intestinal permeability has been described as both a cause and a consequence of inflammation. Both intestinal permeability and inflammation are closely associated with microbial dysbiosis, epithelial dysplasia and mortality but dissecting the complex interplay between these phenotypes remains challenging. Here we genetically induce intestinal immune activation in Drosophila and stratify animals by their intestinal barrier status using the Smurf assay. We demonstrate that intestinal barrier failure has a distinct impact on the microbiota. Further, immune activation, both within the intestine and systemically, drives intestinal barrier failure and mortality even in the absence of the microbiota. Importantly, immune-induced intestinal barrier failure takes time to develop and is closely associated with the onset of mortality. Our work adds to building evidence that the impact of intestinal permeability on the microbiota and on animal health needs to be considered independently of its relationship with inflammation.Temporary childbirth migration (TCM), where women return to their natal homes for pregnancy, delivery or postpartum for a limited duration, is a long-standing sociocultural practice in India. While often motivated by familial support and traditional norms, its implications for maternal and child health and health system engagement remain poorly understood. This study aims to quantify the impact of TCM on maternal and newborn outcomes and to explore how continuity of perinatal care and social support mediate these relationships.
We are conducting a three-site, community-based, prospective cohort study across the Health and Demographic Surveillance System sites of Vadu (Maharashtra), Sevagram (Maharashtra) and DEESHA (Delhi). A total of 3000 pregnant women will be enrolled in pregnancy (
This study has been approved by the Ethics committees at the KEM Hospital Research Centre Pune (KEMHRC/RVM/EC/1931), Society for Applied Studies (SAS/ERC/TCM Study/2024), Mahatma Gandhi Institute of Medical Sciences (MGIMS/lEC/COMMED/8412023) and University of California San Francisco (22-36484). All research activities are conducted in accordance with Indian Council of Medical Research Guidelines for biomedical research and the Declaration of Helsinki. On study completion, findings will be disseminated to diverse local, national and global stakeholders and published in academic journals.
CTRI/2024/02/062881.
To provide an overview of a project aimed at enhancing person-centred surgical care through teamwork and professional development.
A discursive paper with the purpose of describing and discussing the project activities to strengthen person-centred care, teamwork and professional development.
This project aimed to strengthen evidence-based surgical nursing care within a Surgery Department. The overarching goal was to foster an attractive and sustainable work environment for nursing professionals while simultaneously enhancing the quality of person-centred care, thereby improving patient outcomes and safety. Ultimately, the project aimed to position the department as a leading example of excellence in surgical nursing care, where evidence-based practice and person-centred values form the foundation of everyday work.
The activities were guided by previous nursing evidence and aligned with Magnet Hospital standards. Continuous quality improvement efforts and team dialogue were central to achieving the goals. Leadership was provided by experienced nurses and researchers. The structured activities improved patient safety and care quality.
The project was successful as it enhanced precision in surgical nursing care by implementing structured activities focused on person-centred care, patient safety and professional development. These efforts led to improved quality of care and patient outcomes, demonstrating the effectiveness of evidence-based practices.
A project with similar activities to those described in this paper can ensure that surgical patients receive high precision nursing care and serve as an example of promoting person-centred surgical nursing.
None.
None.
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.Leprosy remains a significant public health challenge in many low and middle-income countries, including India. People affected by leprosy face multifaceted challenges: physical, psychological, social and economic. In response, donors support self-help groups (SHGs) to improve health, social integration and economic circumstances for marginalised people, including those with leprosy. This study aims to assess the sustainability of SHGs in India after the withdrawal of donor support by examining whether they remain functional and exploring the key factors, barriers and facilitators that influence their long-term social and economic viability.
To examine the functionality of SHGs after withdrawal of donor support, and to explore the factors, barriers and facilitators influencing their long-term social and economic sustainability.
Using qualitative methods, we conducted semistructured interviews with 40 key informants associated with five SHGs formed under the Self-Help Community Development Project implemented in an endemic state of India and funded by The Leprosy Mission Trust India.
It was an exploratory qualitative study using interviews with SHG members and key informants, situated within the self-help community-based project.
While some SHGs demonstrated resilience and adaptability, others faced challenges such as internal discord, loss of members to migration and lack of access to government schemes. Thematic analysis revealed key drivers and barriers to sustainability and realising the benefits of SHGs, highlighting variations in leadership, governance, economic performance and social engagement across groups.
SHGs are often sustained after the funding and managerial donor support have been withdrawn. The findings emphasise the importance of strong leadership, community support and external facilitation in sustaining SHGs and enhancing their impact on marginalised populations. This study contributes to understanding the role of SHGs in addressing the socioeconomic challenges faced by individuals affected by leprosy and offers insights for improving their long-term viability.
To evaluate healthcare professionals' perspectives on factors that lead to success in the implementation of strategies to strengthen evidence-based surgical nursing care.
A qualitative study design with focus group interviews, according to Krueger and Casey in a surgical department at a university hospital in Sweden.
Four focus groups were conducted with 18 participants, including specialist nurses in surgical care, registered nurses and assistant nurses. Data were collected in February–March 2024. A semi-structured interview guide was used, and data were analysed using qualitative content analysis.
Three themes with seven subthemes were developed to capture the evaluation of health care professionals' perspectives of the implementation strategies to strengthen evidence-based surgical nursing care. The themes were (1) Roles and leadership, (2) Engagement in the implementation, and (3) Facilitators and barriers to implementation. The implementation has meant the transition from theory to practice and integrating new routines into the surgical department. It was a learning process where the health care professionals needed to familiarise themselves with new concepts and working methods. The positive outcome of the project and support from the nursing leadership were important facilitators in the implementation process.
The implementation of new ways of working was a complex process with both resistance and learning, but it ultimately led to positive changes in the surgical care environment.
The project has entailed that specialist nurses in surgical care have increased nursing power in the department and extended responsibilities. Support from the head of the department and the management team has been crucial to being able to carry out the project, and the implementation of activities in small steps has been successful.
Adhered to the SRQR guidelines.
No patient or public contribution.
by Hellen W. Kinyi, Charles Kato Drago, Lucy Ochola, Gertrude N. Kiwanuka
Macronutrients serve as principal sources of energy, structural components, and regulators of physiological processes. However, the optimal macronutrient combination for health remains unclear. While previous studies indicate that dietary macronutrient composition influences immune function, many have examined individual nutrients in isolation, failing to reflect the interactive effects of macronutrients. This study addresses this gap by examining how varying ratios of dietary carbohydrates, proteins, and lipids modulate serum cytokine responses to lipopolysaccharide challenge in Swiss albino mice. Male and female Swiss albino mice (n = 6 per group), aged 6–8 weeks, were randomly assigned to six purified isocaloric diets with differing macronutrient ratios for 15 weeks. Body weights were monitored to assess nutritional status. Serum levels of TNF-α, IL-6, IL-1β, and IL-10 were measured in unchallenged mice and after three hours of intraperitoneal LPS administration. Mice fed high-carbohydrate, low-protein diets had the highest weight (33.1 g ± 1.1), while those on high-lipid, low-protein diets had the lowest (28.3 g ± 0.6). Plasma levels of TNF-α and IL-10 varied significantly (pThe HOPSCOTCH study ‘Helping Optimise Primary Care Support During Transition From Children’s Hospice Care’ aims to develop a toolbox to enable engagement of primary care services in the care of young people with life-limiting conditions (LLC) with a specific focus on the point of transition from children’s hospice services.
Individual interviews will be held with young people with LLC, their families and healthcare professionals (HCPs). In alignment with Experience Based Co-Design (EBCD) methodology, extracts of film and audio from young people and family interviews will be combined to professionally produce a ‘catalyst film’ highlighting key points and experiences before, during and after the transition from children’s hospice care. Role-specific workshops will be held with young people with LLC, their families and HCPs working in primary care, children’s hospices and adult hospice services. The catalyst film will be used in feedback workshops to prompt prioritisation of key issues to take forward into toolbox development in a shared young people, family and HCP workshop. A documentary analysis of resources currently used to support transition and communication between care settings will support contextual understanding of the transition process. Young people, parents and professionals have shaped and continue to have influence over the study delivery as advisors alongside a multidisciplinary steering committee.
The study design has been guided by the UK Medical Research Council complex intervention framework. Intervention development draws on the principles of EBCD and is theoretically driven by the Behaviour Change Wheel.
The study is registered with the UK’s Clinical Study Registry (ISCTRN75964234).
Ethical approval was obtained from Wales 3 ethics board on 2 July 2025 (IRAS ID 334486). This study will include ongoing dissemination and knowledge transfer to key audiences (young people, parents, service providers, commissioners) via publications, national bodies, knowledge exchange events, web-based platforms, social media and clinical/academic forums.
The USA has the highest incarceration rate in the world, with 1 in 48 adults under correctional supervision. Approximately half of state and federal prisoners are parents, nearly 80% of women in jails are mothers, and an estimated 1 in 14 children have had an incarcerated parent. Incarceration increases the risk of physical and mental health issues, family strain and disconnection and housing and employment instability. Children of incarcerated parents are particularly vulnerable to health problems, behavioural issues and academic struggles. Given these impacts, there is growing interest in using strategies besides incarceration that address both community safety concerns and promote parental and family well-being. Efforts to keep people out of jail and prison most commonly include deflection (before arrest) and diversion or alternatives to incarceration (after arrest but before conviction, or after conviction but as an alternative to prison or jail). However, there is limited understanding of what is known about these approaches when used with parents and a lack of empirical evidence about their effectiveness. This scoping review aims to map concepts, document evidence and identify knowledge gaps about parent and caregiver-focused alternatives to incarceration in the USA.
This scoping review will characterise alternatives to incarceration across the criminal legal system for parents and caregivers and map existing concepts and research in the field. The review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews (PRISMA-ScR) guidelines. Five interfaces with one or more databases will be searched including EBSCOhost, ProQuest, Web of Science, PubMed, HeinOnline and SCOPUS, in addition to Google Scholar and Google. All available published articles and grey literature on US-based alternatives to incarceration for parents and caregivers (18+) will be considered. Two research team members will independently screen sources based on inclusion criteria and resolve any disagreements through discussion or a third reviewer if necessary. The findings will be charted, synthesised and reported. The study will be conducted from approximately November 2025 to August 2026.
Ethics approval is not required for this scoping review. The findings will be disseminated through academic publications, conference presentations and to policy and practice audiences. The results will help inform a research agenda aimed at improving the development, implementation and evaluation of parent-focused alternatives to incarceration in the USA.
This protocol is registered with Open Science Framework registries (https://osf.io/39zn8).
by Caroline Gatwiri Gitonga, Charles Githinji, Boniface Chege, Frederick Bukachi, Peter Waweru
ObjectiveCalcium carbide-derived acetylene is widely used as an artificial fruit ripening agent despite its potential health risks. This study aimed to investigate the effects of sub-chronic exposure to crude acetylene on cardiometabolic parameters using a rodent model.
MethodsTwenty-four male Sprague Dawley rats were randomized into four groups: control (no exposure) and three test groups exposed to 58,000 ppm crude acetylene for 10, 30, or 60 minutes daily over 42 days. Body weight, fasting blood glucose, oral glucose tolerance, hepatic triglyceride levels, adipose tissue mass, liver enzyme activity, and oxidative stress markers were assessed. Histopathological analysis of liver tissue was also conducted.
ResultsAcetylene exposure did not significantly alter body weight but led to dose-dependent increases in central adiposity, hepatic triglycerides, and markers of oxidative stress. Higher doses were also associated with impaired glycemic control, elevated liver enzyme levels, and increased free heme concentration in plasma, suggesting oxidative damage and hemolysis. Histological analysis revealed central vein congestion and hepatic structural alterations in exposed groups.
ConclusionSub-chronic inhalation of crude acetylene induced metabolic dysfunction characterized by impaired glucose regulation, hepatic steatosis, and oxidative stress, despite no changes in overall body weight. These findings highlight the potential health risks associated with acetylene exposure and underscore the need for regulatory measures to limit its use in fruit ripening.
by Bwambale Jonani, Emmanuel Charles Kasule, Bwire Roman Herman, Joel Fredrick Arturo, Mwesigwa Calvin Mugambwa, Ssebulime Stephen, John Bosco Mundaka, Richard Kwizera, Gerald Mboowa, Felix Bongomin
IntroductionSickle Cell Anemia (SCA) is a significant genetic disorder in Africa; however, comprehensive data on its prevalence and geographic distribution remain limited. We aimed to estimate the pooled prevalence of SCA (HbSS) in African populations and examine regional, demographic, and temporal variations from 1994–2024.
MethodsWe systematically searched PubMed, Scopus, Google Scholar, and BASE databases for studies reporting SCA prevalence in African populations. Screening and quality assessments were performed using JBI tools. A random-effects meta-analysis with logit transformation was performed, with subgroup analyses by region, age, sex, and study design. Meta-regression explored heterogeneity sources, including geographic region, age category, diagnostic method, study design, and publication year.
ResultsFrom 115 studies with 1,203,839 participants and 17,458 confirmed HbSS cases, the pooled prevalence was 1.43% (95% CI: 1.08%–1.88%), with substantial heterogeneity (I2 = 99.1%) and a prediction interval of 0.21%–8.91%. Central Africa showed the highest prevalence (1.99%), and Southern Africa showed the lowest (0.59%). Children exhibited a higher prevalence (1.65%) than adults (0.45%), while sex differences were non-significant (males 2.71%, females 1.74%; p = 0.694). The prevalence has remained stable over three decades despite a six-fold increase in research output, although wide prediction intervals indicated substantial between-study variability. Electrophoretic techniques predominated (86.4% of cases). Diagnostic method (χ² = 16.73, p = 0.033) and age category (χ² = 33.66, p 2 = 98.6%). Leave-one-out sensitivity analysis showed that no single study significantly impacted the pooled estimates.
ConclusionSCA represents a substantial and geographically variable public health challenge across Africa. These findings highlight the need for region-specific interventions, expanded newborn screening programs, improved diagnostic accessibility with quality assurance for point-of-care technologies, and continued surveillance to address geographic gaps.
by Helen W. Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A. Blatnik, JoAnna Hunter-Squires, Ivan Seno Saruni
BackgroundCapacity for elective general surgical care is an important reflection of a health system’s ability to meet a population’s surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system.
MethodsWe conducted a qualitative study of 38 convenience-sampled patients diagnosed with an elective hernia condition at a tertiary referral hospital in Kenya between November 2023 and March 2024. We utilized Braun and Clarke’s six-step model of thematic analysis to generate key themes across the phases of care seeking, reaching and receiving as modeled in the Three Delays Framework.
ResultsWe identified three main cross-cutting themes including (1) the flow of power from patients to providers, and vice versa, take the form of consent or knowledge, respectively; (2) trust is a limited currency required for patients to engage with formal care; and (3) internal and external contextual factors remain the foundation for patient-provider care activities. We incorporated these themes together in a framework which illustrates the cyclical nature by which each factor feeds back on the others, ultimately affecting patient care.
ConclusionsFluctuating flows of patient power and trust interacts with existing infrastructural context to influence the ability of a health system to generate care. Recognizing the interaction of these key factors may have important bearing on the successful implementation of any larger systemic efforts or policies to improve access to elective surgical care.
by Sugy Choi, Elizabeth Knopf, Megan A. O’Grady, Ivy Van Domselaar, Jessica Ortiz, Carla King, Charles J. Neighbors, Thomas D’Aunno
BackgroundPregnant and parenting women with substance use disorders (SUDs) face complex and overlapping challenges, including substance use, legal issues, housing instability, and trauma. Effective interorganizational collaboration is critical but often hindered by fragmented care and resource limitations. This study explores the key barriers and facilitators that impact collaborative efforts among healthcare providers, government agencies, and community organizations in addressing SUD among pregnant and parenting women.
MethodsThis qualitative study was conducted in New York State between April 2022 and April 2023. The study focused on organizations that provide services to pregnant and parenting women with SUDs, including government agencies, SUD treatment centers, healthcare settings, and community-based care organizations. Semi-structured, one-on-one interviews were conducted with staff to explore how their organizations coordinate care. Thematic analysis was used to identify patterns related to interorganizational collaboration. Primary data were collected through interviews with 30 staff members across multiple stakeholder groups: child welfare services (n = 8), criminal legal agencies (n = 5), health agencies (n = 3), healthcare service settings (n = 4), SUD treatment programs (n = 6), and community-based organizations (n = 4). Interviews lasted approximately one hour and focused on organizational roles, referral processes, and coordination efforts in serving the target population.
ResultsCollaborative care was primarily facilitated through referral networks, case management teams, and the presence of embedded healthcare professionals. However, these systems were frequently limited by fragmented communication, stigmatizing attitudes, and insufficient resources. Organizational facilitators included co-located healthcare staff within child welfare services and formalized partnerships across sectors. Key barriers included staffing shortages, burnout, and misalignment of organizational goals. At the individual level, collaboration often depended on informal relationships and staff-driven initiatives, though interdisciplinary knowledge gaps remained a significant challenge.
ConclusionsImproving service coordination for pregnant and parenting women with SUDs will require stronger organizational infrastructure, investment in cross-sector communication strategies, and deliberate efforts to address stigma. Future research should explore models that support sustained, formalized interagency partnerships to enhance care integration.
The use of invasive life support in patients with a prolonged critical illness clearly saves lives but carries substantial risks, including intensive care unit-acquired weakness (ICUAW) and long-term disability. Early mobilisation might improve outcomes, yet the evidence is conflicting and complicated by the lack of a responsive outcome measurement to detect change in critically ill patients’ physical function and activity. The Chelsea Critical Care Physical Assessment tool (CPAx) is a valid and reliable instrument for patients at risk of ICUAW. However, its ability to measure change over time (responsiveness) and the minimal clinically important difference (MCID) have not yet been rigorously investigated.
The primary objective of this prospective, international, multicentre, longitudinal cohort study is to investigate responsiveness and to establish the MCID of the CPAx during the ‘intensive care unit (ICU) period’, from ICU baseline to ICU discharge, and ‘hospital period’, from ICU to hospital discharge. Adults with any critical illness who are mechanically ventilated for at least 72 hours, expected to remain in ICU (≥48 hours) and being treated by a physiotherapist are eligible for study inclusion. Functional measurements, including the CPAx and a global rating of change (GRC) scale, will be collected during routine physiotherapy. Responsiveness will be evaluated primarily using the GRC as an anchor to distinguish changed from unchanged/deteriorated patients (criterion validity). As such, the magnitude of change will be analysed with receiver operating characteristics. Additionally, construct validity will be explored with correlation coefficients and effect sizes to confirm/reject a priori formulated hypotheses. MCID will be investigated with anchor-based and distribution-based methods. We plan to recruit 120 patients across three sites in Australia and Switzerland.
Ethical approval has been obtained from each local ethics committee (Canton of Bern, Switzerland (2024-00346), Monash Health, Australia (HREC/106143/MonH-2024-438474(v3)), the Alfred, Australia (490/24)). The results will be disseminated through international/national conferences, peer-reviewed journals and social media. The high quality, rigorous testing of the CPAx could benefit researchers, clinicians and patients.
Shared decision-making (SDM) between clinicians and patients is considered ‘best practice’. There is limited evidence regarding SDM in surgery, particularly in the emergency setting. Emergency SDM may be particularly challenging due to: time pressures, the patient’s underlying condition and the nature of the patient-surgeon interaction. However, emergency surgery arguably has a greater need for SDM due to the likelihood of disparate outcomes from intervention, which is dependent on the various treatment options available. This is necessary for patients to make informed decisions regarding their treatment of surgical pathology. The primary objective of this scoping review is to understand the extent and type of evidence in relation to SDM in emergency surgery to determine methods for improving SDM.
Any studies reporting SDM in emergency surgery on adult patients (age >18 years) will be included. EMBASE, Medline, Cochrane, CINAHL and Scopus databases will be searched for articles with no language or date limits. Studies will be screened by two independent reviewers, with consensus met prior to data extraction. Data extracted to include study design, details of study population, tools used to measure SDM, prevalence of SDM and barriers and enablers for SDM.
A systematic narrative synthesis will be performed following JBI (Joanna Briggs Institute) guidance. These will summarise findings of included studies. The findings may inform future research into facilitating implementation of SDM in emergency surgery.
This study does not require ethical approval. Final findings will be submitted for peer-reviewed publication and presentation at surgical conferences.
Micronutrient deficiencies remain prominent drivers of adverse maternal and child health outcomes in Nepal. Gender-based inequalities and norms around women’s status and access to nutrition exacerbate poor nutritional status. Many newly married, preconception women lack adequate nutrition due to delayed engagement with the health system and limited autonomy to prioritise their own health. To address this gap, the Sumadhur trial provides multiple micronutrient supplements (MMS) alongside a household-level behavioural intervention targeting newly married women, their husbands and mothers-in-law.
This will be a village-cluster randomised controlled trial across three districts in Nepal, enrolling 700 households, each comprising a triad of newly married woman, husband and mother-in-law. Villages will be randomised to receive either Sumadhur behavioural intervention+MMS (intervention) or standard of care (control). In intervention villages, participants will join weekly group sessions for 5 months, covering maternal and reproductive health, equitable household food allocation and nutrition information, and gender norms and household relationships. Women will receive three bottles of MMS (180 tablets each) over 18 months. Quantitative data collection at baseline, 6, 12 and 18 months will include surveys, venous blood draws (not at 12 months) and anthropometry. Primary outcomes will be anaemia prevalence and micronutrient status (iron, folate, vitamin B12). Secondary outcomes will include reproductive behaviours, birth outcomes and intrahousehold relationship dynamics. A nested qualitative component will employ longitudinal in-depth interviews with triads to understand the mechanisms of behavioural change. Impact will be measured through an intention-to-treat approach using mixed-effects logistic regression analyses.
The study is approved by institutional review boards in the Ethics Board of the Nepal Health Research Council and the University of California, San Francisco IRB. Results will be disseminated to participating communities, local stakeholders and international audiences through workshops, peer-reviewed publications and policy briefs.
All data will be made publicly available (deidentified) after the publication of the main impact paper.