Our primary objectives were (1) to develop and validate an administrative data algorithm for the identification of hand trauma cases using clinical diagnoses documented in medical records as the reference standard and (2) to estimate the incidence of hand trauma in a universal public healthcare system from 1993 to 2023 using a population-based research cohort constructed using a validated case identification algorithm.

A population-based retrospective validation study.

Ontario, Canada, from 2022 to 2023 (validation) and from 1993 to 2023 (estimation).

Our reference standard was the known hand trauma status of 301 patients (N=147 with hand trauma) who presented to an urban tertiary-care hand trauma centre in Toronto, Ontario.

(1) The sensitivity, specificity, positive and negative predictive values of the optimal algorithm to identify hand trauma using provincial health administrative data and (2) age-standardised and sex-standardised incidence rates of hand trauma among men and women, by age, and by area of patient residence.

The optimal algorithm had a sensitivity of 73.8% (95% CI 66.6% to 81.0%), specificity of 80.1% (95% CI 73.8% to 86.5%), positive predictive value of 78.1% (95% CI 71.2% to 85.0%) and negative predictive value of 76.1% (95% CI 69.5% to 82.7%). Over the study period, the age-standardised and sex-standardised incidence of hand trauma increased from 384 to 530 per 100 000. The greatest increase was observed in males and individuals aged 0–19 and 80+, with higher incidence rates in Southern compared with Northern Ontario.

Our algorithm enabled identification of hand trauma cases using health administrative data suitable for population-level surveillance and health services research, revealing a rising burden of hand trauma from 1993 to 2023. These findings can support improved surveillance, resource allocation and care delivery for this public health problem.

To examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.

Retrospective cohort study.

Tertiary care cancer genetics service in Singapore.

The study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes.

The primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.

Receipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56–68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18–39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57–66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.

Financial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.

The MD Anderson Oropharynx Cancer (MDA-OPC) cohort is a unique single-institution, prospective longitudinal cancer cohort. The cohort aims to enhance the therapeutic index of OPC management by supporting data needs for independent investigators to conduct rigorous observational studies examining exposures and factors associated with acute and late toxicities, cancer progression, recurrence, new malignancies and quality of life in OPC survivors.

A total of 1811 patients with OPC with a minimum follow-up of 6 months have been consented to our prospective registry between 18 March 2015 and 29 December 2023. Clinical and treatment (Tx) data are available on all patients, including previously untreated patients (1443, 80%). Most previously untreated patients (97%) consented to longitudinal patient-reported outcomes and functional assessments for critical time points including pre-Tx, during-Tx and post-Tx at 3–6 months, 12 months, 18–24 months and annually up to 5 years.

The median age for the MDA-OPC cohort is 66 years (range, 25–96) with the majority being male (89%), white (92%) and with human papillomavirus (HPV)/p16-associated OPC (88%) primarily located in the tongue base or tonsil (90%). For previously untreated patients, 79% were diagnosed with stage I/II disease, and nearly half underwent curative intent chemoradiation. Overall survival was significantly higher for HPV/p16-associated OPC at 1 year (98% vs 93%) and 5 years (83% vs 54%; p

Future work includes expansion of the MDA-OPC cohort and survivorship surveillance to 10 years under the recently funded OPC-SURVIVOR research programme (P01CA285249), which aims to identify non-invasive, clinic-ready biomarkers and examine novel phenotypes and mechanistically matched mitigation strategies for latent OPC sequelae. Additionally, we aim to expand our advanced data infrastructure by integrating large data streams from parallel clinical trials and imaging registries.

NCT01893307, NCT03145077.

Neutropenic fever (NF) has a crude mortality rate of 3–18%. International guidelines recommend that all patients with NF receive ultrabroad-spectrum antibiotics (UBSAs) within 1 hour of emergency department (ED) registration. However, over 70% patients presenting to hospital with suspected NF (sNF) cannot access absolute neutrophil count (ANC) result within 1 hour, do not have NF and do not require UBSAs. In ED and hospitalised patients with sNF, we hypothesise that the ASTERIC protocol effectively and safely reduces the use of UBSAs compared with standard care alone.

This pragmatic, parallel, multicentre, type 1, hybrid effectiveness-implementation, stepped-wedge, before-and-after, cluster randomised controlled trial aims to evaluate whether antibiotic prescribing can be safely reduced through implementing a multifaceted antibiotic stewardship intervention (ASTERIC) in adult patients with sNF presenting to EDs. The sNF was defined as a fever with a single oral temperature of ≥38.3°C (101°F) within 24 hours before ED registration or a temperature of ≥38.0°C (100.4°F) sustained over a 1-hour period, following last chemotherapy or targeted therapy within 6 weeks for any solid tumour, or in any period following therapies against leucaemia, lymphoma, myelodysplastic syndrome, aplastic anaemia, multiple myeloma or recipient of HSCT. The study will involve eight hospitals in Hong Kong with variable baseline practice. We will include 704 adult patients (352 patients in pre-implementation and post-implementation periods, respectively) with sNF (tympanic temperature ≥38.3°C) and 48 staff participants (6 staff participants in each hospital). Healthcare professionals will receive a multifaceted stewardship intervention consisting of risk assessment tools, fast-track ANCs, a decision tool for patient management and antibiotic use, supported by an educational package and staff interaction programmes (ASTERIC protocol). Patients’ blood ANC, and cancer therapy and chronic illness therapy scores will be measured. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and Proctor conceptual frameworks will be followed for evaluation of implementation. The main outcome measures are the mean total dose of UBSAs prescribed in 7 days and serious adverse events at 30 days. Data analysis will incorporate intention-to-treat, per-protocol and as-treated analyses for service outcomes (effectiveness, safety, quality of life assessments and cost-effectiveness) and mixed methods for implementation outcomes, informed by the Theoretical Domains Framework. We expect that the study results will inform health policy with improvement in hospital services in treating stable sNF, evidenced by improved safe antibiotic stewardship, early antibiotic de-escalation and reduced costs and length of stay.

The institutional review boards of all study sites approved this study. This study will establish the ASTERIC protocol safely improves antibiotic stewardship and clinical management in adult patients with sNF. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. All patients with sNF will be influenced by the new protocol which is agreed at hospital level. Randomisation is at hospital level, not patient level. Patient consent is sought for follow-up and data access, not for treatment. Staff consent is sought for interviewing.

NCT06794320.

While loneliness has been recognised as a global public health concern, there are still knowledge gaps about how to prevent or reduce loneliness. The Social Relationship Expectations (SRE) Framework (Akhter-Khan et al, 2023) has been developed to enhance mechanism-based interventions targeting individuals’ expectations for social relationships. However, no scale has yet been developed to measure these expectations. We aim to measure SRE across the six interdependent dimensions identified in the theoretical framework, across diverse settings. This protocol outlines the methodology for developing the SRE scale.

The scale will be developed using both inductive and deductive techniques in a multicountry observational study. First, items will be extracted from published qualitative studies on loneliness and SRE across 15 lower-middle-income countries and from a qualitative focus group study with older Myanmar and Thai adults. Second, using a Delphi process for item development, experts across five world regions (Africa, the Americas, Asia, Europe and Oceania) will be involved in the item selection and scale creation process. A preliminary item pool will be administered in English, German and Chinese. Classical test theory as well as network analysis will be used to assess the dimensionality of the scale, understand item relationships and clusters, and select the final items for the SRE scale.

Ethics approval for the scale development has been obtained from King’s College London (reference number: MRSP-24/25-46512). Informed consent will be obtained from all participants prior to completing the cognitive interviews and online surveys. Results will be disseminated in peer-reviewed journals in collaboration with coauthors across different countries and disciplines.

The aim of this work was to understand carer involvement in transitions of care from hospital to home in relation to medicines management. Specifically, via a realist review, to describe how carers provide support, to what extent do they support patients and under what circumstances are carers able to provide support towards patient care in relation to medicines management.

A realist review was conducted in line with a published protocol and as registered via PROSPERO (CRD42021262827). An initial programme theory (PT) was developed before searches of three databases, PubMed, CINHAL and EMBASE, were conducted in accordance with eligibility criteria. Data were extracted from eligible studies and synthesised into realist causal explanations in the form of Context-Mechanism-Outcome-Configurations (CMOCs) and the PT was refined. Throughout the review, a patient and PPIE group (n≥5) was involved, meeting five times, to inform the research focus and develop CMOCs and the PT by providing feedback and ensuring they capture the carer experience.

Following title and abstract screening of 4835 papers, the final number of included articles was 208. The evidence synthesis identified 31 CMOCs which were categorised into three themes: (1) continuum of support; (2) understanding the carers’ priorities, role and responsibilities through shared decision-making (SDM) and (3) access to appropriate materials, resources and support information. These themes were formed into an updated PT with accompanying narrative that explained the transition from hospital to home involving carers in medicines management and identified possible areas for future intervention development.

This review provides insights and recommendations on how carers can be better supported when managing medicines when patients are discharged from hospital. Carers need a continuum of support throughout and following the transition. Healthcare professionals can support this by understanding the carer’s priorities, role and responsibilities through SDM during the hospital stay. Consequently, carers can then be offered access to appropriate materials, resources and support information which allows them to provide better care relating to medicines in the long term.

Preventable hospital patient harm events disproportionally affect certain patient populations. For some, harm extends beyond physical injury to include cultural, emotional or spiritual impacts. While these disparities are linked to socio-demographics (eg, race, education), they are driven by structural factors (eg, procedures and policies). Patient safety monitoring systems (eg, incident reporting, patient concerns) were not originally designed to identify equity-related harms and may inadvertently obscure or reinforce the injustices they should address. This study will examine how equity is currently considered within hospital incident reporting and patient concerns systems across Canada and will identify opportunities to strengthen these systems’ responsiveness to inequities in patient safety.

This 3-year exploratory sequential mixed-method study began in September 2024. Phase one involves qualitative interviews with patient safety and equity leads, patients/families/caregivers and leaders of innovative initiatives to explore current practices, gaps and innovations in how equity-related factors are identified and addressed within incident reporting and patient concerns systems. Findings will inform Phase 2, a modified Delphi process with patient safety and equity experts and persons with lived experience of equity-related harm events to refine and reach consensus on key equity-promoting features, considerations and recommendations for these systems. In Phase 3, consensus items will be used to develop a national cross-sectional survey assessing the extent to which equity is integrated into hospital incident reporting and patient concerns systems in Canada. A patient advisory committee will inform data collection, interpretation of findings and dissemination.

Ethics approval has been received for Phase 1, with subsequent approvals to be sought for later phases. Dissemination plans include peer-reviewed publications, presentations at international conferences and knowledge exchange activities to inform patient engagement, the design of incident reporting and patient concerns systems and policy development.

Post-traumatic stress disorder (PTSD) is a heterogeneous psychiatric disorder, with symptom variation between patients.

We describe clinical and demographic characteristics of patients with PTSD based on real-world data.

This non-interventional, retrospective cohort study analysed de-identified electronic health records of patients from the Holmusk NeuroBlu database in the USA. Patients with ≥2 PTSD diagnoses captured in the database within 30 days between 2001 and 2020 were included. The index date was defined as the date of the first recorded PTSD diagnosis. In patients who were aged ≥18 years, demographic and clinical characteristics at baseline (index date ±14 days), in the 6 months prior to baseline and 12 months after baseline were described. Patients were stratified into four mutually exclusive subgroups according to treatment received: psychotherapy only, pharmacotherapy only, psychotherapy and pharmacotherapy, and untreated. Natural language processing models were used to derive PTSD symptoms from unstructured clinician-documented mental state examination data. Data were analysed descriptively.

A total of 37,449 patients had ≥2 PTSD diagnoses within 30 days between 2001 and 2020; 32,875 patients received care at clinical sites with both inpatient/outpatient units; 25,507 patients received psychotherapy and/or pharmacotherapy as per further prespecified criteria, and 17,234 were ≥18 years old and included in this analysis. Most patients (84.9%) received psychotherapy, pharmacotherapy or both during the first year post-baseline. Mean age (SD) was 37.7 (12.4) years, 73.4% of patients were female and 59.6% were White. At baseline, 98% of patients had ≥1 psychiatric comorbidity; major depressive disorder (42.2%), substance use disorder (35%) and anxiety disorder (30.7%) were most frequently reported. Reported suicidal ideation/attempts were most frequent in the pharmacotherapy only group compared with other subgroups at baseline. The most frequently prescribed drug classes were antidepressants (51.8%), second-generation antipsychotics (29.9%) and anxiolytics (23.3%) at baseline. Trazodone, clonazepam, quetiapine and sertraline were the most frequently prescribed medications.

In the overall study population, most patients were female, with a high prevalence of psychiatric comorbidities. Demographic and clinical characteristics observed in this study varied across treatment subgroups. These insights may support patient-specific treatment planning and inform health-economic decision models in PTSD.

The mental health first aid (MHFA) training is an evidence-based programme that is known to improve undergraduate students’ attitudes towards mental illness and confidence in helping people with mental health problems. MHFA training will be implemented at a university in Hong Kong to address growing concerns about mental health challenges among students. Given the context of a university-wide systematic MHFA training implementation, this evaluation uses an intervention logic framework to evaluate the processes and longitudinal outcomes.

A mixed-method approach will be used where the quantitative component will gather data from a review of records and a case-control study for outcome evaluation; the qualitative component will gather data from individual interviews. All first-year students from the university in the academic year 2024–2025 (ie, September 2024 to August 2025) will be enrolled in the mandatory MHFA training. The outcome evaluation will assess effectiveness through short-, intermediate- and long-term outcomes. An online questionnaire will be distributed to the students before (pre) and immediately after (post) the MHFA training. For comparison, second-year students who had not participated in MHFA training will be invited to complete the same online questionnaire. The questionnaires will be administered further to those who completed the MHFA training at 12 months (ie, academic year 2025–2026) and 24 months (ie, academic year 2026–2027) post-training to evaluate intermediate-term and long-term effects, respectively. The process evaluation explores feasibility, fidelity, adoption and the barriers and enablers to implementation.

This evaluation has been approved by the Human Research Ethics Committee of Hong Kong Metropolitan University (reference number HE-SF2024/35). The findings are expected to contribute to establishing long-term effects on mental health literacy and on the actual mental health support actions provided by participants, which goes beyond the intention to help. This evaluation would also facilitate a better understanding of the processes that need to be considered in a systematic MHFA training implementation in a university context. The findings will be disseminated in academic and public health community settings.

This project has been registered in the Open Science Framework. Fully anonymised data will be saved and subsequently made available through the following OSF registration: https://doi.org/10.17605/OSF.IO/92N5Q.

Excessive opioid prescribing after surgery can lead to adverse events and exacerbate the opioid crisis. Patients undergoing outpatient breast surgery are often prescribed opioids to manage pain at home; however, the value of this approach is uncertain. The Postoperative Analgesia Intervention with Non-opioid Alternatives (PAIN Alt) trial will address the following research question: among patients undergoing outpatient breast surgery, does opioid-free analgesia (OFA) result in non-inferior 7-day pain intensity and pain interference in comparison to opioid analgesia (OA)?

This is a parallel, assessor-blind, open-label randomised trial conducted at seven university-affiliated hospitals in Canada. A sample of 540 adult patients (>18 years) undergoing outpatient mastectomy or lumpectomy will be included. Participants are allocated 1:1 to receive OA (around-the-clock non-opioids and opioids for breakthrough pain) or OFA (around-the-clock non-opioids, with adjustment of non-opioid drugs and/or non-pharmacological interventions for breakthrough pain). The co-primary outcomes are 7-day pain intensity and pain interference (measured using the Brief Pain Inventory). Secondary outcomes include adverse drug events, physical and mental health status, satisfaction with pain management, postoperative complications, chronic pain, opioid misuse, persistent opioid use, healthcare utilisation and costs. The primary statistical analyses will follow the intention-to-treat principle and be conducted using mixed-effects modelling.

This trial is coordinated by the McGill University Health Centre (ethics approval MP-37-2024-102530), with ethics approval being sought at all participating sites. Our results will be published in an open-access, peer-reviewed journal, presented at relevant conferences and disseminated to the public through press releases.

NCT06507345.

To compare birth weight-to-placental weight (BW:PW) ratios between pregnancies complicated by gestational diabetes mellitus (GDM) and normoglycaemic pregnancies, and to evaluate the associations between BW:PW ratio, perinatal outcomes, and placental histopathologic features within the GDM group.

A prospective cohort study.

A university hospital in Bangkok, Thailand.

A total of 200 women with GDM and 100 normoglycaemic controls.

BW:PW ratios were calculated and compared between the two groups. Participants with GDM were stratified into three categories based on the BW:PW ratio percentiles: 90th. Perinatal outcomes and placental histological abnormalities were analysed across these categories.

Median BW:PW ratios were not significantly different between the GDM and normoglycaemic groups: 6.3 (IQR 5.6 to 6.9) versus 6.2 (IQR 5.6 to 6.8); p=0.399. Within the GDM cohort, the BW:PW ratio cut-offs corresponding to the 10th and 90th percentiles were 5.2 and 7.6, respectively. The prevalence of small-for-gestational-age (SGA) neonates differed significantly among the three BW:PW ratio groups: 14.3% (90th); p=0.004. Similarly, the prevalence of chorangiosis varied significantly across these groups (66.7%, 52.9% and 22.7%, respectively; p=0.009). A BW:PW ratio 90th percentile was associated with reduced odds of chorangiosis (aOR 0.35; 95% CI 0.11 to 0.85).

BW:PW ratios did not differ significantly between the GDM and normoglycaemic groups. However, in GDM pregnancies, extremes in the BW:PW ratio were associated with distinct perinatal and placental outcomes, indicating altered placental efficiency and potential clinical relevance.

TCTR20211122001.

Chronic kidney disease (CKD) affects 1 in 10 people worldwide and can progress towards kidney failure, which is best predicted by the severity of kidney fibrosis. Currently, kidney fibrosis can only be detected by invasive kidney biopsy which carries procedural risks with limitations on repeat testing. MRI techniques have emerged as potential surrogate markers for kidney fibrosis, though data remain limited. To date, no studies have examined postgadolinium contrast T1 mapping in kidney fibrosis despite its proven utility in assessing myocardial fibrosis. This study aims to develop a multiparametric MRI biomarker including postcontrast imaging to quantify kidney fibrosis in individuals with CKD.

In this observational cohort study, a control group of 20 healthy adult volunteers will establish healthy kidney MRI parameters. Two adult non-dialysis CKD cohorts (each n=24) who have undergone kidney biopsy within the last month will derive and validate the MRI models, respectively. Tubulointerstitial fibrosis on kidney biopsy will be assessed by Masson trichrome staining and quantified based on the percentage of cortex affected by blinded pathologists. All participants will undergo a single multiparametric kidney MRI including kidney volumetry, T1 mapping (pre-low-dose and post-low-dose contrast), T2 mapping, T2* mapping, diffusion weighted imaging and phase-contrast MRI of renal artery flow. The primary outcome will be the association between a composite multiparametric MRI marker and tubulointerstitial fibrosis with a minimum variance of 50%. The association between the multiparametric MRI marker and individual MRI variables, and tubulointerstitial fibrosis, estimated glomerular filtration rate and albuminuria will also be studied.

Ethics approval has been obtained by the Northern Sydney Local Health District Human Research Ethics Committee (2022/ETH00972). Results will be disseminated in relevant peer-reviewed journals and presented at academic conferences.

ACTRN12622000855729p (Pre-results).