Dietary recommendations should be based on scientific evidence, and ideally, systematic reviews (SRs) are conducted as part of the guideline development process. The usability of SRs for decision-making is primarily determined by the quality of the evidence from available primary studies, as well as the quality of the SRs themselves. A comprehensive SR protocol ensures high-quality implementation and minimises bias, while making these protocols publicly accessible, promotes transparency and prevents redundancy. The PROSPERO database offers valuable insights into planned methodologies. The aim of this study is to investigate the completeness of reporting in SR protocols for diet- or nutrition-related trials, determine how this has changed over time, and examine the publication of completed SRs by comparing their content with those described in the corresponding protocols.

We developed a systematic search strategy for PROSPERO to identify nutrition- or diet-related SR protocols registered at two different time points (2019 and 2024). Following a screening process to identify eligible protocols, relevant predefined data will be extracted. Subsequently, a structured search will be conducted to identify potential journal publications of the selected protocols, as well as publications describing the results of the SRs, from which relevant predefined data will be also extracted. The methodology of the published articles will be compared with the corresponding a priori protocols registered in PROSPERO. The PROSPERO records registered in 2019 will be compared with those registered in 2024. The results will be evaluated by descriptive statistics, the reporting completeness of PROSPERO records will be assessed based on Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P), the planned use of any approaches to assess certainty of evidence will be investigated, and the adherence of published SRs to the methodological details outlined in their corresponding PROSPERO entries will be examined.

Since both databases and publications used in this study are publicly available, ethical approval is not required. Results of the study will be submitted for publication in an international, peer-reviewed journal.

The present study has previously been registered with the Open Science Framework (https://osf.io/8fsx7).

A neglected area of patient safety research is how the characteristics of mental health staff and teams may influence incidents, specifically, through unintended and harmful consequences of clinical care. While the research literature into patient safety has increased, there is still a need to further consider safety on mental health wards, for example, the role of the staff team in containment and conflict. This review aims to explore the question, ‘How do staff and team characteristics relate to safety incidents in adult inpatient mental health settings?’.

The review will follow Whittemore and Knafl’s integrative review framework. CINAHL, Cochrane, Embase, MEDLINE, PsycINFO, Web of Science will be searched. Literature published after 1999, that includes extractable quantitative, qualitative and mixed methods data exploring the relationship between staff and team characteristics on incidents in adult inpatient mental health settings, will be suitable for inclusion. The Mixed Methods Appraisal Tool will be used for quality appraisal and data analysis and will comprise data reduction, display and comparison.

No new data or access to participants will be involved in this review. As such, ethical review will not be required. Dissemination will include publication in peer-reviewed journals and presentations at national and international conferences.

This review has been registered on PROSPERO (ref. CRD420251119981; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251119981).

To develop a resilience assessment tool for cardiac care pathways in Europe, informed by stakeholder insights on the impact of COVID-19, emerging innovations and recommendations to enhance resilience.

Mixed-methods study comprising three phases: (1) survey among European cardiac care providers; (2) five multistakeholder focus groups and (3) participatory tool development. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed thematically.

The survey targeted cardiology professionals from the 27 European Union Member States and Ukraine who worked during the COVID-19 pandemic. Focus group participants were purposefully sampled to represent clinical, organisational and policy perspectives.

A total of 177 survey respondents and 40 informants in focus groups.

Six key resilience dimensions of cardiac care pathways were identified: workforce, organisation of care delivery, governance and trust, communication and cooperation, medical devices and products, and data collection and use. Staff shortages and infrastructure capacity were key challenges during the pandemic. The most frequent measures were the reallocation of health staff (75%; n=133) and repurposing infrastructures (38%; n=32). Participants discussed the six resilience dimensions around a total of 17 subdimensions and 39 recommended actions to enhance resilience were identified. The resulting resilience assessment tool included four components: (1) mapping a context-specific cardiac care pathway; (2) stakeholder identification critical to participate in collective self-assessment; (3) a preparedness checklist generating a visual heat map and (4) a resource toolkit.

The resilience assessment tool offers step-by-step guidance to strengthening cardiac care pathways across six key resilience dimensions, supported by actionable recommendations. The tool enables the identification of context-specific vulnerabilities and improvement priorities, thereby supporting healthcare professionals and policymakers in enhancing preparedness and ensuring care continuity before, during and after crises. Its implementation is currently being piloted in European hospitals to evaluate and refine its practical applicability.

To assess the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with coexisting ischaemic heart disease (IHD) and type 2 diabetes (T2D) in primary care, in relation to European guidelines.

Cross-sectional observational study.

209 primary healthcare centres in Region Västra Götaland, Sweden (population 1.8 million in 2023).

14 414 patients with registered prevalent diagnoses of coexisting IHD and T2D, September 2023, in QregPV, the regional primary care quality of care register in Region Västra Götaland. Data on dispensed drugs were retrieved from the regional prescribed drug register, Digitalis.

The primary outcome was the proportion of patients with dispensed SGLT2i or GLP-1 RA in relation to sex, age and primary healthcare centres (including private vs public ownership). The secondary outcome was estimated additional prescription costs.

SGLT2i was dispensed to 37.2%, less often to women (adjusted OR (aOR) 0.64 (95% CI 0.59 to 0.70)). GLP-1 RA was dispensed to 10.0%, with no sex difference (aOR 1.04 (95% CI 0.92 to 1.18)). Use of SGLT2i and GLP-1 RA declined with age (p

SGLT2i and GLP-1 RA were underutilised in patients with coexisting IHD and T2D. The sex disparity in SGLT2i use warrants attention, as does the substantial variation between primary healthcare centres and the challenges of implementing costly cardioprotective therapies.

The opioid crisis remains a significant public health emergency. Key contributors to this crisis include an increasingly toxic drug supply and inadequate health policies that rely on strategies to address opioid-related harms and underutilise primary prevention and early intervention approaches. To inform comprehensive prevention and early intervention strategies, research is needed to explore pathways involving hazardous opioid use (ie, daily opioid use that results in, and may arise from, disruptions to health, relationships, work or social functioning) and the individual, social and structural factors that shape such pathways. This qualitative study aims to address this research gap by exploring the substance use journeys of adults with lived or living experiences of hazardous opioid use who are receiving substance use treatment at a large Canadian mental health hospital.

A qualitative descriptive study informed by the life course perspective will be conducted. Data will be collected using participant-led timeline mapping in combination with semistructured interviews. Participants will include 20–30 adults who are receiving or have received substance use treatment from the hospital where the study is being conducted. Timelines and interviews will be analysed using thematic analysis. A brief demographic questionnaire will also be administered to describe characteristics of the sample.

Ethical approval was granted on 1 October 2025 by the Centre for Addiction and Mental Health Research Ethics Board (Protocol no. 2025/026). Findings will be reported through peer-reviewed publications, lay language reports and/or academic conferences on mental health and substance use health research.

Global discussions surrounding the medical use of marijuana have gained momentum; yet in Malaysia, cannabis remains strictly prohibited under the Dangerous Drugs Act 1952. Despite its legal status, there is growing public discourse on its potential therapeutic benefits. Understanding public acceptance is critical for informing future health policies and public education efforts.

This study used a cross-sectional design, web-based survey among Malaysians aged 18 years and above using convenience and snowball sampling methods. The survey collected data on sociodemographic characteristics, lifestyle factors (eg, smoking and drug use), awareness of medical marijuana and perceived risk. Multivariable logistic regression analysis was performed to identify factors associated with acceptance of medical marijuana decriminalisation.

Out of 2047 respondents, 88.4% supported medical marijuana decriminalisation based on clinical evidence. Key predictors of acceptance included male gender (adjusted OR (AOR) 1.71; 95% CI 1.29 to 2.26), higher education (Bachelor’s degree AOR 1.56; 95% CI 1.09 to 2.23 and Master’s/PhD AOR 2.04; 95% CI 1.34 to 3.10), self-employment (AOR 1.84; 95% CI 1.22 to 2.77) and private sector employment (AOR 1.40; 95% CI 1.03 to 1.89). Behavioural factors, such as smoking (AOR 1.58; 95% CI 1.10 to 2.27), prior drug use (AOR 1.86; 95% CI 1.30 to 2.67) and low perceived risk (AOR 5.82; 95% CI 3.48 to 9.73), were also significantly associated with acceptance.

A large proportion of Malaysian adults supported the clinical use of medical marijuana. Acceptance was strongly associated with demographic and behavioural factors, particularly gender, education and perceived risk. These findings may guide the development of targeted public health education and inform future discussions on regulatory approaches in Malaysia.

This cross-sectional survey study evaluates the influence of international observerships organised by the coalition of healthcare professionals from academic institutions—the Ukrainian Alliance for Medical Exchange and Development (UA-MED)—on the professional development, knowledge transfer and clinical practice improvement of Ukrainian healthcare professionals during the war.

A total of 263 international observerships were facilitated for 204 Ukrainian medical professionals across the institutions in the USA, Canada, Europe and Australia during 2022–2024. To assess the impact of these observerships, a survey was administered focusing on overall satisfaction, procedural knowledge gained and challenges faced when implementing new techniques on return. The primary outcome was the success score, defined as a composite score of implementing new procedures, initiating quality improvement projects and knowledge dissemination efforts.

A total of 128 medical professionals from 45 Ukrainian institutions who completed 138 observerships in 27 institutions abroad participated in the survey (response rate of 62.7%). Observers varied by profession: surgeons (32.8%), radiation oncologists (14.8%), medical oncologists (11.7%), anaesthesiologists (11.7%) and others. Observerships lasted a median of 4 weeks; 74.1% included conference attendance. The average success and satisfaction scores were 6.5/10 and 9.3/10, respectively.

The majority (92.7%) reported a shift in perception of how to practise medicine and 75.5% implemented new procedures on returning to Ukraine. Encouraged to disseminate knowledge, participants provided informal training to colleagues (67.3%), prepared presentations for their institutions (65.5%) and national conferences (32.7%), incorporated learnt materials into educational lectures (39.1%) and engaged in all the activities above (15.5%).

The international observerships played an important role in enhancing the reported skills and knowledge of Ukrainian healthcare professionals during the war. Improvements were reported in clinical practice, medical education and the implementation of new procedures. The success of these observerships underscores the potential for similar programmes in other low-income and middle-income countries/upper-middle-income countries.

The study aims to present recommendations for a revised Doctor of Pharmacy (Pharm-D) curriculum that aligns with regional needs and international standards of pharmacy education.

An exploratory qualitative study involving individual semistructured interviews. Data were collected and reported in accordance with Consolidated Criteria for Reporting of Qualitative Studies.

Face-to-face interviews were conducted in the respective offices of the experts and online interviews were conducted on Zoom and Google Meet.

Purposive and snowball sampling was used to recruit experts due to the eligibility criteria of including associate professors with a PhD, and snowball sampling facilitated the recruitment of experts from all provinces and internationally. Interviews were transcribed verbatim and data were analysed using an inductive thematic approach using NVivo V.15. All interviews were conducted in English.

The study engaged 49 experts from national and international settings with an age range of 25–60 years (median=43 years). The researchers came out with six themes and their subthemes from the data including: (a) understanding current Pharm-D curriculum in Pakistan, (b) inevitable changes required in the Pharm-D curriculum, (c) specific-subject based changes, (d) foundational steps to achieve the required changes, (e) barriers to the implementation of these changes and (f) impact of Pharm-D curriculum change.

The findings highlighted a clear need to revise the curriculum by incorporating enhanced clinical pharmacy content, integrated learning approaches, elective courses, interprofessional education, mandatory hospital and clinical placements, experiential learning through simulation-based methods and research components through a collaborative approach from policy makers and academic stakeholders.

To evaluate the impact of various antihypertensive drugs on secondary stroke prevention in a real-life setting.

Nationwide historic cohort study.

French healthcare system data (SNDS).

Adults hospitalised for ischaemic stroke between 2014 and 2015 were followed up until December 2021 and stratified based on the presence of atrial fibrillation (AF).

Risk of stroke recurrence was assessed using a time-dependent Cox cause-specific model accounting for changes in drug exposure. We also investigated the risk of major adverse cardiovascular events (MACE) or all-cause death. Models were adjusted on stroke characteristics, coprescriptions and co-morbidities, at inclusion and across follow-up.

Among 54 764 patients without AF (median age 71; 46% women) and 17 960 with AF (median age 79; 51% women), stroke recurrence occurred in 11% and 13%, respectively. In non-AF patients, reduced recurrence risk was associated only with use of calcium channel blockers (adjusted HR (aHR) 0.91, 95% CI 0.86 to 0.97), thiazide diuretics (aHR 0.90, 95% CI 0. 83 to 0.97), loop diuretics (aHR 0.86, 95% CI 0.77 to 0.95) and potassium-sparing agents (aHR 0.83, 95% CI 0.70 to 0.98). In AF patients, only potassium-sparing agents (aHR 0.82, 95% CI 0.69 to 0.99) were associated with reduced recurrence risk. All antihypertensive drugs, apart from loop diuretics, were associated with a reduced risk of MACE or all-cause death.

In this large cohort, only diuretics and calcium channel blockers were associated with a reduced risk of recurrent stroke. Most antihypertensive drugs, however, may be more effective in overall cardiovascular prevention.

Asthma is a chronic respiratory disorder requiring ongoing medical management. This ecological study investigated the spatial and temporal patterns of notification rates for asthma from clinic visits and hospital discharges and identified demographic, meteorological and environmental factors that drive asthma in Bhutan.

Monthly numbers of asthma notifications from 2016 to 2022 were obtained from the Bhutan Ministry of Health. Climatic variables (rainfall, relative humidity, minimum and maximum temperature) were obtained from the National Centre for Hydrology and Meteorology, Bhutan. The Normalised Difference Vegetation Index (NDVI) and surface particulate matter (PM2.5) were extracted from open sources. A multivariable zero-inflated Poisson regression (ZIP) model was developed in a Bayesian framework to quantify the relationship between risk of asthma and sociodemographic and environmental correlates, while also identifying the underlying spatial structure of the data.

There were 12 696 asthma notifications, with an annual average prevalence of 244/100 000 population between 2016 and 2022. In ZIP analysis, asthma notifications were 3.4 times (relative risk (RR)=3.39; 95% credible interval (CrI) 3.047 to 3.773) more likely in individuals aged >14 years than those aged ≤14 years, and 43% (RR=1.43; 95% CrI 36.5% to 49.2%) more likely for females than males. Asthma notification increased by 0.8% (RR=1.008, 95% CrI 0.2% to 1.5%) for every 10 cm increase in rainfall, and 1.7% (RR=1.017; 95% CrI 1.2% to 2.3%) for a 1°C increase in maximum temperature. An increase in one unit of NDVI and 10 µg/m³ PM2.5 was associated with 27.3% (RR=1.273; 95% CrI 8.7% to 49.2%), and 2.0% (RR=1.02; 95% CrI 1.0% to 4.0%) increase in asthma notification, respectively. The high-risk spatial clusters were identified in the south and southeastern regions of Bhutan, after accounting for covariates.

Environmental risk factors and spatial clusters of asthma notifications were identified. Identification of spatial clusters and environmental risk factors can help develop targeted interventions that maximise impact of limited public health resources for controlling asthma in Bhutan.

We hypothesise that women with type 2 diabetes and hypertension are less likely than comparable men to receive renin–angiotensin system (RAS)-inhibiting antihypertensive treatment, particularly as first-line therapy. This study’s main aim is to investigate the delivery of RAS inhibitor treatments by sex and number of antihypertensive treatments used.

Cross-sectional study in a cohort.

Constances cohort, France, 2012–2019.

2541 participants with type 2 diabetes among the 196 477 individuals aged 18–69 included in the Constances cohort.

Proportion of individuals treated with RAS inhibitors by sex and number of antihypertensive treatments dispensed. Factors associated with the use of RAS inhibitors.

Among 2541 diabetics, 1742 (68.6%) had received at least one antihypertensive treatment during the year preceding inclusion—a percentage that did not differ significantly between men and women (p=0.07). In analyses stratified by the number of antihypertensive classes, RAS inhibitors were delivered significantly less often to women than men for single-drug therapy (OR 0.46, 95% CI 0.25 to 0.81; p=0.008) and two-drug therapy (0.35, 95% CI 0.16 to 0.75, p=0.007) but not in regimens of three or more drugs (0.29, 95% CI 0.05 to 1.56; p=0.15). In the multivariate analysis, women received RAS inhibitors significantly less often than men (0.41, 95% CI 0.27 to 0.62; p

Women with type 2 diabetes are less likely than men to receive a prescription for RAS inhibitors, although this drug class is recommended as first-line therapy in this population.

Cognitive impairment is considered a challenge in medication management for both the affected patient as well as their caregiver. Numerous studies have investigated interventions aiming to improve medication therapy safety in this population; however, there is insufficient knowledge on interventions which support patients and caregivers effectively. The aim of this systematic review is to (1) identify interventions to improve medication therapy safety in older patients with cognitive impairment, and (2) to evaluate their effectiveness.

We will conduct a systematic review of literature with participatory elements of public involvement in every step of the process. Five literature databases (PubMed, CENTRAL, Embase, PsycINFO and CINAHL) will be screened to identify interventions to improve medication therapy safety in older (≥65 years of age) adults with cognitive impairment. To support methodology and evidence synthesis, we will conduct expert panel discussions as well as focus group discussions of caregivers and healthcare professionals. Study selection, data extraction and bias assessment will be conducted independently by two reviewers. For data synthesis, studies will be organised by setting (eg, community setting, hospital setting, nursing home setting).

The responsible Ethics Committee of the Medical Faculty of Heidelberg granted approval for the public involvement strategies in this project (S-562/2024). Results will be presented by publication in an academic journal and at scientific conferences.

CRD42024623352.

Despite the increasing availability of non-invasive prenatal testing (NIPT), women’s experiences and motivations remain largely unknown. The use of NIPT is increasing in Italy; however, its organisation and access paths vary considerably. Women may undergo testing in either public or private facilities, where differences in pretest information, testing procedures and result communication may influence their experience. This study aims to investigate the attitudes, awareness and experiences of Italian women undergoing NIPT.

A cross-sectional anonymous online survey was conducted via social media in the period March–August 2023.

This nationwide study was conducted in Italy.

Women over 18 years old who had undergone NIPT were included.

Responders were 4154 women from every part of Italy. Most participants perceived the information provided during pre-NIPT counselling as extremely/very clear (68.2%) and helpful (72.5%), with higher proportions observed when counselling was delivered by geneticists. The mean knowledge score was 12.3 (range: 0–15) and was statistically higher for women with higher education level and prior NIPT experience. Half of the women reported no change in their perceived risk of having a child with chromosomal abnormalities after pre-NIPT counselling, and risk perception reduction was associated with lower knowledge scores. Pretest negative emotions were common (54.9%) and influenced by testing context, information sources and reasons for testing. Most women reported a positive impact from results (92.7%), shaped by information delivery made and prior knowledge. Regret was rare (3.0%) and linked to reasons and perceived risk changes. Overall, satisfaction was high (97.3%), particularly among those prioritising informed decision-making.

Improving personalised counselling and education throughout the NIPT journey seems crucial to minimise negative emotional impacts, highlighting the need for well-trained healthcare professionals.

A key part of the patient safety system is how it responds to and learns from safety incidents. To date, there is limited research on understanding system-based approaches to investigating incidents that occur within this complex interacting system.

The aims of this study were to qualitatively explore mental health professionals’ perceptions of patient safety incident investigations; to understand the impact of the transition to systems-based approaches and to explore the influence of different elements of the system on the goals of patient safety.

The qualitative study involved 19 semi-structured interviews with professionals working within the patient safety system across two mental health National Health Service trusts. The data were analysed using thematic analysis.

Those interviewed identified that a change in approach to incident investigation, from root cause analysis to systems-based, would lead to rigorous investigations that are effectively linked to learning. Over time, this was described as a contributory factor to reducing feelings of blame and positively influencing safety culture. There were considerations of potential negative effects from a systems-based approach, such as the shifting rather than elimination of blame, and the possibility of missing individual poor practice. The findings identify the presence of several interdependencies across the system that could have a positive or negative influence on the outcomes of incident responses.

This study demonstrates that the interdependencies within the system and our limited understanding of safety in mental healthcare introduces complexity and uncertainty to incident investigation outcomes. This is likely to impact on safety incident responses and learning, where acknowledging and evaluating this complexity is likely to reduce any potential negative outcomes that exist.