BMJ Open最新文献

{"title":"Estimating diagnostic delay in patients with pituitary adenomas in Sweden: a cross-sectional study.","authors":"Maria Forsgren, Christina Dahlgren, Caroline Alkebro, Pia Burman, Per Dahlqvist, Charlotte Höbye, Margareta Lindgren, Oskar Ragnarsson, Helena Wik, Maria Wärn, Anna-Karin Åkerman, Britt Eden Engström, Bertil Ekman, Cecilia Follin","doi":"10.1136/bmjopen-2024-097804","DOIUrl":"10.1136/bmjopen-2024-097804","url":null,"abstract":"<p><strong>Objective: </strong>A delayed diagnosis of pituitary adenomas (PAs) can lead to increased morbidity and reduced quality of life. The aim was to estimate diagnostic delay and investigate the concordance between patient-reported symptoms and the medical record documentation in patients with PA.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Seven university hospitals.</p><p><strong>Participants: </strong>654 patients: non-functioning PA (NFPA, 314), prolactinoma (118), acromegaly (164) and Cushing's Disease (CD, 58).</p><p><strong>Data collection: </strong>Questionnaires and medical record extraction.</p><p><strong>Primary and secondary outcomes: </strong>Type of first healthcare contact, delay of PA diagnosis and patient-reported symptoms and symptoms documented in medical records.</p><p><strong>Results: </strong>First healthcare contact was usually a general practitioner. Estimated time from symptoms to diagnosis varied from <1 year (66%), 1-5 years (12%), 5-9 years (13%) and >10 years (9%). The longest diagnostic delays were observed in acromegaly and CD. A longer delay was observed in women compared with men (p<0.001). The most frequent patient-reported symptoms among NFPA were headache and visual disturbances; for prolactinomas, menstrual irregularities and headache; for acromegaly, change in appearance and snoring; and for CD, weight gain and tiredness. Concordance between patient-reported symptoms at diagnosis and medical records was found for visual disturbances in NFPA and prolactinomas (<i>Cohen's</i> kappa >0.6) and for menstrual irregularities in prolactinomas (<i>Cohen's</i> kappa >0.7).</p><p><strong>Conclusion: </strong>We report a large variation in symptom duration before diagnosis with a substantial diagnostic delay in patients with CD and acromegaly. An increased awareness about endocrine diseases in the general population and health professionals may contribute to earlier diagnosis of pituitary adenomas.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097804"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of hospital and follow-up care among patients with type 2 diabetes and newly diagnosed cardiovascular disease: a cohort study in Sweden.","authors":"Björn Agvall, Junmei Miao Jonasson","doi":"10.1136/bmjopen-2024-096633","DOIUrl":"10.1136/bmjopen-2024-096633","url":null,"abstract":"<p><strong>Objective: </strong>To examine hospital discharge practices, including clinical and laboratory assessments, in patients with type 2 diabetes mellitus (T2DM) following their first hospitalisation for cardiovascular disease (CVD), and to explore the association of these practices with adverse events, defined as hospital readmission, emergency department visits and mortality.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Follow-up for 100 days after a newly diagnosed CVD among patients with T2DM in Region Halland, Sweden.</p><p><strong>Participant: </strong>A total of 1482 patients with T2DM and a new diagnosis of CVD during hospitalisation were included. Patients were followed from hospital discharge for up to 100 days. Inclusion criteria were a hospital discharge diagnosis of CVD and a prior diagnosis of T2DM. Patients with incomplete discharge data or without follow-up records were excluded.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the overall risk of serious adverse events after hospital discharge, including mortality, hospital readmission and ED encounters, within 100 days of discharge. Secondary outcomes included primary care visits and pharmacotherapy adjustments for CVD and T2DM during the same period.</p><p><strong>Results: </strong>The readmission rate within the study period was 27%, while 86% of patients visited primary care within 100 days after discharge. Cardiovascular pharmacotherapy increased, with beta-blocker usage rising to 73% and statin use reaching 82%. A significant, though modest, increase in pharmacotherapy for T2DM was observed, with metformin use increasing from 53% to 57% (p<0.001). Laboratory test results and clinical measurements at discharge, including missing glycated haemoglobin values (68%) and elevated systolic blood pressures, were associated with modest treatment adjustments at discharge, suggesting potential gaps in discharge practices and documentation.</p><p><strong>Conclusions: </strong>Despite moderate improvements in postdischarge pharmacotherapy, limited changes in diabetes management suggest room for optimisation. The findings emphasise the need for improved discharge planning and continuity of care. Future research should investigate the effects of standardised discharge protocols on treatment outcomes and readmission rates for this patient group.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e096633"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of hospital stay and associated treatment costs for patients with susceptible and antibiotic-resistant <i>Salmonella</i> infections: a systematic review and meta-analysis.","authors":"Chaelin Kim, Isabel Frost, Nichola R Naylor, Heidi Au, Yeonhee Kim, Yubin Lee, Anna Bzymek, Kamila Majgier, Ana Laura Moldoveanu, Omar Mukhtar Salman, Shillah Simiyu, Dina Mohamed Youssef, Mateusz Hasso-Agopsowicz, Kaja Abbas","doi":"10.1136/bmjopen-2024-092494","DOIUrl":"10.1136/bmjopen-2024-092494","url":null,"abstract":"<p><strong>Objectives: </strong>The global disease burden of <i>Salmonella</i> infections in 2017 included 135 900 deaths caused by <i>Salmonella</i> Typhi and Paratyphi and 77 500 deaths caused by invasive non-typhoidal <i>Salmonella</i>, with increasing antimicrobial resistance (AMR) exacerbating morbidity, mortality and costs. The aim of our systematic review and meta-analysis is to estimate the length of hospital stay and associated treatment costs for patients with susceptible and antibiotic-resistant <i>Salmonella</i> Typhi, Paratyphi and non-typhoidal <i>Salmonella</i> infections.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>We searched EMBASE, Medline/PubMed, Scopus, Hinari and LILACS databases for studies published between 1 January 2005 and 15 May 2024, with no language restrictions.</p><p><strong>Eligibility criteria: </strong>We included 30 studies that reported the length of hospital stay or treatment costs for patients with susceptible or antibiotic-resistant <i>Salmonella</i> Typhi, Paratyphi and non-typhoidal <i>Salmonella</i> infections. We excluded studies with sample sizes of less than 30 patients, those focused on non-human subjects and those not reporting our outcomes of interest.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently screened studies and extracted data on the length of hospital stay and associated costs, with monetary values converted to 2019 USD. We aggregated data according to GDP per capita quantiles using a random-effects meta-analysis. We conducted a quality assessment using an adapted Joanna Briggs Institute tool.</p><p><strong>Results: </strong>Patients with drug-resistant <i>Salmonella</i> infections had longer hospital stays, with an additional 0.5-2.2 days compared with drug-susceptible <i>Salmonella</i> infections. Based on our meta-analysis, the mean hospital stay for typhoidal <i>Salmonella</i> infections was 6.4 days (95% CI 4.9 to 7.8) for drug-susceptible cases and 8.4 days (95% CI 5.1 to 11.7) for resistant cases in the lowest income quartiles. While there were insufficient data to perform a pooled analysis, individual studies inferred that treatment costs for resistant typhoidal <i>Salmonella</i> infections were higher than for susceptible infections, and resistant non-typhoidal <i>Salmonella</i> infections had longer hospital stays and higher costs compared with susceptible infections. Data were scarce from high-<i>Salmonella</i>-burden countries, particularly in sub-Saharan Africa and parts of Asia.</p><p><strong>Conclusions: </strong>Patients with antibiotic-resistant <i>Salmonella</i> infections experience a greater healthcare burden in terms of hospitalisation length and direct costs compared with those with susceptible infections. We highlight the economic burden of AMR in <i>Salmonella</i> infections and emphasise the need for preventive measures.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e092494"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Incident Measure (PRIM) tools for reporting patient safety incidents: protocol for a scoping review.","authors":"Dimelza Osorio, Maria Nieves Plana, Maria Rubio-Valera, Julio Muñoz-Miguel, Ignasi Bolíbar, Maria Teresa Franco, Mariona Secanell-Espluga, Mercè Soler-Font, Paula Fernández-Torres, Stefanie Suclupe, Karla Salas-Gama, Daniel Torres-López, Ignacio Ferreira-González","doi":"10.1136/bmjopen-2024-096983","DOIUrl":"10.1136/bmjopen-2024-096983","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Patient safety incidents during healthcare cause a high burden and mortality, but many go unreported. Involving patients and caregivers in the identification and reporting of safety incidents would add value to the current incident reporting systems used by health professionals. Identifying and analysing patient safety incidents is essential to prevent future events, allowing organisations to apply a learning-from-error approach and to implement improvement plans. Patient-Reported Incident Measures are tools for patients and caregivers to report safety issues related to their healthcare. In accordance with WHO's patient safety taxonomy, the term patient safety incidents is used throughout this protocol to encompass events that do and do not reach the patient, including what are commonly referred to as near misses and adverse events. We aim to identify and describe the published literature about tools for patients or caregivers to report patient safety incidents in healthcare.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;We will conduct a scoping review. We have developed inclusion criteria using the PCC (population, concept and context) format, where population includes adult patients or caregivers; concept refers to documents describing formal tools used to report patient safety incidents; and context includes any healthcare setting, such as hospitals or mental health centres, during or immediately after care. The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Evidence sources include primary research, systematic reviews, meta-analyses, conference abstracts, letters, guidelines, as well as policy documents, reports, blogs and websites, without language restriction. An initial database search in Medline, Embase, CINAHL, and Cochrane Library from database inception up to June 2023 identified 4500 initial citations, of which 4103 were selected for evaluation after duplicates were removed. We will supplement the search by checking the reference lists of included studies for additional sources of evidence and an additional search in Google to identify non-peer-reviewed documents. This initial search will be updated before completing the review. We will use a self-created data collection form for data extraction and perform a narrative synthesis to integrate and summarise the review findings. We will describe the general characteristics of the tool: setting, scope, format, content, type of patient safety incident and severity, the moment of notification, relation to patient safety incident reporting and learning systems, development process, testing, validation, or piloting, among other characteristics. As a result of this scoping review, we intend to provide an index of patient/caregiver-reported safety notification tools and a list of descriptive or evaluation studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemi","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e096983"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of a single low dose of esketamine for patients with irritable bowel syndrome: study protocol for a randomised controlled trial.","authors":"Zhe Sun, Lei Jiang, Yan Xing, Fang Luo","doi":"10.1136/bmjopen-2025-099793","DOIUrl":"10.1136/bmjopen-2025-099793","url":null,"abstract":"<p><strong>Introduction: </strong>As a disorder of gut-brain interaction, irritable bowel syndrome (IBS) is a common reason for patient visits in primary and specialist care settings. IBS is associated with recurrent abdominal pain, altered bowel habit, resulting in alternating constipation and diarrhoea, bloating, without serious organic diseases. The bidirectional relationship between IBS and psychological factor is also complex. Studies have suggested that tricyclic antidepressants can effectively control the concomitant symptoms of IBS, especially some severe and refractory symptoms. At present, the conventional treatment of IBS remains somewhat unsatisfactory. Studies have shown that the antidepressant effects of esketamine are rapid and significant, whether a single low dose of esketamine is effective in IBS deserves further investigation. In this study, we hypothesise that a single low dose of esketamine will be effective for IBS.</p><p><strong>Methods and analysis: </strong>This is a single-centre, randomised, double-blind, placebo-controlled trial. Patients with IBS are divided into three levels according to the severity of IBS: mild, moderate and severe. 92 patients in the esketamine group and 92 patients in the control group who are scheduled for colonoscopy will be prospectively recruited in each level. The primary outcome is the IBS Severity Scoring System at baseline and at 3 days, 1 week, 3 weeks, 6 weeks after colonoscopy. The secondary outcome includes IBS-Quality of Life, Bristol Stool Form scale, Hospital Anxiety and Depression Scale, Patient Health Questionnaire-12 Somatic Symptom Score and adverse events. The allocation sequence is assigned by a random number table using a block randomisation method by SPSS (Version 26, IBM Inc., USA) Statistics software. All enrolled patients, anaesthesiologist B and researchers responsible for follow-up and data collection and analysis are therefore fully blinded. All data will be performed using SPSS Statistics software, and a p value <0.05 will be considered statistically significant.</p><p><strong>Ethics and dissemination: </strong>The protocol has been approved by the Medical Ethics Committee of Beijing Tiantan Hospital affiliated to Capital Medical University (KY2024-414-02). All participants will sign a written informed consent form. The results will be submitted for publication in peer-reviewed journals, presented at international conferences, and shared with participants via hospital newsletters.</p><p><strong>Trial registration number: </strong>Efficacy of Esketamine for Patients With Irritable Bowel Syndrome (NCT06788444).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099793"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Annual cases of colon cancer by age group after Medicaid expansion in the USA in 2014: a difference-in-differences study.","authors":"Edgar Asiimwe, Folasade May, Eran Bendavid","doi":"10.1136/bmjopen-2025-099058","DOIUrl":"10.1136/bmjopen-2025-099058","url":null,"abstract":"<p><strong>Background: </strong>Studies examining the association between Medicaid expansion (ME) under the Affordable Care Act (ACA) and colon cancer incidence have produced mixed results.</p><p><strong>Objective: </strong>To re-visit the association between the ACA-ME and annual cases of colon cancer.</p><p><strong>Design: </strong>Difference-in-differences (DiD).</p><p><strong>Setting: </strong>The primary analyses used data from the National Cancer Database from 2010 to 2018, a hospital-based cancer registry in the USA. We also conducted exploratory analyses using data from the Surveillance, Epidemiology and End Results (SEER) registry.</p><p><strong>Patients: </strong>Patients aged 40 and older with newly diagnosed colon cancer.</p><p><strong>Measurements: </strong>The primary outcome was the percent change in colon cancer of all stages. Secondary outcomes were percent changes in stage I and stage IV cases.</p><p><strong>Results: </strong>Among those aged 40-49, we observed a statistically significant greater increase in stage I colon cancer in expansion states relative to non-expansion states (DiD (percent change) 9.7% (95% CI, 2.5% to 17.4%)). In those aged 50-64, we did not observe statistically significant differences between the two state groups in any of the outcomes. Among those aged 65+, we observed a statistically significant relative decrease for all stages in ACA-ME states (-1.0% (95% CI, -1.0% to -3.0%)) and for stage IV (-3.0% (95% CI, -2.0% to -5.0%)). We explored our findings among younger individuals (<50) in trend plots comparing annual colorectal cancer cases to percent uninsured using SEER data and observed that increases in cases coincided with declining uninsurance in several states.</p><p><strong>Conclusion: </strong>Post-ME, we observed a greater relative increase in colon cancer among those <50 in expansion states. Our exploratory analyses suggest that fewer barriers to healthcare post-ME may have contributed to these findings; additional studies are needed. We also observed relative decreases in the 65+ age group, corroborating previous reports of spillover benefits in expansion states.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099058"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial stiffness in acute decompensated heart failure and acute kidney injury: a prospective observational cohort study protocol in a tertiary hospital setting.","authors":"Mithilesh Joshi, Patrick Tran, Thomas M Barber, Laith Khweir, Krishna Appunu, Waqar Ayub, Prithwish Banerjee","doi":"10.1136/bmjopen-2024-097718","DOIUrl":"10.1136/bmjopen-2024-097718","url":null,"abstract":"<p><strong>Introduction: </strong>The cardiovascular (circulatory) system is a closed-loop system. The dynamic interaction of the heart and vascular system plays a pivotal role in maintaining adequate cardiac output. Heart failure (HF) is commonly described as a problem of the pump, that is, mechanical myocardial failure causing poor perfusion to the body. Still, the contribution of the vasculature is often neglected. Acute decompensated heart failure (ADHF) carries a poor prognosis and is often accompanied by concomitant chronic kidney disease (CKD) and acute kidney injury (AKI), which inevitably lead to adverse outcomes. The interaction of the heart with the vasculature is conceptualised as ventricular-vascular (arterial) coupling. Arterial stiffness, a non-traditional risk factor for cardiovascular disease, can be measured non-invasively using carotid-femoral pulse wave velocity (cf-PWV). High cf-PWV values mimicking increased arterial stiffness could be a causational factor towards precipitating ADHF or AKI. This study aims to assess whether cf-PWV is higher during the hospitalisation phase of patients with HF (ADHF) and CKD (AKI in CKD) compared with stable compensated HF and stable CKD.</p><p><strong>Methods and analysis: </strong>This prospective non-randomised observational study aims to recruit 120 patients aged≥60 years. Arterial stiffness will be assessed in three groups. These groups are decompensated HF with reduced ejection fraction (n=40), decompensated HF with preserved ejection fraction (n=40) and AKI in CKD stage 3a, 3b and 4, n=40. After 4 weeks from hospital discharge, patients in a stable, compensated state will be asked to attend a follow-up clinic visit to repeat the cf-PWV measurement. The primary outcome measure is variation in cf-PWV during hospitalisation against follow-up.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was granted in October 2021 (REC reference 21/EM/0239), recruitment started in February 2022 and the results are expected in late 2025. The findings will be published in peer-reviewed journals.</p><p><strong>Trial registration number: </strong>NCT05012722.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097718"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for 'Re: CBT Dialysis': a realist evaluation-why, for whom and in what circumstances does cognitive behaviour therapy work for people with depressive symptoms receiving dialysis?","authors":"Kara Schick-Makaroff, Richard Sawatzky, Joanne Greenhalgh, Daniel Cukor, Hubert Wong, Scott Klarenbach, Charlotte Berendonk, Loretta Lee, Katrin Micklitz, Lori Suet Hang Lo, Megan Kennedy","doi":"10.1136/bmjopen-2024-090228","DOIUrl":"10.1136/bmjopen-2024-090228","url":null,"abstract":"<p><strong>Introduction: </strong>Nearly 40% of adults receiving life-saving dialysis for kidney failure report depressive symptoms. With more than 40 000 Canadians on dialysis, this is a significant health burden. Cognitive behavioural therapy (CBT) has been shown to be effective for treating depressive symptoms; however, it is rarely considered or used for people receiving dialysis. The aim of this realist study is to evaluate and explain how, why, for whom and in what circumstances therapist-guided and remotely delivered CBT works in order to provide equitable mental healthcare to individuals with depressive symptoms receiving dialysis.</p><p><strong>Methods and analysis: </strong>The project will include a realist synthesis, a quantitative cohort study and a realist evaluation. Realist methodology is a theory-driven approach that seeks to explain how generative mechanisms are shaped by contextual features, giving rise to outcome patterns. We will begin by developing an initial programme theory (IPT) from the literature and interviews with CBT therapists to understand how CBT is intended to work and for whom. We will use data from the quantitative cohort study to identify contexts that may shape outcome patterns in CBT for people receiving dialysis. This includes previously collected survey data and data from a longitudinal cohort study, both sourced from people across Canada undergoing dialysis. We will test and refine the IPT using data from a realist evaluation and existing literature. The realist evaluation will involve participants from the quantitative cohort study who received therapist-guided, remotely delivered CBT.</p><p><strong>Ethics and dissemination: </strong>Ethical approvals have been granted. We have planned a wide range of dissemination strategies: journal manuscripts and conference presentations, executive memos for administrators of renal programmes in Canada, an online inventory of resources for depressive symptoms and presentations of findings together with patient partners at all participating sites.</p><p><strong>Prospero registration number: </strong>CRD42023476184.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e090228"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does less invasive surfactant administration during high-flow nasal cannula oxygen treatment reduce the need for invasive ventilation in late preterm and early term born infants with respiratory distress? A study protocol for a single-centre study with a treatment and control arm.","authors":"Eleanor Jeffreys, Allan Jenkinson, Ourania Kaltsogianni, Chris Harris, Ravindra Bhat, Theodore Dassios, Anne Greenough","doi":"10.1136/bmjopen-2024-089399","DOIUrl":"10.1136/bmjopen-2024-089399","url":null,"abstract":"<p><strong>Introduction: </strong>Up to 40% of late preterm and early term infants require neonatal admission with respiratory disease being the most common cause. Less invasive surfactant administration (LISA) has previously been used with good success in the very preterm population, but it is unclear whether late preterm infants suffering from respiratory distress syndrome and early term infants suffering from secondary surfactant deficiency might also benefit from LISA. Continuous positive airway pressure (CPAP) in that population can increase asynchrony and air leaks, whereas these may be avoided by using high flow nasal cannula (HFNC). This trial will investigate whether LISA during HFNC reduces the need for invasive ventilation.</p><p><strong>Methods and analysis: </strong>This non-blinded, single-centre study with a treatment and a control arm will take place on the Neonatal Intensive Care Unit at King's College Hospital National Health Service (NHS) Foundation Trust and the local neonatal unit at the Princess Royal University Hospital. The study will recruit 245 infants born between 34+0 and 38+6 weeks gestational age, who are requiring respiratory support via HFNC. The 245 participants will be placed into a control and treatment group. Those infants eligible for SURFactant Or Not (SurfON) will be randomised as per the SurfON protocol. The remaining infants will, where possible, be recruited to the treatment group. All recruited infants will have 2 minutes of respiratory function monitoring. Those receiving LISA will receive a further 2 minutes of monitoring after the procedure. As HFNC, LISA and respiratory monitoring are part of routine clinical practice, retrospective consent will be gained from parents or guardians after the procedure to analyse the respiratory function data. The primary outcome will be the percentage of neonates needing invasive ventilation within 72 hours from birth. The secondary outcomes are length of neonatal unit stay; the cost of stay as estimated via standard NHS tariffs; and the lung function parameters including tidal volume, respiratory rate, end tidal CO₂ (ET CO₂), fraction of inspired oxygen (FiO₂) and ratio of oxygen saturations to fraction of inspired oxygen (SpO₂/ FiO₂) ratio before and 2 minutes after LISA and the SpO₂/FiO₂ ratio 2 hours after the administration of LISA.</p><p><strong>Ethics and dissemination: </strong>A favourable opinion was sought and obtained from the London - Hampstead Research Ethics Committee and Health Research Authority for the study protocol and other relevant documentation (informed consent forms and patient information leaflets) prior to commencing the study (REC reference: 24/PR/0431). Anonymised study data will be presented at conferences and published by the investigators in peer-reviewed journals TRIAL REGISTRATION NUMBER: NCT06421506.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e089399"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding disparities in access to and quality of surgical care for African, Caribbean and Black communities in high-income countries with universal healthcare: a scoping review protocol.","authors":"Linda Bakunda, Dina M Nyjong, Diane Lorenzetti, Oluwatomilayo Daodu, Zack Marshall, Pamela Roach, Khara Sauro","doi":"10.1136/bmjopen-2025-099213","DOIUrl":"10.1136/bmjopen-2025-099213","url":null,"abstract":"<p><strong>Introduction: </strong>African, Caribbean and Black (ACB) communities experience disparities in health outcomes, with higher rates of chronic diseases, such as heart disease and stroke, and lower self-reported health status compared to their White counterparts. Barriers to timely access to healthcare services further exacerbate these inequities. Some studies link racialisation to surgical disparities and subpar surgical outcomes. However, the findings are diverse, and there is no synthesis of the evidence on disparities in surgical care for ACB patients in high-income countries with universal healthcare systems. The objective of the scoping review is to systematically describe, characterise and map the existing literature on disparities in the access to and quality of surgical care among ACB patients in high-income countries with universal healthcare systems, and to identify gaps in the literature on surgical access and quality of surgical care in ACB patients.</p><p><strong>Methods and analysis: </strong>The scoping review will follow the Joanna Briggs Institute methodology and report according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The search strategy will be customised for each database (MEDLINE, Embase, CINAHL, APA PsycINFO and Cochrane Library) using terms for ACB and surgery. Grey literature and references from included studies will be searched for additional sources, with no limitations on publication date or language. All study designs will be eligible. Two independent reviewers will screen titles, abstracts and full texts in duplicate for eligibility. One reviewer will chart data, with a second reviewer validating the data charted. The findings will be synthesised, quantitatively summarised using descriptive statistics and qualitatively analysed through thematic analysis.</p><p><strong>Ethics and dissemination: </strong>Ethics approval is not required as the study utilises published data. The dissemination of the findings will inform future research and improve understanding of the surgical care experiences of ACB patients. Dissemination will target academics and healthcare professionals through publications, presentations and workshops.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099213"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}