Chronic dyspnoea is a prevalent symptom, and primary care is ideally placed to identify and manage it. However, chronic dyspnoea is under-reported by patients and can be a diagnostic dilemma for practitioners. A fully automated system of patient screening, coupled with a clinical decision support system (CDSS) that uses a validated and evidence-based dyspnoea algorithm, may improve detection, diagnosis and management of the condition. There is currently no CDSS validated for chronic dyspnoea diagnosis and management in primary care in Australia. The objectives of this study are to assess the clinical impact of a CDSS for chronic dyspnoea in primary care. We hypothesise that the use of the CDSS will lead to a clinically significant improvement in patient-reported dyspnoea scores, reduced time to diagnosis and healthcare costs at 12 months compared with standard care.

The BREATHE study is an open-label, cluster-randomised controlled trial of standard of care compared with a CDSS. General practices (n=40) in metropolitan, regional/rural and rural/remote settings will be recruited and randomised equally to pre-screening for chronic dyspnoea and usual standard-of-care management or pre-screening and CDSS-guided management. The CDSS includes an algorithm derived from a robust data and clinical knowledge model and incorporates evidence-based recommendations for the assessment and management of chronic dyspnoea. It is integrated into general practice medical software systems, fitting in the workflow of general practitioners (GPs). Eligible patients will be ≥18 years old and will have previously consented to receive SMS communication from their practice. In-scope patients will receive an automated text message prior to their GP appointment and will be screened for chronic dyspnoea (≥4 weeks). Patients identified with chronic dyspnoea will be invited to participate in the BREATHE study and followed up for 12 months. The primary outcome is improvement in the Dyspnoea-12 (D-12) score from baseline to 12 months, measured by the Dyspnoea-12 (D-12) questionnaire. Secondary outcomes include disease-specific questionnaires to assess changes in clinical outcomes, time to final diagnosis, quality of life, healthcare utilisation and costs incurred to patients.

The trial is registered at ANZCTR (ACTRN12624001451594). ANZCTR is a primary registry that meets the requirements of the ICMJE and is listed on the ICTRP Registry Network.

The study protocol has been approved by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and complies with the National Health and Medical Research Council ethical guidelines. Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practice reception area.

There is interest in using predictive models to address non-attendance of healthcare appointments without prior notification. Although several National Health Service (NHS) hospital trusts have piloted predictive models for non-attendance, there is a lack of published evidence in clinical settings.

This mixed-methods evaluation of the pilot of a predictive model intervention in outpatient services aimed to examine (1) the effect of the intervention on patient non-attendance and (2) staff engagement in the delivery of the intervention.

A mixed-methods study across two pilot phases. Quantitative data explored the use and impact of the predictive model on non-attendance. Z-tests were conducted to assess changes to non-attendance rates prepilot and in the two phases. Qualitative ethnographic work included 30 periods of observation and interviews with staff.

Nine outpatient services in an NHS Foundation Trust that volunteered to pilot the predictive model intervention. Qualitative participants were NHS clerical and administrative staff delivering the intervention and service managers.

An off-the-shelf predictive model, consisting of a cloud-based, random forest algorithm, produced a risk score of non-attendance by drawing on information from patients’ electronic health records. Staff in the pilot sites attempted to phone patients with a risk score to remind them of upcoming appointments.

Quantitative analysis showed that in phase 1, there were low volumes of intervention calls made across services, but three of nine outpatient services significantly reduced their non-attendance rate. There was a lower overall call rate in phase 2 among the four remaining participating services. One significantly reduced its non-attendance rate from 20.4% to 19.1% (p

The predictive model intervention was positioned as a simple solution to address a complex problem; however, there were challenges inherent in deployment within a dynamic healthcare setting. The sustainability of the intervention and its impact on patient experience warrants further exploration.

This research aimed to explore student paramedics’ experiences of participating in group-based simulation activities used as part of their summative assessment. It sought to understand their perceptions of the effectiveness of group-based simulation in fostering learning and informing future assessment design.

A qualitative questionnaire-based study.

A UK higher education institution.

A total of 34 first-year (level 4) student paramedics from the September 2022 to September 2023 cohorts.

Following the completion of a summative assessment for the introduction to non-technical skills and simulation module, students were invited to reflect on their experiences of group-based simulation through an online questionnaire. The assessment incorporated team-based simulation scenarios intended to evaluate non-technical competencies within a realistic and supportive environment.

Four key themes emerged through thematic analysis of the responses: experiential learning; autonomous learning; reflective learning; and support and learning. These themes provide insights into the pedagogical value of group-based simulation, with students identifying both individual and collective benefits in developing non-technical skills within a group assessment framework.

Group-based simulation assessments enhance student engagement and promote collaborative decision-making in a context that mimics real paramedic practice. While students often associate realism with increased confidence, their experiences highlight complex interactions between perceived fidelity, assessment pressure and learning. This underscores the need to further investigate how group dynamics and authenticity influence learning outcomes in assessment-focused simulations.

Fibrosis is a pathological feature that can occur in a wide range of diseases including diabetes mellitus. We investigated whether in people with type 1 (T1DM) or type 2 diabetes mellitus (T2DM), glycaemia or diabetes-related complications are associated with fibrotic diseases.

Retrospective cohort study using UK Clinical Resource Datalink (CPRD) Aurum and Hospital Episode Statistics.

We included people with prevalent T1DM or T2DM as of 31 December 2015 (recorded in CPRD Aurum), eligible for linkage with Hospital Episode Statistics and followed up for 3 years.

We defined diabetes status using blood/urine biomarkers and complications. In the T2DM cohort, we also investigated exposures of hyperglycaemia, insulin resistance and metformin prescription. Fibrotic condition diagnoses were determined from both primary and secondary care records. Logistic regression analyses were undertaken to understand the strength of association between diabetes status/diabetic complications and fibrotic conditions, respectively.

The T1DM cohort consisted of 9669 people while the T2DM cohort included 504 066 people. In T1DM, we found that albuminuria was associated with lung fibrosis (ORadj: 2.07, 99% CI 1.35 to 2.17), and microvascular complications were associated with atherosclerosis (ORadj: 1.81, 99% CI 1.18 to 2.77) and cardiomyopathy (ORadj 1.53, 99% CI:1.15 to 2.04). In the T2DM cohort, both glycaemia above target and diabetes complications were associated with most fibrotic conditions.

Within the T1DM population, no consistent association between diabetes status and all fibrotic diseases was observed. More research is required to understand whether the association between diabetes complications and fibrotic diseases is due to shared risk factors or whether glycaemia in T2DM may be influenced by fibrotic pathology.

Peer support in youth mental health settings holds promise as a developmentally appropriate and impactful initiative; however, research exploring implementation remains limited. To advance the field and strengthen future implementation efforts, the aim of the present study was to generate new understandings about how non-peer service providers working alongside youth peer support workers experience the peer support role in youth mental health settings.

Guided by interpretive description and tenets of a research community partnership model, semi-structured interviews were conducted with non-peer service providers (n=11) across three integrated youth services centres in British Columbia, Canada, from August to December 2020. Data were analysed inductively using a constant comparative approach to identify and construct themes.

Participants emphasised integration and supervision of youth peer support workers as essential for successful peer programming within integrated youth services, highlighting three interconnected themes: defining supervisory roles, envisioning role clarity and capacity and governance of youth peer support services.

Integrated youth services initiatives and peer-led agencies can play key roles—both directly and indirectly—to strengthen the governance and infrastructure of youth peer support.