The Clinical Times
The Front Page of Medicine

Clinical & Research · page 38

New research and findings from open-access journals and the U.S. research agencies.

BMJ Open · Jun 30, 2026

Determinants of high annual sickness absence in older workers: a prospective cohort study in England (Health and Employment After Fifty study)

Objectives To quantify contributions of health- and employment-related risk factors to high annual sickness absence (HASA) among a population-based cohort of older workers in England. Design Prospective cohort study. Setting 24 general practices geographically dispersed across England. Participants Men and women initially aged 50–64 years recruited as part of the Health and Employment After Fifty study. Primary and secondary outcome measures HASA, defined as a total of more than 20 days sickness absence over a 12-month interval. Results 4726 men and women were analysed, providing data on 15…

BMJ Open · Jun 30, 2026

Circulating tumour DNA in patients with colorectal cancer undergoing curative-intent LIver MEtastases Surgery in France: a prospective, multicentre GERCOR G-118 CLIMES PRODIGE 77 cohort study protocol

Introduction Curative-intent resection of colorectal cancer (CRC) liver metastasis (CRLM), combined with perioperative chemotherapy, is the standard of treatment for selected patients. However, accurately predicting which patients will benefit from this strategy remains challenging. Circulating tumour DNA (ctDNA) has emerged as a promising non-invasive biomarker for detecting minimal residual disease and predicting prognosis. This study aims to evaluate the prognostic value of ctDNA in patients with CRC undergoing surgery for CRLM. Methods and analysis CRC patients undergoing LIver…

BMJ Open · Jun 30, 2026

Effect of home-based cardiac rehabilitation on quality of life, health behaviours and cardiac anxiety in patients with coronary artery disease: findings from a single-blinded randomised controlled trial

Objective To evaluate the effectiveness of a contextually developed home-based cardiac rehabilitation (HBCR) programme on heart-related quality of life (QoL), cardiac health behaviours (CHB) and cardiac anxiety (CA) among patients with coronary artery disease (CAD) in Lahore, Pakistan. Design Single-blinded randomised controlled trial (RCT). Setting Cardiology department of a public tertiary-care hospital in Lahore, Pakistan. Participants 120 patients aged 18–65 years diagnosed with coronary artery disease who had undergone percutaneous coronary intervention or medical management were…

BMJ Open · Jun 30, 2026

Pairwise and three-country comparisons of high and low COVID-19 vaccination rates in 12 African countries: a mixed-method study protocol

Introduction The COVID-19 pandemic has highlighted significant disparities in vaccine uptake across sub-Saharan Africa, yet research exploring the regional and country-specific factors influencing these rates remains limited. Understanding these factors is crucial for developing targeted regional and global public health interventions to improve vaccination uptake and strengthen pandemic preparedness. This study aims to fill a critical knowledge gap by assessing the factors influencing vaccination rates across sub-Saharan Africa at the operational, systemic and socio-political levels. Methods…

BMJ Open · Jun 30, 2026

Healthcare service user-reported quality of care in Malawi: a national multifacility cross-sectional study

Objective Improving healthcare service user-reported quality of care is one of the three core objectives of the Malawian government’s health sector strategic plan. As such, a robust understanding of service user-reported quality is crucial to inform the development of patient-centred services. This study aimed to explore how service users in Malawi evaluate the quality of the healthcare they receive across services and facilities and to investigate the association between individual and health service characteristics and reported quality of care. Design A national multifacility cross-sectional…

BMJ Open · Jun 30, 2026

Characteristics and clinical outcomes of patients with severe asthma receiving tezepelumab after marketing approval in Spain (T-ROSS II study): an observational study protocol

Background Asthma is a prevalent chronic respiratory disease characterised by airway inflammation, reversible airflow obstruction and airway hyper-responsiveness. Most patients with severe asthma (SA) remain uncontrolled despite the availability of multiple therapies, representing a significant global health burden. Thymic stromal lymphopoietin (TSLP) is an epithelial cell-derived cytokine that plays a central role in asthma initiation via both allergic and non-allergic mechanisms as well as in the persistence of airway inflammation in patients with asthma, acting upstream in the inflammatory…

BMJ Open · Jun 30, 2026

Differential impact of smoking on intracerebral haemorrhage based on cerebral microbleed status: a case-control study

Objectives While smoking is a well-established risk factor for various cardiovascular diseases, its association with intracerebral haemorrhage (ICH) remains controversial. Cerebral microbleeds (CMBs) are markers of haemorrhage-prone small vessel disease, but ICH can also occur without detectable CMBs. Therefore, we investigated the association between smoking and ICH according to CMB status. Design Single-centre retrospective case-control study. Setting A tertiary stroke centre in Osaka, Japan (2017–2021). Participants 487 patients with ICH as their first stroke (female sex 41.5%) and 322…

BMJ Open · Jun 30, 2026

Occupational burns among migrant workers in South Korea: a qualitative study of challenges and coping strategies

Objective Burns are a global public health concern, and migrant workers face a disproportionately high risk for occupational burns. We traced their trajectory from injury occurrence through treatment to return to work, to identify key public health issues along this pathway. Design, setting and participants This qualitative study involved repeated semi-structured interviews with seven migrant workers in South Korea who had experienced occupational burns. Participants had diverse nationalities, occupations and legal statuses. Interpreters were employed when needed. Thematic analysis was used to…

BMJ Open · Jun 30, 2026

Lascufloxacin switch therapy versus ampicillin/sulbactam for older patients with community-acquired pneumonia in Japan (STEP study): a study protocol for a multicentre open-label randomised controlled non-inferiority trial

Introduction Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in older adults in Japan. Prolonged hospitalisation accelerates functional decline, promotes the progression of frailty and increases the need for long-term care. An early switch from intravenous to oral antibiotics helps achieve clinical outcomes comparable to those of continued intravenous therapy while shortening hospital stays. For older adults with frailty, avoiding unnecessary hospitalisation may help prevent further deterioration of functional status. Demonstrating non-inferiority of oral…

BMJ Open · Jun 30, 2026

Ophthalmic self-medication among adult ophthalmic patients attending a tertiary eye care centre in Northwest Ethiopia: a mixed-methods study assessing prevalence, associated factors and lived experience

Objective To determine the prevalence and associated factors of ophthalmic self-medication (OSM) and explore the lived experiences of adult patients with ophthalmic problems attending the University of Gondar Comprehensive Specialized Hospital Tertiary Eye Care and Training Center, Northwest Ethiopia. Design An institution-based mixed-methods study comprising a cross-sectional quantitative component and a phenomenological qualitative component. Setting This study was conducted at the University of Gondar Comprehensive Specialized Hospital Tertiary Eye Care and Training Center, Northwest…

BMJ Open · Jun 30, 2026

Caregiving challenges among caregivers of patients with low-vision glaucoma: a qualitative exploration at the Presbyterian Hospital, Agogo, Ghana

Purpose To understand the challenges faced by family members or friends providing informal care and support to patients with low-vision glaucoma seeking treatment at the Presbyterian Hospital, Agogo in the Ashanti region of Ghana. Methods The study employed a qualitative design using semi-structured in-depth interviews to explore the lived experiences of informal caregivers of patients with low vision due to glaucoma. Participants were purposively selected at the hospital during patients’ review visits, as they accompanied them for care. Data were collected through audio-recorded interviews in…

BMJ Open · Jun 30, 2026

Protocol for a systematic review of mental healthcare for Afghan refugees and asylum seekers in high-income countries

Introduction In the past five decades, Afghanistan has experienced one of the world’s largest and most protracted displacement crises. Stressors experienced during the pre-migration, transit and post-resettlement stages of asylum-seeking and refugee journeys can trigger or exacerbate adverse mental health outcomes. More than 750 000 Afghan refugees and asylum seekers reside in high-income countries (HICs), yet no recent review has synthesised evidence on their mental health status, barriers and enablers to well-being and accessing mental healthcare, and interventions and strategies to improve…

BMJ Open · Jun 30, 2026

Consensus on the definition of locoregional recurrence of colon cancer: protocol for an international Delphi study

Introduction Cancer recurrence is a pivotal outcome after treatment with curative intent for colon cancer patients, as it is related to worse survival, the subsequent need for further treatment and the associated use of healthcare resources. However, at present there is no consensus regarding the definition of locoregional recurrence of colon cancer. This contributes to variability in reporting outcomes and clinical management, limiting comparability across registries and clinical studies. This study aims to establish a consensus definition of locoregional recurrence using the Delphi method…

BMJ Open · Jun 30, 2026

Prospective evaluation of atrial fibrillation-related stroke patients in rehabilitation programme (PEARL), clinical study for the 'Health virtual twins for the personalised management of stroke related to atrial fibrillation (TARGET) project: a protocol for a prospective cohort analysis

Introduction Rehabilitation is recognised as a cornerstone of recovery in the stroke care pathway, and the intensity of therapy is closely related to functional recovery. However, longitudinal studies investigating differences in short- and long-term outcomes between ischaemic and haemorrhagic strokes remain scarce. In particular, it is not yet clear whether atrial fibrillation-related stroke (AFRS) entails specific rehabilitation needs or leads to different functional outcomes compared with non-AFRS. Identifying aetiology-specific recovery patterns may support the development of predictive…

BMJ Open · Jun 30, 2026

PRIME pilot trial: a protocol for a multicentre pilot randomised controlled trial of PRehabilitation In advance of Major Elective surgery (PRIME)

Introduction Prehabilitation is a promising preoperative intervention to improve patient recovery after surgery. Virtually delivered, home-based programmes represent the most efficient model for prehabilitation delivery. However, virtually delivered prehabilitation interventions remain understudied. This manuscript describes the protocol for a pilot randomised controlled trial (RCT) of a virtually monitored, home-based prehabilitation intervention. Methods and analysis We will conduct a pilot RCT comparing the standard of care to a virtually monitored home-based prehabilitation programme in…

BMJ Open · Jun 30, 2026

Understanding the wider determinants of child road fatalities in England and opportunities for prevention: protocol for a mixed-methods study of the national child mortality database

Introduction In Great Britain, an estimated 4% of road deaths occur among children under 16 years-old. Previous research has often focused on individual-level risk factors, with less attention to the broader social, environmental and system-level determinants shaping child road safety. Emerging systematic reviews highlight the need for integrated approaches that consider inequalities, built environment characteristics and transport systems in understanding child injury risk. The establishment of the National Child Mortality Database (NCMD) in 2019 provides a unique opportunity to…

BMJ Open · Jun 30, 2026

Screening for endometrial hyperplasia and endometrial cancer in premenopausal women with polycystic ovary syndrome: a systematic review protocol

Introduction Endometrial hyperplasia (EH) is a condition that arises due to prolonged exposure of the endometrium to unopposed oestrogen, resulting in abnormal proliferation of endometrial tissue. Atypical hyperplasia, a subtype of EH, is considered a precursor lesion for endometrial cancer (EC). Polycystic ovary syndrome (PCOS) is a recognised risk factor for the development of EH and EC due to chronic anovulation and prolonged oestrogen exposure without progesterone opposition. Despite this increased risk, current clinical guidelines do not recommend routine screening for EH or EC among…

BMJ Open · Jun 30, 2026

Cardiopulmonary interactions during paediatric mechanical ventilation: protocol for a scoping review

Introduction The heart and lungs are closely linked anatomically and physiologically, sharing the thoracic cavity and jointly ensuring oxygenation and removal of carbon dioxide. With the introduction of positive pressure ventilation, significant changes in cardiopulmonary dynamics were noted. Guyton described these mechanisms of reduced venous return and cardiac output via elevated right atrial pressure. Mechanical ventilation, particularly positive pressure ventilation, is widely used in paediatric critical care, yet data on its clinical effects on children’s circulation remain limited. Many…

BMJ Open · Jun 30, 2026

Comparison of effectiveness and safety of different haemostatic materials in patients undergoing transradial coronary intervention and diagnosis: a protocol for systematic review and network meta-analysis

Introduction Effective compression haemostasis is essential after transradial coronary procedures. However, evidence directly comparing different haemostatic materials remains limited. This study aims to compare and rank the efficacy and safety of different haemostatic materials used as adjuncts to compression after transradial coronary angiography and/or percutaneous coronary intervention, and to explore whether compression modality modifies their relative effects. Methods and analysis We will systematically search nine databases (Cochrane Library, Embase, PubMed, Web of Science, China…

BMJ Open · Jun 30, 2026

Development and internal validation of a neonatal mortality risk prediction model for low birthweight neonates in public hospitals, North-West Ethiopia: a prospective follow-up study

Objectives This study aimed to develop and internally validate a neonatal mortality risk prediction model for low birthweight (LBW) neonates in public hospitals of North-West Ethiopia. Design An institution-based prospective follow-up study. Setting The study was conducted in seven hospitals, comprising three general hospitals and four primary hospitals, between 14 February and 31 October 2025. The general hospitals, Injibara, Finote Selam and Pawi, provide level II neonatal intensive care services, whereas the primary hospitals, Dangila, Chagni, Jawi and Gimja Bet, provide level I newborn…

BMJ Open · Jun 30, 2026

Routine external aortic compression versus no aortic compression in elective caesarean delivery to reduce blood loss: study protocol of a randomised controlled trial

Introduction External aortic compression is used to reduce excessive blood loss in childbirth. However, it has never been evaluated for the prevention of postpartum haemorrhage. This study aims to investigate whether routine external aortic compression, in patients undergoing elective caesarean delivery, is an effective and acceptable preventive method to reduce severe postpartum haemorrhage. Methods and analysis This multicentre, randomised, controlled, open-label trial aims to enrol 2246 patients across 10 maternity hospitals in Sweden. Patients with a live single or multiple pregnancy after…

Fierce Biotech · Jun 30, 2026

Vistagen fails another phase 3 social anxiety trial but spies path to market

Vistagen’s social anxiety disorder drug candidate has flunked another phase 3 trial. But, with a post hoc subpopulation analysis linking fasedienol to a nominally statistically significant improvement, the biotech plans to talk to the FDA about a path to approval built around a single future phase 3 study and confirmatory evidence from its broader PALISADE program.

JAMA Network Open · Jun 30, 2026

Error in Figures

In the Original Investigation titled “Thiazides and Risk of Hyponatremia by Age and Sex,” published April 2, 2026, the values in the y-axes in Figures 1 and 2 were incorrect. Instead of cumulative incidences being expressed as proportions (unitless values from 0 to 1), they should be expressed as percentages. This article has been corrected.

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