Molecular Tumor Boards (MTBs) generate highly technical recommendations. The language used in their protocols is rarely accessible to patients. Lay-language patient protocols could support patient-clinician communication, yet manual production is difficult to sustain in high-volume oncology settings. Large language models (LLMs) may offer scalable drafting assistance, yet clinical usability remains largely uninvestigated under real-world deployment constraints. Existing evaluations rely predominantly on synthetic data or closed-source models that are incompatible with strict data protection requirements. This study evaluated whether open-weight LLMs can provide clinically usable drafting support for German MTB patient protocols under real-world deployment constraints and developed a transferable evaluation framework for patient-facing text generation. Eight open-weight LLMs were evaluated under zero-shot (A1) and one-shot (A2) prompting with constrained decoding, which ensures section-schema compliance. Automatic evaluation used ROUGE-1 (Recall-Oriented Understudy for Gisting Evaluation), BERTScore-F1 (Bidirectional Encoder Representations From Transformers Score), Wiener Sachtextformel version 4, and DistilBERT (Distilled Version of Bidirectional Encoder Representations From Transformers)-based complexity using a corpus of 316 MTB protocols and 47 expert-written patient protocols. For expert evaluation, 7 medical oncologists evaluated 50 protocols from the best-performing model across 3 International Organization for Standardization 9241-11 usability dimensions using fine-grained error annotation, perceived postediting effort (PPEE), and net promoter score. Critical errors were defined as bearing the risk of patient harm. Llama-3.3-70B-Instruct achieved the strongest automatic performance. Across models, A2 significantly improved most automatic metrics compared to A1. However, expert usability evaluation of Llama-3.3-70B-Instruct showed the opposite picture: the proportion of protocols containing at least 1 critical error doubled under A2 (10/25, 40% vs 5/25, 20%) compared with A1, and the dominant error type shifted from language (40/108, 37%) errors to factual errors (69/145, 48%). Overall, 16% (230/1420) of the annotated paragraphs contained errors. Median PPEE was 2 (IQR 2.0-3.0; low), and median net promoter score was 7 (IQR 5.0-9.0). Detractors (46/100, 46%) outweighed promoters (29/100, 29%), which suggests hesitation toward routine adoption. These differences in expert evaluation between A2 and A1 were directionally consistent but did not reach individual statistical significance for the paired samples (n=25). Prompting strategies that improve automatic metrics can simultaneously increase the number of critical errors. Surface-level metric gains were, therefore, insufficient proxies for clinical safety. This was observed as a consistent directional pattern for a single model, but generalization to other models remains to be investigated. Nonetheless, the low paragraph-level error rate and favorable PPEE suggest that structured open-weight LLM generation may be a useful drafting support in a clinician-supervised setting. The proposed evaluation framework provides a text-quality-focused basis for future assessment of patient-facing LLM applications in real-world clinical settings.
Implementation science (IS) plays a critical role in translating research into real-world health outcomes. Few studies have evaluated models that provide technical assistance and other resources to build IS capacity. The Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation Research (CHESHIRE) network supports US-based HIV research awardees participating in the Ending the HIV Epidemic in the US (EHE) initiative. The objective of this study is to describe the evaluation protocol for CHESHIRE and assess the effect of the implementation of hub technical assistance activities on EHE-funded research team outcomes, including IS competencies, scientific collaboration, and research productivity. This protocol describes a mixed methods evaluation using qualitative interviews with EHE project leads (n=36); social network analysis of CHESHIRE-affiliated researchers and hub members (n=265); and secondary data analysis of National Institutes of Health (NIH) RePORTER, PubMed, and NIH Implementation Science Coordination Initiative EHE Project Final Progress Report Survey data (n=248). We will use descriptive analyses, network metrics, and thematic coding to describe outcomes following CHESHIRE implementation, including IS competencies, interinstitutional partnerships, and research productivity. CHESHIRE coordinating center and hub activities were funded through NIH Center for AIDS Research and AIDS Research Center supplements beginning in 2019, with hubs funded between 2019 and 2024. Available survey data include EHE projects that completed the EHE Project Final Progress Report Survey between August 2021 and February 2025. As of January 2026, we have completed enrollment, with 265 network members in the final recruiting list. Data abstraction and analysis of the evaluation components are ongoing. Publication of findings is anticipated for December 2026. Evaluation findings will be disseminated after completion of data analysis. The findings will provide insights on whether structured IS support through CHESHIRE increases researchers' IS competencies, interinstitutional partnerships, and research productivity. This evaluation will provide empirical evidence to guide the development and optimization of technical assistance hubs in public health research and inform their future evaluation of hub-based IS capacity-building models. Findings will inform strategies to optimize IS capacity building and accelerate the translation of evidence-based interventions into practice, especially in HIV prevention and treatment. DERR1-10.2196/91374.
Sleep disorders represent a significant public health burden associated with cardiovascular and neurocognitive morbidities. While AI technologies offer potential for personalized sleep medicine, clinical integration remains limited. This translational disparity is often attributed to a lack of human-centered design, specifically insufficient stakeholder engagement in the development and implementation of these technologies. Current research frequently prioritizes algorithmic performance over usability and patient trust. This scoping review systematically maps the extent and nature of human-centered AI (HCAI) research within sleep medicine across different AI modalities, evaluating how diverse stakeholders are involved in the design, validation, and implementation of AI tools, including patients, clinicians, and technologists. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we searched 8 databases (PubMed, Web of Science, Embase, Scopus, IEEE Xplore, ACM Digital Library, APA PsycINFO, and CINAHL) for literature published up to June 18, 2026. We identified primary research describing the design, development, or evaluation of AI technologies for sleep health with explicit human-centered components. Included studies (n=34) were categorized based on AI technology type and the method of stakeholder engagement. Data were extracted and synthesized using a thematic analysis approach. Based on the included studies, the analysis reveals an uneven distribution of research focus across technological domains as descriptive patterns rather than definitive trends. Research on generative AI (GenAI) is predominantly restricted to downstream expert auditing of output accuracy (comprising 7/11, 64% of GenAI studies), with a noticeable gap in upstream participatory design involving patients. Conversely, deep learning research primarily focuses on technical explainable AI methods to address algorithmic opacity for clinicians, yet lacks progression to real-world clinical implementation. Mobile health and wearable technologies (17/34, 50%) demonstrate the most balanced HCAI ecosystem, evidencing a complete translational cycle from upstream co-design to downstream clinical implementation. Furthermore, an emerging trend is observed where AI is evolving from an automated diagnostic tool into an interactive therapeutic agent, with recent studies indicating that lay users may perceive responses from large language models as more empathetic than those from physicians. Lacking formal quality appraisal, our findings reflect research activity patterns rather than confirmed clinical effectiveness. Nevertheless, this scoping review innovatively applies the HCAI framework to the sleep AI lifecycle. Unlike existing reviews prioritizing algorithmic performance metrics over usability, clinical workflow integration, and patient trust, this study systematically maps these essential sociotechnical factors. It contributes to the field by revealing distinct methodological disparities and the urgent need for upstream participatory design, particularly for GenAI. In the real world, establishing standardized protocols for human-AI interaction, ensuring algorithmic transparency, and addressing demographic biases are essential to foster the clinical trust required for effective AI adoption.
Supporting youth and their caregivers during the transition from pediatric to adult health care is a priority across Canada. Many transition in care (TiC) innovations exist, yet these innovations often fail to be effectively implemented and/or sustained. Knowledge translation (KT) interventions, such as developing educational materials and identifying champions, are used to promote the uptake of innovations into clinical practice. However, there is limited information on what, when, and how these KT interventions are used to implement and sustain TiC innovations. This paper presents the protocol for a realist review aiming to understand what KT interventions work, how they work, for whom, and under what circumstances to support the implementation and sustainability of TiC innovations for youth moving from pediatric to adult health care. The objectives are to (1) identify and map KT interventions and (2) develop initial program theories. We will follow Pawson's 5 iterative steps for realist reviews, integrating aspects of rapid realist review methodology. We will adhere to the RAMESES (Realist and Meta-narrative Evidence Syntheses-Evolving Standards) quality standards for realist synthesis. Using an integrated KT approach, we will leverage the lived and professional expertise of a team of knowledge users and researchers. This project has received funding from Canadian Institutes of Health Research, starting in January 2026. A research partner team of 24 people with lived and professional expertise in transition has been assembled, as well as a team of 18 scientific members. Step 1 of the review is underway. The review is anticipated to be completed within 12 months. Using a theory-driven approach, this realist review will result in initial program theories about the underlying mechanisms, contextual factors, and processes within KT interventions that influence implementation and sustainability outcomes of TiC innovations for youth and their caregivers. A subsequent explanatory mixed methods realist evaluation with a multiple comparative case study design will test and refine initial theories. This research will be important to inform future TiC innovations for diverse health contexts across Canada and beyond.
Alcohol use disorder (AUD) is a complex, chronic medical disease wherein patients have traditionally benefited from a multidisciplinary and comprehensive therapeutic approach, including a comprehensive treatment plan that addresses the psychological, behavioral, and social dimensions of the individual. Holistic health is a nontraditional system of wellness that focuses on well-being through body, mind, and spirit and aims to restore balance through combined physical, mental, and emotional care. This approach may incorporate nonpharmacological and alternative treatments alongside allopathic medicine. In recent years, there has been a growing interest in integrating holistic health strategies into addiction treatment. The primary objective of this scoping review is to identify and characterize holistic health interventions currently used in the management of people with AUD. A secondary objective is to collate the reported efficacy of these interventions. Additionally, this review will identify gaps in the literature and suggest areas for future research. This review will adhere to the Arksey and O'Malley methodological framework for scoping reviews. Published research and pilot clinical trials reporting on holistic health interventions in AUD will be included. Five databases will be searched: PubMed and MEDLINE, Embase, CINAHL, Web of Science, and Scopus. There will be no date restrictions, though only English-language articles will be included. To qualify, studies must include at least one holistic intervention (eg, meditation, homeopathy, and special diets). Excluded studies will include those that do not involve people with AUD and/or hazardous drinking or that only test pharmaceutical treatments without a holistic component. Two reviewers will independently screen and extract data with a third reviewer as a tiebreaker; discrepancies will be resolved through discussion. This scoping review began in Covidence in December 2024 and is currently funded by the National Institutes of Health Intramural Research Program. Data collection was completed in February 2026, and data analysis was completed in June 2026. Results are expected to be published in late 2026. This review will provide an overview of holistic approaches and interventions used in AUD treatment. It will highlight gaps in the literature and recommend directions for future research. Results will be submitted for publication in a peer-reviewed journal. No ethics approval is required because the review involves only publicly available literature.
African American and Black women are among the least physically active demographic groups in the United States and experience disproportionate burdens of chronic disease that may be reduced through regular physical activity (PA). Mixed methods research is increasingly used to examine the behavioral, social, and contextual factors that influence PA in this population. This study aims to identify, examine, and describe the mixed methods designs used in research on PA practices among African American and Black women in the United States; compare methodological approaches; identify gaps in the literature; and provide recommendations for future research. This scoping review will follow Joanna Briggs Institute methodology. A 3-step search strategy was developed and peer reviewed using the Peer Review of Electronic Search Strategies guideline. Seven databases will be searched: Academic Search Ultimate, Agricultural and Environmental Science Database, APA PsycINFO, CINAHL Ultimate, PubMed, SocINDEX, and SPORTDiscus. Eligible studies will be primary mixed methods investigations involving non-Hispanic African American or Black women aged ≥18 years residing in the United States. Studies must include both quantitative and qualitative components with evidence of integration. Records will be deduplicated and screened in Rayyan according to population, concept, and context eligibility criteria. Data will be summarized using descriptive statistics, tables, and an evidence map. The review will be limited to English-language studies published from February 1, 2011, through February 18, 2026. The protocol was registered with the Open Science Framework. The search strategy was piloted, refined, and finalized on February 18, 2026. Database searching has been completed, records have been imported and deduplicated, and screening is currently ongoing. Data extraction and synthesis have not yet commenced. Completion of study selection, data charting, and synthesis is anticipated by August 2026, with submission of the completed scoping review planned thereafter. This review will provide a methodological map of mixed methods studies examining PA among African American and Black women, including design types, integration strategies, timing, prioritization, use of joint displays, and reporting practices. Findings will inform future mixed methods research and support the development of more rigorous and transparent investigations in this field. Open Science Framework 10.17605/OSF.IO/NA9ME; https://osf.io/na9me/overview. PRR1-10.2196/93012.
Therapist-guided internet-delivered cognitive behavioral therapy (guided iCBT) is increasingly implemented in routine mental health care to expand access to evidence-based treatments. Although the clinical effectiveness and patient acceptability of guided iCBT for common mental health disorders are well established, less is known about how introducing such digitally mediated interventions reshapes therapists' everyday work practices and professional roles. Existing research has primarily focused on treatment outcomes, service uptake, and organizational implementation challenges, leaving therapists' lived professional experiences and role enactment in routine practice underexplored. This study aimed to explore how the introduction of guided iCBT in routine clinical practice influences mental health care professionals' perceptions and enactment of their professional roles, and to examine how these roles are shaped by interactions between technology and health care professionals. We conducted an exploratory qualitative study using semistructured interviews and observations with 31 health care professionals who delivered guided iCBT in specialized mental health care settings between January and December 2022. Participants were recruited through purposive and snowball sampling, and data were analyzed using reflexive thematic analysis. The study was theoretically informed by actor-network theory and sociological perspectives on professional roles, enabling a sociotechnical interpretation of how professional work is shaped through interactions between human and nonhuman actors. Two overarching themes described how guided iCBT reconfigures therapeutic work. First, participants reported increased professional agency through enhanced flexibility and autonomy, including greater control over work schedules and opportunities to tailor standardized treatment elements to individual patients. Second, the therapist's role expanded beyond traditional clinical tasks, encompassing increased administrative responsibilities ("the administrative therapist") and expectations to actively promote and legitimize guided iCBT to patients ("the professional salesperson"). While guided iCBT enabled more flexible and individualized care, it also introduced new constraints through standardized protocols, digital platforms, and organizational expectations, resulting in professional discretion and authority being actively negotiated rather than simply reduced or maintained. This study offers a practice-oriented, sociotechnical account of how guided iCBT is implemented in routine care. The findings show how therapists' roles are shaped by everyday clinical workflows, in which responsibility, decision-making, and clinical judgment are distributed among therapists, patients, digital platforms, treatment protocols, and organizational arrangements. The concept of distributed therapeutic authority offers a useful lens for understanding how therapeutic work is reorganized in digitally mediated care without implying a loss of professional expertise. Professional judgment remains central but is exercised in interaction with digital tools and standardized treatment structures. These findings underscore the importance of aligning digital systems, clinical routines, and professional roles when implementing guided iCBT to support both access to care and the quality of therapeutic practice.
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the Middle East and Africa (MEA), with a rising incidence particularly among women. Regional factors such as limited health care access, cultural barriers, and sex-specific risk factors exacerbate this burden. Despite this, women remain significantly underrepresented in cardiovascular research, and no large-scale, multicenter prospective trials have been conducted to provide national data. To address this gap, we established the Middle East African Registry Women Cardiovascular Disease (MEA-WCVD) to create a comprehensive database on the epidemiological profile and management of heart failure (HF), atrial fibrillation (AF), ischemic heart disease (IHD), and valvular heart disease (VHD) in women. The primary aim of this study is to compare the management of CVDs in women and men across MEA countries in accordance with current clinical practice guidelines. The study also seeks to identify gender-based disparities in health care insurance, income, and access to cardiovascular services. The MEA-WCVD is a prospective, multicenter, observational study enrolling consecutive patients aged ≥18 years with diagnosed HF, AF, IHD, or VHD across 25 tertiary care centers. Participants provide informed consent during a single visit, and trained investigators collect sociodemographic, clinical, and treatment data via electronic case report forms. The electronic case report form captures general characteristics (age, gender, and comorbidities) and diagnosis-specific details (imaging, guideline-based therapies, and complications). Data are stored in a centralized, contract research organization-managed database (Eshmoun-Clinical Research, Tunisia). An initial 75-day enrollment phase (May 2023-July 2023) is followed by a planned 1-year follow-up for outcome analysis. Data will be analyzed using SPSS (version 25) to compare gender disparities in management and outcomes using multivariable regression and survival analyses. The MEA-WCVD study was funded in April 2023, and data collection began in May 2023. As of July 2023, a total of 15,366 participants have been enrolled across 25 centers. A 1-year follow-up is expected to be completed by July 2024. Data analysis is planned to commence in July 2024, with primary results anticipated for publication in March 2025. The study aims to establish the largest registry in the MEA region for HF, AF, IHD, and VHD, providing valuable insights into demographic trends, clinical management, and adherence to current guidelines. The MEA-WCVD registry will provide essential real-world data on the management and outcomes of the most prevalent CVDs (HF, AF, IHD, and VHD) in the MEA region. By directly comparing standard care management between men and women, this study will highlight gender disparities and inform future strategies for equitable cardiovascular care. The registry is expected to contribute to the largest contemporary cohort of patients with CVD in the region, advancing knowledge in cardiovascular epidemiology and clinical practice.
TikTok is one of the fastest-growing social media platforms in the world. It has become an important space for sharing information on a wide range of topics, including medical conditions such as atopic dermatitis (AD). Advice on skin conditions has become popular on TikTok, and most previous research in this area focuses on the credibility of the information being shared. However, little research has focused specifically on physician-created videos and their audience engagement and interaction. Our study aimed to (1) characterize the audience's online response to board-certified physicians' TikTok content related to AD according to established protocols and (2) better understand the interactions that happen among members of the audience in the comment section of this content. In December 2023, searches were conducted for the terms "atopic dermatitis" and "eczema" on 3 unique TikTok accounts to identify videos created about AD by board-certified dermatologists. A total of 28 final videos were analyzed and classified into the following categories: (1) explanation of disease, (2) recommendation, (3) debunking misinformation, and (4) informal or anecdotal. The top 50 original comments on each of the 28 videos were collected and classified into one of the following categories: (1) "positive personal experience," (2) "negative personal experience," (3) "neutral personal experience," (4) "requesting advice," (5) "learning," (6) "appreciative reaction," (7) "critical reaction," (8) "giving advice," (9) "humor," (10) "tagging another user," and (11) "off-topic." Replies to comments were also analyzed and grouped into similar categories. Video category did not have a significant impact on engagement rate (P>.99). Across all video categories, comments that involved personal experiences or sharing information made up a larger percentage than those that were critical or off-topic (P<.001). Of the comments related to personal experience, the percentage of negative personal experience comments was significantly higher than that of positive personal experience comments (P=.001). Among replies to comments, "recommendation" and "emotional support" replies were significantly more common than other types of replies (P<.001). Our study suggests that videos created by dermatologists on TikTok are generally well received regardless of video style or category. The comment sections appear to provide transient supportive environments where users connect over shared challenges and exchange personal experiences and recommendations. There is a gap in dermatologist-produced TikTok content involving darker skin tones.
Nurse-initiated management of antiretroviral therapy (NIMART) has expanded access to life-saving antiretroviral therapy and enhanced the decentralization of HIV care. The psychobiological and psychosocial responses of nurses implementing this strategy have been largely underexplored. This scoping review aims to systematically map the extent, nature, and characteristics of the existing literature on the psychobiological and psychosocial responses of NIMART-trained nurses providing care to people living with HIV. The review will be conducted in accordance with the Joanna Briggs Institute methodology and the population, concept, and context (PCC) framework, which will guide the development of the review question and define the eligibility criteria. A comprehensive search strategy will be used to identify empirical studies published between 2010 and 2026 across electronic databases (PubMed, SABINET, PsycInfo, CINAHL, Scopus, and Google Scholar). Two independent reviewers will screen the titles and abstracts to determine which studies are eligible. If there is any disagreement, a third reviewer will resolve it. Data will be analyzed using narrative synthesis and thematic mapping to identify patterns, knowledge gaps, and implications for future research, practice, and policy. The review is expected to identify the scope, trends, and gaps in the literature on psychobiological and psychosocial responses among NIMART-trained nurses. The estimated outcomes will include a synthesis of existing evidence. The scoping review was initiated in July 2025, and is expected to be completed by the end of July 2026. This scoping review will provide an evidence-based understanding of the psychobiological and psychosocial responses of NIMART-trained nurses, highlighting implications for policy, practice, workforce support, and future research.
Pharmacotherapy for common mental disorders is frequently limited by adverse events and suboptimal adherence. While music therapy offers a promising nonpharmacological alternative, its clinical utility is currently constrained by limited accessibility, inconsistent efficacy, and a lack of mechanistic clarity. This study aims to describe the development of individualized (receptive) music therapy (IMT), an artificial intelligence (AI)-enabled, neuroscience-guided intervention, and to evaluate its efficacy, safety, and underlying neurobiological mechanisms in adults with major depressive disorder, generalized anxiety disorder, and primary insomnia. This multistage research program is being conducted at Peking Union Medical College Hospital and comprises four sequential studies: (1) a cross-sectional pilot study (n=20) to benchmark clinical and electroencephalography features, (2) a prospective cohort study (n=80) evaluating the efficacy and safety of nonindividualized receptive music therapy, (3) a pilot randomized clinical trial (n=300) comparing nonindividualized therapy with IMT over 8 weeks, and (4) a prospective validation study (n=60) of a treatment-response prediction model. Participants include adults aged 18 to 60 years with mild-to-moderate major depressive disorder, generalized anxiety disorder, or primary insomnia, along with healthy controls. In the nonindividualized arm, participants engage in daily 30-minute listening sessions using therapist-curated instrumental tracks designed to regulate mood. In the IMT arm, an AI generation pipeline creates bespoke instrumental tracks based on weekly participant preferences regarding tempo, instrumentation, and emotional valence. To equalize participant-researcher contact across arms and reduce attention and expectation bias, participants in the nonindividualized arm complete a weekly music-experience questionnaire matched in length and timing to the IMT arm's weekly preference assessment, and treatment credibility and outcome expectancy are measured at baseline in both arms. The primary outcomes are the response rate at 8 weeks (defined as ≥50% reduction in Montgomery-Åsberg Depression Rating Scale [MADRS], Hamilton Anxiety Rating Scale [HAMA], or Pittsburgh Sleep Quality Index [PSQI] scores) and changes in quantitative electroencephalography characteristics. Secondary outcomes include changes in MADRS, HAMA, and PSQI scores from baseline to 8 weeks. Ethical approval was obtained from the Ethics Review Committee of Peking Union Medical College Hospital (I-24PJ0689). Written informed consent will be obtained from all participants. The recruitment started on May 24, 2024, and the study is expected to be completed by December 2027. Results will be disseminated via peer-reviewed publications, conference presentations, and stakeholder communications. Authorship will follow the International Committee of Medical Journal Editors (ICMJE) criteria. The participant-level dataset will be available upon reasonable request. This protocol outlines a translational framework designed to address the "therapeutic ceiling" of traditional music therapy. By integrating generative AI with neurophysiological monitoring, this program aims to develop a scalable, precision-medicine approach to mental health care that is both clinically effective and biologically grounded.
Older adult care systems face severe workforce shortages, rising demands, and high levels of stress and burnout, undermining the quality of care and organizational resilience. Support4Resilience (S4R, 2024-2028) aims to improve working conditions and mental well-being by equipping leaders with an evidence-based, organizational-level intervention. The project develops and evaluates a digital S4R Toolbox consisting of 3 tools: (1) mapping and identification (MAP); (2) reflection and education (IMPROVE); and (3) reorganization (REMOVE). The project aims to strengthen resilience and mental well-being among health care workers and informal caregivers in older adult care across Europe and Australia through the development and implementation of the digital S4R Toolbox. Secondary objectives are identifying determinants of resilience and mental well-being across diverse contexts; exploring needs and perspectives that inform successful adaptation to changing working conditions and ethical challenges; designing the S4R Toolbox; evaluating its relevance, effectiveness, and cost-effectiveness across health care systems; advancing theory on the relationship among individual resilience, organizational resilience, and leadership; and producing research-based recommendations and interventions through the open-access S4R Resource Bank. S4R applies an exploratory, longitudinal, mixed-methods co-design approach across 4 phases. The input phase gathers evidence through literature reviews, context mapping, and qualitative and quantitative data collection in 7 countries. The co-design and prototype testing phase involves developing the S4R Toolbox and conducting pilot testing. The implementation, evaluation, and finalization phase includes a 1-year implementation period, followed by process, effectiveness, and cost-effectiveness evaluations and final refinement of the Toolbox. The output phase disseminates the results through the open-access S4R Resource Bank. The project has achieved substantial early progress, including 5 literature reviews, completed and published context mapping, and comprehensive data collection involving health care workers, leaders, and informal caregivers in 7 countries. Toolbox development is well advanced, and pilot testing has been completed. S4R will deliver a research-based digital Toolbox that supports leaders in strengthening the resilience and mental well-being of health care workers and informal caregivers in older adult care. By integrating the perspectives and experiences of leaders, health care workers, and informal caregivers, identifying resilience factors, and developing theory-informed, cost-effective interventions, S4R will provide actionable resources through an open-access platform, contributing to more resilient older adult care systems. ClinicalTrials.gov NCT07504042; https://clinicaltrials.gov/ct2/show/NCT07504042. DERR1-10.2196/73701.
From July 2024, Australian pharmacists are remunerated through federal funding to practice on-site within aged care homes. This Aged Care On-site Pharmacist (ACOP) program is novel in both Australian and international practice, aiming to improve the quality use of medicines for vulnerable older persons through medicines governance, person-centered medication reviews, and more. In this program, pharmacists are embedded in facilities and health care teams, varying from historical Australian models where they are visiting health care professionals. Distinct from pharmacist practice in hospital and community pharmacy, the role is professionally isolated from other pharmacists, limiting opportunities for peer collaboration and practice-specific professional development. Peer learning, mentorship, and workplace-based learning opportunities are considered integral for health professional development. This project aims to co-design a training program that provides a pathway to professional development for ACOPs aligned with the diverse interests of stakeholders, including health care professionals, residents, and informal caregivers. Focus group-style co-design workshops and stakeholder consultations will be used in this project. The "Double Diamond" framework will be used to structure the process, using 4 stages of alternating convergent and divergent exploration of stakeholder perspectives. A consumer advisory group has been engaged, consisting of persons with lived experience of aged care settings, for consistent observation and overarching guidance of the project. Exploratory workshops with pharmacists, allied health and medical professionals, residents, and families of residents will be conducted. Workshops will be audio- and video-recorded, transcribed verbatim, and analyzed using thematic analysis. Insights obtained from overarching themes as well as individual perspectives will be used to design a pilot program, which will be presented and discussed for feedback during follow-up focus groups. A pilot phase will then be undertaken with ACOPs, who will be further involved in feedback and workshop-style focus groups to collaboratively refine the program. Funding for this project was granted through the Medicines Research Future Fund on March 27, 2023. Recruitment for preliminary phases began in January 2025, and data collection began in March 2025. Data collection is expected to end in October 2026. Ethics approval for this study was granted on December 19, 2024, by the University of South Australia Human Research Ethics Committee. Recruitment has exceeded the initial estimates of minimum participant involvement. Output data are expected to be available in early 2027. This will be the first co-designed workplace-based training program available for pharmacists undertaking the novel and complex role of ACOPs. It is expected to benefit the development of clinical and nonclinical skills, facilitate integration into existing teams, and offer a pathway to professional recognition.
With shorter window periods than serologic point-of-care (POC) tests and faster turnaround than laboratory-based nucleic acid tests (NAT), POC NATs could improve early detection of HIV. Furthermore, semiquantitative POC NAT may provide real-time monitoring for persons with HIV. There have been limited evaluations of POC NAT implementation in the United States. This paper describes the protocols and procedures used to evaluate the acceptability and feasibility of POC NAT implementation and test performance in clinical and community settings in Seattle, Washington. The Greater Access and Impact through POC NAT (GAIN) study was a Centers for Disease Control and Prevention-funded study that enrolled participants at a Ryan White-funded, hospital-based clinic (Madison Clinic) and a community site (Seattle's LGBTQ+ Center [the Center]). Persons seeking HIV testing, nonoccupational postexposure prophylaxis, or pre-exposure prophylaxis (PrEP) enrolled at either site received the standard of care plus the SAMBA II HIV-1 Qualitative Whole Blood Test (SAMBA Qual) and pooled laboratory HIV NAT, and persons with HIV enrolled at the Center received standard-of-care sexually transmitted infection testing plus the SAMBA II HIV-1 Semiquantitative Whole Blood Test (SAMBA Semi-Q) and laboratory viral load testing. Persons with HIV from Madison Clinic were recruited into a randomized clinical trial (RCT) to compare the clinical standard of care with the addition of the SAMBA Semi-Q (backed up by Food and Drug Administration-approved laboratory NAT). All participants completed a demographic survey during their study visit and contributed prospective data via electronic medical records. Subsets of participants from each group were invited to complete a postvisit acceptability survey and participate in an individual interview. Patient flow was observed at Madison Clinic to assess the impact of POC testing on clinic visit timing. From January 2022 to December 2024, 733 participants completed 753 GAIN research visits. Of those, 491 visits were completed by 489 participants seeking HIV testing and/or PrEP at the Center, and 61 visits were completed by 43 participants seeking HIV testing, nonoccupational postexposure prophylaxis, and/or PrEP at Madison Clinic. Test result data will assess test performance, with analyses anticipated in 2027. Seven people with HIV were enrolled at the Center, and 194 people with HIV were enrolled in the Madison Clinic RCT. Data from patients with HIV at Madison Clinic will be used to conduct a survival analysis evaluating the impact of POC NAT on time to viral suppression and to assess test performance, with analyses anticipated in 2026. In-depth acceptability surveys were completed by 193 participants, and 41 interviews were conducted. These data will contribute to qualitative and mixed methods analyses, which are anticipated in 2026. Time-and-motion observations conducted in 2021 and 2023 included 47 patients; results are anticipated in 2026. The GAIN study is an important evaluation of POC NAT implementation in the United States in community and clinical care settings for HIV diagnosis and viral load monitoring. Results will be reported in future publications.
Comorbid anxiety and depression in patients with multiple sclerosis (MS) are common, conferring a greater risk of poorer outcomes and increased health care costs. Few MS services include scalable treatment pathways for psychological distress. This study aims to conduct a real-world longitudinal study evaluating the implementation and potential effectiveness of an integrated pathway involving digital screening for psychological distress and COMPASS-MS, a therapist-guided digital cognitive behavioral therapy tailored to the challenges of living with MS. This is a mixed methods, observational, real-world, longitudinal study being conducted in the United Kingdom. Routine mental health screening in the MS clinic will identify patients experiencing distress (using predefined clinical cutoffs), who will be assessed for eligibility for psychological treatment, including the COMPASS-MS program. Participants will receive COMPASS-MS online over approximately 12 weeks (including up to six 30-min therapist sessions). The implementation, reach, and adoption of the treatment pathway within a specialist MS service will be assessed using aggregate data on the uptake of mental health screening, eligibility, and consent rates for COMPASS-MS, as well as the number of COMPASS-MS sessions completed. Interviews with patients and health care professionals will primarily assess the scalability and potential or actual barriers and facilitators of the new pathway. Potential effectiveness will be assessed using participant questionnaires at preintervention and 12 weeks postintervention. The primary effectiveness outcome will be pre-post changes in distress (Patient Health Questionnaire Anxiety and Depression Scale scores). Quantitative data will be summarized using descriptive statistics and mixed effects models. Qualitative data will be analyzed using reflexive thematic and framework analysis. Recruitment of both patients and health care professionals began in June 2024. For patients, recruitment was completed as of September 2025, including 82 participants. For health care professionals and stakeholders, as of September 2025, 7 had consented and completed interviews, and 13 more were expected to be recruited by August 2026. Data analysis has not yet started; however, quantitative results are expected by September 2026. The study findings will inform treatment pathways that can be incorporated into MS clinics and highlight adaptations or implementation protocols required to increase future scalability and effectiveness.
Digital applications based on health care conversational agents (HCAs) are increasingly being developed to support health care provision. The usability and user experience of these solutions are critical determinants of their acceptability and, consequently, their impact on health-related outcomes. This systematic review aims to synthesize current evidence on the use of valid and reliable subjective instruments for assessing the usability and user experience of HCAs and to examine whether assessment outcomes vary according to their technical characteristics. A systematic search was conducted in PubMed, Web of Science, and Scopus from inception to February 2026. Studies were included if they used subjective instruments to evaluate the usability or user experience of HCAs. A total of 127 studies met the inclusion criteria. The studies examined 3 categories of HCAs-text-based, voice-based, and embodied-applied to patient care, health education and prevention, health data collection, and support for daily activities among older adults. The System Usability Scale (SUS) was the most frequently used assessment instrument. Comparative analysis of SUS scores indicated higher usability ratings for text-based HCAs relative to voice-based and embodied systems. However, SUS and other subjective instruments used in the included studies may not fully capture key dimensions of usability and user experience of HCAs. Additionally, substantial heterogeneity was observed in assessment methodologies across studies. Comparative analysis suggested that text-based HCAs were associated with significantly higher SUS scores than voice-based and embodied HCAs. However, this finding should be interpreted with caution given the substantial heterogeneity across the included studies in health care application domains, study designs, evaluation contexts, participant populations, and HCAs' implementation and use characteristics, as well as the limitations of the SUS in evaluating the usability of modern HCAs. The variability in assessment approaches underscores the need for standardized protocols and the development of more context-specific evaluation frameworks to enhance methodological consistency and comparability across studies.
Small island developing states (SIDS) are home to approximately 65 million people worldwide. SIDS have some of the highest rates of cancer mortality burden in the developing world. Disparities in cancer mortality could be attributed to reliance on services overseas, which is a common feature across SIDS due to limited resources for comprehensive cancer care on the islands. However, overseas travel for cancer care remains largely understudied in SIDS, and epidemiological data on the implications on cancer survivorship are lacking. We aim primarily to map patterns of overseas travel for cancer care among cancer survivors in Caribbean SIDS and examine the lived experiences of cancer survivors and caregivers. Additionally, we will explore how overseas travel may affect key domains of cancer survivorship. We will conduct a multicountry, cross-sectional study using a convergent mixed methods design. We will establish a sample of 900 cancer survivors residing in the islands of Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia, and Saint Vincent. Eligible participants will be adult cancer survivors who have accessed health services in their island of residence due to cancer. Sites for recruitment will be cancer support groups and hospitals. Surveys will be conducted face-to-face. For every country visited for diagnosis and/or treatment, we will record the services accessed and motives for the choice of country. We will compute the proportions of patients traveling for cancer care by country of destination. We will use regression models to explore associations with time to treatment and lifestyle factors (after treatment). In-depth interviews (n=24) and focus groups (n=54 participants) will be conducted with cancer survivors and caregivers to learn about overseas travel with an emphasis on social support systems. Open-ended questions and prompts will assess aspects of the day-to-day logistics and travel arrangements and experience living overseas. We will use an inductive thematic analysis approach to identify and interpret patterns. Planning and development to implement the logistics for data collection were started in February 2023. We started with pilot testing in September 2024, and we have recruited 113 cancer survivors as of May 31, 2026. We envisage active patient recruitment and data collection until March 31, 2029, across all participating countries. This is the first multicountry study on overseas travel on cancer care in Caribbean SIDS. Our work will produce evidence that will inform recommendations to fill performance gaps in transnational systems for cancer care in the Eastern Caribbean that will improve patients' lives. It is an important first step to developing data resources for high-quality research in understudied SIDS.
Infections with respiratory viruses such as SARS-CoV-2 and influenza are significant international public health concerns. While patients with cancer remain the most vulnerable group, they show poor vaccine response in general. Immunological data in this population are limited and mainly focus on serological parameters. However, in these patients, cellular, and especially T-cell, responses often seem to be induced more reliably than humoral responses. To gain further insights into vaccine-induced immunity, the RESPONSE study will analyze the effect of early and late booster vaccination on humoral and cellular responses, with special focus on T cell-induced immune responses. In addition, we aim to investigate factors influencing humoral and cellular vaccine-induced immunity in patients with hematological and oncological malignancies, including state of disease, treatment, and demographic factors. Humoral immune responses will be assessed by measuring binding and neutralizing antibodies using standardized assays. Cellular immunity will be evaluated using functional assays such as flow cytometry and FluoroSpot, as well as in-depth analyses using additional exploratory assays as appropriate. Immune responses will be correlated with clinical parameters, including disease status, treatment, and demographic factors. This study was initiated following ethics approval and is currently recruiting participants. Enrollment commenced on March 25, 2025, and is ongoing, whereas biosample collection and follow-up visits are nearing completion for most participants. Final data cleaning, dataset integration, and statistical analyses of adaptive immune responses are planned from the third quarter of 2026 onward. This study intends to lay a foundation for a structured translational research platform on vaccination to aim for best protection from infection by different respiratory pathogens. Long-term objectives are reaching best possible protection from vaccine-preventable disease with a first focus on influenza infection. In addition, we plan to investigate vaccine-induced immune responses to the recently approved respiratory syncytial virus vaccine using this platform and possibly extend this to further vaccines in the future. Urgent questions, such as the influence of different targeted therapies on vaccine immune response, will be part of these projects. ClinicalTrials.gov NCT06612515; https://clinicaltrials.gov/study/NCT06612515. DERR1-10.2196/88520.
Hypnosis is a focused state of consciousness that enhances concentration, attention, and responsiveness to suggestion. It has shown efficacy in treating psychiatric disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD). However, its potential for addressing burnout and related symptoms remains underexplored. This systematic review and meta-analysis aims to assess the effectiveness of hypnotherapy in alleviating symptoms of burnout and associated conditions, including depression, anxiety, and PTSD. This study aims to evaluate the efficacy of hypnotherapy in treating burnout and its related psychopathologies, including depression, anxiety, and PTSD. A comprehensive search was conducted across PubMed, Scopus, and PsycINFO for peer-reviewed, English-language observational and experimental studies published up to February 2024. Only studies with adults (>18 y) who received hypnotherapy for psychiatric symptoms will be included. Data extraction will focus on treatment effects related to burnout and associated psychiatric conditions. Statistical analysis will be performed using Comprehensive Meta-Analysis (version 4.0). A random-effects model will be used to account for heterogeneity, with Cochran Q and I² statistics used to assess variability. Subgroup analyses will explore moderators such as sociodemographic factors, country, and study quality. Sensitivity analyses will identify influential studies, and publication bias will be assessed using funnel plots and the Egger test. All analyses will be 2-sided (P<.05), and the results will be presented in forest plots. The search strategy underwent a PRESS (Peer Review of Electronic Search Strategies) review in December 2023 and was registered in PROSPERO (International Prospective Register of Systematic Reviews) in January 2024. Database searches were completed between February and April 2024, followed by title and abstract screening from May to November 2024. Full-text screening began in December 2024, with data extraction conducted from January through April 2025. A preliminary narrative synthesis was completed between May and August 2025. Quantitative analysis began in September 2025 and is ongoing, with completion anticipated in early summer 2026. The final findings are expected to be submitted for publication by fall 2026. This review aims to synthesize existing evidence on the potential role of hypnotherapy for burnout and related psychiatric symptoms. This systematic review will provide an updated synthesis of evidence on hypnotherapy for burnout and associated psychological outcomes. Limitations include variability in study designs and measurement tools. The results will be disseminated through peer-reviewed journals and scientific meetings to guide future clinical and research applications.
Patient navigation is a critical component of health care delivery, facilitating connections with appropriate services. A new era of virtual navigation systems has emerged, with systems that can be accessed through websites or smartphone apps. However, it is unknown which features of these novel systems impact patient outcomes. The objective of this scoping review is to understand the current landscape of existing virtual navigation systems. In this review, we will determine the features of these systems, as well as the patient outcomes and accessibility barriers associated with them that have been reported in the literature. This review will follow the guidelines for scoping reviews outlined by the Joanna Briggs Institute methodology. This will include systems that provide recommendations for health care, mental health and addiction services, and social services. This will include systems designed for patients, caregivers, and/or care providers. A search strategy will be used to locate both published and unpublished literature. The databases to be searched include PubMed, PsycINFO (ProQuest), Cochrane Library, Web of Science Core Collection (Clarivate), Cumulative Index of Nursing and Allied Health Literature (EBSCO), ScienceDirect, IEEE Xplore, and ACM Digital Library. Papers will be screened and selected, and data will be extracted by 2 independent members of the research team. The extracted data will primarily focus on outcomes and features of the virtual navigation systems. This will include the information they ask of users and the content and format of the information on services they provide. Funding for this project was received in May 2024. As of June 2026, abstract and full-text screening have been completed, data extraction is underway, and data analysis has not begun yet. Our search resulted in the retrieval of 14,461 studies that were eligible for screening. We anticipate that the full scoping review manuscript will be prepared for submission by winter 2027. Results will be presented in tabular format and accompanied by a narrative summary. This review will synthesize the current literature on virtual navigation systems that aim to connect patients to appropriate health care services. By identifying trends and gaps, this review will provide critical information for the development of new and innovative systems that can support health care and public health systems.