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Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context.
The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.
Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication.
CTRI/2025/08/092672.
by Haruki Naruse, Noriyuki Watanabe, Sachie Koyama, Sachi Tanaka, Yoshitada Taji, Yasuhiro Ebihara
IntroductionBloodstream infections are life-threatening, and the rapid identification of pathogens and resistance genes is essential for the administration of appropriate antimicrobial agents. The BioFire Blood Culture Identification 2 (BCID2) panel on the FilmArray multi-parameter genetic analyzer is a fully automated PCR test that rapidly identifies species and resistance genes. Here, we compared the performance of the Filmarray BCID2 panel (BCID2 method) with the conventional method.
MethodsAmong the blood culture-positive specimens submitted between January 2023 and November 2024, this study analyzed 201 specimens that contained the target microorganisms of the BCID2 panel. In our laboratory, after subculturing the culture medium obtained from a positive blood-culture bottle, we perform species identification using mass spectrometry and drug susceptibility testing (the conventional method). We compared the results of the BCID2 method with those of the conventional method.
ResultsConcordance between the BCID2 and conventional methods was found in 152 of the 161 monomicrobial specimens (94.4%) and in 31 of the 40 polymicrobial specimens (77.5%). The 18 specimens that were discordant were mostly matched at the genus level, but the BCID2 method also detected other microorganisms that were not identified by the conventional method. Resistance genes were identified in 57 of the 61 matched specimens (93.4%).
ConclusionThe BCID2 method exhibits excellent identification results and resistance gene detection rates, suggesting that it is a reliable and rapid diagnostic test system for bloodstream infections.
To examine whether the use of a venous access-site closure device is associated with the occurrence of postoperative nausea and vomiting (PONV) after atrial fibrillation (AF) ablation under propofol sedation.
Observational study.
A single-centre retrospective observational study in Okayama, Japan.
We retrospectively analysed consecutive patients who underwent AF ablation under deep propofol sedation with adaptive servo-ventilation. A total of 686 patients were included. Patients were managed using a standardised sedation protocol with or without low-dose pentazocine. Patients treated with conventional manual compression for haemostasis (n=383) were compared with those treated using a venous access-site closure device (n=303).
Postprocedural bed rest duration and the incidence and timing of PONV were compared between groups. Associations between closure device use and PONV were evaluated using logistic regression analysis.
The primary outcome was the occurrence of PONV following AF ablation.
All procedures were completed under propofol sedation without conversion to general anaesthesia. The duration of postprocedural bed rest was shorter in the device group than in the conventional-compression group (mean difference –14.7 hours, 95% CI –15.2 to –14.0).
PONV occurred in 6/303 patients (2.0%) in the device group and 20/383 patients (5.2%) in the conventional-compression group, corresponding to a relative risk of 0.38 (95% CI 0.15 to 0.93), an OR 0.25 (95% CI 0.10 to 0.62) and a risk difference of –3.2% (95% CI –6.0% to –0.5%).
In multivariable analysis, use of a venous closure device was associated with a lower likelihood of PONV.
In this single-centre observational study, use of a venous access-site closure device was associated with a lower occurrence of PONV after AF ablation under propofol sedation. These findings suggest that postprocedural management strategies enabling earlier mobilisation may be associated with improved patient comfort; however, causal inference is limited by the observational design.
Chronic diabetic foot ulcers and venous leg ulcers remain difficult to treat due to delayed healing and high complication rates. Biologic skin allografts derived from living or amniotic tissue provide extracellular matrix components, cytokines, growth factors and viable cells that facilitate tissue repair. This investigation systematically reviewed randomised controlled trials comparing Apligraf, Theraskin, Amnioband, Amnioexcel, EpiCord and Epifix for chronic lower extremity wounds. Searches were conducted in PubMed, Embase and Cochrane databases. Primary outcomes included complete wound closure at 12 weeks, time to healing and percent area reduction. Secondary outcomes included infection, amputation and recurrence rates. Nineteen trials with a total of 1303 participants met inclusion criteria. Analysis demonstrated statistical significance in 12-week wound closure (p = 0.0394), with Theraskin achieving the highest mean closure (84.7%) and Amnioexcel the lowest (37.5%). Epifix and Amnioband showed faster healing trends and greater closure advantages compared with standard care. Reported complications were uncommon and inconsistently defined. While no single graft demonstrated statistically superior outcomes, descriptive trends suggest Theraskin, Epifix and Amnioband may offer greater clinical benefit. These findings provide comparative insight to guide clinical selection of skin substitutes and highlight the need for large-scale head-to-head trials to establish relative efficacy.
To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion.
An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021–2022).
Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi-squared tests of association and multivariable logistic regression.
Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables.
There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision.
Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety.
This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain.
This study adheres to the STROBE guidelines for reporting observational studies.
In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.
To examine the relationship between weight loss and problems with oral intake in institutionalised older adults.
A 1-year longitudinal observational study.
Data were obtained from a prospective study conducted in three nursing homes and two long-term care facilities in Japan. Participants' problems with oral intake were assessed using items published in 2021 by the Japanese Ministry of Health, Labour and Welfare. Baseline and follow-up factors were compared between individuals who experienced a weight loss of 5% or more and those who did not. Separate multivariable logistic regression models were constructed for each oral intake assessment item to examine its independent association with weight loss of 5% or more, accounting for transitions in each item between baseline and the 1-year follow-up.
In total, 172 institutionalised older adults were included in the analysis. Among them, 57 (33.1%) participants experienced a weight decrease of 5% or more. The emergence of somnolence or clouding of consciousness during meals at the 1-year follow-up in participants without these signs at baseline was independently associated with a weight loss of 5% or more, after adjustment for baseline characteristics.
Recognising signs of somnolence or clouding of consciousness during meals may be useful for the early detection and prevention of weight loss in institutionalised older adults.
Early detection of individuals at risk is essential to prevent significant weight loss and its associated adverse outcomes. Recognising somnolence or clouding of consciousness during meals may enable earlier detection and intervention to prevent weight loss and improve the quality of care for older adults.
Strengthening the Reporting of Observational Studies in Epidemiology.
No patient or public contribution.
by Matheus de O. Costa, Roman Nosach, Maite H. M. de Almeida
Porcine ear necrosis (PEN) (also referred to as ear-tip necrosis, ETN) is a syndrome of global presence and unclear aetiology. Initially reported in the 1950s, many different infectious and non-infectious causes have been suggested as the causative(s) agent(s), but none has been confirmed in controlled studies. Here, we investigated the aetiology of PEN using pure culture of bacteria associated with lesions in controlled animal trials. A commercial farm with no history of ear-tip necrosis was identified and used as the source for 5-week-old pigs. Two independent trials were initially executed with identical designs. Piglets (=12/trial) were intradermally inoculated with either pure cultures of Staphylococcus hyicus or Fusobacterium necrophorum (left ear, n = 10) or sterile media (right ear, n = 10). Two pigs in each trial were not inoculated, serving as sentinels. A third trial used F. necrophorum as the inoculum, 3 pigs as sentinels and 9 as inoculated. All animals were clinically monitored daily following challenge, and an ear score was used to follow disease progression. All ears inoculated with S. hyicus remained lesion free. Four out of ten and 7/9 pigs challenged with F. necrophorum developed lesions undistinguishable from PEN, including necrosis and loss of portions of the ear pinna (P F. necrophorum was isolated from 4/10 and 7/9 pigs that developed necrotic lesions. Histopathology after resolution of necrosis revealed granulomatous tissue. Evidence presented here suggests that F. necrophorum causes PEN-like lesions, as seen in commercial barns. It is therefore suggested as the etiological agent of this syndrome.Adolescent parents are at an increased risk for loneliness and mental health challenges compared to childless peers. Nature-based interventions are shown to promote social connectedness.
To identify elements of a nature-based intervention to reduce loneliness and foster nature connection among pregnant and parenting adolescents.
Sequential exploratory mixed methods.
In 2020 and 2021, we piloted the 8-week MINT program at a school for pregnant and parenting teens. Our qualitative approach (n = 17) included online and in-person group meetings with nature-based educational content, discussion, park excursions, mindfulness activities, journaling and nature photography. Subsequently, we recruited 131 young mothers at a children's hospital for a cross-sectional survey based on qualitative school findings.
Qualitative results from the school-based intervention showed a preference for meditative and contemplative activities and for spending time in nature with extended family. Participants typically accessed nature close to home. Our clinic-based teen parent survey illustrated that participants' access to nature were most limited by lack of time (25% of responses), company (18%) and energy (28%). While participants showed a close nature connection (mean NR-6 score = 3.9 (SD = 0.84)), they also showed moderate levels of loneliness (mean UCLA Loneliness score = 4.78 (SD = 1.60)). Walking, hiking and/or running were the most preferred nature activity.
These findings provide key details to define nature-based activities to address loneliness and psychological well-being among teen mothers.
Nature-based health interventions can address loneliness and nature disconnection by building community resilience, improving provider and patient well-being and motivating environmental stewardship.
We identify key features of a nature-based intervention for adolescent mothers. These findings support teen mothers in the US and abroad and may serve as a foundation for using nature-based solutions for vulnerable mothers and for adolescents facing loneliness and mental health challenges.
No patient or public contribution.
Targeted biologic therapies have transformed outcomes for individuals with psoriasis, a common immune-mediated inflammatory skin disease. The widespread use of these highly effective treatments has led to a growing number of individuals with clear or nearly clear skin remaining on continuous, long-term treatment. Personalised strategies to minimise drug exposure may sustain long-term disease control while reducing treatment burden, associated risks and healthcare costs. This study aims to evaluate the feasibility of a definitive pragmatic effectiveness trial of two personalised dose minimisation strategies compared with continuous treatment (standard care) in adults with well-controlled psoriasis receiving the exemplar biologic risankizumab.
This is a multicentre, assessor-blind, parallel group, open-label randomised controlled feasibility trial in the UK, evaluating two personalised biologic dose minimisation strategies for psoriasis. 90 adults with both physician-assessed and patient-assessed clear or nearly clear skin on risankizumab monotherapy for ≥12 months will be randomised in a 1:1:1 ratio to (1) patient-led ‘as-needed’ treatment, where risankizumab is administered at the first sign of self-assessed psoriasis recurrence, (2) therapeutic drug monitoring-guided treatment, with personalised dosing intervals determined using a pharmacokinetic model or (3) continuous treatment as per standard care, for 12 months. Participants will be invited to submit self-reported outcomes and self-taken photographs every 3 months using a bespoke remote monitoring system (mySkin app) and will attend an in-person assessment at 12 months. They may also request additional patient-initiated follow-up appointments during the trial if needed. The primary outcome is the practicality and acceptability of the two personalised biologic dose minimisation strategies, assessed as a composite measure including recruitment and retention rates, adherence to the assigned strategies and acceptability to both patients and clinicians. The feasibility of collecting healthcare cost and resource utilisation data will also be evaluated to inform a future cost-effectiveness analysis. A nested qualitative study, involving semistructured interviews with patients and clinicians, will explore perspectives on the personalised biologic dose minimisation strategies. These findings will inform the design of a future definitive trial.
This study received ethical approval from the Seasonal Research Ethics Committee (reference 24/LO/0089). Results will be disseminated through scientific conferences, peer-reviewed publications and patient/public engagement events. Lay summaries and infographics will be codeveloped with patient partners to ensure the findings are accessible for the wider public.
Providing care management, treatment and support to patients with Alzheimer’s Disease and Related Dementias (ADRD) is a difficult task for health systems. Over the past 20 years, interventions designed to improve outcomes for patients living in the community with dementia and their care partners have moved progressively, but separately, from large scale trials and pragmatic models of collaborative care. Given the projected increase in the number of people living with dementia coupled with the realignment of payment for services to be value-based and provided in the community, system-level approaches are needed to address the complex needs of patients with a dementia diagnosis and their care partners. We designed a statewide, pragmatic trial to evaluate virtual delivery of an evidence-based dementia collaborative care program on patient healthcare utilization and medication use.
The Aging Brain Care Virtual (ABCV) program is a 12-month embedded, cluster randomized, usual care controlled trial designed to test the effectiveness of a virtual dementia collaborative care program in 24 Indiana University Health primary care clinics (12 intervention, 12 control) across the state of Indiana, enrolling 860 persons living with dementia (430 intervention, 430 control) and their care partners. ABCV relies on a tailored approach in which dyad needs are identified during virtual visits and addressed with standardized protocols previously tested in a randomized controlled trial delivered in person. The ABCV trial will measure emergency department utilization (primary outcome) and appropriate medication use (secondary outcome) at 12 months using electronic medical record data. Additionally, this study will use semi-structured interviews with care partners and clinicians to explore the implementation context, process and outcomes of the ABCV program.
Ethics approval was obtained from the Indiana University Institutional Review Board (20249). Research findings will be published in peer-reviewed journals and presented at scientific conferences.
Globally, the circulation of influenza and other seasonal respiratory viruses changed dramatically during the COVID-19 pandemic. This study aims to determine the trends of acute respiratory infections (ARIs) caused by SARS-CoV-2, influenza A, influenza B and respiratory syncytial viruses (RSVs) in patients presenting to hospitals in the Lao People’s Democratic Republic (PDR) (Laos).
Prospective surveillance study.
Four provincial hospitals across Laos between March 2021 and July 2023.
Participants of all ages who met our case definition for an ARI (axillary temperature ≥37.5°C or history of fever AND cough or other respiratory symptoms/signs OR loss of smell and/or taste) presenting to the hospital less than 10 days after symptom onset were eligible to be enrolled in the study. Combined nasopharyngeal and throat swabs were tested for SARS-CoV-2, influenza A, influenza B and human RSV (hRSV) using probe-based real-time RT (Reverse transcription)-PCR assays.
The proportion of patients in whom SARS-CoV-2, influenza A, influenza B and hRSV was detected.
There were 4203 patients recruited, of whom 898 (21%) were children aged under 5 years. SARS-CoV-2 was detected in 16.9% of patients, followed by influenza A, influenza B and hRSV (8.4%, 7.2% and 4.7%, respectively). 98 patients (2.3%) were diagnosed with probable co-infection, with at least two viruses detected. After May 2022, the number of cases of influenza A, influenza B and hRSV increased rapidly. Six per cent of patients (263) had a quick Sequential Organ Failure Assessment score of ≥2, and 34 (0.8%) patients died, of whom 11 tested positive for a respiratory virus.
During the COVID-19 pandemic in Laos, few respiratory viruses were detected by passive surveillance until the relaxation of non-pharmaceutical interventions implemented for infection control. After restrictions were lifted, influenza A, influenza B and hRSV emerged rapidly, showing the importance of continuous surveillance.
No abstract available 
FreshRSS 