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☐ ☆ ✇ BMJ Open

Prevalence and determinants of pregnancy termination in Ethiopia: a systematic review and meta-analysis

Por: Kumsa · H. · Mislu · E. K. · Arage · M. W. · Kidie · A. A. · Hailu · T. · Tenaw · L. A. — Marzo 14th 2024 at 06:01
Objective

This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia.

Design

Systematic review and meta-analysis.

Data sources

Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines.

Eligibility criteria for selecting studies

The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case–control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis.

Data extraction and synthesis

The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I2 statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16.

Results

The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination.

Conclusions

One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.

☐ ☆ ✇ BMJ Open

Comparison of ultrasound-guided subtransverse process interligamentary plane block with paravertebral block for postoperative analgesia in thoracic surgery: protocol for a randomised non-inferiority trial

Por: Wu · W. · Wang · D. · Liu · Y. · Zhu · T. · He · W. · Shi · H. — Marzo 14th 2024 at 06:01
Introduction

The subtransverse process interligamentary (STIL) plane block is an emerging interfascial plane block that has garnered attention for its potential to provide effective postoperative analgesia for breast and thoracic surgeries. However, a direct comparative assessment between the STIL plane block and the paravertebral block is currently lacking. Consequently, our study aims to assess the analgesic efficacy of the STIL block in comparison to paravertebral block for patients undergoing video-assisted thoracoscopic surgery (VATS).

Methods and analysis

This study is a randomised, parallel-controlled, double-blind, non-inferiority trial, with the goal of enrolling 114 participants scheduled for uniportal VATS at Shanghai Pulmonary Hospital. Participants will be randomly assigned in a 1:1 ratio through block randomisation to receive either the STIL plane block (n=57) or the paravertebral block (n=57). The primary outcome of the study is the area under the curve of Numerical Rating Scale(NRS) scores recorded over a 48-hour period following the surgical procedure. Secondary outcomes encompass the evaluation of Quality of Recovery-40, cumulative sufentanil consumption, serum inflammatory factors, rescue medication usage, the incidence of adverse events and the patient satisfaction scores.

Ethics and dissemination

This study has received approval from the Medical Ethics Committee of Shanghai Pulmonary Hospital (approval no. L22-329). Written informed consent will be obtained from all participants. The findings will be submitted for publication in peer-reviewed journals.

Trial registration number

ChiCTR2200066909.

☐ ☆ ✇ BMJ Open

Reinforcing informed medication prescription for low back pain in the emergency department (RIME): a controlled interrupted time series implementation study protocol

Por: O'Leary · S. · Heine · J. · Warren · J. · Smyth · T. · Ballard · E. · Mitchell · G. · See · W. · Barlas · P. · Machado · G. C. · Cottrell · M. · Comans · T. · Foster · N. E. — Marzo 13th 2024 at 05:20
Introduction

Management guidelines for low back pain (LBP) recommend exclusion of serious pathology, followed by simple analgesics, superficial heat therapy, early mobilisation and patient education. An audit in a large metropolitan hospital emergency department (ED) revealed high rates of non-recommended medication prescription for LBP (65% of patients prescribed opioids, 17% prescribed benzodiazepines), high inpatient admission rates (20% of ED LBP patients), delayed patient mobilisation (on average 6 hours) and inadequate patient education (48% of patients). This study aims to improve medication prescription for LBP in this ED by implementing an intervention shown previously to improve guideline-based management of LBP in other Australian EDs.

Methods and analysis

A controlled interrupted time series study will evaluate the intervention in the ED before (24 weeks; 20 March 2023–3 September 2023) and after (24 weeks; 27 November 2024–12 May 2024) implementation (12 weeks; 4 September 2023–26 November 2023), additionally comparing findings with another ED in the same health service. The multicomponent implementation strategy uses a formalised clinical flow chart to support clinical decision-making and aims to change clinician behaviour, through clinician education, provision of alternative treatments, educational resources, audit and feedback, supported by implementation champions. The primary outcome is the percentage of LBP patients prescribed non-recommended medications (opioids, benzodiazepines and/or gabapentinoids), assessed via routinely collected ED data. Anticipated sample size is 2000 patients (n=1000 intervention, n=1000 control) based on average monthly admissions of LBP presentations in the EDs. Secondary outcomes include inpatient admission rate, time to mobilisation, provision of patient education, imaging requests, representation to the ED within 6 months and healthcare costs. In nested qualitative research, we will study ED clinicians’ perceptions of the implementation and identify how benefits can be sustained over time.

Ethics and dissemination

This study received ethical approval from the Metro North Human Research Ethics Committee (HREC/2022/MNHA/87995). Study findings will be published in peer-reviewed journals and presented at international conferences and educational workshops.

Trial registration number

ACTRN12622001536752.

☐ ☆ ✇ BMJ Open

Association between socioeconomic status and hypertension among adults in Fujian province and the mediating effect of BMI and cooking salt intake: a cross-sectional study

Por: Li · Y. · Ge · W. · Wu · M. · Gao · M. · Peng · Z. · Han · Y. · Hu · X. · Li · L. — Marzo 13th 2024 at 05:20
Objectives

This study aimed to investigate the association between socioeconomic status (SES) and the prevalence of hypertension in Fujian province, China, and to evaluate the mediating effect of body mass index (BMI) and cooking salt intake between SES and hypertension.

Design

Community-based cross-sectional survey was conducted between June 2018 and December 2019.

Setting

Fujian province, China.

Participants

A total of 26 500 participants aged >18 years completed the survey.

Outcome measures

The primary outcome was the prevalence of hypertension. Education, income and occupation were used as SES indicators. Meanwhile, certain health behaviours and metabolic risk factors were used as secondary indicators of SES.

Results

The prevalence of hypertension was relatively high among participants who finished primary education (34.8%), had the lowest annual income (46.0%), were unemployed or retired (34.7%). Education and income levels were negatively associated with the prevalence of hypertension (p

Conclusions

SES was associated with the prevalence of hypertension among adults in Fujian province, China. BMI and cooking salt intake were partial mediators of the association between SES and hypertension.

☐ ☆ ✇ BMJ Open

Qualitative study of challenges with recruitment of hospitals into a cluster controlled trial of clinical decision support in Australia

Por: Baysari · M. T. · Van Dort · B. A. · Stanceski · K. · Hargreaves · A. · Zheng · W. Y. · Moran · M. · Day · R. O. · Li · L. · Westbrook · J. · Hilmer · S. N. — Marzo 13th 2024 at 05:20
Objective

To identify barriers to hospital participation in controlled cluster trials of clinical decision support (CDS) and potential strategies for addressing barriers.

Design

Qualitative descriptive design comprising semistructured interviews.

Setting

Five hospitals in New South Wales and one hospital in Queensland, Australia.

Participants

Senior hospital staff, including department directors, chief information officers and those working in health informatics teams.

Results

20 senior hospital staff took part. Barriers to hospital-level recruitment primarily related to perceptions of risk associated with not implementing CDS as a control site. Perceived risks included reductions in patient safety, reputational risk and increased likelihood that benefits would not be achieved following electronic medical record (EMR) implementation without CDS alerts in place. Senior staff recommended clear communication of trial information to all relevant stakeholders as a key strategy for boosting hospital-level participation in trials.

Conclusion

Hospital participation in controlled cluster trials of CDS is hindered by perceptions that adopting an EMR without CDS is risky for both patients and organisations. The improvements in safety expected to follow CDS implementation makes it challenging and counterintuitive for hospitals to implement EMR without incorporating CDS alerts for the purposes of a research trial. To counteract these barriers, clear communication regarding the evidence base and rationale for a controlled trial is needed.

☐ ☆ ✇ BMJ Open

Facilitators and barriers to codesigning social robots with older adults with dementia: a scoping review protocol

Por: Hung · L. · Chen · I. · Wong · K. L. Y. · Jackson · L. · Lou · V. W. Q. — Marzo 13th 2024 at 05:20
Introduction

Social robots including telepresence robots have emerged as potential support in dementia care. However, the effectiveness of these robots hinges significantly on their design and utility. These elements are often best understood by their end-users. Codesign involves collaborating directly with the end-users of a product during its development process. Engaging people with dementia in the design of social robots ensures that the products cater to their unique requirements, preferences, challenges, and needs. The objective of this scoping review is to understand the facilitators, barriers, and strategies in codesigning social robots with older adults with dementia.

Methods and analysis

The scoping review will follow the Joanna Briggs Institute scoping review methodology and will be conducted from November 2023 to April 2024. The steps of search strategy will involve identifying keywords and index terms from CINAHL and PubMed, completing search using identified keywords and index terms across selected databases (Medline, CINAHL, PubMed, AgeLine, Web of Science, PsycINFO, Scopus, IEEE, and Google Scholar), and hand-searching the reference lists from chosen literature for additional literature. The grey literature will be searched using Google. Three research assistants will screen the titles and abstracts independently by referring to the inclusion criteria. Three researchers will independently assess the full text of literature following to the inclusion criteria. The data will be presented in a table with narratives that answers the questions of the scoping review.

Ethics and dissemination

This scoping review does not require ethics approval because it collects data from publicly available resources. The findings will offer insights to inform future research and development of robots through collaboration with older people with dementia. In addition, the scoping review results will be disseminated through conference presentations and an open-access publication in a peer-reviewed journal.

☐ ☆ ✇ BMJ Open

Adverse birth outcomes and childhood overweight at age of 3-8 years in a prospective cohort study in Tianjin, China

Por: Zhang · R. · Gao · M. · Li · W. · Liu · H. · Wang · S. · Wang · H. · Li · N. · Li · J. · Yu · Z. · Hu · G. · Leng · J. · Yang · X. — Marzo 13th 2024 at 05:20
Objectives

To explore associations between adverse birth outcomes and childhood overweight at 3–8 years of age.

Design

A prospective cohort study.

Setting

Six central urban districts of Tianjin, China.

Participants

1681 woman–child pairs.

Methods

1681 woman–child pairs were followed up for 8 years in Tianjin, China. Demographic and clinical information including birth outcomes was collected longitudinally, commencing from first antenatal care visit till postpartum period. Offspring height and weight were measured at 3–8 years of age. High and low weight/length ratios (WLR) at birth were, respectively, defined as ≥90th and ≤10th gestational week and sex-specific percentiles. Overweight for children at 3–5 and 6–8 years of age were, respectively, defined as body mass index (BMI)-for-age and -sex above the 2 z-score and 1 z-score curves of the WHO’s child growth standards. Binary logistic regression analysis was used to obtain ORs and 95% CI with a stepwise backward selection method to select independent predictors.

Primary outcomes measures

Childhood overweight.

Results

Of 1681 children, 10.7% (n=179) and 27.8% (n=468) developed overweight at 3–5 and 6–8 years of age, respectively. Large for gestational age (LGA) was associated with increased risk of overweight at 3–5 years of age (aOR: 1.86, 95% CI: 1.27 to 2.72) while high WLR at birth was associated with increased risk of overweight at 6–8 years of age (1.82, 1.41 to 2.34). Low WLR at birth was associated with decreased risk of overweight at 6–8 years of age (0.52, 0.30 to 0.90).

Conclusions

LGA and high WLR at birth predicted childhood overweight at 3–5 and 6–8 years of age, respectively. Low WLR at birth was associated with decreased risk of childhood overweight at 6–8 years of age.

☐ ☆ ✇ BMJ Open

Willingness to purchase institutionalised elderly services and influencing factors among Chinese older adults: a nationwide cross-sectional study

Por: Zhu · R. · Hou · W. · Wang · L. · Zhang · C. · Guo · X. · Luo · D. · Wang · F. — Marzo 12th 2024 at 06:06
Objectives

In view of the serious ageing of China’s population and the low desire of elderly people to purchase institutionalised elderly care services, we explored the willingness of Chinese elderly people to purchase institutionalised elderly care services and its influencing factors.

Design

This was a cross-sectional study. Three multivariate logistic regression analysis models of the willingness of elderly people to purchase institutionalised elderly care services were established (model 1: ‘reluctance – willingness’; model 2: ‘reluctance – hesitation’; and model 3: ‘hesitation – willingness’) to explore the factors that influence elderly people’s willingness to purchase institutionalised elderly care services.

Setting

This study was based on the 2022 Psychology and Behaviour Investigation of Chinese Residents database.

Participants

Research data from 4123 older adults who met the requirements of this study were screened from the database.

Results

Of the 4123 respondents, roughly equal numbers had negative and positive attitudes towards purchasing institutionalised senior care services (1125, 27.3% vs 1079, 26.2%, respectively), and 1919 (46.5%) had hesitant attitudes. The analysis of model 1 showed that medical insurance participation, the number of children and siblings, chronic diseases and per capita monthly household income had an influential effect on the willingness of elderly people to purchase institutional care. In model 2, we found that factors such as per capita monthly household income and anxiety led to hesitancy among older adults to purchase institutionalised senior care services. In model 3, we further found that social support and health literacy led to a shift from hesitation to willingness to purchase institutionalised elderly care services.

Conclusion

The number of children, number of siblings, per capita monthly income of the family, medical insurance participation, health status, health literacy and social support were found to be the main factors influencing the purchase of institutionalised care by elderly individuals.

☐ ☆ ✇ BMJ Open

Portable devices for diagnosis and monitoring of glaucoma: a scoping review protocol

Por: Garba · F. · Kyari · F. · Nolan · W. · Burton · M. J. · Gordon · I. · Evans · J. R. · Hu · V. H. — Marzo 12th 2024 at 06:06
Introduction

Glaucoma is the leading cause of irreversible blindness in the world. The need to diagnose glaucoma early in its natural history before extensive sight loss occurs cannot be overemphasised. However, glaucoma is largely asymptomatic in the early stages of the disease making it complex to diagnose clinically and requires the support of technology. The objective of this scoping review is to determine the nature and extent of the evidence for use of portable devices in the diagnosis of glaucoma.

Methods

We will consider studies conducted in all healthcare settings using portable devices for the detection of all type of adult glaucoma. We will also include any systematic reviews or scoping reviews, which relate to this topic. Searches will be conducted in MEDLINE, Embase, CENTRAL on the Cochrane Library and Global Health databases, from their inception to the present. Reference lists from publications identified in the searches will also be reviewed. Two authors will independently screen titles and abstracts, followed by full-text screening to assess studies for inclusion. Any disagreements will be discussed and resolved with a third author. Tables accompanied by narrative descriptions will be employed to discuss results and show how it relates to review questions.

Ethics and dissemination

Ethical approval is not required in this review. Only published and publicly accessible data will be used. We will publish our findings in an open-access, peer-reviewed journal and develop an accessible summary of results and recommendations.

☐ ☆ ✇ BMJ Open

Impact of evidence-based guidelines on healthcare utilisation and costs for disc related sciatica in the Netherlands: a population-based, cross-sectional study

Por: van Munster · J. · Noordenbos · M. W. · Halperin · I. J. Y. · van den Hout · W. B. · van Benthem · P. P. · Seinen · I. · Moojen · W. A. · Peul · W. — Marzo 12th 2024 at 06:06
Objective

The aim of this study was to assess the impact of high-quality evidence supporting surgical treatment of lumbar disc herniation (LDH) on healthcare practice in the Netherlands by examining changes in healthcare utilisation, including the timing of surgery, and the healthcare costs for patients with LDH.

Design

A retrospective, cross-sectional study was performed using population-based, longitudinal data obtained from the Dutch Healthcare Authority (2007–2020) and NIVEL’s primary care (2012–2020) administrative databases.

Setting

The study was conducted within the healthcare system of the Netherlands.

Participants

We included adults (≥18 years) who visited a Dutch hospital or a general practitioner (GP) for lumbar degenerative disc disease. Patients with LDH were identified based on registered diagnosis code, type of surgery (discectomy) and age (

Main outcome measures

The primary outcome measure was the difference in the annual number of LDH procedures following the publication of evidence-based guidelines in 2009 (comparing the periods 2007–2009 to 2017–2019). Secondary outcome measures focused on the timing of surgery and associated healthcare costs. To validate the outcomes, secondary outcomes also include the number of discectomies and the number of procedures in the younger age group (discectomies, laminectomies, and fusion surgery).

Results

The number of patients suffering from LDH increased from 55 581 to 68 997 (+24%) between 2007 and 2019. A decrease was observed in the annual number of LDH procedures (–18%), in the number of discectomies (–22%) and in the number of procedures for patients aged

Conclusions

Healthcare utilisation for LDH changed tremendously in the Netherlands between 2007 and 2020 and seemed to be associated with the publication and implementation of evidence-based guidelines. The observed decrease in the number of procedures has been accompanied by a corresponding reduction in healthcare costs. These findings underscore the importance of adhering to evidence-based guidelines to optimise the management of patients with LDH.

☐ ☆ ✇ BMJ Open

Appraising the quality standard of clinical practice guidelines related to central venous catheter-related thrombosis prevention: a systematic review of clinical practice guidelines

Por: Zhang · J. · Wu · Y. · Zhang · S. · Yao · W. · Bu · F. · Wang · A. · Hu · X. · Wang · G. — Marzo 12th 2024 at 06:06
Objective

To evaluate the quality and analyse the content of clinical practice guidelines regarding central venous catheter-related thrombosis (CRT) to provide evidence for formulating an evidence-based practice protocol and a risk assessment scale to prevent it.

Design

Scoring and analysis of the guidelines using the AGREE II and AGREE REX scales.

Data sources

Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature, and the relevant websites of the guideline, were searched from 1 January 2017 to 26 March 2022.

Eligibility criteria

Guidelines covering CRT treatment, prevention, or management were included from 1 January 2017 to 26 March 2022.

Data extraction and synthesis

Three independent reviewers systematically trained in using the AGREE II and AGREE REX scales were selected to evaluate these guidelines.

Results

Nine guidelines were included, and the quality grade results showed that three were at A-level and six were at B-level. The included guidelines mainly recommended the prevention measure of central venous CRT from three aspects: risk screening, prevention strategies, and knowledge training, with a total of 22 suggestions being recommended.

Conclusion

The overall quality of the guidelines is high, but there are few preventive measures for central venous CRT involved in the guidelines. All preventive measures have yet to be systematically integrated and evaluated, and no risk assessment scale dedicated to this field has been recommended. Therefore, developing an evidence-based practice protocol and a risk assessment scale to prevent it is urgent.

☐ ☆ ✇ Journal of Clinical Nursing

“But what do you really think?” Nurses' contrasting explicit and implicit attitudes towards people with disabilities using the implicit association test

Por: Daniel W. Derbyshire · Tamsin Keay — Marzo 8th 2024 at 06:53

Abstract

Aims

To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers.

Method

We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021.

Data Sources

We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/.

Reporting

STROBE checklist.

Results

There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD—among all groups—has not improved over the 15 year period of our sample.

Conclusions

We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently.

Implications

We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding.

Patient or Public Contribution

There is no patient or public contribution.

☐ ☆ ✇ CIN: Computers, Informatics, Nursing

Factors Influencing Medication Administration Outcomes Among New Graduate Nurses Using Bar Code–Assisted Medication Administration

imageParamount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code–assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.
☐ ☆ ✇ BMJ Open

Psychological adjustment to death anxiety: a qualitative study of Chinese patients with advanced cancer

Por: Chen · F. · Ou · M. · Xia · W. · Xu · X. — Marzo 9th 2024 at 02:25
Objectives

Death anxiety (DA) refers to the negative emotions experienced when a person reflects on the inevitability of their own death, which is common among patients with cancer. It is crucial to understand the causes, coping styles and adjustment processes related to DA. The purpose of this qualitative study is to explore the adaptation process and outcome of patients with advanced cancer with DA and to provide evidence-based support for the development of targeted intervention measures to improve the mental health of such patients.

Design

This cross-sectional qualitative study sampled patients with advanced cancer (n=20). Grounded theory procedures were used to analyse transcripts and a theoretical model generated.

Setting

All interviewees in this study were from a tertiary oncology hospital in Hunan Province, China. The data analysis followed the constructive grounded theory method, involving constant comparison and memo writing.

Participants

A purposive and theoretical sampling approach was used to recruit 20 patients with advanced cancer with diverse characteristics.

Results

A total of 20 participants were included in the study. Four stages of DA in patients with advanced cancer were extracted from the interview data: (1) death reminder and prominence; (2) perception and association; (3) defence and control; (4) transformation and Acceptance.

Conclusions

This study highlights the psychological status and coping strategies of dynamic nature of patients with advanced cancer when confronted with negative emotions associated with death. It emphasises the importance of timely identification of DA in psychological nursing for patients with advanced cancer and the need for targeted psychological interventions based on their specific psychological processes.

Implications

Knowing interventions that aim to promote the integration of internal and external resources, enhance self-esteem and facilitate a calm and accepting attitude towards death could ultimately reduce the overall DA of patients with advanced cancer.

☐ ☆ ✇ BMJ Open

Survival outcomes following complete mediastinal lymphadenectomy or selective mediastinal lymphadenectomy in patients with stage I-IIIA non-small cell lung cancer: protocol for a systematic review and meta-analysis

Por: Xu · J. · Lai · J. · Huang · X. · Ren · Y. · Chen · Q. · Li · W. — Marzo 9th 2024 at 02:25
Introduction

Lung cancer remains the largest cause of cancer-related deaths worldwide. Surgical removal of non-small cell lung cancer (NSCLC) has the potential to achieve a cure, although there is ongoing debate regarding the significance of removing mediastinal nodes and the optimal extent of lymph node excision. The purpose of this research is to assess the survival outcomes in patients diagnosed with stage I–IIIA NSCLC who received either complete mediastinal lymphadenectomy (CML) or selective mediastinal lymphadenectomy (SML).

Methods and analysis

The protocol follows the guidelines recommended in Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and this meta-analysis will be conducted in accordance with the standard methodology recommended by the Cochrane Collaboration and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance. We will conduct a comprehensive search for randomised controlled trials and non-randomised studies examining the effectiveness of CML compared with SML in patients with stage I–IIIA NSCLC. Two authors will perform a comprehensive search of the MEDLINE/PubMed, Embase, the Cochrane Library, CNKI, WanFang, Sinomed, VIP and Web of Science databases. There will be no restrictions on language or publication date, and the search will be conducted on 10 April 2024, with ongoing searches for new research. Reference lists will also be checked and pertinent journals will be hand searched. The primary outcomes include overall survival (OS) and disease-free survival (DFS), while the secondary outcomes consist of 1-year, 3-year and 5-year OS rates and 1-year, 3-year and 5-year DFS rates. Two independent reviewers will screen, extract data, assess quality and evaluate the potential for bias in the selected research, with a third acting as arbitrator. Subgroup analyses and sensitivity analyses are planned. The quality of the evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation. Review Manager V.5.4 will be used for the analysis and synthesis process.

Ethics and dissemination

Ethical review and approval are not necessary for this study because it is based on a secondary analysis of the literature. The results will be submitted for reporting in a peer-reviewed publication.

Study registration

Open Science Framework (https://doi.org/10.17605/OSF.IO/PN7UQ).

☐ ☆ ✇ BMJ Open

Developing blood-brain barrier arterial spin labelling as a non-invasive early biomarker of Alzheimers disease (DEBBIE-AD): a prospective observational multicohort study protocol

Por: Padrela · B. · Mahroo · A. · Tee · M. · Sneve · M. H. · Moyaert · P. · Geier · O. · Kuijer · J. P. A. · Beun · S. · Nordhoy · W. · Zhu · Y. D. · Buck · M. A. · Hoinkiss · D. C. · Konstandin · S. · Huber · J. · Wiersinga · J. · Rikken · R. · de Leeuw · D. · Grydeland · H. · Tippett · L. · Caw — Marzo 9th 2024 at 02:25
Introduction

Loss of blood-brain barrier (BBB) integrity is hypothesised to be one of the earliest microvascular signs of Alzheimer’s disease (AD). Existing BBB integrity imaging methods involve contrast agents or ionising radiation, and pose limitations in terms of cost and logistics. Arterial spin labelling (ASL) perfusion MRI has been recently adapted to map the BBB permeability non-invasively. The DEveloping BBB-ASL as a non-Invasive Early biomarker (DEBBIE) consortium aims to develop this modified ASL-MRI technique for patient-specific and robust BBB permeability assessments. This article outlines the study design of the DEBBIE cohorts focused on investigating the potential of BBB-ASL as an early biomarker for AD (DEBBIE-AD).

Methods and analysis

DEBBIE-AD consists of a multicohort study enrolling participants with subjective cognitive decline, mild cognitive impairment and AD, as well as age-matched healthy controls, from 13 cohorts. The precision and accuracy of BBB-ASL will be evaluated in healthy participants. The clinical value of BBB-ASL will be evaluated by comparing results with both established and novel AD biomarkers. The DEBBIE-AD study aims to provide evidence of the ability of BBB-ASL to measure BBB permeability and demonstrate its utility in AD and AD-related pathologies.

Ethics and dissemination

Ethics approval was obtained for 10 cohorts, and is pending for 3 cohorts. The results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal.

☐ ☆ ✇ BMJ Open

Do they stay, or do they go? Children presenting to five emergency departments across New South Wales, Australia with acute burn injuries: a retrospective review

Por: Phillips · W. · Southern · E. · Cattell · C. · Owens · P. · Jaques · M. · Melbourne · G. · Kezhekkekara · S. · Frost · S. A. — Marzo 9th 2024 at 02:25
Objective

The overall objective of the study was to describe the disposition status of children presenting with a burn injury to five emergency departments (ED) across New South Wales (NSW), Australia.

Design

A retrospective study design was used to review routinely collected ED data.

Setting

Study sites included five acute hospitals across NSW, Australia.

Participants

During the 5-year study period between 1 January 2015 to 31 December 2020, there were 5213 paediatric burn injury presentations.

Results

The mean age of burn injury presentations was 24 months (Inter-Quartile-Range (IQR) 12–84), of which 57% (2951/5213) were males. The most common presentation time was between 16:00 and 23:59 hours (63%, 3297/5213), and the median time spent in the ED was 3 hours (IQR 1–4). The majority (80%, 4196/5213) of the burn injuries presentations did not require hospital admission. The most common principal diagnoses were ‘Burn body region unspecified’ (n=1916) and ‘Burn of wrist and hand’ (n=1060).

Conclusion

Most children who presented to the hospital with a burn injury were not admitted. Often the details of these burns were poorly recorded and a complete picture of the true burden of burn injury in children, especially the ongoing care given outside the acute hospital setting, is missing. This information is crucial, as it would inform future models of care as the paradigm shifts rapidly towards primary, ambulatory and outpatient models of care.

☐ ☆ ✇ BMJ Open

A socially interdependent choice framework for social influences in healthcare decision-making: a study protocol

Por: Nouwens · S. P. H. · Veldwijk · J. · Pilli · L. · Swait · J. D. · Coast · J. · de Bekker-Grob · E. W. — Marzo 9th 2024 at 02:25
Objectives

Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users’ decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making.

Design

A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework.

Ethics and dissemination

This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).

☐ ☆ ✇ BMJ Open

Association between long-term use of calcium channel blockers (CCB) and the risk of breast cancer: a retrospective longitudinal observational study protocol

Por: Ho · C. · Ha · N. T. · Youens · D. · Abhayaratna · W. P. · Bulsara · M. K. · Hughes · J. D. · Mishra · G. · Pearson · S.-A. · Preen · D. B. · Reid · C. M. · Ruiter · R. · Saunders · C. M. · Stricker · B. H. · van Rooij · F. J. A. · Wright · C. · Moorin · R. — Marzo 9th 2024 at 02:25
Introduction

Calcium channel blockers (CCB), a commonly prescribed antihypertensive (AHT) medicine, may be associated with increased risk of breast cancer. The proposed study aims to examine whether long-term CCB use is associated with the development of breast cancer and to characterise the dose–response nature of any identified association, to inform future hypertension management.

Methods and analysis

The study will use data from 2 of Australia’s largest cohort studies; the Australian Longitudinal Study on Women’s Health, and the 45 and Up Study, combined with the Rotterdam Study. Eligible women will be those with diagnosed hypertension, no history of breast cancer and no prior CCB use at start of follow-up (2004–2009). Cumulative dose-duration exposure to CCB and other AHT medicines will be captured at the earliest date of: the outcome (a diagnosis of invasive breast cancer); a competing risk event (eg, bilateral mastectomy without a diagnosis of breast cancer, death prior to any diagnosis of breast cancer) or end of follow-up (censoring event). Fine and Gray competing risks regression will be used to assess the association between CCB use and development of breast cancer using a generalised propensity score to adjust for baseline covariates. Time-varying covariates related to interaction with health services will also be included in the model. Data will be harmonised across cohorts to achieve identical protocols and a two-step random effects individual patient-level meta-analysis will be used.

Ethics and dissemination

Ethical approval was obtained from the following Human research Ethics Committees: Curtin University (ref No. HRE2022-0335), NSW Population and Health Services Research Ethics Committee (2022/ETH01392/2022.31), ACT Research Ethics and Governance Office approval under National Mutual Acceptance for multijurisdictional data linkage research (2022.STE.00208). Results of the proposed study will be published in high-impact journals and presented at key scientific meetings.

Trial registration number

NCT05972785.

☐ ☆ ✇ BMJ Open

Artificial intelligence driven malnutrition diagnostic model for patients with acute abdomen based on GLIM criteria: a cross-sectional research protocol

Por: Ma · W. · Cai · B. · Wang · Y. · Wang · L. · Sun · M.-W. · Lu · C. D. · Jiang · H. — Marzo 9th 2024 at 02:25
Background

Patients with acute abdomen often experience reduced voluntary intake and a hypermetabolic process, leading to a high occurrence of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria have rapidly developed into a principal methodological tool for nutritional diagnosis. Additionally, machine learning is emerging to establish artificial intelligent-enabled diagnostic models, but the accuracy and robustness need to be verified. We aimed to establish an intelligence-enabled malnutrition diagnosis model based on GLIM for patients with acute abdomen.

Method

This study is a single-centre, cross-sectional observational investigation into the prevalence of malnutrition in patients with acute abdomen using the GLIM criteria. Data collection occurs on the day of admission, at 3 and 7 days post-admission, including biochemical analysis, body composition indicators, disease severity scoring, nutritional risk screening, malnutrition diagnosis and nutritional support information. The occurrence rate of malnutrition in patients with acute abdomen is analysed with the GLIM criteria based on the Nutritional Risk Screening 2002 and the Mini Nutritional Assessment Short-Form to investigate the sensitivity and accuracy of the GLIM criteria. After data cleansing and preprocessing, a machine learning approach is employed to establish a predictive model for malnutrition diagnosis in patients with acute abdomen based on the GLIM criteria.

Ethics and dissemination

This study has obtained ethical approval from the Ethics Committee of the Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital on 28 November 2022 (Yan-2022–442). The results of this study will be disseminated in peer-reviewed journals, at scientific conferences and directly to study participants.

Trial registration number

ChiCTR2200067044.

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