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To assess the quality of the Spanish Triage System performed by nurses according to the triage code assigned to each patient and to examine factors associated with the need for re-evaluation after completion of triage.
Retrospective longitudinal observational study.
A retrospective analysis was conducted of patients triaged in the emergency department between 2018 and 2023. Patients triaged by other healthcare professionals and those who did not receive a triage priority level were excluded.
493,211 episodes were analysed. Most were low/intermediate acuity (Level IV 65.4%, Level III 23.9%; Level I 0.1%). Mean time-to-first physician record entry increased as acuity decreased (38 min Level I vs. 81 min Level V), yet recorded time-target compliance was lowest in Levels I–II (23.8% and 14.7%). Re-evaluation occurred more often in high-acuity levels and was independently associated with older age, male sex, lower oxygen saturation and longer emergency department length of stay; compared with Level I, Levels II–III and lower adjusted odds of re-evaluation.
Nurse-led triage demonstrated coherent clinical and operational stratification; however, the lowest recorded time-target compliance in the sickest patients suggests a gap between immediate care and electronic documentation.
Streamline documentation workflows for high-acuity cases and use re-evaluation risk profiles to prioritize monitoring and escalation.
Evidence on nurse-led Spanish Triage System performance and time-documentation quality is limited. Acuity and flow metrics showed expected gradients, but target-time compliance was lowest in Levels I–II; predictors of re-evaluation were also identified. Findings support emergency department nursing, quality improvement and potential benefits for patients attending emergency departments.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
by Cecilia Aguilar-Vega, Jaime Bosch, Satoshi Ito, Benjamin Ivorra, Hyunkyu Jeong, José Manuel Sánchez-Vizcaíno
African swine fever (ASF) is a lethal disease of swine that has spread across Asia since its introduction in 2018. South Korea first reported the disease in September 2019 in domestic pigs, and since then, more than 4,000 cases have been reported in wild boars during its expansion up to August 2024. Due to the high number of ASF notifications in wild boars in South Korea, contrasted with their scarcity in most Asian countries, analyzing the spatiotemporal spread of the disease in a setting with active surveillance provides valuable insights. In this study, we performed a trend-surface analysis on temporally gridded case data to characterize the overall geographic spread and direction of ASF in wild boars across South Korea, from its emergence to August 2022. Additionally, we propose a novel approach distinct from previous studies, to estimate spread velocity by incorporating an upper threshold to avoid unrealistic values. The model described the spread of ASF in the study area. The disease showed greater expansion in the east of the country. Initially, a south and eastward direction was estimated. The estimated median velocity was 19.53 km/month, with cell-level velocities ranging from 2.45 to 69.99 km/month. Velocity increased notably from autumn 2021 onward and varied substantially across years. Our results show the dynamics of ASF in wild boars of South Korea, providing new evidence of their role in the epidemiology of the disease.by Claudia Jaramillo-Mazo, Daniel Bravo, Diego Fernando Villanueva-Mejía, Javier Correa-Alvarez
Cadmium (Cd), a toxic heavy metal found in agricultural landscapes worldwide, has been pointed out in cropped soils with Theobroma cacao L., as one of the main contaminants that translocate into plant tissues. Among the factors linked to cadmium translocation into plants, the role of soil bacterial communities in chemical transformation in soils has been poorly investigated. Overall, soil bacterial communities are shaped by diverse environmental and anthropogenic factors that influence crop yield and health. Cadmium alters soil microbial communities and increases the risk to human health through plant uptake. Although the impacts of cadmium on soil bacteria have been studied in other crops, there is limited information on cacao. Thus, this study aimed to assess the responses of soil bacterial communities in cacao farms to cadmium exposure, both natural and spiked. A total of 225 rhizosphere soil samples were collected from 16 plots across five cacao farms in two Colombian departments. The complementary approaches used were: (i) 16S rDNA amplicon sequencing to assess the composition of the bacterial community in soils with natural Cd concentrations, and (ii) isothermal microcalorimetry (IMC) to measure the temporal metabolic responses of bacteria to Cd in closed systems for 80 hours at 25 °C. The findings suggest that nearly 28% of the bacterial community responds to high cadmium concentrations in soils, both in natural and experimental conditions. Field-based observations revealed that Cd-responsive taxa detected under natural soil conditions included several unculturable bacterial groups, whereas laboratory experiments with Cd spiking predominantly selected for previously characterized cadmium-tolerant bacteria (CdtB). Significant variation in natural Cd-bacterial community composition and Cd-related metabolic activity was observed across the farms. Moreover, Cd-responsive bacterial taxa exhibited increased abundance during Cd spikes. As expected, contrasting patterns were revealed by the activity-response measured by IMC and taxonomic analyses of 16S rRNA gene sequences.The interfaces between the fields of communication, education and health have been indicated by international institutions such as the WHO and the European Centre for Disease Prevention and Control. However, hegemonic scientific practices supersede dialogue between the three fields, isolating their practices. This fragmenting tendency is observed in scientific literature, which has created gaps in the dialogue and articulation between communication, education and health. Although health promotion requires both communicative and educational practices, the epistemological, historical, political, cultural and socioeconomic aspects have also engendered tensions between the fields. Communication is often seen as a mere instrument for other practices, rather than a phenomenon that (re)produces meanings and power dynamics. In opposing the reductionist and instrumentalising perspectives of knowledge fields, the primary objective of the scoping review is to map the scientific evidence on the interfaces between communication and education in health to indicate a conceptual framework that articulates communication and education practices within the context of health.
A transdisciplinary team developed this protocol based on the 2024 Joanna Briggs Institute Manual for Evidence Synthesis. The procedures required to conduct the review were guided by the frameworks proposed by Arksey and O'Malley, Levac et al and Peters et al. The study eligibility criteria were established based on the Problem, Concept and Context outlined in the research questions. Primary and secondary studies will be retrieved from nine sources, covering both conventional and grey literature. These sources include Embase, ERIC, LILACS, PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, the Brazilian Digital Library of Theses and Dissertations, and the Networked Digital Library of Theses and Dissertations. A categorised form will be used for data collection and subsequent analysis. The reporting of the review findings will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
The nature of the research and the use of secondary data sources do not require informed consent forms or approval from ethics committees in Brazil. The scientific findings from the review will be disseminated through peer-reviewed journals, academic conferences and other scientific communication channels.
The protocol was registered on the Open Science Framework (OSF) and is available at https://doi.org/10.17605/OSF.IO/Z3CX7.
The study explored patient experiences of the Call for a Kit (CFAK) intervention, a community-based initiative designed to improve bowel cancer screening uptake and examined the mechanisms that may support participation among non-responders.
A convergent parallel mixed-methods design was employed, combining quantitative surveys and qualitative interviews.
The evaluation was conducted in general practices across Lancashire and South Cumbria, Northwest England, where CFAK clinics were delivered by an external health promotion team based within the Community Voluntary Services. These clinics target practices with low screening uptake.
A total of 113 CFAK attendees aged 54 and above, and who had missed their most recent screening invitation, completed a patient experience survey. 12 participants were purposively sampled for follow-up interviews.
Statistical analyses examined associations between patient experience and screening behaviours, including kit ordering and intention to complete the screening kit. Thematic analysis explored barriers and facilitators to participation, as well as experiences of CFAK clinics.
Patient experience scores were significantly higher among women than men and were positively associated with intention to complete the kit, though not with kit ordering. Qualitative findings indicated that CFAK addressed key barriers such as low awareness, confusion and emotional discomfort by providing personalised education, reassurance and culturally sensitive support. Participants particularly valued the relational aspects of the intervention, including the face-to-face delivery and communication in preferred languages.
CFAK clinics appear to enhance psychological capability and motivation for bowel screening by offering tailored, inclusive and supportive care. These findings highlight the value of patient-centred approaches in addressing inequalities in cancer screening and offer insights for the design of future community-based interventions.
We aim to identify trajectories of probable maternal common mental disorders (CMD), as well as risk and protective factors associated with maternal mental health among postpartum women during the pandemic using life course theory approach.
Prospective individual level cohort study from the Iracema-COVID Study.
Mothers (n=335) at postpartum period who delivered during the COVID-19 pandemic in the fourth largest city in Brazil.
Probable CMDs were accessed using validated instruments in five cohort waves at postpartum period. Sequence analyses (SA) were employed to extract CMD trajectories, and a set of generalised binomial logistic and log-Poisson multivariable regression models with robust variance were employed to assess risk and protective factors for probable CMDs diagnosis.
Trajectories patterns of probable maternal common mental disorders.
Fit indices demonstrated a two-cluster-SA solution of probable CMD. The patterns of probable CMDs indicated that 335 mothers were clustered into occasional/transitory (n=240, 71.64%) and mostly/persistent (n=95, 28.36%) CMD trajectories. We found that mothers with low education (OR: 2.44; 95% CI 1.13 to 5.23), single (OR: 1.97; 95% CI 1.03 to 3.75) or in a stable union (OR: 2.00; 95% CI 1.02 to 3.90) and travel time spent to access the nearest primary healthcare unit (OR: 1.02; 95% CI 1.006 to 1.04) were associated with increased OR of belonging to the mostly/persistent CMD trajectory. Deprived green areas acted as a risk factor to maternal CMDs prevalence (OR: 1.37; 95% CI 1.002 to 1.87).
This study provides evidence that individual vulnerabilities and neighbourhood deprivation play an important role in understanding maternal mental health, beyond the patterns and trajectories of probable maternal CMD due to issues confronted during the COVID-19 outbreak in the northeastern region of Brazil. Policies to prevent and treat maternal mental health issues and improvement in neighbourhood deprivation need to be developed and addressed to avoid exacerbation of probable maternal CMDs.
Bipolar disorder affects around 2% of the population and is linked with reduced life expectancy and socioeconomic burden. Depressive episodes are difficult to treat and typically more prevalent, enduring and burdensome than manic episodes. The use of antidepressants alone has limited effect and is associated with significant clinical risk through polarity switch. Current National Institute for Health and Care Excellence guidelines recommend quetiapine, olanzapine (with or without fluoxetine) and lamotrigine; however, these medications have limited efficacy, tolerability and acceptability. The ASCEnD study aims to assess the clinical and cost-effectiveness of aripiprazole plus sertraline compared with quetiapine, offering potential improvements for outcomes in bipolar depression. The study is funded by the National Institute for Health and Care Research Health Technology Assessment programme (NIHR132773).
ASCEnD is a prospective, two-arm, superiority, individually 1:1 randomised, controlled, pragmatic, parallel group, type A open-label clinical trial of aripiprazole/sertraline medication combination compared with quetiapine for bipolar depression. The study is conducted in the UK National Health Service setting with the aim of recruiting and randomising 270 participants followed-up for 24 weeks. Adults with bipolar disorder self-refer or are recruited through primary and secondary care services. The primary outcome is change in depressive symptoms 12–16 weeks after randomisation. Secondary outcomes include measures of symptom change, treatment satisfaction, tolerability, medication adherence, concomitant medication use, psychosocial functioning, quality of life and cost-effectiveness and informal carer measures of quality of life and costs of caring. The exploratory outcome is change in participant reward and punishment responsiveness. Analysis will follow a prespecified statistical analysis plan. A nested qualitative study is included to examine feasibility and acceptability of the trial design.
A Clinical Trial Authorisation from Medicines and Healthcare products Regulatory Agency, and approval from the Health Research Authority (IRAS 1007468) and North East – Newcastle and North Tyneside 1 Research Ethics Committee (23/NE/0132) were obtained. Results will be disseminated through peer-reviewed publications, conference presentations and lay summaries for participants and patient and public groups.
Strong primary healthcare enhances resource efficiency and resilience. Type 2 diabetes poses a growing global health challenge, with Argentina’s healthcare system struggling to detect and manage the disease effectively. Many patients bypass primary healthcare for secondary facilities, undermining continuity of care and increasing costs. Following a diagnostic process in collaboration with policymakers, we propose evaluating a redesigned primary care model consisting of codesigned evidence-based implementation strategies to improve type 2 diabetes management in Mendoza, Argentina.
This is an efficient, parallel-arm cluster randomised controlled Hybrid Type II trial with 12 clusters (administrative areas with 2–3 health facilities) allocated 1:1 to control (usual care) or intervention. In phase I, we will codesign, pilot and refine an implementation strategy package. In phase II, we will conduct the trial: 9-month baseline data collection, 15-month intervention and 6-month sustainability period. We will enrol a cohort of 396 patients with type 2 diabetes at primary healthcare centres and follow them for 12 months during the intervention and 6 months sustainment using routine clinical records and patient surveys. In phase III, we will conduct analysis, report and disseminate findings. The primary outcome will be a composite outcome including glycaemic control (glycated haemoglobin (HbA1c)
All study activities will comply with national and international ethics guidelines, presenting minimal risk to participants. The protocol was submitted and approved by the local independent ethics committee at the Mendoza Ministry of Health (Consejo Provincial de Evaluación ética en investigación en Salud-Provincial Health Research Ethics Review Board, Reference number: 149/2024). Facility-level permission will be obtained for participation and sharing of deidentified data. Written informed consent will be required from study participants, who will receive information on the study’s purpose, procedures, risks and benefits. Dissemination activities and outputs will include writing and submitting manuscripts for publication; writing policy briefs to support strategy implementation in other regions or countries; and tailoring outputs for patients, clinicians and researchers. We anticipate that improvements in disease management and patient experience will have clinical and economic benefits related to reduced usage of secondary-level and tertiary-level facilities, lower cost per visit and a reduced number of clinical events related to diabetes.
To describe symptom patterns in first-time mothers through 3 months postpartum.
Longitudinal, descriptive correlational.
Secondary analysis of data from a randomised clinical trial of first-time mothers. Symptoms were assessed at 1, 2 and 3 months postpartum using the Memorial Symptom Assessment Scale for dimensions of 32 symptoms.
New mothers (n = 114) reported an average of 7.0 (SD 4.7) symptoms at 1 month, decreasing to 5.3 (SD 4.3) at 3 months. Physical symptoms decreased to the greatest degree. Symptoms reported by over 33% of participants included lack of energy, worrying, pain, difficulty sleeping or concentrating and feeling irritable, sad or drowsy. The most distressing were lack of energy, feeling irritable, pain, nervousness and hair loss. Symptoms did not differ by type of birth or infant feeding. Older mothers (≥ 35 years) had significantly more symptoms and distress than younger mothers.
Most symptoms improved over time, yet some were still prevalent at 3 months. Symptoms not appraised as particularly distressing may still be of clinical concern for safety reasons. Frequent postpartum assessments and interventions are important, particularly for older mothers.
In the first 3 months, postpartum symptoms not perceived as distressing may lead to adverse health outcomes. These symptoms may threaten maternal–infant welfare beyond the first 3 months postpartum. Older first-time mothers merit particular attention by clinicians.
The authors complied with STROBE reporting guidelines.
No patient or public contribution.
To explore how older women experiencing poverty in a high-income country perceive their family caregiver role from a gender perspective.
Descriptive qualitative study.
A convenience sample of seventeen older female caregivers experiencing poverty was interviewed in-depth between October 2023 and March 2024. Reflexive thematic analysis was conducted following the phases described by Braun & Clarke. ATLAS.ti software was used for data analysis.
Three main themes were developed from the data analysis: (1) The duality of family caregiving: between informal female support and structural neglect, (2) family care in later life as a continuation of a life devoted to others, (3) older female family caregiving as a gender issue.
Older female caregivers experiencing poverty have limited formal support and unequal access to resources. Older women experiencing poverty experience both gratitude and despair in their caregiving role, which inevitably deteriorates their health.
Nursing interventions for older female caregivers experiencing poverty should include an assessment of social determinants of health, focusing on gender and socio-economic barriers. Implementing system navigation interventions, such as community-based case management, resource referral programmes, and personalised care coordination, could connect older female family caregivers to essential resources and support networks, thus addressing their mental health needs and promoting equity, which would enhance their overall well-being and dignity.
Experiencing poverty increases the vulnerability of older female caregivers, exacerbating gender inequality. These women often face mental health issues as they face the pressure of meeting their own needs and those of their care recipients with a lack of formal support. This neglect can lead to serious health problems, which emphasises the need for equitable nursing interventions.
The study is reported following the COREQ guidelines.
No patients or public were involved in the study development and implementation.
Negative pressure wound therapy (NPWT) is widely used to facilitate healing by improving local perfusion, reducing edema and controlling exudate. The porous foam dressing is central to NPWT effectiveness, however, its performance in viscous, particle-rich exudates remains challenging. Standard industry tests often rely on protein-free aqueous solutions, which overlook the complex rheology and particulate load of real wounds. This study reports a bench evaluation of a multilayer foam prototype compared with three commercial dressings under NPWT, using a simulated viscous exudate with suspended particles. We recorded 60-min drainage curves and quantified effluent turbidity as a simple, interpretable proxy for particulate transport, summarised as percentage of input turbidity recovered. The mass-based endpoint (percent solid matter recovered) showed the same ranking as turbidity. At −75 mmHg, the prototype recovered 31.6% of input turbidity, exceeding commercial foams (≤ 9.7%). At −125 mmHg, particulate recovery decreased across all dressings (≤ 9.1%). A matrix-only control indicated that commercial effluents, particularly at −75 mmHg, clustered near background level, whereas the prototype evacuated substantially more particulate while maintaining robust fluid drainage. These findings suggest that moderate negative pressure and multilayer architecture can help preserve channel patency and reduce clogging in complex exudates. We highlight the need for test methodologies that incorporate viscosity and particulate content, and for practical guidance that links dressing architecture and pressure settings to exudate characteristics. Prospective validation, including larger-sample confirmation, particle-size distributions and ultimately clinical endpoints, is warranted.
Newborn bloodspot screening (NBS) is freely and universally available to babies born in Australia, with nearly 300 000 newborns screened each year. The NBS programme screens for approximately 30 conditions; however, there are hundreds of childhood conditions that could be treated if identified earlier and asymptomatically. Contemporary screening platforms have relied on mass spectrometry-based technologies, limiting surveillance to conditions with validated biomarkers detectable within the neonatal period. Advancements in metabolic techniques and genomics have expanded the range of conditions that could be detected. The NewbornsInSA research study will develop, validate and evaluate a novel multi-omic model of newborn screening, integrating metabolomic and genomic newborn screening as complementary methodologies.
Parents can opt in to additional NBS through NewbornsInSA during pregnancy or shortly after birth. One thousand prospectively recruited families will be offered genomic NBS by whole-genome sequencing, including analysis of a virtual gene panel of over 600 genes, and concurrent metabolomic screening. Clinically actionable pathogenic or likely pathogenic genetic variants will be reported to parents and whole genome sequencing data will be available on request for diagnostic reanalysis, if required later in life.
Acceptability of the NewbornsInSA programme will be evaluated through stakeholder engagement activities with healthcare professionals, members of the public and patient advocacy groups. Family experiences will be assessed using online surveys. The diagnostic yield, accuracy and the costs and consequences of the multi-omic NBS model will be assessed by comparison to standard-of-care NBS.
NewbornsInSA will investigate the acceptability, feasibility and cost-effectiveness of a multi-omic newborn screening model in a prospectively recruited South Australian population. We hypothesise that this approach will increase the number of conditions identified, reduce the time to diagnosis and facilitate earlier care with better outcomes for newborns with genetic conditions.
This research study has been ethically approved by the Women’s and Children’s Health Network Human Research Ethics Committee (2022/HRE00258 and 2023/HRE00236). Findings will be disseminated through peer-reviewed publication and conferences.
Migration is a complex global phenomenon, with millions of people relocating each year driven by various social or personal reasons. Among them, refugees and asylum seekers form a particularly vulnerable subgroup, often forced to escape conflicts, persecution or life-threatening conditions. Most mental health assessment tools, originally developed in high-income countries and validated primarily in Western populations, may lack the cultural validity needed for this demographic. The primary objective is to systematically review and synthesise the psychometric properties and cultural validity of mental health assessment tools validated for refugees and asylum seekers. Secondary objectives are to (a) identify the range of mental health symptoms these tools assess and (b) describe the geographical coverage in terms of the regions of origin and host countries where tools have been validated.
Reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the review will conduct searches across different databases (ie, MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, Global Index Medicus, CINAHL and Scopus), from inception to January 2025, with no restrictions on language. We will include validation, adaptation or diagnostic accuracy studies, as well as any other study design that reports at least one psychometric property of a mental health assessment tool. Two pairs of reviewers will screen, extract and appraise each study independently. Methodological quality will be assessed with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk-of-Bias checklist for measurement studies and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) for diagnostic accuracy studies; the certainty of the evidence per property will be graded using the COSMIN-GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Narrative synthesis will be performed for all properties; where appropriate, meta-analyses will pool Cronbach’s α (Fisher-Z), intraclass correlations and sensitivity/specificity estimates using random-effects models. Inconsistency will be explored with subgroup analyses and meta-regressions; publication bias will be investigated with funnel plots and Egger’s test when ≥10 studies are available.
Ethical approval is not required for this systematic review, as no empirical data will be collected. Results will be disseminated through a peer-reviewed publication in a scientific journal and presented at relevant conferences.
CRD42024510901.
Social camouflaging (SC; ie, the concealing of autistic traits to socially assimilate) is associated with poor mental health, self-identity and quality of life outcomes, yet its typology, consequences and contextual triggers remain unexplored in autistic adolescents. Further study is necessary to identify protective factors against the potentially negative outcomes associated with SC to promote long-term well-being.
The current project will investigate SC in youth and its mental health, cognitive and neurophysiological correlates. Camouflaging will be captured by triangulating self-reported and caregiver-reported SC behaviours, as well as SC behaviours in day-to-day contexts using intensive longitudinal methods (ie, daily diaries). Non-autistic, self-identifying autistic and formally diagnosed autistic adolescents aged 15–18 years (N=150) will be recruited. Adolescents and caregivers will complete rating scales to assess mental health, and adolescents will complete in-lab cognitive assessments of attention, executive function, intellectual ability and theory of mind. Brain neurophysiological function and cortisol concentration over time will be measured during the same visit using electroencephalography and hair samples, respectively. Over the following 7 days, adolescents will complete daily diaries using their smartphones. The daily diaries pose survey questions about the type and degree of SC behaviour used within their daily environment, including the social context, individuals who are present and current well-being. Adolescents will also complete brief performance-based cognitive assessments of attention and executive function integrated within the daily diary surveys. Finally, adolescents and their parents will complete a follow-up of SC behaviours and mental health at 3 months. Correlations and regression analyses will be conducted to explore the associations between SC and mental health/cognitive outcomes and how baseline measures of cognition, mental health and SC predict patterns seen on the daily diaries. Multilevel modelling will be used, nesting daily data to capture within-person and between-group differences in contextual predictors of camouflaging behaviour. Results will contribute to current understanding of the typology of camouflaging, as well as inform intervention to mitigate mental health challenges for autistic youth.
This project is approved by the University of Victoria Human Research Ethics Board (#23–0013) and the University of Calgary Conjoint Faculties Research Ethics Board (#23–0641). Informed consent will be obtained from caregivers and adolescent participants, and safety procedures will be put in place to support the adolescent should mental health concerns arise. Results will be disseminated through academic publications and conferences, as well as summarised and communicated to interested participants and relevant stakeholders.
Inflammation plays a central role in atherosclerosis development and subsequent cardiovascular complications, including heart attack and stroke. Patients with inflammatory conditions such as community-acquired pneumonia (CAP) present with an elevated risk of cardiovascular events, which is likely driven by unresolved systemic inflammation. Targeting this heightened inflammatory burden may present a novel therapeutic strategy to attenuate heart attack risk in CAP survivors. Icosapent ethyl (IPE), an omega-3 fatty acid, demonstrates both pro-resolving and cardioprotective properties. The Targeting Vascular Inflammation In Patients with CAP (TIN-CAP) trial aims to evaluate the efficacy of IPE in mitigating vascular inflammation in CAP survivors.
TIN-CAP is a multicentre, randomised, double-blind, placebo-controlled trial. Eligible adults diagnosed with CAP in hospital or the emergency department will complete baseline assessments within 14 days of diagnosis including 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT angiography, bloodwork and quality of life evaluation (EuroQol – 5 Dimensions (EQ-5D)). Participants will then be randomised 1:1 to receive IPE (4 g/day) or placebo for 6 months. Follow-up visits will occur at 30 days (bloodwork and EQ-5D only) and 6 months. The primary endpoint is the change in FDG uptake in the ascending aorta from baseline to 6 months between IPE and placebo groups. Secondary endpoints include FDG uptake in the bone marrow, spleen, lungs and other vasculature, in addition to major adverse cardiac events and quality of life assessments. An initial lead-in cohort of 18 patients will be enrolled to assess recruitment, imaging feasibility and IPE tolerability prior to full trial enrolment. These patients will remain blinded and will be included in the final analysis (Vanguard design).
The TIN-CAP trial has been approved provincially by the Clinical Trials Ontario Research Ethics Board (approval number: 5045). Participants will provide written informed consent prior to enrolment. Study findings will be disseminated through peer-reviewed publications and conference presentations.
Workplace disclosure of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) identity by healthcare employees is an understudied area and existing reviews of LGBTQ+ disclosure in the healthcare sector focus on patient perspectives, overlooking the unique challenges that healthcare professionals encounter. The aim of this study was to conduct a systematic review and meta-synthesis of existing qualitative studies exploring disclosure experiences of LGBTQ+ healthcare employees.
The literature search integrated current research from 2011 to March 2023 and focused on qualitative studies exploring disclosure experiences of LGBTQ+ healthcare professionals. Ovid served as the primary platform for literature searches, supplemented by forward and backward citation tracking and additional searches in academic databases such as Google Scholar and Scopus. The studies underwent quality evaluation using the Critical Appraisal Skills Programme 2022 checklist and were synthesised using thematic analysis.
The findings revealed seven studies with five prominent themes: (1) risk associated with disclosure, (2) making the decision to disclose, (3) cost of non-disclosure, (4) cost of disclosure and (5) benefit of disclosure. Additionally, five critical factors of disclosure were identified: level, scope, time, elements and method. Finally, the risk–benefit analysis underscored the dilemma and balance between authenticity and conformity, largely influenced by pervasive heteronormativity, resulting in a significant mental toll.
The findings must be interpreted considering certain limitations, such as the lack of generalisability of studies. However, the findings emphasise the critical need for cultivating trusting and accepting healthcare work environments for LGBTQ+ staff.
To assess the acceptability and adoption of multiparameter point-of-care testing (POCT) devices for the diagnosis and management of non-communicable diseases (NCDs) at the primary healthcare level in a resource-limited region of Peru.
Qualitative case-control process evaluation.
Eight primary healthcare facilities in northern Peru, including both urban and rural centres, where routine chronic care and laboratory services are provided.
Sixty-three participants: 36 patients, 12 laboratory technicians, 10 healthcare professionals and five facility heads. Eligible patients were ≥18 years, residing in the catchment area, with or without prior NCD diagnoses. Healthcare workers, including physicians, nurses, laboratory staff and facility managers.
Multiparameter POCT devices were installed in four intervention facilities, accompanied by staff training and community awareness activities, while four control facilities continued with conventional laboratory diagnostics.
Primary outcome: perceptions of patients and healthcare workers regarding the acceptability and adoption of POCT devices. Secondary outcomes: identification of facilitators and barriers to implementation, including infrastructure, supply chains and training gaps.
(1) Individuals: POCT was valued for speed and comfort, but concerns over accuracy were mentioned. (2) Intervention characteristics: laboratory staff valued POCT’s practicality in emergencies, but noted limitations in handling multiple samples. (3) Outer setting: urban centres outperformed rural facilities, with more staff and longer operating hours. (4) Inner setting: calibration gaps impacted POCT and conventional test reliability, requiring quality control and training. (5) Process: clear staff communication boosted patient confidence in POCT, but inconsistent training could lead to reliability doubts.
Multiparameter POCT devices show promise for enhancing NCD care in resource-limited primary healthcare settings, particularly in rural areas. However, their sustainability depends on broader health system reforms, including reliable supply chains, expanded training and stronger quality assurance mechanisms. Further research should examine strategies for embedding POCT within national regulatory and policy frameworks.
International guidelines on breast cancer (BC) screening have differing recommendations leading to uncertainty on best practices for primary care providers. The purpose of this study was to create a Canadian best practices document on BC health and screening for primary healthcare providers through multidisciplinary consensus using Nominal Group Technique and Delphi method.
A 9-member multidisciplinary expert group and a patient advocate participated in the consensus methods and voting. Experts included those involved in BC management and two primary care physicians. Twenty-nine experts across BC disciplines participated in external review.
Two study objectives included (1) building consensus on key ‘best practice’ behaviours related to BC-related health and screening and (2) building consensus on specific definitions related to BC screening.
The final consensus document consists of 65 statements grouped in five categories with companion resources to support uptake of all best practices. Categories include identification and work-up for diagnostic imaging, risk factors and identifying individuals eligible for high-risk screening, shared decision-making, decisions and referrals for BC screening and screening outcomes. Special areas of focus were shared decision-making, age to initiate screening, and BC screening in special populations.
We created a comprehensive consensus document distilling the latest evidence to provide practical Canadian consensus-based advice on specific ‘best practice behaviours’ related to BC health and screening to serve as a resource for providers.
Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
FreshRSS 