BMJ Open最新文献

{"title":"Exploring experiences of healthcare and clinical challenges for Deaf people: for better healthcare equity! A mixed-methods study protocol.","authors":"Chengang Hong, Zhongling Zhou, Liping Wang, Feier Zhou, Jinhui Chu, Jiaqi Sun, Weichao Liu, Jinghan Yang, Qianyu Zhang, Min Wang","doi":"10.1136/bmjopen-2024-091450","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091450","url":null,"abstract":"<p><strong>Introduction: </strong>China is home to the world's largest deaf population, yet there remains a dearth of knowledge regarding the healthcare experiences and challenges encountered by this community, as well as the factors influencing their healthcare encounters. This protocol will outline a mixed-methods study aimed at gaining comprehensive insights into the healthcare experiences and challenges faced by the Deaf population in China.</p><p><strong>Methods and analysis: </strong>This study will adopt a mixed research design strategy in relation to the cultural context of the Deaf population. The first stage is a quantitative study, using a cross-sectional survey to investigate the current situation of the healthcare experience of the Deaf population in China. Important factors influencing the healthcare experience of the Deaf population and the pathways through which the factors interact will be validated through structural equation modelling. The second phase of the qualitative research will involve face-to-face semistructured interviews with members of the Deaf population using purposive and maximum variance sampling techniques to gain insights into their experiences of healthcare and clinical challenges they may have encountered. The interview data will be thematically summarised, organised and analysed based on the socioecological theoretical framework and Colaizzi's phenomenological 7-step analysis. A triangulation strategy will be used to integrate the experiences and perceptions of the Deaf population regarding healthcare across micro, meso and macro levels within the framework of social ecological theory.</p><p><strong>Ethics and dissemination: </strong>The study has been approved by the Ethics Committee of School of Nursing Hangzhou Normal University (ethic ID: 2023-083). All the participants will sign written informed consent forms. This study will be conducted in accordance with the 1964 Declaration of Helsinki guidelines. Findings of this work will be written for peer-reviewed publications and disseminated at international nursing conferences. Data related to this study will be available from the corresponding author on reasonable request after completing this study.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e091450"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511541","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":"Multicomponent intervention for controlling hypertension in the adult rural population of Pakistan: a protocol for a hybrid type III implementation-effectiveness cluster randomised controlled trial.","authors":"Imran Naeem, Aysha Almas, Aziz Sheikh, Catherine Hewitt, Hajra Khwaja, Saima Afaq, Saira Bukhari, Sajid Soofi, Salim S Virani, Sawera Hanif, Shiraz Hashmi, Simon Walker, Zulfiqar Ahmed Bhutta, Kamran Siddiqi, Zainab Samad","doi":"10.1136/bmjopen-2025-100365","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-100365","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Though prior trials have shown the effectiveness of community-based hypertension detection and care delivery models, their adoption and translation to practice has been slow. In this study, we will develop and test strategies for the implementation and scale-up of a proven multicomponent hypertension intervention (MCHI) in Pakistan that comprises health education, blood pressure (BP) monitoring and referrals by lady health workers (LHWs) and hypertension management by physicians in primary care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;In this 24-month hybrid type III implementation-effectiveness cluster-randomised controlled trial, we will recruit 3000 adult hypertensive patients from two rural districts of Pakistan. We will engage public health sector managers, physicians and LHWs and use the &lt;b&gt;C&lt;/b&gt;onsolidated &lt;b&gt;F&lt;/b&gt;ramework for &lt;b&gt;I&lt;/b&gt;mplementation &lt;b&gt;R&lt;/b&gt;esearch to identify barriers and facilitators to the implementation of an already proven-to-be-effective MCHI. Using &lt;b&gt;E&lt;/b&gt;xpert &lt;b&gt;R&lt;/b&gt;ecommendations for &lt;b&gt;I&lt;/b&gt;mplementing &lt;b&gt;C&lt;/b&gt;hange and the modified Delphi technique, a set of implementation strategies addressing barriers will be identified. The strategies will be categorised as level 1 (requiring a change in processes), level 2 (requiring a change in infrastructure) and level 3 (financial restructuring). Basic health units and 250-300 households from their catchment will be considered as clusters. Clusters will be randomised in a ratio of 1:1 to intervention and control. While MCHI will be offered in both trial arms (intervention and control), the aforementioned implementation strategies will be randomised to the intervention arm only, starting with level 1 and moving to levels 2 and 3 as needed. Baseline and 6-monthly follow-up surveys, each of 6 months duration, will be conducted to collect data from the recruited participants on sociodemographics, cardiovascular disease (CVD) risk factors, CVD-related expenses and quality of life. The &lt;i&gt;primary outcome&lt;/i&gt; will be the mean difference in BP-lowering medications per participant between the intervention and control arms. The primary outcome will be analysed using a linear mixed model with fixed effects for baseline value of the outcome. Additional outcomes include &lt;i&gt;implementation outcomes&lt;/i&gt;: proportion of LHWs conducting health education, BP screening and monitoring, facility referrals and proportion of physicians diagnosing and treating hypertensive patients; &lt;i&gt;effectiveness outcomes:&lt;/i&gt; proportion of participants with controlled BP and improved EQ-5D-5L score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;Ethical approval has been obtained from the Ethics Review Committee of Aga Khan University Pakistan (ERC # 2023-9084-26739). Findings will be reported to: (1) study participants; (2) funding body and institutes collaborating and supporting the study; (3) provincial and district health departments to inform policy; (4)","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e100365"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511548","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":"Real-world effectiveness and safety of oral azvudine versus Paxlovid in patients with COVID-19 and pre-existing hypertension: a multicentre, retrospective, cohort study in Henan Province, China.","authors":"Fuwei Wang, Bohan Jia, Guotao Li, Xiaoli Jin, Mengzhao Yang, Guangming Li, Shixi Zhang, Guowu Qian, Hong Luo, Ming Cheng, Ling Wang, Donghua Zhang, Silin Li, Hongxia Liang, Zhigang Ren","doi":"10.1136/bmjopen-2024-090230","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-090230","url":null,"abstract":"<p><strong>Objectives: </strong>Azvudine and Paxlovid are the primary antiviral agents for the management of COVID-19. However, there is currently insufficient evidence regarding the effectiveness and safety of these drugs in treating COVID-19 patients with pre-existing hypertension. The objective of this study was to assess their effectiveness and safety among those patients in a real-world context.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Electronic medical record data of COVID-19 patients with pre-existing hypertension were extracted from nine hospitals in Henan Province from 5 December 2022 to 31 January 2023.</p><p><strong>Participants: </strong>Following 2:1 propensity score matching (PSM), 996 individuals who received treatment with azvudine and 498 individuals who received treatment with Paxlovid were included in the analysis.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was all-cause death and the secondary outcome was the composite disease progression.</p><p><strong>Results: </strong>Following adherence to the inclusion and exclusion criteria and 2:1 PSM, 996 individuals were included in the azvudine group and 498 in the Paxlovid group. The Cox regression analysis revealed that the azvudine group had a significantly lower risk of all-cause death compared with the Paxlovid group (HR 0.64, 95% CI 0.455 to 0.911, p=0.013). However, there was no statistically significant difference in composite disease progression between the two groups (HR 0.93, 95% CI 0.711 to 1.229, p=0.629). Subgroup analysis indicated that, compared with Paxlovid, patients with moderate disease receiving azvudine treatment exhibited a significantly reduced risk of composite disease progression (HR 0.46, 95% CI 0.24 to 0.89). The safety analysis showed that the azvudine group had fewer adverse events.</p><p><strong>Conclusions: </strong>Among COVID-19 patients with pre-existing hypertension, the effectiveness of azvudine is not inferior to Paxlovid in reducing all-cause death and composite disease progression, with fewer adverse events.</p><p><strong>Trial registration number: </strong>NCT06349655.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e090230"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511557","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":"Effect of aerobic exercise combined with meditation on cognitive frailty: study protocol for a parallel group randomised controlled trial.","authors":"Sijia Xia, Feng Chen, Wenju Wang, Tao Jiang, Jingfang Zhu, Lei Yang, Minguang Yang, Qing Xiang, Weilin Liu","doi":"10.1136/bmjopen-2024-094645","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-094645","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive frailty (CF) is a clinical syndrome characterised by the concurrent occurrence of physical frailty and cognitive impairment, excluding Alzheimer's disease and other forms of dementia. Recent studies have shown that combining aerobic exercise (AE) and meditation (ME) effectively enhances both physical and cognitive functions in individuals with CF. The study aims to determine whether the combined application of AE and ME can elicit significantly greater improvements in physical and cognitive functions among individuals with CF compared with the independent practice of either AE or ME alone.</p><p><strong>Methods and analysis: </strong>The research design employs a four-arm, assessor-blind randomised controlled trial. A total of 140 qualified subjects will be randomly allocated among four groups: AE, ME, AE combined with ME and a health education control group, ensuring equivalent distribution across groups. The intervention phase of the study will last for 12 weeks. The primary outcomes will include the Edmonton Frailty Scale, while secondary outcomes will encompass evaluations of cognitive functions (including global cognitive function, memory, attention, executive function and visuospatial abilities), physical performance (measured by gait speed and lower extremity strength), subjective experiences (such as fatigue, quality of life, mindfulness, mood and sleep quality), as well as structural and functional MRI assessments and serum biomarkers. Outcomes will be evaluated at baseline and following the 12-week intervention.</p><p><strong>Ethics and dissemination: </strong>The Ethics Committee of the Affiliated Rehabilitation Hospital of the Fujian University of Traditional Chinese Medicine granted ethical approval for the study (2023KY-012-02). The findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences.</p><p><strong>Trial registration number: </strong>ChiCTR2300073563.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094645"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511450","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":"Effectiveness of Kushal Maa, a group-based mhealth interactive education and social support intervention for maternal and neonatal health outcomes: study protocol for a multisite randomised controlled trial in India.","authors":"Alison M El Ayadi, Mona Duggal, Lakshmi Gopalakrishnan, Rashmi Bagga, Pushpendra Singh, Tracy Lin, Anant Bhan, Sujata Saunik, Garima Singh Verma, Alka Ahuja, Jasmeet Kaur, Deepak Tugnawat, Shailendrakumar Gujarathi, Abhishek Singh, Azaz Khan, Dinesh Chandke, Shashi Kant Dhir, Supriya Dhakne-Palwe, Praveen Kumar, Mrunal Patil, Sonam Kumar, Nitin Vasaikar, Laura Weil, Nadia Diamond-Smith","doi":"10.1136/bmjopen-2025-104213","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-104213","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Perinatal care continuity across the full continuum is essential for optimising maternal and infant health; however, a stark gap occurs post partum, with less than one half of Indian mothers receiving postpartum care due to significant logistical and sociocultural barriers, particularly for periurban and rural residents. To overcome these barriers and reduce women's postpartum isolation, our international team of maternal and infant health clinicians and researchers developed and pilot-tested a culturally-tailored mobile interactive education and support group intervention, &lt;i&gt;Kushal Maa ('informed-mother'&lt;/i&gt;), confirming feasibility and acceptability and preliminary effectiveness. The current study seeks to estimate the effectiveness of the &lt;i&gt;Kushal Maa&lt;/i&gt; intervention compared with standard care on maternal and neonatal health-related behaviours and health, characterise the mechanisms of intervention impact and evaluate the cost-effectiveness of the &lt;i&gt;Kushal Maa&lt;/i&gt; intervention in improving postpartum maternal and neonatal health compared with the standard of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;We will conduct a prospective, parallel block-randomised controlled trial with a 1:1 allocation ratio among 2100 pregnant women across three geographically diverse Indian states. Inclusion criteria for women: aged 18+years of age at enrolment, in the last trimester of pregnancy (30-33 weeks of gestation), with any parity, carrying single or multiple gestation (1-2), with knowledge of site-specific local language and had access to a mobile phone. Participants will be block-randomised in groups of 15. Intervention participants will receive 28 tailored education and support sessions weekly via audio/video conference facilitated by trained moderators (four prenatal and 24 weekly postpartum sessions through 6 months) and will be engaged in WhatsApp groups for health education videos and peer discussion via text chat. Control participants receive the standard of care. Data will be collected at four points: 30-33 weeks of pregnancy (enrolment), 6 weeks, 3 months and 6 months postpartum (endline). Investigators, outcome assessors and data analysts will be blinded to group allocation. Primary outcomes will be measured at 6 weeks, 3 months and 6 months post partum and include: postpartum depression (using Edinburgh Postnatal Depression Scale), exclusive breastfeeding and met need for postpartum family planning. Secondary outcomes include other maternal and child health knowledge, outcomes and maternal and newborn healthcare use indicators. We will use intention-to-treat analysis. Mixed-effects models will account for clustering due to the group-oriented delivery of the intervention and repeated measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;This study has been approved by the Health Ministry Screening Committee, Government of India and approved by ethics boards at the Post-Graduate Institute for Med","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e104213"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511452","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":"Developing and integrating a destination decision support algorithm into an innovative electronic communication platform to improve injury care service coordination in Rwanda: the Rwanda912 study protocol.","authors":"","doi":"10.1136/bmjopen-2025-102355","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-102355","url":null,"abstract":"<p><strong>Introduction: </strong>Delays in getting injured patients to the hospital in a timely manner can increase avoidable death and disability. Like many low-income or middle-income countries, Rwanda experiences delays related to a lack of efficient prehospital communication and formal guidelines to triage patients for hospital care. This study describes the protocol to develop, roll-out and evaluate the effectiveness of a destination decision support algorithm (DDSA) integrated in an electronic communication platform, '912Rwanda'. The DDSA will facilitate the linkage of patients to health facilities able to treat their condition(s).</p><p><strong>Methods and analysis: </strong>Work will be conducted in the prehospital emergency service 'Service d'Aide Médicale Urgente' and health facilities in Kigali city and Musanze district, which serve predominantly urban and rural populations, respectively. We will develop interfaces to capture facility and patient-relevant data, which feed into a guideline-based electronic DDSA to match patients to hospitals. We will assess existing trauma care processes using qualitative and quantitative methodologies. This will be followed by a series of consensus workshops to develop at-scene triage guidelines and agree on variables to capture in the interfaces. The DDSA will be developed based on outputs from these workshops and will be tested against historical ambulance data and expert opinion until acceptable thresholds of performance are achieved. User interfaces will be developed and tested using human-computer interface design principles.</p><p><strong>Discussion: </strong>The combined collaborative approach of bringing together experts and software developers, and with deep engagement of Rwandan stakeholders, including leadership of Rwanda Ministry of Health through its technical arm, Rwanda Biomedical Center, should lead to an ambulance communication system which is used, sustained and effective.</p><p><strong>Ethics and dissemination: </strong>The project was approved by the Rwanda National Research Ethics Committee. Annual reports will be disseminated to relevant stakeholders, followed by the public. Publications will be open access as per the funding policy.</p><p><strong>Trial registration number: </strong>ISRCTN97674565. Registered on 29 July 2024. https://doi.org/10.1186/ISRCTN97674565.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e102355"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511538","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":"Exploring the social dimensions of AI integration in healthcare: a qualitative study of stakeholder views on challenges and opportunities.","authors":"Julia-Astrid Moldt, Teresa Festl-Wietek, Wolfgang Fuhl, Susanne Zabel, Manfred Claassen, Samuel Wagner, Kay Nieselt, Anne Herrmann-Werner","doi":"10.1136/bmjopen-2024-096208","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-096208","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the opportunities and challenges associated with integrating artificial intelligence (AI) in healthcare by exploring the perspectives of various stakeholders. The objective was to provide a nuanced understanding of stakeholder views to address concerns and promote the acceptance and successful integration of AI technologies in medical practice.</p><p><strong>Design: </strong>This exploratory qualitative study used semi-structured interviews. Data were analysed using a combination of deductive and inductive coding, followed by content analysis to identify and develop categories.</p><p><strong>Setting: </strong>This study was conducted in Tübingen, Germany, within the framework of the TüKITZMed project (Tübingen AI Training Center for Medicine), between August 2022 and March 2023.</p><p><strong>Participants: </strong>A total of 38 stakeholders participated, including 6 lecturers, 9 clinicians, 10 healthcare students, 6 AI experts and 7 institutional stakeholders. Inclusion criteria included professionals involved in or affected by AI in healthcare, while exclusion criteria comprised individuals without relevant experience.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Outcome measures: </strong>The main outcome was the identification of thematic categories capturing stakeholders' perceptions, expectations and concerns regarding the integration of AI in healthcare.</p><p><strong>Results: </strong>The analysis identified two main thematic categories: two main categories encompassing a total of 14 subcategories: (1) perceived opportunities of AI in medicine, including aspects of increased efficiency, reduced workload and improved patient safety and (2) perceived challenges of AI in medicine, such as its impact on medical decision-making and concerns about dependence on technology. These themes reflect diverse perspectives and insights across stakeholder groups.</p><p><strong>Conclusions: </strong>Diverse stakeholder perspectives offer valuable insights into the anticipated effects of AI in healthcare. Understanding these perspectives can support decision-makers in designing context-sensitive AI strategies and identifying areas for further professional and institutional development. Future research should monitor how these attitudes evolve in response to technological progress and real-world implementation.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e096208"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and surgeon perspectives of a large-scale system for automated, real-time monitoring and feedback of shared decision-making integrated into surgical practice: a qualitative study.","authors":"Christin Hoffmann, Kerry N L Avery, Rhiannon C Macefield, Val Snelgrove, Leila Rooshenas, Hilary L Bekker, Della Hopkins, Christie Cabral, Jane M Blazeby, Ben Gibbison, Shireen Hickey, Adam Williams, Jon Aning, Andrew Judge, Andrew Smith, Archana Lingampalli, Barnaby Reeves, Jessica Preshaw, Michael R Whitehouse, Paul Cresswell, Philip Braude, Shelley Potter, Timothy Beckitt, Timothy Whittlestone, Angus G K McNair","doi":"10.1136/bmjopen-2025-099090","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-099090","url":null,"abstract":"<p><strong>Objective: </strong>To explore patient and healthcare professional perceptions about the acceptability and impact of a large-scale system for automated, real-time monitoring and feedback of shared decision-making (SDM) that has been integrated into surgical care pathways.</p><p><strong>Design: </strong>Qualitative, semistructured interviews were conducted with patients and healthcare professionals between June and November 2021. Data were analysed using deductive and inductive approaches.</p><p><strong>Setting: </strong>Large-scale monitoring of SDM has been integrated in NHS surgical care across two large UK National Health Service Trusts.</p><p><strong>Participants: </strong>Adult surgical patients (N=18, 56% female), following use of an SDM real-time monitoring and feedback system, and healthcare professionals (N=14, 36% female) involved in their surgical care. Patient recruitment was conducted through hospital research nurses and professionals by direct approach from the study team to sample individuals purposively from seven surgical specialties (general, vascular, urology, orthopaedics, breast, gynaecology and urgent cardiac).</p><p><strong>Results: </strong>10 themes were identified within three areas of exploration that described factors underpinning: (1) the acceptability of large-scale automated, real-time monitoring of SDM experiences, (2) the acceptability of real-time feedback and addressing SDM deficiencies and (3) the impact of real-time monitoring and feedback. There was general support for real-time monitoring and feedback because of its perceived ability to efficiently address deficiencies in surgical patients' SDM experience at scale, and its perceived benefits to patients, surgeons and the wider organisation. Factors potentially influencing acceptability of large-scale automated, real-time monitoring and feedback were identified for both stakeholder groups, for example, influence of survey timing on patient-reported SDM scores, disease-specific risks, patients' dissatisfaction with hospital processes. Factors particularly important for patients included concerns over digital exclusion exacerbated by electronic real-time monitoring. Factors unique to professionals included the need for detailed, qualitative feedback of SDM to contextualise patient-reported SDM scores.</p><p><strong>Conclusions: </strong>This study explored factors influencing the acceptability of automated, real-time monitoring and feedback of patients' experiences of SDM integrated into surgical practice, at scale among key stakeholders. Findings will be used to guide refinement and implementation of SDM monitoring and feedback prior to formal development, evaluation and implementation of an SDM intervention in the NHS.</p><p><strong>Trial registration number: </strong>ISRCTN17951423. THE ORIGINAL PROTOCOL: doi: 10.1136/bmjopen-2023-079155.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099090"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511552","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":"Prevalence of low-level viremia in the treatment of chronic hepatitis B in China: a systematic review and meta-analysis.","authors":"Lu Xie, Guangwei Liu, Yanan Liu, Pengyu Li, Huijun Guo","doi":"10.1136/bmjopen-2024-088756","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-088756","url":null,"abstract":"<p><strong>Objectives: </strong>Low-level viremia (LLV) is a risk factor affecting the prognosis of patients with chronic hepatitis B (CHB). The objective of this study was to systematically assess the prevalence of LLV, thereby providing robust evidence-based medical insights into effective clinical interventions and preventative measures against LLV.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>A comprehensive literature search was conducted across various databases, including China National Knowledge Infrastructure, Wanfang Data (Wanfang), China Science And Technology Journal Database (VIP-CSTJ), China Biology Medicine disc (CBMdisc), PubMed, Embase, Web of Science and the Cochrane Library, spanning from the inception of these databases up to 5 January 2024.</p><p><strong>Eligibility criteria: </strong>The research type included either a cross-sectional study or a cohort study focusing on the Chinese population, with the outcome being LLV. The languages were limited to both Chinese and English. Studies with any of the following were excluded: subjects with other comorbidities, original articles inaccessible or data unavailable, and duplicate publications.</p><p><strong>Data extraction and synthesis: </strong>Literature management used EndNote X9.1, and an information extraction table was created using Microsoft Excel to record research information, including first author, year of publication and study type. The prevalence of LLV was assessed via meta-analysis. Meta-analyses were conducted in RStudio using the 'metaprop ()' function. Subgroup analysis and sensitivity analysis were used to identify sources of heterogeneity, and funnel plots and AS-Thompson tests were employed to evaluate publication bias.</p><p><strong>Results: </strong>18 studies, encompassing a total sample of 9773 patients, were included in the analysis. Of these, 3336 patients were identified with LLV. The meta-analysis revealed that the prevalence of LLV among treated CHB patients stands at 33.6% (95% CI 30.2 to 37.0). The antigen status, antiviral treatment regimen (type of drugs and nucleos(t)ide analogues (NAs)), treatment duration, medication adherence and baseline hepatitis B virus DNA levels all affected the prevalence of LLV. Sensitivity analysis further corroborated the stability of these meta-analysis findings. The funnel plot and AS-Thompson test indicated no significant publication bias (t = -0.01, p=0.995).</p><p><strong>Conclusions: </strong>The prevalence of LLV among CHB patients was established at 33.7% (95% CI 29.8% to 37.6%). Thus, it is imperative for clinical decision-makers to consider the various influencing factors of LLV when formulating treatment plans in order to mitigate any potential adverse outcomes.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e088756"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511554","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":"Yoga for older adults with multimorbidity: teaching insights for optimising participant safety and inclusion from the process evaluation of the Gentle Years Yoga trial.","authors":"Lesley Ward, Laura Wiley, Fiona Rose, Jenny Howsam, Laura Bissell, Garry Tew, Tim Rapley","doi":"10.1136/bmjopen-2024-097472","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-097472","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a teaching exemplar for optimising the safe and accessible delivery of chair-based yoga to multimorbid older adult populations.</p><p><strong>Design: </strong>A qualitative process evaluation embedded within the multi-site, randomised controlled Gentle Years Yoga trial for older adults (65+ years) with two or more long-term health conditions (trial status: completed).</p><p><strong>Setting: </strong>Online and face-to-face interviews were conducted with participants and yoga teachers involved in the 12-week chair-based yoga intervention. Interview data were supplemented with observations of in-person and online yoga class delivery.</p><p><strong>Participants: </strong>All yoga teachers delivering the yoga intervention were invited to take part in the interviews, together with a subsample of participants receiving the yoga intervention. Participants were purposively selected to represent the trial cohort demographics of gender, age, ethnicity, index of multiple deprivation, and number and intensity of chronic health conditions.</p><p><strong>Results: </strong>25 yoga participants and 11 yoga teachers took part in one (N=19) or two (N=17) interviews. Participants were aged 66-91 years (mean age 74 years), with 2-8 long-term health conditions, most commonly osteoarthritis (N=15, 60%), cardiovascular disease (N=14, 56%), sensory conditions (N=9, 36%) and depression or anxiety (N=8, 32%). Yoga teachers were predominantly female (N=10, 91%), with 4-35 years yoga teaching experience across multiple yoga styles. Feedback from yoga teachers and participants was classified into six categories, generating a 21-item teaching exemplar. These covered aspects of delivery including class size and delivery formats, choosing appropriate physical content, enhancing inclusivity of personal beliefs through non-physical content, proactive teaching styles, communication tips and ways to boost visibility.</p><p><strong>Conclusions: </strong>This 21-item list adds to the current educational base of yoga for older adults. Addressing both face-to-face and online class formats, this exemplar offers pragmatic guidance for yoga teachers to enhance the safe and accessible delivery of chair-based yoga to older adults and multimorbid populations.</p><p><strong>Trial registration number: </strong>ISRCTN13567538.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097472"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511580","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}