An estimated 262 million people lived with asthma globally in 2019. Similarly, in 2021, chronic obstructive pulmonary disease (COPD) was responsible for 3.5% million global deaths. They are usually distinct disorders, but the Global Initiative Chronic Obstructive Lung Disease (GOLD) 2024 strategy document asserts that asthma and COPD are conditions that may coexist in an individual and may require specific personalised approaches and treatments. It is acknowledged that they may share some common treatable traits and clinical features There are many challenges to manage asthma and COPD in the older population, including poor adherence to prescribed medications and poor inhaler techniques. The overall aim of this systematic review is to identify, appraise and synthesise available evidence around digital health interventions used to improve medication adherence in older people with asthma or COPD.

This systematic review will examine studies that evaluated digital health interventions for asthma or COPD in any setting (eg, primary or secondary care). To be included, studies must be reported in English, Arabic or French and published from the year 2000 onwards. A literature search will be performed in MEDLINE via Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE and PsycINFO via Ovid to identify relevant articles published since 2000 and up to December 2024. No language restrictions will be applied.

The Cochrane risk-of-bias tool for randomised trials will be used to assess the quality of retrieved randomised controlled trials and quasi-experimental studies. The quality of cross-sectional, cohort and case-control studies will be assessed using the Newcastle Ottawa Scale. Mixed-methods studies will be assessed using the Mixed Methods Appraisal Tool (MMAT). The quality of qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist.

Data will be synthesised using a convergent segregated approach, which involves an independent synthesis of quantitative and qualitative data leading to the generation of quantitative and qualitative evidence, which will then be integrated.

Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through a peer-reviewed publication and conference presentations. Findings will be used in a bigger project aimed to answer the question on how to embed a pharmacist-led digital health service to support older people with asthma or COPD into the NHS (National Health Service) usual care.

CRD42024575924.

To describe the lessons learnt during the promotion of a new approach to the care of critically ill patients in TanzaniaEssential Emergency and Critical Care (EECC).

A descriptive qualitative study using thematic analysis of structured interviews.

The study was conducted in Tanzania, involving 11 policymakers, researchers and senior clinicians who participated in the promotion of EECC in the country.

Five inter-related themes emerged from the promotion of EECC in Tanzania: (1) early and close collaboration with the government and stakeholders; (2) conduct research and use evidence; (3) prioritise advocacy and address misconceptions about EECC; (4) leverage events and embed activities in other health system interventions; and (5) employ a multifaceted implementation strategy. The themes map to the normalisation process theory domains of coherence, cognitive participation, collective action and reflexive monitoring.

The integration of EECC into Tanzania’s health policy is a result of a multidisciplinary collaboration including government and partners that has used evidence, advocacy and context and included multifaceted implementation strategies. The lessons from Tanzania’s experience provide guidance for adoption in similar settings to improve critical care systems, foster access to care and optimal outcomes for all critically ill patients.

Sepsis and antibiotic resistance constitute a deadly synergy, causing the loss of millions of lives across the world, with their economic and developmental consequences posing a threat to global prosperity. Their impact is disproportionately felt in resource-limited settings and among vulnerable populations, especially children. A key challenge is prompt diagnosis and timely commencement of appropriate antibiotic therapies. These challenges are compounded in low-income and middle-income countries by a lack of comprehensive epidemiological data, with Nigeria being one such country for which it is lacking. Kaduna is the third largest state in Nigeria, with over 10 million inhabitants, of whom more than half are children under 14 years old. While bacterial sepsis and antimicrobial resistance (AMR) are recognised as a growing problem in the state, there are huge gaps in the current understanding of their aetiology. This project employs a cross-sectional design to investigate the clinical and haematological markers of paediatric sepsis, alongside determining the bacterial cause and prevalence of AMR at four high-turnover hospitals in Kaduna State, Nigeria. Further, whole-genome sequencing of isolated bacterial pathogens will be performed to determine the genetic features of resistance. This project represents the largest surveillance study of paediatric sepsis in Kaduna to date. Additionally, we aim to use the clinical, haematological, microbiological and genomic data to derive predictive models for sepsis causes, treatment strategies and patient outcomes.

This is a hospital-based, cross-sectional study that will recruit up to 461 children with bacterial sepsis who were admitted at the two teaching and two general hospitals in Kaduna State, Nigeria. Children presenting with features of fever, subnormal temperature and body weakness would be recruited into the study and have their blood samples collected. The blood samples will be used for culture, complete blood count, HIV and malaria testing. Accordingly, we will capture clinical presentation, haematological characteristics, causative pathogen from blood culture and patient outcomes. Nutritional status, known congenital immunosuppressive diseases, HIV infection and malaria infection will also be determined and documented. The bacterial isolates will be phenotypically characterised for AMR and genotypically following whole genome sequencing. Known and potential confounders to the outcomes of bacterial sepsis would be assessed in all participants, and adjustment for confounding would be performed using logistic regression and/or stratification±Mantel-Haenszel estimator where applicable.

Ethical approvals were granted by the University of Birmingham (ERN_2115-Jun2024), the Ahmadu Bello University Teaching Hospital (ABUTHZ/HREC/H45/2023), Barau Dikko Teaching Hospital, Kaduna (NHREC/30/11/21A) and the Kaduna State Ministry of Health (MOH/AD M/744/VOL.1/1110018). The study will be conducted using the international guidelines for good clinical practice and based on the principles of the Declaration of Helsinki. The results will be disseminated via oral and poster presentations in scientific conferences and published in peer-reviewed journal articles.

To investigate whether quantitative retinal markers, derived from multimodal retinal imaging, are associated with increased risk of mortality among individuals with proliferative diabetic retinopathy (PDR), the most severe form of diabetic retinopathy.

Longitudinal retrospective cohort analysis.

This study was nested within the AlzEye cohort, which links longitudinal multimodal retinal imaging data routinely collected from a large tertiary ophthalmic institution in London, UK, with nationally held hospital admissions data across England.

A total of 675 individuals (1129 eyes) with PDR were included from the AlzEye cohort. Participants were aged ≥40 years (mean age 57.3 years, SD 10.3), and 410 (60.7%) were male.

The primary outcome was all-cause mortality. Quantitative retinal markers were derived from fundus photographs and optical coherence tomography using AutoMorph and Topcon Advanced Boundary Segmentation, respectively. We used unadjusted and adjusted Cox-proportional hazards models to estimate hazard ratios (HR) for the association between retinal features and time to death.

After adjusting for sociodemographic factors, each 1-SD decrease in arterial fractal dimension (HR: 1.54, 95% CI: 1.18 to 2.04), arterial vessel density (HR: 1.59, 95% CI: 1.15 to 2.17), arterial average width (HR: 1.35, 95% CI: 1.02 to 1.79), central retinal arteriolar equivalent (HR: 1.39, 95% CI: 1.05 to 1.82) and ganglion cell-inner plexiform layer (GC-IPL) thickness (HR: 1.61, 95% CI: 1.03 to 2.50) was associated with increased mortality risk. When also adjusting for hypertension, arterial fractal dimension (HR: 1.45, 95% CI: 1.08 to 1.92), arterial vessel density (HR: 1.47, 95% CI: 1.05 to 2.08) and GC-IPL thickness (HR: 1.56, 95% CI: 1.03 to 2.38) remained significantly associated with mortality.

Several quantitative retinal markers, relating to both microvascular morphology and retinal neural thickness, are associated with increased mortality among individuals with PDR. The role of retinal imaging in identifying those individuals with PDR most at risk of imminent life-threatening sequelae warrants further investigation.

Data on postdischarge care for stroke and myocardial infarction (MI) patients remain limited. Logistical barriers, including fragmented communication and poor coordination between patients and physicians, contribute to suboptimal outcomes and hinder secondary prevention. Mobile health (mHealth) offers a promising strategy to support continuity of care. We aimed to synthesise existing literature and evaluate mHealth interventions for postdischarge MI and stroke care.

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.

PubMed, CINAHIL, Scopus and Cochrane were searched from 26 July 2016 to 5 July 2024.

This scoping review included randomised controlled trials and observational studies published in peer-reviewed journals that evaluated mHealth interventions for postdischarge care in MI and stroke. Studies reporting outcomes such as mortality, functional capacity, readmissions or adverse events were included.

Two authors independently extracted and summarised the data. Subsequently, methodological quality was independently assessed by two other authors using the Joanna Briggs Institute checklist.

We identified 31 eligible studies, with 14 631 participants and 59.9 mean years old. Most participants were male. Among these, three (%) originated from low-middle income, seven (%) from upper-middle income and 21 (%) from high-income countries. Overall, we identified 17 studies using mobile apps: eight as a single intervention, and nine combined with remote sensors, seven with SMS, three studies used web-based platforms, two used phone calls, one study combined SMS and phone calls and another used remote sensors only. Multimodal telerehabilitation reported better outcomes compared with single-mode mHealth interventions. Most studies assessed functional capacity (26 studies) and quality of life (21 studies).

This review highlighted increased mHealth uptake among postdischarge MI and stroke patients, including significant underrepresentation of female participants, scarce studies from low-middle-income countries or rural areas and limited reporting of hard clinical endpoints. While mHealth showed positive outcomes across most studies, it further highlights contextual factors that account for digital disparity and the need to prioritise inclusive, user-centred designs and integrate objective measurement tools on future trials and policy frameworks.