BMJ Open最新文献

{"title":"Impact of race, sex and age on the probability of pancreatic cancer among patients with newly diagnosed diabetes in a claims-based cohort.","authors":"Elham Afghani, Bryan Lau, Laura K Becker, Michael Goggins, Alison P Klein","doi":"10.1136/bmjopen-2025-099488","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-099488","url":null,"abstract":"<p><strong>Objective: </strong>Pancreatic cancer diagnoses are frequently preceded by a new diabetes diagnosis. Screening individuals newly diagnosed with diabetes could enable the earlier detection of pancreatic cancer. We sought to estimate the risk of pancreatic cancer by age, sex, race and time since diabetes diagnosis.</p><p><strong>Design: </strong>Claims-based cohort study.</p><p><strong>Setting: </strong>Johns Hopkins Medicine conducted this deidentified claims-based cohort study using the Optum Labs Data Warehouse.</p><p><strong>Participants: </strong>Insurance enrollees from 1/2008-9/2018 were identified as non-diabetic or newly diagnosed diabetic. Our risk set included 4 732 313 individuals (424 129 newly diabetic) in 5 844 934 enrolment periods.</p><p><strong>Primary outcome measures: </strong>Time to pancreatic cancer. Diabetes and cancer were defined using <i>International Classification of Diseases</i> (ICD)-9/10 codes.</p><p><strong>Results: </strong>Individuals with newly diagnosed diabetes were at an increased HR of pancreatic cancer, but this effect waned over time. The HR of pancreatic cancer following a diabetes diagnosis was higher in younger individuals and varied by race (lower HR in non-White individuals) (p<0.01, main effects and interactions). Thus, the probability of pancreatic cancer following a diabetes diagnosis was dependent on age, race and sex. For example, the 1-year probability of pancreatic cancer in a White male aged 75 was 0.45% (95%CI 0.41% to 0.49%) if they were newly diagnosed with diabetes and 0.090% (95%CI 0.084% to 0.096%) if they were free of diabetes. In contrast, the risk was lower at 0.15% (new-diabetic, 95% CI 0.13% to 0.16%) and 0.022% (diabetes free, 95%CI 0.020% to 0.023%) at age 55. The HR of pancreatic cancer for individuals with newly diagnosed diabetes compared with those free of diabetes was highest in the month following diagnosis (HR=14.7 and 9.6 for a 55 and 75 year old White male, respectively) but decreased in the following months, with a HR of 7.8 and 5.8 at 3 months, 5.6 and 4.1 at 6 months, and 3.9 and 2.8 at 1 year (p<0.01).</p><p><strong>Conclusions: </strong>Consideration of the age-race-sex specific probability of pancreatic cancer and time since diabetes diagnosis is necessary when evaluating the risk of pancreatic cancer following a diabetes diagnosis.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e099488"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156919","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":"Analgesic effects of intrathecal bupivacaine with neostigmine or morphine among elective surgical patients in selected comprehensive specialised hospitals, Southern Ethiopia: a prospective cohort study.","authors":"Nesredin Shemsu Delmolo, Temesgen Sidamo, Ashagrie Sintayehu, Selman Reshad, Abdulkadir Kedir, Mebratu Kebede, Mebratu Tila, Sintayehu Samuel, Rashed Edris Usure, Nuredin Chura Waritu, Mohammed Jemal, Getahun Dendir","doi":"10.1136/bmjopen-2024-093193","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093193","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the analgesic effects of intrathecal neostigmine with bupivacaine, morphine with bupivacaine and bupivacaine alone among patients undergoing surgical procedures below the umbilicus.</p><p><strong>Design and setting: </strong>A multicentre prospective cohort study was conducted from 29 May to 29 August 2023 at Wolaita Sodo University Comprehensive Specialized Hospital, Nigest Mohammed Eleni Memorial Comprehensive Specialized Hospital and Werabe Comprehensive Specialized Hospital. A systematic random sampling technique was used to select the participants from the sample of 180.</p><p><strong>Participants: </strong>The study included American Society of Anesthesiologists classes I and II patients aged 18-85 years scheduled for elective surgeries under spinal anaesthesia with bupivacaine with neostigmine (50 µg), bupivacaine with morphine (100 µg) and bupivacaine alone at a dose of 17.5 mg.</p><p><strong>The primary outcome measures: </strong>The duration of pain relief, the severity of pain and the time of first analgesic requirement.</p><p><strong>The secondary outcome measures: </strong>Postoperative complications such as respiratory depression, pruritus, nausea and vomiting RESULTS: Administration of intrathecal bupivacaine with neostigmine group (NG) and morphine group (MG), respectively, produces a long duration of postoperative analgesia with a first analgesia request mean time of 9.4±3.18 and 9.65±4.9, while using bupivacaine group (BG) alone produces a shorter duration of postoperative analgesia with a mean first analgesia request time of 3.58±0.98 hours. The mean visual analog scale scores in 28 hours were 0.99, 0.79 and 2.05 for the NG, MG and BG, respectively. The overall postoperative pain severity was highest in the BG. The mean total analgesic consumption was 77.5, 73.8 and 189.2 mg for diclofenac, whereas 54.2, 63.9 and 151.7 mg for tramadol in the NG, MG and BG, respectively. Incidence of nausea (31.3%) and vomiting (30%) was highest in the NG, while pruritus (15%) and respiratory depression (15%) were more in the MG.</p><p><strong>Conclusion: </strong>Compared with BG, MG and NG had longer-lasting postoperative analgesic effects, less severe pain and required fewer analgesics overall. Patients in the NG had more incidences of nausea and vomiting. The incidences of pruritus and respiratory depression were highest in the MG. Effective analgesia appeared to work better in the MG and NG. We recommend morphine and neostigmine as adjuvants to local anaesthetics for effective postoperative analgesia. We also recommend researchers compare different doses of neostigmine and morphine as adjuvants to bupivacaine in further studies.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093193"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156967","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":"Development of risk prediction equations for 5-year diabetes incidence using Japanese health check-up data: a retrospective cohort study.","authors":"Shin Kawasoe, Takuro Kubozono, Satoko Ojima, Satoshi Yamaguchi, Koji Higuchi, Hironori Miyahara, Koichi Tokushige, Masaaki Miyata, Mitsuru Ohishi","doi":"10.1136/bmjopen-2024-097005","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-097005","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to develop risk prediction equations for the 5-year incidence of diabetes among the Japanese population using health check-up data. We hypothesised that demographic and laboratory data from health check-ups could predict diabetes onset with high accuracy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Data from a health examination in Japan between 2008 and 2016.</p><p><strong>Participants: </strong>Data were analysed from 31 084 participants aged 30-69 years. The presence of baseline diabetes and endocrine disease was included in the exclusion criteria, as were participants with missing data for the analysis. The study population was randomly divided into derivation and validation cohorts in a 1:1 ratio.</p><p><strong>Primary outcome measures: </strong>The primary outcome was the incidence of diabetes at the 5-year follow-up, defined as a fasting blood glucose level ≥126 mg/dL, glycosylated haemoglobin A1c (National Glycohemoglobin Standardization Program (NGSP)) ≥6.5%, or initiation of diabetes treatment. Predictor variables included age, sex, body mass index, blood pressure, underlying diseases, lifestyle factors and laboratory measurements. The primary measure was the area under the receiver operating characteristic curve (AUC) for the predictive equations.</p><p><strong>Results: </strong>In the derivation cohort, diabetes incidence was 5.0%. The prediction equation incorporating age, sex, body mass index, fasting blood glucose and glycosylated haemoglobin A1c showed good discriminatory ability with an AUC of 0.89, sensitivity of 0.81 and specificity of 0.81 in the validation cohort.</p><p><strong>Conclusions: </strong>The equation with laboratory measures effectively predicted the 5-year diabetes risk in the general Japanese population. It has potential clinical utility for identifying individuals at high risk of diabetes and guiding preventive interventions.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e097005"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156973","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":"Online child sexual abuse: a convergent parallel mixed-method exploration among Bangladeshi youth.","authors":"Marium Salwa, Md Redwanul Islam, Mohammad Ibrahim Ibne Towhid, Anika Tasnim, Md Maruf Haque Khan, M Atiqul Haque","doi":"10.1136/bmjopen-2024-091042","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091042","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore the experience of online sexual abuse among school-going Bangladeshi youth.</p><p><strong>Design: </strong>A convergent parallel mixed-method study. The quantitative strand employed a self-administered questionnaire survey conducted in classroom settings, while the qualitative strand used in-depth interviews guided by semistructured protocols. Data from both strands were analysed separately and then merged.</p><p><strong>Participants and settings: </strong>Grade 9-10 students from four randomly selected schools in both an urban and a rural area of Bangladesh participated in the study. A total of 456 students participated in the quantitative survey, and 16 were subsequently interviewed for qualitative data.</p><p><strong>Outcome measures: </strong>The frequency of online sexual abuse along with its contributing factors and patterns, including victim's characteristics, perpetrator's identity, potential avenue of abuse, knowledge and psychosocial consequences.</p><p><strong>Results: </strong>About 88% of the participants reported using the Internet, and nearly 53% reported being victims of online sexual abuse at some point in their lives. The occurrence of common sexual abuses included online grooming (53%), cyberflashing (38%), sexting (35%), sexual solicitation (18%) and sextortion (12%) among Internet users. The odds of being sexually abused online were higher among urban children (OR=2.04, 95% CI 1.21-3.45), who spent more hours daily on the Internet (OR=1.09, 95% CI 1.01-1.18), who visited more social media (OR=1.42, 95% CI 1.27-1.59) and who used more Internet devices (OR=1.93, 95% CI 1.25-2.98). Many participants were aware of these incidents but did not know how to respond to online sexual abuse. Social media, chat groups and video games were described as primary avenues for abuse, while unemployed male young adults and partners in love affairs were identified as the possible perpetrators. Psychosocial consequences such as anxiety, depression, helplessness, stress, distrust, lack of concentration, social isolation, self-hate and suicidal attempts were reported by the victims. Encountering online sexual abuse also manifested in academic underperformance.</p><p><strong>Conclusion: </strong>Urgent multisectoral measures are needed to address online sexual abuse to safeguard children's right to be protected on online platforms.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e091042"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156000","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":"Knowledge, attitudes and practices relating to nutritional support and immune-related adverse events among patients undergoing immunotherapy for liver cancer: cross-sectional study.","authors":"Wen Wen, Yingshuang Chen, Fangqing Gao, Liling Tong","doi":"10.1136/bmjopen-2024-086854","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-086854","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the knowledge, attitude and practice (KAP) regarding immune-related adverse events (irAEs) and nutritional support among patients with liver cancer (LC).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Recruitment was carried out at Haikou People's Hospital, Haikou, China, from December 2022 to April 2023.</p><p><strong>Participants: </strong>Patients undergoing immunotherapy for LC.</p><p><strong>Primary and secondary outcome measures: </strong>Mean knowledge, attitudes, practices, and lifestyle scores were assessed using an investigator-designed questionnaire completed by patients during immunotherapy.</p><p><strong>Results: </strong>The study included 402 participants. The mean knowledge, attitudes, practices and lifestyle scores were 6.60±3.51 (/10, 66.00%), 41.26±5.06 (/50, 82.52%), 30.74±4.20 (/40, 76.85%) and 42.37±6.04 (/55, 77.04%), respectively. Attitude scores were associated with practice scores (β=0.381, p<0.001) and lifestyle (β=1.928, p<0.001). Urban residence was associated with higher attitude scores (β=1.242, p=0.013). Living with someone was associated with a higher attitude score (β=1.619, p=0.044). More than one immunotherapy line was associated with a higher lifestyle score (β=1.928, p<0.001). Finally, the female gender was associated with a lifestyle score (β=1.431, p=0.023).</p><p><strong>Conclusion: </strong>Patients with LC and undergoing immunotherapy had moderate KAP towards irAEs and nutritional support. They also displayed moderate lifestyle scores. Urban residents, people not living alone, females and those having received two or more immunotherapy treatments were positively associated with attitude, while attitude was positively associated with practice and lifestyle.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e086854"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155877","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":"Efficacy and acceptability of different blood flow restriction training interventions during the rehabilitation of military personnel with lower limb musculoskeletal injuries: protocol for a two-phase randomised controlled trial.","authors":"Luke Gray, Russ J Coppack, Robert Barker-Davies, Robyn P Cassidy, Alexander N Bennett, Nick Caplan, Gavin Atkinson, Lauren Bradshaw, Janisha Chauhan, Kieran M Lunt, Luke Hughes, Peter Ladlow","doi":"10.1136/bmjopen-2024-096643","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-096643","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Musculoskeletal injury (MSKI) is the leading cause of medical downgrading and discharge within the UK military, with lower limb MSKI having the greatest incidence, negatively impacting operational readiness. Pain is a primary limiting factor to rehabilitation progress following MSKI. Heavy-load resistance training (RT; ie, loads &gt;70% 1-repetition maximum) is traditionally used but may be contraindicated due to pain, potentially prolonging recovery and leading to failure of essential physical employment standards for UK military personnel. Low-load RT with blood flow restriction (BFR) can promote favourable morphological and physiological adaption, as well as elicit hypoalgesia in healthy and clinical populations (eg, post-operative), and has proven a viable option in military rehabilitation settings. The acceptability and tolerance of higher relative BFR pressures in persistent pain populations are unknown due to the complexity of presentation and the perception of discomfort experienced during BFR exercise. Greater relative pressures (ie, 80% limb occlusion pressure (LOP)) elicit a greater hypoalgesic response in pain-free individuals, but greater perceived discomfort which may not be tolerated in persistent pain populations. However, lower relative pressure (ie, 40% LOP) has elicited hypoalgesia in pain-free individuals, which therefore may be more clinically acceptable and tolerated in persistent pain populations. The primary aim of both randomised controlled trials (RCT) is to investigate the efficacy and acceptability of using high-frequency, low-load BFR-RT in UK military personnel with lower limb MSKI where persistent pain is the primary limiting factor for progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;The presented protocol is a two-phase RCT based within a military rehabilitation setting. Phase One is a 1-week RCT to determine the most efficacious and acceptable BFR-RT protocol (7× BFR-RT sessions over 5 days at 40% or 80% LOP; n=28). Phase Two is a 3-week RCT comparing the most clinically acceptable BFR pressure, determined by Phase One (21× BFR-RT sessions over 15 days; n=26) to usual care within UK Defence Rehabilitation residential rehabilitation practices. Outcomes will be recorded at baseline, daily and following completion of the intervention. The primary outcome will be the brief pain inventory. Secondary outcomes include blood biomarkers for inflammation and pain (Phase Two only), injury-specific outcome measures, lower extremity function scale, objective measures of muscle strength and neuromuscular performance, and pressure pain threshold testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;The study is approved by the Ministry of Defence Research Ethics Committee (2318/MODREC/24) and Northumbria University. All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration number: &lt;/strong&gt;Register","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e096643"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156978","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":"From grief to resilience: a qualitative study of women's reactions and coping methods after perinatal loss in Türkiye.","authors":"Tuba Ucar, Esra Sabanci Baransel, Osman Tayyar Çelik","doi":"10.1136/bmjopen-2024-092544","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092544","url":null,"abstract":"<p><strong>Objective: </strong>Perinatal loss, which includes miscarriage, stillbirth and neonatal death, is a significant public health problem worldwide. Perinatal loss causes a range of short-term and long-term reactionsin women. Knowing these reactions and coping methods is essential for appropriate support and treatment. This study aims to examine the complex reactions and coping methods experienced by women after perinatal loss.</p><p><strong>Design and methods: </strong>In this study, a qualitative descriptive approach was used, in which indepth interviews were conducted with the data collected using semistructured interviews. 10 women who experienced perinatal loss were included in the study using the snowball sampling method. Analysis was conducted using an inductive content analysis approach.</p><p><strong>Results: </strong>The findings showed that women who experienced perinatal loss exhibited a variety of complex reactions, which could be grouped under five themes. These are emotional reactions, concerns, changes in life, subsequent pregnancy and blame. We also observed that these women used strategies classified under seven different themes to cope, which we expressed as relying on religious or spiritual beliefs, restructuring, the healing power of more challenging experiences, reflecting on worse scenarios, isolating oneself, avoiding remembering and concretising the loss.</p><p><strong>Conclusions: </strong>This study found that women experiencing perinatal loss may react differently and develop different strategies to cope with their loss and reactions. These findings may help to assess the emotional and behavioural states of women after perinatal loss and guide healthcare professionals to provide more individualised care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e092544"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156917","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":"Does paired genetic testing improve targeted therapy choices and screening recommendations for patients with upper gastrointestinal cancers and their families? A prospective cohort of 42 patients.","authors":"Kevin Tatunay, Stacey Cohen, Lorraine V Naylor, Cynthia L Handford, Angela Jacobson, Veena Shankaran, Brant Oelschlager, William M Grady, Britta Sjoding, Everett Lally, Lauren Facchini, Qin Sun, Mercy Y Laurino, Colin Pritchard, Eric Q Konnick, Marianne E Dubard-Gault","doi":"10.1136/bmjopen-2024-091745","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091745","url":null,"abstract":"<p><strong>Objectives: </strong>Our study was designed to assess whether paired normal-tumour testing increased access to targeted therapy, clinical trials and influenced cancer screening recommendations given to patients and their families.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Academic cancer centre in the Pacific Northwest region of the USA.</p><p><strong>Participants: </strong>Patients newly diagnosed between 01 January 2021 and 31 December 2022 with cancers of the oesophagus, gastro-oesophageal junction and stomach (CEGEJS) were included. All other cancer diagnoses such as head and neck, duodenal and lower gastrointestinal tract cancers were excluded.</p><p><strong>Intervention: </strong>Paired germline and tumour genetic test within 90 days of new patient visit.</p><p><strong>Primary outcome measures: </strong>Number of targeted therapies received (or not) when eligible, follow-up treatment data and number of inherited predispositions to cancers identified. No secondary outcome measures.</p><p><strong>Results: </strong>Of 42 patients, 32 (76.2%) were eligible for at least one targeted therapy. 19 patients received immunotherapy, when 16 had a biomarker predicting immunotherapy benefit, and benefit of immunotherapy was unclear for 3. Another 11 did not have this biomarker, and 6 of them received immunotherapy. Six pathogenic variants were identified in four high-risk genes. By 01 January 2024, 18 patients (42.9%) had died of complications of cancer.</p><p><strong>Conclusion: </strong>More than 75% of patients who received tumour testing were eligible for a targeted therapy regardless of their stage at diagnosis, emphasising the need to expand access to testing with staging workup to improve survival outcomes. Six families received personalised screening recommendations, thanks to this study.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e091745"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156975","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 a data-informed care planning improvement intervention in long-term care in Nova Scotia: protocol for an advisory-led interpretive qualitative study.","authors":"Michael Kalu, Nazanin Nasiri, Andrea Iaboni, Parisa Ghanouni, John Hirdes, Steve Iduye, Elaine Moody, Kathleen Norman, Samuel Searle, Olga Theou, Luke Turcotte, Linda Verlinden, Lori E Weeks, Caitlin McArthur","doi":"10.1136/bmjopen-2023-082610","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-082610","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The quality of care provided in long-term care (LTC) homes has been a concern for many years, and the COVID-19 pandemic has further raised awareness of this issue. Care planning helps identify and prioritise areas to improve LTC residents' health. Data are routinely collected to support care planning, for example, the interRAI LTC facilities instrument and real-time location systems. However, the best way to use these data to inform care planning and decision-making while including residents and family members remains elusive. This study aims to develop a &lt;i&gt;data-informed care planning improvement intervention&lt;/i&gt; that uses routinely collected data to guide resident-centred care planning in LTC. Specifically, we will: (1) examine how, where and why routinely collected data are used in current care planning processes in LTC; (2) identify barriers and facilitators to using data to guide care planning from the perspectives of staff, residents and family caregivers; and (3) develop care planning intervention guided by the Behaviour Change Wheel.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;An advisory committee of residents, family members and LTC staff will provide study oversight of this &lt;i&gt;interpretive qualitative description study,&lt;/i&gt; conducted in LTC homes in Nova Scotia from May 2023 to April 2025. Participants, including LTC residents, their family members and staff, will be invited to participate in two 60-90 min focus groups or 45-60 min individual interviews and/or three 2-hour observation sessions. Data from interviews, focus groups and care observations will be analysed using inductive content analysis to answer the objectives. Next, we will deductively map the identified barriers and facilitators onto the Behaviour Change Wheel, which suggests that &lt;b&gt;C&lt;/b&gt;apability, &lt;b&gt;O&lt;/b&gt;pportunity and &lt;b&gt;M&lt;/b&gt;otivation are needed for a Behaviour to occur (COM-B system). Subsequently, we will have a 1 day advisory committee meeting to: (1) select the intervention components using the APEASE criteria, which asks whether the function is &lt;u&gt;A&lt;/u&gt;ffordable, &lt;u&gt;P&lt;/u&gt;racticable, &lt;u&gt;E&lt;/u&gt;ffective, &lt;u&gt;A&lt;/u&gt;cceptable, &lt;u&gt;S&lt;/u&gt;afe, and promotes &lt;u&gt;E&lt;/u&gt;quity; and (2) describe the final intervention using the Template for Intervention Description and Replication checklist to ensure the reproducibility of the intervention in future work. The result of this study has the potential to contribute to the understanding of the process in enhancing care and resident outcomes in LTC homes across Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;This study has been approved by the Dalhousie University Health Sciences Research Ethics Board. Informed consent will be obtained from all participants or their substitute decision-makers before they take part in interviews, focus group discussions and care observations. Data will be de-identified, and privacy and confidentiality will be maintained through secure storage and handling of b","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e082610"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156971","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 the relationship between adolescents with tuberculosis and health services: an indepth qualitative study from Cape Town.","authors":"Dillon Timothy Wademan, Graeme Hoddinott, Zara Kavalieratos, Mfundo Mlomzale, Arlene J Marthinus, Lucia N Jola, Stephanie Jacobs, Khanyisa Mcimeli, James Seddon","doi":"10.1136/bmjopen-2024-094295","DOIUrl":"10.1136/bmjopen-2024-094295","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescents' experiences (10-19 years-old) with tuberculosis (TB) remain poorly understood. Descriptions of adolescent TB experiences, particularly how they interact with the health system, are scarce. We aimed to understand adolescents' experiences of TB health services in the Western Cape, South Africa. We focused on how TB services were aided or hindered through interactions with healthcare providers and health system processes.</p><p><strong>Methods: </strong>Teen TB, an observational study in Cape Town, enrolled 50 newly diagnosed adolescents with multidrug-resistant and drug-susceptible TB. A subset of 20 was selected for serial qualitative data collection, with 19 completing all tasks between December 2020 and September 2021. 52 interviews were conducted and thematically analysed using a case descriptive process for experiences across the TB care cascade.</p><p><strong>Findings: </strong>Adolescents criticised the difficulties and delays they encountered in obtaining an accurate TB diagnosis. Initial misdiagnoses and delayed TB diagnoses were reported, despite seeking help from multiple healthcare providers at different facilities. Adolescents questioned whether the financial, social and emotional costs of TB care outweighed the costs of delaying treatment initiation and adherence. Adolescents reported that the treatment regimen, adherence support processes and interactions with the health system posed significant challenges to maintaining adherence. Encouragingly, however, most adolescents reported being well treated and cared for by health workers.</p><p><strong>Conclusion: </strong>Our study shows that adolescents experience challenges throughout their TB treatment journeys. More adolescent-focused research is needed to tailor treatment and healthcare processes to their needs.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e094295"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}