BMJ Open最新文献

{"title":"Determinants of access to anticancer medicines in South Asia: a multimethod study.","authors":"Sundus Shukar, Iltaf Hussain, Ahamed Iqbal, Ali Rahimi, Gulam Mohiyuddin Shirol, Ibrahim Shirzad, Jigme Tenzin, Syed Masudur Rahman Dewan, Siwani Kumari Mishra, Amna Saeed, Zaheer-Ud-Din Babar, Caijun Yang, Yu Fang","doi":"10.1136/bmjopen-2025-115068","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-115068","url":null,"abstract":"<p><strong>Objective: </strong>South Asia bears a high cancer burden, low universal health coverage and high out-of-pocket expenditure. Access to anticancer medicines is challenging and is influenced by determinants-National Essential Medicines List (NEML), registration and local production-yet these are rarely evaluated. This study evaluates these determinants in eight South Asian countries.</p><p><strong>Design: </strong>Multimethod study using a document analysis phase and semistructured interviews.</p><p><strong>Setting: </strong>Eight South Asian countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) for document analysis, with stakeholder interviews conducted in six countries, excluding Bhutan and Maldives.</p><p><strong>Participants: </strong>Data were collected from eight regulatory authorities and 30 interviews with drug supply chain stakeholders across six South Asian countries.</p><p><strong>Main outcome measures: </strong>The inclusion of 67 anticancer medicines from the 2023 WHO Essential Medicines List (EML) into NEML, their registration and local production, along with macrolevel indicators and stakeholders' perspectives regarding them.</p><p><strong>Results: </strong>The median number of medicines included in NEMLs, registered and locally produced was 23.5, 45 and 6.5, respectively. Local production correlated positively with NEML inclusion (ρ=0.884, p=0.004) and negatively with healthcare expenditure (r = -0.732, p=0.039). Three countries listed >50% of the WHO EML medicines on their NEMLs; six had >50% registered. Local production remained limited, with imports dominating supply. Qualitative analysis identified three key barriers to improving availability: financial constraints, a weak regulatory system and insufficient strategic planning.</p><p><strong>Conclusions: </strong>Access to anticancer medicines is constrained by systemic misalignment between NEML inclusion, registration and local production, undermined by weak regulatory coordination, limited strategic planning and financial constraints. Strengthening regulatory coordination, improving registration efficiency and supporting regional production strategies aligned with guided WHO guidance may help improve equitable access to cancer medicines in the region.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e115068"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855862","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":"Socioeconomic disparities and mortality among acute patients with sepsis: a retrospective Danish cohort study.","authors":"Camilla Schade Skov, Mikkel Brabrand, Bas de Groot, Flemming Schønning Rosenvinge, Helene Skjøt-Arkil, Christian Backer Mogensen, Isik Somuncu Johansen, Annmarie Touborg Lassen","doi":"10.1136/bmjopen-2025-112451","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-112451","url":null,"abstract":"<p><strong>Objectives: </strong>Socioeconomic inequalities exist in infectious diseases and sepsis in high-income countries. We investigated the association between income and mortality among patients with sepsis, overall and among those treated in the intensive care unit (ICU) versus general wards.</p><p><strong>Design: </strong>A retrospective register-based cohort study.</p><p><strong>Setting: </strong>The Region of Southern Denmark (RSD).</p><p><strong>Participants: </strong>All adult patients with an unplanned contact with a hospital in the RSD from 1 January 2016 to 20 March 2018. Patients with sepsis were identified based on the following criteria: (1) blood culture(s) performed within 48 hours of arrival, (2) antibiotic(s) administered within 48 hours of arrival, (3) a discharge diagnosis of infection and (4) a SOFA (Sequential Organ Failure Assessment) score of ≥2. The cohort was divided into quartiles according to household income.</p><p><strong>Primary and secondary outcome measures: </strong>Cox proportional hazards models were used to estimate the association between income groups and mortality. The primary outcome was 90-day mortality with 7-day and 365-day mortality as secondary outcomes. All outcomes were calculated overall and stratified by general ward treatment only and ICU admission.</p><p><strong>Results: </strong>We identified 7813 first-time visits with community-acquired sepsis, including 886 ICU admissions (11.3%). Among patients in the lowest income group, sepsis was associated with a HR of 1.16 (95% CI 1.01 to 1.34) for 90-day mortality compared with the highest income group. This association was particularly pronounced at 365-day follow-up: HR=1.24 (95% CI 1.10 to 1.39). No difference was observed in 7-day all-cause mortality, HR=1.13 (95% CI 0.89 to 1.45). The association was not observed among patients admitted to the ICU.</p><p><strong>Conclusion: </strong>Low income was associated with increased mortality in patients with sepsis, particularly during long-term follow-up. The impact of income disparities was not observed among patient admitted to the ICU.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e112451"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855994","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 and types of anxiety disorders among patients with cardiac conditions and elevated HADS-A scores: findings from the initial screening phase of the Heart and Mind trial in Denmark.","authors":"Selina Kikkenborg Berg, Line Ryberg Rasmussen, Charlotte Brun Thorup, Trine Bernholdt Rasmussen, Anne Vinggaard Christensen, Cecilie Bech Hammer, Martin Balslev Jorgensen, Jesper Hastrup Svendsen, Signe Stelling Risom, Carsten Juul, Inge Schjødt","doi":"10.1136/bmjopen-2025-113682","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-113682","url":null,"abstract":"<p><strong>Objectives: </strong>To identify whether patients with arrhythmia, heart failure or ischaemic heart disease presenting with anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS) have identifiable anxiety according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) and, if so, which type of anxiety disorder based on the SCID.</p><p><strong>Design: </strong>Initial screening data from the Heart and Mind randomised clinical trial.</p><p><strong>Setting: </strong>Patients with arrhythmia, heart failure or ischaemic heart disease were screened using HADS, and patients with a HADS-anxiety (HADS-A) score≥8 were invited to participate. Participants were interviewed by trained cardiac nurses using the SCID to determine whether they met the criteria for anxiety and, if so, the type of anxiety disorder.</p><p><strong>Results: </strong>Of the 7816 patients who completed the HADS questionnaire, 1803 (23%) had a HADS-A score≥8. Among these, 398 (22%) agreed to the SCID interview, and 336 (84%) met the diagnostic criteria for an anxiety disorder. The mean age was 61 years, with 40% being female. The mean HADS-A score was 11.3 (SD=2.7). The most common types of anxiety were generalised anxiety disorder (61%), panic disorder (23%) and specific phobia (8%).</p><p><strong>Conclusions: </strong>The majority of individuals identified by the instrument also met the diagnostic criteria for an anxiety disorder. Generalised anxiety disorder and panic disorder were the most prevalent subtypes. Anxiety was common across the cardiac population, underscoring the need for routine assessment and targeted intervention in clinical practice.</p><p><strong>Trial registration number: </strong>NCT04582734.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e113682"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855940","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":"ODIN Biobank: a Danish cohort for dementia research- cohort profile.","authors":"Kristina Laugesen, Casper Skjærbæk, Niels Okkels, Holger Jon Møller, Per Borghammer, Hanne Gottrup, Tina Parkner","doi":"10.1136/bmjopen-2025-114084","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-114084","url":null,"abstract":"<p><strong>Purpose: </strong>Biomarkers related to the diagnosis, prognosis and treatment of dementia will play a key role in future clinical practice. The overarching aim of the ODIN (blood and cerebrospinal fluid) Biobank is to study biomarkers for dementia and contribute to the transition from cerebrospinal fluid to blood-based biomarkers.</p><p><strong>Participants: </strong>ODIN recruited 451 patients (median age 74 years, 53% females) referred to the Department of Neurology at Aarhus University Hospital, Denmark, for diagnostic assessment of dementia. Enrolment started in March 2020 and ended in July 2025. Patients referred for a lumbar puncture were eligible for inclusion. Cerebrospinal fluid and blood samples (plasma, serum and buffy coat) were stored at -80°C. Information about sociodemographic, educational level, dementia subtype, cognitive test scores, neuroimaging results, hypertension, diabetes, height, weight, alcohol consumption and smoking was collected.</p><p><strong>Findings to date: </strong>The most frequent diagnoses were Alzheimer's disease (n=268, 59%), frontotemporal dementia (n=26, 5.8%) and mixed Alzheimer's and vascular disease (n=23, 5.1%). N=82 (18%) were cognitively unimpaired or had mild cognitive impairment but not dementia. The median Mini-Mental State Examination score was 23 (IQR: 20-26) and the median Addenbrooke's Cognitive Examination score was 68 (IQR: 58-77).</p><p><strong>Future plans: </strong>ODIN will contribute to the development, validation and implementation of new biomarkers related to diagnosis, prognosis and treatment of dementia. Furthermore, the cohort will assist the transition from cerebrospinal fluid to blood-based biomarkers.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e114084"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855997","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":"Risk factors and population attributable fraction for large-for-gestational-age and macrosomic births in low- and middle-income countries between 2000 and 2025: a protocol for systematic review and meta-analysis.","authors":"Fati Kirakoya-Samadoulougou, Hannah Blencowe, Dieudonné Ilboudo, Joyeuse Ukwishaka, Lorena Suarez Idueta, Elizabeth A Hazel, Eric Ohuma, Daniel J Erchick, Joanne Katz, Anne Cc Lee, Robert E Black","doi":"10.1136/bmjopen-2025-110407","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-110407","url":null,"abstract":"<p><strong>Introduction: </strong>Large-for-gestational-age (LGA) and macrosomic births pose significant maternal and neonatal health risks, particularly in low- and middle-income countries (LMICs), where access to care are often limited. Despite well-established associations between LGA, macrosomia, and various risk factors, the relative contributions of these factors remain underexplored in LMICs. This study aims to identify risks factors for LGA and macrosomia in LMICs, with an emphasis on modifiable ones, and quantify their population attributable fractions (PAFs).</p><p><strong>Methods and analysis: </strong>A systematic review will be conducted across the following databases: MEDLINE, Scopus and ProQuest Central and regional databases (Africa Index Medicus, Index Medicus for South Asia and Latin America and Caribbean literature of health sciences). Eligible studies will include observational studies, reviews and interventional research conducted between 2000 and 2025 that report on prevalence or association of risk factors for large-for-gestational-age (LGA) and/or macrosomia births in low- and middle-income countries (LMICs). Data extraction will encompass study characteristics, prevalence/incidence estimates, risk factor distributions and measures of association. Quality assessment will be performed by two independent reviewers using the Newcastle-Ottawa Scale for observational cohort, case-control and cross-sectional studies. While Cochrane Risk of Bias Tool will be used for randomised controlled trials and a Measurement Tool to Assess Quality of Systematic Reviews 2 (AMSTAR-2) for systematic reviews and meta-analyses. Meta-analyses using a random-effects model, which accounts for population heterogeneity, will synthesise risk estimates for factors examined in three or more studies from LMICs, up-to-date meta-analysis including all relevant studies identified through our search. Population attributable fractions for individual and combined risk factors will be calculated.</p><p><strong>Ethics and dissemination: </strong>This systematic review will use only previously published information. Ethical approval is therefore not required. The results will be submitted for publication in a peer-reviewed journal and the findings will be presented at international conferences to engage relevant stakeholders including policymakers and public health organisations in LMICs with the aim of informing the development of targeted interventions to reduce the burden of LGA and macrosomia births in the region.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e110407"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855962","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":"Understanding patient preferences, experiences and engagement with ambulatory heart rhythm monitoring: a scoping review.","authors":"Michael Robert James Bennett, Bill Chaudhry, Gill Norman, Tomos Robinson, Laura Ternent, Louise Coats","doi":"10.1136/bmjopen-2025-110631","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-110631","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature reporting patient preferences for ambulatory heart rhythm monitoring (AHRM) and what factors affect experience and engagement.</p><p><strong>Background: </strong>The prevalence of arrhythmia continues to rise and contributes significantly to outpatient care burden. There is limited understanding of patient experience and compliance with monitoring. As innovative technologies are developed and healthcare strategies move towards surveillance and prevention, understanding this is key.</p><p><strong>Methods: </strong>A scoping review was conducted using guidance from the Joanna Briggs Institute and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review included studies of adults under investigation or surveillance for arrhythmia with a range of devices (Holter monitor, patch device, event recorder, mobile cardiac telemetry, external and implantable loop recorders, wearables and other implantable cardiac devices) in ambulatory care settings worldwide. The final search was conducted on 3 January 2026 across Medline (PubMed), Embase (Ovid), Web of Science (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), PsycINFO (Ovid) and Google Scholar. Quantitative, qualitative, mixed methods, multiple methods and any type of review articles were included.</p><p><strong>Results: </strong>54 studies were eligible for inclusion from the initial search that identified 1320 articles. Two overarching themes emerged from the quantitative and qualitative data: patient factors and device factors affecting experience and engagement. Patient factors included clinical and demographic factors, education and expectations, experience and preferences and impact on daily life and healthcare. Device factors could be common to several devices, for example, skin irritation or device specific, for example, the nature of activation.</p><p><strong>Conclusion: </strong>Patient and device factors influence preferences for and experience and engagement with AHRM. While existing literature is incomplete and heterogeneous, it identifies key considerations that should be integrated into the development and testing of novel approaches for arrhythmia surveillance in healthcare contexts.</p><p><strong>Registration: </strong>https://doi.org/10.17605/OSF.IO/6K3W8 (Open Science Framework).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e110631"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855957","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":"An Open Pharma Vision for company-sponsored biomedical research publications.","authors":"Joana Osório, Slávka Baróniková, Sally-Anne Dews, Santosh Mysore, Kalliopi Patrikis, Valérie Philippon, Christopher P Rains, Anja Schmidt, Catherine Skobe, Christopher C Winchester","doi":"10.1136/bmjopen-2025-104128","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-104128","url":null,"abstract":"<p><p>Open Science aims to fight misinformation and improve trust in scientific research; it encourages the reliability and accessibility of evidence, reduces inequalities through the democratisation of scientific knowledge and focuses scientific endeavours on issues of societal significance. As a multisponsor collaboration committed to driving positive change, Open Pharma has a multifaceted vision for scientific research publications funded by pharmaceutical companies ('company research publications') that aligns strongly with Open Science tenets. This new vision statement outlines our forward-looking principles for company research publications, both for short-term attainment ('immediate') and long-term commitment ('ultimate'). Together, the principles provide a framework for positive collective action by all stakeholders involved in the development and dissemination of peer-reviewed company research publications. Underpinned by our central commitment to transparency for company research publications, we outline goals for: universal access to these publications; provision of peer-reviewed plain language summaries of the publications to aid comprehension among non-specialist readers; leveraging author and institutional metadata to advance transparency, discoverability and research impact; working towards FAIR (Findability, Accessibility, Interoperability, and Reuse) data principles through cross-sector consensus and action, and disclosure of patient involvement in research and its reporting to support transparency and encourage a research ecosystem attuned to patient centricity. We call on all stakeholders to realise the Open Pharma Vision and achieve an open and trusted future for company research publications that will ultimately advance patient care and improve global health.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e104128"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855842","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":"Mapping same day, urgent and emergency care services across the UK: a mixed methods study protocol.","authors":"","doi":"10.1136/bmjopen-2025-111403","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-111403","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;In the UK, a range of services provide same day, urgent and emergency care (UEC). Urgent medical needs can be addressed through pharmacy services, same day general practice (GP) appointments, phone or online triage services, out-of-hours GP appointments and urgent treatment centres (or equivalents). For emergency medical needs, patients can access emergency departments (EDs) and ambulance services. These services are highly vulnerable to excessive strain due to rising, unpredictable demand and limitations in patient flow across the system. The workforce operates in time-critical situations, often with limited resources, which can lead to staff burnout, low job satisfaction and retention and poor health. The organisation of services and their workforce continues to evolve in response to local and national pressures and varies considerably across the UK, where there are four distinct, publicly funded healthcare systems managed separately in each country. This makes it difficult to describe and compare services within and across regions and understand the impact of workforce organisation on service delivery, staff well-being and patient care. This study aims to develop a comprehensive understanding of the range and types of UK UEC services, the relative experiences of the workforce and the available workforce data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;This mixed-methods study includes two components, integrated through an explanatory sequential design. Study 1 will use data on NHS service availability and direct enquiry to map UEC services and populate a structured database, which will facilitate the generation of a UEC typology of the range and types of services and regional variation across the UK. Multiple case studies will be conducted in a subset of services using qualitative interviews (n=136-220) with service leaders (n=3-5), workforce (n=10-12), and patients or carers (n=4-5), as well as document analysis where relevant, in each service of interest (n=8-10). Study 2 will create a metadata catalogue of workforce data and produce descriptive summaries of key metrics (eg, staffing levels and skill mix). The study will be supported by our Community Inclusion and Engagement (CIE) panel and Patient and Public Advisory Group (PPAG) to ensure relevance, inclusivity and impact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;This study received ethical approval from Yorkshire and The Humber - Sheffield Research Ethics Committee (04/08/2025, IRAS ID: 357276, REC Reference: 25/YH/0125) and HRA and Health and Care Research Wales approval (12/08/2025). Data collection poses minimal risk, informed consent will be obtained, and participants may withdraw at any time. Dissemination will follow knowledge mobilisation principles to maximise impact. We will build on our existing networks and work with our CIE panel and PPAG to tailor study outputs to different audiences. The outputs will improve understanding of the va","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e111403"},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855865","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":"Environmental impact of total hip replacements: a life cycle assessment study.","authors":"Anna Roe Rasmussen, Stig Brorson, Katarzyna Dudka, Michael Zwicky Hauschild","doi":"10.1136/bmjopen-2025-109563","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-109563","url":null,"abstract":"<p><strong>Objectives: </strong>Healthcare contributes considerably to greenhouse gas emissions, particularly from operating theatres. The global demand for total hip replacements (THR) is rising, highlighting the need to understand its impact on the environment. The study aims to assess the environmental impact of THRs using life cycle assessment (LCA) and to identify key contributors.</p><p><strong>Design: </strong>A process-based LCA focusing on the surgical procedure was conducted in accordance with global standards (ISO 14040:2006 and ISO 14044:2006). Eleven sensitivity scenarios were performed to assess the robustness of the results.</p><p><strong>Setting: </strong>A Danish University Hospital.</p><p><strong>Participants: </strong>The empirical data involved the quantity and type of surgical equipment, material composition, energy usage and clinical infrastructure. There were no study participants.</p><p><strong>Interventions: </strong>No study interventions were performed.</p><p><strong>Primary and secondary outcome measures: </strong>18 environmental impact scores, such as global warming, human toxicity and water consumption, were assessed.</p><p><strong>Results: </strong>The carbon footprint of a THR was 62.0 kg CO₂e, with major contributors being single-use disposable utensils (54 %), implants (22 %), and sterilisation of non-disposable utensils (18 %). Operating theatre energy usage, non-disposable utensils and clinical infrastructure contributed less, at 3 %, 2 % and 1 % each. Although the results of the other 17 environmental impact scores varied, they were predominantly influenced by the same factors as the carbon footprint. The sensitivity analysis showed that the overall carbon footprint varied by no more than 6 % unless the energy system shifted to less renewable energy, potentially increasing the footprint by 47 %.</p><p><strong>Conclusion: </strong>THRs impose a substantial environmental burden, and sustainable solutions should focus on the primary drivers of this impact: disposable utensils, implants and the sterilisation process. In contrast, clinical infrastructure and non-disposable utensils appear to have a relatively minimal environmental impact.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e109563"},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833555","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":"Prospective multi-phase observational study evaluating local field potentials to guide deep brain stimulation programming in dystonia at a UK Tertiary Neurosciences Centre (LFP-DYT): a protocol.","authors":"David Ledingham, Russell Mills, Michelle Gibbs, Madeleine Maynes, Anubhab Pal, Robyn Iredale, Victoria Foster, Stephanie Ong, Sahana Sathyanarayana, Alistair Jenkins, Claire Nicholson, Mohammed Hussain, Mark R Baker, Nicola Pavese","doi":"10.1136/bmjopen-2026-117391","DOIUrl":"https://doi.org/10.1136/bmjopen-2026-117391","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) for dystonia is effective but programming optimisation can take months. Local field potentials (LFPs) recorded by the Medtronic Percept device may provide biomarkers to guide stimulation. This study will prospectively evaluate whether chronic LFP profiles correlate with clinical outcomes and can inform DBS programming strategies.</p><p><strong>Methods and analysis: </strong>LFP-DYT is a single-centre, multi-phase observational study at Newcastle upon Tyne National Health Service (NHS) Foundation Trust. An internal pilot (Cohort 1) will refine recording workflows, followed by Cohort 2 (traditional programming with LFP recordings) and Cohort 3 (LFP-informed programming). 20-25 adults with primary dystonia undergoing globus pallidus internus DBS will be recruited. The study combines chronic LFP sensing with neurophysiology (electromyography, electroencephalography), motor inhibition testing (stop-signal reaction time), patient-reported outcomes and wearable sensor monitoring (STAT-ON) to provide a comprehensive multi-modal assessment framework.</p><p><strong>Primary outcome: </strong>reproducibility of alpha-theta frequency LFP peaks and concordance with optimal stimulation site. Secondary outcomes include stimulation and medication effects on LFP profiles, clinical improvement (Toronto Western Spasmodic Torticollis Rating Scale-2 (TWSTRS-2), Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS)) and beta-band activity as a marker of stimulation-related bradykinesia. Analyses will be descriptive and exploratory. Feasibility outcomes, including recruitment rates, retention and data completeness, will inform design and power calculations for future multi-centre trials.</p><p><strong>Ethics and dissemination: </strong>The study has NHS Research Ethics Committee approval from the East Midlands-Derby Research Ethics Committee (REC reference: 24/EM/0246; IRAS ID: 337426). All participants will provide informed consent. Data will be pseudonymised and stored on secure NHS servers. Results will be disseminated via peer-reviewed publications, conferences and participant summaries. De-identified data and analysis code will be available on reasonable request.</p><p><strong>Trial registration number: </strong>NCT07309133.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 5","pages":"e117391"},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833647","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}