BMJ Open最新文献

{"title":"Mapping the evidence on the assessment of fitness to work at heights: a scoping review.","authors":"Lyndsey Swart, Tania Buys, Nicolaas Claassen","doi":"10.1136/bmjopen-2024-093525","DOIUrl":"10.1136/bmjopen-2024-093525","url":null,"abstract":"<p><strong>Objectives: </strong>Falls from heights are a leading cause of workplace injuries and fatalities. Ensuring worker fitness is crucial, yet many countries lack formal guidelines for fitness for work (FFW) assessments, posing safety and legal risks. This scoping review sought to identify and map the existing evidence on the assessment of fitness to work at heights.</p><p><strong>Design: </strong>Scoping review following the Joanna Briggs Institute Scoping Review Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.</p><p><strong>Data sources: </strong>Searches were conducted in March 2024 across ProQuest Central, Google Scholar, PubMed, Scopus, ScienceDirect, Web of Science and PsycINFO. Grey literature was sourced from the websites of organisations including the International Labour Organisation, Safe Work Australia, Canadian Centre for Occupational Health and Safety, Health and Safety Executive (UK), Occupational Safety and Health Administration (USA), WHO, Centre for Construction Research and Training (USA), Institution of Occupational Safety and Health (UK), South African Society of Occupational Medicine, South African Society of Occupational Health Nursing and Institute for Work at Height (South Africa), in addition to general Google searches.</p><p><strong>Eligibility criteria for selecting studies: </strong>Our inclusion criteria encompassed both peer-reviewed and grey literature that addressed either 'fitness for work at heights', 'fitness for work in high-risk settings requiring work at heights' or human risk factors associated with working at heights.</p><p><strong>Data extraction and synthesis: </strong>A data extraction framework and guidance sheet were developed, piloted and refined through team discussions. An iterative review process was followed, with one author extracting and coding data while two authors conducted quality checks. Deductive qualitative content analysis was applied to the extracted data.</p><p><strong>Results: </strong>68 articles met the inclusion criteria, but only 7 directly addressed fitness to work at heights, with the rest focusing on fitness to work in high-risk settings requiring work at heights or human risk factors associated with work at heights. This highlights a lack of peer-reviewed research specific to the topic. Key challenges included FFW assessments failing to reflect job demands, inconsistent application of FFW evaluations, lack of standardisation and inadequate stakeholder collaboration. Legal tensions between employer safety obligations and worker rights were also noted. Critical human risk factors-such as physical and mental limitations, adverse states, human error and rule violations-significantly affected worker safety, though evidence of their specific impact in this context remained limited. Findings on the economic implications of FFW assessments were also inconclusive.</p><p><strong>Conclusion: </strong>Asses","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e093525"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742322","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":"Changes in peripapillary microvasculature and retinal nerve fibre layer in diabetes and diabetic retinopathy using optical coherence tomographic angiography: a community-based, cross-sectional study.","authors":"Jiahui Liu, Dan Kang, Zhiyi Xu, Qianhong Xian, Shuhui Chen, Shulun Zhao, Jiali Li, Xuewen Huang, Wei Wang, Wenyong Huang, Minyu Chen, Lanhua Wang","doi":"10.1136/bmjopen-2023-079572","DOIUrl":"10.1136/bmjopen-2023-079572","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate changes in the peripapillary retinal microvasculature and retinal nerve fibre layer (RNFL) in diabetic participants with various stages of diabetic retinopathy (DR) using swept-source optical coherence tomographic angiography (OCTA).</p><p><strong>Design: </strong>Community-based, cross-sectional study.</p><p><strong>Setting: </strong>This study was conducted in a tertiary teaching hospital in Guangzhou, China.</p><p><strong>Participants: </strong>A total of 1325 ocular-treatment-naive participants, of whom 1115 had no DR and 210 had DR, were recruited in a community in Guangzhou, China.</p><p><strong>Primary and secondary outcome measures: </strong>A commercially available OCTA device was used to obtain various peripapillary retinal microvascular metrics centred on the optic disc, including vessel density (VD), vessel length density (VLD) and vessel diameter index (VDI). The peripapillary RNFL thickness was automatically obtained using built-in software. Linear regression analyses were used to evaluate the association of the peripapillary OCTA parameters (VD, VLD and VDI), RNFL thickness with various DR stages and average RNFL thickness with peripapillary OCTA parameters.</p><p><strong>Results: </strong>Moderate and severe DR had progressively decreased VD in the peripapillary ring (β = -0.72, 95% CI = -1.31 to -0.14 and -1.79, 95% CI = -2.81 to -0.77, respectively) and other regions (all p<0.05). Similar changes were observed between peripapillary VLD and moderate and severe DR (all p<0.05). Moderate (β = -4.56, 95% CI = -8.97 to -0.15, p=0.043) and severe DR (β = -10.12, 95% CI = -18.29 to -1.95, p=0.015) had significant thinner peripapillary RNFL in the inferior quadrant. VD and VLD were linearly associated with the average RNFL in the peripapillary ring and average peripapillary area (all p<0.05).</p><p><strong>Conclusions: </strong>The peripapillary retinal microvasculature and RNFL were significantly reduced with the progression of DR, which suggests that monitoring differences in peripapillary microvasculature and the RNFL may be a promising approach to detecting DR progression.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e079572"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742296","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":"Drive-the-doctor paradigm in acute ischaemic stroke for improving regional stroke care networks: a cost-effectiveness analysis.","authors":"Chi Phuong Nguyen, Maarten Uyttenboogaart, Willemijn J Maas, Erik Buskens, Maarten M H Lahr, Durk-Jouke van der Zee","doi":"10.1136/bmjopen-2024-091413","DOIUrl":"10.1136/bmjopen-2024-091413","url":null,"abstract":"<p><strong>Background and objective: </strong>In a drive-the-doctor (DD) paradigm, an interventionalist travels from a comprehensive stroke centre (CSC) to primary stroke centres (PSCs) to perform endovascular thrombectomy (EVT) for acute ischaemic stroke due to large vessel occlusion (LVO). The DD paradigm may reduce time delays from onset to recanalisation. This study aimed to analyse the cost-effectiveness of the DD paradigm versus a drip-and-ship (DS) paradigm, where LVO patients are transferred from PSCs to a CSC for EVT in the northern Netherlands.</p><p><strong>Design: </strong>Economic evaluation was performed using a simulation model combined with a decision tree and a Markov model.</p><p><strong>Setting: </strong>Stroke centres in the northern Netherlands.</p><p><strong>Participants: </strong>A hypothetical cohort of 100 000 LVO patients with an average age of 70 years.</p><p><strong>Interventions: </strong>Two strategies were tested, including the DD paradigm with one upgraded PSC and the DD paradigm with two upgraded PSCs.</p><p><strong>Main outcome measures: </strong>Total costs and quality-adjusted life years (QALYs) were measured over a 15-year time horizon from a Dutch healthcare provider perspective. An incremental cost-effectiveness ratio (ICER) of €50 000 was used as a willingness-to-pay threshold. One-way sensitivity, probabilistic sensitivity and scenario analyses (interventionalist transportation by car, ambulance and helicopter) were conducted to examine parameter uncertainty.</p><p><strong>Results: </strong>The DD paradigm using car as a transport modality and two PSCs was the optimal strategy, resulting in the lowest ICER. This strategy provided an additional 0.13 QALYs at incremental costs of €2367, yielding an ICER of €18 306 compared with current practice. The DD paradigm with two PSCs reduced ICERs compared with the scenario with one PSC when varying transportation modalities (car, ambulance and helicopter). Probabilistic sensitivity analyses showed that the DD paradigm with two PSCs using car was preferred in 72% of 10 000 Monte Carlo simulations.</p><p><strong>Conclusions: </strong>The DD paradigm appeared cost-effective for LVO patients and may be considered a promising evolution for a regional stroke network.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e091413"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742316","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 a single-centre randomised pilot study to assess the safety and feasibility of adding a CytoSorb filter during kidney normothermic machine perfusion to remove inflammatory and immune mediators prior to kidney transplantation.","authors":"Maithili Mehta, Sarah Hosgood, Michael L Nicholson","doi":"10.1136/bmjopen-2024-093001","DOIUrl":"10.1136/bmjopen-2024-093001","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of perfusion technologies in kidney transplantation has the potential to improve graft function and survival and increase utilisation. Our previous work demonstrated that kidneys with an enhanced inflammatory and immune response during normothermic machine perfusion (NMP) had significant graft dysfunction after transplantation. The addition of a cytokine filter (CytoSorb) to the NMP circuit dramatically reduces both circulating inflammatory mediators and inflammatory gene expression, but this has not been trialled in clinical practice.</p><p><strong>Methods and analysis: </strong>This is a randomised phase 1 pilot study to evaluate the safety and feasibility of using a CytoSorb filter in clinical NMP to remove inflammatory and immune mediators. Eligible kidney transplant recipients on the waiting list in the East of England will be approached for consent. A total of 20 patients will be recruited and randomised in a 1:1 ratio for the donor kidney to receive either NMP or NMP with a CytoSorb filter pre-transplantation. The kidney will be transplanted according to standard practice after NMP. The primary endpoint is inflammatory and immune gene expression measured in a cortical biopsy from the kidney 60 min post-transplant. Secondary endpoints include rates and duration of delayed graft function and graft function as assessed by change in creatinine clearance and estimated glomerular filtration rate 2 days, 5 days, 1 month and 3 months post-transplant. Additionally, inflammatory mediators and injury markers will be measured in peripheral blood and urine samples taken pre-operatively and on days 2 and 5 after transplant.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the Health Research Authority Health and Care Research Wales Committee (REC 23/WM/0141) and by National Health Service (NHS) Blood and Transplant (Ref: Study 148). Findings will be published in a peer-reviewed journal and disseminated at scientific conferences. The dataset will be made available on request.</p><p><strong>Trial registration: </strong>The study is prospectively registered on the ISCRTN registry (ID: 13698207).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e093001"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742324","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":"Evaluation of the psychometric properties of patient-reported outcome measures of health-related quality of life across the European cancer continuum: a systematic review protocol using COSMIN methodology.","authors":"Laurence Leysen, Karla Marticic Giljevic, Claire Piccinin, Morena Shkodra, Madeline Pe, Morten Petersen, Giovanni Apolone, Cinzia Brunelli, Claudio Lombardo, Galina Velikova, Alexandra Gilbert, Gabriella Pravettoni, Gennaro Ciliberto, Mogens Groenvold, Montserrat Ferrer, Nanne Bos, Ricardo Pietrobon, Norbert Couespel, Augusto Caraceni, Marianne Guren, Aude Sirven, Hugo Vachon","doi":"10.1136/bmjopen-2024-088716","DOIUrl":"10.1136/bmjopen-2024-088716","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past decades, there has been increasing recognition that assessing patients with cancer's health-related quality of life (HRQoL) is pivotal to delivering optimal patient-centred healthcare. However, with the increasing number of patient-reported outcome measures (PROMs) available, it becomes more and more challenging to identify the most appropriate PROM to capture HRQoL. Therefore, the aim of this systematic review is to (1) identify all available PROMs assessing HRQoL across the European cancer continuum and (2) critically appraise, compare and summarise the psychometric properties of the identified PROMs.</p><p><strong>Methods and analysis: </strong>Bibliographic databases MEDLINE and PubMed Central (through PubMed) and EMBASE (through Scopus) will be comprehensively searched from database inception until March 2024. Studies reporting on the measurement properties of PROMs assessing HRQoL throughout the European cancer continuum will be included. The evaluation of the psychometric properties, data extraction and data synthesis will be conducted according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. Two reviewers will independently assess the methodological quality using the COSMIN risk of bias checklist and the COSMIN criteria for good measurement properties. Subsequently, findings will be qualitatively summarised. The Grading of Recommendations Assessment, Development and Evaluations (GRADE) guidelines will be used to grade and summarise the quality of the evidence.</p><p><strong>Ethics and dissemination: </strong>Ethical clearance for this research is not required, as the systematic review will only use information from previously published research. The results of this review will be submitted for publication in a peer-reviewed journal and will be used to provide a set of evidence-based recommendations for a European project (EUonQOL), which aims at developing a new PROM (EUonQOL toolkit) to assess HRQoL across the European cancer continuum. Moreover, findings will be disseminated to a clinical audience and policymakers through conferences, supporting researchers and clinicians in choosing the best measure to evaluate HRQoL in patients with cancer and survivors in Europe.</p><p><strong>Prospero registration number: </strong>CRD42023418616.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e088716"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742320","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":"Correction for 'Protocol for a randomised 'screen-andtreat' Helicobacter pylori eradication trial in 14-18-years-old adolescents residing in three regions of Chile: effectiveness and microbiological host implications'.","authors":"","doi":"10.1136/bmjopen-2024-084984corr1","DOIUrl":"10.1136/bmjopen-2024-084984corr1","url":null,"abstract":"","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e084984corr1"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742303","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":"Measures of diabetic retinopathy treatment coverage: protocol for a methodological review.","authors":"Nimisha Chabba, Pushkar Raj Silwal, Covadonga Bascaran, Rinki Murphy, Iris Gordon, Nyawira Mwangi, Subash Bhatta, Nayana Pant, Matthew J Burton, Stuart Keel, Jennifer Evans, Jacqueline Ramke","doi":"10.1136/bmjopen-2024-092081","DOIUrl":"10.1136/bmjopen-2024-092081","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic retinopathy is one of the leading causes of vision impairment globally. Alongside the systemic control of diabetes and timely detection of diabetic retinopathy, the prompt initiation and completion of treatment is essential to prevent vision loss. Routine monitoring of access to retinal screening services for the detection of diabetic retinopathy is common, while monitoring of coverage of subsequent treatment services is far less common. When diabetic retinopathy treatment coverage is assessed, there is great variability in how it is defined and reported. If a definition of treatment coverage could be standardised, the monitoring of the quality of diabetes eye care could more readily be compared between settings and over time. The aim of this review is to summarise how diabetic retinopathy treatment coverage has been measured in published studies and the extent to which these have been disaggregated by population groups.</p><p><strong>Methods and analysis: </strong>A search will be conducted on Medline and Embase without any language restrictions, for cohort and cross-sectional studies published from 1 January 2015 that report diabetic retinopathy treatment coverage for adults with diabetic retinopathy and/or macular oedema. We will include studies from any world region reporting diabetic retinopathy treatment coverage for one or more of: (1) laser photocoagulation; (2) intravitreal injections of antivascular endothelial growth factor agents; (3) intravitreal injections of corticosteroids; (4) vitrectomy. The PROGRESS framework (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status and social capital) will be used to assess disaggregation by population groups. Two investigators will independently screen studies and extract relevant data. Data will be synthesised descriptively to outline the full range of definitions of diabetic retinopathy treatment coverage in the literature and identify the common sources of data used.</p><p><strong>Ethics and dissemination: </strong>This review will only include published data; thus, no ethical approval will be sought. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences. The findings will also be considered in conjunction with an ongoing review on retinal screening for diabetic retinopathy to develop indicators for monitoring of services along the diabetes eye care pathway, which may include an indicator of effective service coverage.</p><p><strong>Registration: </strong>Open Science Framework registration 6/08/2024: https://osf.io/5b93m.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e092081"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742323","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":"Temporal trends in hospitalisations for venous thromboembolic events in England: a population-level analysis.","authors":"Mark Hughes, Mark D Russell, Ritika Roy, Daksh Mehta, Sam Norton, Fabiola Atzeni, James B Galloway","doi":"10.1136/bmjopen-2024-090301","DOIUrl":"10.1136/bmjopen-2024-090301","url":null,"abstract":"<p><strong>Objectives: </strong>To describe temporal trends in hospitalisation episodes for venous thromboembolic events (VTEs) in England, and compare hospitalisation rates for pulmonary emboli (PEs) and deep vein thrombosis (DVT).</p><p><strong>Methods: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Secondary care in England, UK, between April 1998 and March 2022.</p><p><strong>Participants: </strong>Individuals with hospitalisations for VTE recorded in the NHS Digital Hospital Episode Statistics dataset.</p><p><strong>Primary and secondary outcomes: </strong>The primary outcome was temporal trends in hospitalisation episodes for PE, DVT and VTE overall between 1 April 1998 and 31 March 2022. Secondary outcomes included the proportion of all-cause hospital admissions that were due to VTE; the proportion of all VTE hospitalisations that were recorded as primary admission diagnoses; the male/female split in hospitalisation episodes for VTE; and temporal changes in hospitalisation rates by age.</p><p><strong>Results: </strong>Between 1998 and 2022, hospitalisations for VTE increased by 62.6%, from 109.5 to 178.1 per 100 000 population. This was driven by a 202% increase in hospitalisations for PE (from 40.4 to 122.2 per 100 000 population). In contrast, hospitalisations for DVT decreased by 19.1% over this period (from 69.1 to 55.9 per 100 000 population). Overall, VTE remained stable as a proportion of all-cause hospital admissions between 1998/1999 and 2019/2020 (0.45% and 0.43%, respectively), before increasing after the onset of the COVID-19 pandemic in England (0.59% in 2020/2021 and 0.51% in 2021/2022).</p><p><strong>Conclusion: </strong>Hospitalisations for VTE increased markedly in England between 1998 and 2022, driven by large increases in hospitalisations for PE. In contrast, hospitalisations for DVT decreased overall, which may reflect the success of primary care DVT management pathways. Our findings suggest that preventative measures are needed to reduce the incidence of hospitalisations for PE.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e090301"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742330","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":"What laparoscopic skills are necessary for the certificate of completion of training? A prospective nationwide cross-sectional survey of obstetrics and gynaecology and general surgery trainees and consultants in the UK.","authors":"Zaibun N Khan, Donna Shrestha, Abdulwarith Shugaba, Joel E Lambert, Elizabeth Haslett, Karolina Afors, Theodoros M Bampouras, Daren Subar, Christopher Gaffney, T Justin Clark","doi":"10.1136/bmjopen-2024-095777","DOIUrl":"10.1136/bmjopen-2024-095777","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the views of obstetrics and gynaecology (O&G) and general surgery (GS) trainees and consultants on the laparoscopic skills considered necessary to achieve the certificate of completion of training (CCT) and identify any mismatch between consultants and trainees in their expectations of these skills.</p><p><strong>Design: </strong>A prospective nationwide cross-sectional study in the UK.</p><p><strong>Setting: </strong>A national survey distributed through Health Education, England and national training bodies such as the Royal College of Obstetricians & Gynaecologists, British Society for Gynaecological Endoscopy and the Association of Surgeons of Great Britain and Ireland.</p><p><strong>Participants: </strong>O&G and GS consultants and specialty trainees in O&G and GS. Specialty trainees below ST3 level and consultants performing open surgery or minor laparoscopic surgery only were excluded.</p><p><strong>Interventions: </strong>Trainees completed a 27-item questionnaire on their training characteristics, rated their confidence and perceived importance of 10 laparoscopic skills required for CCT using a 5-point Likert scale. Consultants answered a 36-item questionnaire on their demographic details, their views on the importance of the same 10 laparoscopic skills, their confidence and the standard of laparoscopic skills they observed among trainees approaching CCT.</p><p><strong>Results: </strong>345 participants responded to the questionnaire: 117 O&G trainees, 95 O&G consultants, 57 GS trainees and 76 GS consultants. O&G trainees and consultants expected similar laparoscopic skills required for CCT for all 10 skills (p>0.050), while GS consultants had higher expectations of GS trainees for use of endovascular devices (p<0.05), suturing (p<0.01) and staplers (p<0.05). Consultants in both specialties observed that trainees were performing significantly below the expected standards; p<0.010 (O&G) and p<0.001 (GS) for all 10 listed skills. O&G trainees reported lower confidence than GS trainees for all 10 laparoscopic skills, p<0.001.</p><p><strong>Conclusions: </strong>This nationwide study showed that UK O&G trainees and consultants both agree on the skills required for CCT, but GS consultants had higher expectations than their trainees. Trainees in GS were more confident in their surgical skills than those in O&G. However, consultants in both specialities believed that trainees were not achieving the requisite laparoscopic skills required for CCT.</p><p><strong>Trial registration number: </strong>NCT05116332.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e095777"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742333","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":"Association between the preoperative triglyceride-glucose index and myocardial injury following non-cardiac surgery: a cross-sectional study.","authors":"Yuanjun Zhou, Weiming Chen, Fei Liang, Liping Zhong, Yilin Liao, Yuting Zhong","doi":"10.1136/bmjopen-2024-091978","DOIUrl":"10.1136/bmjopen-2024-091978","url":null,"abstract":"<p><strong>Objective: </strong>An elevated triglyceride-glucose (TyG) index positively correlates with adverse cardiovascular events. However, its association with myocardial injury after non-cardiac surgery (MINS) remains unclear. This study aimed to examine the association between the preoperative TyG index and MINS.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>Meizhou People's Hospital.</p><p><strong>Participants: </strong>Adult patients under general anaesthesia and with MINS.</p><p><strong>Main exposure measure: </strong>The preoperative TyG index, calculated using triglyceride (TG) and fasting blood glucose (FBG) levels.</p><p><strong>Main outcome measure: </strong>The occurrence of MINS, defined using postoperative troponin measurements.</p><p><strong>Results: </strong>889 patients were included, with an 8.3% incidence of MINS (74/889). The median TyG index was 8.57 (8.13, 9.02). TyG exhibited higher discriminatory ability for MINS than TG and FBG, with an area under the curve of 0.624, 0.544 and 0.500, respectively. Fully adjusted logistic regression indicated that an elevated TyG index was independently associated with MINS (OR 1.75, 95% CI 1.21 to 2.52; p=0.003). A multivariate restricted cubic spline suggested a linear relationship between TyG and MINS (p value for non-linearity=0.059). Subgroup analyses showed results consistent with the primary analysis, with no significant interaction effects between subgroups.</p><p><strong>Conclusion: </strong>An elevated preoperative TyG index is independently associated with an increased incidence of MINS. Monitoring the TyG index perioperatively may improve the management of patients at risk for MINS.</p><p><strong>Trial registration number: </strong>ChiCTR2400082834.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 3","pages":"e091978"},"PeriodicalIF":2.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742291","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}