To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery.

Mixed-methods study describing the development of a patient decision aid.

A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids.

Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group’s research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis.

We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid’s acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional).

Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.

Poststroke motor dysfunction places a heavy burden on individuals and society. Virtual reality (VR) offers enhanced motor skill transfer and active rehabilitation by overcoming the scenario-specific constraints of conventional therapies. Validating the efficacy of VR rehabilitation could lead to scalable and cost-effective solutions, potentially enabling home-based rehabilitation. However, the widespread clinical application remains constrained by the lack of rehabilitation-specific VR and multidimensional quantitative assessments. The aim of this study was to investigate the multidimensional effects and neural mechanisms of VR rehabilitation in poststroke motor recovery.

This study is a prospective, randomised, controlled clinical trial protocol designed to evaluate the effects of multisensory VR training on motor dysfunction in patients who had a stroke using multidimensional assessments. The trial consists of a baseline assessment, a 4-week intervention period and an endpoint assessment. A total of 40 patients who had a stroke will be randomly allocated in a 1:1 ratio to either a VR combined with treadmill group or a treadmill-only group. The primary outcome measure is the Fugl-Meyer Assessment of Lower Extremity score, while secondary outcomes include three-dimensional gait analysis, the Berg Balance Scale score, the activities of daily living score and functional near-infrared spectroscopy results. Safety will be evaluated by monitoring the incidence of adverse events. This study aims to determine whether VR rehabilitation offers superior efficacy in improving motor function in patients who had a stroke by using a multidimensional assessment approach, including neural coupling function, muscle movement mechanics and clinical performance. The findings will provide robust, high-quality evidence to support the broader application of VR in clinical practice.

The trial was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (2022–155). This study protocol was registered with the clinicaltrials.gov (NCT06275516). The results will be published in a peer-reviewed journal or presented at a conference.

NCT06275516.

Video-assisted thoracoscopic surgery (VATS) lobectomy is a commonly employed surgical technique for the management of operable early stage non-small cell lung cancer (NSCLC). This procedure, however, is dependent on the patient’s ability to tolerate surgery. In light of this, stereotactic ablative radiotherapy (SABR) has emerged as a viable alternative treatment strategy for patients who are inoperable or who refuse surgery. Considering the lack of randomised controlled trials and the increased risk of bias in observational cohort studies, this study protocol proposes an emulated target trial design to investigate the causal effect of SABR, in comparison to VATS, on overall survival in operable early stage NSCLC patients.

Data on NSCLC patients will be collected from routinely collected university hospital records linked with German cancer registry data. This study protocol was developed using the target trial methodology outlined by Hernan et al. The protocol establishes specific parameters for key trial components in order to mitigate bias in the analysis of observational data and to facilitate the calculation of causal estimands. The target trial design that would be emulated is a multicentre open-label two-parallel arm superiority randomised trial. Mediators and confounding variables were determined through the use of a directed acyclic graph. The statistical analysis aims to measure the per-protocol and intention to treat effect of SABR versus VATS within 3 months of diagnosis, on survival, through the difference in restricted mean survival times, using weighted non-parametric Kaplan-Meier curves.

The Ethics Committee of the Medical Faculty of Martin Luther University Halle-Wittenberg with an approved addendum with Dnr 2023–112 has approved this study. The study uses anonymised routinely collected hospital and cancer registry data in accordance with applicable data protection regulations. Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

Early screening of non-alcoholic fatty liver disease (NAFLD) is critical for early diagnosis and management. The disease was renamed and its diagnostic criteria revised as metabolic-associated FLD (MAFLD) in 2020 and further updated to metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. This study evaluated the predictive performance and clinical feasibility of non-invasive diagnostic indicators across the NAFLD, MAFLD and MASLD diagnostic criteria.

Cross-sectional study.

Health Management Centre in China.

A total of 5810 participants aged ≥18 years were enrolled. Individuals with missing laboratory data, imaging results or self-reported information were excluded.

Disease-specific indicators included Fatty Liver Index (FLI), Hepatic Steatosis Index and Zhejiang University index (ZJU). Non-disease-specific indicators included lipid accumulation product (LAP), Visceral Adiposity Index and the Triglyceride and Glucose Index. Subgroup analysis was performed by gender and Body Mass Index (BMI).

The area under the receiver operating characteristic curve (AUROC) for all six non-invasive indicators exceeded 0.7. FLI showed the optimal predictive performance across the three criteria (NAFLD-AUROC: 0.802, MAFLD-AUROC: 0.847 and MASLD-AUROC: 0.811), with comparable performance observed for ZJU (0.797, 0.838 and 0.809, respectively). Pairwise z-tests demonstrated a significant difference between FLI and ZJU for MAFLD (p0.05). Subgroup analyses revealed that ZJU performed better in males (NAFLD-AUROC: 0.790, MAFLD-AUROC: 0.839 and MASLD-AUROC: 0.803), while FLI was superior in females (NAFLD-AUROC: 0.832, MAFLD-AUROC: 0.838 and MASLD-AUROC: 0.838) and in participants who were overweight (NAFLD-AUROC: 0.709, MAFLD-AUROC: 0.765 and MASLD-AUROC: 0.709). LAP exhibited the highest predictive efficacy in the normal BMI subgroup (NAFLD-AUROC: 0.758, MAFLD-AUROC: 0.804 and MASLD-AUROC: 0.796).

FLI exhibited the highest predictive efficacy across all diagnostic criteria, and ZJU showed comparable performance. Considering diagnostic accuracy and clinical practicality, ZJU is recommended as a favourable, non-invasive tool for population-based screening in the Chinese population.

To analyse the trajectory of sleep quality changes and identify influencing factors among patients undergoing maintenance haemodialysis (MHD).

Longitudinal study design.

The study was conducted in the nephrology departments of two tertiary hospitals in Urumqi, Xinjiang, China.

This study employed convenience sampling and completed follow-up assessments for 282 patients with MHD between December 2024 and August 2025.

Data collection used a general information questionnaire, the Pittsburgh Sleep Quality Index and the Self-Rating Depression Scale. Sleep quality assessment timepoints included baseline (T1), 3 months (T2) and 6 months (T3). Latent class growth models were used to identify heterogeneous trajectories of sleep quality. Univariable and multivariable logistic regression analyses were used to determine independent predictors of sleep disorders trajectory categories.

Among 282 MHD patients, latent class growth modelling identified four distinct sleep trajectories: ‘High-Slightly Increasing’ (C1, 24.5%), ‘Low-Slightly Increasing’ (C2, 29.4%), ‘High-Declining’ (C3, 27.7%) and ‘Moderate-Increasing’ (C4, 18.4%). Multivariable analysis showed that, compared with C2, baseline depression significantly increased the odds of belonging to C1 (OR=8.53, p

This study reveals four heterogeneous sleep trajectories in MHD patients, underscoring a dynamic view of sleep quality. Depression is an overarching risk factor for unfavourable trajectories, while pruritus and inflammation specifically predict persistent poor sleep. Early screening and targeted interventions against these factors are crucial to improve sleep quality in MHD care.

Community pharmacies are increasingly recognised as accessible providers of public health services. Integrating cardiovascular health checks and behaviour change strategies with the community pharmacy vaccination service has the potential to improve population health outcomes. This scoping review aims to identify potential pharmacist-led cardiovascular-related services suitable for such integration, and to explore the acceptability and feasibility of pharmacy-led services among both service users and providers.

MEDLINE, EMBASE, CINAHL and Web of Science were systematically searched for UK-based empirical studies published between January 2013 and December 2024.

Primary studies reporting on pharmacist-led cardiovascular-related interventions (eg, blood pressure monitoring, cholesterol screening, smoking cessation) delivered to adults (≥18 years) in community pharmacy settings and reporting on clinical outcomes, feasibility or acceptability were included.

Data were extracted using a standardised form on Excel and synthesised narratively. Key domains of interest included intervention characteristics, facilitators, barriers, perceived outcomes, delivery mode and intervention content including behavioural change strategies or components to support implementation.

Of 8322 records screened, 53 studies met the inclusion criteria. Cardiovascular-related interventions were broadly feasible and acceptable to both patients and pharmacy staff. High patient satisfaction was attributed to the accessibility and convenience of pharmacy locations, as well as the ability of pharmacy staff to establish rapport during interactions. Facilitators of service delivery included private consultation spaces, structured training and access to digital screening tools (eg, devices for atrial fibrillation detection). Barriers included workload constraints and limited public awareness of pharmacy services. Five studies described successful integration of lifestyle interventions within pharmacy-based settings, but the long-term clinical outcomes produced by the intervention were rarely reported. Patients valued the convenience and trusted relationships with pharmacists, though concerns about privacy were raised. Pharmacists reported the need for clearer clinical protocols, and multidisciplinary support and training to improve their confidence in delivering health checks as part of their routine work.

Community pharmacies offer an optimal setting for integrating cardiovascular-related screening interventions with the vaccination service delivered within community pharmacy. Successful implementation will require attention to the identified facilitators including the quality of staff training, competing priorities and optimisation and utilisation of pharmacy space. Future research should prioritise definitive controlled trials and cost-effectiveness analyses to assess long-term health outcomes. Policy action is also needed to support service integration and expand pharmacists’ public health roles within the wider National Health Service.

Open elbow arthrolysis effectively treats post-traumatic elbow stiffness, but severe postoperative pain during early rehabilitation impedes recovery. Continuous brachial plexus blocks, though effective, face limitations such as catheter displacement and infection risks. Liposomal bupivacaine, an ultra-long-acting local anaesthetic, offers prolonged analgesia and may circumvent these challenges. This study aims to compare the analgesic efficacy of a single-dose liposomal bupivacaine supraclavicular block versus continuous ropivacaine infusion in patients undergoing open elbow arthrolysis.

This single-centre, randomised, double-blind, non-inferiority trial will enrol 72 adults (ASA I–III，the American Society of Anesthesiologists physical status classification for preoperative risk) scheduled for open elbow release surgery. Participants will be randomised (1:1) to receive either a single supraclavicular block with 10 mL liposomal bupivacaine plus 10 mL 0.5% ropivacaine followed by saline infusion (liposomal bupivacaine group) or continuous catheter infusion with 20 mL 0.5% ropivacaine followed by 0.2% ropivacaine infusion (control group). The primary outcome is the weighted area under the curve (AUC) of Numerical Rating Scale (NRS) pain scores during functional exercises within 72 hours postoperatively. Secondary outcomes include resting NRS scores, sleep quality (Pittsburgh Sleep Quality Index), rehabilitation metrics (range of motion, grip strength), recovery quality (Quality of Recovery -15) and long-term functional outcomes (Quick Disabilities of the Arm, Shoulder and Hand scores, Quick-DASH scores) at 2 weeks, 6 weeks and 12 weeks. Non-inferiority will be established if the upper 95% confidence limit of the AUC difference is ≤1.3. Statistical analyses will employ intention-to-treat principles with SPSS V.24.0.

Ethical approval was granted by Beijing Jishuitan Hospital Ethics Committee (K2025-213-00). The trial is registered with the Chinese Clinical Trial Registry (ChiCTR2500103911). Results will be disseminated via peer-reviewed journals, contributing evidence on liposomal bupivacaine’s role in perioperative analgesia and rehabilitation for elbow surgery.

Chinese Clinical Trial Registry (ChiCTR ID provided on acceptance).

This study aimed to examine the impact of type 1 diabetes (T1D) on the sexual functioning of young women and men, concerning demographic and social factors.

Cross-sectional quantitative survey study.

Online survey distributed via internet forums for people with T1D in Poland (March 2021).

344 individuals completed the survey; 329 sexually active participants were included in the analyses (15 excluded due to sexual inactivity), of whom 177 had T1D (aged 20–60 years; mean age 31.31±7.40) and 152 were healthy controls (mean age 35.43±7.46).

Sexual functioning was assessed using the CSFQ-14 (Changes in Sexual Functioning Questionnaire), available in female and male versions. Additional author-designed questions were included to enhance understanding of the problem.

34.4% of men and 28.4% of women with T1D reported sexual dysfunctions. Women with T1D showed significantly lower overall sexual functioning compared with controls (mean difference: –4.09 points, 95% CI (–6.29 to –1.90), Cohen’s d=–0.54). Men with T1D demonstrated substantially greater impairment (mean difference: –11.15 points, 95% CI (–14.89 to –7.41), Cohen’s d=–1.47). Among men with T1D, significant differences were found in the total CSFQ score (²=8.98, p=0.003, V=0.26) and the orgasm subscale (²=11.91, p

Sexual dysfunction in young adults with T1D is more common than in healthy individuals. Men with T1D are more likely to report difficulty achieving orgasm and decreased desire for their partner, whereas women with T1D are more likely to report difficulty experiencing pleasure and lower levels of arousal.

The over 14 million African children who are HIV-exposed but uninfected (CHEU) are at risk for poor health outcomes, including neurodevelopmental conditions such as autism; however, no study to date has examined autism in CHEU in Africa, where the vast majority of these children live. Scalable diagnostic and neurobehavioural tools, including powerful, low-cost approaches such as eye-tracking, for detection and study of mechanistic neural processes are necessary to advance autism research in these settings. The objective of this study is to examine autism diagnostic outcomes and eye-tracking biomarkers in relation to CHEU while at the same time building capacity for neuro-health research in Kenya.

This study will leverage a longitudinally assessed cohort of CHEU and children who are HIV-unexposed and uninfected (CHUU) with well characterised HIV-related and contextual exposures. We will first determine and compare autism diagnostic outcomes between young CHEU and CHUU across a large cohort (n=850) of Kenyan children using research-grade autism assessment tools, and, second, determine whether neurobehavioural eye-tracking markers predict autism outcomes across this cohort.

Human subjects approvals have been obtained from Moi University Institutional Review and Ethics Committee (IREC; IREC/909/2024; Approval #0004835), Kenya’s National Commission for Science, Technology and Innovation (NACOSTI; Reference #NACOSTI/P/25/415028), the Institutional Review Board of the Indiana University School of Medicine (Protocol #23171), with reliance agreements executed with Purdue University and Boston University. Dissemination of findings will occur through multiple channels within the research and clinical community, including peer-reviewed journal publications and conference abstracts and presentations. As part of capacity building efforts, the research team will also communicate study results to policy makers, the lay public and other health systems involved in the care of young children with disabilities via study-hosted workshops and conferences.

Ensuring equity in medical specialist distribution is essential for achieving universal health coverage (UHC). This study explored the changes in the availability and distribution of medical specialists in Thailand from 2015 to 2024 and assessed the equity impacts on workforce.

A retrospective longitudinal analysis of national administrative workforce data.

Public and private hospitals across Thailand, covering 1471 facilities in 77 provinces.

The primary outcomes were specialist-to-population ratios and geographical equity measured using the Gini coefficient (G), where values closer to 0 indicate greater equity. Explanatory variables included specialty type, geographical region and the timing of major workforce policies, including mandatory service and specialty-specific legislative interventions.

Between 2015 and 2024, the GPs and specialists in Thailand expanded significantly, with improvements in both density and distribution. The Gini coefficient for GPs showed the largest equity improvement (G=0.42 in 2015 and G=0.22 in 2024), reflecting the impact of mandatory service programme and rural recruitment programmes. Among specialists, emergency and family medicine have shown rapid growth and significant reductions in distribution inequity, reflecting the success of legislative policies. Sustainability of workforce policies was challenged by the ‘leaking stock’ phenomenon due to attraction of career opportunities and economic drives.

Workforce targeted interventions have led to improvements in the availability and equitable distribution of GPs and medical specialists over the past decade. Further policy, such as retention incentives and assisted technology, is needed to achieve equitable distribution across all specialties, particularly in low-density fields. Thailand’s experience offers the lessons for other low- and middle-income countries as the evidence-based and equity-focused workforce policies for UHC advancement.

This multi-centre, randomised controlled trial (RCT) investigates the effects of intensive upper limb (UL) motor training on neurophysiological and functional recovery in individuals with cervical spinal cord injury (c-SCI) during the sub-acute phase. The study aims first to assess neurophysiological adaptations in the central and peripheral nervous systems and functional changes to evaluate the impact of intensive UL motor training on recovery. Second, it determines dose dimensions and their correlation with neural and functional improvements.

A total of 44 individuals with c-SCI within 13 weeks post-injury will be recruited from five rehabilitation centres in Belgium and the Netherlands. They will be randomised into an intervention group, receiving six additional hours of goal-directed UL training per week for 8 weeks, or a control group receiving standard care. Primary outcomes are changes in resting motor threshold, a proxy for corticospinal tract integrity; compound muscle action potential amplitude, indicating peripheral nerve excitability and functionality; and assessments of strength, sensory function and prehension, with the primary comparison between groups at baseline and after the intervention period. Secondary outcomes cover additional neurophysiological assessments and motor function. Dose dimensions will be quantified and related to primary and secondary outcomes.

The central medical ethics committees, METC Máxima MC (NL84212.015.23) and MEC Gent (B6702023000227), as well as local ethics committees, reviewed and approved this trial. The protocol is registered (ClinicalTrials.gov; NCT06065384). The findings of this RCT will be disseminated through articles in peer-reviewed journals and at neurological rehabilitation conferences.

NCT06065384.

This study was to estimate the potential social value and net benefit of OpenUp, a 24/7 text-based online counselling service for youth in Hong Kong, and draw policy-relevant conclusions for service provision.

A retrospective, model-based cost–benefit analysis using social return on investment (SROI) methods. Adopting a societal perspective, service, health and social outcomes were valued over a 1-year period, and productivity gains associated with avoided suicide deaths were valued over a 10-year period. Costs are reported in 2022 HK dollars (HK$; US$1=HK$7.8). Reporting was guided by Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement.

A text-based, synchronous online emotional support counselling platform in Hong Kong was accessible through WhatsApp, Facebook, SMS and the official web portal.

A total of 19 543 users aged 11–35 years accessed OpenUp services during the study period (1 December 2020 to 31 May 2022).

These included total social value (HK$), net social benefit (social value minus investment) and the SROI ratio. The secondary outcomes included monetised savings in medical and social services and productivity gains from avoiding suicide attempts and death.

The total social value was estimated to be HK$226 119 729 against an investment of HK$47 655 000 (SROI=4.74). Suicide risk reduction (productivity gains from avoided attempts and deaths) accounted for 75.4% of the social value. Deterministic one-way sensitivity analyses yielded SROI values ranging from 3.62 to 6.99 aggregated across the three groups, with results being most sensitive to assumptions about the duration of productivity impacts for avoided attempts and avoidable mortality.

Based on conservative assumptions, OpenUp can generate potential social value by providing an online emotional support service. Given the study’s reliance on modelling and proxy monetisation, these estimates should be interpreted with caution. Further integration of offline services with online intervention strategies requires continuous investment and evaluation.

To explore the association between COVID-19 bed utilisation and changes in rehabilitation service provision in Japan, focusing on cerebrovascular, musculoskeletal and respiratory rehabilitation in the pre-COVID-19, during-COVID-19 and post-COVID-19 periods.

Retrospective study using seasonal autoregressive integrated moving average model to predict expected values, which were compared with actual values to calculate observed-to-expected (OE) ratios.

Acute care hospitals in Kanagawa Prefecture, which has the second largest population in Japan after Tokyo, covering April 2014 to March 2024.

Patients aged 0–74 years who were enrolled in the National Health Insurance of Kanagawa Prefecture and underwent the studied types of rehabilitation.

COVID-19 pandemic waves and associated bed utilisation rates, with multiple distinct peaks.

The difference between the predicted and actual values of the volume of rehabilitation services provided and the number of patients per insured person calculated as OE ratios during periods of peak bed utilisation for COVID-19.

The OE ratio of inpatient rehabilitation services for cerebrovascular showed a significant decrease after five waves at –14.3%, and musculoskeletal conditions showed a similar decline during periods of high COVID-19 bed utilisation. Outpatient services experienced sharp declines initially but showed differential recovery patterns. Respiratory rehabilitation displayed unique patterns, with inpatient services increasing up to 62.4% above expected levels until September 2021, before sharply declining. By March 2024, musculoskeletal rehabilitation demonstrated complete recovery, cerebrovascular rehabilitation showed partial recovery, while respiratory rehabilitation exhibited mixed patterns with persistent outpatient deficits.

Rehabilitation services in Japan showed substantial changes associated with the COVID-19 pandemic, with inpatient services for cerebrovascular and musculoskeletal conditions being particularly vulnerable to disruptions during high COVID-19 bed utilisation periods. The differential recovery patterns across rehabilitation types, with some structural changes persisting beyond the acute pandemic phase, indicate the need for flexible healthcare systems to deal with future healthcare crises. These findings underscore the importance of developing strategies to maintain essential rehabilitation services during public health emergencies, especially considering the ageing global population and rising demand for rehabilitation.