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).

To describe prescription patterns, dosing and persistence of guideline-directed medical therapy (GDMT) among patients with heart failure with reduced ejection fraction in Singapore, and to identify factors associated with the use of quadruple therapy (ACE inhibitor (ACEi)/angiotensin II receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), β-blocker, mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter-2 (SGLT2) inhibitor).

Retrospective, observational cohort study.

Secondary and tertiary care settings across seven public hospitals in Singapore.

3999 adults hospitalised from 2020 to 2022 with a first heart failure-related admission and left ventricular ejection fraction ≤40%. Patients with absolute contraindications to specific GDMT classes were excluded from eligibility calculations.

Primary outcomes were the proportions of eligible patients prescribed each GDMT class and quadruple therapy at discharge. Secondary outcomes were 6-month prescription patterns, dose attainment and predictors of quadruple therapy use.

Among eligible patients, 80%–99% met criteria for each GDMT drug class, yet only 29% received quadruple therapy at discharge in 2022. Prescription rates for ACEi/ARB/ARNI (67%), beta-blockers (89%), MRAs (40%), and SGLT2 inhibitors (46%) remained suboptimal despite high eligibility. At discharge, over 90% of patients on ACEi/ARB/ARNI and beta-blockers received ≤50% of target doses. By 6 months, prescription rates declined by 16% for ACEi/ARB/ARNI, 26% for beta-blockers and 7% for MRAs, while SGLT2 inhibitor use increased. Older age (OR 0.97, 95% CI 0.96 to 0.98) and chronic kidney disease stage 3a–4 (OR 0.65 to 0.04) were associated with lower odds of receiving quadruple therapy, while significant institutional variation was observed.

Despite high eligibility, uptake and optimisation of GDMT remain poor in Singapore, with substantial treatment gaps driven by underprescription, inadequate dosing and discontinuation. Interventions targeting clinician awareness, postdischarge support and institutional practice variation may improve adherence to guideline-recommended therapy.

The institutionalisation of older adults has become increasingly common in Sri Lanka due to recent socioeconomic changes. Tai Chi is a traditional Chinese martial art that provides numerous physical and psychological health benefits. Despite its proven effectiveness, Tai Chi is a relatively new intervention in Sri Lanka, with no local research on its feasibility and efficacy among older adults. This study aims to evaluate the feasibility and effectiveness of Tai Chi on physical function and fall risk, lung function, depression, pain and health-related quality of life (HRQOL) in older adults residing in aged care homes in Sri Lanka.

A single-arm pretest-posttest feasibility study will be conducted among older adults aged 60 and over (n=40) living in aged care homes in Kandy District, Sri Lanka. A certified Tai Chi instructor will deliver two 60 min sessions of the Tai Chi for Arthritis and Fall Prevention programme per week over a 12-week period in aged care home settings. Acceptability, demand, implementation, practicality, adaptation, integration, expansion and study limitations will be assessed to determine feasibility. Baseline and post-12-week Tai Chi programme outcomes will be assessed, focusing on physical function and fall risk, lung function, pain, depression and HRQOL. Additionally, field notes will be taken during the intervention, and a post-intervention follow-up group discussion will be conducted. Paired t-tests will be used to assess the effectiveness of the Tai Chi programme. A narrative synthesis will be used to analyse qualitative data.

The Research Ethics Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka, approved this study (No.: 2024/EC/34). Written informed consent will be obtained from each participant before data collection. The findings will be presented at national and international research conferences and published in a reputed journal.

This study was registered with the Sri Lanka Trial Registration (SLCTR/2025/025) at https://slctr.lk/trials/slctr-2025-025 (date: 26 June 2025).

This study intended to investigate barriers to implementing evidence-based intrapartum care during vaginal births, from maternity care providers’ point of view.

A descriptive qualitative study was conducted using in-depth interviews, with data analysed through thematic analysis.

The labour room of a major tertiary care hospital in Central Sri Lanka.

Purposively selected 17 maternity care providers including doctors, nurse managers, nurse-midwives and midwives.

Three major themes and twelve sub-themes were generated: (1) barriers related to care providers (lack of human resources, negative attitudes of care providers, poor relationship among care providers, poor relationship between women and care providers, lack of knowledge on evidence-based practice in childbirth care); (2) barriers related to organisational environment (gaps in management, heavy workload, inadequate physical resources, insufficient in-service training and lack of availability/use of updated guidelines) and (3) barriers related to women’s birth preparedness (women’s limited knowledge on childbirth and intrapartum practices and women’s limited engagement during labour and childbirth). Many maternity care providers perceived that prevailing challenges to implement evidence-based childbirth care were one of the major reasons that impacted the quality of current childbirth care in the labour room.

The findings showed that an integrative approach may be essential to address the diverse barriers to the implementation of evidence-based intrapartum care. It is necessary to engage healthcare administrators, healthcare professionals and care recipients to enhance the quality of current childbirth care in the setting through the successful implementation of evidence-based care.

To determine if communication disorders (1) increase the risk for common mental and physical health conditions and (2) if risk varies by age of onset (≤25 years (developmental) or >25 years (acquired)) by using the large-scale All of Us Research Program participant-reported survey data to electronic health records (EHR) data. We hypothesised that adults with a communication disorder would have a higher risk of mental and physical health conditions.

A retrospective cross-sectional study.

Secondary analysis of EHR and online surveys conducted in the USA.

We assessed 410 360 US adults enrolled in the All of Us Research Program from August 2023 to May 2024 for study eligibility. We used medical diagnosis of a communication disorder from EHR data to group participants into communication disorder (CD) and typical communication (TC) groups, and age of first diagnosis to assign to age of onset (≤25 years (developmental) or >25 years (acquired)) groups. 234 519 participants (median (IQR) age 57.00 (41.00, 68.00); 3700 (1.6%) qualified for the CD group) were included in the analyses.

Primary outcome measures were diagnosis of 11 common mental and physical health conditions from EHR data.

Multiple logistic regression models with propensity score weighting revealed that participants with CD had higher odds for attention deficit hyperactivity disorder, anxiety, asthma, cancer, chronic kidney disease, cardiovascular disease, depression, diabetes and hypertension. Estimates for chronic kidney disease (acquired: adjusted OR (AOR), 1.89 (1.62, 2.20); developmental: AOR, 1.26 (0.42, 3.82)), diabetes (acquired: AOR, 1.64 (1.49, 1.81); developmental: AOR, 1.51 (0.95, 2.41)), hypertension (acquired: AOR, 2.02 (1.85, 2.19); developmental: AOR, 1.16 (0.80, 1.68)) and substance use (acquired: AOR, 1.76 (1.47, 2.12); developmental: AOR, 1.08 (0.65, 1.82)) varied by age of onset. Confounding factors are controlled in the analysis, such as age, income, employment, enrolment, sex at birth, gender identity and US census division.

Our study demonstrates that adults with CD experience health disparities compared with adults with TC, and that these disparities vary by age of onset of CD.

To examine inpatient benzodiazepine receptor agonists prescribing patterns and assess how hospitalisation affects use at discharge.

Subanalysis of the WEsleep trial, a cluster-randomised controlled single-centre study conducted at Amsterdam University Medical Center (Amsterdam UMC) (two locations) between July 2023 and March 2024. Twelve departments (six medical, six surgical) were matched and randomised to intervention or standard care. On intervention wards, multiple measures to improve sleep were implemented, including minimising nighttime disruptions.

Amsterdam UMC, across medical and surgical hospital departments.

Adult patients admitted for ≥2 nights (medical) or undergoing elective non-cardiac surgery in a surgical department.

Benzodiazepine use was classified as no use, pre-admission use or new in-hospital initiation. Prescribing patterns were summarised descriptively according to type, timing, indication and discharge status.

Of 746 patients, 187 (25%) used benzodiazepines: 80 (43%) had pre-admission use, and 107 (57%) were newly initiated during their hospital stay. Among pre-admission users, two discontinued and five had adjustments at discharge. Among newly initiated users, 94 (88%) had their benzodiazepine discontinued at discharge. Approximately half of pre-admission prescriptions and one-third of in-hospital prescriptions lacked a documented indication.

Although most newly initiated benzodiazepine treatments were discontinued during hospitalisation, pre-existing use was rarely reassessed and nearly 10% of new users were discharged with a prescription. Structured deprescribing protocols, better documentation of indications and improved discharge planning are needed to promote safer and more rational benzodiazepine use.

NCT05683483.

To explore the perspectives and experiences related to caring for older people during clinical placement among undergraduate nursing students.

A qualitative exploratory study analysing individual interview data.

Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka.

Participants: A purposive sample of 14 undergraduate nursing students.

Semi-structured in-depth interviews were conducted, audio-recorded and transcribed. Data were analysed using Braun and Clarke’s reflexive thematic analysis framework.

Five themes emerged: (1) understanding ageing: The concept of ‘Age’, (2) Complexity of care: navigating challenges, (3) Care provision: rewards, growth and fulfilment, (4) Addressing challenges: barriers to support and (5) Reaching the horizon: enhancing geriatric education. Nursing students encountered both positive and negative experiences related to caring for older people. Positive experiences included increased self-awareness, learning opportunities, skill development and personal satisfaction. Negative experiences involved student-related and patient-related challenges, initial difficulties in providing care and inadequate support and mentoring during clinical placements.

Despite the complexities of caring for older people, nursing students are motivated to learn and provide the necessary care. This study highlights the need for quality care for older people, the importance of early geriatric education and the need for enhancing clinical supervision and mentoring.

Although the health impacts of floods are well described, there is limited research on how flooding affects health systems, services and the health workforce—despite their central role in mitigating and responding to these impacts. This scoping review examines the nature and extent of existing research evidence on the impact of flooding events on Australia’s health system.

A scoping review following the Johanna Briggs Institute methodology.

MEDLINE, Embase, CINAHL, Scopus, Web of Science, ProQuest Central and PsycINFO were searched through to 22 October 2024. Reference lists of included publications were screened for additional publications.

We included studies that reported any health system or health service disruption associated with flooding in Australia. Disruptions encompassed impacts on hospitals, primary care, health information systems, infrastructure, public health and health promotion activities, and the health workforce. We included peer-reviewed publications, including original research, commentaries, perspectives, editorials, letters to the editor, modelling studies and reviews. Grey literature was excluded.

Screening of full texts and data extraction were completed by two independent reviewers. A health system disruption analytical framework was iteratively developed and was used to categorise the findings.

Our search identified 6687 publications, of which 28 were included in the final review. 13 publications were original research publications and 15 were commentaries or reviews, with the majority published in the past ten years. Of the publications included, most focused on disruptions to hospital services and transport systems, including a reduction in health workforce availability, primarily due to the latter. Less than one-third reported impacts on health services for socially vulnerable populations. Floods affect multiple levels of the health system, intersecting with impacts across three key domains: infrastructure and health information systems, access to healthcare and the health workforce.

Original research on how floods impact Australia’s health system, its services and workforce has been limited, particularly in relation to general practice, allied health and the differential impacts on socially vulnerable populations. Further research is needed to inform targeted disaster preparedness and response strategies and to understand the complex and intersecting impacts. The analytical framework developed in this review provides a way to conceptualise how floods disrupt different components of the health system and offers a foundation for future research and policy development to strengthen system resilience in the face of increasing flood risk.

The objective of this study was to explore medical practitioners’ understanding of antimicrobial resistance (AMR) and its aspects, such as its causes, possible outcomes and how doctors can contribute to its prevention.

This qualitative study was conducted in Sri Lankan healthcare settings.

Using convenience sampling, the study included allopathic medical practitioners aged 18–60 years, excluding intern-medical officers, until data saturation.

One-on-one interviews were conducted online or in person, depending on each participant’s preference. A structured questionnaire was used to triangulate the information.

Data were categorised into four: (1) understanding, awareness and identifying AMR as an issue among medical practitioners, (2) knowledge and understanding of factors that contribute to AMR development among medical practitioners, (3) knowledge and understanding of the outcome of AMR and (4) knowledge and understanding of preventive measures against AMR among medical officers. Interviewees showed an awareness of AMR; however, their knowledge was not up to date. Key reasons for inappropriate antibiotic use included unavailability and poor quality of antibiotics and unawareness of updated guidelines, especially in the government sector. In the private sector, patient pressure, the need to attract patients and the high cost of investigations contributed to misuse. Additionally, low patient literacy about AMR was a significant factor.

This study revealed that although medical practitioners in Sri Lanka are aware of AMR, their knowledge remains limited in certain areas. Several challenges contributed to inappropriate antibiotic use, including the availability and quality of antibiotics, external pressures from patients and financial constraints. The findings of this study highlight the urgent need for continuous medical education and public awareness campaigns to improve both practitioner and patient understanding of AMR. Addressing these issues is essential for effectively preventing and managing AMR in healthcare settings in Sri Lanka.

With the rapid increase in the number of older adults living with chronic diseases and disabilities, there is a growing need to prepare nurses with positive attitudes and a willingness to work with older adults. This study aims to examine attitudes towards and willingness to work with older adults among nurses.

A cross-sectional survey was conducted among a purposive sample of 267 nurses at the University Hospital of Kotelawala Defence University, Sri Lanka. Participants completed a self-administered questionnaire consisting of socio-demographic variables, Kogan’s Attitudes Toward Old People Scale and questions related to willingness to work with older adults. Descriptive statistics and linear and logistic regression analyses were used in data analysis.

The majority were female nurses (71.9%, n=192) and held slightly negative (58%, n=155) or slightly positive (41.9%, n=122) attitudes towards working with older adults. Only 35.2% (n=94) were willing to work with older adults in this study. A male nurse (beta coefficient (β)=4.644, CI 2.392 to 6.896, p

Most nurses express slightly negative to positive attitudes and have little interest in working with older adults. Various socio-demographic factors have an impact on attitudes towards and willingness to work with older adults. Since nurses play a significant role in providing care for older adults, the development of positive attitudes is essential, and interventions and strategies are crucial to increasing their willingness to work with older adults.

The hospital-at-home (HaH) model has gained traction as a viable alternative to traditional inpatient care, allowing patients to receive care in their own homes. Despite its growing popularity, there is a lack of comprehensive research addressing effectiveness, safety and factors critical to the successful implementation of HaH programmes. We conducted a scoping review to comprehensively map and summarise the evidence on both admission avoidance and early-supported discharge up until now.

A scoping review of randomised controlled trials (RCTs), conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews (PRISMA-ScR) guidelines.

Ovid MEDLINE, Embase, CINAHL and Web of Science were systematically searched up to July 2024

We included English-language RCTs published from 2005 onwards, involving adults (≥18 years) receiving acute care at home who would otherwise require hospital admission. Eligible studies evaluated admission avoidance or early supported discharge within HaH settings for acutely ill patients. Studies focusing on outpatient care, non-acute conditions or interventions not aligning with the widely accepted HaH definition were excluded. COVID-19-related studies were also excluded to avoid context-specific bias.

Two reviewers independently extracted data on study characteristics, interventions and outcomes including mortality, length of stay, escalation rates, costs and patient and caregiver satisfaction. Implementation facilitators and barriers were also collected. Discrepancies were resolved by a third reviewer. Results were synthesised descriptively in accordance with PRISMA-ScR guidelines.

Nine RCTs were identified. The review shows that the HaH model is at least as safe as usual care, with lower or comparable mortality rates. Length of stay varied, with some studies reporting longer stays in the HaH group due to cautious clinical practices. Cost analyses often indicate lower healthcare costs with staffing as the largest expense. Patient and caregiver satisfaction was high, but essential implementation factors were not clearly addressed.

The HaH model represents a promising alternative to acute inpatient care for suitable patients. Future research should focus on conducting larger RCTs, expanding the range of conditions suitable for HaH. Despite favourable clinical outcomes, substantial implementation barriers remain underexplored in current RCTs. This underscores the need to identify strategies for successful implementation, including the integration of technological advancements and qualitative insights into patient and caregiver experiences.

Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) reduces morbidity and mortality and remains widely underused. An HFrEF polypill containing all four pillars of GDMT has been proposed as an implementation strategy to improve GDMT treatment rates and subsequent patient outcomes. We present the design and protocol for a proof-of-concept, pilot type I hybrid randomised clinical trial evaluating an HFrEF polypill compared with usual care among patients with HFrEF in Sri Lanka to evaluate short-term feasibility.

This multi-centre, open-label, pilot type I hybrid randomised clinical trial will recruit 40 adults with HFrEF from two public hospital sites in Colombo, Sri Lanka. Participants will be randomised to an HFrEF polypill (containing bisoprolol, losartan, eplerenone, and dapagliflozin in three available strengths) or usual care and followed for 4 weeks. The primary outcome is feasibility of recruitment measured by recruitment rate and adherence to study protocols measured by completion rate of study-related procedures. Other key outcomes include adherence to GDMT and assessment of serious adverse events among other exploratory outcomes.

The study has been approved by the ethics review committee at the Faculty of Medicine, University of Kelaniya (Sri Lanka), the institutional review board at Washington University in St. Louis (United States), and the National Medicines Regulatory Authority (Sri Lanka). The findings of this pilot trial will inform the design and implementation of a future large-scale type I hybrid trial to assess the efficacy and safety of an HFrEF polypill in improving clinical outcomes.

Sri Lanka Clinical Trials Registry (SLCTR/2024/003); ClinicalTrials Registry (NCT06831864).