Department of Clinical Research

ComBaScale aims to empower community health workers (CHWs) in under-resourced settings to deliver a high-quality, evidence-based, holistic package of integrated care for cardiovascular risk factors (CVRF). Its scalability will be tested in two districts of Lesotho, a low-income country disproportionately affected by a rising burden of non-communicable diseases (NCDs).

Guided by a validated implementation framework, trial evidence on the safety and effectiveness of CHW-led titration of antihypertensive and antidiabetic therapy will be translated into practice, while embedded in the national system. A pilot study will refine the intervention and align it with CHWs’ routine responsibilities, including HIV and tuberculosis screening, before roll-out through a stepped-wedge cluster randomised trial with a hybrid effectiveness-implementation design.

The CHWs will be supported by a patient-facing clinical decision-support application, interoperable with the national information system and featuring an innovative authoring tool to ensure safety and guideline fidelity. The trial will include an equity-informative extended cost-effectiveness analysis, while mixed-methods will examine acceptability, stigma, and gender-related barriers.

People living with CVRF will play a central role in co-developing and monitoring the intervention via community advisory boards, alongside village authorities, implementing partners, and researchers. All trial results, implementation frameworks, training material, and digital tools will be compiled in a comprehensive toolkit and piloted in a separate district for further scale-up. By applying the principles of implementation science throughout, ComBaScale will generate a validated, co-created, integrated CVRF care package, ready for adaptation across Lesotho and other under-resourced populations to reduce the NCD burden globally.

Background: Accurate measurement of patient height is critical in intensive care units (ICUs) for calculating ideal body weight, which directly guides weight-based interventions such as lung-protective ventilation settings and tidal volume adjustments. Currently, height estimation by ICU physicians and nursing staff is often unreliable, potentially leading to medical errors and suboptimal patient care. To overcome the challenges of measuring highly instrumented or immobile patients, contactless smartphone-based distance-measurement applications could offer a reliable, safe, and practical alternative in clinical practice.

Study Aim: first, to investigate whether the visual height estimations by nursing staff and physicians at the intensive care unit of the University Hospital Basel are indeed unreliable when compared to standard tape-measure readings with patient contact; second, to evaluate whether contactless height measurement using smartphone distance-measuring apps can provide a reliable and accurate assessment of patient height from a distance; and third, to determine whether this app-supported height measurement remains stable and reliable when performed by different healthcare professionals from various imaging heights and distances.

Methods This prospective observational study will be conducted in the intensive care unit of the University Hospital Basel. In the first phase, ICU physicians and nurses will visually estimate the height of a sample of ICU patients, and these subjective estimates will be compared against actual patient height measured using a standard manual tape measure. In the second phase, staff will use designated smartphone distance-measurement apps to evaluate patient height from a distance without direct patient contact. In the third phase, to test the robustness and inter-rater reliability of the digital tool, height measurements will be repeated by different healthcare professionals and systematically varied by altering the camera angle, height, and distance from the patient bed.

Background:

Insomnia and sleep disturbances are highly prevalent in palliative care patients and are associated with reduced quality of life, increased symptom burden, and psychological distress. Despite the frequent prescription of pharmacological sleep interventions in this vulnerable population, evidence regarding their efficacy and safety remains limited.

Aim:

To systematically evaluate the efficacy and safety of pharmacological interventions for insomnia and related sleep disorders in adult palliative care patients.

Methods:

We are conducting a Cochrane systematic review and meta-analysis of randomized controlled trials investigating pharmacological treatments for insomnia in adults with advanced, incurable diseases. Interventions include benzodiazepines, Z-substances, melatonin, antidepressants, antipsychotics, and other sleep-promoting agents. Primary outcomes include patient-reported sleep quality, sleep duration, sleep latency, daytime functioning, and adverse events. Secondary outcomes include quality of life, anxiety, and other symptom-related outcomes.

Results:

The review is currently ongoing.

Conclusion:

This project aims to provide a comprehensive evidence synthesis on pharmacological treatment of insomnia in palliative care. The findings will support evidence-based clinical decision-making, identify gaps in current research, and inform future guideline development for symptom management in patients with serious illness.