Patient falls in hospitals lead to patient harm, staff distress and economic burden on health systems. There are few strategies with robust evidence demonstrating benefit for the prevention of falls, especially in acute hospital settings. Education and multicomponent fall prevention approaches are promising. Rigorous systematic measurement of implementation has been lacking in most hospital fall prevention trials. This paper describes the protocol for a trial that will evaluate the impact of supported implementation of tailored multicomponent fall prevention interventions on patient falls in hospital.

A stepped-wedge hybrid type I effectiveness implementation cluster randomised trial will be conducted. Twelve inpatient wards across four metropolitan hospitals will be enrolled in the trial, clustered into groups of four and randomised to commence the intervention at one of three time periods. Patients and ward staff will be recruited to complete pre-implementation surveys, which, combined with analysis of routinely collected local falls data and staff brainstorming, will inform tailored multicomponent fall prevention interventions for each ward. Wards will receive quality improvement training, clinical facilitation and staff education for at least 4 months to support implementation of their fall prevention interventions. The primary outcome—rate of falls—will be measured using routinely collected hospital falls data from the incident management system and medical records. Pre-implementation and post-implementation patient and staff surveys, qualitative interviews and bedside audits will measure secondary effectiveness and implementation outcomes. Healthcare utilisation from hospital data will inform the cost-effectiveness analysis.

The Sydney Local Health District Human Research Ethics Committee (RPAH Zone) approved this trial (protocol number X24-0087 and 2024/ETH00583). The trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12624000896572). Data collection commenced in October 2024, due for completion in May 2026. Results will be published in reputable international journals and presented at relevant conferences.

Australian and New Zealand Clinical Trials Registry (ACTRN12624000896572).

Common mental health outcomes among children in conflict with the law in correctional facilities in Africa are an under-researched area with significant public health implications. This review will synthesise available and accessible evidence on the prevalence and associated factors of common mental health outcomes among children in conflict with the law in Africa.

Comprehensive electronic searches will date from 01 January 2015 to 31 December 2025 and will be conducted in PubMed, Sabinet, Scopus, EBSCOhost, Web of Science and PsycINFO. Articles will be screened using defined inclusion and exclusion criteria and assessed for eligibility by three independent reviewers. Discrepancies will be reviewed by a ninth reviewer. The selection process of included articles will be reported by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used. The Mixed Methods Appraisal Tool will assess study quality, and data will be synthesised using meta-analysis or a narrative synthesis approach, depending on heterogeneity levels.

This study will not require ethical approval from an institutional review board, as it does not entail the direct collection of data from children in conflict with the law, nor does it pose any risk to their privacy. Once finalised, the full review report will be submitted for publication in a peer-reviewed journal. The key findings will also be shared at both local and international conferences, highlighting common mental health outcomes among children in conflict with the law.

CRD420251011484.

In the field of medicine, there has been a growing understanding of the impact of social and economic inequities on patients’ health outcomes. Social medicine was established with the intention of addressing these social and economic drivers of health when caring for patients. Physicians who practise social medicine aim to take an interdisciplinary and interprofessional approach to patient care with an emphasis on the promotion of health equity and patient advocacy. As the effects of social determinants of health (SDOH) on health outcomes have become more widely appreciated, medical professional organisations and accrediting bodies have advocated for formal education on the impact of SDOH in undergraduate and graduate medical curricula. The goal of this scoping review is to examine how undergraduate and graduate medical education programmes in the USA have implemented social medicine concepts into their curricula.

The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The review team worked with a medical librarian, who created a unique search for five databases (PubMed, Embase, Cochrane CENTRAL Register of Controlled Trials, ERIC and the Web of Science Core Collection). Additionally, we will conduct a grey literature search that includes medical school and residency programme websites, as well as Association of American Medical Colleges (AAMC), Council of Residency Directors in Emergency Medicine (CORD), Alliance for Academic Internal Medicine (AAIM) and Society for Academic Emergency Medicine (SAEM) conference abstracts. Two independent reviewers will assess all articles for eligibility. Data will be extracted using the Covidence data extraction tool. We will present the results of the extraction in tabular form. Themes identified during the full-text review and data extraction process will be discussed.

Data will be gathered from publicly accessible sources, so ethics approval is not necessary. The results will be disseminated through a peer-reviewed journal and reported at conferences related to medical education and social medicine.

This protocol is registered on OSF (https://doi.org/10.17605/OSF.IO/7PZ8U).

Admission to a mental health ward can be distressing for people living with dementia and their carers. While carer involvement is associated with improved outcomes, carers often report feeling excluded from decision-making and support during admissions. There is limited understanding of how wards engage with carers and what strategies might enhance involvement. This study seeks to address this gap by exploring carer and patient experiences during and after admission and co-producing evidence-based strategies for improved support and involvement.

The FIND ME study uses a convergent parallel mixed-methods design. A national online survey will map provision of mental healthcare for people with dementia across the UK. Narrative interviews will be undertaken with carers of current inpatients (n=24) and recently discharged individuals (n=24), with opportunities for dyadic interviews with people with dementia. Ethnographic fieldwork across three wards (30 days per site) will provide insight into organisational cultures, staff practices and carer involvement. Evidence-based co-design workshops with carers, people with dementia and staff will use these findings to identify priorities and develop practical strategies for service improvement. Finally, a feasibility study will test the acceptability, relevance and potential for implementation of these co-designed strategies. Quantitative data will be analysed descriptively, while qualitative data will undergo narrative and thematic analysis. Triangulation across datasets will ensure rigour.

Ethical approval has been granted by London Camberwell St Giles Research Ethics Committee and the Health Research Authority (REC Ref: 25/LO/0040). Informed consent will be obtained from all participants, with capacity assessed in line with the Mental Capacity Act (2005). Dissemination will include peer-reviewed publications, conference presentations and freely available multilingual resources for carers, people with dementia and ward staff, supported by NHS and third-sector partners.

NIHR161439

Prehospital care, though critical to injury survival, is largely unavailable in many low and middle-income countries, including Cameroon. Lay first responder (LFR) programmes train persons with high injury exposure in first-aid and emergency transport, but stakeholder buy-in from trainees and healthcare workers (HCWs) is essential. To design a context-appropriate prehospital care system, we evaluated barriers and facilitators of implementing a driver-based LFR programme in Cameroon.

In April 2023, we performed a mixed-methods evaluation targeting commercial mototaxi drivers and HCW in Limbe, Cameroon. Drivers were recruited for focus groups through union leaders. Trauma HCW at Limbe Regional Hospital completed Likert surveys and a subgroup completed semistructured interviews. Data collection focused on perceptions, barriers and facilitators of LFR programme implementation. Survey data were summarised using median and IQR. Interviews were recorded, transcribed, translated and analysed with open and axial coding using reflexive thematic analysis.

Overall, 92 mototaxi drivers and 34 HCWs participated in the LFR programme assessment. Among the HCW surveyed, 93% felt mototaxi drivers were capable of training as LFR but only 44% felt that drivers would be able to provide care safely. Interviews identified negative HCW perceptions of drivers, including drivers being uneducated and financially motivated, as key barriers, whereas driver exposure to injury was identified as a facilitator to LFR programme implementation. Driver groups demonstrated a positive perception of LFR training but identified unpaid time spent transporting injured persons as a significant barrier. Both groups described a need for hospital involvement in trainings and bidirectional standardised communication with HCW.

In Cameroon, driver-based LFR may facilitate increased prehospital care but further exploration of possible systems of collaboration that promote long-term success of the programme is required. Specifically, sustainable implementation will need to include clear bidirectional communication guidelines and provide driver incentive commensurate to effort.

For people whose stroke risk would be reduced by taking a long-term oral anticoagulant (OAC), it is important to implement effective strategies to support medication initiation, adherence and persistence. To do this, a better understanding of the factors associated with implementation of interventions to optimise OAC management is needed.

This scoping review aimed to summarise the evidence-based characteristics associated with implementing interventions designed to optimise long-term OAC adherence.

Primary research (published post-2000) evaluating any intervention designed to optimise implementation of long-term OAC for stroke prevention by way of change in OAC services, staff or patient behaviour.

Five databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Cochrane Library) were searched from 1 January 2000 to 4 August 2023 using a combination of terms relating to population, intervention and study design.

Titles/abstracts were screened by at least one reviewer. Data from each full text were abstracted (with 20% double-checked for accuracy) and its implementation content reviewed, guided by the Expert Recommendations for Implementing Change strategies.

216 studies were included, with varying descriptive reporting of implementation strategies, and only 61 (28%) self-identifying as an implementation study. The median number of implementation strategies used was three, with recently published studies (2015 onwards), those including patients receiving either direct OACs (DOACs) or vitamin K antagonists (VKAs) and those including multiple intervention targets (service, staff or patients) associated with using more implementation strategies. ‘Train and educate stakeholders’ strategies were the most commonly used, and ‘Adapt and tailor to the context’ strategies were the least used by included studies. Conversely, self-defined implementation studies were less likely to use ‘Train and educate stakeholders’ strategies, although they were positively associated with use of ‘Adapt and tailor to the context’. ‘Use evaluative & iterative’ strategies were used more frequently in studies where patients used either VKAs or DOACs, or were published more recently.

Studies need to self-define as implementation studies, improve implementation strategy reporting and be transparently registered, alongside conducting process evaluations or more richly describing implementation processes. Future research could explore why some implementation strategies are used more than others and whether aligning strategy clusters with intervention targets results in clinically significant differences in patient care.

Infant feeding practices in the first 2 years of life are linked to long-term weight trajectories. Despite the importance of obesity prevention interventions, there are no randomised controlled trials (RCTs) evaluating early childhood education and care (ECEC) and primary caregiver-targeted interventions on child weight and feeding outcomes.

To assess the efficacy of an 18-month digital health intervention (Tiny Bites) delivered to ECEC services and primary caregivers of children aged 4 to ≤12 months on child age-adjusted and sex-adjusted body mass index-for-age z-score (zBMI) relative to usual care control in the Hunter New England (HNE) region of New South Wales, Australia.

This type 1 hybrid cluster RCT will include up to 60 ECEC services and 540 children/caregiver dyads. The intervention supports ECEC services and caregivers to deliver recommended responsive feeding practices to infants. ECEC services will receive access to an online assessment platform, training and resources, and implementation support. Primary caregivers will receive text messages, monthly e-newsletters, online links and direct communication from ECEC services. We will assess the impact on child zBMI at 18-month follow-up. Secondary outcomes include duration of consuming any breastmilk, child diet and caregiver responsive feeding practices. We will also assess ECEC policy and practice implementation related to targeted feeding practices, programme cost effectiveness, adverse effects and engagement with the programme (ECECs and caregivers). For the primary outcome, between-group differences will be assessed for paired data using two-level hierarchical linear regression models.

Ethics approval has been provided by HNE Human Research Ethics Committee (HREC) (2023/ETH01158), Deakin University (2024-202) and University of Newcastle HREC (R-2024-0039). Trial results will be submitted for publication in peer-reviewed journals, presented at scientific conferences locally and internationally and to relevant practice stakeholders.

ACTRN12624000576527.

To implement an overview of reviews that discuss the current state of syntheses (such as systematic reviews) of only observational studies on health risk behaviours (HRBs), including smoking, alcohol intake, poor sleep, poor quality diet, common mental health problems (depression and anxiety), and glycated haemoglobin (HbA1c), while excluding synthesis of clinical trials.

Overview of reviews or umbrella review following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines.

PubMed, Scopus, Web of Science, PsycINFO-PsychArticles and Epistemonikos, searched from January 2013 to 30 June 2025.

We included systematic reviews and meta-analyses of observational studies that assessed the relationship between HRBs—including smoking, alcohol intake, poor sleep, poor quality diet, physical activity and common mental health problems such as depression and anxiety—and HbA1c. Reviews of clinical trials were excluded.

We synthesised systematic reviews and meta-analyses on the above topic from five databases following the PRIOR protocol. Two independent reviewers screened titles, abstracts and full texts using standardised methods. Data extracted included study design, exposures, outcomes and population characteristics. Risk of bias was assessed using the AMSTAR-2 tool. Overlap across reviews was evaluated using the corrected covered area metric.

Eight systematic reviews were included in the final synthesis, encompassing a total sample size of around 307 019 individuals. The study highlights a significant paucity of systematic reviews of observational studies in this area, with no reviews on alcohol and exercise. The existing evidence on poor sleep, poor quality diet and smoking points towards these HRBs leading to worse HbA1c. A bidirectional relationship was found between depression and HbA1c.

This umbrella review highlights the significant association between HbA1c and key health risk factors underscoring the importance of observational studies, highlighting their ability to capture real-world conditions and complex interactions. While in agreement with existing study designs, this review provides convergent evidence of the critical role of HRBs in managing HbA1c levels.

To propose a novel approach to evidence-based medicine (EBM) for medication safety. To critically evaluate the appropriateness of the traditional pyramid hierarchy of evidence for pharmacovigilance.

For over three decades, the traditional pyramid hierarchy of evidence has guided the practice of EBM, primarily in evaluating the efficacy of medications. While the traditional pyramid has a place in evaluating evidence for efficacy outcomes, this model is usually inappropriate for the evaluation of safety outcomes of therapeutic interventions in the postmarketing setting. In the context of pharmacovigilance, a rigid hierarchy fails to accommodate the complexity and diversity of data required for evaluation of medication safety.

This article critically evaluates the appropriateness of this traditional hierarchy of evidence for decision-making in pharmacovigilance and argues for using a non-hierarchical approach to how evidence is appraised in this context. It explores the expanding role of real-world data (RWD) and real-world evidence, which increasingly contribute to therapeutic decision-making in the postmarketing setting, noting that clinical trials and real-world studies are complementary rather than competitive. To address the limitations of the traditional EBM model in the context of pharmacovigilance, we propose an ‘amphitheatre (circular) approach’ which embraces the totality of evidence available for the safety of an intervention with no rigid hierarchy and emphasises the integration of diverse data sources to answer research questions and provide healthcare.

The amphitheatre of evidence offers a more flexible, inclusive and pragmatic alternative to the traditional pyramid hierarchy for assessing safety outcomes in pharmacovigilance. By embracing the totality of evidence, this model uses a more holistic approach to support clinical decision-making and protection of public health. While this review is focused on pharmacotherapeutic interventions in the postmarketing setting, the proposed novel approach may be generalised to a broader evaluation of therapeutic and diagnostic interventions.

During the first wave of the COVID-19 pandemic, there was a notable decline in emergency department (ED) usage in many jurisdictions. This study assessed changes in ED use during this period and explored how the pandemic may have aggravated existing healthcare access inequities.

Our primary objective was to assess pandemic-related changes to ED visits and emergency hospitalisations for distinct demographic groups.

We conducted a retrospective observational study using population-based provincial administrative data.

We analysed data from all the 109 EDs and urgent care centres in Alberta, Canada, during the first wave of the COVID-19 pandemic (15 March 2020 to 30 June 2020), and during the corresponding (control) period 1 year earlier. We conducted subgroup analyses by age, First Nations status, sex, location and material deprivation. We repeated all analyses for pre-selected life-threatening emergency diagnoses.

We examined outcomes for a priori subgroups, including female and ‘other’ sex patients, paediatric patients (age 0–17 years), seniors (age 65 years and older), patients living in remote areas (greater than 200 km from an urban centre), First Nations members and patients living in materially deprived postal codes falling into the two most deprived Pampalon Index quintiles.

Primary outcomes were number of ED visits, number of ED visits with admission to hospital and number of ED visits resulting in patient death in the ED. A secondary outcome was change in ED use for life-threatening diagnoses (eg, cardiac conditions and hepatic disease).

ED visits in the COVID-19 period decreased by 34% (Poisson means test p

Reductions in critical emergency care and emergency hospital admissions were unequally distributed across demographic groups during the COVID-19 period. Study methods could be used to monitor and support equitable access to emergency care among distinct populations.

To assess the feasibility and acceptability of three SMS-delivered safer gambling interventions (goal setting (GS), descriptive norms (DN), injunctive norms (IN)) aimed at reducing the transition from low or moderate risk of gambling harm to problematic gambling, and the feasibility of a full-scale randomised controlled trial evaluating their effectiveness and cost-effectiveness.

Four-arm, parallel-group, pragmatic, randomised controlled feasibility study with a nested qualitative study.

The study was conducted in the UK. Participants were recruited online via UK-licensed gambling operators’ websites.

Adults aged ≥18 years, gambling online at least weekly, with low-to-moderate gambling risk levels.

Participants were block randomised in equal proportions to a delayed intervention control group or one of three 6-week text message interventions delivered via the secure messaging app WIRE: (1) GS: weekly prompts to set gambling-related goals with personalised feedback; (2) DN: weekly messages challenging misperceptions about peer gambling behaviours and (3) IN: weekly messages addressing misperceptions about peer attitudes towards gambling.

Feasibility was assessed through recruitment and retention rates, intervention adherence, data completeness and feasibility and acceptability of the interventions and study procedures. Secondary outcomes included gambling risk behaviours and cognitions, anxiety, depression, quality of life, healthcare use and productivity, measured at baseline, 7-weeks, and 3- and 6-months post-randomisation.

Recruitment took place between April 2021 and August 2022 with final follow-up in February 2023. 167 participants (mean age 51.5; 36% male) were randomised (GS=43; DN=41; IN=42; Control=41). Retention at 6-months was 95.2%, with >95% completion for all outcome measures. Intervention adherence was high, with >95% of DN and IN participants responding to ≥4 messages and 93% of GS participants setting ≥4 goals. Qualitative findings indicated broad acceptability of the interventions and study procedures.

The study was feasible to conduct, interventions and study procedures acceptable to participants, and predefined progression criteria met. Findings support proceeding to a full-scale randomised controlled trial of effectiveness and cost-effectiveness, focusing on the social norms interventions.

ISRCTN37874344.

Systematic literature reviews (SLRs) are essential for synthesising research evidence and guiding informed decision-making. However, SLRs require significant resources and substantial efforts in terms of workload. The introduction of artificial intelligence (AI) tools can reduce this workload. This study aims to investigate the preferences in SLR screening, focusing on trade-offs related to tool attributes.

A discrete choice experiment (DCE) was performed in which participants completed 13 or 14 choice tasks featuring AI tools with varying attributes.

Data were collected via an online survey, where participants provided background on their education and experience.

Professionals who have published SLRs registered on Pubmed, or who were affiliated with a recent Health Economics and Outcomes Research conference were included as participants.

The use of a hypothetical AI tool in SLRs with different attributes was considered by the participants. Key attributes for AI tools were identified through a literature review and expert consultations. These attributes included the AI tool’s role in screening, required user proficiency, sensitivity, workload reduction and the investment needed for training. Primary outcome measures: The participants’ adoption of the AI tool, that is, the likelihood of preferring the AI tool in the choice experiment, considering different configurations of attribute levels, as captured through the DCE choice tasks. Statistical analysis was performed using conditional multinomial logit. An additional analysis was performed by including the demographic characteristics (such as education, experience with SLR publication and familiarity with AI) as interaction variables.

The study received responses from 187 participants with diverse experience in performing SLRs and AI use. The familiarity with AI was generally low, with 55.6% of participants being (very) unfamiliar with AI. In contrast, intermediate proficiency in AI tools is positively associated with adoption (p=0.030). Similarly, workload reduction is also strongly linked to adoption (p

The findings suggest that workload reduction is not the only consideration for SLR reviewers when using AI tools. The key to AI adoption in SLRs is creating reliable, workload-reducing tools that assist rather than replace human reviewers, with moderate proficiency requirements and high sensitivity.

This project aims to comprehensively examine the incidence of suicidality, individual and population characteristics, and health pathways, for a cohort of Australian veterans using linked administrative data.

The cohort will comprise veterans who are clients of the Department of Veterans’ Affairs (DVA) residing in Queensland between 1 January 2017 and 31 December 2022. People currently serving in the Australian Defence Force, Australian Federal Police personnel, other DVA clients who are not veterans (eg, eligible dependents), and clients currently known to DVA who have requested that their data not be disclosed for research will be excluded. This cohort will be linked to DVA administrative data, the Queensland Hospital Admitted Patients Data Collection (QHAPDC), Queensland Hospital Non-Admitted Patients Data Collection, Emergency Data Collection (EDC), Consumer Integrated Mental Health and Addiction Application (CIMHAA), Queensland Death Register, National Death Index, Medicare Benefits Schedule, Centrelink (Data Over Multiple Individual Occurrences) database and Pharmaceutical Benefits Scheme. These data will be linked for a period of at least 1-year preindex and postindex contact with DVA, such that the entire study period is expected to encompass at least 1 January 2016 to 31 December 2023.

This study received ethical approval from the Departments of Defence and Veterans’ Affairs Human Research Ethics Committee (HREC; Project ID: 556-23), and the Australian Institute of Health and Welfare HREC (Project ID: EO2024/1/1461). This project also received Public Health Act approval (File reference: PHA 556-23). The project was ratified by the University of Queensland HREC (Project ID: 2024/HE002153). The findings of this project will be disseminated via a publicly available report, presentations and peer-reviewed publications.

The management of severe traumatic brain injury (sTBI) in the intensive care unit (ICU) is focused on preventing secondary brain insults, by ensuring adequate cerebral perfusion, oxygenation and substrate delivery. Despite optimisation of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) using evidence-based guidelines, brain tissue hypoxia can still occur and is strongly associated with adverse functional outcomes post sTBI.

The Brain Oxygen Neuromonitoring in Australia and New Zealand Assessment – Global Trial (BONANZA-GT) is an international, two-arm, open-label, parallel group, randomised controlled trial comparing sTBI management incorporating early brain tissue oxygen (PbtO₂) monitoring and optimisation, with ICP/CPP-based management alone. A total of 860 adults admitted to participating institutions with non-penetrating sTBI and requiring insertion of an ICP monitor (as determined by the treating neurosurgeon) will be enrolled. The primary outcome is the proportion of patients with favourable neurological outcomes, as defined by a Glasgow Outcome Score-Extended (GOS-E) >4, at 6 months following injury. Key secondary outcomes include all-cause mortality at ICU discharge, hospital discharge, adverse events, as well as hospital and ICU length of stay and GOS-E at 12 months. The BONANZA-GT will determine whether a protocolised therapeutic strategy guided by continuous PbtO₂ monitoring in addition to ICP/CPP targets results in improved neurological outcomes when compared with standard care using ICP/CPP-guided management alone.

Approval has been obtained from relevant ethics boards in every jurisdiction that is participating in the trial. Inclusion of adults who lack capacity for informed consent will be governed in accordance with the legal requirements of each participating site. Study findings will be presented at scientific meetings and disseminated via peer-review publications.

Australian and New Zealand Clinical Trials Registry (ACTRN 12619001328167).

Many cancer treatments can result in reduced fertility, impacting survivors’ opportunities for biological parenthood. Fertility preservation (FP) methods for boys and young men, such as cryopreservation of testicular tissue or sperm, offer hope but are currently underused among young male patients with cancer. Despite guidelines recommending early discussion of fertility implications, many newly diagnosed males do not receive FP counselling or referral to fertility services. Male cancer survivors face a higher likelihood of infertility than their peers, yet focused FP decision-making support is lacking. This study aims to address this gap by developing and evaluating the first dedicated patient decision aid (PtDA) for boys and young male patients with cancer aged 11–25 years old, to help them make informed FP decisions before receiving cancer treatment.

The current study follows a multistage process: developing the PtDA, alpha testing for acceptability with former patients, parents and healthcare professionals, and beta testing in clinical settings to ensure effective integration into routine care. Using a combination of interviews and questionnaire data, this research will assess the PtDA’s acceptability and impact on decision-making.

This study has been prospectively registered on the Research Registry (10273). Ethics approval has been obtained from Leeds Beckett University and the National Health Service/Health Research Authority before undertaking data collection. The final resource will be disseminated widely and made freely available online via our dedicated Cancer, Fertility and Me website, for use in clinical and research practice.