Objectives This study aims to examine the electronic prescription programme in Iran by thoroughly identifying the key strengths, weaknesses, opportunities and threats (SWOT) associated with its implementation and utilisation among healthcare stakeholders. Design A thematic analysis was adopted, with data systematically examined through the SWOT analytical framework. Setting Hospital, pharmacy, specialised clinic, insurance affiliated clinic in Iran. Participants Participants consisted of four groups involved in implementing the electronic prescription programme, including physicians…
Objectives To identify and compare respiratory illness presentation rates and service utilisation to primary care in Aotearoa, New Zealand (NZ) before, through and after the COVID-19 pandemic. Design A natural language processing (NLP) software interference algorithm was used to interrogate quantitative and qualitative cross-sectional and retrospective cohort data from clinical consultation notes. Setting Primary care presentations across Aotearoa, NZ, encompassing both urban and rural areas. Participants Electronic records were obtained from general practice interactions from 2018 to end of…
Background The Role Checklist is broadly used to assess perceived role participation. Although stroke survivors often experience decreased participation, its reliability has not been evaluated for Spanish-speaking individuals with stroke. Objective To evaluate the psychometric properties of the Role Checklist in Spanish-speaking individuals with stroke. Design Validation study. Setting Randomly selected public primary care centres. Participants 179 participants with stroke. Outcome measures Internal consistency was analysed using Cronbach’s alpha and item-total correlations. Test–retest and…
Background Ethnic and socioeconomic inequities in respiratory illness outcomes are well established. Monitoring primary care presentation rates is important for assessing health system equitable responsiveness, particularly during health crises. Aim To examine changes in primary care respiratory illness presentation rates in Aotearoa New Zealand (NZ) by ethnicity and socioeconomic status before, during and after the COVID-19 pandemic. Design and setting Retrospective cohort study using natural language processing (NLP) of electronic health records from 37 general practices across eight…
Objectives To investigate the circumstances and contributory factors in cases where cardiopulmonary resuscitation (CPR) is administered to people with a learning disability despite a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) recommendation being in place. Limited understanding exists around why DNACPR recommendations are sometimes not followed in practice. This study aims to address this gap by examining what occurs when CPR is performed contrary to an established DNACPR recommendation. Design Qualitative study using inductive thematic analysis of secondary data derived from…
Introduction Falls are a significant concern for older adults, particularly those with neurological, vestibular, cognitive and post-viral conditions, due to dizziness and imbalance. Conventional balance rehabilitation programmes, though effective, face challenges in adherence and accessibility. The TeleRehabilitation Decision Support System (TeleRehaB DSS) uses artificial intelligence (AI) and motion tracking to provide individualised multisensory balance rehabilitation (MBR) remotely. This trial aims to evaluate the acceptability, feasibility, safety and preliminary efficacy of a home-based…
Introduction Asthma affects over 300 million people worldwide and is often accompanied by night-time symptoms that disrupt sleep and contribute to cognitive deficits. Despite growing recognition of these interrelated burdens, data from low-resource settings are scarce. This study addresses this gap by assessing the burden of cognitive dysfunction among adult patients with asthma in northwest Ethiopia. Methods An institution-based multicentre cross-sectional study was conducted from 1 June to 30 August 2024. A multistage sampling technique was used to recruit 635 adult asthmatic patients. Data…
Introduction Enteric bacterial pathogens are a major cause of diarrhoeal disease in low-income and middle-income countries, with complex transmission pathways involving human, animal and environmental reservoirs. Conventional epidemiological and microbiological approaches provide important insights into pathogen burden and distribution but lack the resolution needed to characterise fine-scale diversity, antimicrobial resistance (AMR) and transmission dynamics. Whole-genome sequencing offers high-resolution tools to investigate these processes within a One Health framework. Methods and analysis…
Objectives Carotid plaque is an early manifestation of atherosclerosis and is closely associated with the risk of myocardial ischaemia, ischaemic stroke and other atherosclerotic cardiovascular diseases (ASCVDs). To identify new protein biomarkers associated with carotid plaque, which will enhance early warning of ASCVDs Design Nested case–control study within a prospective cohort, with external assessment of transportability in an independent population-based cohort. Participants and data sources The development cohort is from China, which is a nationwide, community-based cohort and the…
Introduction Lipid-lowering therapies, particularly statins, are central to the prevention of atherosclerotic cardiovascular disease. However, their effectiveness is often compromised by statin-associated muscle symptoms, leading to non-adherence, discontinuation and/or switching to alternative, more expensive therapies such as Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors or bempedoic acid. Recent studies suggest that N=1-interventions may help distinguish true side effects from nocebo-driven symptoms and support reinitiation of statin therapy. Methods and analysis The…
Objective Autonomy supportive interventions such as the guided self-determination method (GSD), may reduce diabetes distress in people with type 2 diabetes. The objective was to investigate the benefits and harms of GSD intervention versus attention control group intervention in adults (≥18 years old) with type 2 diabetes. Research designs and methods The design was a pragmatic, dual-centre, randomised, assessor-blinded, superiority clinical trial. People with type 2 diabetes were assigned by computer-generated randomisation to GSD or attention control, both interventions provided…
Background Whether surgical haematoma evacuation leads to reduced brain damage in patients with spontaneous supratentorial intracerebral haemorrhage (SSICH) remains unknown. Blood biomarkers reflecting brain damage could aid in prognosticating the clinical outcome and hence support quantifying the benefit of surgical interventions. Methods Blood samples from 10 patients with SSICH in the phase II early minimally invasive image-guided endoscopic evacuation of intracerebral hemorrhage (EMINENT-ICH) pilot study (NCT04805177, completed) were collected longitudinally (at baseline, 24 hours, 3 days…
Objective To explore intensive care unit (ICU) healthcare professionals’ perceptions and experiences of shared decision-making with conscious patients. Design A qualitative descriptive study using semistructured interviews. Setting Three ICUs at a Joint Commission International-accredited hospital in Hangzhou, Zhejiang Province, China. Participants 16 ICU healthcare professionals (9 females, 7 males; aged 23–45 years) were interviewed between September and November 2024. Results We identified 10 subthemes that were classified into three themes: (a) conscious but not ready: unstable…
Objective To examine the effectiveness and safety of pharmacist prescribing across multiple healthcare settings. Design A systematic review of quantitative studies. Eligibility criteria for the selection of studies Quantitative studies assessing the effectiveness and safety of pharmacist prescribing compared with non-pharmacist prescribing in any healthcare setting and for any healthcare population. A clear statement of pharmacists’ prescriptive authority was required for inclusion in this systematic review. Data sources A systematic search was conducted using six electronic databases: Embase…
Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is a progressive condition that may lead to liver cirrhosis and hepatocellular carcinoma. It is strongly associated with cardiometabolic diseases such as type 2 diabetes (T2D) and obesity. Weight loss is a key therapeutic strategy to treat MASLD. In recent years, there has been increasing attention to weight-reducing medication, but promising dietary interventions—such as early time restricted eating (eTRE)—have also been developed. Whether these dietary interventions are a good alternative to weight-reducing…
Introduction Opioid use disorder (OUD) remains a serious and life-threatening disease. Medications for opioid use disorder (MOUD) are effective treatments for OUD but a minority of eligible patients receive them. Hospitalisation is an opportune time to increase MOUD use. However, the description of the most successful strategies to implement MOUD is underexplored. This scoping review will methodically review what strategies have been described in the literature to increase MOUD use in hospital settings in the USA. Methods and analysis Our scoping review will be completed using methods outlined…
Objectives To evaluate the pilot implementation of Parwarish (Parenting for Lifelong Health–Teens) programme on reducing violence against adolescents and improving parenting practices, mental health, gender attitudes, resilience and financial coping among families in disadvantaged communities in North India. Design Pilot implementation study using a pre-post study design. Setting Community-based implementation in three disadvantaged settings in North India, including urban informal settlements, rural agricultural areas and remote tribal communities. Participants A total of 239 adolescents…
Objective Although body mass index (BMI)-defined non-obesity metabolic dysfunction-associated steatotic liver disease (MASLD) predicts poor prognosis, the role of visceral adiposity and weight-based phenotypes is unclear. This study aimed to examine the clinical correlates of four unique MASLD phenotypes based on BMI and waist-to-height ratio (WHtR) and to assess the prognostic value of this classification with respect to mortality. Design Population-based cross-sectional study with prospective mortality follow-up. Setting Nationally representative US population derived from the National…
Objective 30-day survival after cardiac arrest is low, 12.4% and 36% for out-of-hospital and in-hospital cardiac arrest, respectively. Heart failure is a known risk condition for cardiac arrest. Improving our ability to identify patients at high risk of cardiac arrest would enable prevention. We aimed to develop a prediction model for cardiac arrest to be used in patients newly diagnosed with heart failure. Design A nationwide registry-based observational study. Setting Data were sourced from the Swedish Heart Failure Registry (1 January 2005 to 31 December 2021). Participants This cohort…
Background Weighted capitation formulas are used in many countries to allocate primary care funding. Most rely heavily on demographic and area-level factors to weight payments, with limited direct adjustment for morbidity. This may disadvantage practices serving populations with greater morbidity or earlier onset of disease. Objectives To assess how well the current National Health Service (NHS) weighting formula reflects morbidity-related workload and how incorporating morbidity would alter national funding allocations. Design Retrospective observational study using patient-level electronic…
Introduction The mechanisms generating immunity involved in nasal vaccination for children are likely to differ significantly from both adult immunity and animal models. A deeper understanding is necessary for the development of future paediatric mucosal vaccines. Live-attenuated influenza vaccines (LAIVs) are licensed mucosal vaccines which confer protection in children against severe influenza. Beyond individual protection, mucosal vaccines can also limit transmission and colonisation, offering broader public health benefits than parenteral vaccination. We describe a protocol for an…
Introduction Developments in blood biomarkers (BBMs) in dementia call for studies that evaluate their diagnostic, prognostic and societal implications in real-world populations. Such evidence is essential to support the safe and effective integration of BBMs into clinical practice. Methods and analysis The REAl world Dementia OUTcomes study (READ-OUT) is a UK-based, multi-site study that assesses the prognostic and diagnostic utility of BBMs in people attending memory assessment services (‘secondary care’). READ-OUT phase 1 is a 3-year observational study of 3165 people representative of the…
Introduction Nurse practitioner (NP) education must address increasingly complex demands of the healthcare setting, as underprepared students demonstrate poor clinical performance and difficulties in making autonomous decisions. Educational preparedness is an important element impacting transition to practice. Difficulties during role transition impact intent to leave the profession, inability to implement advanced practice skills, anxiety and poor job satisfaction, leading to poor patient care and adverse outcomes. This study aims to explore factors that influence novice NP role transition in…
Introduction Guideline-directed medical therapy (GDMT) has been demonstrated to reduce morbidity and mortality in patients with heart failure (HF). In addition to the need for GDMT, a large number of cardiovascular and non-cardiovascular medications are prescribed to patients with HF, especially the elderly, due to multiple comorbidities and chronic health conditions, such as chronic pain, musculoskeletal problems, insomnia or gastrointestinal issues. Polypharmacy may reduce adherence to GDMT and compromise its optimisation, potentially leading to worse clinical outcomes in patients with HF…