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Compression therapy is the evidence-based treatment for healing venous leg ulcers. However, it is not routinely applied in many UK hospitals. This paper explores hospital staff's' perspectives of venous leg ulcer care provision where compression therapy is not routinely applied. A semi-structured interview study was conducted with 11 participants, drawn from a larger study, who confirmed that their respective hospitals did not apply compression therapy to inpatients with venous leg ulcers. The interviews were analysed using reflexive thematic analysis. Findings indicate that venous leg ulcer care in hospitals was de-prioritised, which, along with structural and organisational constraints, affected clinicians' engagement and focus on it in their hospitals. This de-prioritisation also led to a lack of formal leg ulcer training in hospitals. However, some clinicians showed remarkable empathy for patients derived from their clinical professionalism and deep understanding of their suffering. To help hospital clinicians and senior managers prioritise venous leg ulcer care, it is crucial to first understand their clinical practise priorities. Secondly, understanding how some hospitals implement compression therapy could be beneficial for those where it is not routine practise. Further research should focus on better understanding clinicians and senior managers' clinical priorities and the structural and organisational constraints in real-world settings, ideally in hospitals where compression therapy is a routine practise. Most importantly, the study highlighted key questions for hospital leaders and policymakers: consider fostering the established clinicians' empathy before it is too late.
by Sven Göbel, Lennart Jacobtorweihe, Max-Leopold Rössig, Frauke Braatz, Fabien Perugi, Yvonne Genzel, Udo Reichl
Building on the established use of enveloped viral vectors, like lentivirus and vesicular stomatitis virus, we investigated the stability of the oncolytic Newcastle disease virus LaSota strain and the chimeric construct of a Zika vaccine candidate YF ZIKprM/E. These vectors are currently being developed for the treatment of solid tumors, such as melanoma and glioblastoma, and for vaccine initiatives, respectively. Virus stability is a critical attribute during cell culture-based virus production and also relevant for downstream processing, storage of the produced material, final vaccine storage and shelf life. Therefore, temperature and pH stability were tested as important parameters during upstream processing and freeze-thaw cycles were tested in context of laboratory-analytics. In this study, both viruses exhibited strong stability of the infectious virus titer when subjected to repeated freeze-thaw cycles. However, exposure to temperatures above 22°C substantially reduced the infectious titers, indicating sensitivity to elevated temperatures. To improve viral stability during storage, we investigated the use of sucrose as a stabilizing excipient. While this did not result in significant improvements for YF-ZIKV, an extended half-life for NDV at room temperature was observed. The observed half-life values of upstream material from NDV of 2.6 h and 2.8 h for YF-ZIKV at 37°C demand consideration of changes to the process design, such as the implementation of a perfusion process to enable continuous, cooled virus harvesting.Emerging evidence supports a role for interleukin 6 (IL-6), a pro-inflammatory cytokine, in the pathogenesis of treatment-resistant major depressive disorder (TRD). However, interventional studies targeting IL-6 in this population remain scarce. Tocilizumab is a humanised monoclonal antibody that inhibits IL-6 signalling and is approved for the treatment of autoimmune conditions such as rheumatoid arthritis. The primary objective of this study is to examine whether IL-6 inhibition via tocilizumab can impact depressive symptoms, inflammation-related biomarkers and cognition in patients with TRD. A secondary objective is to compare the biological profiles of patients with TRD with elevated inflammation to those of healthy controls.
This is a proof-of-concept, randomised, parallel-group, triple-blind, placebo-controlled clinical trial. 22 adult outpatients diagnosed with TRD and evidence of low-grade inflammation (serum C reactive protein≥3 mg/L) will be randomised (1:1) to receive either one intravenous infusion of tocilizumab (8 mg/kg; maximum 800 mg) or normal saline, administered as an add-on to their ongoing treatment. Psychiatric, cognitive and biomarker assessments will be performed at baseline and at follow-up visits on days 7, 14 and 28 post-infusion. Additionally, 10 healthy controls with no psychiatric history will undergo the same baseline assessments for biomarker comparison.
The study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (Project number: 2025-0245, CAAE: 88904825.7.0000.5327). Findings will be disseminated through peer-reviewed publications, scientific meetings and, on request, lay summaries for participants.
Ophthalmic complaints account for a substantial proportion of presentations to emergency and acute eye care services, yet initial assessment or referral is frequently performed by non-ophthalmologist healthcare professionals. Previous single-centre studies suggest that one-third of referrals are incorrectly diagnosed, potentially delaying appropriate management of vision-threatening conditions. However, the overall magnitude of diagnostic error and patterns of misdiagnosis across healthcare settings remain unclear. This study aims to systematically review and synthesise the evidence on the diagnostic concordance of ophthalmic referral diagnoses made by non-ophthalmologists in acute eye care.
A systematic review and meta-analysis will be conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guidance and registered with PROSPERO. MEDLINE (Ovid), Embase (Ovid) and the Cochrane CENTRAL database will be searched from inception to April 2025. Studies evaluating the diagnostic accuracy of referrals made by non-ophthalmologist healthcare professionals in emergency or acute eye care settings will be included. Two reviewers will independently screen studies, extract data and assess risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) framework adapted for referral-diagnosis studies. The primary outcome will be diagnostic concordance between referral and final ophthalmologist diagnosis. Where appropriate, pooled concordance proportions will be synthesised using a random-effects meta-analysis. Condition-specific 2x2 diagnostic accuracy analyses will only be undertaken where valid binary target conditions and sufficient denominators are reported. Heterogeneity will be assessed using Cochran’s Q test and the I² statistic with subgroup analyses exploring differences by referring clinician type and anatomical location of ophthalmic pathology.
Ethical approval is not required for this study as it will synthesise data from previously published studies; findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences.
CRD420261352717.
This study aims to explore the ability to identify high-grade intracranial arterial stenosis (ICAS) by an artificial intelligence (AI) designed to detect large vessel occlusions (LVO) and the clinical relevance of these ‘false positive’ findings.
We are presenting a retrospective cohort study.
The study was conducted at a supraregional stroke centre of an urban tertiary care provider.
Consecutive stroke cases treated between January 2023 and December 2023 of patients >18 years of both sexes and any ethnicity were eligible for inclusion. 934 patients (52.7% male) with a mean age of 71.7±13.6 years (25–101 years) were included.
CT angiographies were analysed by a deep learning algorithm for LVO detection of the anterior circulation. AI results were compared with radiology reports and secondary focused evaluation.
Diagnostic accuracies for ICAS detection by the AI were calculated.
Primary reports identified 30 ICAS and nine additional ICAS were detected during secondary evaluation (incidence 4.2%). The sensitivity of radiology reports was 77% (95% CI 0.61 to 0.89), the specificity 99% (95% CI 0.98 to 1.00), negative predictive value (NPV) 99% (95% CI 0.98 to 0.99) and positive predictive value (PPV) 79% (95% CI 0.65 to 0.88). The AI identified 13 of 39 ICAS correctly. 18 false positive cases (neither LVO nor ICAS) were flagged by the AI. The sensitivity of the algorithm was 33% (95% CI 0.19 to 0.50), the specificity 98% (95% CI 0.97 to 0.99), the NPV 97% (95% CI 0.96 to 0.98) and PPV 42% (95% CI 0.28 to 0.58).
Detection of high-grade ICAS by an algorithm trained to identify LVO is per se a false positive finding but occurred in 13 of 39 cases. Dedicated training for ICAS might lead to a beneficial tool during the diagnostic work-up for ischaemic stroke.
German Register for Clinical Trials (DRKS: DRKS00034019 https://drks.de/search/de/trial/DRKS00034019).
Adult-onset type 1 diabetes (T1D) is often misclassified as type 2 diabetes (T2D), resulting in delayed treatment, missed opportunities for referrals to specialists and increased risk of complications including diabetic ketoacidosis. An electronic medical record (EMR)-based algorithm—originally trained on a large national EMR dataset to identify likely misclassified adult-onset T1D cases—was tested and retrained on a health information exchange (HIE) dataset from HealthShare Exchange (HSX). Promising results were achieved on historical data, particularly when using the retrained algorithm. However, its prospective validation is essential to more reliably assess its clinical utility and real-world precision in flagging high-risk patients for clinician review.
This is a prospective, multicentre, non-interventional cohort study in two HSX-member healthcare organisations (HCOs) in southeastern Pennsylvania. At the onset of the study, all adult T2D patients are scored by the algorithm analysing HIE data on relevant predictors found in the 24-month lookback period. Patients meeting a prespecified score threshold estimated in retrospective testing to yield 10% recall will be presented to designated endocrinology or primary care providers for structured chart review, attribution confirmation and guideline-concordant follow-up (including autoantibody testing where appropriate). The primary endpoint is positive predictive value for confirmed adult-onset T1D among flagged patients. Secondary endpoints characterise operational cascade metrics (attribution, provider recommendation, test ordering/results and diagnosis updates) along with 95% CIs. Exploratory endpoints will assess provider adoption, interpretability and workflow integration via structured provider interviews.
This study was reviewed and approved by Advarra Institutional Review Board (protocol Pro00075945). The Institutional Review Board waived patient informed consent and granted a full waiver of HIPAA authorisation for patient records, while providers were required to provide written informed consent. HSX data were accessed and shared under its member-defined use cases. Findings will be disseminated via peer-reviewed publications and conference presentations. Reporting will follow Strengthening the Reporting of Observational Studies in Epidemiology guidance for cohort studies.
To determine the prevalence, patterns and correlates of medicinal herb use in a rural Iranian population and to evaluate demographic and clinical predictors using adjusted regression models.
Cross-sectional analysis of baseline data from the Fasa Prospective Epidemiological Research Studies in Iran Cohort Study.
Sheshdeh, a rural district in southern Iran.
10 143 adults aged 35–70 years enrolled between 2017 and 2019.
Prevalence of self-reported medicinal herb use during the past year and its associations with demographic variables and non-communicable diseases (NCDs).
Overall, 84.7% of participants (95% CI 83.9% to 85.5%) reported herb use. In multivariable logistic regression, higher educational attainment was positively associated with herb use (university education vs. illiterate: adjusted OR 1.41, 95% CI 1.11 to 1.88). No significant adjusted associations were observed between herb use and major NCDs including diabetes, hypertension, ischaemic heart disease or depression. The most frequently used herbs were Zataria multiflora, Echium amoenum and Matricaria chamomilla, most commonly for anxiety/neurasthenia (81.6%), gastric pain (59.6%) and common cold (49.8%).
Medicinal herb use is highly prevalent among adults in southern Iran. Educational level, but not chronic disease status, was associated with herb use. These findings highlight the need for integrated public health strategies regarding safe and evidence-based use of medicinal herbs.
by Wen-Jui Han, Johanna Carrasco Saravia, Matthias Pollmann-Schult, Tinh Doan, Jianghong Li
Study aimsUsing a cross-country lens, we investigate the links between longitudinal work trajectories and health among parents with children under age 18.
BackgroundEmployment serves as a valuable resource, affording us a decent standard of living. The rising dominance of digital and technology, together with the service economy since the 1980s, has transformed the utility of employment from a resource to a vulnerability, subjecting more families to uncertain, unstable, and insecure work. Nonstandard work schedules or shiftwork, which often fall outside regular 9-to-5 daytime hours and can be unpredictable, carry potential health consequences.
MethodsUsing the longitudinal data from Australia (HILDA), Germany (SOEP), the UK (UKHLS), and the US (NLSY79), we used sequence analysis to first chart parental work schedule patterns between three stages of the life course, 25–34, 35–44, and 45–54, to show the changes and transitions in work patterns. We then conducted multivariate regression analysis to examine how variations in parental work patterns may shape individual health (i.e., physical and mental health) at ages 35/40, 45/50, and 55/60 while controlling for a rich set of sociodemographic characteristics.
ResultsOur sequence analyses uncovered roughly 4–6 work patterns during those three periods, revealing the heterogeneities of parental work trajectories that might correspond to childrearing demands and their sociodemographic backgrounds. We also found that mainly not-working pattern or volatile work arrangements (e.g., switching between daytime and non-daytime hours) were associated with significantly poorer physical and mental health; however, the persistence and magnitude of these associations varied by country.
ConclusionsThis study advances our understanding of the critical role of employment in our health from a cross-country perspective and bears important implications for the intergenerational transmission of employment and health vulnerabilities.
Semirigid thoracoscopy plays an important role in the diagnosis of pleural diseases. However, its diagnostic performance remains unsatisfactory particularly in terms of the negative likelihood ratio. Therefore, more effective supplementary diagnostic tools are required. Probe-based confocal laser endomicroscopy (pCLE), which allows live tissue imaging at the cellular level, can discriminate between malignant and benign pleura during medical thoracoscopy. However, the clinical relevance of pCLE in pleural disease remains unclear. This protocol describes a randomised controlled trial that evaluates the additional diagnostic value of pCLE in diagnosing pleural diseases using semirigid thoracoscopy.
This study is a multicentre, parallel-group, randomised controlled trial that will be conducted at ten sites in China. A total of 158 adult patients with undiagnosed exudative pleural effusions will be enrolled and randomly allocated (1:1) to undergo either a conventional pleural biopsy (control group) or a pCLE-guided pleural biopsy (intervention group) via semirigid thoracoscopy. In the intervention group, a pCLE system will be applied during thoracoscopy to identify suspicious pleural areas for targeted biopsy. The primary outcome is the diagnostic yield of the procedure in patients with unknown causes of pleural effusion. Secondary outcomes include negative likelihood ratio, diagnostic sensitivity in specific diseases, procedural time, rate of adequate specimens for achieving molecular diagnosis and complications.
Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2025-KY-018). Written informed consent will be obtained from all the participants. The findings will be disseminated through journal publications and conference presentations.
To explore healthcare professionals’ perspectives on the potential role of molecular breast imaging (MBI) for breast cancer imaging and to inform future clinical study design and implementation.
Qualitative interview study.
UK National Health Service (NHS) breast screening and diagnostic pathways.
Purposively sampled stakeholders.
Semistructured interviews with key professional stakeholders explored potential MBI pathways and routes to adoption, including barriers and facilitators. Data were analysed thematically.
22 participants were recruited between January 2020 and October 2021. Barriers to MBI adoption were identified at three levels: scan-related, system-level, and cultural within the screening programme. Overcoming these is likely necessary for implementation. A further theme highlighted the potential for MBI to improve screening in selected patient groups, contingent on addressing these barriers. Specifically, adoption would require advances in next-generation MBI systems, particularly reductions in radiation dose and scan time, alongside prospective clinical studies in UK populations to assess diagnostic accuracy.
Once identified barriers are overcome, participants perceived that MBI could improve screening pathways, particularly for women with dense breast tissue.
To identify factors influencing unnecessary non-sterile glove use in operating theatres and to estimate how common these factors are across the UK.
Mixed-methods study using interviews and a cross-sectional survey.
Imperial College Healthcare Trust for interviews and nationally across the UK for the survey.
19 interviewees and 329 survey respondents, all clinical staff working in UK operating theatres.
Barriers and facilitators to unnecessary non-sterile glove use in operating theatres.
The findings highlight a combination of key drivers leading to the unnecessary use of non-sterile gloves: (1) lack of prioritisation of sustainability, (2) fears around negative patient outcomes, (3) strong social influences such as norms to use gloves, (4) the absence of clear guidelines and limited training on glove use, (5) availability of alternatives and quality of gloves and (6) beliefs about personal safety and habitual glove use. Respondents also suggested potential intervention strategies.
67% of participants reported using gloves unnecessarily. Our findings highlight the role of habitual behaviour, social influences and unclear guidelines in driving this practice. Interventions should address these factors, for example, by clearly communicating when gloves should and should not be worn, encouraging changes to local social norms towards waste reduction, improving access to hand gel and supporting habit change to reduce unnecessary glove use and associated environmental impact.
The increasing global burden of long-term illnesses necessitates high-quality data to inform effective interventions, particularly in low-resource settings. Despite the critical role of data collectors in health research, their lived experiences and challenges remain understudied, especially in low- and middle-income countries (LMICs) like Nigeria. This study explored the experiences, barriers and facilitators encountered by field researchers working with individuals living with long-term illnesses.
A qualitative, descriptive phenomenological design was employed, involving in-depth interviews with 12 research coordinators across 12 healthcare facilities in Nigeria. Participants were purposively selected from the Nigeria Implementation Science Alliance–Model Innovation and Research Centres. Data were analysed using Colaizzi’s phenomenological method, with thematic analysis to identify key patterns.
Field researchers described both rewarding experiences and significant obstacles. While they found value in contributing to impactful research, they faced emotional strain from engaging with sensitive narratives. Key barriers included low health literacy, cultural and religious constraints, hesitation to engage in the study and logistical constraints such as unreliable infrastructure. Facilitators included prefield training, trust-building and support systems. Recommendations emphasised ethical adherence, continuous skill development, context-appropriate incentives and streamlined data collection tools.
The study underscores the need for systemic support for data collectors, including mental health resources, adaptive methodologies and institutional policies that address logistical and emotional issues. These findings advocate for participant-centred, ethically sound research practices to enhance data quality and collector well-being in long-term illness studies.
Future research needs to evaluate interventions to optimise data collection processes in LMICs.
Maternal anaemia remains a pressing global health challenge, with a notable burden in low- and middle-income countries. Existing studies in sub-Saharan Africa have largely relied on average associations, thereby concealing key variation among women and failing to account for heterogeneity.
To assess the association between completing at least eight antenatal care (ANC) contacts and maternal anaemia in Ghana and to explore heterogeneity in this association using causal machine learning.
An institution-based cross-sectional study was conducted using a retrospective review of medical records and causal machine learning analysis.
Juaben Government Hospital.
Of 2326 women who delivered at the hospital, 2114 with complete data on the main exposure and outcome variables were included in the analysis.
Completion of at least eight ANC contacts. ANC contact was defined as the in-person visit to the clinic with a healthcare professional for routine ANC services and follow-up.
Maternal anaemia, defined as a haemoglobin level below 11 g/dL in the last ANC before delivery.
A causal forest model was used to estimate the association between completing at least eight ANC contacts and maternal anaemia. Conditional average treatment effects were used to explore individual-level variation in these associations, providing policy-relevant insights.
Completing ≥8 ANC contacts was associated with a 6 percentage-point lower probability of maternal anaemia compared with having fewer visits (average treatment effect: -0.06, 95% CI –0.11 to –0.02). Predicted individual-level effects ranged from –0.21 to 0.09. Participants’ age, malaria prophylaxis, marital status, parity and educational level were the five most important contributors to the observed heterogeneity.
This study demonstrated that completing ≥8 ANC contacts is associated with a lower probability of maternal anaemia, with heterogeneity across subgroups. We recommend differentiated, context-specific ANC interventions that focus on high-impact subgroups while strengthening the effectiveness and quality of care delivered at each visit.
Fibromyalgia is a polysymptomatic central sensitisation disorder characterised by widespread pain, fatigue, sleep disturbances and neuropsychiatric features. Hyperbaric oxygen therapy modulates neuroinflammation, mitochondrial function and neuroplasticity, thereby yielding analgesic and functional benefits.
Evaluate the efficacy and optimal timing of hyperbaric oxygen therapy as an adjunct to standard care for fibromyalgia.
This single-centre, randomised, cross-over group, assessor-blinded clinical trial was conducted in the Department of Rheumatology at the University Hospital of the Federal University of Juiz de Fora, Juiz de Fora, Brazil, and adhered to Consolidated Standards of Reporting Trials (CONSORT) guidelines. Women (18–70 years) with a diagnosis of fibromyalgia for ≥2 years were randomised 1:1 to early hyperbaric oxygen therapy plus standard care or standard care alone (delayed group). Intention-to-treat (ITT) analysis was conducted with all 56 participants (mean age: 51.0±9.8 years; mean body mass index: 30.5±5.1 kg/m²).
Standardised care (education, exercise and pharmacotherapy) plus hyperbaric oxygen therapy was delivered at 2.3 atmospheres absolute for 90 min, five times per week, over 8 weeks (total 32–40 sessions). The early group received hyperbaric oxygen therapy during weeks 0–8, while the delayed group received it during weeks 8–16, following the same protocol.
Primary endpoints included the Fibromyalgia Impact Questionnaire-Brazilian Portuguese (FIQR-Br), the pain visual analogue scale (VAS) and the Symptoms Assessment Scale-40 (EAS-40) for psychopathology. Secondary endpoints included the 12-Item Short-Form Health Survey (SF-12) physical and mental components and adverse effects. Assessments were conducted at baseline, 8 weeks and 16 weeks, and analysed using a mixed-design 2x3 analysis of variance (group: early vs delayed; time: baseline, 8 weeks and 16 weeks) with Greenhouse-Geisser corrections as needed, followed by Bonferroni post hoc tests. Missing data were assessed using Little’s missing completely at random (MCAR), and considering the ITT analysis, the means imputed for missing data were estimated through expectation maximisation. Effect sizes were reported as partial ² and Cohen’s d with α=0.05.
44 participants completed the study, and the overall withdrawal rate was 21.4% with no baseline between-group differences. Significant time effects were observed for all primary outcomes and the SF-12 outcome (pxtime interactions were significant for FIQR-Br, VAS, EAS-40 and SF-12 physical and mental (p≤0.02; interaction ² up to 0.23), indicating improvements during active hyperbaric oxygen therapy exposure. Compared with standard care alone over 8 weeks, combined treatment achieved greater gains: FIQR-Br, –31.1% vs –14.4%; VAS, –54.0% vs –33.5%; EAS-40, –28.4% vs –3.7%; SF-12 physical, +39.1% vs +14.8%; SF-12 mental, +57.4% vs +31.9%. Large within-group effect sizes were observed (eg, VAS d=2.5–2.7; FIQR-Br d=1.4–1.7). Efficacy was equivalent regardless of time started, and the benefits converged by the end of each hyperbaric oxygen therapy phase. After stopping hyperbaric oxygen therapy, the FIQR-Br and SF-12 mental component scores regressed towards standard care levels, whereas residual improvements persisted for up to 8 weeks in VAS, EAS-40 and SF-12 physical component scores. Adverse events were infrequent; one case of otalgia required extended management. Withdrawals were primarily due to non-compliance or intolerance to chamber confinement. No serious or unexpected safety concerns were reported.
Hyperbaric oxygen therapy, delivered under a standardised protocol, is an effective and well-tolerated adjunct to multimodal fibromyalgia care. Timing can be individualised: early initiation for rapid relief or stepped introduction after optimised usual care, with comparable overall efficacy. The durability of the benefit appears to be exposure dependent, and maintenance or booster schedules merit further evaluation.
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by Amir Hossin Moradpour Dehnavi, Abolfazl Alavi, Amin Beigzadeh, Ali Reza Yusefi
Religious ceremonies can play a pivotal role in shaping ethical values among medical sciences students. However, participation in such ceremonies is often influenced by multiple academic, social, and cultural factors. This study aimed to explore the perceived value of religious ceremonies and the barriers affecting student participation in these practices within the context of their ethical development. This qualitative study was conducted at Sirjan School of Medical Sciences in southern Iran from March to July 2025, using a latent content analysis approach grounded in the interpretivist paradigm. Semi-structured, in-depth interviews were conducted with 33 students from diverse academic programs and backgrounds. Data were analyzed inductively based on Graneheim and Lundman’s framework using MAXQDA 2022 software. Trustworthiness was ensured through Lincoln and Guba’s criteria including credibility, confirmability, dependability, and transferability. Seven main themes and twenty- four subthemes emerged. The themes included: (1) Time and Academic Pressure (e.g., course overload, exam clashes); (2) Perceived Irrelevance (e.g., disconnection from professional goals); (3) Cultural and Personal Beliefs (e.g., secular upbringing, concerns about religious imposition); (4) Social Dynamics (e.g., fear of judgment, peer influence); (5) Institutional Support (e.g., lack of promotion, insufficient facilities); (6) Perceived Ethical Value (e.g., development of professionalism and compassion); and (7) Emotional and Community Benefits (e.g., stress relief, sense of belonging, spiritual recharge). While religious ceremonies hold perceived ethical and emotional value for many students, numerous academic, institutional, and cultural barriers limit participation. Integrating religious practices into educational contexts in a more inclusive, flexible, and voluntary manner could enhance students’ moral development without alienating diverse beliefs.To examine the role of self-efficacy in the relationship between medication adherence and self-care behaviours in patients with Inflammatory Bowel Disease by describing their levels and exploring the interconnections among these variables.
Multicenter, cross-sectional.
A total of 452 patients were recruited through consecutive non-probabilistic sampling across nine Italian outpatient Inflammatory Bowel Disease Units. Data were collected using validated tools: the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analyses were performed to explore associations and the mediating role of self-efficacy between medication adherence and self-care behaviours.
Participants had a mean age of 43.49 years; 50.9% were male, 49.2% had Crohn's disease, and 50.8% had ulcerative colitis. Only 10.2% reported high medication adherence, while most showed medium or low adherence. The mean self-efficacy score was 74.82. Medication adherence was positively associated with self-care maintenance, and self-efficacy statistically accounted for part of this association. Lower levels were observed in self-care monitoring and management behaviours.
Medication adherence was positively associated with self-care maintenance, and self-efficacy partially explained this relationship.
Routine assessment of medication adherence and self-efficacy may help identify patients at risk of poor self-care. Interventions aimed at strengthening self-efficacy, such as motivational interviewing, nurse-led counselling, and digital monitoring tools, may improve adherence and self-care maintenance.
The study addressed low medication adherence and suboptimal self-care in patients with IBD. Findings support integrating self-efficacy-enhancing strategies into multidisciplinary care to improve adherence and self-care behaviours.
Patients completed validated self-report questionnaires; however, they were not involved in the study design, conduct, analysis, or manuscript preparation.
People living with concurrent cancer and mental health disorders face heightened vulnerability within healthcare systems that are predominantly organised around biomedical treatment pathways. Although cancer care has advanced substantially, less is known about how these patients experience recognition of their psychological vulnerability, continuity of care, communication and opportunities to participate meaningfully in decisions about treatment.
To explore patients' experiences of living with concurrent cancer and mental health disorders, with particular focus on how they experience being met in their individual needs within oncology care.
This qualitative study used individual semi-structured interviews with 11 adult patients receiving current or recent cancer treatment and living with an existing mental health or neurodevelopmental condition. Participants were recruited purposively from oncology and haematology departments at two Danish hospitals between September 2024 and December 2025. Data were analysed using interpretive qualitative content analysis.
Six interrelated themes were identified: (1) being treated for cancer while mental illness was left outside the room; (2) the hidden work of self-coordination in a fragmented system; (3) communication as care: the need for predictability and adaptation; (4) cancer treatment as a trigger for mental health deterioration; (5) stigma, legitimacy and self-silencing; and (6) relational continuity and being remembered as protective factors. Across themes, participants described a persistent tension between technically competent somatic treatment and insufficient recognition of psychological vulnerability, support needs and relational needs.
Patient-centred oncology care for people living with co-morbidity depends not only on clinical expertise, but on recognition, adapted communication, shared responsibility and relational continuity. The findings suggest that vulnerability is shaped not only by illness itself, but also by how care systems and professional practices are organised.
Small but meaningful changes in everyday oncology practice including psychologically informed communication, continuity of contact persons, explicit recognition of mental health needs and shared coordination of care—may substantially improve safety, participation and patient experience for this population.
Patients living with concurrent cancer and mental health disorders contributed to this study through individual qualitative interviews. Their lived experiences formed the empirical foundation of the study and informed the analysis and interpretation of findings. Patients were not involved in the design of the study or the preparation of the manuscript.
To understand healthcare professionals' perspectives of what works well and what can be improved in the supply and administration of anticipatory medications at the end of life in the community.
Qualitative interpretive study using focus groups.
Semi-structured focus groups included healthcare professionals with experience of using anticipatory medications, and public contributors with lived experiences of relatives' end-of-life care. Participants' demographic information was elicited in a brief questionnaire. Transcripts were analysed inductively using thematic analysis. Data were collected in September 2022.
Eight focus groups involved 58 UK-based participants. Each group included people with a variety of professional roles from diverse geographical areas, and public contributors with relevant lived experiences.
The administration of anticipatory prescriptions was widely perceived to be a valuable intervention, but extensive operational challenges were identified, with three interconnected themes arising from the data: (a) Communication between healthcare teams; (b) Intuitive documentation; (c) Accessibility of medications. Addressing these challenges was perceived to be onerous, particularly for nurses and families.
Operational barriers to the timely and appropriate administration of anticipatory medications risk were perceived as adversely affecting patient care and patients' and families' experiences.
System-level improvements are needed to streamline care processes and ensure equitable, appropriate, and timely access to end-of-life symptom control medications in the community.
This study adheres to relevant EQUATOR guidelines and follows the appropriate Standards for Reporting Qualitative Research (SRQR).
Our Public and Clinician Advisory Group helped shape questions and commented on findings. Focus groups included public participants with lived experience of end-of-life care in the community.
FreshRSS 