BMJ Open最新文献

{"title":"Surgical patients' experiences with the Patients' Safety Checklist (PASC): a qualitative interview study.","authors":"Kristin Harris, Hilde Valen Wæhle, Anette Storesund, Stig Harthug, Randi Julie Tangvik, Denisa Monsen Lukcova, Wenche Håvik, Åse Humberset, Evelyn Stavang, Kjetil Hagerup, Åshild Teigland Tepstad, Ann Kristin Sandsbakk Austarheim, Andy Healey, Nick Sevdalis, Arvid Steinar Haugen","doi":"10.1136/bmjopen-2025-105554","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-105554","url":null,"abstract":"<p><strong>Background: </strong>Engaging patients in surgical safety is challenging and has not been thoroughly investigated. Although surgical checklists and other safety protocols have been introduced across various surgical fields, preventable adverse events still occur, highlighting the need for additional research. A Patient's Safety Checklist (PASC) has been developed and validated for use by surgical patients. Its effect on patient safety and patient outcomes is currently being investigated in a Stepped Wedge Cluster Randomised Controlled Trial (NCT03105713). In connection with this trial, we have examined elective patients' experiences with using the PASC.</p><p><strong>Methods: </strong>An exploratory qualitative study was conducted based on individual in-depth telephone interviews with 31 elective surgical patients. The interviews were carried out across three Norwegian hospitals including seven surgical specialties. The patients interviewed were part of the trial's intervention arm and had used PASC. The interviews were transcribed verbatim, and reflective thematic analysis was applied.</p><p><strong>Result: </strong>Three themes were identified in the data: patient awareness, patient actions and utility value. Patients perceived PASC to increase awareness around surgical information, preparations, what to speak up about and which information to seek and repeat. This awareness led to a series of actions, such as ensuring medication control, optimising their own health, contacting healthcare professionals, asking questions, and for some no actions were needed. Patients perceived PASC to have high utility value for their surgical preparation.</p><p><strong>Conclusions: </strong>The PASC enhanced patients' involvement in surgical care and safety by ensuring they received systematic, accurate, clear, and understandable information and instructions throughout the surgical pathway. It is one of the few existing interventions that specifically focuses on assisting patients in preparing for surgery and managing their recovery. Further research is needed on the implementation of PASC and its adaptation to other clinical settings.</p><p><strong>Trial registration number: </strong>NCT03105713.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e105554"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231460","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":"Deep learning prediction of peak oxygen uptake in patients with coronary heart disease: a retrospective study.","authors":"Tao Shen, Guomin Hu, Wei Zhao, Chuan Ren","doi":"10.1136/bmjopen-2025-098878","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-098878","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate prediction models for peak oxygen uptake (VO₂peak) in patients with coronary heart disease (CHD) using submaximal cardiopulmonary exercise testing (CPET) indicators and deep learning methods.</p><p><strong>Design: </strong>Retrospective model development and validation study.</p><p><strong>Setting: </strong>Cardiac Rehabilitation Centre, Peking University Third Hospital, China.</p><p><strong>Participants: </strong>A total of 10 538 patients with CHD who underwent CPET between January 2014 and December 2019.</p><p><strong>Methods: </strong>Clinical data and CPET indicators were collected. Multiple machine learning and deep learning models were developed and compared. Model performance was assessed using R², mean absolute error (MAE), bias, Bland-Altman analysis and SHapley Additive exPlanations (SHAP) feature importance ranking.</p><p><strong>Results: </strong>The neural network model achieved the best performance (R² = 0.82, MAE=1.55 mL/kg/min, bias=0.08). XGBoost was the best-performing traditional machine learning model (R² = 0.74). SHAP analysis identified eight top-ranked features, including VO₂@AT, OUES, weight, VE/VCO₂ slope, VE/VCO₂@AT, age, gender and HR@AT.</p><p><strong>Conclusion: </strong>The CPET deep learning model shows potential for predicting VO₂peak in CHD patients, but further external validation and prospective studies are required before clinical application.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e098878"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231538","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":"Identification of gestational diabetes mellitus in European electronic healthcare databases: insights from the ConcePTION project.","authors":"Ditte Mølgaard-Nielsen, Vera Mitter, Angela Lupattelli, Vjola Hoxhaj, Constanza L Andaur Navarro, Saeed Hayati, Sandra Lopez-Leon, Joan K Morris, Anja Geldof, Susan Jordan, Maarit K Leinonen, Visa Martikainen, Marco Manfrini, Luca Cammarota, Amanda Neville, Laia Barrachina-Bonet, Clara Cavero-Carbonell, Laura García-Villodre, Anthony Caillet, Marie Beslay, Christine Damase-Michel, Marleen M H J van Gelder, Hedvig Nordeng","doi":"10.1136/bmjopen-2025-102343","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-102343","url":null,"abstract":"<p><strong>Objective: </strong>To develop and compare algorithms for identifying gestational diabetes mellitus (GDM) across European electronic healthcare databases and evaluate their impact on the estimated prevalence.</p><p><strong>Design: </strong>Multi-national cohort study using routinely collected electronic healthcare data SETTING: National and regional databases in five European countries (Norway, Finland, Italy, Spain and France), in primary and/or secondary care.</p><p><strong>Participants: </strong>Pregnancy cohorts resulting in stillbirths or live births between 2009 and 2020, comprising 602 897 pregnancies in Norway, 507 904 in Finland, 374 009 in Italy, 193 495 in Spain and 116 762 in France.</p><p><strong>Primary and secondary outcomes: </strong>The primary outcome was the prevalence of GDM identified using six algorithms: (1) Only diagnosis; (2) Diagnosis or prescription; (3) Two diagnoses or prescriptions (<i>2DxRx</i>); (4) Diagnosis including unspecified diabetes in pregnancy or prescription (<i>DxRx broad</i>); (5) Diagnosis excluding pre-existing diabetes in pregnancy or prescription; (6) Registration of GDM in a birth registry (<i>BR</i>).</p><p><strong>Results: </strong>The strictest algorithm (<i>2DxRx</i>) resulted in the lowest GDM prevalence, while the broadest (<i>DxRx broad</i>) resulted in the highest, except in France where it was <i>BR</i>. In the Nordic countries, GDM prevalence varied only slightly by algorithm; greater variations were observed in other countries. The prevalence ranged from 3.5% (95% CI: 3.5% to 3.5%) to 4.6% (95% CI: 4.5% to 4.7%) in Norway; 12.1% (95% CI: 12.0% to 12.2%) to 15.8% (95% CI: 15.7% to 15.9%) in Finland, where prevalence was much higher than elsewhere. The prevalence ranged from 1.3% (95% CI: 1.3% to 1.3%) to 5.4% (95% CI: 5.3% to 5.5%) in Italy; 1.6% (95% CI: 1.5% to 1.7%) to 6.2% (95% CI: 6.1% to 6.3%) in Spain; and 1.7% (95% CI: 1.6% to 1.8%) to 5.8% (95% CI: 5.7% to 5.9%) in France.</p><p><strong>Conclusions: </strong>In this multinational study, GDM prevalence ranged from 1.3% to 15.8% depending on the algorithm and database. Nordic countries showed smaller differences in prevalence between algorithms, while the other countries showed larger variations, likely due to differences in coding practices, healthcare systems and database coverage.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e102343"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231525","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":"Exploratory mixed-methods analysis of the determinants of use of health research evidence among planning teams in Tanzania.","authors":"Pius Kagoma, Richard Mongi, Albino Kalolo","doi":"10.1136/bmjopen-2025-099692","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-099692","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving universal health coverage requires the use of health research evidence in decision-making; however, this remains understudied in lower and middle-income countries (LMICs) such as Tanzania. Despite several health sector reforms and the availability of locally generated research, evidence indicates that the use of such research in health planning and decision-making remains limited in Tanzania, creating a gap between research production and its practical application. This study examined the extent of research evidence used in health planning and the factors influencing its use among health planning teams.</p><p><strong>Methods and analysis: </strong>A sequential exploratory mixed-methods design was employed, starting with qualitative data from focus group discussions (N=6) and KIIs (N=34) with health planners from selected regions in Tanzania, recruited based on their direct involvement in health planning, using semistructured guides informed by the Capability, Opportunity, Motivation-Behaviour (COM-B) model. This was followed by a quantitative survey of 422 participants meeting the same inclusion criteria, administered with a structured questionnaire derived from the model. The COM-B framework guided both tool development and analysis. Qualitative data were thematically analysed using a framework approach, yielding three themes, while quantitative data were analysed using descriptive statistics and binary logistic regression.</p><p><strong>Results: </strong>Qualitative findings revealed barriers such as limited knowledge and skills, inadequate access to knowledge translation tools, poor dissemination processes, financial and technical constraints, and lack of training. Opportunities included supportive guidelines, research coordinators, collaborations, dedicated budgets and improved internet access. Motivators such as job promotions, professional development, allowances and targeted training were also identified. Quantitative results showed moderate evidence use (66.2%), slightly higher than in other LMICs. Barriers included suboptimal dissemination (74.5%; OR=2.035, p=0.0008), inadequate resources (70.0%; OR=0.965, p=0.8759) and lack of training (63.7%; OR=1.361, p=0.1806). Integrated findings highlighted convergence on dissemination, resource and training challenges, with divergence in statistical significance between methods.</p><p><strong>Conclusions: </strong>Barriers related to dissemination, resources and training hinder evidence use. Interventions such as digital repositories, guideline development and capacity building, alongside institutionalised frameworks, resource allocation and accountability mechanisms, are essential to strengthen evidence-based health planning in Tanzania.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e099692"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231617","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":"More is more? The role of surgeon in the volume-outcome relationship: an Italian population-based cohort study.","authors":"Salvatore Soldati, Paola Colais, Marina Davoli, Paola Michelozzi, Luigi Pinnarelli","doi":"10.1136/bmjopen-2024-098569","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-098569","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between surgical volume and clinical outcomes is complex and varies considerably across surgical specialties. While the role of hospital volume is well-established, the specific contribution of surgeon-level volume and the interaction between these two factors are less clear.</p><p><strong>Objectives: </strong>This study investigates the association between surgeon volume and clinical outcomes for surgeons performing breast-conserving surgery for malignant breast cancer, laparoscopic cholecystectomy and surgery for malignant colon cancer.</p><p><strong>Methods: </strong>Data from the Lazio Region's health information systems (2020-2023) were analysed. Primary outcomes included 120-day reinterventions after breast-conserving surgery for breast cancer, 30-day complications after laparoscopic cholecystectomy and 30-day mortality after colon cancer surgery. The association between surgeon volume and outcomes was examined for all surgeons performing at least five procedures annually in Lazio hospitals. A stratified analysis was conducted to assess the impact of hospital volume on the surgeon-volume-outcome relationship, comparing outcomes between surgeons in low-volume and high-volume hospitals. Fractional polynomial and segmented regression models were employed to identify non-linear relationships and potential breakpoints in the surgeon volume-outcome association.</p><p><strong>Results: </strong>Higher-volume surgeons demonstrated significantly improved outcomes across all three procedures, including lower reintervention rates, fewer complications and reduced mortality. This positive association was further amplified for surgeons practising in high-volume hospitals. Graphical analysis, which involved stratifying the volume-outcome relationship for individual surgeons by hospital volume (high vs low), strongly suggested a synergistic effect between surgeon and hospital volume, clearly illustrating how the benefits of higher surgeon volume were further amplified in high-volume settings.</p><p><strong>Conclusions: </strong>These findings underscore the critical role of both surgeon-level and hospital-level factors in determining surgical outcomes. Optimising patient care requires a comprehensive approach that considers both individual surgeon performance and the overall quality of the healthcare system. Future research should focus on elucidating the underlying mechanisms driving these associations to inform the development of strategies for improving surgical care delivery.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e098569"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231594","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":"Integrating social drivers of health screening and management into prenatal care: protocol for a mixed-methods implementation evaluation.","authors":"Paige Anderson, Vanessa Neustrom, Samantha Hepting, M Kathryn Menard, Keziah Cash, Korene Gbozah, Jennifer Tang","doi":"10.1136/bmjopen-2025-104837","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-104837","url":null,"abstract":"<p><strong>Background: </strong>Social drivers of health (SDOH), such as housing stability, food security and access to transportation, profoundly influence both healthcare access and health outcomes. In pregnancy, screening positively for SDOH domains correlates with poorer perinatal outcomes. While the American college of Obstetricians and Gynaecologists recommends screening for SDOH at every routine prenatal visit, many prenatal practices struggle to systematically screen patients for SDOH. This study evaluates the implementation of a universal SDOH screening and management protocol in prenatal care and aims to bridge the gap between the recommendation for universal SDOH screening in prenatal care and its actual integration by evaluating implementation strategies that can serve as a guide for other prenatal care clinics.</p><p><strong>Methods and analysis: </strong>This multi-site, prospective formative implementation evaluation will assess the integration of standardised SDOH screening and management into prenatal care workflows at four prenatal clinic sites within an academic Obstetrics and Gynaecology department. The study employs a concurrent triangulation mixed-methods approach integrating chart-abstracted patient data, staff surveys, and staff and patient semi-structured interviews, guided by established implementation science frameworks (exploration, preparation, implementation and sustainment, consolidated framework for implementation research and implementation outcomes framework). Key implementation strategies include workflow integration, electronic medical record optimisation, role clarification and comprehensive training. Implementation outcomes to be evaluated include feasibility, acceptability, appropriateness, adoption, fidelity and sustainability.</p><p><strong>Ethics and dissemination: </strong>This study was approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB #24-3104). Verbal informed consent will be obtained from all interview participants, and consent will be embedded in staff surveys. Results will be disseminated through peer-reviewed publications, conference presentations, stakeholder meetings and directly to participating clinical sites.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e104837"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231551","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":"Psychosocial determinants of psychological distress among people with disabilities in Ethiopia: a cross-sectional study.","authors":"Endalamaw Salelew, Shegaye Shumet, Alemu Lemma, Tilahun Kassew, Dessie Abebaw Angaw, Yohannes Mirkena, Tadele Amare Zeleke, Getachew Tesfaw","doi":"10.1136/bmjopen-2024-092928","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092928","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the psychosocial determinants of psychological distress among people with disabilities in Ethiopia.</p><p><strong>Design: </strong>A cross-sectional study was conducted at an institution from 01 to 30 May 2021, using a census sampling approach.</p><p><strong>Setting and participants: </strong>A total of 269 individuals aged 18 and older with disabilities were present at the University of Gondar in Ethiopia.</p><p><strong>Main outcome: </strong>The Kessler psychological distress scale (K10), the multidimensional scale of perceived social support, the actual help-seeking behaviour and the stigma scale for chronic illness-8 were used to assess the dependent and independent variables, respectively. Binary logistic regression analyses were performed; a p value less than 0.05 was considered statistically significant at a 95% CI.</p><p><strong>Result: </strong>In this study, the prevalence of psychological distress was 34.6% with a 95% CI (29.40 to 40.10). Factors, such as older age (adjusted ß=1.09; 95% CI 1.04 to 1.15), low perceived social support (adjusted OR (AOR)=1.83; 95% CI 1.16 to 2.89), experiencing stigma (AOR=2.50; 95% CI 1.12 to 5.61) and cognition problems (adjusted ß=0.73; 95% CI 0.62 to 0.85), were significantly associated with increased psychological distress. Of the participants with psychological distress, professional help-seeking behaviour was 7.5%.</p><p><strong>Conclusion: </strong>Psychological distress was notably high among individuals with disabilities, while professional help-seeking remained very low. This underscores the urgent need for targeted mental health interventions to reduce stigma, strengthen social support and improve access to appropriate psychological care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e092928"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231085","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":"Italian oncology nurses' perceptions of empowering leadership styles: a descriptive cross-sectional exploratory study.","authors":"Elsa Vitale, Alessandro Rizzo, Rocco Mea, Yun-Chen Chang","doi":"10.1136/bmjopen-2024-096579","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-096579","url":null,"abstract":"<p><strong>Objective: </strong>The study aims to assess the associated influencing oncology nurses' perceptions of managers' empowering leadership style and to examine the influence of sex, work experience, shift work, membership of an oncology nursing association or a scientific society, nursing educational level and specialised nursing training in oncology on oncology nurses' perceptions of managers' empowering leadership style and its subdimensions.</p><p><strong>Design: </strong>Descriptive cross-sectional study.</p><p><strong>Setting: </strong>In March 2024, oncology nurses employed in oncology settings were invited to participate.</p><p><strong>Participants: </strong>All Italian oncology nurses who were currently employed were eligible to participate.</p><p><strong>Main outcome measures: </strong>The Italian version of the Empowering Leadership Questionnaire was used to assess nurses' perceptions of managers' performance in leading by example, participative decision-making, coaching, informing and demonstrating concern/interacting with the team.</p><p><strong>Results: </strong>A total of 298 nurses agreed to participate. The associated factors for an empowered leadership style across all subdimensions were sex (p=0.006) and the educational level in nursing (p=0.004). Participative decision-making, coaching, informing and demonstrating concern/interacting with the team subdimensions were associated with shift work. Participation in scientific associations (p=0.005) was also influential.</p><p><strong>Conclusions: </strong>Exploring the data according to the nursing specialisation appeared intriguing, since it could be a more indicative suggestion for future interventions to implement an empowering leadership style in clinical nursing practice and better inform health policymakers to achieve the right solution in their health organisations.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e096579"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231559","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":"Estimating the economic and societal burden of suicide and suicide attempts in India: a study protocol.","authors":"Nikhil Jain, Ben Wijnen, Isha Lohumi, Jason Madan, Silvia Evers","doi":"10.1136/bmjopen-2025-100616","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-100616","url":null,"abstract":"<p><strong>Introduction: </strong>Suicide has a substantial economic burden, yet in low- or middle-income countries, the analysis is constrained by the absence of disaggregated economic data. Existing studies primarily rely on gross costing methods, overlooking sector-specific costs such as healthcare, law enforcement and productivity losses at the family and community levels. Furthermore, the societal perspective, essential for understanding the multifaceted economic impacts of suicide, remains insufficiently explored in the Indian context.</p><p><strong>Methods and analysis: </strong>This study will quantify the economic burden of suicide and suicide attempts in India. The initial phase will involve developing a resource-use measure instrument to capture the societal costs associated with suicide. Subsequently, a retrospective, incidence-based study will be conducted in India using the developed instrument. This will also be complemented with the Health-Related Quality of Life Assessment using EuroQOL (EQ-5D-5L). Exploratory subgroup cost comparisons (eg, suicide methods, healthcare facility type) will use non-parametric tests, including the Mann-Whitney U and Kruskal-Wallis tests. Generalised linear mixed models (gamma distribution and log link) will analyse longitudinal cost and HRQoL data, besides bootstrapping techniques and sensitivity analyses.</p><p><strong>Ethics and dissemination: </strong>Ethics approval was obtained for the study from the institutional review board of the Indian Law Society (ILS/141/2024). All data collected during the study will adhere to ethical guidelines, taking informed consent. The findings of the study will be disseminated through peer-reviewed journals to aid data-driven decision-making.</p><p><strong>Trial registration: </strong>Clinical Trial Registry of India (CTRI/2025/02/080380), date of registration: 12/02/2025.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e100616"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231522","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":"Patient's knowledge, attitudes and behaviours towards pulmonary nodule management: a cross-sectional study in Wenzhou, China.","authors":"Tingting Xie, Zhicheng Liao, Lingpei Yu, Song Jin, Dandan Zhang, Maohao Cheng, Yuanyuan Wang, Hanyan Zhao, Jizhou Zhang","doi":"10.1136/bmjopen-2024-092048","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092048","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of pulmonary nodules (PNs) has been rising in China, but PN patients' perceptions towards the management remain underexplored. This study aimed to investigate the knowledge, attitudes and behaviours (KAB) regarding PN management among Chinese patients.</p><p><strong>Design: </strong>A cross-sectional study was conducted to evaluate the KAB scores using a self-designed questionnaire.</p><p><strong>Participants: </strong>The study included 519 PN patients (275 males, aged 41.07±19.47) diagnosed at Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University between November 2022 and January 2023. Participants completed a self-designed questionnaire assessing their KAB regarding PN management.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcomes included mean scores for KAB, with secondary outcomes examining correlations and associations with demographic factors.</p><p><strong>Results: </strong>The mean KAB scores were 4.24±2.93 (range: 0-10), 17.97±4.88 (range: 0-32) and 31.30±11.98 (range: 0-52). Pearson's correlation analysis revealed a weakly positive correlation between knowledge and behaviour (r=0.248, p<0.001). Medical insurance (OR=3.62, 95% CI 1.18 to 11.15, p=0.025) and family history of lung cancer (OR=1.85, 95% CI 1.10 to 3.12, p=0.020) were positively associated with knowledge, while self-employment showed a negative association (OR=0.35, 95% CI 0.15 to 0.78, p=0.011). Female gender (OR=1.79, 95% CI 1.10 to 2.91, p=0.019), moderate income (OR=2.80, 95% CI 1.09 to 7.16, p=0.032) and longer diagnosis duration (OR=5.27, 95% CI 2.63 to 10.54, p<0.001) were positively associated with attitude, but divorced/widowed status (OR=0.31, 95% CI 0.14 to 0.66, p=0.003), comorbidities (OR=0.35, 95% CI 0.22 to 0.56, p<0.001) and family history of lung cancer (OR=0.24, 95% CI 0.13 to 0.45, p<0.001) were the opposite. Moreover, positive associations were noted of knowledge (OR=1.10, 95% CI 1.03 to 1.18, p=0.008), attitudes (OR=1.06, 95% CI 1.01 to 1.10, p=0.018) and postgraduate education (OR=4.91, 95% CI 1.47 to 16.36, p=0.010) with practice.</p><p><strong>Conclusions: </strong>PN patients demonstrate insufficient knowledge and moderate attitudes and behaviours regarding PN management. These findings highlight the need for targeted educational interventions to improve understanding among PN patients.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e092048"},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231077","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}