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Fatigue is common in many long-term medical conditions. Interventions to date have largely been in single conditions. To conduct a mixed-methods evidence synthesis of the clinical and cost-effectiveness and acceptability of non-pharmacological interventions for fatigue in adults with long-term medical conditions. Randomised controlled trials, cost-effectiveness studies, or qualitative studies of non-pharmacological interventions for fatigue in long-term medical conditions where fatigue was either a criterion for inclusion, the primary target of the intervention, or the primary or coprimary outcome. Studies of post-infectious, post-traumatic, cancer-related or idiopathic fatigue were excluded. Searches used the MEDical Literature Analysis and Retrieval System, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association PsycInfo® (American Psychological Association, Washington, DC, USA) databases. We used systematic CLUSTER searching for qualitative studies and Epistemonikos for systematic reviews. We held three rounds of five focus groups involving people with fatigue in long-term conditions to ensure that assumptions in, and reporting of, the research had validity with the patient population. Risk-of-bias assessment of all studies included in the network meta-analysis was undertaken using an adapted version 2 of the Cochrane risk-of-bias tool for randomised controlled trials. Clinical effectiveness evaluation used random effects network meta-analyses at three time points. The cost-effectiveness analysis involved a de novo analysis of interventions identified as clinically effective. The qualitative synthesis involved a thematic synthesis of primary studies of interventions and a mega-synthesis of reviews of patient experience of fatigue across different conditions. Focus groups were analysed by thematic analysis, and findings from all work packages were integrated in a final synthesis by the research team. The clinical effectiveness review included 88 randomised controlled trials, involving 27 interventions, with 6636 participants included at end of treatment, 1849 in the short term and 2322 in the long term. Compared to usual care at long-term follow-up, cognitive-behavioural therapy-based interventions and physical activity promotion showed statistically significant reductions in fatigue (standardised mean difference -0.4, 95% credible interval -0.63 to -0.21, 9 studies; and -0.52, -0.86 to -0.18, 2 studies), respectively. Effective interventions provided positive net monetary benefit versus usual care, particularly when delivered in a group format, when valuing a quality-adjusted life-year at £20,000. Individuals vary in their experience of fatigue in ways that are not simply due to their medical condition, indicating that interventions need to be adaptable to individuals' experiences and capabilities. The evidence base is relatively small, heterogeneous and includes studies at moderate to high risk of bias. More than half of the included trials were in multiple sclerosis. Interventions for fatigue that support people to increase physical activity or are based on cognitive-behavioural therapy are acceptable and effective in reducing fatigue in people with different long-term medical conditions, with the potential to be cost-effective. Based on the qualitative synthesis, we propose a three-stage component model for interventions. Future trials should focus on the feasibility and effectiveness of transdiagnostic fatigue services, fatigue interventions in multimorbidity, and investigations of emerging non-invasive stimulation interventions. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR154660. We looked for research studies of non-drug treatments for fatigue in people with long-term medical conditions. We brought together the best evidence from studies of clinical effectiveness, cost-effectiveness, people’s experience of these treatments and people’s experience of fatigue in different conditions. We ran focus groups with people with fatigue and long-term medical conditions. This meant we could match the research findings with the experience of people in the United Kingdom. Treatments for fatigue which support people to increase physical activity or deliver cognitive–behavioural therapy-reduced fatigue. The effect was moderate but enough to make a difference for most people and across different conditions. Some treatments were not effective. We also found reports of new treatments that might work but need more testing. Providing effective treatments costs the health services but produces measurable improvements. Group interventions cost less to deliver and may have other advantages. There is no one-size-fits-all treatment – treatments should match the person and their situation. People’s experience of fatigue can differ, even compared to others with the same condition. Fatigue is often an invisible problem. The people in our focus groups told us they would like their professionals to tell them more about fatigue and about the non-drug treatments that may work. We now know more about non-drug interventions that work and do not work for fatigue in long-term medical conditions and that there is variation between people with the same condition. Health professionals need to recognise and respect this. Our research has shown some promising options, and we want more people to access these.

Inter-professional education (IPE) is recognized as best-suited strategy to improve health professionals' collaborative competencies, leading to improved patient outcomes. However, assessment of attitude of healthcare professionals towards these competencies is also important for developing effective strategies for promoting inter-professional collaboration. The present study was designed to assess IPE collaborative (IPEC) competencies of healthcare professionals including physicians, nurses and pharmacists in Pakistan. A descriptive cross-sectional study design was used to assess IPEC competencies of 500 healthcare professionals i.e. (physicians, nurses, and pharmacists) working in tertiary care healthcare facilities located in 4 cities of Pakistan were selected using convenient sampling technique. A pre-validated tool IPEC self-assessment was used for data collection. After data collection, data was analyzed statistically. The mean scores of healthcare professionals regarding IPEC Competencies were calculated for total items in which mean score of nurses was highest (67.34 ± 0.52), followed by pharmacists (66.24 ± 0.58) and then doctors (65.88 ± 0.44). The results depicted higher IPEC competencies in all the health professionals. On both the domains i.e., inter-professional values and inter-professional interaction, nurses outscored both pharmacists and doctors with mean scores 34.46 ± 0.26 and 32.88 ± 0.28 respectively. The findings indicate that healthcare professionals in Pakistan generally demonstrate positive attitudes toward inter-professional collaborative competencies, with nurses showing comparatively higher scores across both inter-professional values and inter-professional interaction domains. Although the overall competency levels were encouraging, the variation across professional groups suggests the need for more targeted efforts to strengthen collaborative practice among all disciplines. Integrating structured IPE and training into clinical and academic settings may help bridge these gaps and further enhance teamwork, ultimately supporting better patient care outcomes.

Interprofessional collegiality reflects mutual respect, empathy and solidarity among different health professionals. Limited studies have explored interprofessional collegiality in Uganda. This study was conducted to determine the magnitude of interprofessional collegiality among healthcare workers in Eastern Uganda. We used a mixed-methods study design. The study was conducted among healthcare workers in two institutions in Eastern Uganda. We used the Practice Environment Scale to assess interprofessional collegiality among a sample size of 136 healthcare workers. The Likert Scale was used to assess the different dimensions of interprofessional collegiality. Ethical approval was obtained. Descriptive statistics were used for quantitative data, while thematic analysis was used for qualitative data. The majority of the participants were nurses/midwives (48%), allied health professionals (40%) and medical doctors (11%). The majority (65%) of participants strongly agreed and agreed that there was effective interprofessional collaboration in their workplace. Participants strongly agreed/agreed that there were good working relations (60%) and good teamwork (56%) between nurses/midwives and medical doctors. However, uncivil behaviours were common among healthcare workers, including psychological/emotional abuse (78%), physical abuse (4%), and sexual abuse (4%). In a qualitative study, uncivil behaviours occurred in the form of cold wars, name-calling, political interference, silent hatred, psychological stress, demotivation, absenteeism, and poor work relations. Poor collegial relations occurred from the individual (gender bias, perceived lack of capacity, poor supervision and leadership), interpersonal (lack of interpersonal respect, perceived lack of role clarity) and institutional factors (workload, poor working conditions, and maldistribution of incentives). Despite the high interprofessional collegiality reported between nurses/midwives and medical doctors, workplace abuse among healthcare workers was high in our setting. Policymakers could prioritise strategies that address individual, interpersonal and institutional factors that result in poor work relations among healthcare workers.

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.

Despite evidence and guidelines supporting rehabilitation, people with dementia experience limited access due to health professionals' attitudes, knowledge gaps, and systemic barriers. The INCLUDE package is an interdisciplinary online training programme and Community of Practice (CoP) designed to address these barriers. The aim of this study was to evaluate the impact of the INCLUDE package on health professionals' knowledge, attitudes, confidence, advocacy, and practice change in dementia rehabilitation. A pre-post longitudinal study involved two groups of health professionals across Australia. Group 1 (n = 103) completed the online training and an 8-month CoP; Group 2 (n = 373) completed training only. Surveys administered at pre-training (T1), post-training (T2), and 10-month follow-up (T3; Group 1 only) assessed knowledge, attitudes and confidence towards dementia and dementia rehabilitation. Multilevel mixed-effects regression models were used to examine changes over time. Content analysis was used to explore advocacy, practice changes, barriers, and sustainability. 476 health professionals participated. The largest groups were physiotherapists (n = 121, 26.7%), occupational therapists (n = 120, 26.5%) and nurses (n = 37,13.6%). The Dementia Attitudes Scale (coefficient 10.4, 95% CI 9.4-11.4), Dementia Rehabilitation Questionnaire (3.8, 95% CI 3.0-4.5), and Confidence in Delivering Dementia Rehabilitation Scale (3.2, 95% CI 2.8-3.5) improved from T1 to T2. In Group 1, improvements in attitudes towards dementia and confidence in rehabilitation were sustained at T3, but knowledge and attitudes towards dementia rehabilitation declined from T2 to T3. Participants advocated for dementia rehabilitation and made changes in their workplace including revising rehabilitation access criteria, advertising dementia rehabilitation to referrers, and developing interdisciplinary programs. The INCLUDE package improved health professionals' attitudes, knowledge and confidence in dementia rehabilitation. Although participants made changes in their workplace, barriers still existed. Organisational and system-level changes are also required to improve access to dementia rehabilitation. This study is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12623001029684.

This review examined 28 studies to understand how political economy analysis (PEA) is conceptualized and applied in health. Definitions of political economy varied, with only 11 studies offering explicit definitions. Most commonly, political economy was framed as the study of power, interests, institutions, and ideas shaping health policy processes and outcomes. Applications ranged from analysing structural determinants of health to understanding stakeholder influence in health reforms. Across studies, 31 distinct frameworks and theories were used. Frequently employed models included Campos and Reich's Political Economy of Health Financing Reform Framework, Harris's Applied PEA, and the DFID and World Bank 'How-to' notes. Theoretical underpinnings were drawn from economics, political science, and sociology-such as historical institutionalism, stakeholder theory, and discursive institutionalism-highlighting the interdisciplinary nature of PEA. Health issues analysed through a political economy lens primarily included health financing, governance, human resources for health, and service delivery. PEA was used to explore challenges such as policy reform feasibility, institutional capacity, health workforce equity, and donor dependency. The rationale for applying PEA included uncovering the influence of actors, navigating complex political contexts, and enhancing policy implementation. Overall, PEA in health is marked by conceptual diversity and methodological pluralism. Its growing application reflects the need to understand the interplay of politics, institutions, and economics in addressing systemic health challenges.

Adolescents with rare diseases and their families navigate challenges that extend well beyond clinical symptoms, intersecting with educational, social, and structural constraints. In this qualitative study, we examined the lived experiences of adolescents with rare conditions, their caregivers, and healthcare professionals, focusing on the interpersonal and systemic factors that shape well-being and form care pathways within the Greek National Healthcare System (NHS). A constructed interpretive framework for this study integrates ecological, dialogical, and relational dimensions of rare disease experiences. Ten focus groups were conducted, each including two adolescents, two parents, one to two pediatricians and one allied health professional (physiotherapist, speech therapist, occupational therapist, nurse). Semi-structured group interviews were audio-recorded, transcribed verbatim and analyzed using the approach of qualitative content analysis. Adherence to the COREQ-32 criteria supported the systematic design, documentation and presentation of research findings. Analysis yielded eight themes: (a) family dynamics and caregiving burden, (b) educational and occupational challenges, (c) social participation and financial strain, (d) healthcare accessibility and effectiveness, (e) conflicting priorities among adolescents, caregivers and providers, (f) future planning and goal setting, (g) emotional strain as a shared burden, and (h) parental advocacy and activism.  Rare disease experience emerges from the interplay of structural conditions, relational processes and policy dynamics. Ecological forces shape daily life, while dialogical interactions influence how illness is understood and managed and power relations determine whose perspectives are prioritized. Despite these constraints, adolescents, families and healthcare personnel demonstrate resilience and agency, mobilizing resources and developing networks to navigate difficulties within the available healthcare settings. • Adolescent care for rare diseases is often fragmented, adult-oriented, and insufficiently responsive to young people's social, educational, and familial realities. • Young people's lived experiences and meaning-making around rare disease care remain insufficiently explored in research and practice. • An integrated adolescent care framework combines ecological context, dialogical construction of meaning, and critical reflexivity to center adolescents' voices and include the lived experiences of both families and therapists. • Through qualitative study, these concepts are translated into preliminary suggestions, offering an approach for more equitable, youth-friendly care situated in the Greek National Healthcare System.

TeleCHAT is the Comprehensive High-dose Aphasia Treatment program delivered via telerehabilitation. TeleCHAT is a complex intervention, with delivery challenges arising from its comprehensive scope and individualised therapeutic and technological requirements. Thus, training for speech-language pathologists (SLPs) in the delivery of TeleCHAT is necessary. This study aimed to evaluate the acceptability and effectiveness of a training package in equipping SLPs with the knowledge, skills and confidence to deliver TeleCHAT via telerehabilitation. Three cohorts of SLPs (n = 14) completed the TeleCHAT training package, which consisted of theoretical content and practical training. Participants completed a 13-item satisfaction survey using a 5-point Likert scale and an observation of technological skills checklist (OTSC) post-training. Video recordings of four SLPs' delivery of their first TeleCHAT session was observed by researchers. The SLPs' independence delivering therapy was rated using the OTSC. Quantitative and qualitative data were analysed using descriptive statistics (mean, standard deviation and range) and content analysis, respectively. Data from each cohort informed improvements to the training package for the next cohort. Participants self-rated as moderately to totally independent in the use of telerehabilitation technology post-training, with high levels of understanding, confidence and preparedness of delivering TeleCHAT. Observations of SLPs' first TeleCHAT sessions demonstrated total independence with delivering TeleCHAT and troubleshooting technological issues. Content analysis revealed suggestions to improve (a) the content and (b) the structure and delivery of training. The theoretical components transitioned to self-paced online modules to address the time constraints in SLPs' workload for Cohorts 2 and 3. The training package was well received by participants. Multimodal learning approaches, practical training and specificity of the components of the intensive, comprehensive aphasia program were essential in building confidence in SLPs. What is already known on the subject There is evidence to suggest that formal training equips clinicians with the necessary knowledge and skills for delivering services via telerehabilitation. Existing studies primarily provided content-based learning but promoted the inclusion of practical and observational training components to build clinician confidence in telerehabilitation. What this paper adds to existing knowledge This study highlights the importance of multimodal and specific training, emphasising practical training to build clinician confidence in delivering complex and specialist interventions, such as ICAPs, via telerehabilitation. It also provides an example of the design of a clinician training package for telerehabilitation based on behaviour change theory. What are the potential or actual clinical implications of this work? The findings of this study advocates for the integration of practical training and content tailored to the specific intervention in telerehabilitation services. By focusing on these aspects in training, clinicians are better prepared to deliver telerehabilitation services, thereby enhancing patient care outcomes.

Breast cancer is the most commonly diagnosed malignancy worldwide. Breast cancer survivors face an increased risk of cardiovascular disease (CVD), a leading cause of death in this group. Social determinants of health (SDoHs), operationalized as economic, environmental, and psychosocial factors, play an important role in CVD disparities. However, few studies have examined how SDoHs are associated with CVD disparities in this population, and no systematic review has addressed their multilevel influences. This systematic review summarizes the current evidence on the relationships between SDoHs at different levels and CVD disparities among breast cancer survivors. Using the 2024 American College of Cardiology/American Heart Association framework, SDoHs were categorized at the individual, interpersonal, or community levels. Studies published in peer-reviewed journals between January 1, 2010, and November 30, 2025, were identified through searching electronic databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO) and citations. Of 6550 unique records, 37 articles that addressed the impact of SDoHs on CVD outcomes were selected. Most (n=31) were conducted in the United States and used retrospective designs (n=29). Most (n=30) focused on individual-level SDoHs such as race, income, or education; 2 on interpersonal-level SDoHs (ie, psychosocial stress); and 13 on community-level SDoHs, including neighborhood socioeconomic status and residential area. Black race, lower neighborhood socioeconomic status, and rural residence were associated with a higher incidence of CVD and increased cardiovascular death. This review highlights the urgent need to address SDoHs and emphasizes the importance of multilevel interventions to reduce CVD disparities among breast cancer survivors.

People experiencing homelessness (PEH) face multiple barriers to seeking healthcare and have poorer health outcomes. Point of care tests (POCTs) provide a potential solution to improving access to diagnostics for this population. This survey aimed to understand if these technologies could address unmet needs in primary care for PEH. An online survey was circulated via dedicated inclusion healthcare newsletters to professionals providing community-based care for PEH in England. The survey focused on experiences of diagnostics and opinions on the use of POCTs for this population. Thirty-two healthcare workers participated, including GPs, nurses and other allied practitioners from 13 different Integrated Care Boards across England. Descriptive analyses were performed using standard statistical parameters. A reflexive thematic analysis was performed on free-text responses. There was evidence of current POCT use but with marked variation across services as to which tests are available. Healthcare workers were overwhelmingly positive about the potential for POCTs, with rapid results facilitating prompt diagnosis and management, increasing likelihood of engagement. C reactive protein testing was considered as the test, which could confer the most benefit to acute care, with renal function and troponin also being discussed, whereas tests to determine cardiometabolic risk were thought to have the most patient benefit in chronic care. Point of care ultrasound for diagnosis of respiratory pathologies and deep vein thrombosis and POCTs for malnutrition were suggested as potential future technologies to address unmet healthcare needs. The majority of responders expressed that enhancing the provision of POCTs would be beneficial, both in acute and chronic care scenarios, due to the benefits of getting rapid results and reducing the need for repeat appointments or onward referral for diagnostics.

What is the effect of group exercise-based telerehabilitation compared with a single session of in-person assessment and advice on health-related quality of life in cancer survivors? What are the effects on activity, function, safety and cost-effectiveness? An assessor-blinded, pragmatic randomised controlled trial with embedded cost analysis, concealed allocation and intention-to-treat analysis. Adult cancer survivors with any cancer diagnosis who were receiving treatment or within 12 months of treatment completion. The experimental group received an 8-week, twice-weekly, physiotherapist-led exercise group via videoconferencing, supplemented with support resources and a single in-person session of assessment and advice (TeleCaRe). The control group received a single in-person session of exercise assessment and advice. Assessments were completed at baseline, after the intervention (week 9) and at follow-up (week 26). The primary outcome was health-related quality of life, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, at week 9. Secondary measures were walking capacity (6-minute walk test), physical activity (accelerometer), self-efficacy (Health Action Process Approach Questionnaire), adverse events, and health service and cost data. In total, 117 participants were recruited. Their mean age was 59 years, 82 (70%) were female, and 47 (40%) had breast cancer. Participants attended an average of seven out of 16 sessions (SD 6). There were no major adverse events. Intention-to-treat analysis found that TeleCaRe was not superior for improving quality of life (MD -5.3 units, 95% CI -13.3 to 2.6) or any secondary outcomes. TeleCaRe cost AU$363 per participant. Group exercise-based cancer telerehabilitation was safe but attendance was poor. The addition of telerehabilitation to assessment and advice was not superior to a single in-person physiotherapy session alone for improving quality of life. ACTRN12621001417875.

For people in old age, the risk of limitations in activities of daily living (ADL), low physical performance, and chronic diseases increases. Home rehabilitation targeting physical performance is a common intervention for older people with multimorbidity. Still research on home rehabilitation is mainly diagnosis specific. The objectives of this study were to summarize intervention components and evaluate the effects of home rehabilitation on ADL and physical performance in community-dwelling older people (65 years or older) with low physical performance and/or ADL difficulties. The databases MEDLINE, Web of Science, and CINAHL (January 2006-September 2025), plus references were screened, using keywords related to aging, home rehabilitation, ADL, and physical performance in randomized controlled trials (RCTs). RCTs of supervised home rehabilitation, targeting physical performance and/or basic and/or instrumental ADL (BADL/IADL) in community-dwelling people 65 years of age or older with low physical performance and/or ADL difficulties. scope of specific diagnoses, assisted living settings, centre-based, interventions areas outside the occupational therapy or physiotherapy disciplines, mainly delivered by home help service staff, exclusively outcomes outside the scope of ADL and physical performance conducted at home or non-English publications. 3,360 records were screened independently by two reviewers. Data extraction followed the PROSPERO protocol. Methodological quality was assessed using the Joanna Briggs Institute RCT checklist (2020) (JBI), and certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Random effects models generated pooled effects. The review included 27 RCTs (n&#x2009;=&#x2009;4,948), which were grouped into three intervention approaches. Twenty-three studies were graded as having low risk of bias, three as moderate risk of bias, and one of high risk of bias, using the JBI tool. The age of the participants ranged from 74 to 87 years of age. Activity-based interventions improved BADL (n&#x2009;=&#x2009;1,048, SMD 0.29, 95% CI 0.17 to 0.41, P<.001; moderate evidence) but not IADL (n&#x2009;=&#x2009;603, SMD&#x2009;-&#x2009;0.15, 95% CI&#x2009;-&#x2009;0.31 to 0.01) or selected ADL tasks (n&#x2009;=&#x2009;158, non-significant). Exercise-based interventions improved BADL and physical performance (n&#x2009;=&#x2009;310, SMD 0.43, 95% CI 0.21 to 0.66, P<.001; n&#x2009;=&#x2009;1,472, SMD 0.20, 95% CI 0.10 to 0.30, P<.001), with low evidence due to imprecision and risk of bias according to GRADE. Reablement-based interventions showed no significant effects on selected ADL tasks measured with Canadian Occupational Performance Measure (COPM) (n&#x2009;=&#x2009;291, COPM performance MD 0.30, 95% CI&#x2009;-&#x2009;0.25 to 0.86; COPM satisfaction MD 0.19, 95% CI&#x2009;-&#x2009;0.04 to 0.42) or physical performance (n&#x2009;=&#x2009;555, SMD 0.12, 95% CI&#x2009;-&#x2009;0.05 to 0.28), with low to very low evidence according to GRADE. Home rehabilitation comprises three main intervention approaches. The Activity-based and Exercise-based yield small improvements in BADL and physical performance. Evidence for other ADL outcomes and the Reablement-based remains limited. PROSPERO (CRD42023488726).

Previous research highlights that people with specific dietary needs, such as texture-modified diets for dysphagia, often struggle to find suitable food in the community. However, few studies have investigated food service professionals' role in remedying this barrier. The current study aimed to understand food service professionals' perspectives and experiences accommodating dietary requests, with a specific focus on texture modification for dysphagia. Using a qualitative descriptive approach, food service professionals from a range of contexts (n = 13) engaged in semi-structured interviews about their personal experiences and perspectives on accommodating dietary requirements. Through reflexive thematic analysis, four themes were identified: (1) consumer demand for dietary modifications drives change in the food service industry; (2) factors that facilitate accommodating dietary modification requests; (3) a lack of knowledge and training about dysphagia exists in the food service industry; and (4) accommodating dietary needs requires a collaborative approach. Modification requests are becoming increasingly common in the food service industry and are resulting in menu and service changes. The lack of awareness and knowledge about dysphagia among staff highlights the need for speech-language pathologists to collaborate with both the food service industry and people with dysphagia, to improve accessibility of suitable food. What is already known on this subject Previous literature has identified the challenges faced by individuals with dysphagia in accessing appropriate food in the community. However, there is a distinct lack of research exploring the perspectives of the food service industry in accommodating this population. What this study adds to existing knowledge With an aim to address this gap in knowledge, the current study investigated the perspectives and experiences of food service professionals in providing texture modified foods for this consumer group. The results indicated that the overall lack of education and training for food service professionals about dysphagia is contributing to reduced knowledge and awareness about how to make appropriate dietary accommodations. What are the clinical implications of this study? As such, there is a strong need for speech-language pathologists to collaborate with the food service industry to improve accessibility of suitable foods, and work with clients with dysphagia to educate and assist them in accessing suitable foods within commercial settings. It is hoped that the findings from this study will support the development of appropriate and relevant education and training initiatives about texture modification for the food service industry.

Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman's rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies.

Out-of-home care experienced young people have elevated mental health needs, yet their mental health help-seeking remains insufficiently understood. Understanding help-seeking is critical for identifying barriers and facilitators that shape whether, how and from whom care-experienced young people seek and access mental health support. Existing syntheses are limited in scope and have under-represented quantitative evidence, residential care, care leavers and equity-relevant subgroups. This review will synthesise international evidence on sources, barriers and facilitators of mental health help-seeking among care-experienced young people. This mixed-methods systematic review and meta-analysis protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and informed by Preferred Reporting Items for Systematic Review and Meta-Analyses-Equity. Electronic searches will be undertaken in PsycINFO, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, Social Sciences Citation Index, Social Policy and Practice, Health Management Information Consortium, ProQuest Dissertations & Theses Global, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus and Child Development and Adolescent Studies, alongside grey literature and citation searching. Eligible studies will include qualitative, quantitative and mixed-methods research involving care-experienced young people aged 13-25 years, including care leavers, and studies reporting help-seeking initiated by young people or on their behalf by adults, carers or professionals. Quantitative and qualitative evidence will be synthesised separately before narrative integration. Meta-analysis will be considered where independent quantitative studies report sufficiently comparable populations, outcomes and effect measures; otherwise, findings will be synthesised narratively using Synthesis Without Meta-analysis (SWiM) guidance. Qualitative findings will be synthesised using thematic synthesis. Study quality will be appraised using the Newcastle-Ottawa Scale, Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool. Equity-relevant characteristics will be extracted where reported, informed by the PROGRESS-Plus framework. Care-experienced young advisors have informed the wider programme and this review, and will contribute to interpretation and dissemination. Ethical approval is not required as the review involves secondary analysis of the existing evidence base. Findings will be disseminated through peer-reviewed publication, conferences, webinars and accessible outputs co-developed with care-experienced young people. CRD420251047424.

Lung cancer remains a major contributor to cancer mortality in sub-Saharan Africa (SSA), where late diagnosis, driven by low awareness, sociocultural barriers, and health system constraints, limits effective treatment. Despite the growing burden, evidence on patients' quality of life (QoL) and symptom experience in SSA is limited. This study aimed to describe the common symptoms and QoL of patients with lung cancer treated at 2 hospitals in SSA, and to investigate the association of demographics, clinical characteristics, and symptom burden with QoL. This was a cross-sectional study that consecutively recruited patients with lung cancer from 2 teaching hospitals in SSA: Bugando Medical Centre (BMC) in Tanzania and the University of the Witwatersrand Centre of Respiratory Excellence (WITS-CORE) in South Africa. Data collected included demographics, clinical information, and performance status using the Eastern Cooperative Oncological Group Performance Scale (ECOG-PS). Health-related QoL was assessed using the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The study followed all ethical procedures, and data were analyzed using both descriptive and inferential statistics in Stata 18. A P value of <.05 was considered statistically significant. A total of 174 patients with lung cancer were enrolled across the 2 sites. The score on the EORTC QLQ-C30 global health status/QoL subscale was low, with a median of 41.67 (IQR 33.33-41.67), and it varied by site. Patients from WITS-CORE demonstrated higher social functioning scores, while those from BMC reported greater financial difficulties. A low global health status/QoL score was independently associated with the BMC site (adjusted odds ratio [aOR] 3.5, 95% CI 1.3-9.3) and poor performance status (ECOG-PS 3-4; aOR 3.4, 95% CI 1.2-6.6). Furthermore, symptoms such as nausea and vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea, and financial struggles were all associated with a low global health status/QoL score. QoL among patients with lung cancer in SSA is poor. Low QoL is strongly associated with the Multinational Lung Cancer Control Program study site, poor performance status, and a range of symptoms and financial difficulties. Addressing these factors may help to improve patient outcomes and well-being in SSA.

Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are closely linked. Affected groups present with similar symptoms and share many risk factors (eg, poverty-related factors, smoking, occupational exposures). PTB is itself an independent risk factor for chronic lung disease. However, in many high TB-incidence settings health services for these conditions are provided separately, with little integration of prevention, diagnosis or care. We describe a transdisciplinary programme of research investigating strategies for integrated TB-CRD care in Arusha, Tanzania, Nairobi, Kenya and Lagos, Nigeria, using clinical, health economic, health systems and qualitative research methods. A prospective clinical cohort study will describe the burden and impact of non-TB respiratory disease (eg, asthma, chronic obstructive pulmonary disease, post-TB lung disease) among adolescents and adults presenting to primary and secondary health facilities with chronic cough who would normally be managed via TB care pathways. Health economics methods will explore patient costs of non-TB respiratory disease, facility-level costs of integrated TB/respiratory diagnostics and will develop a modelling framework to estimate the costs and consequences of integration more broadly. In-depth interviews, focus group discussions, observations and participatory methods will be used to explore lived experiences of chronic respiratory symptoms, disease and exposures among patients and providers, and to identify and address challenges around respiratory health and care. Lastly, existing TB and CRD healthcare services and systems in our three research sites will be described, and local, national and policy level understandings of 'integration' of TB and CRD care will be explored. Together, the findings of this work will be used to develop context-informed model(s) of integrated TB-CRD care and a theory of change and framework for evaluation in future implementation studies. Ethical approval has been obtained from Imperial College London in the UK, the Scientific Ethics Review Unit in Kenya, University of Lagos in Nigeria and the National Institute of Medical Research in Tanzania. Findings of this study will be presented in research publications and symposia, and will be shared with local communities and stakeholders.

Hormonal intrauterine device (IUD) is an effective contraceptive method with high user satisfaction rates. To guide the introduction of hormonal IUD into the public sector in Tanzania, an operational research study was conducted to assess client acceptability of hormonal IUDs. To explore clients' perspectives on contraceptives and experiences with hormonal IUDs. This observational mixed-methods study (2023-2024) used focus group discussions with current or future contraceptive users (N&#x2009;=&#x2009;58, baseline), plus facility register reviews, a structured quantitative survey (N&#x2009;=&#x2009;100, endline) and semi-structured in-depth qualitative interviews (N&#x2009;=&#x2009;18 at midline 2, N&#x2009;=&#x2009;15 at endline) with hormonal IUD clients. Register and survey data were analysed for descriptive statistics. Qualitative data was analysed thematically and triangulated with quantitative data. In total, 1,198 clients chose hormonal IUD during the eight-month study. At baseline, women had limited knowledge and several concerns about IUDs and emphasised the importance of good contraceptive counselling. Client satisfaction with hormonal IUD at six months post-insertion was high (93% were strongly or somewhat satisfied). Most (92%, 83% and 100%) clients were strongly satisfied with the counselling, follow-up care and removal services received, respectively. Hormonal IUD clients found the characteristic of localised release of hormones possibly offering a better side-effect profile than other hormonal methods appealing. Hormonal IUD clients showed high satisfaction with the method and care received throughout the study. The authors recommend introduction of hormonal IUD into the public sector in Tanzania, with investments in community awareness, male engagement, and strengthening the quality of contraceptive counselling and side effects management. Main findings: Hormonal intrauterine devices were highly acceptable to women accessing family planning services at primary health care level in TanzaniaAdded knowledge: While other studies have found high acceptability of hormonal intrauterine device across several settings, this was the first such study conducted in Tanzania. It strengthens the evidence base that hormonal intrauterine devices are acceptable to clients across different contexts and adds new insight into features of hormonal intrauterine devices that women in Tanzania found appealing or concerning, which can help tailor counselling materials and provider training materials.Global health impact for policy and action: This study contributes to the global literature supporting high acceptability of hormonal intrauterine devices among women across a range of contexts and provides insights on how to align comprehensive counselling on contraceptive options with women&#x2019;s needs.

Poor outcomes of odontogenic infections usually increase the length of stay (LOS) in hospitals, and the cost of treatment increases substantially. The LOS of patients with odontogenic infections is not set in stone. In clinical practice, it is observed that cost, certain medications and treatments, age and a plethora of factors influence this. However, it is unclear which factors have direct effects on it. As such, evidence-based interventions become difficult. The study utilised a retrospective observational approach and a total population sampling technique to investigate 286 out of the 811 patients admitted at the allied ward of STH from 2021 to 2025. Data was extracted from the Lightwave Health Information Management System and analysed with IBM SPSS 27, Claude (Anthropic, version Sonnet 4.6) and Python (Version 3.12). A total of 286 patients were included, with a mean hospital length of stay (HLOS) of 9.28 &#xb1; 4.21 days. Necrotising fasciitis and Ludwig's angina were associated with the longest admissions. On proportional odds ordinal logistic regression, severe infection classification (OR 25.39, 95% CI: 4.21-153.32) and necrotising fasciitis (OR 9.36, 95% CI: 3.87-22.61) were the strongest independent predictors of prolonged HLOS (all p < 0.001). HIV/AIDS, diabetes mellitus, hypertension, Ludwig's angina and male sex were also significant independent predictors. The model demonstrated strong explanatory power (Nagelkerke R2 = 0.686, p < 0.001). All predictor variance inflation factors were below 2.5, indicating no multicollinearity concerns. Infection severity, primary diagnosis, immunocompromising comorbidities and surgical interventions were the principal independent determinants of prolonged HLOS. Multispace involvement showed a crude association with extended HLOS but did not emerge as an independent predictor in the adjusted ordinal regression model. Early diagnosis and prompt, multidisciplinary management are crucial to reducing hospitalisation and improving patient outcomes.