BMJ Open最新文献

{"title":"Randomised controlled trial to assess the impact of hospital-community pharmaceutical care on drug-related problems in oncology practice for at-risk outpatients treated with oral anticancer drugs-a French Society for Oncology Pharmacy (SFPO) study: DROP-SFPO study protocol.","authors":"Florence Ranchon, Laure Huot, Christophe Bardin, Isabelle Madelaine, Jean Louis Cazin, Bertrand Pourroy, Patrick Tilleul, François Lemare, Catherine Rioufol","doi":"10.1136/bmjopen-2024-094825","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-094825","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-related problems (DRPs) associated with oral anticancer drugs are frequent and require a new healthcare organisation to manage them on an outpatient basis. The aim of this article is to present the study protocol of the Drug Related problems in Oncology Practice (DROP) randomised controlled trial (RCT), endorsed by the French Society for Oncology Pharmacy. The main objective of the DROP RCT is to measure the impact at 6 months of the DROP community/hospital pharmaceutical intervention programme, compared with usual treatment, on the mean number of DRP (ie, adverse effects, drug-drug interactions, medication errors) related to oral anticancer drugs in at-risk outpatients.</p><p><strong>Methods and analysis: </strong>The DROP protocol is a prospective, multicentre controlled clinical trial, with individual randomisation, comparing in parallel and in open, two groups of outpatients treated with oral anticancer drugs. The interventional group benefits from the DROP multidisciplinary intervention on oral anticancer treatment. The control group receives usual care. The primary outcome of the DROP RCT is the number of DRP due to oral anticancer drugs, per patient, identified between the inclusion of the patient and 6 months after inclusion ETHICS AND DISSEMINATION: Approval to conduct this study was obtained for all participating centres from an Ethics Committee (<i>Comité de Protection des Personnes Sud-Méditerranée V</i>) in August 2018 in accordance with French law. The trial results will be disseminated at clinical conferences and published in peer-reviewed journals.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov: NCT03257969, recruitment started in June 2019. The current protocol version is V.9, 13 December 2023.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094825"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability, fidelity and implementation of systematic integrated pain management in oncology outpatient services: a process evaluation protocol for a multicentre clustered randomised pilot trial.","authors":"Olivia Claire Robinson, Florence Day, Elaine G Boland, Michelle Collinson, Marie Fallon, Amanda Farrin, Kate Flemming, Sean Girvan, Sue Hartup, David Meads, Adam Hurlow, Catriona Mayland, John O'Dwyer, Simon Pini, Daniel Swinson, Suzanne H Richards, Matthew R Mulvey","doi":"10.1136/bmjopen-2025-101935","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-101935","url":null,"abstract":"<p><strong>Introduction: </strong>In the UK National Health Service (NHS), most people with cancer are cared for at oncology outpatient services, where there are no standardised procedures for managing pain. As a result, patients with cancer may receive inadequate care for pain. The Cancer Pain-assessment Toolkit for Use in RoutinE oncology outpatient services aims to assess the feasibility of conducting a multicentre cluster-randomised trial of a systematic pain assessment and management programme integrated within routine care at UK NHS oncology outpatient services. This protocol describes an embedded process evaluation that aims to evaluate the acceptability, fidelity and implementation of the intervention and trial procedures.</p><p><strong>Methods and analysis: </strong>A combination of methods will be used in the process evaluation. Quantitative data on fidelity and intervention implementation will be collected using case report forms completed at sites, capturing details on training, intervention delivery and adherence. Qualitative data on acceptability and trial experience will be collected through semistructured interviews with intervention recipients (participants), intervention deliverers (healthcare professionals), research nurses and intervention champions. Researcher fieldnotes will also document trial acceptability throughout the trial. Quantitative data will be summarised descriptively. Qualitative data will be analysed using thematic analysis, guided by the framework of acceptability.</p><p><strong>Ethics and dissemination: </strong>The trial received ethical approval from South Yorkshire Research Ethics Committee and Health Research Authority (21/HRA/5245). Site-specific approvals were obtained from the research and innovation offices at Leeds Teaching Hospital and Hull Teaching Hospital. Trial findings will be disseminated through peer-reviewed publications and via participating sites.</p><p><strong>Trial registration number: </strong>ISRCTN86926298.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e101935"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying patterns of multimorbidity, polypharmacy and frailty in the elderly: a clustering analysis of baseline data from a French, randomised, controlled trial in primary care.","authors":"Aziz Guellich, Nadia Oubaya, Joel Cogneau, François Lacoin, Pascal Clerc, Etienne Audureau, Julien Le Breton","doi":"10.1136/bmjopen-2023-083584","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-083584","url":null,"abstract":"<p><strong>Objectives: </strong>To identify distinct profiles among elderly patients in primary care so that general practitioners (GPs) can develop more targeted care strategies.</p><p><strong>Design: </strong>A cross-sectional analysis of baseline data from the French nationwide 'Elderly Appropriate Treatment in Primary Care' trial.</p><p><strong>Setting: </strong>Primary care in France: 277 GPs included patients.</p><p><strong>Participants: </strong>The study participants were aged 75 or over, living at home, and taking five or more prescription medications. Of the 2724 patients included, 2651 were analysed.</p><p><strong>Primary and secondary outcome measures: </strong>To identify specific patterns of multimorbidity, polypharmacy and frailty, we applied an unsupervised clustering analysis with self-organising maps.</p><p><strong>Results: </strong>Seven clusters were identified: cluster 1 (16% of the patients) comprised frail men and women with cardiovascular, respiratory, musculoskeletal and endocrine diseases and marked polypharmacy; cluster 2 (9.3%, mainly men) comprised frail patients with cancer and cardiovascular or urogenital/renal diseases; cluster 3 (15.5%, mainly men) comprised not-very-frail patients with cardiovascular and urogenital/renal diseases; cluster 4 (18.1%) comprised not-very-frail men and women with cardiovascular diseases; cluster 5 (13.5%, mainly women) comprised mainly lonely, very frail patients with hypertension and endocrine, musculoskeletal and neuropsychiatric disorders; cluster 6 (19.1%, mainly women) comprised frail, socially isolated patients with digestive, musculoskeletal and neuropsychiatric diseases; lastly, cluster 7 (8.6%, mainly women) comprised frail, socially isolated patients with hypertension, cancer, or musculoskeletal, psychological and digestive disorders.</p><p><strong>Conclusion: </strong>Our phenotypic classification of elderly patients might facilitate efforts to align healthcare services with the care needs that are encountered by GPs in their everyday practice. TRIAL REGESTRATION NUMBER: (NCT03298386).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e083584"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive accuracy of ophthalmic artery Doppler for pre-eclampsia: a systematic review.","authors":"Joseph Arkorful, Joyce Linda Browne, Kwame Adu-Bonsaffoh, Sam Ali, Emmanuel Srofenyoh, Kitty M W Bloemenkamp","doi":"10.1136/bmjopen-2024-094348","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-094348","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This systematic review investigated available evidence on the stand-alone and incremental predictive performance of ophthalmic artery Doppler (OAD) for pre-eclampsia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;We conducted a literature search from PubMed (Medline), the Cochrane CENTRAL, EMBASE and Scopus from inception to 8 April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Studies eligible for inclusion were prospective or retrospective cohort studies, case-control studies or randomised controlled trials that reported on the predictive performance of OAD for pre-eclampsia in singleton pregnancies; and conducted in either high-income country (HIC) or low- and middle-income country (LMIC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Two reviewers independently screened and assessed articles for inclusion. One reviewer then extracted data using a standardised data extraction sheet, and any uncertainties were discussed with a second reviewer. The Prediction model Risk of Bias Assessment Tool was used for quality and risk of bias assessment. Findings were summarised and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and synthesised qualitatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified and included 11 observational studies (3 from HIC and 8 from LMICs) with a total of 12 150 singleton pregnancies, of which 517 (4.3%) were complicated by pre-eclampsia at end of follow-up. The included studies were of varied quality, with three at low risk of bias, four at unclear risk and four at high risk. No interventional study was identified. Three studies (27.3%) recruited high-risk pregnancies (defined according to the American College of Obstetricians and Gynecologists (ACOG) criteria as one or more of the following: chronic hypertension, personal or family history of pre-eclampsia, early (≤18 years) or late (≥40 years) first pregnancy, primipaternity, chronic kidney disease, increased body mass index &gt;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, presence of diabetes mellitus prior to pregnancy, autoimmune disease and thrombophilia), while eight studies (72.7%) recruited undetermined risk pregnancies. Stand-alone performance of OAD (interpreted by area under the receiver operating curve at 95% CI) showed that in the first trimester, the peak systolic velocity (PSV) ratio demonstrated very good predictive ability (0.97, 95% CI 0.92 to 1.0) (n=1 study), and the second PSV (PSV&lt;sub&gt;2&lt;/sub&gt;) demonstrated very good predictive ability (0.91, 95% CI 0.82 to 0.99) (n=1 study). Also, PSV&lt;sub&gt;2&lt;/sub&gt; demonstrated fair predictive ability (0.61, 95% CI 0.42 to 0.79; and 0.53, 95% CI 0.40 to 0.66) for early and late pre-eclampsia, respectively (n=1 study). In the second trimester, the PSV ratio demonstrated very good predictive ability (0.88, 95% CI 0.84 to 0.91) (n=1 study), and PSV&lt;sub&gt;2&lt;/sub&gt; demonstrated good predictive ability (0.73, 95% CI 0","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094348"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study.","authors":"Edward Patrick Callaly, Peter Shuangyue Tan, Emily Schembri, Marija Borosak, Helen Dewey, Philip Choi","doi":"10.1136/bmjopen-2025-102092","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-102092","url":null,"abstract":"<p><strong>Introduction: </strong>Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prophylaxis in non-valvular atrial fibrillation. Yet, DOAC use is regarded as a contraindication for intravenous thrombolysis in acute ischaemic stroke. The stratification of patients into 'on-therapy' and 'off-therapy' categories based on their plasma DOAC concentrations is particularly crucial in the acute phase of stroke when decisions for thrombolysis or anticoagulation reversal are time-sensitive. The novel point-of-care DOAC dipstick assay (DOASENSE) rapidly assesses urine for clinically significant DOAC levels, potentially broadening eligibility for thrombolysis or targeted reversal therapy. This multicentre prospective observational registry study aims to evaluate the accuracy and clinical utility of DOAC dipstick testing compared with plasma DOAC assays in acute stroke management across regional Australian hospitals.</p><p><strong>Methods and analysis: </strong>This multicentre, prospective, observational study will enrol participants presenting to hospitals across Victoria and Tasmania with acute ischaemic stroke or intracerebral haemorrhage with DOAC ingestion within 48 hours of presentation. Plasma DOAC concentrations measured by chromogenic assays will be compared with rapid urine dipstick results from DOASENSE testing. There is a target sample size of 146 participants. The primary outcomes are as follows: (1) proportion of ischaemic stroke participants with off-therapy plasma DOAC levels and (2) eligibility for reperfusion therapy based on DOASENSE and plasma DOAC concentrations. Secondary outcomes are follows: (1) ischaemic stroke aetiology for participants with on-therapy vs off-therapy DOAC levels; (2) proportion of participants meeting criteria for pharmacological DOAC reversal based on DOASENSE outcomes; (3) incidence of false-negative and false positive DOASENSE results in clinically significant DOAC plasma concentrations at a threshold of ≥30 ng/mL and (4) an exploratory analysis of any false negative DOASENSE assays to identify potential contributing factors.</p><p><strong>Ethics and dissemination: </strong>Ethics approval has been granted by the Eastern Health Human Research Ethics Committee (reference number: 99628). Dissemination of findings will occur through peer-reviewed publications and academic conferences.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e102092"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily mobility, activity and environmental determinants of stress in ecological momentary assessment (EMA) and GPS studies: a scoping review protocol.","authors":"Noemie Topalian, Guy Fagherazzi, Camille Perchoux","doi":"10.1136/bmjopen-2024-091509","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091509","url":null,"abstract":"<p><strong>Introduction: </strong>Stress is omnipresent in our everyday lives and a key risk factor for our physical and mental health. Yet little is known about the impact of geographic life environments, linked to our daily activities and mobility patterns, on our momentary and daily stress levels.We propose this review to gather evidence on the spatio-temporal determinants of momentary or daily stress in studies using ecological momentary assessment (EMA) or experience sampling methods (ESM) in addition to global positioning systems (GPS) tracking. We will focus on the spatio-temporal definition and modelling of environmental exposures accounting for participant daily activities and mobility patterns and their association with stress.</p><p><strong>Methods and analysis: </strong>This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for scoping reviews (2018). We will search the PubMed/Medline, Web of Science, PsycInfo and Scopus databases. We will include papers using EMA or ESM and GPS measuring chronic, daily or momentary stress as an outcome; these methods are also referred to as geographically-explicit ecological momentary assessment.Articles published from January 2000-June 2025 will be screened. Two independent reviewers will screen titles and abstracts to agree on the inclusion of articles. No geographical or population limitation will be imposed.</p><p><strong>Ethics and dissemination: </strong>This study is a scoping review based on previously published and publicly available literature. It does not involve the collection of primary data, human participants, or the processing of personal or sensitive information. Therefore, ethical approval is not required in accordance with institutional and international research ethics guidelines. The results will be submitted in peer-reviewed journals and presented at international conferences.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e091509"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact assessment of Benazir Nashonuma Programme (BNP) on maternal, child health and nutritional status in Pakistan: a quasi-experimental study protocol.","authors":"Shah Muhammad, Asma Abdul Malik, Sajid Soofi, Atif Habib, Muhammad Umer, Arjumand Rizvi, Imran Ahmed, Jef Leroy, Simon Cousens, Zulfiqar Ahmed Bhutta","doi":"10.1136/bmjopen-2024-094565","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-094565","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal and child malnutrition is a significant public health concern in Pakistan, with 40% of children under five being stunted. In response, the Government of Pakistan initiated the Benazir Nashonuma Programme (BNP), a nutritional supplementation programme for pregnant women, mothers of children aged 0 to 23 months and children aged 6 to 24 months. This study aims to evaluate the effectiveness of the BNP in reducing childhood stunting and improving maternal and child health outcomes.</p><p><strong>Methods and analysis: </strong>A quasi-experimental longitudinal study comprising baseline, midline and endline surveys will be conducted across 18 districts (9 intervention and 9 control) in Pakistan. The surveys will use a two-stage cluster sampling method to enrol 13 200 children aged 0-59 months and their mothers from the Benazir Income Support Programme households. The primary outcome of interest is the prevalence of under-five stunting. We will use a difference-in-differences approach to estimate the impact by comparing the documented changes over time between the intervention and control groups.</p><p><strong>Ethics and dissemination: </strong>This study will provide critical insights into the effectiveness of the BNP in addressing childhood undernutrition in Pakistan. The findings will inform policy and programmatic decisions aimed at reducing undernutrition in resource-constrained settings. Ethical approval has been obtained from the Ethics Review Committee of Aga Khan University and the Pakistan National Bioethics Committee.</p><p><strong>Trial registration number: </strong>NCT06025786.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094565"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process evaluation of a randomised trial of a triple low-dose combination pill strategy to improve hypertension control: a qualitative study.","authors":"Abdul Salam, Tracey Laba, Rupasvi Dhurjati, Lakshmi K Josyula, Asita de Silva, Pavithra Godamunne, Rama Guggilla, Stephen Jan, Pallab Kumar Maulik, Nitish Naik, Anushka Patel, Arunasalam Pathmeswaran, Dorairaj Prabhakaran, Anthony Rodgers, Vanessa Selak, Ruth Webster Griffiths","doi":"10.1136/bmjopen-2025-101689","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-101689","url":null,"abstract":"<p><strong>Background: </strong>High blood pressure (BP) is a significant global health issue, with many treated patients failing to achieve BP control. The Triple Pill vs Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial evaluated the effectiveness, cost-effectiveness and acceptability of early use of low-dose triple fixed-dose combination of BP-lowering drugs ('triple pill') compared with usual care in the management of hypertension. The TRIUMPH trial showed superior BP control with the triple pill strategy compared with usual care. This process evaluation of the TRIUMPH trial aimed to explore the contextual factors that influenced the trial outcomes, implementation of the triple pill strategy, mechanisms of its effects and potential barriers and facilitators for implementing the triple pill strategy in routine practice.</p><p><strong>Methods: </strong>Guided by the UK Medical Research Council's framework, semistructured interviews were conducted with 23 patients and 13 healthcare providers involved in the TRIUMPH trial. Data were analysed using the framework analysis method in NVivo.</p><p><strong>Results: </strong>Hypertension care in Sri Lanka was hindered by the absence of systematic screening and overcrowded public clinics. Despite free medication provision at public clinics, long waiting times and occasional stock-outs posed challenges. In the TRIUMPH trial, both intervention and usual care were delivered in the context of 'better than usual' care, including team-based management, reduced waiting times, monetary assistance for travel, routine adherence monitoring and intensive follow-up. The triple pill strategy provided a simplified regimen, better access to BP-lowering medications and better BP-lowering efficacy. Key barriers to implementation in routine practice included the triple pill's large size, therapeutic inertia and restrictive regulatory policies regarding fixed-dose combinations.</p><p><strong>Conclusions: </strong>Implementation of the triple pill strategy into routine practice requires health system strengthening, provider training and supportive policy measures to replicate its effectiveness seen in the trial.</p><p><strong>Trial registration number: </strong>ACTRN12612001120864, SLCTR/2015/020.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e101689"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an interpretable machine learning model for predicting Philadelphia chromosome-positive acute lymphoblastic leukaemia using clinical and laboratory parameters: a single-centre retrospective study.","authors":"Wuchen Yang, Jingya Liu, Yang Gou, Xingqin Huang, Maoshan Chen, Dezhi Huang, Shengwang Wu, Jing Zhang, Cheng Zhang, Shuiqing Liu, Xiangui Peng, Xi Zhang","doi":"10.1136/bmjopen-2024-097526","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-097526","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a prediction model of Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ALL).</p><p><strong>Design: </strong>A single-centre retrospective study.</p><p><strong>Participants: </strong>This study analysed 471 newly diagnosed patients with ALL at the Second Affiliated Hospital of Army Medical University from January 2014 to December 2023.</p><p><strong>Methods: </strong>Clinical and laboratory parameters were collected, and the important characteristic parameters were selected using BorutaShap. Multiple machine learning (ML) models were constructed and optimised by using the active learning (AL) algorithm. Performance was evaluated using the area under the curve (AUC), comprehensive indicators and decision curve analysis. The interpretability of the model was evaluated by using SHapley Additive Interpretation (SHAP), and external validation was conducted on an independent test cohort.</p><p><strong>Results: </strong>10 parameters were selected to construct multiple ML models. The CatBoost model integrated with an AL algorithm (CatBoost-AL) was found to be the most effective model for predicting Ph+ALL within the validation data set. This model achieved an AUC of 0.797 (95% CI 0.710 to 0.884), along with sensitivity, specificity and F1 score of 0.667, 0.864 and 0.777, respectively. The prediction performance of CatBoost-AL was further validated with an external testing set, where it maintained a strong AUC of 0.794 (95% CI 0.707 to 0.881). Using SHAP for global interpretability analysis, age, monocyte count, γ-glutamyl transferase, neutrophil count and alanine aminotransferase were identified as crucial parameters that significantly influence the diagnostic accuracy of CatBoost-AL.</p><p><strong>Conclusion: </strong>An interpretable ML model and online prediction tool were developed to determine whether newly diagnosed patients with ALL are Ph+ALL. The key parameters identified by the optimal model provided a further understanding of Ph+ALL characteristics and were valuable for accurate diagnosis and treatment of Ph+ALL.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097526"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding preconception care: a scoping review of knowledge, attitudes and practices among reproductive age individuals, healthcare workers and stakeholders in low- and middle-income countries.","authors":"Yared Asmare Aynalem, Pauline Paul, Janice Y Kung, Amber Hussain, Zohra Lassi, Salima Meherali","doi":"10.1136/bmjopen-2025-099143","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-099143","url":null,"abstract":"<p><strong>Objectives: </strong>This scoping review aims to map existing evidence on knowledge, attitudes and practices (KAP) and barriers to preconception care in low- and middle-income countries. The primary objective is to identify key gaps and research priorities to guide future efforts to improve maternal and child health.</p><p><strong>Design: </strong>This review followed Arksey and O'Malley's scoping review framework, with a comprehensive search across Medline, EMBASE, CINAHL and Scopus from inception to May 2025. Eligible studies included original research on preconception care (PCC), KAP in low- and middle-income countries (LMICs) without date restrictions. Two independent reviewers conducted screening in Covidence. Findings were presented in graphical, tabular and narrative formats, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews (PRISMA-ScR) standard.</p><p><strong>Setting: </strong>The review focused on PCC studies conducted in LMICs across various healthcare settings, emphasising primary and secondary levels of care. The geographical scope was global but limited to LMICs as defined by World Bank criteria.</p><p><strong>Result: </strong>A total of 62 studies were included in the review. Of these, 42 employed quantitative methods, 18 used qualitative approaches and 2 used a mixed-methods design. Regarding focus areas, 25 studies assessed knowledge, 14 assessed practices, 12 studies assessed KAP comprehensively and 10 assessed attitudes. Participants were mainly women of reproductive age (44 studies), with only five studies including men. Among healthcare providers, KAP varied, with midwives being the most frequently studied group. Stakeholders such as policymakers were notably under-represented. Identified barriers included limited training, cultural beliefs and inadequate policies. Facilitators highlighted were targeted education, spousal support and policy advocacy, emphasising the need for gender-sensitive and systemic interventions.</p><p><strong>Conclusion: </strong>LMICs face complex challenges in utilising PCC, influenced by socioeconomic, cultural, and healthcare system factors. To address these challenges, nuanced approaches incorporating intersectional perspectives and practical qualitative methodologies are essential for improving couples' and child health outcomes.</p><p><strong>Trial registration number: </strong>The study protocol was registered in the Open Science Framework (OSF) on December 23, 2022, with DOI: 10.17605/OSF.IO/H3MK6.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099143"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}