Adenotonsillectomy is the primary treatment for type 1 obstructive sleep apnoea (OSA1). Although polysomnography (PSG) remains the gold standard for measuring Apnoea-Hypopnoea Index, it is a labour-intensive procedure and does not correlate with improvements in quality of life postadenotonsillectomy. Mouth breathing is associated with poorer quality of life in children. Mandibular movement (MM), which measures mouth opening, is a validated measure of respiratory effort that can be easily and safely assessed in children using the JAWAC technology. This study aims to evaluate the relationship between changes in quality of life and changes in mouth opening in children with OSA1 after undergoing adenotonsillectomy. Secondary objectives include evaluating changes in quality of life, clinical symptoms and other MM and PSG metrics in the same population.

This exploratory, non-randomised, monocentric, prospective cohort study with a non-blinded single arm will include 50 children aged 3–7 years, undergoing adenotonsillectomy at the Clinique Saint Jean, Montpellier, France. Quality of life will be measured using the parent version of the Paediatric Quality of Life Inventory and MM metrics will be measured during PSG using the JAWAC system during the inclusion visit and 3 months after adenotonsillectomy. The primary outcome will be the correlation between the changes in quality of life and mouth opening (1/10 mm) postadenotonsillectomy. Secondary analyses will evaluate changes in clinical symptoms, PSG measures and other MM metrics including respiratory effort, as well as the associations between these measures.

This study was approved by an independent ethics committee (Comité de Protection des Personnes Est) on 24 March 2025 (2024-A02761-46) and will be conducted in accordance with French law, good clinical practice and the guidelines of the Declaration of Helsinki. Study findings will be disseminated through international peer-reviewed journal articles as well as public, academic presentations at national and international conferences.

NCT06973928.

To identify the barriers and facilitators towards deceased organ donation among Pakistanis living globally.

Systematic review using narrative synthesis.

CINAHL, Medline with Full Text, Global Health and PsycINFO via EBSCO; Scopus via Elsevier; Web of Science via Clarivate; and PubMed through the US National Library of Medicine and the National Institutes of Health were searched between 1 January 1995 and 31 July 2024 and limited to English.

We included qualitative and cross-sectional studies involving Pakistani participants aged 18 years and above, conducted both within Pakistan and internationally across settings such as universities, religious venues, hospitals and workplaces.

Four independent reviewers were involved in screening, quality assessment and data extraction. A narrative synthesis method was employed to synthesise and integrate the data from qualitative and cross-sectional studies. The Joanna Briggs Institute tool was used to assess the quality of the included studies.

Out of 11 944 studies retrieved, 26 studies were included in the current review. Based on the narrative synthesis, the findings are presented under the following five themes: (1) knowledge of deceased organ donation, (2) willingness towards deceased organ donation, (3) collective decision-making overriding individual’s preferences, (4) religious uncertainty and its impact on deceased organ donation and (5) trust and the healthcare systems.

This review shows that decisions about deceased organ donation are shaped by family dynamics, religious beliefs and trust in healthcare. More diverse research is needed to uncover new gaps and improve donor registration and consent rates in Pakistan. A whole-systems approach, considering families, religion and trust, is essential for effective strategies.

CRD42022346343.

The sustainable employability of healthcare workers is associated with quality of care and vice versa, but how both interact remains largely unknown. This study aims to better understand the underlying mechanisms that explain the interconnectedness between healthcare workers’ sustainable employability and quality of care by examining organisational practices in two hospital teams that work on improving specific clinical processes.

A qualitative study was conducted, where team leaders, department managers and healthcare teams were observed and interviewed about their experiences with, and perspectives on, the (organisation of the) respective clinical process and daily (quality improvement) work. Transcripts and field notes were analysed in accordance with reflexive thematic analysis.

The emergency room and operating room of a recently merged Dutch hospital.

A total of 49 hours of observations and 10 interviews were conducted with team leaders, department managers, (scrub) nurses, physicians and other allied health professionals. Interviewees were purposively recruited when they were involved in, or considered knowledgeable about, the clinical processes.

This study identified three mechanisms as a result of different organisational practices that affected healthcare workers’ sustainable employability and quality of care separately and set in motion their interconnectedness: routinely overburdened staff, prolonged perceived distance between staff and regular disregard of raised concerns by staff. Over time, as these mechanisms remained unaddressed, undertows of slumbering sentiments—discontent, distrust and inertia—emerged. These sentiments proved hard to bring to the surface and to resolve and, in turn, may further compromise sustainable employability of healthcare workers and quality of care.

In this study, we show how the relationship between the sustainable employability of healthcare workers and quality of care is set in motion by seemingly unrelated organisational practices. To benefit both healthcare workers and patients, leadership and healthcare teams are urged to prevent (undertows of) slumbering sentiments by recognising sentiments as important signals of dysfunctional circumstances and by effectively organising participatory practices that enable healthcare workers’ voice and input.

Sleep problems are an escalating global health concern, with prevalence estimates ranging from 8.3% to 45%. Physicians are disproportionately affected, with rates around 44% compared with 36% in the general population. In Bangladesh, reported rates range from 32% to 58%, with physicians being particularly vulnerable. Poor sleep among physicians is strongly linked to burnout, medical errors and increased mental health risks. Despite these serious implications, existing evidence from Bangladesh remains fragmented and inconsistent, limiting its utility for health policy and workforce interventions. This review therefore seeks to generate reliable pooled prevalence estimates and identify key determinants of sleep problems among Bangladeshi physicians.

The research team will search the PubMed, Scopus, Web of Science, EMBASE, PsycInfo, ProQuest Medical, CINAHL, Google Scholar and BanglaJOL electronic and regional databases following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for published studies from inception until 1 August 2025, using truncated and phrase-searched keywords, relevant medical subject headings and citation chaining from grey literature. Observational cross-sectional studies published within the predefined timeframe, using validated assessment tools, and published in English or other major international languages will be prioritised for inclusion. Review papers, case reports, case series, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished articles and letters will be excluded. Two independent reviewers will screen the retrieved papers using the Rayyan web-based application, with any disagreements resolved by a third reviewer. Quantitative estimates of sleep problems, including prevalence, duration, quality and associated risk factors among Bangladeshi physicians will be extracted. A narrative synthesis and meta-analysis will be performed to assess the pooled prevalence using a random effects meta-analysis model. Forest and funnel plots will be generated for visualisation. Heterogeneity will be assessed using the I² statistic, with sensitivity or subgroup analysis conducted as required. The quality of included studies will be evaluated using Joanna Briggs Institute critical appraisal tools for observational study designs. All statistical analysis will be conducted using Jamovi V2.7.6, R V4.3.2 ‘meta’ packages and GraphPad Prism V9.0.2.

This review will synthesise evidence from existing published literature. While completing the findings, the findings will be submitted to an international peer-reviewed journal and disseminated through conferences, policy forums and stakeholders’ networks to inform future research and interventions.

CRD420251123294.

Evaluation of the impact of atherosclerotic cardiovascular disease (ASCVD), particularly polyvascular disease, on 30-day and 365-day mortality among intensive care unit (ICU) patients diagnosed with sepsis.

Retrospective cohort study.

This study was conducted using data from the Medical Information Mart for Intensive Care IV, a publicly available critical care database from a tertiary care hospital in the US.

A total of 7895 adult ICU patients with sepsis were included between 2008 and 2022. Among them, 3314 (41.97%) had ASCVD, defined by International Classification of Diseases (ICD) codes for coronary artery disease, peripheral artery disease or stroke.

The primary outcomes were all-cause mortality at 30 and 365 days following ICU admission.

ASCVD patients with a greater number of disease beds tend to be male, older, have lower body mass index, heart rates, mean blood pressure, respiratory rate and temperature, compared with non-ASCVD patients. Before propensity-score matching, patients with ASCVD (3314) had significantly higher 30-day (29.21% vs 24.14%, p

Integrated management of sepsis and ASCVD—using targeted interventions such as tailored pharmacotherapy and risk factor modification—may reduce mortality and morbidity in this high-risk population.

The Communication and Symbolic Behaviour Scales Developmental Profile Infant–Toddler Checklist (CSBS DP ITC) is a screening tool designed to identify early deficits in social communication, expressive speech/language and symbolic functioning in children aged 6–24 months. This study aimed to translate and content validate the CSBS DP ITC into Modern Standard Arabic.

Methodological study involving translation and content validation.

The study was conducted in the United Arab Emirates.

The translation process involved five bilingual translators and one monolingual Arabic language expert. Ten experts participated in the content validation phase, and 10 parents of young children participated in the face validity assessment.

Content Validity Indices (CVIs), including the Item-level CVI (I-CVI), the Scale-level CVI by Average (S-CVI/Ave) and the S-CVI by Universal Agreement (S-CVI/UA), along with modified kappa statistics, were calculated to assess item-level and scale-level clarity, relevance and comprehensiveness.

Expert panel ratings showed high clarity (I-CVI: 0.8–1, S-CVI/Ave: 0.98, S-CVI/UA: 0.88) and similar relevance scores. Face validity assessments yielded clarity I-CVI scores of 0.9–1, with S-CVI/Ave at 0.98 and S-CVI/UA at 0.8. The modified kappa statistic ranged from 0.89 to 1, indicating strong agreement among parents.

The CSBS DP ITC was effectively translated and content validated into Modern Standard Arabic. The calculated CVI values ranged from excellent to acceptable. This step establishes a foundation before proceeding to full psychometric testing of the instrument, paving the way for a reliable and culturally appropriate tool to identify early communication delays for use across the Arab-speaking population.

To analyse the impact of selected neonatal care interventions on regional care capacity.

Design

Discrete event simulation modelling based on clinical data.

Neonatal care in the southwest of the Netherlands, consisting of one tertiary-level neonatal intensive care unit (NICU), four hospitals with high-care neonatal (HCN) wards and six with medium-care neonatal (MCN) wards.

44 461 neonates admitted to at least one hospital within the specified region or admitted outside of the region but with a residential address inside the region between 2016 and 2021.

The impact of three interventions was simulated: (1) home-based phototherapy for hyperbilirubinaemia, (2) oral antibiotic switch for culture-negative early onset infection and (3) changing tertiary-level NICU admission guidelines.

Regional neonatal capacity defined as: (1) occupancy per ward level, (2) required operational beds per ward level to provide care to all inside region patients at maximum 85% occupancy, (3) proportion rejected, defined as outside region transfers due to no capacity to provide local care and (4) the weekly rejections in relation to occupancy to provide a combined analysis.

In the current situation, with many operational beds closed due to nurse shortages, occupancy was extremely high at the NICU and HCNs (respectively 91.7% (95% CI 91.4 to 92.0) and 98.1% (95% CI 98.0 to 98.2)). The number of required beds exceeded available beds, resulting in >20% rejections for both NICU and HCN patients. Although the three interventions individually demonstrated effect on capacity, clinical impact was marginal. In combination, NICU occupancy was reduced below the 85% government recommendation at the cost of an increased burden for HCNs, highlighting the need for redistribution to MCNs.

Our model confirmed the severity of current neonatal capacity strain and demonstrated the potential impact of three interventions on regional capacity. The model showed to be a low-cost and easy-to-use method for regional capacity impact assessment and could provide the basis for making informed decisions for other interventions and future scenarios, supporting data-driven neonatal capacity planning and policy development.

To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.

A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.

Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.

Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).

Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.

The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).

Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.

Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.

Polysubstance use (PSU), particularly opioid-involved and stimulant-involved PSU, is a growing issue in the USA. PSU increases the risk of negative health consequences, including infectious diseases, worsening physical and mental health conditions, and overdose-related deaths. These consequences occur in the context of varying health risk behaviours, substance-related preferences, and treatment engagements among people with PSU. To inform improvements in prevention, harm reduction, and substance use disorder (SUD) treatment, additional research is needed to comprehensively understand the current context and drivers of PSU preferences, motivations, and behaviours.

Herein, we describe the protocol for a prospective cohort study designed to capture detailed patterns, profiles, and trajectories of PSU, with the aim of comprehensively examining the drivers of PSU behaviours and SUD treatment utilisation. Adults (ages 18–75; n=400) who engage in PSU will be recruited from healthcare institutions, an established participant database maintained by an adjacent SUD research team, and online advertisements. Study assessments will capture dynamic patterns, choice preferences, and motivators of PSU via behavioural economic (BE) measures, detailed Timeline Follow-Back (TLFB) interviews, and self-administered surveys. The assessment timeline will include a baseline survey and TLFB interview, weekly TLFB interviews for 4 weeks post-baseline, and follow-up surveys and TLFB interviews at 4-, 8-, and 12-months post-baseline.

The study is funded through the National Institutes of Health Helping to End Addiction Long-term (HEAL) initiative and was approved by the University of Michigan Medical Institutional Review Board. Findings will be disseminated to academic, clinical, and community partners through the Michigan Innovations in Addiction Care through Research and Education programme. Results from this study will inform actionable and practical insights relevant to the delivery of personalised care in the context of PSU.

Large differences exist in chronic kidney disease (CKD) rates between countries, but differences within diverse populations living in the same setting with universal healthcare are not well understood.

To compare dialysis prevalence, CKD risk factors and control, and CKD progression by ethnicity and birth country in an ethnoculturally diverse setting with high rates of kidney disease and universal healthcare.

Scarborough, Toronto’s most diverse region and site of Canada’s largest regional dialysis programme.

Double observational cohort study of 2397 participants: a retrospective cohort of 1116 residents who received dialysis between 2016–2019, and a prospective cohort of 1281 individuals with non-dialysis CKD followed for 3 years between 2010–2015 in Scarborough.

Dialysis prevalence, calculated by comparing frequencies of birth countries and ethnicities in the dialysis cohort with census-derived community frequencies. Secondary outcome measurements were traditional CKD risk factor prevalence (diabetes, hypertension, cardiovascular disease) and control (haemoglobin A1c, blood pressure); and CKD progression (estimated glomerular filtration rate decline, proteinuria) adjusted for socioeconomic status in the non-dialysis cohort.

Dialysis prevalence was 4.2 times higher in immigrants (p

Despite universal healthcare access, marked disparities in CKD risks and rates exist within ethnoculturally diverse immigrants living in this Canadian kidney disease hotspot. More focused research and tailored interventions are required.

To synthesise the perspectives of healthcare professionals and patients/residents of hospitals/nursing homes about determinants of inappropriate indwelling urinary catheter (IUC) use and strategies for reduction.

Qualitative evidence synthesis.

We searched MEDLINE, Scopus and CINAHL for studies published between 1 January 2000 and 23 May 2025.

Studies were eligible if they used qualitative methods to explore the perceptions and experiences of healthcare professionals and patients/residents of hospitals/nursing homes or their family members regarding the determinants of IUC use and reduction. Included studies focused on behavioural drivers or strategies to reduce inappropriate IUC use.

Two independent authors reviewed the search results, extracted and coded data, and assessed methodological strengths and limitations of studies. We used a thematic synthesis approach following the Cochrane–Campbell Handbook for Qualitative Evidence Synthesis and applied the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach to assess confidence in the findings.

We synthesised 24 studies. Perceived determinants of inappropriate IUC use included non-adherence to guidelines due to vague indications for initial IUC insertion, differing perspectives on benefits and risks, low priority given to the topic, limited accessibility or perceived unsuitability of alternatives, high nurse workload and staff shortages (moderate confidence). Ineffective nurse–physician communication, documentation difficulties and lack of training were also assumed to be linked to inappropriate IUC use (low confidence). Mentioned strategies for the reduction of inappropriate IUC use included additional training for healthcare professionals, clinician reminders to review or remove catheters, improved electronic documentation systems, increased staffing and greater use of IUC alternatives.

Key drivers of inappropriate IUC use are vague indications and routine decisions, lack of suitable and available alternatives, staff shortages and perceived lack of importance of the topic. Addressing these barriers is important for deimplementing inappropriate IUC use, and multifaceted strategies appear to be the most promising approach to address the multiple factors that drive current IUC misuse.

CRD42024531522.

The treatment of tobacco dependence in patients admitted to hospital is a priority for the National Health Service in England. We aimed to conduct an economic analysis of a pilot ‘opt-out’ tobacco dependence treatment intervention adapted from the Ottawa Model of Smoking Cessation.

Observational cost analysis of an inpatient tobacco dependence treatment intervention, and matched cohort study comparing readmission costs between patients who received the intervention and benchmarked equivalents who did not.

11 acute inpatient wards in a major teaching hospital in London, England.

673 patients who smoked, admitted between 1 July 2020 and 30 June 2021.

The intervention consisted of the systematic identification of smoking status, automatic referral to tobacco dependence advisors, provision of pharmacotherapy and behavioural support throughout the hospital stay and telephone support for 6 months after discharge.

The primary outcomes were cost-per-patient, cost-per-quit and incremental cost effectiveness ratio among patients who received the intervention. The secondary outcomes were patient-level readmission costs and bed-days from 6 months after discharge, compared between the intervention group and a group of matched benchmark patients who smoked but did not receive the intervention.

The total cost of the intervention was £178 105. On the basis of 104 patients who reported not smoking at 6 months, the cost-per-quit was £1712.55, equating to an estimated age-adjusted incremental cost per life year gained of £3325. Among 611 patients who were successfully matched to a benchmark cohort, readmissions for patients in the intervention group cost £492 k less than their benchmark equivalents over 21 months from 1 January 2021 to 30 September 2022 (£266 k vs £758 k), incurred 414 fewer bed days (303 vs 717) and readmitted at a lower rate (5% vs 11%). There were reduced readmission rates and costs among all patients who received the intervention compared with their benchmarked equivalents, regardless of smoking status at 6 months, except among those who opted out.

A pilot ‘opt-out’ tobacco dependence treatment intervention implemented in an acute hospital setting in London demonstrated value for money through reduced readmission rates and costs among all patients who received it.

A quality management system (QMS) in healthcare organisations encompasses not only policies, processes and necessary procedures but also the quality, safety and risk management of medical technology. Tactical and operational decision-making levels should be closely interconnected. Previous studies have shown that nurses at the operational level do have good awareness of patient safety, but especially in teams with a strong degree of self-organisation, interaction with tactical levels is an issue. The tactical level is regarded as crucial for linking top-down policy with bottom-up experiences.

To explore the perspectives of homecare employees working at a tactical level regarding (1) the quality frameworks used within their organisation according to these employees, (2) the extent to which these employees are aware of the procedures for the safe use of advanced medical technologies (AMTs), such as infusion pumps, within their organisation and (3) how these employees perceive the patient safety culture related to the use of AMTs within their organisation.

A qualitative descriptive research design was employed.

15 semistructured interviews were conducted online with purposively sampled participants from homecare organisations across the Netherlands that had previously participated in related studies. The participants were employees at the tactical level within these homecare organisations, responsible for the quality and safety of AMTs.

All participating organisations possess a QMS; however, only seven indicated that there is a dedicated plan for ensuring the quality and safety of AMTs. National protocols for the use of AMTs and the supplier’s maintenance protocols are commonly followed. Although some participants say that their organisation has no formal procedure for resolving malfunctions with AMTs, all participants know pathways for solving problems. Tailored training programmes for nurses on AMTs are provided, but often without testing knowledge and skills or formal registration of nurses’ competence. Professionals report an incident on a separate form in the electronic client file or via a separate reporting system. However, there is no uniformity within organisations about handling incidents. Most interviewees state that, in any case, incidents are discussed within the team. On the dimension ‘reporting, evaluating and learning from incidents’ of the ‘Instrument for Self-Evaluation of Patient Safety Culture’, the prevailing patient safety culture is, on average, characterised as ‘proactive’.

There is a lack of uniformity regarding quality and safety procedures for the use of AMTs in homecare organisations, and structured policies for the implementation, use and maintenance of AMTs are needed. This study identified additional risk factors regarding individual competencies in the use of AMTs at home. Employees at the tactical level seem to be more positive about the patient safety culture with AMTs in their organisations than nurses at the operational level are.

To explore the patient and informal-carer reported factors that influence prescribing decisions in the management of borderline personality disorder (BPD).

The study employed a qualitative methodology of semi-structured interviews with patients and informal carers to examine perspectives on prescribing decisions and the factors shaping them.

Interviews were conducted across both primary and secondary care settings in England.

A total of 10 participants were recruited for the study, comprising eight females and two males, all aged 18 years or older. Participants either had a formal diagnosis of BPD or were informal carers of individuals diagnosed with BPD. All participants had experience with the prescribing of medication for the management of BPD.

Thematic analysis, employing both inductive and deductive strategies and informed by agency theory, yielded three interrelated themes: prescribing for symptom relief, the impact of risk on prescribing and difficulties in accessing services. Participants described medication as a necessary means of managing distress, especially when access to psychological therapies was constrained. Despite awareness of potential adverse effects, many expressed a strong desire to make their own decision around medication.

Improving clarity around the likelihood of both symptomatic relief and potential adverse effects through co-designed informational resources may support more informed decision-making in the treatment of BPD. Furthermore, to change prescribing patterns, systemic gaps in the provision of long-term psychological therapies must be addressed.

This study investigates how environmental and household variables relate to groundwater quality in Indonesia.

The research uses data from the 2020 Cross-sectional Household Drinking Water Quality Study, the National Socioeconomic Survey 2020, and climate records.

Indonesia.

The study includes 5965 households across 34 provinces, using descriptive and path analysis techniques.

The microbiological quality of drinking water was primarily focused on Escherichia coli as an indicator of microbial contamination.

Out of 5965 households, only 5.15% had emptied faecal sludge (FS) in the last 3 years, while E. coli contamination was detected in 71.21% of the samples. Improved drinking water sources and proper FS emptying practices were associated with better water quality.

These findings highlight the urgent need for enhanced surveillance and evidence-based policymaking to safeguard both drinking water quality and sanitation practices, which are crucial for public health and environmental sustainability.

Anxiety disorders, obsessive–compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are common in children and adolescents and can lead to significant impairment. Cognitive behavioural therapy (CBT) with exposure is the first-line treatment, yet approximately half of treated youth do not achieve full remission. Dysfunctional cognitions—negative automatic thoughts, maladaptive beliefs and distorted interpretations—are considered key targets of CBT, but evidence in youth is mixed and underpowered. This study will examine whether change in dysfunctional cognitions mediates treatment outcome in anxiety, OCD and PTSD symptoms and whether this association varies across individual characteristics.

An individual participant data meta-analysis (IPDMA) of randomised controlled trials of CBT for youth aged 5–18 years with anxiety disorders, OCD or PTSD will be conducted. The search strategy includes the databases APA PsycINFO, MEDLINE and Web of Science Core Collection from inception to 8 September 2025. It is supplemented by screening reference lists, trial registries, grey literature and outreach to relevant research groups. Eligible trials must include at least one validated measure of dysfunctional cognitions administered at minimum pre- and post-treatment, and clinical outcomes assessed at post-treatment and follow-up. The two primary outcomes are (1) child-reported symptom severity and (2) clinician-rated clinical severity. Data will be harmonised for dysfunctional cognition scores, moderators (age, gender, socioeconomic status, comorbidity), and primary outcomes. One-stage Bayesian mixed-effects models will examine whether changes in dysfunctional cognitions predict improvements in primary outcomes and whether these effects are moderated by individual characteristics. Missing data will be addressed using multiple imputation within the Bayesian framework, and study-level heterogeneity will be modelled using random intercepts and slopes.

All datasets will be de-identified and managed under General Data Protection Regulation standards. Each included trial will have ethical approval permitting data sharing and reuse, and the secondary analysis of the shared datasets has been approved by the University of Amsterdam. Findings will be disseminated via a peer-reviewed publication, scientific conferences and open sharing of analysis scripts and harmonisation procedures.

CRD420251139130.

To develop survey items for a national patient registry on Long COVID using a modified Delphi process.

This study was based on a modified Delphi process involving three rounds of anonymous, online surveys to develop consensus on and prioritise survey elements to be included in a minimum dataset for use in a national patient registry in Canada. Initial Long COVID items were identified through an environmental scan of the literature.

This study focused on healthcare systems in Canada and was conducted online.

A panel of 52 experts (patients, caregivers, clinicians and researchers) participated in all three rounds of the online survey. These participants were recruited through the Long COVID Web network and word of mouth.

In total, 243 survey elements related to care, quality of life and symptoms were included in round 1 of the survey. 200 reached consensus and moved to round 2 with two additional elements being developed based on open-ended responses. In round 2, participants ranked these survey elements and 34 advanced. In round 3, 33 survey elements met the threshold of consensus with one added a priori. The 33 survey elements were then used to develop a Long COVID minimum dataset, which consists of 48 items.

The findings affirm broad consensus for collecting data related to fatigue, post-exertional malaise, cardiovascular issues, respiratory problems and cognitive issues. This highlighted the desire for quality-of-life indicators and information related to care utilisation, quality and access.

Alcohol use disorder (AUD) is a prevalent, chronic condition generating considerable global morbidity, mortality and socioeconomic burden. Despite the availability of established pharmacotherapies, overall treatment uptake remains low and effect sizes are moderate at best. Emerging evidence highlights substantial differences in treatment response between sexes and genders, yet these factors are rarely systematically considered in clinical trials or routine care. Existing reviews have limited scope and often exclude gender-diverse populations. This project aims to (1) Synthesise evidence on gender- and sex-specific efficacy, safety and adherence in AUD pharmacotherapies, (2) Evaluate the consideration of sex and gender beyond binary classifications in existing research and (3) Develop recommendations for gender- and sex-sensitive treatment strategies.

A systematic review and meta-analysis will be conducted using (PubMed, Web of Science, Scopus, Google Scholar, German Clinical Trials Register and ClinicalTrials.gov). We will include randomised controlled trials of pharmacotherapies for AUD with a minimum treatment duration of 4 weeks, reporting gender-specific and/or sex-specific results. The literature search will cover studies published up to October 2025, with inclusion restricted to articles published in English or German, regardless of setting. Two reviewers will independently screen records and assess risk of bias (Cochrane RoB), with evidence certainty evaluated using Grading of Recommendations Assessment, Development and Evaluation and aligned to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Sex and Gender Equity in Research guidelines.

Ethics approval is not required as only data from already completed studies and supplementary information directly provided by study authors are used. Findings and recommendations will be disseminated in peer-reviewed journals and presented at conferences and workshops.

CRD420251079160.

To evaluate progress in the implementation of the WHO Eastern Mediterranean Regional Office (EMRO) Regional Framework for Action on Diabetes Prevention and Control, identify implementation barriers and facilitators, and provide recommendations for accelerating progress, with a particular focus on fragile, conflict-affected and vulnerable settings (FCVs).

Mixed-methods study combining secondary analysis of quantitative data from WHO datasets with qualitative synthesis of inputs from WHO consultative meetings with EMR member states.

22 countries of the WHO EMR, including 10 classified as FCV and 12 as non-FCV according to World Bank and WHO classifications.

Quantitative data were drawn from the 2021 WHO Country Capacity Survey targeting all EMR countries and other WHO sources. Qualitative data were based on insights from 16 country representatives during a regional WHO EMRO webinar, including non-communicable diseases programme managers, policy leads and WHO country office staff.

Among the 22 countries analysed, only 10% (1/10) of FCVs had a national diabetes action plan compared with 67% (8/12) of non-FCVs. A sugar-sweetened beverage tax was implemented in 75% (9/12) of non-FCVs but in just 10% (1/10) of FCVs. For diabetes management, detailed national guidelines were available in 30% (3/10) of FCVs compared with 83% (10/12) of non-FCVs; insulin was available in primary care in 50% (5/10) of FCVs compared with 83% (10/12) of non-FCVs. Surveillance systems were less robust in FCVs: while 70% (7/10) collected data on diabetes status, only 30% (3/10) had a national diabetes registry, compared with 83% (10/12) of non-FCVs.

Addressing diabetes in the EMR requires strategic collaboration and tailored approaches for FCVs, including strengthened governance, preparedness, integrated care, medication access and surveillance. Prioritising primary healthcare and embedding diabetes prevention and control in universal health coverage and emergency response frameworks is critical to reducing inequities and improving health outcomes in fragile contexts.