Penicillins are the most frequently prescribed antibiotics for a broad range of infections. In North America, up to 15% of hospitalized patients report a penicillin allergy, but research has shown that 98% of these patients can tolerate penicillins. Removing inaccurate allergy labels is an essential component of antimicrobial stewardship. While allergy delabelling used to be complex or require an allergist referral, the emergence of new tools, such as the PEN-FAST score, facilitates direct delabeling of low-risk patients.

The primary objective of this study was to trial the use of the PEN-FAST scoring tool at a major tertiary care center in Canada. Secondary objectives included measuring the pharmacy workload associated with the delabeling process.

A prospective pilot study was implemented at a Canadian tertiary care hospital to identify new patients with a penicillin allergy label, perform a review of their medical history, obtain a PEN-FAST score, and if applicable, implement an oral challenge with amoxicillin.

Most of the 155 screened patients were delabeled based on their medical history. Twenty-nine patients were eligible for an oral challenge, and three challenges were conducted.

PEN-FAST scoring in combination with direct oral challenge is a practical tool that can be prospectively implemented by pharmacists.

Comorbid obsessive–compulsive disorder (OCD) or obsessive–compulsive symptoms (OCS) are common in people with severe mental illness (SMI; including schizophrenia, bipolar disorder and schizoaffective disorder), with little known about associations with smoking.

To estimate the association between OCD/OCS and smoking status among people with SMI in a huge electronic database.

Using the Clinical Records Interactive Search (CRIS) platform for data of service users in the South London and Maudsley (SLaM) NHS Foundation Trust, tobacco smoking status was retrospectively detected through an algorithm of natural language processing technique, categorising into ‘current smoker’, ‘ex-smoker’ and ‘non-smoker’ by the clinical notes of SMI individuals during 2007–2015. A hierarchical assignment rule was applied following the order of ‘smoker’, ‘ex-smoker’ and then ‘non-smoker’ in an individual. Logistic regression was used to examine the association between smoking and OCS in people with SMI for univariable and multivariable analyses.

We identified 15 479 SMI individuals (56% male; mean age 41 years old), with 90.4% ever smoked. Among them, 2320 (15%) had OCS (without OCD), while 2174 (14%) had a clinical diagnosis of comorbid OCD. After adjusting for demographics and functional status as confounders, both SMI individuals with OCS only and an OCD diagnosis were significantly more likely to have ever smoked (adj. odds ratio 1.47, 95% CI 1.23, 1.76 and adj. odds ratio 1.33, 95% CI 1.11, 1.60, respectively) compared with those without OCD/OCS.

In this large-scale analysis of people with SMI, we found that individuals with OCS or OCD were more likely to have ever smoked.

Newfoundland and Labrador (NL) introduced Canada’s first excise tax on sugar-sweetened beverages (SSB) in 2022. Industry marketing practices in response to SSB taxation may affect public health impacts. We examined changes in posted beverage pricing and marketing of taxable and non-taxable beverages in NL before and after the SSB tax was implemented.

Pre-/post-observational study with in-store audits of beverage prices and marketing. Changes including pricing discounts and promotions were assessed at the individual beverage level for pre/post-tax implementation years.

Eighty food stores (grocery, convenience, drug and dollar) in NL, Canada.

There was no evidence of a change in posted shelf prices between pre/post years. There was a significant increase (+2·5 %, χ2 = 9·693, P = 0·002) in proportion of discounted taxable SSB with no change in non-taxable beverages (P = 0·350). There were no significant differences in change of number of promotions for taxable SSB (+5·2 [−0·1, 10·5], F = 3·789, P = 0·053) nor non-taxable beverages (+3·4 [–1·0, 7·7], F = 2·268, P = 0·134).

The lack of change in posted prices of taxable SSB indicates that the NL SSB tax was not communicated at the point of decision-making. While some marketing changes post-tax were observed, results should be interpreted cautiously as they cannot be attributed definitively to the tax. Existing literature implies that industry may adapt marketing conduct to counteract beverage taxes. Such changes were limited in NL, suggesting retailers may have opted not to display the tax rather than attempt to actively counteract it. Lack of transparency surrounding the tax may neutralise intended behavioural effects.

Major depressive disorder (MDD) is the leading cause of disability worldwide, affecting roughly 322 million people. Recently, doses of psilocybin have shown promise in treating mood disorders, sparking interest in other dosing practices. According to anecdotal reports and observational studies, microdosing psilocybin yields benefits to mental health; however, rigorously controlled trials have failed to produce compelling evidence for this.

To conduct a phase II, double-blind, placebo-controlled, randomised partial crossover trial to compare microdosing psilocybin to placebo for MDD, evaluating its safety, tolerability and preliminary antidepressant effects.

Forty adults with MDD will be randomised to four doses of psilocybin (2 mg) or placebo (maltodextrin) once weekly over 4 weeks, then four doses of psilocybin (2 mg) once weekly for an additional 4 weeks. The primary efficacy end-point will be change in depression symptoms, as measured at baseline (0 weeks), after the experimental phase (4 weeks), and after the open-label phase (8 weeks). A battery of mood, well-being, attention, creativity, mindfulness and pro-sociality measures will be administered at each time point. Follow-ups will occur every 6 months for up to 2 years after the trial start date, as part of a long-term extension study.

The results of the primary outcome of this trial will be published as a manuscript in a peer-reviewed science or medical journal regardless of the magnitude or direction of effect.

Findings will inform future research on microdosing psilocybin for MDD, regarding dose regimens, effect sizes and expectancy bias. Findings will also facilitate discussions on the comparable benefits of sub- versus threshold doses of psilocybin and the therapeutic value of radically altered perception.

ClinicalTrials.gov identifier: NCT05259943.

Recruitment for rare disease studies is challenging due to small eligible populations. Traditional clinical research management systems often lack tools to track recruitment contacts prior to enrollment. The NET-PRO study, focused on neuroendocrine tumors (NETs), implemented a participation monitoring system to enhance recruitment efficiency and representativeness.

NET-PRO is a multicenter cohort study of 2538 adults diagnosed with gastroenteropancreatic (GEP) or lung NETs between January 2018 and September 2024. Recruitment occurred from January 2022 to February 2025 across 14 U.S. medical centers. Sites used flexible recruitment methods (email, mail, phone, in-clinic) and tracked contacts using REDCap-based tools. Participant characteristics were analyzed by enrollment mode (online or mail) and recruitment difficulty (number of contacts required prior to enrollment) using standardized mean differences, chi-square tests, and ANOVA.

Of 9279 contacted patients, 2675 consented (28.8%) and 2538 enrolled (27.4%). Most enrolled online (83.2%), while 16.8% enrolled by mail. Mail respondents were older, had lower education and income, and more comorbidities. Among those enrolled, recruitment difficulty was associated with older age, lower education and income, but not comorbidity. Over half of the most difficult-to-recruit participants enrolled online. Contact methods varied by attempt, with email dominating early contacts and phone/mail used more in later attempts.

A participation monitoring tool supported flexible, multimodal recruitment and improved sample representativeness in a rare cancer study. Tracking recruitment contacts enabled adaptive strategies and may reduce bias in observational research by enabling better outreach to harder-to-reach populations.

Carers of people living with breathlessness face common challenges due to the chronic, distressing and unpredictable nature of the symptom. These include unmet information and support needs resulting in worsened health and psychosocial outcomes. This review aimed to (1) identify the relative volume of studies on supportive interventions for carers of people living with breathlessness due to different respiratory diseases, (2) characterize the nature of the interventions, and (3) explore their reported effectiveness on outcomes identified by carers as being important.

Medline and CINAHL were searched for studies reporting interventions targeting unpaid adult carers of people with breathlessness, lung cancer, chronic obstructive pulmonary disease (COPD), Interstitial Lung Diseases (ILD) published 2000-2025. Intervention characteristics and reported outcomes were extracted and compared across diagnoses and intervention categories. Our findings were shaped by consultation with unpaid carers in a series of patient and public involvement workshops.

From 72 included interventions, three approaches were identified: Education, therapeutic support, and interventions for patient management. Interventions for lung cancer carers most frequently offered therapeutic support to the carer, while those for COPD carers most frequently focused on managing the patient. COPD and ILD carers have been underserved by research. We found few therapeutic support interventions for COPD carers. Reporting of carer demographics was poor, including among RCTs.

There was a dominance of research focusing on carers of people with lung cancer (56% of participants). In PPI consultations, carers identified stigma and poor communication with health providers as factors contributing to the disparity between lung cancer and other respiratory diseases. More research is needed to compare the efficacy of different intervention strategies to improve outcomes that matter most to carers. To improve equity, researchers must consistently report carer demographics and prioritize developing interventions for carers underserved by research.