Health inequities in the United Kingdom disproportionately affect racialised, globally marginalized, and working-class communities. Research training programmes shape who becomes a researcher, which questions are prioritized and which knowledge is recognized as legitimate. This Perspective provides a reflexive, practice-informed account of the NIHR Inspiring Students into Research Training (INSIGHT) Programme across three South East England institutions: the University of Kent (MSc Applied Health and Care Research), the University of Brighton (MRes), and the University of Chichester (MRes). Drawing on programme documentation, early evaluation insights, teaching experiences and reflections from programme leaders, learners, and partner organizations, the paper examines how equity-oriented pedagogies have been embedded in postgraduate research training. Illustrative reflections from learners and informal contributors, drawn from module feedback, demonstrate the programme's collaborative ethos. The curriculum integrates structural competence, cultural humility, epistemic justice and co-produced patient and public involvement (PPI) alongside core research methods. Findings suggest that embedding equity-focused, socially accountable approaches enhances learner engagement, supports epistemic inclusion, and strengthens the relevance of research for underserved communities. The programme also highlights structural tensions between workforce composition and eligibility criteria: many internationally trained and minoritised practitioners in the NHS and social care, often recruited to address workforce shortages, may be excluded from funded training due to residency, fee-status, or professional timelines. This Perspective argues that reflexive, practice-informed curriculum design, together with more flexible and inclusive eligibility policies, can contribute to a diverse, socially accountable applied health and care research workforce.
Young onset dementia, which comprises a group of neurodegenerative conditions, affects adults aged under 65 years and has significant adverse effects on their lives and those of their families. Early recognition of symptoms and diagnosis can facilitate timely access to treatment and support. However, younger adults typically experience a significantly longer wait for a dementia diagnosis than older adults, in part due to a lack of recognition of symptoms and initial misdiagnosis. This article provides an overview of young onset dementia, discusses some of the barriers to timely diagnosis and describes the associated signs and symptoms in younger adults. The author discusses ways in which the diagnostic process and post-diagnosis support may be improved for this population and poses questions for nurses to consider with regards to local service improvement. The author includes a fictional case study to illustrate the experiences of younger adults with dementia and their families.
Extending previous research, this study examines distance runners' narrative accounts of sport injury and disordered eating, highlighting how these experiences intersect and unfold across their athletic careers. Ten regional to international level distance runners participated, who had experienced a range of injuries throughout their career (e.g., acute, chronic, overuse, career-ending). Life-story interviews (n = 28) and visual methods (i.e., photographs) were used to facilitate the participants in telling their stories. Data were analysed using dialogical narrative analysis and represented through creative-non-fiction. Framed within narrative theory and taking a thick social-relational perspective, five stories were constructed that illustrate the complex and nuanced relationship between sport injury and disordered eating over time: Is it good for me?, I know I've gone too far, Maybe it wasn't too late for me?, Is this what normal feels like?, and I love food too much. This study deepens understanding of how injury and disordered eating unfold within performance-oriented cultures, pointing toward more supportive narrative and relational possibilities, and provides pedagogical resources that can promote a shared understanding across interdisciplinary practitioners who aim to work collaboratively to support athletes' well-being.
BACKGROUND: This study has two objectives: (1) to identify the attitudinal and demographic factors most closely associated with performance-enhancing drugs (PED) use in sports; (2) to propose a new method for estimating PED use prevalence that mitigates the limitations of self-report surveys. METHODS: We analyse survey data from a sample of 2113 athletes attending ten UK universities, using a two-step approach. First, Bayesian Variable Selection (BVS) is used to identify the factors most closely associated with PED use. Second, these factors are incorporated into a Bayesian Profile Regression (BPR) model to identify clusters of athletes with similar attitudes toward PEDs. The prevalence of PED use is then estimated by linking these clusters with reported PED use via a logit model. RESULTS: Four key factors are significantly associated with PED use: being male, believing PED use is necessary to excel in sports, having a perceived estimate of PED use prevalence among elite athletes higher than the sample average, and having a perceived estimate of PED use prevalence among sportspeople in general higher than the sample average. BPR identifies four distinct clusters of athletes: (1) non-users; (2) use-admitters; (3) use-admitters and non-admitters; (4) most likely non-users. Using this new methodology, PED use prevalence is estimated at 13.7%, considerably higher than the 3.4% obtained through direct questioning. CONCLUSION: The proposed method identifies attitudinal and demographic factors associated with PED use and provides a more accurate estimate of its prevalence, which can inform the development of more effective anti-doping programmes.
Arthroplasty generates the most waste among the sub-specialties of orthopaedic surgery. Infectious waste generates ten times more CO2 than recycled waste, and over 90% of it is misallocated. This multicentre study aimed to quantify waste from primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) across UK NHS trusts, guiding strategies for waste reduction and improved segregation. Data were collected prospectively from ten UK centres over six months between October 2023 and April 2024, covering at least ten arthroplasty cases per centre. Waste was categorized and weighed across six streams (infectious, offensive, recycling, general, sharps, and linen). Data on scrubbed personnel, drapes, implant brand, and intraoperative complications were also collected. Data from 222 procedures (92 THAs, 130 TKAs) revealed significant differences in total waste production across centres (p < 0.001). THAs produced a mean of 14.8 kg waste, while TKAs generated 13.6 kg. Only 5/10 trusts utilized the offensive waste stream. Implant brand, number of scrubbed personnel, and reusable drapes were predictors of increased waste production on unadjusted univariate analysis; multivariable linear regression analysis showed local centre practice was the only significant predictor of waste production. Local waste management practices were the strongest predictors of waste production, underscoring need for standardization, education, and adherence to best practices. The use of offensive waste streams eliminated infectious waste, supporting a shift towards less carbon-intensive disposal. Adherence to established national guidelines is required to reduce the quantity of infectious waste and reduce the carbon footprint of arthroplasty surgery. Implementing offensive waste streams can reduce carbon intensity significantly. Addressing centre-specific policies, adhering to national guidance, and industry collaboration are essential for minimizing arthroplasty waste.
Background: Self-paced tasks, like putting in golf, are executed under interacting task, environmental, and individual constraints. Purpose: However, contextual constraints such as previous performance and score are often absent in research investigating these tasks. Study sample/research design: Thirteen tour professional golfers were interviewed about their experiences of adapting to constraints when putting in competitive golf. Data analysis: We adopted a deductive theory driven reflexive thematic analysis based on previous work on contextual constraints in self-paced sporting tasks. Results: We generated 18 sub-themes, which were categorised into four themes of task (e.g., pace control and proximity to hole), individual (e.g., pressure and self-expectations), environmental (e.g., green difficulty and weather conditions), and contextual constraints (e.g., consequences and performance). Conclusions: Findings give practitioners a unique insight into what professional golfers experience in competition, and we offer practical suggestions on how to best support golfers in performance environments.
The purpose of this study was to examine the effects of handheld dumbbell load on force-time characteristics during countermovement jumps with accentuated eccentric loading (CMJAEL). Nineteen youth athletes (9 males and 10 females; age 15 ± 2 years; stature 1.66 ± 0.09 m; body mass 54.8 ± 8.4 kg) performed bodyweight CMJs (CMJBW) followed by CMJAEL conditions at 20% (CMJAEL20) and 30% (CMJAEL30) of body mass. Vertical ground reaction force (vGRF) data were analysed using a combined forward and backward integration method to account for changes in system mass. Jump height increased in both CMJAEL conditions compared with CMJBW, with the greatest improvement during CMJAEL20. Propulsion time increased with load, while propulsion mean vGRF decreased, suggesting participants produced force over a longer duration to attain a greater jump height. Propulsion mean velocity and power increased under CMJAEL20 but changes were uncertain for CMJAEL30. Braking responses were inconsistent, as higher braking vGRF were not accompanied by meaningful changes in braking velocity or power. These findings suggest CMJAEL can acutely increase jump height; however, associated changes in force-time characteristics, particularly phase durations and velocities, should be considered, as they provide insight into how jump performance is achieved in response to AEL.
Kelps are distributed across more than a quarter of the world's coastlines, where they serve as foundation organisms and support high levels of biodiversity and primary productivity. They are increasingly threatened by a range of anthropogenic stressors and given their significant ecological and socioeconomic value there is a pressing need to better understand the structure and functioning of these forests, and their role in underpinning and providing ecosystem services. However, robust quantitative assessments are mostly lacking and certain services remain underexplored, which hinders evidence-based approaches to management, restoration and protection. We focused on Laminaria hyperborea forests in and around Plymouth Sound (southwest UK) as a model region to present a robust quantification of four key ecosystem services spanning provisioning (fisheries), regulating (climate through carbon storage) and supporting (habitat creation and biodiversity). Data were collated from a range of sampling techniques and approaches, including diver-based collections and deployment of baited remote underwater video (BRUV) systems. Our survey data showed that kelp forests consistently support very high levels of biodiversity and carbon standing stock and provide stable and extensive habitat for a variety of fishes and mobile macrofauna species, some of which have socioeconomic value. While ecological structure differed amongst survey sites, all kelp forests underpinned critical ecosystem services by supporting biodiversity, assimilating carbon and providing fisheries habitat. High-resolution survey data highlight the socioeconomic importance of kelp forests along temperate wave-exposed coastlines. Improved monitoring and targeted management and conservation of these habitats is needed to safeguard ecosystem service delivery in the face of multiple anthropogonic stressors, notably ocean warming, decreased water quality and fishing activities.
Robotic transanal minimally invasive surgery (R-TAMIS) is increasingly used for local excision of rectal lesions, offering improved precision, ergonomics and access compared with conventional TAMIS. Although early reviews demonstrated feasibility, pooled data on operative and oncological outcomes remain limited. This systematic review synthesizes contemporary evidence to provide descriptive weighted estimates of procedural efficiency, safety and short-term clinical outcomes. A systematic search of PubMed, Scopus and Web of Science through June 2025 identified studies reporting R-TAMIS outcomes in ≥ 5 patients. Extracted variables included demographics, operative metrics and oncological results. Continuous data were descriptively pooled when possible, and risk of bias was assessed using Joanna Briggs Institute and Newcastle-Ottawa tools. Owing to heterogeneity, findings were summarized qualitatively. Twenty-two studies (n = 437), predominantly case series, met inclusion criteria. The mean patient age was 63 years, BMI 27.5 kg/m2 and ASA score 2.2. Robotic systems used included da Vinci S/Si/Xi/SP and Medrobotics Flex platforms. Mean docking time was 20 min, operative duration 103 min, blood loss 18 mL and hospital stay 1.7 days. Postoperative morbidity remained low (Clavien-Dindo I–II 8%, III 1%) with reoperation and readmission rates of 2%. R0 resection was achieved in 96% of tumors, most of which are early stage (77%). R-TAMIS appears safe and feasible for local excision of early rectal tumors, with descriptive estimates suggesting low perioperative morbidity and short hospital stay. While currently more costly than laparoscopic TAMIS, efficiency gains in high-volume centers may mitigate costs. Further prospective studies are needed to better define outcomes and refine procedural indications.
Background: Standardised Ashwagandha root extract (SARE), characterised by its content of bioactive withanolides, is widely used for its antioxidant and adaptogenic properties; however, recent case reports have raised safety concerns, primarily involving non-standardised or multi-ingredient formulations. This systematic review evaluated the safety and tolerability of SARE in healthy adults, with a focus on clinical biomarkers and adverse event reporting. Methods: Randomised trials were identified through searches of PubMed, Web of Science and Google Scholar, published from 2010 to April 2026. Studies administering single-ingredient, standardised root-only extracts to generally healthy populations were included. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Twenty-three studies with a total of 2317 participants met the inclusion criteria, with doses ranging from 125 to 600 mg/day and intervention durations from a single dose to 180 days. Across studies, hepatic, renal, haematological, endocrine, and cardiovascular biomarkers remained within normal clinical ranges, with no clinically meaningful adverse alterations reported. Reductions in cortisol were consistently observed, while increases in testosterone remained within physiological ranges. No serious adverse events attributable to SARE were reported. Mild adverse events, including gastrointestinal discomfort, headache, and transient drowsiness, were infrequently reported and occurred in both intervention and comparator groups. Conclusions: SARE was well tolerated in healthy adults at the studied doses and durations. However, limited long-term data (>180 days) and heterogeneity in study design and reporting warrant further large-scale, standardised trials to confirm safety across extended use and diverse populations. The review is registered in the PROSPERO database with ID CRD420261337116.
Diabetes mellitus continues to be a significant worldwide health burden, necessitating safe and efficient treatment alternatives. In alloxan-induced diabetic rats, this study examined the combined antidiabetic effectiveness of chromium picolinate and Prunus persica kernel extract. Gas chromatography/mass spectrometry was used to phytochemically characterize a polyphenolic-rich extract (60% acetone). Alloxan monohydrate (140 mg/kg b.w.) was administered intraperitoneally to develop diabetes in rats. The animals were split into groups for normal control, diabetic control, chromium picolinate, Prunus kernel extract, three combination therapy groups, and conventional medication. The treatments were administered orally on a 21-day basis. Insulin levels in serum were also measured following dissection, and body weight and fasting blood glucose (FBG) were monitored prior to and after treatment. Pancreatic tissue was taken in order to determine the preservation and regeneration of B-cells through a histological analysis. Compared to individual therapy, the combined therapy had a significant benefit of reducing the level of FBG (p < .01), increasing serum insulin significantly, and rescuing the morphology of the pancreatic B-cells. These findings confirm the P. persica kernel extracts and chromium picolinate as supplementation therapies in diabetes management because they suggest that the two compounds act synergistically to enhance pancreatic protection and control glucose levels.
This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally. This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital. Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge. This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.
A hernia containing a Meckel's diverticulum is termed a Littre hernia, with the mixed subtype describing the presence of additional abdominal viscera. Mixed Littre hernias are rare and often identified intra-operatively. We report the case of a man in his 60s undergoing a right inguinoscrotal hernia repair who was found to have a 10 cm Meckel's diverticulum with a loop of ileum within the hernia sac. The diverticulum appeared normal and was managed non-operatively with no complications at 6 months. Management of an incidental Meckel's diverticulum remains controversial, divided between non-operative and operative management which can include selective or routine prophylactic resection. High-quality evidence is limited, and existing studies focus on intra-abdominal Meckel's diverticula rather than those within a hernia sac which may have a distinct risk profile. Further research and development of guidelines are required to guide intra-operative decision making in rare cases such as a mixed Littre hernia.
Background/Objectives: Chronic intake for 7 to 14 days of anthocyanin-rich blackcurrant extract or powder has been shown to alter cardiorespiratory and metabolic responses during rest and moderate-intensity exercise. Whether the observed effects were due to the final intake on the day of testing is not known. We examined whether there were effects of an acute intake of blackcurrant extract on the cardiorespiratory and metabolic responses during supine rest and moderate-intensity treadmill walking. Methods: Healthy men (n = 15, age: 24 ± 6 years, body mass index: 24.4 ± 4.5 kg·m-2) volunteered in a randomized, cross-over designed exploratory study. Acute intake effects of blackcurrant extract (210 mg of anthocyanins) were compared to a control condition. Hemodynamic recordings and indirect calorimetry techniques were used to record physiological and metabolic responses during 10 min of supine rest and 30 min of moderate-intensity treadmill walking. Results: At rest, there may have been an effect for an increase in cardiac output (p = 0.088). Based on the smallest worthwhile change (i.e., 0.2 × the standard deviation in the control condition), eight participants were classified as responders with an increase in cardiac output of 13.5 ± 8.4% (range: 4.0 to 24.7%). For total peripheral resistance, a decrease was observed (p = 0.048, d = -0.40, small effect size), with nine participants classified as responders with a decrease of 17.5 ± 6.1% (range: -9.7 to -28.0%). No changes were observed for other cardiorespiratory and metabolic parameters during supine rest. During moderate-intensity exercise, only heart rate was lower by 2 beats·min-1 for the cohort (d = -0.11, trivial effect size) with four participants considered responders when presenting a heart rate lower than the smallest worthwhile change of 3 beats·min-1. Conclusions: An acute intake of a blackcurrant extract with 210 mg of anthocyanins may have had an effect on vascular regulation mechanisms affecting total peripheral resistance and cardiac output during rest in at least ~50% of the male participants. No acute effects were observed for metabolic responses during rest and exercise. Our findings regarding the metabolic effects are not consistent with previous chronic dosing studies suggesting that repeated daily intake with a dose of 210 mg of anthocyanins is needed to alter substrate oxidation at rest and during moderate-intensity exercise.
Identity abuse (IA) is a form of domestic abuse (DA) seen in LGBTQ+ romantic relationships, which weaponizes a partner's gender or sexual identity against them. This scoping review had the primary aim of identifying risk and protective factors of LGBTQ+ IA in romantic relationships. The secondary aim was to determine the prevalence of specific IA tactics (Outing, Isolation from LGBTQ+ Community, Derogatory Language, Belittling Identity). The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Search terms focused on LGBTQ+ identities and DA. A total of 8,918 papers were retrieved across three databases (PubMed, Web of Science, and PsycInfo), with 41 papers meeting the inclusion criteria. Both qualitative and quantitative papers were included in this review. The review identified multiple risk factors for IA perpetration and victimization, such as LGBTQ+ enacted stigma, specific gender expressions, and mental illness. Identifying the prevalence of IA tactics specifically was difficult to determine due to measurement differences. Across 21 quantitative papers, outing was the most reported tactic, being reported in 73.91% of the papers. Overall, the review highlights the field of IA as being under-researched. The synthesis of literature that the review provides is a crucial step to understand and develop IA as a theoretical concept and provides direct recommendations for future research.
This case report describes a female in her late 80s who presented with progressive dyspnoea and marked hypoxia. Notably, the hypoxia was refractory to high-flow supplemental oxygen. Her medical history included myeloperoxidase (MPO) positive vasculitis, vitamin B12 deficiency with a baseline haemoglobin of 88g/dL and well-controlled hypertension. A venous blood gas showed a MetHb of 10.2% [< 2%], which was initially overlooked. She was admitted to the ward and remained refractory to supplementary oxygen. A subsequent arterial blood gas (ABG) revealed an oxygen saturation (SaO2) of 95% and a methaemoglobin (MetHb) level of 10.7%. On review of her drug history, it was noted that she was taking 100 mg of dapsone once daily for Pneumocystis jirovecii pneumonia (PCP) prophylaxis. Dapsone was discontinued; her symptoms and hypoxia rapidly improved, and she was discharged 48 hours later.
To explore workplace violence (WPV) amongst Latvian undergraduate nursing students during clinical placements. Workplace violence has profound consequences. Nursing students on placement are often victims of non-verbal and verbal abuse, physical or sexual violence, causing psychological problems, hindering their professional identity and causing them to leave the nursing profession. Numerous studies indicate the problem's extent, yet reporting in the Baltic region has been absent in the literature. Cross-sectional survey. This study, conducted October to December 2023, was based on similar studies in Australia and the UK, using a validated 4-point Likert scale with 24 questions assessing WPV. Questions were uploaded to a commercial internet survey provider, distributed across three universities providing nursing programs in Latvia. Ethical approval was obtained from the University of Latvia's Ethics Committee. Participation was voluntary, involving 119 students (21% from three universities). STROBE checklist: cross-sectional studies. The majority of nursing students (52.9%) on placement experienced bullying (n = 63). Perpetrators included registered nurses and patients. Exposure included negative non-verbal behaviour (69.8%, n = 83), being ignored (55.5%, n = 66), neglected (52.1%, n = 62), and unfairly criticized (51.3%, n = 61). Only 13.4% (n = 16) reported these episodes. There was a significant association between bullying and students considering leaving the nursing profession. Latvian nursing students experience various forms of WPV, including emotional bullying (e.g., negative non-verbal behaviour, being ignored, neglected, unfairly criticized, verbally abused), physical abuse (e.g., being pushed), sexual harassment (e.g., inappropriate touching, sexist remarks). The lack of reporting may result in unresolved issues for both students and nursing profession. Clinical nurses working directly in healthcare settings and academic facilitators/lecturers involved in teaching and training should collaborate on implementing targeted training programs addressing WPV. This ensures that both practical and theoretical WPV-handling aspects are covered comprehensively. None.
The present research assessed the efficacy of 12-week high-intensity interval training (HIIT) and blue-green algae (Spirulina) consumption on pro-inflammatory and anti-inflammatory factors (Dectin-1, IL-1β, and IL-10), along with lipid-associated signaling elements (ApoM and S1P) in obesity. We hypothesized that 12-week intervention combining HIIT and Spirulina consumption will demonstrate superior efficacy than HIIT or Spirulina alone on plasma concentrations of pro- and anti-inflammatory factors and lipid-associated signaling molecules in men with obesity. Sixty-four men with obesity (BMI ≥ 30 kg/m², 20-35 years) were randomly allocated to four treatment groups: control placebo (CP), blue-algae (BA), HIIT + placebo (HIIT+P), or HIIT + blue-algae (HIIT+BA). The treatment consisted of three weekly sessions of HIIT protocols, daily intake of 6 grams of capsulated Spirulina, or simultaneous implementation of both interventions. Plasma biomarkers (Dectin-1, IL-1β, IL-10, ApoM, and S1P), anthropometric measurements, cardiorespiratory assessments, and lipid profiles were examined at baseline and after the 12-week intervention. Statistical analyses demonstrated an elevation in plasma concentrations of IL-10 and ApoM, along with a reduction in concentrations of IL-1β in the BA, HIIT+P, and HIIT+BA groups (P< .05), with the most pronounced changes observed in the HIIT+BA. Also, an increase in S1P concentrations was observed in the HIIT+P and HIIT+BA groups (P = .03, P = .003, respectively). A decrease in Dectin-1 concentrations post-intervention was found only in the HIIT+BA group (P = .03). In conclusion, while HIIT and/or Spirulina have shown potential for targeting lipid- and inflammation-associated markers in obesity, combining these interventions demonstrates superior efficacy for certain parameters.
This study aimed to explore the interrelated nature of how caregivers of people with limb absence impact and are impacted by the hospital-to-home transition. Moreover, this study aimed to explore how caregivers can be better supported to fulfil their role. A qualitative research study positioned within an interpretivist paradigm. Semi-structured interviews were conducted with 14 people with limb absence and 15 nominated caregivers. Data was analysed using a reflexive thematic analysis. Three themes were identified. (1) Lost in transition: Disconnection and divergence from hospital to home: Both service-users and caregivers described how caregivers were marginalised during the rehabilitation process, creating differing expectations regarding the service-users' functional abilities upon returning home. (2) Bearing the weight of unseen struggles: The impact of caregiving on the caregiver. Participants described the cumulative impact of caregiving on caregivers' physical and mental well-being. (3) Supporting the supporter: Participants highlighted informational, care continuity, communication, and social support gaps and described how such gaps could be addressed. This study offers novel insights into the lived experiences of both caregivers and service-users in navigating the hospital-to-home transition and foregrounds how caregivers can be better supported. Centralising caregivers' perspectives can help ensure that they inform evidence-based initiatives to support integrated rehabilitation environments. Practitioners should be aware of the diverse ways that caregivers may experience the hospital-to-home transition to develop a more person-centred, broader, and longer-term view of the rehabilitation process.Including caregivers throughout rehabilitation could help mitigate against the mismatch in expectations concerning service-users’ functional limitations upon returning home, ultimately improving long-term care outcomes.Participants suggested addressing support gaps by implementing educational material and talks, social support groups, and creating stronger links between hospitals and communities.To support future integrated care policies, the findings articulate a need to shift from the patient-centred ethos of rehabilitation towards viewing caregivers as partners in care.
Approximately 50% of the estimated 14 million people eligible for lung cancer screening (LCS) currently smoke. Gaps in knowledge regarding optimal tobacco treatment interventions in the context of LCS remain. Research Questions; What are the most value-efficient, evidence-based combination of tobacco treatment component(s) for people seeking LCS who smoke? Study Design and Methods; Cessation and Screening to Save Lives (CASTL) is an optimization randomized clinical trial conducted at 17 LCS sites in the United States. Eligible participants ages 50-80, scheduled for LCS, and currently smoking were randomized to one of 16 combinations of tobacco treatment components: enhanced standard care, motivational interviewing, nicotine patch/ lozenge and message framing. The primary outcome was self-reported abstinence at 6 months follow-up. The cost of each combination of components was estimated as a function of time and resources. Results; At enrollment (N=758), about 5% of participants were not interested in quitting, 59% were considering quitting and 38% already making changes in their smoking. Most (79%) reported smoking within 30 minutes of waking, indicating high level of addiction. Although there were no significant differences among the intervention components, the most value-efficient intervention with respect to expected abstinence was loss-framed messaging, nicotine patch and lozenge (expected abstinence rate = 30%; mean cost = $287.41). Among the less-costly combinations, a value-efficient alternative included gain-framed messaging only (abstinence = 13%; cost = $51.29).