Introduction: Suicidal thoughts and behaviours (STB) are a critical public health concern, with 700 000 deaths by suicide each year. The period immediately following hospital discharge is associated with an elevated risk for suicide. Monitoring suicidal ideations throughout this period is therefore critical. However, its highly dynamic nature limits the utility of traditional risk assessments through infrequent outpatient visits. Recent advancements in ambulatory assessments and multimodal predictive approaches offer a promising new avenue. Hence, the present study aims to examine how psychological, linguistic, neurobiological and smartphone-based characteristics relate to suicidal ideation and to improve STB monitoring through a deep phenotyping approach.
Methods and analysis: In this interdisciplinary, multicentre, prospective observational study, we plan to recruit a total of 200 inpatients with current and/or past STB. The study comprises the following components: (1) a baseline assessment, conducted while participants are still in the hospital. This includes interviews, an electroencephalography recording, a video-recorded verbal task and self-report questionnaires; (2) data collection through a smartphone application during the first 4 weeks after hospital discharge with two active collection weeks of five daily ecological momentary assessments and two 1 min video diaries every other day, as well as smartphone passive sensing for 28 consecutive days and (3) two follow-up assessments, 4 weeks and 3 months after discharge. The primary outcome is self-reported suicidal ideation after hospital discharge.
Ethics and dissemination: The Ethics Committee of the Faculty of Arts and Social Sciences of the University of Zurich, Switzerland, approved the study for the Zurich and Basel sites (Ref: 22.09.19). Approval for the New York Site was granted by the Institutional Review Board of NYU Langone Health (i23-00366). Study findings will be disseminated via peer-reviewed, open-access publications, conference presentations, patient and public events, and dedicated social media outlets.
Trial registration number: CRSII5_205913.
Introduction: With the increasing frequency and intensity of disasters globally-and their profound effects on the mental well-being of healthcare professionals, particularly nurses-the psychological distress experienced by nurses following natural disasters has become a pressing issue. This study aims to explore prevalent patterns and effective interventions for supporting nurses' psychological recovery after disaster exposure, ultimately aiming to propose an optimal recovery model.
Methods and analysis: This systematic review will include qualitative, quantitative and mixed-methods studies, as well as relevant systematic reviews, published in English between 2010 and 2025. A comprehensive search will be conducted in PubMed, Web of Science, Scopus and Google Scholar. Study selection, data extraction and quality assessment will be performed independently by multiple reviewers, with methodological quality and risk of bias evaluated using the Mixed Methods Appraisal Tool. Due to anticipated heterogeneity, findings will be synthesised using thematic analysis.
Ethics and dissemination: This study protocol raises no ethical issues. The results will be shared through publication in peer-reviewed journals and presentations at appropriate academic conferences.
Prospero registration number: CRD420251014914.
Objectives: To explore how people perceive different forms of education for rotator cuff-related shoulder pain in terms of words or feelings evoked by the education and treatments they feel are needed.
Setting: We performed a content analysis of qualitative data collected in a randomised experiment.
Participants: 2237 participants with rotator cuff-related shoulder pain were randomly assigned to receive three forms of education: best practice education, best practice education plus pain science messages and structure-focused education.
Primary and secondary outcomes: After receiving the education, participants answered two questions regarding (1) words or feelings evoked by the education and (2) treatments they felt were needed.
Results: 2232 responses for each question were analysed (99.7% response rate). Participants who received best practice education more frequently expressed feelings of unhappiness/frustration. The addition of pain science messages to best practice education resulted in slightly more emotional responses and a greater sense of being validated or cared for. In contrast, participants who received structure-focused education more frequently expressed trust in the clinician's expertise and the need for medication, activity modification, rest, diagnostic imaging, injections and surgery. These participants also less frequently considered exercise as a viable treatment option.
Conclusion: Participants with rotator cuff-related shoulder pain expressed generally similar emotional responses across groups, with small differences in treatment preferences favouring self-management in the best practice education groups compared with those who received structure-focused education. Those in the best practice education also less frequently reported needing potentially unnecessary treatments (eg, imaging, injections and surgery).
Trial registration number: Australia New Zealand Clinical Trials Registry (ACTRN12623000197639).
Objectives: To qualitatively explore the lived experiences and perceptions of patients with chronic obstructive pulmonary disease (COPD) using the harmonica as a therapeutic intervention.
Design: A qualitative study.
Setting: The study was conducted at a tertiary hospital in Guangzhou, China.
Participants: Patients with COPD who had participated in supervised harmonica playing for at least 12 weeks. (clinical trial registration: NCT05995847).
Primary and secondary outcome measures: The study focused on patients' experiences, including perceived facilitators, barriers and needs regarding the intervention.
Results: We interviewed 19 patients with COPD between September and December 2024, with interviews lasting an average of 54 min (range: 36-77 min). Five primary themes were identified. Participants reported better physical functioning, including better breathing control, enhanced functional capacity and improved sleep quality. Psychological well-being improved with increased relaxation, emotional improvement and mental engagement. Patients also experienced increased social engagement and role shift, such as expanded social connections, family support and restored family roles. Harmonica playing promoted enhanced self-reliance and personal development, with increased self-management confidence, mastery of the harmonica and encouragement for lifelong learning. Barriers and challenges included physical limitations, breathing difficulties, adherence issues and concerns about the sustainability of long-term benefits.
Conclusions: Our study indicates that harmonica playing could improve physical health, psychological well-being, social participation and self-reliance, although barriers persist. Tailored programmes could enhance benefits and adherence, and future research should evaluate durability within comprehensive COPD care.
Trial registration number: NCT05995847.
Introduction: More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking.
Methods and analysis: The International obServational sTudy on AiRway manaGement in operAting room and non-operaTing room anaEsthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients' characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients.
Ethics and dissemination: The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals.
Trial registration number: NCT05759299.
Introduction: Intravenous fluids are essential components of perioperative care, supporting intravascular volume, acid-base balance and electrolyte homeostasis. Despite extensive research in adult surgical populations, paediatric-specific evidence remains limited, and clinical practice frequently relies on extrapolated adult-based recommendations. This gap is particularly relevant in paediatric non-cardiac surgery, where fluid choice may influence key physiological outcomes such as acid-base status, electrolyte balance, renal function and haemodynamic stability. Given the heterogeneity of study designs, perioperative phases, age groups and reported outcomes in the paediatric literature, a comprehensive synthesis of the existing evidence is needed before a systematic review can be undertaken.
Methods and analysis: We will conduct this scoping review following the methodological guidance of the Joanna Briggs Institute Manual for Evidence Synthesis, and the reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline.This scoping review will map existing evidence on perioperative intravenous fluid management in paediatric patients (<18 years) undergoing elective non-cardiac surgery in outpatient and inpatient settings. Eligible study designs will include randomised trials, observational studies and systematic reviews. A comprehensive search will be developed with a medical librarian and applied to MEDLINE (PubMed), Ovid, Embase, Web of Science, CENTRAL, Google Scholar and ClinicalTrials.gov, with no date restrictions and limited to English, Spanish and German.Eligibility is framed using participants, concept and context: paediatric patients (<18 years) undergoing non-cardiac surgery; concepts related to preoperative fasting/replacement period, intraoperative period and postoperative period up to 24 hours, intravenous fluid management for maintenance/replacement; and hospital/outpatient surgical settings. Study selection and data charting will follow established scoping review methodology. Data will be synthesised descriptively using narrative and tabular formats. No meta-analysis or formal risk-of-bias appraisal is planned, consistent with scoping review methodology.
Ethics and dissemination: This scoping review involves no primary data collection and relies exclusively on published literature; therefore, formal ethical approval is not required. The protocol received administrative approval from the Comité de Ética para la Investigación Científica of Universidad del Cauca (approval no. 6553, 11 June 2025). Findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with paediatric anaesthesia and surgical communities.
Objectives: To understand the political, economic, social and technological facilitators and barriers in obtaining an HIV diagnosis to inform implementation strategies for HIV diagnostics in the Dominican Republic (DR).
Design: In-depth, semi-structured qualitative interviews.
Setting: A high complexity public hospital in Santiago de los Caballeros, DR.
Participants: A convenience and purposive sample of 36 internal medicine physicians and laboratory personnel involved in sample collection, sample analysis or oversight of biological sample analysis.
Results: Using the Social Ecological Model, our results highlighted several interrelated barriers and facilitators to sample analysis at the individual (patient), interpersonal (interactions between laboratory personnel, physicians and patients), organisational (the hospital), community (Santiago de Los Caballeros) and societal (the DR) levels. Some key findings include the importance of psychological support in receiving an HIV diagnosis, how spoken language can be a barrier to care, how inconsistent access to laboratory supplies is a barrier for patients, laboratory personnel and clinicians, and the importance of government public health investment.
Conclusions: Employing qualitative methods to investigate a bioengineering challenge yielded rich data on the sociotechnical implementation context of HIV diagnostics in the DR. Several context-relevant suggestions were developed for HIV diagnostic developers which include incorporating psychological support into the diagnosis workflow, delivering information in multiple languages (ie, Haitian Creole and Spanish) and with non-stigmatising phrasing, working with the public sector to develop and implement technologies, and reducing the supply chain reliance on high-income countries to lessen delays in care. These findings can apply to other types of health technologies and settings and demonstrate the importance of utilizing human-centered design to understand implementation context and promote global health equity in health technology development and adoption.
Objectives: To develop a resilience assessment tool for cardiac care pathways in Europe, informed by stakeholder insights on the impact of COVID-19, emerging innovations and recommendations to enhance resilience.
Design: Mixed-methods study comprising three phases: (1) survey among European cardiac care providers; (2) five multistakeholder focus groups and (3) participatory tool development. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed thematically.
Setting: The survey targeted cardiology professionals from the 27 European Union Member States and Ukraine who worked during the COVID-19 pandemic. Focus group participants were purposefully sampled to represent clinical, organisational and policy perspectives.
Participants: A total of 177 survey respondents and 40 informants in focus groups.
Results: Six key resilience dimensions of cardiac care pathways were identified: workforce, organisation of care delivery, governance and trust, communication and cooperation, medical devices and products, and data collection and use. Staff shortages and infrastructure capacity were key challenges during the pandemic. The most frequent measures were the reallocation of health staff (75%; n=133) and repurposing infrastructures (38%; n=32). Participants discussed the six resilience dimensions around a total of 17 subdimensions and 39 recommended actions to enhance resilience were identified. The resulting resilience assessment tool included four components: (1) mapping a context-specific cardiac care pathway; (2) stakeholder identification critical to participate in collective self-assessment; (3) a preparedness checklist generating a visual heat map and (4) a resource toolkit.
Conclusions: The resilience assessment tool offers step-by-step guidance to strengthening cardiac care pathways across six key resilience dimensions, supported by actionable recommendations. The tool enables the identification of context-specific vulnerabilities and improvement priorities, thereby supporting healthcare professionals and policymakers in enhancing preparedness and ensuring care continuity before, during and after crises. Its implementation is currently being piloted in European hospitals to evaluate and refine its practical applicability.
Objective: Low physical functioning and frailty are prevalent in non-geriatric vulnerable populations such as people experiencing homelessness, addiction and mental health challenges. The objective of this study was to explore the feasibility and impact of a targeted exercise intervention with protein supplementation for women experiencing homelessness, addiction and mental health challenges.
Design: Mixed-methods feasibility study.
Setting: A women's-only day service for people with homelessness and addiction issues, in Dublin, Ireland.
Participants: Women experiencing homelessness, addiction and mental health challenges.
Interventions: The intervention was a 10-week low-threshold exercise and protein supplementation pre-post programme (LEAP-W). Qualitative interviews were conducted following the intervention with programme participants and key stakeholders.
Primary and secondary outcome measures: The primary outcome was feasibility measured by recruitment, retention, adherence, safety and acceptability, and secondary outcomes measured pre-post intervention change in physical function, pain, nutritional and frailty status, and overall health status.
Results: Overall, 33 participants were recruited. Data generated demonstrated that LEAP-W was feasible by its safety, acceptability and high retention in certain subgroups, and high adherence to the exercise and protein supplement; its impact was demonstrated by pre-post intervention improvement in multiple domains (strength (chair stand test), balance (the single leg stance test), pain and quality of life/mental health (mental component summary of the Short Form-12; 95% CI, p<0.05)). Three themes emerged from the qualitative inquiry: (1) the power of exercise; (2) challenges to engagement and (3) the LEAP approach, driven by the trauma-informed and low threshold approach.
Conclusion: Targeted exercise interventions with trauma-sensitive, flexible design can be successfully delivered and yield impact in women with complex needs who experience homelessness, addiction and mental health challenges. Service design should be considered when delivering interventions to this population. Further higher-powered longitudinal studies are warranted.
Trial registration number: NCT06264895.
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