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☐ ☆ ✇ BMJ Open

Feasibility of respondent-driven sampling to recruit participants with recent abortion experiences in humanitarian contexts: a mixed-methods community-engaged research study

Por: Jayaweera · R. T. · Odhoch · L. · Nabunje · J. · Oduor · C. · Zuniga · C. · Powell · B. · Barasa · W. · Aber · F. · Nyalwal · B. · Kakesa · J. · Wado · Y. D. · Ouedraogo · R. · Fetters · T. — Septiembre 30th 2025 at 09:49
Objective

This study aims to assess the feasibility of respondent-driven sampling (RDS) to recruit participants with recent abortion experiences in humanitarian contexts, and describe the composition of the study sample generated with this sampling method.

Design

This was a three-phase mixed-methods community-engaged research study employing an exploratory and explanatory sequential approach. We conducted in-depth interviews, focus group discussions, an interviewer-administered questionnaire on abortion experiences and a health facility assessment.

Setting

Bidibidi Refugee Settlement, Uganda and Kakuma Refugee Camp, Kenya from November 2021 to December 2022.

Participants

Using RDS, we recruited 600 participants in Kakuma and 601 participants in Bidibidi with recent abortion experiences. In Kakuma, participants were primarily from Burundi, the Democratic Republic of the Congo and South Sudan; participants in Bidibidi were primarily from South Sudan. Most participants in both sites had completed at least some primary school and were not employed.

Outcome measures

RDS recruitment dynamics: convergence and bottlenecks on key sociodemographic variables, recruitment and population homophily, reciprocity of social ties, success and experiences recruiting.

Results

There were minor violations of RDS assumptions, particularly regarding assumptions of reciprocity of ties and seed composition independent of sample. In addition, there was a strong tendency of participants to recruit those from the same home country and living within the same camp zone. However, sample proportions for age, home country, marital status, zone of residence and student status reached equilibrium (stabilised) by around 500 participants at each site, and we were able to quickly attain the study sample size.

Conclusions

While the true representativeness of our sample remains unknown, RDS is a practical and effective recruitment method in humanitarian contexts for sensitive topics, particularly for research questions in which no data or sampling frames exist. However, attention to representativeness and community engagement is essential to optimising its application and ensuring success.

☐ ☆ ✇ BMJ Open

Protocol for an observational cohort study integrating real-world data and microsimulation to assess imaging surveillance strategies in stage I-IIIA NSCLC patients in OneFlorida+

Por: Braithwaite · D. · Karanth · S. D. · Bian · J. · Meza · R. · Jeon · J. · Tammemagi · M. · Wheeler · M. · Cao · P. · Rackauskas · M. · Shrestha · P. · Yoon · H.-S. · Borondy Kitts · A. · Verma · H. · Blair · M. C. · Chen · A. · Das · D. · Lou · X. · Wu · Y. · Han · S. · Hochhegger · B. · Guo · Y — Septiembre 29th 2025 at 07:52
Introduction

Although lung cancer remains the leading cause of cancer deaths in the US, recent advances in early detection and treatment have led to improvements in survival. However, there is a considerable risk of recurrence or second primary lung cancer (SPLC) following curative-intent treatment in patients with early-stage non-small cell lung cancer (NSCLC). Professional societies recommend routine surveillance with CT to optimise the detection of potential recurrence and SPLC at a localised stage. However, no definitive evidence demonstrates the effect of imaging surveillance on survival in patients with NSCLC. To close these research gaps, the Advancing Precision Lung Cancer Surveillance and Outcomes in Diverse Populations (PLuS2) study will leverage real-world electronic health records (EHRs) data to evaluate surveillance outcomes among patients with and without guideline-adherent surveillance. The overarching goal of the PLuS2 study is to assess the long-term effectiveness of surveillance strategies in real-world settings.

Methods and analysis

PLuS2 is an observational study designed to assemble a cohort of patients with incident pathologically confirmed stage I/II/IIIA NSCLC who have completed curative-intent therapy. Patients undergoing imaging surveillance will be followed from 2012 to 2026 by linking EHRs with tumour registry data in the OneFlorida+ Clinical Research Consortium. Data will be consolidated into a unified repository to achieve three primary aims: (1) Examine the utilisation and determinants of CT imaging surveillance by race/ethnicity and socioeconomic status, (2) Compare clinical endpoints, including recurrence, SPLCs and survival of patients who undergo semiannual versus annual CT imaging and (3) Use the observational data in conjunction with validated microsimulation models to simulate imaging surveillance outcomes within the US population. To our knowledge, this study represents the first attempt to integrate real-world data and microsimulation models to assess the long-term impact and effectiveness of imaging surveillance strategies.

Ethics and dissemination

This study involves human participants and was approved by the University of Florida Institutional Review Board (IRB), University of Florida IRB 01, under approval number IRB202300782. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations encompass ensuring the confidentiality of patient information. All disseminated data will be de-identified and summarised.

☐ ☆ ✇ BMJ Open

Development of a nurse-led clinical pathway to prevent delirium in older adults in general hospital wards: a realist review protocol

Por: Hoch · J. · Müller · M. · Unger · I. · Mitzkat · A. · Denninger · N.-E. — Septiembre 16th 2025 at 03:21
Introduction

Delirium is a critical and complex neuropsychiatric syndrome that significantly affects older adults in general hospital wards. Although multicomponent interventions have been shown to be effective in preventing delirium, the consistent implementation remains a challenge. Also, to manage the complex pathway of patients from admission to discharge in hospital, the involvement of the nursing staff is essential. Developing a nurse-led clinical pathway for delirium prevention could provide a structured approach to improving care quality. For intervention development taking account of the complexity of the clinical environment, the UK Medical Research Council framework is frequently used. A core element of this framework is mapping a programme theory that explains how, for whom and in what circumstances an intervention may work. The realist review methodology is well suited to uncovering the underlying mechanisms, contexts and outcomes of interventions, translating these into a programme theory.

The aim of this realist review is to develop a programme theory for a nurse-led clinical pathway to prevent delirium in older adults aged 65 years or older in general hospital wards and to identify strategies to support its effective implementation.

Methods and analysis

The realist review is based on the methodical framework developed by Pawson et al and further adapted by Rycroft-Malone et al and the reporting will follow the Realist And MEta-narrative Evidence Syntheses: Evolving Standards guidelines. The process comprises four steps: (1) defining the review scope; (2) systematically searching for and appraising the evidence; (3) extracting and synthesising findings and (4) developing a narrative synthesis. Interest holders, including clinical and academic experts, will be actively involved as an expert reference group to inform and refine the programme theory. The final programme theory will be presented in Context-Mechanism-Outcome configurations and the Implementation Research Logic Model.

Ethics and dissemination

Since no data are collected as part of the review, ethical approval is not required. Findings will be disseminated through academic conferences and publication in a peer-reviewed journal.

Registration

This protocol has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/7EPTF).

☐ ☆ ✇ BMJ Open

Health economic evaluations of perinatal complications with conflicting maternal-fetal interests: a scoping review protocol

Por: Mo · L. · Lopez Aguirre · A. · Sivakumar · N. · Prompalit · S. · Hedriana · H. L. · Hoch · J. S. — Julio 7th 2025 at 06:01
Introduction

Perinatal complications involving conflicts between maternal and fetal health interests present a unique challenge to health economic evaluations. No comprehensive synthesis exists of how such studies account for dual-patient outcomes. We aim to develop a scoping review protocol to map and critically examine the methodologies in this understudied area.

Methods and analysis

The scoping review will be conducted under the Joanna Briggs Institute (JBI) framework. It will include health economic studies, such as cost-effectiveness, cost utility and decision analysis studies, focusing on clinical conditions during pregnancy where maternal and fetal interests conflict. Cost analysis without effectiveness assessment will be excluded. Using comprehensive search strategies in Medline (Ovid), EMBASE (Elsevier) and Cochrane Library (Wiley), two independent reviewers will screen and identify relevant studies via abstract and full-text review. We will perform data extraction following an adapted form from the Consolidated Health Economic Evaluation Reporting Standards checklist, which includes the content details, such as the type of study, population, intervention, comparator, probability, utility, duration, cost, model types and uncertainty measurements. As we try to explore the impact of the health economic studies in clinical practice, we will include citation metrics of each study and whether the study was cited by practice guidelines and clinical trials in the data extraction. We will also apply the JBI Checklist for Economic Evaluations to assess the reporting completeness in each article. Results will be tabulated by clinical theme and synthesised narratively to highlight patterns in valuation approaches, gaps in current methods and impact on clinical guidelines.

Ethics and dissemination

This study does not require ethical approval as it involves secondary analysis of published data. Findings will be disseminated through peer-reviewed publications, conference presentations and stakeholder engagement activities.

PROSPERO registration number

CRD42024557324

☐ ☆ ✇ Journal of Clinical Nursing

Nurses' perceptions of point‐of‐care ultrasound for haemodialysis access assessment and guided cannulation: A qualitative study

Por: Monica Schoch · Paul N. Bennett · Judy Currey · Alison M. Hutchinson — Septiembre 4th 2023 at 06:50

Abstract

Aim

To explore nurses' perceptions of using point-of-care ultrasound for assessment and guided cannulation in the haemodialysis setting.

Background

Cannulation of arteriovenous fistulae is necessary to perform haemodialysis. Damage to the arteriovenous fistula is a frequent complication, resulting in poor patient outcomes and increased healthcare costs. Point-of-care ultrasound-guided cannulation can reduce the risk of such damage and mitigate further vessel deterioration. Understanding nurses' perceptions of using this adjunct tool will inform its future implementation into haemodialysis practice.

Design

Descriptive qualitative study.

Methods

Registered nurses were recruited from one 16-chair regional Australian haemodialysis clinic. Eligible nurses were drawn from a larger study investigating the feasibility of implementing point-of-care ultrasound in haemodialysis. Participants attended a semistructured one-on-one interview where they were asked about their experiences with, and perceptions of, point-of-care ultrasound use in haemodialysis cannulation. Audio-recorded data were transcribed and inductively analysed.

Findings

Seven of nine nurses who completed the larger study participated in a semistructured interview. All participants were female with a median age of 54 years (and had postgraduate renal qualifications. Themes identified were as follows: (1) barriers to use of ultrasound; (2) deficit and benefit recognition; (3) cognitive and psychomotor development; and (4) practice makes perfect. Information identified within these themes were that nurses perceived that their experience with point-of-care ultrasound was beneficial but recommended against its use for every cannulation. The more practice nurses had with point-of-care ultrasound, the more their confidence, dexterity and time management improved.

Conclusions

Nurses perceived that using point-of-care ultrasound was a positive adjunct to their cannulation practice and provided beneficial outcomes for patients.

Implications for the Profession and/or Patient Care

Haemodialysis clinics seeking to implement point-of-care ultrasound to help improve cannulation outcomes may draw on these findings when embarking on this practice change.

Reporting Method

This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Patient or Public Contribution

Patients were not directly involved in this part of the study; however, they were involved in the implementation study.

Trial and Protocol Registration

The larger study was registered with Australian New Zealand Clinical Trials Registry: ACTRN12617001569392 (21/11/2017) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373963&isReview=true

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