BMJ Open最新文献

{"title":"EARLYBIRD: catching the earliest changes of the bone and intervertebral discs in children at increased risk for scoliosis development with MRI - study protocol of a prospective observational cohort study.","authors":"Peter P G Lafranca, Hilde W Stempels, Steven de Reuver, Michiel L Houben, Joeri Kok, Moyo C Kruyt, René M Castelein, Peter R Seevinck, Tijl van der Velden, Yulia M Shcherbakova, Keita Ito, Tom P C Schlösser","doi":"10.1136/bmjopen-2025-098929","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-098929","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent idiopathic scoliosis (AIS) is an acquired deformity that develops in 2-4% of otherwise healthy children during adolescent growth, substantially reducing their quality of life and creating a life-long burden of disease. Despite many years of dedicated research, the cause and mechanism of AIS are still unknown and no effective curative treatments are available for children suffering from this spinal and chest deformity. To date, all etiological studies focused on children with an already established scoliosis. EARLYBIRD aims to uncover the earliest pathoanatomical changes in AIS, by studying longitudinal spinal growth in children at increased risk for scoliosis development with MRI, starting before adolescence.</p><p><strong>Methods and analysis: </strong>This prospective observational cohort study will follow two groups: 60 adolescent girls (8-10 years old) who have an older sibling or parent diagnosed with AIS (cohort 1) and 60 adolescents with 22q11.2 deletion syndrome, a genetic microdeletion associated with 50% scoliosis prevalence (cohort 2). Data collection will be completely radiation-free and occur at baseline and yearly during adolescence up to 15 years of age in girls and up to 16 in boys. A comprehensive physical examination, a dedicated spine and chest MRI as well as a standing three-dimensional (3-D) spinal ultrasound will be obtained at each time point. The main parameter will be the longitudinal changes in segmental axial rotation during growth in subjects that do and do not develop AIS. Secondary endpoints are longitudinal changes in 3-D morphology of the bone and intervertebral discs (IVDs) during normal spinal development and during scoliosis development, determining biomarkers for bone growth, implementing radiation-free imaging methods for spinal monitoring in adolescent patients at risk for scoliosis development and use these for spinal skeletal maturity and patient-specific spinal biomechanical analyses.</p><p><strong>Ethics and dissemination: </strong>This protocol has been approved by the Medical Ethics Committee NedMed and is registered on clinicaltrials.gov (NCT05924347). Written informed consent will be obtained from all parents/legal representatives. Key findings will be disseminated via peer-reviewed journals and presentation at conferences. This study is funded by the European Research Council.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e098929"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511448","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":"Caregivers' challenges in engaging with the health system to optimise medication management of older care recipients: a qualitative study including home visits.","authors":"Annika Kiiski, Elisa Luoma, Marja Airaksinen, Marika Pohjanoksa-Mäntylä, Shane Desselle, Sirkka-Liisa Kivelä","doi":"10.1136/bmjopen-2024-093122","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093122","url":null,"abstract":"<p><strong>Objectives: </strong>Medication management is a demanding task for family caregivers of older adults, adding to their care burden. The aim was to identify the challenges family caregivers experience in managing medications of older care recipients to obtain caregiver-centred evidence for developing social and health services to meet their needs.</p><p><strong>Design: </strong>The qualitative data were collected during two consecutive home visits using thematic interviews with a narrative approach during the period of October 2017 to September 2018. The interview data were qualitatively analysed using the framework method with a combination of the inductive and deductive approaches. Human error theory with systems approach and prospective risk management was used as a theoretical framework.</p><p><strong>Setting: </strong>Family caregiving of older adults.</p><p><strong>Participants: </strong>21 officially contracted family caregivers and their older (≥65 years) care recipients using >1 prescription medicine from the capital region of Finland.</p><p><strong>Results: </strong>Three conceptual models were constructed: (1) to position family caregiving in the public social and healthcare system, (2) to identify challenges and (3) needs for development in medication management prioritised from challenges. Family caregivers were not well integrated as a part of the health system, but left alone to manage the care recipient's medications. When urgent treatment-related matters arose, caregivers were not able to reach the physician. The major development needs concerned (1) identification of the caregivers as family caregivers in healthcare and community pharmacies, (2) making familiar healthcare professionals accessible, (3) ensuring sufficient customised support for managing medications at home (up-to-date medication list, monitoring and medicines information), (4) more active involvement and communication in the care process and (5) adopting compatible electronic health records between primary and secondary care, and pharmacies and social services.</p><p><strong>Conclusions: </strong>Family caregiving practices and support services should be developed in cooperation with the caregivers to meet their needs and place the families at the centre of the medication use process. Strengthening the integration of family caregiving to the social and healthcare system is vital, for example, by making easy access to family physician and involving pharmacists more actively in supporting medication management.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e093122"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511534","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":"How did staffing strategies change amid COVID-19 and post pandemic? A qualitative study.","authors":"Lianne Jeffs, Jacqueline Limoges, Tracey Das Gupta, Lisa Di Prospero, Alexandra Harris, Jane Merkley, Benjamin Rosen, Morgann Reid, Megha Rao, Agnes Black, Rui Lin Zeng, Linda McGillis Hall","doi":"10.1136/bmjopen-2024-091922","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091922","url":null,"abstract":"<p><strong>Objectives and design: </strong>A qualitative study was undertaken to explore the nature of staffing strategies from the perspectives of nursing, medicine and health disciplines employed in a hospital setting.</p><p><strong>Setting: </strong>Interviews were conducted in six hospitals in Canada between November 2022 and September 2023.</p><p><strong>Results: </strong>118 healthcare professionals and leaders who experience<b>d</b> changes in staffing strategies participated in this study. Three themes emerged to describe new or adaptive staffing strategies: (1) valuing new roles and teams; (2) being redeployed; and (3) enhancing coverage.</p><p><strong>Conclusions: </strong>Our study elucidates the staffing strategies that were employed during the COVID-19 pandemic that included creating new and adapting existing roles and teams; redeploying healthcare professionals; and enhancing coverage. Study findings can be used to guide leaders to use a proactive systematic approach to staffing models that includes adaptable and flexible staffing models within local contexts.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e091922"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511544","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":"Outcomes of patient and public involvement in the development of the Cognitive Decline after Brain Radiosurgery (CoDe B-Rad) study: refining the research question and methodology.","authors":"Anna Bangiri, Adele Horobin, Julia Baker, Stefan Pszczolkowski, Stefanie Thust, Paul S Morgan","doi":"10.1136/bmjopen-2024-094788","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-094788","url":null,"abstract":"<p><strong>Objectives: </strong>Patient and public involvement (PPI) was sought in the development of the protocol for the Cognitive Decline after Brain Radiosurgery (CoDe B-Rad) study, which aims to identify potential side effects of stereotactic radiosurgery (SRS). PPI served to refine the research question and methodology.</p><p><strong>Design: </strong>PPI.</p><p><strong>Setting: </strong>PPI conducted online with people based in the UK. The CoDe B-Rad study is running in regional National Health Service tertiary care in the UK and is currently nearing recruitment completion.</p><p><strong>Participants: </strong>Patients and carers with lived experiences of brain radiotherapy. Contributors were identified through national charities.</p><p><strong>Procedures: </strong>Initial focus groups were planned, but participation proved challenging. Instead, online questionnaires, one-to-one discussions and participation in support groups were completed.</p><p><strong>Results: </strong>All contributors experienced changes to their cognition and/or quality of life (QoL) after radiotherapy. Quantifying the side effects of SRS and minimising them were identified as a research gap. Discussion group participation proved challenging. PPI plans were altered to accommodate the physical and mental needs of contributors. It was decided to combine the Montreal Cognitive Assessment along with European Organisation for Research and Treatment in Cancer QLQ-C30 and BN20 to capture cognitive status and QoL of patients with brain metastases and meningiomas after SRS. Patients/carers recommended for sessions to be restricted to 30 min and testing to be offered face-to-face, online, in hospital or at patients' homes. Coproduction was not achievable with our patient population but that did not diminish the input of contributors nor the impact it had on designing the study protocol.</p><p><strong>Conclusions: </strong>In cancer research, diligent considerations are required to ensure the suitability of involvement methods for this vulnerable population. Flexibility and adaptability of draft PPI plans are essential to achieve meaningful contributions. The protocol of the ongoing CoDe B-Rad study was positively shaped by people with lived experiences of brain radiotherapy.</p><p><strong>Trial registration number: </strong>NCT06466720 (CoDe B-Rad study).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094788"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511550","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":"Selective neoadjuvant therapy of rectal cancer patients (SELREC): study protocol for a European randomised controlled, open, multicentre non-inferiority trial.","authors":"Rosa Klotz, Cosima Engerer, Solveig Tenckhoff, Kristin Uzun-Lang, Constantin Schwab, Caroline Wild, Anja Sander, Lukas Baumann, Christina Klose, Hans-Ulrich Kauczor, Peter Schirmacher, Dirk Jäger, Jürgen Debus, Mohammed Al-Saeedi, Pascal Probst, Alexis Ulrich, Martin Schneider, Markus K Diener, Christoph Kahlert, Christoph W Michalski, Bruno C Köhler, Markus W Büchler","doi":"10.1136/bmjopen-2024-092807","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092807","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Neoadjuvant (chemo)radiotherapy (n(C)RT) followed by resection with total mesorectal excision (TME) constitutes the standard treatment for patients with locally advanced rectal cancer of the middle and lower third. However, n(C)RT has demonstrated no significant impact on overall survival but is associated with adverse effects, including impaired sphincter and sexual function. We hypothesise that omitting n(C)RT in selected patients with a clear circumferential resection margin (CRM) &gt;1 mm as determined through preoperative MRI is not inferior regarding local recurrence rate within 3 years after surgery. That treatment approach may show fewer adverse effects and be more cost-effective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;Selective neoadjuvant therapy of rectal cancer patients (SELREC) is a randomised controlled, parallel-group, open, multicentre, non-inferiority trial. The experimental intervention involves performing TME surgery without n(C)RT. In contrast, the control intervention adheres to German S3-guidelines, incorporating neoadjuvant radiotherapy (nRT) with a dosage of 5×5 Gy or a total of 50.4 Gy. Additionally, if applicable, concomitant chemotherapy (CT) based on 5-fluorouracil is administered, followed by TME surgery within less than 12 weeks. Adjuvant treatment according to guidelines is allowed depending on the (y)pTNM stage.The inclusion criteria for this study encompass adult patients with primary adenocarcinoma of the rectum in whom the main tumour mass is located less than 12 cm away from the anal verge, as assessed via proctoscopy. Additionally, eligible participants are required to have a preoperative tumour stage determined by MRI of either T1 or T2 with lymph node involvement (N1) or T3 with no lymph node involvement (N0) or with lymph node involvement (N1) and no distant metastases (M0). The assessment of a clear CRM &gt;1 mm, based on MRI, is another prerequisite for inclusion. A total of 1074 patients in approximately 35 centres are planned to be allocated to the trial.The primary endpoint of the trial is local recurrence within 3 years after surgery. The primary estimand is based on the full analysis set using a logistic mixed model (margin 3%). The first secondary endpoint is no/minor low anterior resection syndrome (LARS) score at 2 years after surgery, and further secondary endpoints include survival outcomes and quality of life. Safety analysis involves describing the frequencies of major intervention-specific complications, such as the acute toxicity of n(C)RT according to CTCAE and perioperative morbidity and mortality according to Clavien-Dindo criteria.SELREC is financially supported by the German Federal Ministry of Education and Research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;This trial has been prospectively registered in the German Clinical Trials Register.Previously, the study had been approved by the responsible ethics committee of Heidelberg and the local et","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e092807"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511559","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":"Synthesis of interventions using an interRAI tool to guide care management and assess intervention efficacy in older adults: protocol for a scoping review.","authors":"Nick W Bray, Ilona Barańska, Emmanuel Bagaragaza, George Heckman, Johanna De Almeida Mello, Nazanin Nasiri, Katarzyna Szczerbińska, Caitlin McArthur","doi":"10.1136/bmjopen-2024-097763","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-097763","url":null,"abstract":"<p><strong>Introduction: </strong>interRAI is a global collaboration of clinicians, researchers and policy-makers who have developed a suite of assessment tools to assess the health status and care needs of older adults in various settings (ie, home, long-term care, etc). We aim to determine how interRAI tools have been used as an intervention and to evaluate intervention efficacy in older adults (65+) across diverse healthcare settings. Importantly, given the deployment of interRAI primarily in high-income countries, we anticipate that the findings may have minimal relevance to low- and middle-income nations, where there is an immediate and urgent need for equity in geriatric assessment.</p><p><strong>Methods and analysis: </strong>To be included, all studies must satisfy our inclusion criteria, outlined by the population (ie, older adults and/or individuals providing some element of care to older adults), intervention (ie, randomised or non-randomised), comparator (ie, with or without one) and outcome (ie, how the interRAI formed the basis of a study intervention). Our search strategy is based on previous reviews of interRAI tools, our research and clinical experience, and the expertise of a specialised librarian. In addition to PubMed, we will conduct our search without date or language restrictions in Scopus, Embase,Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and PsycInfo. Study screening will employ a team-based approach, with Kappa statistics >0.8 indicating 'substantial' agreement and an acceptable threshold. Data extraction will capture the study ID and design, as well as sample characteristics and outcomes. Reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, with findings presented graphically and narratively.</p><p><strong>Ethics and dissemination: </strong>Ethics approval is not required. Our knowledge dissemination strategies include traditional research avenues (ie, manuscript publications). We will also create an infographic to disperse widely and leverage existing partnerships to provide community presentations.</p><p><strong>Registration details: </strong>https://doi.org/10.17605/OSF.IO/BGJKP.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097763"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511561","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":"Striving to integrate self-management into daily life: a qualitative meta-synthesis of the perspectives and experiences from head and neck cancer survivors.","authors":"Jianxia Lyu, Li Yin, Hao Zhang, Linyu Xu, Qing Yang, Aiping Wang","doi":"10.1136/bmjopen-2024-094440","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-094440","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Head and neck cancer (HNC) represents a prevalent category of malignant tumours, with disease-associated and treatment-associated symptoms often resulting in significant complications that adversely impact patient quality of life. Effective self-management during treatment and rehabilitation is crucial for mitigating or delaying the onset of these symptoms. While existing studies have investigated various aspects of self-management, including its content, influencing factors and specific strategies for managing symptom burden in HNC survivors, no comprehensive study of the self-management experience in this patient population has hitherto been conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to systematically synthesise evidence on the content, experiences, barriers and facilitators of self-management among patients with HNC, with the ultimate goal of informing tailored self-management interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A systematic review of qualitative studies was conducted using a meta-aggregation approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A three-step search strategy was implemented to systematically review eight databases, including PubMed, Web of Science, CINAHL and Embase, from inception to June 2024. This review concentrated on studies examining the content of self-management for patients with HNC during treatment and rehabilitation, identifying both facilitators and barriers and delineating empirical self-management strategies. Two researchers independently screened the literature and performed quality assessments using the Joanna Briggs Institute qualitative research evaluation tool. Subsequently, data extraction was conducted to collect pertinent information. This qualitative systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3263 studies were identified, of which 15 met the inclusion criteria and were subsequently incorporated into the meta-synthesis. This integration revealed 3 primary themes and 10 subthemes, specifically: (1) the management of disease-related and treatment-related symptoms and functional alterations in HNC, exploring self-management strategies such as coping with and monitoring physical and mental symptoms and adjusting to modifications in fundamental operations; (2) barriers and facilitators in the integration process of self-management, including psychological, emotional and cognitive disorders, the impact of symptom burden on patients' motivation and capacity for self-management, structural impediments and facilitators; and (3) challenges in incorporating self-management into daily life and strategies for effective implementation, encompassing acceptance and adaptation as strategies for coping and thriving, proactive issue resolution, self-motivation and the employment ","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094440"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511560","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":"Wearable sensing in eating episode monitoring: an updated systematic review protocol.","authors":"Jiaying Zhou, Mingzhu Cai, Mayue Shi","doi":"10.1136/bmjopen-2024-092175","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092175","url":null,"abstract":"<p><strong>Introduction: </strong>Objective and accurate dietary monitoring is critical for comprehensive dietary assessment and improving nutritional health outcomes. The rapid advancement of wearable sensing technology presents a promising solution for effective dietary monitoring by reducing recall bias and enhancing user convenience, with potential benefits for both clinical chronic disease management and nutritional research. This systematic review aims to evaluate the effectiveness and feasibility of wearable sensors in monitoring dietary behaviours, while also examining the latest advancements in the field since 2020.</p><p><strong>Methods and analysis: </strong>This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines for systematic review reporting. We will conduct a comprehensive search across MEDLINE, EMBASE, PubMed, IEEE Xplore and Web of Science to identify studies published between January 2020 and March 2025 involving human participants using wearable sensors for dietary intake monitoring. Studies that focus solely on the development of algorithms or applications for these sensors will be excluded. The outcomes of this review will include evaluations of sensor design, performance metrics and user experience.</p><p><strong>Ethics and dissemination: </strong>Findings of this systematic review will be disseminated through peer-reviewed journals, conferences and seminar presentations. The data used do not include individual patient data, so no ethical approval is required.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e092175"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511564","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":"Advancing health equity and the role of digital health technologies: a scoping review.","authors":"Laura Bitomsky, Estelle Pfitzer, Marcia Nißen, Tobias Kowatsch","doi":"10.1136/bmjopen-2025-099306","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-099306","url":null,"abstract":"<p><strong>Background: </strong>Health disparities persist, posing significant health, social and economic challenges. Digital health technologies (DHTs) present a promising opportunity to address these inequities and advance health equity. Despite this potential, a comprehensive and structured overview of existing frameworks and guidelines on advancing health equity and a clear understanding of the potential of DHTs in their implementation to systematically close the healthcare gap is yet to be done.</p><p><strong>Objective: </strong>To this end, our objectives are twofold: first, to identify frameworks and guidelines that promote health equity and second, to pinpoint the role of DHTs as an avenue for their implementation. We conducted a scoping review informed by Arksey and O'Malley's five-stage framework, methodological guidelines by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.</p><p><strong>Sources of evidence: </strong>A comprehensive search was conducted across seven databases on 6 December 2023: PubMed, EMBASE, Cochrane, PsycINFO, Scopus, Web of Science and WISO.</p><p><strong>Eligibility criteria: </strong>We included primary and secondary studies published in English between 2010 and 2023 focusing on advancing health equity for priority populations.</p><p><strong>Charting methods: </strong>For the analysis, we applied multistaged coding approaches to answer our twofold objective.</p><p><strong>Results: </strong>The search identified 6419 studies, of which 38 met our final inclusion criteria and were included in this review. We extracted 559 recommendations on advancing health equity and synthesised these into 82 distinct recommendations across five levels of initiative and 19 areas of initiative. Thereby, 24% of the included studies explicitly mentioned the use of (digital) technology with 10 impact opportunities on advancing health equity.</p><p><strong>Conclusion: </strong>Our synthesis offers key insights into the advancement of health equity across different levels of initiative and the role of DHTs in their implementation. This offers practitioners and researchers alike a comprehensive overview to make health equity advancement more tangible and actionable.</p><p><strong>Registration details: </strong>https://osf.io/94pht.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099306"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511532","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 acupuncture on endometrial receptivity in women with thin endometrium: study protocol for a single-centre, randomised, sham-controlled trial.","authors":"Xiaoyan Wang, Yigong Fang, Huanfang Xu, Li Yang, Tian Hang, Jiashan Li, Pengfei Du, Chenchen Su, Xin Liu, Weixin Li, Yaoyao Zhu","doi":"10.1136/bmjopen-2024-093683","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093683","url":null,"abstract":"<p><strong>Introduction: </strong>Thin endometrium poses a major therapeutic challenge in assisted reproductive technologies by compromising pregnancy success and live birth outcomes. A substantial proportion of patients remain refractory to existing therapies. Preliminary evidence suggests acupuncture may improve endometrial thickness (EMT). This study aims to assess the effect of acupuncture against sham acupuncture for women with thin endometrium.</p><p><strong>Methods and analysis: </strong>This study is a single-centre, randomised, sham-controlled trial conducted at a specialised acupuncture hospital in Beijing, China. A total of 120 women with thin endometrium will be randomised (1:1) to receive 36 sessions of acupuncture or sham acupuncture over 12 weeks. The primary outcome is the EMT at week 12. Secondary outcomes are endometrial pattern, uterine arterial blood flow parameters (Pulsatility Index, Resistance Index and the ratio of peak systolic to end-diastolic blood flow velocities), endometrium blood flow, serum oestradiol concentration, clinical pregnancy rate and Self-Rating Anxiety Scale Scores.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the ethics committee of the Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (approval no.: S2024-04-23-1). Each participant will be required to provide written informed consent before enrolment. Findings will be disseminated through peer-reviewed publications and conference presentations.</p><p><strong>Trial registration number: </strong>ITMCTR2024000053.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e093683"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511449","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}