To conduct a systematic review and narrative synthesis to identify barriers, facilitators and pre-existing interventions and describe the current status of initiatives/interventions aimed at improving access to quality trauma healthcare after injury in Pakistan.

Systematic review and narrative synthesis

MEDLINE (Ovid), Embase (Ovid), Web of Science (Clarivate Analytics), Cochrane (Wiley), Scopus and ProQuest, as well as grey literature.

Full-text peer-reviewed publications, including cross-sectional studies, cohort studies, case-control studies, randomised controlled trials and qualitative studies published in English from January 2013 to December 2023.

Two independent reviewers used a standardised tool to extract data variables to Excel. The quality of the included studies was evaluated using the CASP checklist. The barriers, facilitators and pre-existing interventions were mapped using the four delays framework, the Institute of Medicine (IOM) quality domains and the WHO health systems building blocks. The data were synthesised narratively to improve access to quality trauma care in Pakistan. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.

The review included 20 studies. 19 studies reported 58 barriers to access to quality care. Six studies reported 20 facilitators, and eight studies described initiatives or interventions aimed at improving access to quality trauma healthcare after injury. According to the four delays framework, the receiving care stage of access to care was primarily studied in 16 studies, which identified 37 barriers and 13 facilitators across 5 studies. Regarding the quality of care according to IOM domains, the effectiveness of quality trauma care after an injury was studied in 15 studies, which identified 19 barriers and 10 facilitators across four studies. According to the WHO health system building blocks, most studies (n=15) described challenges in healthcare service delivery, with these 15 studies identifying 23 barriers and 3 studies identifying 4 facilitators.

Our findings highlighted the scarcity of available literature, identified barriers and facilitators and pre-existing interventions, which informed the need to develop feasible, sustainable and contextually relevant interventions to improve access to quality trauma care after injury in Pakistan.

CRD42024545786

The widespread application of interleukin (IL) inhibitors for various conditions, including gastrointestinal, rheumatologic, dermatologic and pulmonary diseases, has raised concerns regarding the potential for hepatitis B virus reactivation (HBVr). However, the precise risk of HBVr remains unclear due to inconsistencies in existing research. This systematic review aims to quantify the risk of HBVr in patients receiving IL inhibitor therapies.

This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search will be conducted in MEDLINE, PubMed, Google Scholar, CENTRAL, Scopus, Embase, Web of Science and ClinicalTrials.gov up to October 2025. Two reviewers will independently screen studies and extract data, resolving discrepancies by consensus. Eligible studies will include HBV-infected patients receiving IL inhibitors. HBVr rates will be estimated using a generalised linear mixed model with a binomial distribution, applying random-effects models to account for interstudy variability. Heterogeneity will be assessed using I², Cochran’s Q and ². Leave-one-out sensitivity analyses will evaluate robustness. Subgroup analyses will consider HBV serostatus, IL inhibitor type and study characteristics. Studies including patients on antiviral prophylaxis will be excluded from the primary analysis. A secondary analysis will assess prophylaxis efficacy in preventing HBVr according to hepatitis B surface antigen status. Publication bias will be evaluated using Doi plots and the Luis Furuya-Kanamori index.

This study does not require ethics approval as it involves no patient-specific data. Findings will be disseminated at gastroenterology conferences and through peer-reviewed publications.

The protocol is registered in PROSPERO (CRD42024614179).

To evaluate various prioritisation strategies within an algorithm designed to ascertain the most likely ethnicity and create a standardised methodology to benefit future research.

Retrospective cohort study.

The Clinical Practice Research Datalink (CPRD) primary care and linked Hospital Episode Statistics (HES) data sets.

The population of 54 029 174 patients included all acceptable patients registered at English practices in CPRD GOLD or CPRD Aurum from the May 2023 to May 2022 builds, respectively.

Ethnicity data within CPRD and HES data sets were identified by employing established code lists and subsequently categorised into broader ethnic groups. Changes were made to a previously used algorithm to assess their effect on ethnic categorisations. Modifications included prioritising primary over secondary care data, recent over frequent records and ‘non-other’ ethnicity categories. Different data sources were examined: CPRD with all HES data sets, CPRD with HES Admitted Patient Care (APC) only, CPRD only and HES APC only. Ethnic distributions from these variations were compared using counts and percentages, evaluating inter-rater reliability using Cohen’s kappa. Sensitivity analyses included repetition using only currently registered patients and after removing cases with unknown ethnicity. Ethnic distributions were compared with English Census 2021.

There was almost perfect agreement in ethnicity distributions whether prioritising primary over secondary care data (kappa=1.0000, SE=0.0001), whether prioritising most frequently or most recently recorded data (kappa=0.9824, SE=0.0001) and whether prioritising ‘non-Other’ categories (kappa=0.9705, SE=0.0001). There was moderate agreement in ethnicity distributions when sourcing data from single data sources (CPRD only (kappa=0.5554, SE=0.0001) or HES APC only (kappa=0.5526, SE=0.0001)) compared with combined data sources (CPRD and HES datasets).

All variations of the algorithm produced similar population-level ethnicity distributions. Versions using data from multiple sources had higher inter-rater reliability than those using a subset of sources; however, there was little difference in categorisations produced by varying the hierarchical decision-making of the ethnicity algorithm. The CPRD population was representative of the English population in terms of ethnicity. While researchers should remain vigilant of the limitations of using these data, the CPRD Ethnicity Records provide a standardised and pragmatic approach to ascertaining ethnicity for future research.