Introduction Genetic variations impact drug response, driving the need for personalised medicine through pre-emptive pharmacogenetic testing. However, the adoption of pre-emptive pharmacogenetic testing for commonly prescribed drugs, such as tacrolimus, outside of tertiary hospitals is limited due to a lack of pharmacoeconomic evidence to support widespread implementation by healthcare policymakers. The iPHARMGx Consortium addresses this by developing the TRANSPGx clinical trial to assess the hypothesis that widespread adoption of a pre-emptive genotyping scheme in populations susceptible to…
Introduction High cancer mortality in Small Island Developing States (SIDS) is compounded by the insufficient evidence from local epidemiological studies. Stakeholder engagement is particularly important in SIDS to ultimately drive these studies and cancer control. We aimed to map cancer control stakeholders as part of the development of the CaSIDEC study. Methods The Cancer in Small Island Developing States of the Eastern Caribbean (CaSIDEC) study investigates the role of overseas travel on cancer survivorship in the six countries of the Organisation of Eastern Caribbean States (OECS)…
Background To eliminate cervical cancer as a public health problem, the WHO recommends that human papillomavirus (HPV) vaccines should be included in national immunisation programmes and should reach 90% of all girls by age 15 as primary prevention. Lesotho reintroduced the national HPV vaccine programme in 2022. Objective To investigate the prevalence and associated factors of HPV vaccination uptake among adolescent girls in Lesotho. Design A population-based cross-sectional study design. Setting Lesotho. Participants Girls aged 15–17. Primary and secondary outcome measures A multilevel…
Introduction Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) and typically affects young women with obesity. Patients are at risk of permanent visual loss due to papilloedema. Some require emergency intervention to rapidly reduce papilloedema and preserve vision. The international standard of care for patients with sight-threatening IIH is cerebrospinal fluid (CSF) shunting. However, dural venous sinus stenting (DVSS) is an emerging procedure that is offered at many neuroscience centres internationally as the primary intervention. Currently…
Background Emergency medical services (EMS) staff worldwide have long been at risk of encountering violence and aggression (V&A) at work, including threats, verbal, physical and sexual assault, and on rare occasions, fatalities occur. Exposure to V&A can result in stress, fear and burnout. This is an international problem and EMS employers, trade unions and others are working towards tackling it. The aim of this research was to conduct an exploratory qualitative interview study of EMS staff focusing on experiences, perceptions and interpretations of V&A directed towards them. Methods This…
Objectives To compare clinical outcomes between urinary and non-urinary tract sepsis in nonagenarians and centenarians admitted to intensive care units (ICUs). Design Retrospective propensity score-matched multicentre cohort study. Setting Adult ICUs participating in the Australian and New Zealand Intensive Care Society Adult Patient Database across Australia and New Zealand (2010–2023). Participants We included all ICU admissions for sepsis in patients aged 90 years or older, classified as urinary or non-urinary tract sepsis using Acute Physiology and Chronic Health Evaluation III-J…
Objectives To identify clinical indicators reflecting potentially treatment-modifiable prognostic factors associated with pain recovery in patients with non-specific neck pain and to develop a prototype clinical compass for visualising patient-specific profiles. Design Secondary analysis of data from a multicentre, prospective, observational prognostic cohort study, with a 6-month follow-up between January 2020 and March 2023. Setting 30 physiotherapy primary care practices. Participants Patients with a new episode of non-specific neck pain. Primary and secondary outcome measures Patients…
Objectives To explore the sources of job satisfaction and work-related stressors experienced by organ and tissue donation coordinators in Canada. Design A qualitative descriptive approach incorporating semi-structured virtual interviews conducted between March 2022 and April 2024. Inductive coding was used for this analysis. Setting Canadian organ donation organisations. Participants Coordinators from across Canada working in deceased organ and tissue donation programmes. Results Perspectives from 39 coordinators from 10 organ donation organisations across Canada were explored in this…
Introduction Perinatal mental health problems are prevalent during pregnancy and the postpartum period and can have substantial consequences for both mothers and infants. Chatbot-based interventions represent a promising and scalable approach to perinatal mental health support. However, the evidence base remains heterogeneous and has not been systematically mapped. This scoping review aims to synthesise existing research on chatbot-based interventions for perinatal mental health, focusing on study characteristics, intervention features, outcomes and implementation challenges. Methods and…
Objectives To investigate the associations between the use of epidural analgesia (EA) and intrapartum care, labour, birth and neonatal outcomes in uncomplicated pregnancy low-risk women, to inform evidence-based intrapartum practices and support informed maternal choice. Design Retrospective cohort study. Setting Single maternity hospital in Northern Italy. Participants A total of 3406 uncomplicated pregnancy low-risk women who gave birth between 2019 and 2023 were included. Participants were grouped according to whether they received EA (n=417) or not (n=2989). Primary and secondary outcome…
Introduction Upper-limb (UL) impairment following stroke significantly limits independence in activities of daily living (ADLs). Although tabletop functional task-oriented training (FTOT) is a cornerstone of neurorehabilitation, both conventional therapist-led and technology-supported FTOT face limitations in consistency, supervision, progression and continuity across settings. The objectives are to characterise current clinical practices in UL tabletop FTOT and identify stroke survivor–caregiver dyads’ needs, constraints and support requirements across clinical and home contexts to inform…
Introduction Bladder cancer (BC), the second most common urinary cancer, is classified as either non-muscle-invasive BC or muscle-invasive BC. Although numerous studies have identified potential prognostic biomarkers, none have yet been implemented in clinical practice. A comprehensive umbrella review comparing all prognostic biomarkers in BC remains absent. Thus, we aim to synthesise evidence from systematic reviews and meta-analyses on prognostic factors in patients with BC. Methods and analysis We will search PubMed/MEDLINE, Scopus, Web of Science (WOS), EMBASE, Cochrane Database of…
Introduction Anterior shoulder instability is a common condition, frequently seen in young and active individuals. For patients with critical glenoid bone defects (≥15%), Bankart repair has limited effectiveness and bony augmentation surgery is often required. However, traditional bone grafts carry the risk of graft resorption, while 3D-printed personalised implants aimed at anatomical reconstruction face limitations in accessibility, cost and production time. Methods and analysis In this multicentre, randomised controlled trial, anterior shoulder instability patients with critical glenoid…
Introduction Leptospirosis is a zoonotic infection caused by the bacterium Leptospira, which typically enters humans through contact with water or soil contaminated with infected urine. One of the most important causes of death due to leptospirosis is leptospirosis pulmonary haemorrhage syndrome (LPHS). LPHS occurs due to an inappropriate immune response, resulting in excessive release of cytokines/chemokines or direct damage to alveoli by bacteria. Mortality remains high in LPHS, and management strategies of this deadly complication are under-investigated. Survivors have minimal residual lung…
Introduction Dysmenorrhoea is one of the most frequent manifestations of chronic pelvic pain. Endometriosis and adenomyosis are among the most common pathological causes of secondary dysmenorrhoea. Symptoms often persist despite treatment, so individuals frequently engage in self-management strategies. One self-management approach that may have potential benefits for chronic pain is whole-body thermal therapy, which involves exposure to heat or cold stimuli inducing systemic physiological responses. The aim of this scoping review is to map and synthesise the available literature on the use and…
Introduction Stroke is a severe cerebrovascular disease characterised by high morbidity, high recurrence rate, high disability rate, high mortality rate and significant economic burden. The unmet needs of stroke patients are universal and diverse and closely related to their health outcomes. Methods and analysis This protocol describes a mixed-methods systematic review to identify unmet needs in stroke patients. A comprehensive search will be performed in the following databases: PubMed, CINAHL, Embase, Web of Science, PsycINFO, CNKI, Wanfang Database and CQVIP. Google Scholar and ProQuest…
Introduction Post-COVID syndrome (PCS) is an ongoing legacy of the SARS-CoV-2 pandemic. Defined as symptoms persisting beyond 12 weeks following SARS-CoV-2 infection unexplained by an alternative diagnosis, many individuals continue to experience symptoms for months post-infection. Fatigue, breathlessness, cognitive difficulties and sleep disturbances are all commonly reported, frequently impairing daily functioning and quality of life. Acceptance and commitment therapy (ACT), which enhances psychological flexibility and supports values-based behaviour change, has shown effectiveness across…
This cohort study evaluates temporal trends in surveillance testing for patients with pancreatic cystic neoplasms and assesses for any corresponding changes in pancreatic cancer stage at diagnosis or survival.
This cohort study identifies risk factors for bacterial infection after firearm injury and assesses the association between bacterial infection and mortality among adults with these injuries in the US.
This randomized clinical trial compares the rates of successful first attempts for routine tracheal intubations using conventional laryngoscopy, video laryngoscopy with a Macintosh blade, and video laryngoscopy with a hyperangulated blade.
This case-control assesses whether 13 colorectal cancer (CRC) risk factors identified in high-income populations are associated with CRC in adults in Nigeria.
This secondary analysis of a cohort study examines associations between screen use and developmental difficulties in children a large Scottish birth cohort.
This cross-sectional study examines questionnaire responses of US medical school graduates to assess the association of sexual and gender minority identity with where graduates would prefer to start their practice.