There is considerable variability in the management of acute burns globally, including differences between low- and middle-income countries (LMICs) and high-income countries (HICs). This study aimed to describe global surgical burn care practices through an international survey, providing insight into diagnostic, debridement, and coverage techniques and their timing. An online survey was developed and distributed to burn surgeons worldwide, focusing on the management of four patient cases and standard practices. The survey was developed and tested in collaboration with burn care experts, and distributed via email. One respondent per hospital performing burn surgery was permitted to prevent duplication. Data were analysed using descriptive statistics, Fisher's exact tests and Chi-square tests, with responses categorised by country and regional economic status. Burn surgeons from 106 burn units across 50 countries completed the survey, achieving a 44% response rate. Early surgical debridement (<48 h) was most commonly referred to as standard care, although definitions of early grafting differed. LMICs and HICs differed in the availability of diagnostic tools, enzymatic debridement, and wound coverage techniques. Further regional differences were observed among HICs in Europe, North America, and Oceania, highlighting diverse approaches to burn care worldwide. This study offers a global overview of acute surgical burn management, showing both universally common practices and significant regional variations between LMICs, HICs, and continents. The broad heterogeneity in surgical timing and techniques highlights the need for further research.
. To assess antibiotic prescribing patterns and quantify antibiotic use in secondary care hospitals in South India using a point prevalence survey, and to generate baseline data to support antimicrobial stewardship initiatives and national AMR surveillance efforts. . A point prevalence survey (PPS) was conducted between April-September 2025 across 12 secondary care hospitals in India. All inpatients present at 8:00 am on the survey day were included. Data included patients' characteristics, antimicrobials received, and therapeutic indications. . Among the 359 patients surveyed, 196 (54.6%) received at least one antibiotic, with hospital-level prevalence ranging from 24% to 100%. Most antibiotics were administered parenterally (84.8%), and respiratory infections (20.9%) were the leading indication. Empirical therapy accounted for 53.1% of prescriptions. Broad-spectrum antibiotics, predominated. Culture sensitivity testing was documented in 28% of cases, reflecting limited microbiological support. AMS programs were largely absent. According to WHO AWaRe classification, 74.2% of prescriptions were from Watch group, and only 22.1% from Access. . Antibiotic use in secondary care hospitals shows high variability and suboptimal practices, underscoring the need for strengthened AMS, improved diagnostics, and better guideline adherence.
Health guidelines are commonly used by clinicians that practice in the out-of-hospital setting (paramedics, emergency medical technicians, and first responders) to inform clinical decision-making. The specific development techniques used to generate these documents however is currently unclear. To address this, we conducted an anonymous online cross-sectional survey of developers of out-of-hospital health guidelines to determine how current practices compare with guidance contained within the Guidelines International Network (GIN)-McMaster Guideline Development Checklist (GDC). This survey was comprised of binary and open-ended questions that were based upon the 18 topics and 146 steps contained within the GIN-McMaster GDC. Following data collection, we performed a qualitative content analysis which involved grouping responses into categories based on the observed similarities and differences. A total of 104 developers of out-of-hospital guidelines completed the survey, with 34% (35/104) reporting familiarity with the GIN-McMaster GDC and 8% (8/104) having used this resource during guideline development. Overall, 61% (63/104) of respondents reported developing guidelines de novo, while 48% (50/104) and 40% (42/104) had used adaptation and adoption techniques. When developing recommendations, most respondents reported using standardised wording (78/104, 75%), including the certainty of evidence (61/104, 59%), and the strength of the recommendation (60/104, 58%). Conversely, only a small proportion of respondents reported monitoring how recommendations were applied in practice (46/104, 44%), creating performance measures or quality indicators (34/104, 33%), and pilot testing with end-users prior to implementation (25/104, 24%). In this cross-sectional survey, we describe how the current practices of developers of out-of-hospital health guidelines align with the GIN-McMaster GDC. This information will be used to inform the development of a contextualised extension of this checklist to strengthen guideline development processes in this field.
Physical activity (PA) is crucial for maintaining bone mass. However, it remains unclear whether the "weekend warrior" (WW) pattern, namely condensing moderate-to-vigorous physical activity (MVPA) into 1 or 2 days per week, is beneficial for bone health. This study aimed to assess the association between the WW pattern and risk of low bone mass and related fractures. We conducted a population-based study based on two nationwide databases, including 6972 participants aged 20-59 from the National Health and Nutrition Examination Survey (NHANES), 2007-2010 & 2013-2014 cycles, in which PA was self-reported via the Global Physical Activity Questionnaire; and 52,989 participants aged 37-60 years from UK Biobank (UKB), in which PA was measured by wrist-worn accelerometers over 7 days (2013-2015). In both surveys, lumbar spine and femoral neck bone mineral density (BMD) were assessed by dual-energy X-ray absorptiometry (DXA). Associations were analyzed using survey-weighted linear regression (in NHANES), multivariable linear regression (in UKB), and Cox proportional hazards models for incident fracture (in UKB). In NHANES, both the WW pattern and the regular active (RA) pattern were associated with higher femoral neck BMD compared with the inactive group (WW: β = 0.021, 95% CI 0.008-0.035, P = 0.004; RA: β = 0.015, 95% CI 0.007-0.023, P = 0.001), and both were associated with significantly lower odds of low bone mass. In UKB, similar favorable BMD associations were observed, and the WW pattern was associated with a lower hazard of incident fracture compared with both the inactive group (HR = 0.899, 95% CI 0.824-0.981, P = 0.017) and the RA group (HR = 0.897, 95% CI 0.823-0.976, P = 0.012). Meeting weekly PA guidelines is associated with favorable bone health indicators and lower fracture risk, regardless of whether activity is concentrated on weekends or distributed throughout the week. The WW pattern may serve as a time-efficient alternative for bone health maintenance.
This narrative review examines the emerging role of glucagon-like peptide-1 (GLP-1) receptor agonists in reproductive medicine, combining a narrative review of current literature with novel investigational pilot survey data from women seeking fertility care. The survey explores perceptions regarding weight, and weight loss methods including use or awareness of GLP-1. The integration of these perspectives reveals the potential for significant gaps between patient awareness and provider communication regarding these medications, while highlighting their potential therapeutic benefits for obesity-related infertility. A narrative literature review of GLP - 1 receptor agonists in reproductive medicine. An IRB approved anonymous investigational pilot survey to evaluate weight loss perceptions and methods used by those seeking care in a single academic infertility clinic. Narrative literature review with clinic recommendations was completed. Our findings demonstrate that while 86% of patients were aware of GLP-1 medications, only 19.3% had substantive discussions with healthcare providers despite 84.2% attempting weight loss in the past year. This disconnect occurs within a context where emerging evidence suggests GLP-1 receptor agonists may offer unique advantages for fertility optimization through weight loss, metabolic improvement, and potential direct reproductive effects.
In Anglo-Saxon countries, clinical pharmacy (CP) is an integrated component of routine multidisciplinary care in intensive care units (ICUs), improving patient safety and health care efficiency. In France, despite the 2024 SFAR-SFPC joint recommendations, CP development in ICUs remains poorly documented. This study aimed to map CP activities in French ICUs and to identify barriers to its development. A nation-wide survey was conducted between July 2025 and January 2026 using an online questionnaire (LimeSurvey®) distributed through national networks of intensivists and hospital pharmacists. One response per ICU was allowed. Adult, paediatric, neonatal, and mixed ICUs were included; specialised ICUs and emergency departments were excluded. Sixty-five intensivists and 42 pharmacists responded, representing 83 French ICUs. Marked geographical heterogeneity was observed. Twenty-one ICUs (25%) reported a dedicated CP presence, 33 (40%) occasional interaction, and 29 (35%) no collaboration. Median duration since implementation was 7 years (IQR 4 - 12). Core CP activities included prescription review (100%), medication dispensing and supply (89%), therapeutic drug monitoring (78%), risk management and practice optimisation (78%). Reported needs included adverse drug event management (82%), protocol development (71%), practice optimisation (69%), prescription review (68%), and cost optimisation (63%). Main barriers were financial constraints, lack of dedicated pharmacist positions, insufficient critical care pharmacy training, and limited understanding of intensivists' needs. A gap exists between identified needs and current CP availability in French ICUs, reflecting fragmented implementation. Development of ICU CP in France will require organisational support, workforce planning, and structured training programmes.
Acute malnutrition remains a major public health concern in Ethiopia, yet gaps in screening coverage hinder early detection and timely management. Through Community-based Management of Acute Malnutrition (CMAM) and its expanded Integrated Management of Acute Malnutrition (IMAM) program, Ethiopia prioritized community-level screening and referral. However, progress toward achieving full and equitable screening coverage remains limited. This study aimed to estimate the coverage of acute malnutrition screening among children aged 6-59 months in Ethiopia and to compare the screening levels between districts implementing the Integrated Management of Acute Malnutrition (IMAM) program and those not implementing it the program and further evaluate the independent effect of IMAM program implementation on screening coverage after controlling for potential confounders. A comparative cross-sectional study was conducted between June and July 2023. 1,440 children between the ages of 6 -59 months from twelve districts, six of which were implementing the IMAM program and six of which were non IMAM districts were included in the study. Study participants in both IMAM-implementing and non-IMAM districts were selected using a multistage cluster sampling method. Screening coverage was estimated as the proportion of children screened for acute malnutrition out of the total eligible population surveyed. Overall screening coverage over the past three months was 52.8% among children under five. Screening coverage was significantly higher in IMAM-implementing districts compared with non-IMAM districts (56.3% Vs. 38.1%, P<0.001). In multivariable logistic regression analysis, children in IMAM-implementing districts had 61% higher odds of being screened compared to those in non-IMAM districts (AOR = 1.61, 95% CI: 1.25-2.08, p < 0.001). Screening coverage for acute malnutrition remains low in Ethiopia, with marked differences between IMAM-implementing and non-IMAM districts. IMAM implementation resulted in significantly higher screening coverage among children.
Periprosthetic joint infection (PJI) remains a major source of morbidity, mortality, and economic burden, both in the United States (US) and internationally. Understanding regional microbiology profiles in PJI is essential to assist with empiric antibiotic selection. The purpose of this study was to survey an international database to identify and compare the microbiological profile of hip and knee PJI across international sites. A multi-center, international database that included all patients admitted to participating hospitals who had a confirmed diagnosis of PJI was utilized. In the present study, data from four institutions in the following cities were retrospectively reviewed: Melbourne (AU, n = 167), Groningen (NL, n = 117), Weston (FL, USA, n = 201), and Charlotte (NC, USA, n = 180). The most common organisms identified in hip and knee PJI were compared between institutions. Rates of polymicrobial, fungal, and culture-negative PJI specifically were also evaluated. A total of 665 patients who had PJI were included (311 hip and 354 knee). Coagulase-negative staphylococci (CoNS) were the most frequently isolated pathogens across all centers (26.5 to 38%), followed by Staphylococcus aureus (13 to 27%). Rates of polymicrobial PJI were high and varied widely between institutions (14 to 51%), whereas rates of fungal PJI were low and consistent between regions (1 to 3%). The prevalence of culture-negative PJI varied between 8% (AU) and 22% (FL). While subtle regional differences in the microbiology of PJI exist, Staphylococcus species remained the dominant pathogen, accounting for nearly half of the PJIs at each center. Differences in polymicrobial and culture-negative infections emphasize the impact of institutional and geographic factors, supporting the development of region-specific empiric and prophylactic antibiotic protocols.
With the advancement of genetic medicine, opportunities to perform genetic testing in neurology practice are increasing. To address this trend, we conducted a survey on the involvement of neurologists in genetic medicine. A total of 658 respondents (9.6%) participated, and 94.4% reported experience in performing genetic testing. The increased opportunity to perform genetic testing was attributed to the recent emergence of disease-modifying therapies, which are beneficial for the early diagnosis and treatment of patients, as well as the growing need to consider reproductive options such as prenatal testing and preimplantation genetic testing for monogenic disorders. Educational opportunities aimed at improving the genetic medicine skills of all neurologists are urgently needed.
To evaluate the nutritional status of maintenance hemodialysis (MHD) patients in a large Chinese region. A multi-center cross-sectional investigation was carried out. All MHD patients received dialysis treatment from April to June 2024 in dialysis centers selected by convenience sampling within a large Chinese region were recruited. Demographic characteristics, physical parameters, and laboratory indices were collected. Protein energy wasting (PEW) was adopted as a standard for malnutrition assessment and was analyzed in accordance with geographical subgroups. A multivariate Logistic regression model was conducted to identify the influencing factors of PEW. In this study, the data of 4,618 MHD patients from 86 dialysis centers were analyzed. The prevalence rate of PEW was 33.2% (1,531/4,618). Sub-group analysis indicated that the prevalence rate was the highest in the Southern region, reaching 37% (535/1,446), and there were significant differences among different areas (Χ2=19.992, P=0.001). However, the primary manifestations were all characterized by the reduced muscle mass and muscle strength. Multivariate Logistic regression analysis demonstrated that age (OR=1.026, 95% CI: 1.021-1.032, P<0.01), sex (OR=1.185, 95% CI : 1.038-1.352, P=0.012), dialysis frequency (OR=0.842, 95% CI : 0.731-0.969, P=0.017), and hemodiafiltration frequency (OR=0.936, 95% CI : 0.896-0.978, P=0.003) were independent influencing factors of PEW. This study revealed the prevalence and manifestations of PEW among MHD patients in the large Chinese region, as well as differences and related factors in different areas. It offered certain evidence for monitoring the nutritional status and future nutritional interventions of MHD patients in this region.
Health-related quality of life (HRQOL) measures patients' overall well-being and can help guide survivorship care. Evidence comparing individual patients' HRQOL pre- and post-diagnosis is limited due to the unpredictable nature of cancer onset. Our study aims to evaluate trends in HRQOL in elderly colon cancer patients and identify predictors of HRQOL change across two key transitions: (1) pre- to post-diagnosis, and (2) at diagnosis versus 2 years later, with the goal of identifying at-risk patients for a significant HRQOL decrease. Utilizing the SEER-Medicare Health Outcomes Survey (SEER-MHOS), patients diagnosed with colon cancer between 1998 and 2019, ≥ 65 years old, and at least two HRQOL surveys were identified and grouped. Group 1 comprised patients with an initial survey pre-diagnosis and a follow-up survey within 1 year from diagnosis, while Group 2 included patients with an initial survey within 1 year from diagnosis and a follow-up survey 2 years later. Bayesian linear regression identified predictors of physical (PCS) and mental (MCS) score changes, incorporating demographic, socioeconomic, comorbidity, and cancer-related variables. The analysis included 1139 patients (Group 1: 571; Group 2: 568). PCS and MCS scores decreased substantially at diagnosis (4.4 and 2.2 points, respectively) compared to baseline but changed minimally from baseline (-0.3 and +0.6 points, respectively) 2 years post-diagnosis. Advanced disease stage and baseline ADL limitations were the strongest predictors of HRQOL decline, both from pre- to post-diagnosis and from diagnosis to 2 years later. Conversely, positive baseline health perception was protective (probability of direction > 90% for all estimates). Among colon cancer patients, patient-reported baseline health perception and functional limitations emerged as critical determinants of HRQOL trajectories, outweighing socioeconomic and treatment-related factors. These factors remain consistent upon diagnosis and during survivorship. Assessment of these factors could estimate HRQOL outcomes and facilitate early identification of at-risk patients.
Broad demographic representation is important in population-based research to enhance generalizability. The purpose of this manuscript is to describe strategies used to promote broad representation in the RISE FOR HEALTH study (RISE), consistent with its prioritized representation goals; and to compare participants to American women to gauge the success of these strategies. RISE was a large population-based cohort study of community-dwelling women selected by probability sampling of adult female residents of 57 geographically dispersed U.S. counties. Participation entailed completing self-administered surveys and an optional in-person assessment. Diversity goals and associated strategies were to: 1) ensure representation by race, ethnicity, and age similar to the U.S. population (by stratified probability sampling from a large marketing database); 2) remove barriers to participation by preferred Spanish language speakers (cultural adaptation, linguistic translation, bilingual mailings); and 3) promote diversity more broadly (marketing-style materials, community engagement). In 2024-2025, participant characteristics were compared to those of American women, using data from two national surveys (American Community Survey, National Health and Nutrition Examination Survey). 3,400 participants (of 50,367 invited) completed the baseline survey from 2022-2023 and were eligible. Consistent with the stratified sampling plan, participants were similar to the U.S. population with respect to race, ethnicity, and age. In contrast, they differed by Spanish as a primary language spoken (4.4% versus 12.9% in the U.S.) and completion of a high school degree or less (13.8% versus 35.9%). Strategies designed to promote diversity were variably successful in RISE, offering insight for future population-based research.
Contrast-enhanced CT is central to oncological imaging, yet no official guidelines exist for contrast injection protocols. As a result, practices vary widely between institutions affecting image quality and patient safety. Understanding this variability is essential to decrease this heterogeneity. This study aimed to map current oncological body CT contrast protocols in Western Switzerland. An online survey was specifically designed and disseminated by using LimeSurvey platform to 74 medical imaging institutions to collect data about: a) socio-demographic characteristics of contrast users, b) technical acquisition protocols, c) injection protocols, d) optimisation practices, e) clinical information. The survey was composed of 22 closed and 7 open-ended questions. Of the 74 institutions, 42% (31) completed the survey. Regarding the identified protocols, 74% used single-energy CT (23/31), while 26% used dual-energy CT (8/31). Regarding image reconstruction, 68% employed iterative reconstruction algorithms (21/31), whereas 32% used deep-learning-based reconstruction (10/31). Contrast volume was primarily calculated based on total-body-weight (84%; 27/31), with an average injection rate of 3 mL/s. The most used iodine concentrations were 350 mgI/mL (55%; 17/31) and 400 mgI/mL (29%; 9/31). Radiographers (90%; 28/31), radiologists (58%; 18/31) and application engineers (55%; 17/31) were the specialists most involved in protocol optimisation. Dose adjustments were reported in cases of renal impairment (70%; 22/31) and patient morphology (61%; 19/31). These results highlight a marked heterogeneity in oncologic CT practices across Western Switzerland, with significant optimization potential using technologies like spectral imaging and deep learning reconstructions. There is a need to update injection protocols in line with current technological advances, such as spectral imaging and new reconstruction algorithms. These updates should be increasingly based on evidence-based practice.
This paper reviews findings of nine large representative surveys assessing people's evolutionary acceptance and whether it relates to people's (non-) religious identities. It summarises findings of two surveys conducted within the UK and Canada in 2017 and of seven surveys conducted within the UK, Canada, Australia, US, Argentina, Spain, and Germany in 2023. Findings show that evolution acceptance is high. Dissecting the findings shows that evolution rejection might be partially driven by social cognitive processes that facilitate group boundaries. Using a social identity lens and social cognitive theories such a social-projection and counter-projection when interpreting the findings, it provides novel insights into how the perception of a necessary conflict between science and religion drives public perceptions of evolution scepticism.
Dose-response associations between moderate-to-vigorous physical activity (MVPA) and all-cause mortality are nonlinear, but estimating near-zero activity can be sensitive to exposure construction in national surveillance data. We analyzed 594,285 adults from the National Health Interview Survey linked mortality file (1997-2018) with follow-up through 2019. MVPA was quantified as moderate-equivalent minutes per week (moderate + 2×vigorous), explicitly preserving a true-zero category. Survey-weighted Cox proportional hazards models with natural cubic spline were adjusted for demographic, socioeconomic, behavioral, and health-related factors. Hazard ratios (HRs) were estimated relative to 0 minutes/week. Ten-year absolute mortality risk was estimated using inverse probability of censoring weights combined with survey weights. During a median 9.5 years of follow-up (81,689 deaths), 35.8% reported 0 MVPA. Compared with inactivity, adjusted HRs were 0.87 (95% CI: 0.81-0.93) at 5 minutes/week, 0.81 (0.80-0.83) at 150 minutes/week, 0.76 (0.74-0.78) at 300 minutes/week, and 0.74 (0.72-0.76) at 600 minutes/week. Ten-year mortality risk decreased from 19.9% (95% CI: 19.6%-20.2%) at 0 MVPA to 7.2% (6.8%-7.5%) at >600 minutes/week. Higher MVPA was associated with lower mortality across a broad range of activity volumes, with the largest gains observed when moving from none to modest activity.
Adolescent suicidal behaviors pose a critical public health challenge. This study examined the co-occurrence patterns of psychological and behavioral risk factors and evaluated their associations with suicidal ideation (SI) and suicide attempts (SA). A multicenter adolescent survey conducted in 2023-2024 (n = 19,312) collected sociodemographic, psychological, and behavioral data. Complex survey logistic regression was applied to identify factors associated with SI and SA. Latent class analysis (LCA) was used to derive psychological-behavioral risk profiles, and their discriminative performance was evaluated using logistic regression with 10-fold cross-validation. The prevalence of SI and SA was 25.41% and 8.03%, respectively. Fourteen factors were associated with SI, including resilience, social capital, hostility, depression, anxiety, maladjustment, emotional instability, psychological disequilibrium, virtual world integration, adverse childhood experiences, negative life events, sleep quality, internet addiction and alcohol use. For SA, academic stress and smoking were additionally retained, whereas anxiety, emotional instability, psychological disequilibrium and internet addiction were not retained. Four distinct profiles were identified: Low-risk/High-protection, Moderate distress, Psychological-problem dominant and High-risk/Multi-problem. Compared with the Low-risk group, adolescents in the High-risk group demonstrated substantially higher odds of SI (aOR = 15.87, 95% CI: 13.96-18.03) and SA (aOR = 11.72, 95% CI: 10.11-13.60). The LCA-based model showed good discrimination (AUC = 0.796 for SI; 0.772 for SA), outperforming single-variable models. Psychological and behavioral factors among adolescents cluster into distinct risk profiles that are associated with different levels of suicidal behaviors. These findings provide a person-centered, multidimensional perspective for understanding heterogeneity in adolescent suicide-related risk.
Artificial reproductive technologies (ARTs) are central to genetic improvement strategies in livestock, yet adoption remains inconsistent across species. In sheep, uptake has lagged behind that of cattle due to species‑specific reproductive biology, variable oocyte and embryo competence following use of exogenous hormones, economic feasibility and inconsistent success rates. This review synthesises the principles, methodological development, and contemporary performance of semen collection and cryopreservation, artificial insemination (AI), multiple ovulation embryo transfer (MOET), and in vitro fertilization and embryo production (IVF) in sheep, and integrates insights from a global survey of commercial sheep artificial breeding providers (68% response rate; N = 41) on the current size and scale of the industry. It also collates data on optimisation studies working to improve success rates in these technologies. Survey data reveal marked heterogeneity in semen processing practices, cryopreservation method, extender use, insemination dose preparation, and oestrus synchronisation protocols. Laparoscopic intrauterine AI remains the predominant technique, yielding a global weighted pregnancy rate of 71%, despite substantial site, sire, and operator‑dependent variation. MOET is widely implemented, producing an average of 6-8 transferable embryos per donor, with fresh embryo transfer outperforming frozen-thawed embryos across global regions. In contrast, IVF in sheep continues to face technical and commercial constraints related to oocyte recovery, in vitro maturation, and blastocyst development. Collectively, this review highlights critical opportunities for standardised semen assessment, optimised hormone protocols, advanced predictive analytics, and targeted commercialisation of ovine IVP systems to enhance reproducibility, efficiency, and genetic gain within the global sheep artificial breeding industry.
Conspiracy theories about COVID-19 vaccines circulated widely during the pandemic, yet their prevalence and association with vaccine refusal in sub-Saharan Africa remain poorly quantified. Understanding how global misinformation narratives shape vaccination acceptance in low- and middle-income settings is relevant to future pandemic preparedness. We conducted a cross-sectional survey between October 2023 and April 2024, recruiting 870 adults through convenience sampling across Nigeria's six geopolitical regions. COVID-19 vaccines had been available in the country since 2021, but national uptake remained low throughout this period. Structured face-to-face interviews assessed vaccine intentions, endorsement of specific conspiracy beliefs, information sources, and trust networks. Multivariable logistic regression identified factors independently associated with conspiracy endorsement and vaccine refusal. Of 870 participants, 742 (85.3%) were vaccine-hesitant, and 89.4% of these endorsed at least one conspiracy theory. Microchip or tracking device theories were the most frequently cited concern (32.1%). Overall vaccine acceptance was 14.7%. A graded inverse association was observed: each additional conspiracy theory endorsed was associated with an average 69% lower odds of vaccine acceptance (aOR 0.31, 95% CI 0.25-0.39; p for trend <0.001). In multivariable analysis, conspiracy endorsement was the factor most strongly associated with refusal (aOR 0.11, 95% CI 0.06-0.21). Its inclusion in the model substantially attenuated the coefficients for education and region, which suggests that these sociodemographic associations with refusal may be partly accounted for by differential conspiracy endorsement. COVID-19 vaccine conspiracy theories were widespread in Nigerian communities well into the national vaccination campaign, at a time of persistently low uptake, and represented the factor most strongly associated with refusal. The graded association between conspiracy endorsement and refusal, and the attenuation of sociodemographic predictors after adjustment for conspiracy beliefs, suggest that counter-misinformation strategies could be a high-yield component of future pandemic vaccine campaigns.
To describe the 2024 clinical activity of advanced practice nurses in oncology and haemato-oncology across a national cancer network, identify barriers to collecting activity indicators and propose improvements. National descriptive cross-sectional survey. An anonymous electronic questionnaire was administered in February 2025 to all advanced practice nurses working in 20 comprehensive cancer centres. It collected 2024 activity volumes based on predefined indicators, along with perceptions of their relevance and feasibility. The survey also included optional free-text fields to contextualise responses. Quantitative data were analysed descriptively, and free-text comments were reviewed to complement and clarify the quantitative findings. Fifty-three of 69 nurses responded (77%). Most qualified between 2020 and 2023. On average, 68% of time was devoted to direct clinical care, 15% to administration/coordination, 10% to teaching and 7% to research. The median number of distinct patients followed per nurse in 2024 was 266. Inpatient interventions remained limited. Respondents considered current indicators useful to quantify activity but insufficient to assess care quality; they prioritised adding patient-centred outcomes (satisfaction, adherence, unplanned hospitalisations) and harmonising/automating data capture. Main barriers were heterogeneous information systems and reliance on manual collection. Clinical activity expanded markedly and nurses play a central role in coordination and follow-up. Existing indicators are predominantly quantitative and should be complemented with outcome measures and automated capture. Enriching indicator sets with patient-reported experience and outcome measures and integrating automated collection into hospital systems will strengthen evaluation, visibility, and sustainability of advanced nursing roles. Problem: Lack of consolidated, comparable indicators to evaluate advanced nursing practice in oncology at scale. High activity volumes; barriers to indicator capture; strong demand for patient-centred outcomes and automation. Who/where it impacts: Oncology services and patients managed by advanced practice nurses across comprehensive cancer centres. The study adhered to the STROBE checklist for cross-sectional studies. This study did not include patient or public involvement in its design, conduct, or reporting.
The need to design randomized controlled trials (RCTs) with explicit intent, either pragmatic or explanatory, and matching design features is well recognised. There is a need for clear, standardised reporting recommendations for protocols for these RCTs to facilitate communication of trialists' intention and trial design choices. This protocol outlines the development process of a SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) extension applicable to RCTs where authors explicitly declare their intention for the trial. This will enhance the transparency, reproducibility, and comprehensiveness of RCT protocol reports. Using the EQUATOR Network's structured multi-phase approach, the study begins with a scoping review to identify existing literature and reporting guidelines for pragmatic and explanatory RCTs designed using the PRECIS tool (PRECIS RCTs), which will inform a draft checklist. An international panel including trialists, trial methodologists, clinicians and policy decision-makers, biostatisticians, regulatory representatives, research funders, journal editors, and patient partners, will then participate in a Delphi process to achieve consensus on essential checklist items. This will involve at least two rounds of structured surveys. A consensus meeting with approximately thirty experts will meet to finalize the checklist items, incorporating findings from both the scoping review and the Delphi process. The authors will draft the final SPIRIT-PRECIS checklist and accompanying explanation documents., The checklist will be pilot tested with end users to ensure their clarity and practical utility. The final checklist will be refined based on feedback from pilot testing and disseminated through publications, workshops and online training opportunities.