End-of-life care raises complex ethical and legal questions shaped by national frameworks, cultural contexts, and personal beliefs. This comparative study explores how fifth-year medical students in Verona (Italy) and in Halle (Germany) understand and evaluate key end-of-life practices, including advance directives, withholding or withdrawing life-sustaining treatment, palliative care, medically assisted suicide, and life termination through drugs. The study also examines whether religiosity influences ethical orientations. A structured questionnaire consisting of 16 closed-ended items and one open question was administered to fifth-year medical students at the University of Verona and the University of Halle during the 2024-2025 academic year. Items assessed knowledge of legal frameworks, ethical attitudes, personal experiences with dying patients, and perceived educational preparedness. Descriptive statistics, cross-tabulations, and chi-square tests were used to compare cohorts, with statistical significance set at p < 0.05. A total of 259 valid responses were analyzed. Students in both countries showed strong consensus regarding the legitimacy and clinical usefulness of advance directives and the central role of palliative care. Acceptance of withholding or withdrawing treatment was high in both cohorts, though slightly higher in Germany. Marked differences emerged regarding life termination through drugs, with Italian students expressing more permissive and polarized positions and German students showing more moderate and cautious responses. Attitudes toward medically assisted suicide were broadly permissive in both groups, with religiosity emerging as a consistent predictor of more restrictive positions, particularly in Italy. While future physicians in both countries share core commitments to patient autonomy and palliative care, significant differences persist in their evaluation of practices intended to hasten death. These findings suggest that ethical orientations at the end of life are shaped not only by shared professional principles but also by national cultural environments and personal belief systems. Comparative research among medical students offers valuable insight into how medico-legal contexts and education influence emerging professional ethics.
To investigate research attitude and drivers of research engagement among academicians of private dental colleges in Lahore, Pakistan outcomes. The cross-sectional study was conducted from January to August 2022 after approval from the ethics review board of the University College of Dentistry, University of Lahore, Pakistan, and comprised faculty members of five private dental colleges in Lahore. Data was collected using a self-designed questionnaire that had six items assessing attitudes and seven items evaluating drivers of research engagement. Data was analysed using SPSS 25. Of the 200 subjects approached, 169(84.5%) responded; 107(63.3%) females and 62(36.7%) males. The overall mean age was 30.9±4.79 years. There were 56(33.1%) subjects with postgraduate qualification, and 102(60.4%) had a work experience of 1-5 years. The mean attitude score was 23.19±3.38. Many participants 54(32%) reported having insufficient knowledge to conduct research, and 157(92%) believed that more attention needs to be given to research in teaching institutions. Potential drivers of research engagement were the provision of resources 110(65.1%), appreciation by the institution 150(88.8%), a decrease in academic responsibilities 134(79.3%) and research remuneration 153(90.2%). Participants with undergraduate qualification were significantly different from those with postgraduate education with regard to conducting research if provided with incentives (p=0.04). The attitude of faculty members towards research was found to be moderate. Provision of adequate resources and institutional support may serve as a catalyst for enhancing research engagement.
Canadian long-term care (LTC) homes have faced long-standing challenges with quality of care, staffing and resource limitations. In Ontario, specifically, there has been increased focus on resilience and performance in LTC homes given the burden that the COVID-19 pandemic presented (eg, highest number of resident deaths due to COVID-19 across Canada, staffing crisis). Nevertheless, little is known about the current practices and operational state of LTC homes in the province and limited data are collected on Ontario's LTC homes at the organisational level and on the factors that may contribute to their resilience and improved performance. We propose a research protocol that aims to: (1) assess the organisational characteristics and resources in LTC homes in Ontario; and (2) support an in-depth analysis of the relationship between organisational characteristics and health information technology (HIT) resources, resilience and performance for preparedness and system strengthening. All LTC homes in Ontario will be invited to participate in a cross-sectional survey to assess their organisational characteristics and HIT resources and investigate their resilience and performance. In the absence of a complete and detailed list of LTC homes in Ontario, our research team extracted publicly available data from multiple sources to develop a comprehensive list of all LTC homes in Ontario with relevant administrative contact information. This consolidated list will be used in the data collection stage. HIT indices will also be developed for electronic medical records and assistive technology to assess LTC homes' digital capabilities and level of information technology maturity. Exploratory factor analysis will be conducted to identify the underlying factor structure of the measured variables and develop composite measures of digital capabilities/HIT maturity, of resilience and performance. Multivariate analysis will be conducted to examine the relationships between organisational characteristics/HIT use and organisational performance, while controlling for resilience. This study received ethics approval from the University of Ottawa Research Ethics Board (S-06-25-11678). The results of this research will be submitted to relevant peer-reviewed journals and presented at professional and academic conferences. A one-page executive summary of the results will also be shared with the study participants and the two LTC associations in Ontario (ie, Ontario Long-Term Care Association and AdvantAge).
Allied health sciences students face considerable psychological demands during clinical training, which may contribute to elevated levels of stress, anxiety, and depressive symptoms. Identifying protective psychological factors is therefore important for supporting student well-being. This study examined a structural model of the associations among emotional intelligence, self-compassion, and academic resilience, with a focus on the potential mediating role of self-compassion. This multi-center cross-sectional study included 452 students from anesthesia, operating room technology, and pre-hospital emergency care programs across four universities in Tehran. Data were collected using the Self-Compassion Scale-Short Form (SCS-SF), Brief Emotional Intelligence Scale (BEIS-10), and Academic Resilience Scale (ARS), all showing acceptable reliability (Cronbach's α > 0.70). Data were analyzed using Pearson correlation and Structural Equation Modeling (SEM) in AMOS. Model fit was evaluated using GFI, CFI, and RMSEA, and indirect effects were tested via bootstrapping. Emotional intelligence, self-compassion, and academic resilience were significantly and positively correlated (p < 0.001). The proposed model demonstrated acceptable fit (GFI = 0.94, CFI = 0.92, RMSEA = 0.072). Emotional intelligence (β = 0.440, p < 0.001) and self-compassion (β = 0.419, p < 0.001) were significantly associated with academic resilience, explaining 65% of its variance. Bootstrapping results indicated a significant indirect association of emotional intelligence with academic resilience through self-compassion (β = 0.321, p = 0.004). The findings suggest that emotional intelligence and self-compassion are important correlates of academic resilience among allied health sciences students. The results support an integrated model that may inform the design of interventions aimed at strengthening psychological resources and improving student well-being. Given the cross-sectional design, causal interpretations should be made with caution.
Pemphigus vulgaris is a rare autoimmune blistering disease characterised by recurrent mucocutaneous erosions, high symptom burden and unpredictable relapse. Current management relies mainly on pharmacological therapy and hospital-based follow-up, with limited real-time monitoring and individualised support in home-based disease management. To address these challenges, this trial aims to evaluate the effectiveness of an Intelligent Multimodal Symptom Assessment and Response System, integrating patient-reported outcomes, wearable physiological data and image-based lesion assessments, to improve symptom management and quality of life in pemphigus vulgaris patients. Primary objective is to evaluate the effectiveness of the Intelligent Multimodal Symptom Assessment and Response System in improving symptom alerting and symptom management outcomes in patients with pemphigus vulgaris. Secondary objectives are to enhance patients' self-management ability in symptom monitoring and control, to improve treatment adherence throughout the follow-up period, to promote health-related quality of life among pemphigus vulgaris patients, to assess the usability and acceptability of the system from the patients' perspective. This is a multicentre, parallel-group, randomised controlled trial. 160 participants will be randomly assigned to either the intervention group (receiving the Intelligent Multimodal Symptom Assessment and Response System) or the control group (receiving standard care). Eligible participants will be adults aged 18 years or older with a confirmed diagnosis of pemphigus vulgaris and active skin or mucosal lesions, who are able to use digital devices and provide written informed consent. Individuals with severe comorbidities, concurrent participation in other clinical trials or cognitive impairments that may interfere with study adherence will be excluded. The intervention will be delivered via a digital platform, integrating electronic patient-reported outcomes, wearable physiological data and lesion images over a 12-week follow-up period. Ethical approval was obtained from the Institutional Review Board of the School of Nursing, Fudan University (IRB 2025-07-13), the Medical Ethics Committee of the Institute of Dermatology, Chinese Academy of Medical Sciences (2025-KY-034) and the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (2025-452). Approvals were granted on 10 September, 18 July and 23 July 2025, respectively. This protocol is based on V1.0, 13 July 2025 of the protocol. The results of this study will be disseminated through peer-reviewed publications and academic conferences. ChiCTR2500109711.
The global healthcare system is confronting significant structural challenges and urgently requires innovative solutions. Academic entrepreneurship has emerged as a critical response by translating medical discoveries into practical solutions. While research on academic entrepreneurship in healthcare is rapidly growing, the existing literature remains fragmented and lacks a comprehensive synthesis of its progress and future directions. This review addresses this gap by conducting a framework-based systematic literature review of 85 peer-reviewed articles sourced from Scopus and Web of Science. Guided by the SPAR-4-SLR protocol, the review employs two organizing frameworks. The antecedents-phenomenon-consequences (APC) framework uncovers the enabling and constraining factors,diverse entrepreneurial pathways, and both the positive and negative effects associated with academic entrepreneurship in healthcare. Complementing this, the theory-context-method (TCM) framework provides structured insights into the theoretical foundations, research contexts, and methodological strategies applied in the field. Additionally, the review identifies the major gaps in the existing literature and offers a few recommendations for future investigation on academic entrepreneurship in healthcare across three key dimensions: new theoretical perspectives, expanded research settings, and diversified methodological approaches. By integrating these perspectives, the study offers a synthesized understanding of existing research, identifies critical knowledge gaps, and provides actionable insights for scholars, institutional leaders, and policy stakeholders committed to advancing academic entrepreneurship in healthcare.
The quality of teacher-student relationships is a key factor in students' academic performance, psychological well-being, and social development. From an attachment theory perspective, teachers can function as a secure base and safe haven, supporting both the emotional security and exploratory behaviors of students. One of the most widely used instruments for assessing these relationships is the Student-Teacher Relationship Scale Short-Form, which evaluates two dimensions: Closeness and Conflict. Although the long version of this scale has been validated in Spain, no adaptation or validation of the short form existed for Spanish-speaking populations. The present study aimed to adapt and validate the Student-Teacher Relationship Scale Short-Form in a Spanish context. A total of 60 teachers from various regions of Spain completed 240 assessments of their students, including measures of the Student-Teacher Relationship, Student Attributes and Behaviors, and the degree of difficulty in working with each student. Confirmatory factor analysis (CFA) was conducted to examine the internal structure of the scale, and associations with external criteria were analysed. The CFA supported a two-factor structure consistent with the original version of the scale. One item showed weak psychometric performance, and a revised 14-item model demonstrated improved fit and coherence. The adapted version showed high internal consistency (Closeness, α = .892; Conflict, α = .894) and significant associations with teacher perceptions of student behavior and relationship difficulty. These findings provide preliminary evidence of validity based on internal structure and relations to external criteria for the Spanish version of the STRS-SF and highlight its potential as an efficient tool for assessing the quality of teacher-student relationships. This adaptation may provide educators and researchers with a culturally appropriate instrument to identify relational difficulties in the classroom and to inform intervention strategies aimed at promoting positive interactions and student well-being in Spanish-speaking educational settings.
Major depressive disorder (MDD) is a prevalent mental illness characterised by persistent sadness, loss of interest in activities and cognitive impairment. While pharmacological and psychotherapeutic treatments remain the standard for MDD management, non-pharmacological interventions, such as aerobic exercise, have gained attention for their potential benefits in reducing depressive symptoms and improving quality of life. Although several studies have explored the effectiveness of aerobic exercise in managing MDD, there is still no comprehensive synthesis of the existing evidence. This study aims to synthesise existing evidence on the effects of aerobic exercise interventions in the management of individuals diagnosed with MDD. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive search will be conducted across Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science and BioMed Central databases. Search terms will be developed using the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework, incorporating keywords and Medical Subject Headings related to 'Major Depressive Disorder', 'Aerobic Exercise', 'Depression', and 'Quality of Life'. Only intervention studies, including randomised controlled trials, quasi-experimental and pre-post intervention studies, will be included involving adults aged 18 years or older diagnosed with MDD according to standardised criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Statistical Classification of Diseases and Related Health Problems -10 (ICD-10)). For included intervention studies, the comparator will be standard care, placebo or no-exercise control groups. The primary outcome is change in depressive symptoms, and secondary outcomes include quality of life, anxiety and stress-related biomarkers. Three independent reviewers will screen studies, extract data using Covidence software (Veritas Health Innovation in partnership with Cochrane) and assess study quality using the updated Cochrane Risk of Bias 2.0 (Rob-2) tool alongside the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. If feasible, a meta-analysis will be conducted using RevMan V.5.4 (Cochrane's Review Manager), with effect sizes determined by mean differences, standardised mean differences or ORs, depending on the outcome type. This study is currently at the proposal stage, with article searches expected to begin in November 2025 and data extraction anticipated to be completed by January 2026. No ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences. CRD420251151897.
Building research capacity in health settings is essential for improving the relevance and application of health research. Rigorous evaluation of research capacity in health settings optimizes the development, implementation and improvement of such initiatives. Cooke's 2005 framework was the earliest peer-reviewed framework to evaluate research capacity in health settings. While subsequent frameworks exist, it is not clear how they were developed and are used in practice. This review investigates the development, composition and utilization of peer-reviewed frameworks designed to evaluate research capacity in health settings. This two-phased methodological review was informed by the JBI scoping review methodology. Phase 1 involved a systematic search of seven databases on 1 May 2025 to identify peer-reviewed frameworks for evaluating research capacity. Phase 2 involved a forward citation search of included frameworks using Google Scholar, finalized on 18 September 2025, to identify the number and nature of citing studies. Data extraction and narrative synthesis were informed by the review aims. Phase 1 database searches yielded 2581 unique citations, of which 8 met the inclusion criteria. An additional framework was identified through citation searching, totalling 9 frameworks. The frameworks were developed via retrospective processes (reviews of literature and local data) or prospective methods (engagement workshops). Several were informed by earlier frameworks. Frameworks typically comprised an overarching structure, substructural components and a series of outcome indicators. Framework authors defined research capacity building in nuanced ways. Phase 2 forward citation searching of the nine frameworks revealed 881 citations. Of these, 37 citing articles met the inclusion criteria. Most (31/37) citing studies utilized Cooke's 2005 framework. Frameworks were largely used to inform data collection and analysis, and most citing authors only used only some framework components. Limitations and strengths of the frameworks related to the development process and practical application were identified by framework and citing authors. This review facilitated new insights into the development, characteristics and utilization of frameworks to evaluate research capacity building in health settings. There are nine peer-reviewed, published frameworks, several informed by and expanding on earlier frameworks, which is essential for advancing the evaluation of research capacity in health settings.
Poststroke depression (PSD) affects approximately 33% of stroke survivors and is associated with worse outcomes, poor quality of life (QOL) and mortality. Despite its prevalence and consequences, there is no consensus on the most effective strategy for PSD prevention. Behavioural activation (BA) is an effective intervention for depression across diverse populations and is considered safer, better tolerated and a longer-lasting alternative to antidepressant medications. This study aims to test the effectiveness of a remotely delivered BA intervention to prevent PSD (Tele-BA-S). We will conduct a randomised effectiveness trial of 350 low-income adults (≥ 55 years) within 3 months of ischaemic or haemorrhagic stroke and with subthreshold depression (Patient Health Questionnaire-9 score <9 and 24-item Hamilton Depression Rating Scale (HDRS) score <15). Eligible and consented adults will be randomly assigned to Tele-BA-S or treatment-as-usual. Tele-BA-S will be comprised of an orientation session, 5 weekly BA sessions and 2 follow-up monthly booster calls delivered by trained community health workers. We will conduct assessments at 1 month, 2 months, 4 months, 6 months and 9 months after baseline. The primary outcome (PSD) will be measured by the 24-item HDRS. Secondary outcomes will include anxiety (Generalised Anxiety Disorder-7 Scale), psychological well-being (Ryff Scale of Psychological Well-being), QOL (Stroke Specific QOL Scale), medication adherence (Medication Adherence Report Scale-5), rehabilitation adherence (Rehabilitation Adherence Inventory), number of emergency department visits and hospitalisations, functional outcome (Barthel Index) and degree of disability (Modified Rankin Scale). Mediating variables will include self-efficacy (Stroke Self-Efficacy Questionnaire), motivation (Motivation in Stroke Patients for Rehabilitation Scale) and activity engagement (Neuro-QOL Participation in Roles and Activities). Exploratory implementation measures will also be collected. Primary analysis will follow the intention-to-treat principle and evaluate intervention effects over time using mixed-effects models. Ethical approval was obtained by the University of Texas Health Science Center at Houston's (UTHealth Houston) Committee for the Protection of Human Subjects Institutional Review Board. The trial protocol, statistical analysis plan and code, and deidentified participant data will be made available via the National Institute of Mental Health Data Archive. The results will be presented at academic conferences and submitted for publication. The authors declare that they have no conflicts of interest relevant to the content of this manuscript. NCT06864715.
While it is common practice for academic institutions to implement a student honor code, there is not a comprehensive review of the reasons for the implementation, distinction from a code of conduct, implications for a competency-base curriculum design and exam proctoring practices, descriptions and criteria commonly included in a code, and procedural enforcement for non-compliance. This exploratory study offers a broad examination of key considerations when determining whether or not to consider creating and adopting a student honor code by examining in depth the why, what, and how for an academic health science center. A thematic analysis of existing honor codes gathered from sample academic health science centers as well as relevant literature review findings were used to identify common codes or terms for the behaviors associated with an honor code, adjudication procedures, and the body of authority who reviews and enforces the code.
Early gastric cancer is characterised by subtle mucosal and colour changes that frequently lead to missed lesions during routine endoscopy, making detection difficult. Indigo carmine spraying is a classical chromoendoscopic method to enhance mucosal surface irregularities and has been believed to have the potential to facilitate the detection of early gastric neoplasia. This method is widely used in Japan; however, whether it improves gastric neoplasm detection remains unclear. In this prospective study, we aim to evaluate the usefulness of indigo carmine spraying for detecting gastric cancer and gastric adenoma during upper gastrointestinal endoscopy in patients at high risk of gastric cancer. This prospective multicentre observational study will include over 30 institutions. Patients undergoing upper gastrointestinal endoscopy for surveillance after endoscopic treatment or pretreatment screening will be enrolled. The age range has been set from 20 years to 95 years, and patients for whom a biopsy will not be feasible will be excluded. Gastric observation will consist of two steps: the first will use white light imaging, followed by a second-pass observation after spraying 20-40 mL of indigo carmine at a concentration of 0.1-0.4%. The primary endpoint will be the proportion of patients with gastric cancer or adenoma lesions detected during the second-pass observation among those who undergo successful indigo carmine examination. A one-sided binomial test (α=0.05) will be used to compare the detection rate with a predefined threshold of 1.0%. We aim to enrol a total of 1050 patients to achieve 80% power. This study was approved by the Institutional Review Board of Kanagawa Cancer Center (approval number: 2025-92). Written informed consent will be obtained at the time of registration. Following completion of this research, the findings will be promptly compiled and published in appropriate academic conferences and peer-reviewed international journals. UMIN000059685.
As the first peoples of Australia, Aboriginal and Torres Strait Islander peoples have continuing cultures that are essential to wellbeing. Complex sociocultural, health, and wellbeing inequities stemming from colonization, settler-colonialism, and mental health system challenges have led to high rates of negative mental health and wellbeing for Aboriginal and Torres Strait Islander peoples. Improving Aboriginal and Torres Strait Islander mental health and wellbeing outcomes is a national public health priority. Social and emotional wellbeing (SEWB) and the cultural determinants of health (CDH) provide evidence-based approaches for providing culturally centered wellbeing support. There is a need to increase the availability, accessibility, and effectiveness of culturally relevant, holistic, and strengths-based wellbeing supports. It is essential that Aboriginal communities have self-determined opportunities to develop and implement culturally centered wellbeing supports informed by SEWB and the CDH. Aboriginal digital health and wellbeing support research is an emerging field offering potential to help improve wellbeing outcomes. This study aims to explore how virtual reality (VR) could be used to provide SEWB and CDH support for Aboriginal and Torres Strait Islander peoples. This study protocol outlines a 3-phase mixed-methods approach that will inform the co-design and codevelopment of a VR application that aims to provide SEWB and CDH support. In partnership with Tribal Warrior, an Aboriginal Community Controlled Organization, Studio Gilay, an Aboriginal-led animation and storytelling studio, and Phoria, an Australian immersive storytelling technology company, this study will assess cultural relevance, acceptability, and feasibility of the VR application. Using Indigenist and Participatory Action Research methodologies, purposive sampling will be used to recruit 35 Tribal Warrior staff and Aboriginal community members to participate in each phase of research. Qualitative data collection will occur in each phase through yarning circles. Reflexive thematic analysis will guide qualitative analysis. Phase 3 will involve a quantitative survey, generating cultural relevance, acceptability, and feasibility evidence. Descriptive statistics analysis will be used to report results. As of April 2026, data collection and analysis for phases 1 and 2 are complete. This study will culminate in the development and assessment of a co-designed and codeveloped VR application that aims to provide SEWB and CDH support for Aboriginal peoples. Findings from each phase will be published in academic papers and nonacademic outputs. The VR application will be implemented by Tribal Warrior into existing community programs and supports. Findings from this study have potential implications for improving availability and accessibility to culturally centered wellbeing supports for Aboriginal and Torres Strait Islander peoples. Assessing the cultural relevance, acceptability, and feasibility of using VR technology to provide culturally centered wellbeing support will contribute novel evidence to the fields of public health, digital health, and design-based research.
Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a non-surgical intervention that allows controlled colonic washouts, improving symptom control. Evidence supporting TAI for LARS is limited by small sample sizes and is primarily observational, highlighting the need for a rigorous randomised controlled trial (RCT). This study aims to compare TAI with conventional LARS care on QoL, bowel function, faecal incontinence and satisfaction in adults with LARS following LAR. This is a pragmatic, multicentre, crossover RCT conducted at eight academic hospitals across Quebec, Ontario and British Columbia, Canada. Eligible participants are adults (≥18 years) with an LARS score >20, at least 6 months post-LAR and without an ostomy or active colorectal complications. Participants will be randomised to receive either 3 months of daily TAI or conventional LARS care, followed by a 1 month washout and crossover to the alternate intervention. The TAI intervention includes an irrigation system, access to a web-based educational platform and virtual training with a research team member. Primary outcome is difference in global QoL between interventions, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Secondary outcomes include bowel function (LARS score), faecal incontinence (Cleveland Clinic Faecal Incontinence Score) and satisfaction. Sample size (n=66, accounting for 10% attrition) was determined using Monte Carlo simulations to detect a 6-point difference in QoL with 85.8% power. Data will be analysed using linear mixed-effects models accounting for period, treatment and sequence effects. All study data will be collected via Research Electronic Data Capture and maintained in secure, password-protected systems; participant confidentiality will be ensured throughout. Safety monitoring will include training on proper TAI technique and reporting of adverse events. The study has received ethics approval from each participating site. The trial adheres to the Canadian Tri-Council Policy Statement on the use of human participants in research. Findings will be disseminated through peer-reviewed journals, conference presentations and scientific meetings, with authorship following the International Committee of Journal Editors guidelines. NCT05007015.
Although palliative care (PC) is recognized as a component of comprehensive care throughout the life course and universal health coverage, more than 85% of the global need for PC is unmet. Nigeria has isolated PC provision, with a narrow scope, limited availability, and inadequate support for PC services, despite having adequate legislation to support the operation in the country. Given the rising incidence of chronic illnesses that are amenable to PC in Nigeria, this study aimed to explore healthcare professionals' (HCPs') knowledge and attitudes towards PC and identify targets for improving PC delivery nationally. Using a mixed-methods convergent design, an online survey was distributed to multidisciplinary HCPs in Nigeria. The survey included validated tools that assessed knowledge and attitudes related to PC, pain management, and end-of-life (EOL) care. Five focus group discussions (FGDs) were conducted and qualitatively analyzed using rapid matrix analysis to triangulate themes with survey responses. From February to December 2024, 117 HCPs from 26 hospitals across five of six geopolitical zones of Nigeria completed the quantitative survey. Most respondents were nurses (67%) or physicians (26%), worked in public teaching hospitals (70%), and provided care for patients with cancer (94%). Over half (56%) received some PC training, though many expressed interest in additional training on pain management (65%), EOL communication skills (50%), and EOL ethics and decision-making (49%). FGDs from three geopolitical zones revealed 3 major themes: (1) HCPs have a shared high-level understanding of the goals of PC with varied perceptions around PC delivery; (2) Challenges in the practical delivery of PC include systemic barriers, opioid costs and stigma, and patient receptivity; (3) Delivering PC impacts HCPs' job satisfaction and takes a psychological toll. Participant-identified strategies for overcoming barriers to PC delivery included the development of standardized PC protocols, opioid policy changes, patient education about PC, and HCP training and support. HCPs in this study demonstrated broad interest in and knowledge about PC. However, systemic barriers and limited patient and caregiver receptivity limit PC uptake in clinical practice. Future initiatives should involve clinical training related to PC communication, community education programs, and implementation of contextually appropriate protocols and policies for PC delivery.
Care provided in people's own homes (domiciliary care) is an increasingly important part of long-term care. There are various services, including home visits, live-in care and housing with care. Some people directly employ care staff, called personal assistants. Services vary in quality, price and availability, and there is currently little evidence of the value these services provide to the public purse and individuals. This study protocol presents planned research to fill this important gap. This will be a cross-sectional study based on surveys of care recipients, their unpaid carers as well as formal care providers. In the first half of 2026, we will survey 1850 people accessing domiciliary care either through a homecare agency, a housing with care scheme or by directly employing personal assistants and 400 unpaid carers, all based in England. We will conduct a cost-effectiveness analysis taking a 'production function' approach and use quality of life as measured by the Adult Social Care Outcomes Toolkit as the main outcome of interest. The study received ethical approval from the School of Social Sciences Staff Review Committee at the University of Kent on 20 May 2025 (reference 1195) and the Health Research Authority, London-Camberwell St Giles Research Ethics Committee on 28 October 2025 (reference 25/LO/0652). Implications around consent, data protection and confidentiality, risk and participant payment are discussed. In addition to academic outputs (eg, academic articles, conference presentations), we aim to coproduce news items and blogs with people with lived experience of accessing long-term care and jointly present findings at events aimed at the care sector. Moreover, we will offer participating care providers benchmarking briefs based on our findings.
Diabetic foot ulceration represents a prevalent, persistent and resource-intensive complication of diabetes. These ulcers are slow to heal, prone to recurrence and impose a substantial burden on both patients and healthcare providers. The reducing the impact of diabetic foot ulcers (REDUCE) intervention has been designed as a multifaceted approach targeting psychological and behavioural determinants linked to diabetic foot ulcer (DFU) outcomes. Following a successful pilot trial, the REDUCE trial has been designed as a pragmatic, multicentre randomised trial to compare the effectiveness and cost-effectiveness of the REDUCE intervention plus usual care versus usual care alone in reducing recurrence in people with healed DFUs. Additionally, there is an embedded process evaluation and two sub-studies which will be carried out alongside the main trial. Adults over 18 years of age, with a recently healed DFU and two lower limbs, will be identified from around 30 specialist multidisciplinary diabetic foot clinics at participating National Health Service Trusts in the UK. Patients with active Charcot neuro-osteoarthropathy, active DFU or ulcers healed for more than 12 weeks will be excluded. We will aim to recruit 544 participants (1:1 randomisation). The primary outcome for this trial will be total ulcer-free days with limbs intact (ie, without amputation) between randomisation and the end of follow-up (18 months post-randomisation). Secondary outcomes include time to re-ulceration, total number of ulcers, amputation, quality of life (EQ-5D-5L), Patient Health Questionnaire-9, Nottingham Assessment of Functional Footcare, ICEpop capability measure for adults and resource use. As part of the process evaluation, up to 20 REDUCE intervention patient-participants will be interviewed, and the healthcare professionals delivering the intervention will also be interviewed. An assessment of intervention fidelity will also be carried out. Ethics approval was granted by Wales 3 Research Ethics Committee (REC reference 22/WA/0053) on 16 March 2022. The findings will be presented at relevant conferences and disseminated via peer-reviewed research publications and to relevant stakeholders. ISRCTN15570706.
Biliary atresia (BA) is a rare but serious infantile cholangiopathy requiring timely diagnosis and surgical intervention. However, current screening methods are limited by their postnatal initiation. By contrast, antenatal imaging is increasingly considered promising due to growing evidence of a prenatal onset of BA, although high-quality diagnostic evidence remains scarce. This study aims to evaluate the diagnostic performance of antenatal biliary imaging features for the detection of BA. This is a multicentre, prospective cohort diagnostic accuracy study enrolling pregnant women undergoing routine prenatal ultrasound. The index test consists of predefined imaging features of the fetal biliary system. A minimum of 92 082 pregnancies will be screened and a dual follow-up strategy has been designed to balance feasibility and diagnostic rigour. All fetuses with positive index test findings, along with a 1:1 systematically sampled group of test-negative cases, will be included in a direct follow-up subset. The remainder will undergo indirect follow-up through health system linkage and outcome verification. The reference standard for diagnosing BA is based on postnatal clinical follow-up, supplemented by surgical exploration and intraoperative cholangiography when deemed necessary. Diagnostic performance will be assessed by calculating sensitivity, specificity, positive and negative predictive values. The study has been approved by the Ethics Committee of Children's Hospital of Fudan University (number 2024-30). Findings will be disseminated through academic conferences and submitted for publication in peer-reviewed journals. ChiCTR2400087744.
The literature on sustainability performance frameworks for healthcare organisations varies in its applicability to different types of organisations and settings, functions and activities, and definitions and dimensions of sustainability. This fragmentation creates implementation barriers which may be overcome by consolidating existing evidence in a format that can be linked directly to organisations' business models. This protocol proposes a scoping review to assess the extent of the literature on frameworks for monitoring and evaluating the multidimensional sustainability performance of healthcare organisations and to assemble a consolidated framework in an operationally relevant format to support progress towards sustainable healthcare organisations. The search strategy will be applied across Semantic Scholar, Google Scholar, Web of Science, MEDLINE, Embase, Academic Search Premier, CINAHL and Business Source Premier databases. Search results from 2009, coinciding with the publication of the WHO's 'Healthy Hospitals, Healthy Planet, Healthy People' report, will be considered. The scoping review will include studies reporting on multidimensional sustainability monitoring or evaluation frameworks applied or developed for use at the level of healthcare delivery organisations. Studies relating to operational units within organisations or to healthcare systems will be excluded. The review's context will be restricted to operational sustainability and will not consider the literature on sustainable design planning and construction of new facilities. No specific exclusion criteria will be applied to the types of healthcare delivery organisations nor participants implicated in the frameworks. Title and abstract screening against the inclusion and exclusion criteria, followed by full-text assessment of remaining articles, will be performed by two reviewers. Data from included studies will be extracted using a custom-designed extraction tool, analysed using topic or thematic analysis to consolidate themes and presented within the triple-layered business model canvas. Only publicly available sources will be used; research ethics approval is not required. Findings will be submitted to a peer-reviewed journal and presented at scientific meetings.
While intravesical Bacillus Calmette-Guérin Vaccine (BCG) instillation remains standard adjuvant therapy for high-grade non-muscle-invasive bladder cancer (NMIBC) post-resection, marked interpatient response heterogeneity complicates recurrence prediction. This study develops a contrast-enhanced computed tomography (CT) radiomics-based machine learning model to quantify tumor heterogeneity and noninvasively predict 5-year recurrence in high-grade NMIBC. This retrospective study included 136 patients with histopathologically confirmed high-grade NMIBC from our institution and an external cohort of 51 patients from an independent testing center. All patients underwent transurethral resection of bladder tumor (TURBT) followed by BCG instillation therapy. The internal cohort was randomly partitioned into a training set (n = 95) and a validation set (n = 41) at a 7:3 ratio, with an independent external test set (n = 51) used for external validation. All patients received contrast-enhanced CT prior to treatment. Independent clinicopathological predictors were identified through univariate and multivariate logistic regression analyses. Radiomics features were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression, and a radiomics score (Radscore) was constructed. Four machine learning models-Gradient Boosting Decision Tree (GBDT), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Random Forest (RF)-were developed. Model performance was comprehensively evaluated via the area under the receiver operating characteristic curve (AUC), accuracy, precision, F1 score, confusion matrix, calibration curve, and decision curve analysis (DCA). Additionally, the interpretability of the models was assessed using Shapley Additive Explanations (SHAP). Multivariate logistic regression analysis identified tumor size (OR = 3.11, 95% CI: 1.16-8.34, p = 0.024), number of lesions (OR = 4.56, 95% CI: 1.52-13.70, p = 0.007), and tumor calcification (OR = 3.41, 95% CI: 1.15-10.15, p = 0.027) as independent clinical predictors of 5-year recurrence following BCG instillation. A total of 4,738 radiomic features were extracted from contrast-enhanced CT images, and the top 20 most discriminative features were selected via LASSO regression to construct the Radscore. Among the four machine learning models developed by combining clinical factors and Radscore, SVM demonstrated the superior performance, with an AUC of 0.816 (95% CI: 0.774-0.858), accuracy of 73.2%, precision of 74.3%, and F1 score of 0.734. This performance was significantly better than that of XGBoost (AUC = 0.727, 95% CI: 0.683-0.770; accuracy 65.9%, precision 65.4%, F1 score 0.655), RF (AUC = 0.717, 95% CI: 0.675-0.752; accuracy 68.3%, precision 67.9%, F1 score 0.677), and GBDT (AUC = 0.685, 95% CI: 0.633-0.740; accuracy 70.7%, precision 71.4%, F1 score 0.709). External validation using independent test sets confirmed these. SHAP analysis revealed that the number of lesions and Radscore were the most influential predictors in the SVM model. Calibration curves and DCA demonstrated that the SVM model exhibited robust stability and provided substantial clinical benefit. We developed an interpretable machine learning model derived from contrast-enhanced CT radiomics, integrating clinicopathological characteristics and quantitative radiomic features to accurately predict the 5-year recurrence risk in patients with high-grade NMIBC following BCG instillation.