BMJ Open最新文献

{"title":"Intraoperative protective ventilation with or without periodic lung recruitment manoeuvres on pulmonary complications after major abdominal surgery (REMAIN-1): protocol for a randomised controlled trial.","authors":"Nan-Rong Zhang, Li-Zhen Zhang, Yi Chen, Song Zhang, Shan Li, Xiao-Ke Gu, Jing Li, Hong Li","doi":"10.1136/bmjopen-2024-093360","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093360","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pulmonary complications (PPCs) are frequent after abdominal surgery and significantly affect postoperative outcomes. Intraoperative protective ventilation (IPV) has been demonstrated to mitigate PPCs. However, the comparative effectiveness of two common IPV regimens-IPV with or without periodic lung recruitment manoeuvres (PLRM)-in preventing PPCs is unclear. This study aims to compare the effects of these two IPV regimens on PPCs.</p><p><strong>Methods and analysis: </strong>This study is a prospective, double-blinded, randomised controlled trial. A total of 1060 patients at intermediate or high risk for PPCs, scheduled to undergo major abdominal surgery, will be enrolled and randomly assigned to receive either an IPV with PLRM (intensive IPV group) or an IPV without PLRM (moderate IPV group). Patients assigned to the intensive IPV group will receive positive end-expiratory pressure (PEEP) of 6-10 cm H₂O with lung recruitment manoeuvres performed every 30 min. Patients in the moderate IPV group will receive the same level of PEEP without lung recruitment manoeuvres. Both groups will receive a tidal volume of 7 mL/kg predicted body weight and an inspired oxygen fraction of 0.3-0.4. The primary outcome is respiratory failure within the first 7 postoperative days. Secondary outcomes include other PPCs, extrapulmonary complications, unplanned admissions to the intensive care unit, length of postoperative hospital stay and mortality from any cause.</p><p><strong>Ethics and dissemination: </strong>This protocol has been approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. The first participant was recruited on 9 October 2022, with an estimated completion date of 30 May 2025. The results of this trial are expected to be published in peer-reviewed journals.</p><p><strong>Trial registration number: </strong>NCT05556174.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e093360"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623398","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":"Approaches for thoracoabdominal oesophagectomy for oesophageal cancer: a network meta-analysis - study protocol.","authors":"Artur Rebelo, Juliane Friedrichs, Maurizio Grilli, Johannes Vey, Johannes Klose, Marie Merling, Joerg Kleeff, Ulrich Ronellenfitsch","doi":"10.1136/bmjopen-2024-093561","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093561","url":null,"abstract":"<p><strong>Introduction: </strong>Oesophageal cancer is the seventh most frequently diagnosed cancer and the sixth leading cause of cancer-related deaths worldwide. Oesophagectomy remains the main curative treatment option. The effect of different surgical approaches (completely open, hybrid, completely minimally invasive and robot-assisted) on patients undergoing thoracoabdominal oesophagectomy (Ivor-Lewis's procedure) for oesophageal cancer is evaluated, focusing on overall survival, postoperative mortality and morbidity.</p><p><strong>Methods and analysis: </strong>A systematic literature search will be conducted in PubMed/Medline, Cochrane Library, Embase, Cumulated Index in Nursing and Allied Health Literature, ClinicalTrials.gov and International Clinical Trials Registry Platform using predefined search terms. A random-effects (network) meta-analysis using the frequentist framework will be performed.</p><p><strong>Ethics and dissemination: </strong>As this study is based on previously published data, no ethical approval is required. Findings will be disseminated through peer-reviewed publications and conference presentations to inform clinical decision-makers (eg, surgeons, gastroenterologists).</p><p><strong>Trail registration number: </strong>CRD42024564915.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e093561"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623436","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":"Cost-effectiveness analysis comparing QuantiFERON test and tuberculin skin test for the diagnosis of latent tuberculosis infection in immunocompetent children under 15 years of age in Colombia.","authors":"Cristian Eduardo Navarro, Dione Benjumea-Bedoya, Andres Felipe Estupinan-Bohorquez, Ivan D Florez","doi":"10.1136/bmjopen-2024-087333","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-087333","url":null,"abstract":"<p><strong>Objective: </strong>To determine the cost-effectiveness of the QuantiFERON (QFT) test versus the tuberculin skin test (TST) in diagnosing latent tuberculosis infection (LTBI) in immunocompetent children under 15 years of age who are in contact with active tuberculosis (TB) patients in the context of the Colombian healthcare system.</p><p><strong>Design: </strong>Health economic evaluation. Decision tree over a horizon of <1 year.</p><p><strong>Setting: </strong>From the perspective of the Colombian healthcare system, the direct healthcare costs related to tests were considered, and diagnostic performance was used as a measure of effectiveness. The currency was the US dollar (US$) for the year 2022, with a cost-effectiveness threshold of US$6666.</p><p><strong>Participants: </strong>A simulated hypothetical cohort of 2000 immunocompetent children under 15 years of age who are in contact with active TB patients and were vaccinated with BCG at birth.</p><p><strong>Interventions: </strong>QFT test and TST to detect LTBI.</p><p><strong>Primary outcome measure: </strong>The incremental cost-effectiveness ratio (ICER) was estimated, and univariate deterministic and probabilistic sensitivity analyses were conducted using 5000 simulations.</p><p><strong>Results: </strong>QFT was found to be cost-effective with an ICER of US$705 for each correctly diagnosed case. In the one-way deterministic sensitivity analysis, QFT remained cost-effective across nearly all proposed scenarios; however, the QFT was considered 'potentially cost-effective' when TST specificity reached its highest value. The ICER was unaffected by variations in LTBI prevalence. In the probabilistic sensitivity analysis, QFT was cost-effective in 85.06% of the simulated scenarios, while TST was dominant in 11.8%.</p><p><strong>Conclusions: </strong>This study provides evidence of the cost-effectiveness of QFT compared with TST in diagnosing LTBI among immunocompetent children under 15 years who have been in contact with active TB patients in the Colombian context.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e087333"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623553","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":"Sex bias consideration in healthcare machine-learning research: a systematic review in rheumatoid arthritis.","authors":"Anahita Talwar, Shruti Turner, Claudia Maw, Georgina Quayle, Thomas N Watt, Sunir Gohil, Emma Duckworth, Coziana Ciurtin","doi":"10.1136/bmjopen-2024-086117","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-086117","url":null,"abstract":"<p><strong>Objective: </strong>To assess the acknowledgement and mitigation of sex bias within studies using supervised machine learning (ML) for improving clinical outcomes in rheumatoid arthritis (RA).</p><p><strong>Design: </strong>A systematic review of original studies published in English between 2018 and November 2023.</p><p><strong>Data sources: </strong>PUBMED and EMBASE databases.</p><p><strong>Study selection: </strong>Studies were selected based on their use of supervised ML in RA and their publication within the specified date range.</p><p><strong>Data extraction and synthesis: </strong>Papers were scored on whether they reported, attempted to mitigate or successfully mitigated various types of bias: training data bias, test data bias, input variable bias, output variable bias and analysis bias. The quality of ML research in all papers was also assessed.</p><p><strong>Results: </strong>Out of 52 papers included in the review, 51 had a female skew in their study participants. However, 42 papers did not acknowledge any potential sex bias. Only three papers assessed bias in model performance by sex disaggregating their results. Potential sex bias in input variables was acknowledged in one paper, while six papers commented on sex bias in their output variables, predominantly disease activity scores. No paper attempted to mitigate any type of sex bias.</p><p><strong>Conclusions: </strong>The findings demonstrate the need for increased promotion of inclusive and equitable ML practices in healthcare to address unchecked sex bias in ML algorithms.</p><p><strong>Prospero registration number: </strong>CRD42023431754.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e086117"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623558","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":"Demographic variation in continuous glucose monitoring utilisation among patients with type 1 diabetes from a US regional academic medical centre: a retrospective cohort study, 2018-2021.","authors":"Omer Atac, Kory R Heier, Daniela Moga, John Fowlkes, Min-Woong Sohn, Aaron J Kruse-Diehr, Teresa M Waters, Mary E Lacy","doi":"10.1136/bmjopen-2024-088785","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-088785","url":null,"abstract":"<p><strong>Objective: </strong>While continuous glucose monitoring (CGM) utilisation has been increasing among patients with type 1 diabetes (T1D), few studies have examined patterns of use across age, race/ethnicity and insurance status together. In this study, we examine CGM utilisation among patients with T1D from a regional academic medical centre across all insurance types.</p><p><strong>Design and setting: </strong>This is a retrospective cohort study including both paediatric and adult patients with T1D who visited a regional academic medical centre between 1 January 2018 and 31 December 2021.</p><p><strong>Methods: </strong>Patients were followed from the date of their first T1D encounter during the study period until the first of the following: CGM use was documented, ≥730 days with no encounters at this centre or the end of the study period. We compared CGM use across demographic and clinical characteristics and used logistic regression models to assess the association between demographic variables and CGM utilisation.</p><p><strong>Results: </strong>Among 3311 eligible patients with T1D, CGM utilisation was 51.22%. The highest utilisation rates were among patients <18 years old while the lowest rates were among those in the 65+ years age group. Patients with private insurance and those who attended diabetes self-management education and support (DSMES) programmes had significantly higher CGM utilisation than those with public insurance and those who did not attend DSMES, respectively. In models stratified by age, we examined patterns of CGM use across insurance categories and found that CGM rates were persistently low among those with public versus private insurance.</p><p><strong>Conclusions: </strong>In this retrospective review of patients with T1D receiving care at a regional academic medical centre from 2018 to 2021, nearly half of our sample used CGM. However, we found substantial variation in CGM utilisation with lower rates among older versus younger adults and individuals covered by public versus private insurance. Enhancing CGM access is important to mitigate diabetes-related complications for all patients with T1D.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e088785"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623561","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 evaluation of a healthcare decision-making intervention for African American parent-adult daughter dementia dyads: a mixed-methods study protocol.","authors":"Kalisha Bonds Johnson, Karen S Lyons, Fayron Epps, Gaea Daniel, Joan K Monin, Wizdom Powell, Ken Hepburn","doi":"10.1136/bmjopen-2025-099976","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-099976","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;There is a higher proportion of African American care partners due to African American older adults having more than twice the prevalence of Alzheimer's disease and related dementias (ADRD) compared with non-Hispanic white older adults in the USA. African American adult daughters are the largest group of care partners of African American persons living with ADRD. Within this role, they are faced with navigating multiple health-related decisions to optimise the quality of life of their parent with ADRD, which can negatively influence their own quality of life. This study is guided by three conceptual frameworks: National Institute on Aging's Health Disparities Research Framework, Black Family Socio-Ecological Context Model and Superwoman Schema. The purpose of this study was to develop a structured culturally responsive prototype intervention that will improve the healthcare decision-making self-efficacy and quality of life of African American parent-adult daughter dementia dyads. The prototype intervention will be piloted in a single-group clinical trial to evaluate feasibility, acceptability and preliminary efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;This study will be conducted in two phases using an explanatory sequential mixed-methods design, wherein qualitative data collection follows quantitative data collection to explain the findings. In the first phase, the quantitative data collection will examine the behavioural, sociocultural and environmental lifecourse influences on healthcare decision-making self-efficacy and the quality of life of 70 African American parent-adult daughter dementia dyads (ie, persons living with ADRD and their adult daughter care partners). The qualitative data collection will consist of a nested sample of 15 dementia dyads and focus on the decision-making processes that affect current and future healthcare use for the parents living with ADRD. Further, this study will explore how these processes influence the quality of life of both members. In phase 2, integrated findings from phase 1 will provide the basis for the development of the prototype intervention using design thinking and intervention mapping with key informants and community advisory board oversight. Once the prototype intervention is developed, a clinical trial will be conducted. This trial will enrol a new sample of 20 African American parent-adult daughter dementia dyads using a pretest-post-test design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;The first phase of the study has been approved by the Emory University Institutional Review Board and is registered on ClinicalTrials.gov (NCT05139290). This study will contribute to the development of a structured culturally responsive prototype intervention for African American parent-adult daughter dementia dyads. The findings will determine whether a larger randomised controlled trial is warranted. Results of the research will be disseminated in both ac","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e099976"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623567","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":"Effects of colloid versus crystalloid priming on early haemodynamics in critically ill patients receiving CRRT: protocol for a randomised controlled trial.","authors":"Renli Mao, Zhifeng Zhou, Yingying Yang, Bo Wang, Ling Zhang","doi":"10.1136/bmjopen-2024-089777","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-089777","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the acknowledged advantage of continuous renal replacement therapy (CRRT) in maintaining stable haemodynamics compared with intermittent haemodialysis, hypotension remains a common complication, affecting up to 43% of patients immediately following CRRT. This issue can precipitate serious adverse events and is associated with increased mortality. The significant reduction in blood volume during the withdrawal process for machine processing, combined with the rapid elimination of urea during purification, can cause a precipitous decline in plasma osmotic pressure, both of which may serve as triggers for early hypotension during CRRT. Currently, conventional strategies, such as priming the pipeline with normal saline combined with double connections, have failed to significantly reduce the incidence of early hypotension. To prevent this complication, some researchers have turned to the use of human albumin, plasma and colloid fluids instead of normal saline for pipeline priming. Nevertheless, evidence favouring this approach over traditional crystalloid priming is still lacking. This study aims to investigate whether colloid priming is superior to crystalloid priming in reducing the incidence of early hypotension and all-cause mortality, as well as shortening the duration of hospitalisation in intensive care unit and reducing the dialysis dependence in critically ill patients undergoing CRRT.</p><p><strong>Methods and analysis: </strong>A single-centre, prospective, randomised controlled trial will be conducted at West China Hospital of Sichuan University, China. A total of 216 participants who met the inclusion and exclusion criteria will be recruited and divided into either the experimental or control group at a ratio of 1:1 via a central randomisation system. In the experimental group, succinyl gelatin will be used to prime the pipeline prior to the connection with the CRRT machine, whereas the control group will use normal saline. The primary outcome is the incidence of early hypotension during CRRT. The outcome assessors and data analysts will be blinded. All the data will be analysed based on randomly assigned groups unless data for the primary outcomes are missing.</p><p><strong>Ethics and dissemination: </strong>The trial protocol was approved by the Ethics Review Committee of West China Hospital of Sichuan University (2023.2084), and the results will be published in peer-reviewed journals.</p><p><strong>Trial registration number: </strong>ChiCTR2400082835.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e089777"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623585","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":"Value and service match of advanced training skills among rural general practitioners: a qualitative Australian study.","authors":"Hannah M Mason, Abdul-Aziz Seidu, Francis Albert, Emma M Anderson, Faith O Alele, Lawrie McArthur, Aaron Hollins, Paula Heggarty, Tarun Sen Gupta, Richard Hays, Bunmi S Malau-Aduli","doi":"10.1136/bmjopen-2024-089890","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-089890","url":null,"abstract":"<p><strong>Introduction: </strong>Advanced skills training (AST) is a requirement for rural generalist training in Australia. This study explored the lived experience of general practitioners who have undertaken AST to better appreciate its value and fitness for purpose.</p><p><strong>Methods: </strong>Thirteen participants were recruited via convenience sampling. A descriptive phenomenological study design was employed. Semistructured interviews were conducted and thematically analysed to identify patterns in the data.</p><p><strong>Results: </strong>Participants identified the professional value of AST, describing improved clinical competence, clinical courage, development of professional networks, work satisfaction and recognition. AST enabled better provision and continuity of care to rural communities. Potential service mismatches between AST specialty selection and perceived community needs are a current challenge.</p><p><strong>Conclusion: </strong>Recommendations include refining the programme selection process, increasing programme flexibility and developing clearer guidelines to navigate training pathways. Future research should explore the value of AST from community perspectives to inform tailored approaches.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e089890"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623590","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":"Improving Outcomes in Mental Health (IOMH)-an Australian longitudinal clinical study of families with children with neurodevelopmental problems: cohort profile.","authors":"Dana E Galligan, Leanne Payne, Daniel P Sullivan, Madhura Bhadravathi Lokeshappa, Laura Ziser, Lorelle Nunn, Leanne M Wallace, Isabella Andersen, Sophie Howarth, Akina Kato, Mohan Karunanithi, Cassandra Mingin, Sally O'Scanaill, Nisreen Aouira, Ayu Paramecwari, Matthew R Sanders, Vanessa E Cobham, Naomi R Wray, Anjali K Henders, Enda M Byrne, Honey Heussler, Christel M Middeldorp","doi":"10.1136/bmjopen-2024-091676","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091676","url":null,"abstract":"<p><strong>Purpose: </strong>Children with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) face a range of challenges which impact their daily functioning and that of their family. NDDs are often associated with significant mental health problems which can influence the course. The Improving Outcomes in Mental Health cohort described in this article aims to investigate the risk factors for the persistence and severity of mental health problems in children with NDDs.</p><p><strong>Participants: </strong>A total of 1084 families (primary caregivers and children) were recruited from the Child Development Program at the Children's Health Queensland Hospital and Health Service in Brisbane, Australia. 1471 caregivers (female n=1036) participated in the study, which included 382 families with 2 or more caregivers participating. The children were predominantly male (71%), with the average age of all children 5.6 years.</p><p><strong>Findings to date: </strong>The most prevalent child clinical diagnoses were ASD and ADHD, with half of children receiving more than one diagnosis. Caregiver reports indicated that children were experiencing clinical levels of depression (30.8%) and anxiety (27.6%). Approximately 39% of caregivers scored in the subclinical or clinical range for at least one Diagnostic and Statistical Manual of Mental Disorders measure, the majority reporting depressive problems.</p><p><strong>Future plans: </strong>Future plans for this data set include analysis of environmental variables such as family structure, income, school achievements and leisure activities as risk factors for the persistence of mental health problems in children with NDDs. Genetic data will be used to provide insights into the heritability of mental illness and improve prediction.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e091676"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623384","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":"Mechanistic study of transcranial magnetic stimulation intervention for poststroke attention deficit: a randomised controlled trial protocol.","authors":"Wenyan Li, Bonuan Yao, Junying Wu, Yong Xu","doi":"10.1136/bmjopen-2024-088980","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-088980","url":null,"abstract":"<p><strong>Introduction: </strong>Treating attention disorders is one of the hottest studies in the field of rehabilitation medicine. Stroke leads to the destruction of the functional network of the cerebral cortex and impairs the cognitive function of patients. Improvement of attention plays a pivotal role in the rehabilitation of patients who have had a stroke. Repetitive transcranial magnetic stimulation has achieved relatively positive efficacy in rehabilitation applications for patients who have had a stroke; however, its optimal parameters and mechanism of action regarding poststroke attention deficits are still elusive. Therefore, this will be an in-depth study exploring the mechanisms of high-frequency transcranial magnetic stimulation on cerebral functional connectivity in patients with poststroke attentional dysfunction.</p><p><strong>Methods and analysis: </strong>This single-centre randomised controlled trial will involve 120 patients who have had a stroke. They will be randomly allocated to either a high-frequency transcranial magnetic stimulation group or a control group (sham stimulation group). The intervention will take place 5 days a week for 2 weeks. The primary outcome will be a comparison between and within the two groups from baseline to 2 weeks before and after the intervention, and will be based on quantitative electroencephalography to explore the connectivity of brain networks and to assess the efficacy of high-frequency transcranial magnetic stimulation on attentional functioning after stroke. Functional near-infrared spectroscopy imaging, a range of neuropsychological scales, activities of daily living, motor function scores and biological indicators will be used as secondary outcome indicators.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the Ethics Committee of the First Hospital of Shanxi Medical University (NO. KYLL-2023-264 and NO.KYXZ-2024-005). All participants will sign the informed consent form. Findings will be published in peer-reviewed journals and presented at conferences.</p><p><strong>Trial registration number: </strong>ChiCTR2400082383.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e088980"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623437","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}