Delayed post-polypectomy bleeding (DPPB) remains a significant complication of endoscopic resection, contributing to morbidity and increased healthcare costs. Although prophylactic clipping is widely practised to mitigate this risk, evidence from recent randomised controlled trials (RCTs) regarding its efficacy is inconsistent. This protocol outlines a systematic review and meta-analysis to evaluate the effectiveness of prophylactic clips following thermal resection.

We will conduct a comprehensive search of MEDLINE, EMBASE and the Cochrane Library from inception to 10 February 2026, to identify RCTs comparing prophylactic clips vs no clips in patients undergoing thermal endoscopic resection of non-pedunculated polyps. The primary outcome is DPPB within 30 days, defined as overt bleeding requiring medical intervention or a haemoglobin decrease ≥2 g/dL. Secondary outcomes include DPPB in proximal large (≥20 mm) lesions, perforation, post-polypectomy syndrome and procedure time. Data synthesis will use a random-effects model. Methodological quality will be assessed using the Cochrane Risk of Bias 2 tool. Publication bias will be visualised using funnel plots. We will quantify the effect of potential effect modifiers by meta-regression if appropriate. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework.

This study will not use primary data, and therefore formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.

CRD420251246840.

To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups.

Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups.

Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle).

Adults aged ≥18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18–49 years (74–75%), female (66–67%), white (86.6–87.5%) and non-Hispanic (86.6–87.5%).

Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1 week vs ≤1 week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol.

LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1–7 class models; significant demographic differences (² p

In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery.

NCT04610515.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects around 35%–50% of men during their lifetime. The efficacy of current oral medication for CP/CPPS remains limited. Recent studies demonstrated that vagus nerve stimulation may improve chronic pelvic and abdominal pain. Accordingly, transcutaneous auricular vagus nerve stimulation (taVNS) might represent a promising, non-invasive therapeutic approach for the clinical management of CP/CPPS.

The trial of Transcutaneous Auricular vagus nerve Stimulation for moderate to severe Chronic Prostatitis/CPPS is a prospective, randomised, sham-controlled trial with a 1:1 allocation ratio. Participants will be assigned randomly to either the taVNS group or the sham-taVNS group. The intervention period will consist of a 4-week treatment (a total of 40 sessions), followed by an 8-week follow-up period. The primary outcome is the change from baseline in the National Institutes of Health Chronic Prostatitis Symptom Score Index total score at week 4. Secondary outcomes include the International Prostate Symptom Score Scale, European Quality of Life 5-Dimensions-5-Levels questionnaire, Self-Rating Anxiety Scale and Self-Rating Depression Scale. Safety assessments will be conducted throughout the entire study period.

This study protocol and informed consent documents were reviewed and approved by the Institutional Review Board of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (approval number: 2023-250 KY). Written informed consent will be obtained from all participants and/or their legal guardians prior to trial participation. The findings will be disseminated through publication in a peer-reviewed journal and presentations at scientific conferences. The research data will be made available on reasonable request.

NCT06287970.

In March 2016, the Centers for Disease Control and Prevention (CDC) released the CDC Guideline for Prescribing Opioids for Chronic Pain, a set of voluntary recommendations for initiating and managing opioid treatment in the ambulatory setting. This scoping review examined guideline effects on patients, providers and health systems.

A scoping review was conducted with a preregistered protocol. Comprehensive searches of PubMed, Embase and Cumulative Index of Nursing and Allied Health Literature were conducted in April 2025. Reports published between 2016 and 2025 that explored the effects of the CDC guideline were included. No restrictions on language or country of study origin were applied, though all retrieved reports were published in the USA and in English. Two authors independently screened titles, abstracts and full-text reports. Data were extracted by healthcare setting, study aims and design, sample size, study population, participant characteristics and study findings and outcomes. Reports were characterised as empirical studies that evaluated guideline effects or implementation studies that assessed uptake. Study findings were presented descriptively and by evidence maps.

Ninety-four studies met the inclusion criteria: 75 empirical studies and 19 implementation studies. Eighty-eight per cent measured changes in opioid prescribing; all but one found significant reductions in at least one prescribing measure, often among people receiving ≥50–90 morphine mg equivalents per day. Effects occurred across specialties and populations, including groups not targeted by the guideline. Studies found increased rates of tapering, with mixed findings on opioid-benzodiazepine coprescription. Legal analyses showed widespread policy adoption at the state level. Implementation studies described expanded risk-mitigation strategies, sometimes beyond guideline text. Few studies reported patient-centred outcomes, participant race or ethnicity or equity measures.

This voluntary federal guideline had significant intended and unintended effects. The guideline was associated with reductions in opioid prescribing among groups targeted and not targeted by its design, with limited evidence on patient outcomes. Future work should prioritise equity-focused patient outcomes to inform implementation of the 2022 CDC guideline.

To identify early cardiovascular changes in normotensive obstetricians, a high-stress group, using non-invasive haemodynamic monitoring, and to examine the association between burnout and haemodynamic parameters.

Cross-sectional study.

A single tertiary hospital in China.

A total of 120 healthy Han Chinese adults (aged 25–45 years, both sexes) were enrolled using stratified random sampling by age and categorised into three groups: obstetricians, clinical support staff and administrative personnel. Of these, 105 (87.5%) completed the study and entered the final analysis (obstetricians n=40; clinical support staff n=33; administrative personnel n=32); 15 were excluded due to incomplete questionnaire data. Key exclusion criteria were chronic medical conditions, medication use, acute illness, a clinical shift within 24 hours before measurement, pregnancy or lactation, body mass index extremes (≤18.5 or ≥ 28 kg/m²) and major life events within the past 6 months. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey; workload, lifestyle and family history were collected via questionnaire.

Advanced haemodynamics were assessed via Ultrasonic Cardiac Output Monitor. The primary outcome was cardiac power output (CPO). Secondary outcomes included other non-invasive haemodynamic parameters, such as cardiac index (CI), systemic vascular resistance index, Smith–Madigan inotropy index and corrected flow time.

Severe burnout was associated with reduced CPO and CI (–0.152 W and –0.403 L/min/m², respectively; both p2, respectively; both p

In high-stress populations, advanced haemodynamic patterns may serve as an early-warning biomarker for burnout, guiding personalised exercise advice. Longitudinal studies are needed to confirm their predictive value.

Healthcare professionals working in busy hospital environments are expected to make multiple back-to-back critical decisions related to patient assessment and treatment. Fatigue from a combination of complex decision-making over multiple patients can lead to less efficient care and an increased risk of error and harm. Artificial intelligence (AI) risk recommendation systems, hereafter referred to as AI risk recommenders, have the potential to reduce the impact of decision fatigue by prompting healthcare professionals with appropriate recommendations for patient care and management. A key barrier to the effective usage of such systems is the establishment of trust and subsequent acceptance among healthcare professionals. However, little is currently known about how trust and acceptance can be engendered. The aim of this review is to develop a theory explaining what influences healthcare professionals’ usage of AI risk recommenders and how trust and acceptance, facilitate their usage of such systems.

We will conduct a rapid realist review to develop a programme theory exploring how trust and acceptance of AI risk recommenders are established among healthcare professionals and how these mechanisms influence system usage. We will use the following databases—MEDLINE (Ovid), EMBASE (Elsevier), the Cumulative Index to Nursing and Allied Health Literature (CINAHL (EBSCOhost)), PubMed, The Cochrane Library, The Institute of Electrical and Electronics Engineers (IEEE) Xplore, The Association for Computing Machinery Digital Library, Scopus (Elsevier), Web of Science (Clarivate) and ProQuest Dissertation and Theses. The review will focus on identifying the resources and processes that stimulate trust and acceptance, leading to the actual use of the system in clinical practice. The review will be guided by the four steps of realist review described by Rycroft-Malone. Article searching and retrieval was conducted on 15 November 2025; full-text screening is ongoing and the review is expected to be completed by May 2026.

This study does not require formal ethics approval, as it does not involve primary research. Findings will be shared in peer-reviewed publications, conference presentations and engagement with relevant policy-makers involved in the development and integration of AI risk recommenders within hospital settings. Through these efforts, we aim to support the effective utilisation of such systems, leading to improved decision-making and patient care outcomes.

CRD420251155251

This study aimed to identify potential significant statistical associations between the development of delirium, medication and several other patient-specific factors across a 10-year retrospective longitudinal real-world dataset.

A retrospective, population-based cohort study.

The National University Hospital of Iceland.

All patients≥18 years hospitalised between 2010 and 2020.

The primary outcome was a diagnosis of delirium within 2 years of a patient filling a prescription for a specific medication. The exposure was pre-admission medication use or a pre-existing condition. Secondary outcomes included mortality, length of hospital stay, readmission rate and frequency of additional delirium diagnosis.

A total of 85 942 admissions and readmissions were included in the dataset, which comprised 1066 variables. The cohort comprised 55 495 patients (51.5% male) with a median [IQR] age of 71 years [58, 82]. Throughout the study, 3533 patients were diagnosed with delirium at least once over the 10-year study period. A statistically significant association (² test, p

Numerous medications and other patient-specific risk factors have been identified, which underlines the complexity of delirium development. To strengthen patient safety and hinder the development of delirium, an increased emphasis is needed to review medication use and improve our understanding of medication risk associated with delirium cause, treatment and prevention. Specific prescribing/deprescribing advice should be developed to inform prescribing practice and patient safety.

Metabolic dysfunction-associated steatohepatitis (MASH), formerly known as non-alcoholic steatohepatitis (NASH), is the hepatic manifestation of the metabolic syndrome. When it co-occurs with type 2 diabetes (T2DM), it presents a significant therapeutic challenge due to a higher risk of fibrosis progression and adverse outcomes. While new treatments for MASH are emerging, their efficacy in the T2DM subpopulation remains an unmet need. Chiglitazar is a novel peroxisome proliferator-activated receptor pan-agonist that regulates key pathways in lipid metabolism, glucose homeostasis and inflammation. This trial aims to evaluate the efficacy and safety of chiglitazar as a combination therapy for patients with MASH and T2DM.

This is a prospective, multicentre, randomised, double-blind, placebo-controlled study. This trial will enrol 300 adult patients aged 18–75 years with biopsy-confirmed MASH and fibrosis stage F1 or higher. Participants will be randomised (1:1) to receive either chiglitazar 48 mg daily or a matching placebo. All participants will also receive background therapy consisting of vitamin E (100 mg three times a day) and polyene phosphatidyl choline (456 mg three times a day). The treatment duration is 78 weeks. The primary efficacy endpoint is resolution of steatohepatitis with no worsening of liver fibrosis. Key secondary endpoints include improvement in liver fibrosis by at least one stage and changes in metabolic and liver safety biomarkers.

Ethical approval has been obtained from the Shanghai Punan Hospital of Pudong New District Ethics Committee (Punan Branch of Renji Hospital Ethics Committee, Shanghai Jiaotong University School of Medicine). KY2025-066. The findings will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.

NCT07303803.

In the face of pandemics resulting from infectious disease, improving community resilience has become increasingly vital. China’s sudden exit from Zero-COVID policy in December 2022 triggered a surge in COVID-19 cases, compounded by medication shortages due to earlier restrictions, creating a public health crisis. This study assesses community resilience during the first post-Zero-COVID infection wave (8 December 2022 to 7 January 2023), focusing on adaptation mechanisms, resource mobilisation, protective behaviours and medicine access, using real-time social media data to capture these dynamics.

This cross-sectional study analysed all geotagged COVID-19-related posts on Sina Weibo—China’s largest public microblogging platform—collected from a megacity in eastern China with over 10 million residents, covering 8 December 2022 to 7 January 2023. Posts were obtained through a data purchase agreement with Sina Weibo and comprised publicly available content. Machine learning and natural language processing were applied to classify posts across four dimensions: content, responder, response type and time. Community resilience was assessed using the community-level response ratio, response speed and sentiment expressed in interactions related to medicine-seeking posts.

26 973 posts were analysed, of which 12 152 (45.05%) were help-seeking. Among these help-seeking posts, 11 236 (92.46%) specifically sought COVID-19 medicine, of which 8495 (75.61%) of these medicine-seeking posts received community support. Over 4 weeks, community responses comprised >70% of all replies (the rest were from market-based responders, government and NGOs). More than half of the community responses occurred within an hour, and the emotional state at the community level was the most stable and consistently positive, indicating a high level of prompt community engagement.

Communities in the sample area consistently exhibited prompt and proactive responses during the health crisis, with community responses accounting for the majority of interactions on medicine-seeking posts. The power of community mutual aid can significantly enhance responsiveness to public health emergencies. Such insights suggest that strengthening community resilience is crucial in designing more effective disaster response strategies.