BMJ Open最新文献

{"title":"Magnitude of clinical inertia and its associated factors among adult patients with asthma on chronic follow-up at Jimma Medical Center, Ethiopia: prospective observational study.","authors":"Berhanu Teshome Derese, Abduba Guyo Wariyo","doi":"10.1136/bmjopen-2024-090336","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-090336","url":null,"abstract":"<p><strong>Objective: </strong>To assess the magnitude of clinical inertia and its associated factors among adult patients with asthma on chronic follow-up at Jimma Medical Center, Ethiopia, from December 2021 to May 2022.</p><p><strong>Design and setting: </strong>A hospital-based prospective observational study was conducted in Jimma Medical Center from 1 December 2021 to 30 May 2022.</p><p><strong>Participants: </strong>135 patients with asthma who fulfilled the inclusion criteria were enrolled in the study consecutively and followed for 3 months.</p><p><strong>Results: </strong>Of 148 patients, 135 patients' data were analysed. The mean (SD) age of the patients was 52.03 (±15.75) years. More than half (54.1%) of the study participants were men. Most of the study participants (68.9%) at the first and (70.4%) at the second visit, which is 3 months after the first visit, had clinical inertia, respectively. Comorbidity (adjusted OR (AOR) 3.35, 95% CI (1.15, 9.81), p<0.027), asthma duration of 5-10 years (AOR 7.58, 95% CI (1.51, 38.05), p<0.014), moderate persistent asthma (AOR 6.91, 95% CI (2.46, 19.42), p<0.00) and severe persistent asthma (AOR 10.84, 95% CI (1.1, 107.0), p<0.041) were contributing factors for clinical inertia.</p><p><strong>Conclusions: </strong>The burden of clinical inertia in this study was high at both visits. Comorbidity, duration of asthma of 5-10 years, moderate persistent and severe persistent asthma were identified as contributing factors to clinical inertia. Policymaker intervention to avoid clinical inertia is necessary to improve asthma treatment outcomes.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e090336"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085563","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":"Analysis of the most influential factors affecting outcomes of lung transplant recipients: a multivariate prediction model based on UNOS Data.","authors":"Marsa Gholamzadeh, Reza Safdari, Mehrnaz Asadi Gharabaghi, Hamidreza Abtahi","doi":"10.1136/bmjopen-2024-089796","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-089796","url":null,"abstract":"<p><strong>Objectives: </strong>In lung transplantation (LTx), a priority is assigned to each candidate on the waiting list. Our primary objective was to identify the key factors that influence the allocation of priorities in LTx using machine learning (ML) techniques to enhance the process of prioritising patients.</p><p><strong>Design: </strong>Developing a prediction model.</p><p><strong>Setting and participants: </strong>Our data were retrieved from the United Network for Organ Sharing (UNOS) open-source database of transplant patients between 2005 and 2023.</p><p><strong>Interventions: </strong>After the preprocessing process, a feature engineering technique was employed to select the most relevant features. Then, six ML models with optimised hyperparameters including multiple linear regression, random forest regressor (RF), support vector machine regressor, XGBoost regressor, a multilayer perceptron model and a deep learning model were developed based on the UNOS dataset.</p><p><strong>Primary and secondary outcome measures: </strong>The performance of each model was evaluated using R-squared (R²) and other error rate metrics. Next, the Shapley Additive Explanations (SHAP) technique was used to identify the most important features in the prediction.</p><p><strong>Results: </strong>The raw dataset contains 196 270 records with 545 features in all organs. After preprocessing, 32 966 records with 15 features remain. Among various models, the RF model achieved a high R² score. Additionally, the RF model exhibited the lowest error values, indicating its superior precision compared with other regression models. The SHAP technique in conjunction with the RF model revealed the 11 most important features for priority allocation. Subsequently, we developed a web-based decision support tool using Python and the Streamlit framework based on the best-fine-tuned model.</p><p><strong>Conclusion: </strong>The deployment of the ML model has the potential to act as an automated tool to aid physicians in assessing the priority of lung transplants and identifying significant factors that play a role in patient survival.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e089796"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085823","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":"Causal analysis of undernutrition among adolescents in the context of the agrarian community of North-West Ethiopia: a general structural equation modelling approach.","authors":"Eskezyiaw Agedew, Zeweter Abebe, Abebe Ayelign","doi":"10.1136/bmjopen-2023-080359","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-080359","url":null,"abstract":"<p><strong>Objective: </strong>This study was conducted to evaluate the causal analysis of undernutrition among adolescents in the context of the agrarian community of North-West Ethiopia.</p><p><strong>Design: </strong>A community-based case-control study was conducted among 149 cases and 297 control adolescents.</p><p><strong>Setting: </strong>Agrarian communities of North-West Ethiopia.</p><p><strong>Participants: </strong>Adolescents aged 10-19 years, who reside in a randomly selected study setting.</p><p><strong>Outcome measures: </strong>The stunting and thinness nutritional status of adolescents was determined using the WHO AnthroPlus 2010 software. A general structural equation modelling approach was used to determine a multicausal analysis of undernutrition. The Food Frequency Questionnaire was tested for internal reliability among 30 adolescents. The reliability test for the actual dietary tool was done using Cronbach's alpha coefficient (α), which was 0.79. The model adequacy was tested using the Akaike information criterion and Bayesian information criterion. The significant direct and indirect determinants were identified with a value of p<0.05.</p><p><strong>Result: </strong>Adolescents with lower traditional and mixed dietary pattern consumption habits were determinant factors for stunting with adjusted β=0.65, 95% CL (0.143 to 1.159) with a value of p=0.012, adjusted β=2.697, 95% CL (0.563 to 4.831) with a value of p=0.013, respectively. Breakfast eating frequency had a negative indirect determinant factor on the reduction of stunting via lower traditional habits, with adjusted β=-0.207 (-0.299 to-0.116) with a value of p=0.001, and higher consumption habits of animal sources with traditional alcoholic drinking habits with adjusted β=-0.163, 95% CL (-0.260 to -0.065) with a value of p=0.001. Whereas breakfast eating frequency had a direct influence on thinness with adjusted β=-0.332, 95% CL (-0.588 to -0.076) with a value of p=0.011, and an indirect influence via dietary patterns for both stunting and thinness (p<0.05).</p><p><strong>Conclusion: </strong>Dietary patterns and breakfast-eating frequency were direct and indirect determinant factors for adolescents' stunting and thinness. Public health interventions should be implemented to reduce stunting and thinness by improving the dietary feeding and breakfast consumption habits of adolescents and strengthening the national deworming programmes in study areas and similar settings.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e080359"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085861","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":"Application of diagnostic criteria in paediatric complex regional pain syndrome: a scoping review protocol.","authors":"See Wan Tham, Rebecca Lee, Lisa-Marie Rau, Navil Firoze Sethna, Elisabeth Mueller Nylander, Lorenzo Fabrizi, Julia Wager, Helen Koechlin","doi":"10.1136/bmjopen-2025-101963","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-101963","url":null,"abstract":"<p><strong>Introduction: </strong>There are no validated paediatric-specific diagnostic criteria for complex regional pain syndrome (CRPS). As a result, diagnostic tools developed for adults (eg, Budapest Criteria, Japanese Diagnostic Criteria, Veldman Criteria) are frequently applied in the paediatric population. However, the clinical presentations and trajectories of children can differ from adults. Given that treatment outcomes are linked to early diagnosis and intervention, the lack of paediatric-specific screening or diagnostic tools is an important knowledge gap. We aim to identify the frequency of individual criteria used in diagnosing CRPS in children and adolescents in existing literature, summarise assessment methods used to establish the diagnosis, and provide recommendations for research and clinical application.</p><p><strong>Methods: </strong>The following databases and platforms will be searched for articles published from 2003 (year the Budapest Criteria was developed) onward: CINAHL, CENTRAL, Embase, Ovid MEDLINE, PubMed, PsycINFO and Web of Science. Our search strategy will use subject headings and text words related to the concepts of CRPS in paediatric populations, with study inclusion criteria from birth up to 18 years old, and a diagnosis of CRPS. Data will be extracted by our multidisciplinary team and findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.</p><p><strong>Ethics and dissemination: </strong>This study does not involve human participants or unpublished data; therefore, approval from a human research ethics committee is not required. The findings of this scoping review will be disseminated through academic conferences and peer-reviewed publications.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e101963"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085827","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":"Perceived acceptability, barriers and enablers in implementing mobile phone messaging-based message-framing intervention for improved maternal and newborn care in Jimma Zone, Ethiopia: a qualitative study.","authors":"Gebeyehu Bulcha, Hordofa Gutema, Demisew Amenu, Zewdie Birhanu","doi":"10.1136/bmjopen-2024-088342","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-088342","url":null,"abstract":"<p><strong>Objective: </strong>To explore the perceived acceptability, barriers and enablers in implementing mobile phone messaging-based message-framing interventions to improve maternal and newborn care in Jimma Zone, Ethiopia.</p><p><strong>Design: </strong>A qualitative study employing thematic analysis of data collected through in-depth interviews (IDIs) and key informant interviews (KIIs).</p><p><strong>Setting: </strong>The study was conducted in Dedo, Shabe Sombo and Manna districts of Jimma Zone.</p><p><strong>Participants: </strong>We conducted 12 IDIs and 14 KIIs with pregnant women, male partners, health extension workers, healthcare providers and Ethio-Telecom experts across the three districts. Thematic analysis was used to identify patterns and themes in the data.</p><p><strong>Intervention: </strong>Mobile phone messaging-based interventions using gain-framed and loss-framed messages were explored for their potential to promote maternal and newborn health practices.</p><p><strong>Key areas of exploration: </strong>The study explored participants' awareness, perceived relevance, acceptability, and barriers and enablers, as well as participants' engagement with mobile health messaging interventions.</p><p><strong>Results: </strong>Participants were generally aware of the potential benefits of mobile phone messaging for maternal and newborn health. Mobile phone-based messaging was perceived as highly relevant and useful by most participants. However, many had limited prior experience using mobile messaging for health information. Despite this, participants expressed a strong willingness and readiness to receive and actively engage with the maternal and newborn mobile messaging intervention. The study also identified various barriers and enablers affecting the implementation of message-framing interventions through mobile phone messaging.</p><p><strong>Conclusions: </strong>Participants in this study generally recognised and accepted the benefits of mobile phone messaging for improving maternal and newborn health. Although rural women faced challenges in reading and understanding short messages, they demonstrated a strong willingness to engage with mobile health messaging interventions. The identified barriers were categorised as technological, social, cultural, behavioural and contextual. To maximise the impact of mobile health messaging and ensure broad and effective reach, it is crucial to address these barriers while leveraging existing enablers.</p><p><strong>Trial registration number: </strong>This study was conducted as part of a larger cluster randomised controlled trial at Clinical trials PACTR202201753436676, 4 January 2022.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e088342"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085863","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":"Communication-based interventions to increase COVID-19 vaccine willingness and uptake: a systematic review with meta-analysis.","authors":"Claire Iannizzi, Marike Andreas, Emma Bohndorf, Caroline Hirsch, Ana-Mihaela Zorger, Janine Brinkmann-Paulukat, Brigitte Bormann, Jessica Kaufman, Tina Lischetzki, Ina Monsef, Julia Neufeind, Nora Schmid-Küpke, Sebastian Thole, Karina Worbes, Nicole Skoetz","doi":"10.1136/bmjopen-2023-072942","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-072942","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the <i>Cochrane Handbook</i> and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.</p><p><strong>Data sources: </strong>We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature.</p><p><strong>Eligibility criteria for study selection: </strong>We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention.</p><p><strong>Methods: </strong>Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention.</p><p><strong>Conclusion: </strong>Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well.</p><p><strong>Prospero registration number: </strong>PROSPERO (CRD42021296618).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e072942"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085882","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 experiences and expectations of faecal immunochemical testing for investigation of colorectal cancer symptoms: a cross-sectional qualitative interview study with patients and practitioners in the UK.","authors":"Adam Biran, Christina Dobson, Colin J Rees, Willie Hamilton, David Humes, Laura Jane Neilson, James Turvill, Christian von Wagner, John Whelpton, Linda Sharp","doi":"10.1136/bmjopen-2024-093215","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093215","url":null,"abstract":"<p><strong>Objectives: </strong>Faecal immunochemical testing (FIT) is now commonplace in the UK to prioritise symptomatic patients for urgent gastrointestinal investigation. The test requires a stool sample to be collected at home by the patient and returned for analysis. In this qualitative study, we sought to understand the feasibility and acceptability of FIT-based triage for patients.</p><p><strong>Design: </strong>A cross-sectional, qualitative, experiential interview study.</p><p><strong>Setting: </strong>Recruitment was through three participating UK NHS sites (Yorkshire, Midlands, North-East). Health professionals were also identified through membership of the BSG/ACPGBI Symptomatic FIT Guideline Development Group and snowball sampling.</p><p><strong>Participants: </strong>We interviewed 21 patients who had completed FIT and been referred for colonoscopy and 30 primary and secondary care health professionals involved in symptomatic FIT delivery.</p><p><strong>Results: </strong>Completion of FIT was unproblematic from the perspective of patients who returned the test. However, health professionals expressed concern over non-return. Among patients, understanding of the purpose of FIT and the meaning of results varied. Health professionals acknowledged that ensuring patient understanding of these can be challenging. Patients believed colonoscopy was less likely to miss cancer than FIT. Patients with a family or personal history of cancer were particularly anxious and wanted the reassurance of colonoscopy, even with a negative FIT result.</p><p><strong>Conclusions: </strong>We found no major barriers to the use of FIT in prioritising symptomatic patients for urgent investigation. Improving communication might increase compliance and, possibly, acceptability of non-referral for colonoscopy in the case of a negative test result.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093215"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085906","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":"Outcomes associated with older patients who present or develop delirium in the emergency department: protocol for a systematic review and meta-analysis.","authors":"Sarah King, Oddvar Uleberg, Sindre A Pedersen, Lars Petter Bjørnsen","doi":"10.1136/bmjopen-2024-095495","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-095495","url":null,"abstract":"<p><strong>Introduction: </strong>Delirium is commonly observed in older patients who are admitted to the emergency department (ED). Previous systematic reviews have identified poor outcomes associated with delirium in surgical, intensive care and other hospital settings, yet none have specifically considered the ED. This systematic review aims to examine associations between older patients who present or develop delirium in the ED and adverse outcomes within the hospital and after discharge.</p><p><strong>Methods and analysis: </strong>Searches will be conducted in MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. There will be no date or language restrictions. Key terms will include concepts related to delirium, the ED and older adults. Observational studies or non-intervention clinical studies will be included that compare outcomes in older patients (ie, ≥65 years) with and without delirium. Outcomes of interest will include length of hospital stay, non-home discharge (eg, nursing home/residential aged care facility), cognitive impairment, decreased physical function, mortality, readmission to hospital and quality of life measures. Two reviewers will independently screen the studies. Data extraction and quality assessment will be extracted by one reviewer and checked by a second reviewer, with any disagreements resolved by discussion or by a third reviewer. Where appropriate, data will be combined in a meta-analysis and a GRADE assessment will be made for each outcome. All methods will be guided by the Cochrane Handbook and the Centre for Reviews and Dissemination and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement as well as the recommendations set out by the Meta-analysis Of Observational Studies in Epidemiology group.</p><p><strong>Ethics and dissemination: </strong>As this systematic review will use published data, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations.</p><p><strong>Prospero registration number: </strong>CRD42024594975.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e095495"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085756","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":"AI-DBS study: protocol for a longitudinal prospective observational cohort study of patients with Parkinson's disease for the development of neuronal fingerprints using artificial intelligence.","authors":"Mariëlle J Stam, Martijn G J de Neeling, Bart J Keulen, Deborah Hubers, Rob M A de Bie, Rick Schuurman, Arthur W G Buijink, Bernadette C M van Wijk, Martijn Beudel","doi":"10.1136/bmjopen-2024-091563","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091563","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) is a proven effective treatment for Parkinson's disease (PD). However, titrating DBS stimulation parameters is a labourious process and requires frequent hospital visits. Additionally, its current application uses continuous high-frequency stimulation at a constant intensity, which may reduce efficacy and cause side effects. The objective of the AI-DBS study is to identify patient-specific patterns of neuronal activity that are associated with the severity of motor symptoms of PD. This information is essential for the development of advanced responsive stimulation algorithms, which may improve the efficacy of DBS.</p><p><strong>Methods and analysis: </strong>This longitudinal prospective observational cohort study will enrol 100 patients with PD who are bilaterally implanted with a sensing-enabled DBS system (Percept PC, Medtronic) in the subthalamic nucleus as part of standard clinical care. Local neuronal activity, specifically local field potential (LFP) signals, will be recorded during the first 6 months after DBS implantation. Correlations will be tested between spectral features of LFP data and symptom severity, which will be assessed using (1) inertial sensor data from a wearable smartwatch, (2) clinical rating scales and (3) patient diaries and analysed using conventional descriptive statistics and artificial intelligence algorithms. The primary objective is to identify patient-specific profiles of neuronal activity that are associated with the presence and severity of motor symptoms, forming a 'neuronal fingerprint'.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was granted by the local ethics committee of the Amsterdam UMC (registration number 2022.0368). Study findings will be disseminated through scientific journals and presented at national and international conferences.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e091563"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085901","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":"What ethical challenges arise in global health programmes? A qualitative case study of global health programme leaders' experiences.","authors":"Michelle Grek, Ashley Graham, David Addiss, James V Lavery","doi":"10.1136/bmjopen-2024-096456","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-096456","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to describe the ethical challenges global health programme (GHP) leaders encounter in their day-to-day work and to understand how they address these ethical challenges, as an important first step toward improving the relevance and precision of ethical guidance for GHPs.</p><p><strong>Design: </strong>We employed a qualitative case study approach using grounded theory data collection and analysis methods.</p><p><strong>Setting: </strong>GHPs based at a major GHP hub in Decatur, Georgia, USA, providing a wide range of health services to more than 150 countries globally PARTICIPANTS: Leaders of all 15 GHPs in the programme hub were invited to participate and 9 were available and consented to participate. Two senior leaders of the programme hub also participated in the study.</p><p><strong>Results: </strong>We identified 10 categories of ethical challenges encountered by GHP leaders: (1) ethical misalignment between funders and implementing partners; (2) budgets functioning as constraints on ethical decision-making; (3) the limited impact of programmes on improving host country capacity; (4) concerns about missed opportunities to benefit host country communities; (5) shortcomings in current ethics guidance (6) issues in data governance, stewardship and management; (7) navigating complex sociocultural contexts; (8) photography in the context of GHPs; (9) trustworthiness and reputational risks and (10) accountability for unintended consequences. The challenges often result in divided or conflicting loyalties for GHP leaders and uncertainty about what to do. We have characterised this form of uncertainty as 'moral ambiguity,' which we define as the inability to discern the best ethical way forward when there is tension or conflict among multiple stakeholder interests.</p><p><strong>Conclusions: </strong>Our findings suggest that moral ambiguity is a common experience for GHP leaders and that current approaches to global health ethics fail to guide and support GHP leaders to recognise and address moral ambiguity and limit the distress it can cause. The experiences of GHP leaders offer important diagnostic insights for improving the way GHPs are imagined, financed, delivered and evaluated.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e096456"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085949","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}