BMJ Open最新文献

{"title":"Prevalence of potentially inappropriate medication among older patients in a primary care unit of a tertiary care hospital in Thailand: a retrospective cross-sectional study.","authors":"Thareerat Ananchaisarp, Panya Chamroonkiadtikun, Kittipon Kodchakrai, Tanaboon Saeung, Thitiwut Charatcharungkiat, Patnaree Leelarujijaroen, Nopason Sae-Tang, Nanapat Kumkiem, Wipada Kanhin, Haran Sintateeyakorn, Kasidintorn Watcharajiranich","doi":"10.1136/bmjopen-2024-091465","DOIUrl":"10.1136/bmjopen-2024-091465","url":null,"abstract":"<p><strong>Objective: </strong>Older adults are prone to developing multiple chronic diseases and have increased medication usage. This has led to the prescription of potentially inappropriate medications (PIMs). This study aimed to assess PIM prevalence among patients visiting the primary care unit (PCU) of a tertiary care hospital and evaluate the associated factors.</p><p><strong>Design: </strong>A retrospective cross-sectional study by reviewing medical records in the hospital information system.</p><p><strong>Setting: </strong>The PCU of a tertiary care hospital.</p><p><strong>Participants: </strong>Patients aged ≥65 years who visited the PCU between 1 June and 30 November 2023 and received at least one oral medication.</p><p><strong>Primary and secondary outcome measures: </strong>PIMs were diagnosed using the updated American Geriatrics Society Beers criteria 2023, and logistic regression was used to identify factors associated with PIM prescriptions.</p><p><strong>Results: </strong>The study included 1600 participants, of whom 62.9% were female, with a median age of 72.0 years (IQR=68.0-77.0). The prevalence of PIMs was 39.4%. The three most common PIMs prescribed were diuretics, benzodiazepines and sulfonylureas. An increasing number of underlying diseases, presenting with acute illness (compared with follow-up only) and being treated by staff physicians (compared with trainee physicians) were significantly associated with increased odds of PIM prescriptions (adjusted OR (95% CI) = 1.59 (1.42 to 1.79), 1.58 (1.28 to 1.94) and 1.84 (1.33 to 2.54), respectively).</p><p><strong>Conclusion: </strong>PIM prescriptions among older patients in the PCU were high, particularly in those with multiple comorbidities and acute illness presentations. Therefore, physicians should prescribe medications with caution, and various explicit criteria can be used as screening tools to prevent PIM prescriptions.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e091465"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between emotion dysregulation and sleep in children and adolescents with ADHD: protocol for a systematic review.","authors":"Lin Sørensen, Daniel A Jensen, Amalie Lykkebø, Steinunn Adolfsdottir, Nina Holmen, Stephen P Becker, Elisabeth Flo-Groeneboom","doi":"10.1136/bmjopen-2025-099096","DOIUrl":"10.1136/bmjopen-2025-099096","url":null,"abstract":"<p><strong>Introduction: </strong>Over half of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties with emotion dysregulation (EDR) and/or sleep, yet the interrelations between emotional regulation and sleep are not well-characterised in this population. This systematic review will address the relationship between these difficulties and investigate whether specific aspects of EDR are more strongly related to sleep problems in youth with ADHD.</p><p><strong>Methods and analysis: </strong>We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline for systematic reviews. A wide set of electronic databases will be searched for peer-reviewed quantitative studies investigating the relationship between EDR and sleep in children and adolescents (ages 5 to 18 years) with ADHD. In addition, the reference list of all studies will be searched for other relevant studies, and Scopus will be used to search for citations of the included studies. We will also contact experts in the field to request published and unpublished studies. The primary outcome will be the effect size of the relationship between EDR and sleep in children and adolescents with ADHD. We will look at EDR and sleep broadly and also consider the multifaceted nature of both terms. Secondary outcomes will include which facets of EDR and sleep have been measured and how they have been measured, developmental differences between children and adolescents with ADHD and how-and the extent to which-studies controlled for the use of CNS medications and cooccurring disorders in their study design and/or statistical analyses. The quality and risk of bias of the included studies will be assessed using the Mixed Methods Appraisal Tool.</p><p><strong>Ethics and dissemination: </strong>This protocol is for a review of studies and does not involve any new data collection and therefore does not need ethical or human subjects approval. The results will be presented at international conferences and in a peer-reviewed journal.</p><p><strong>Prospero registration number: </strong>CRD42024612984.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e099096"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and risk of psychiatric disorders in patients with polymyositis and dermatomyositis: a nationwide population-based cohort study in Taiwan.","authors":"I-Ping Lee, Yao-Tung Lee, Fang-Yi Wu, Chin-Fang Su, Jui-Hung Kao, Sheng-Hong Lin, Yu-Sheng Chang","doi":"10.1136/bmjopen-2024-097829","DOIUrl":"10.1136/bmjopen-2024-097829","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the incidence and risk factors for psychiatric disorders, including depression and anxiety, and assess the risk of suicide in patients with polymyositis (PM) and dermatomyositis (DM).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Data were obtained from Taiwan's National Health Insurance Research Database (NHIRD) between 2000 and 2018.</p><p><strong>Participants: </strong>A total of 3477 patients with PM/DM and 13 908 age- and sex-matched non-PM/DM controls were included in the study.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the incidence and risk of psychiatric disorders in patients with PM/DM compared with controls. Secondary outcomes included the identification of risk factors for psychiatric disorders, mortality and suicide risk in the PM/DM cohort.</p><p><strong>Results: </strong>The incidence rate ratio (IRR) of psychiatric disorders was significantly higher in the PM/DM cohort than in controls (IRR 1.62, 95% CI 1.39 to 1.89), with depression being the most prevalent disorder (IRR 2.25, 95% CI 1.83 to 2.75). Key risk factors included female sex, intravenous steroid therapy, and high-dose oral steroid use. Additionally, the PM/DM cohort exhibited a higher mortality rate (IRR 3.4, 95% CI 3.15 to 3.67) and elevated suicide risk (IRR 1.99, 95% CI 0.96 to 3.86) compared with controls.</p><p><strong>Conclusion: </strong>Patients with PM/DM face a significantly higher risk of psychiatric disorders, mortality and suicide. Integrating mental healthcare into the routine management of PM/DM is crucial to improving patient outcomes and reducing mortality. Future research should focus on the impact of early psychiatric interventions on survival outcomes in this population.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e097829"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between patient activation, self-management behaviours and clinical outcomes in adults with type 2 diabetes: a systematic review with narrative synthesis.","authors":"Koghanadhacharve Thinakaran, Amy Ahern, Robert S Beckett, Sara F Shaida, Harriet M Wills, Rebecca Richards, Jack M Birch, Simon J Griffin, Julia Mueller","doi":"10.1136/bmjopen-2024-095456","DOIUrl":"10.1136/bmjopen-2024-095456","url":null,"abstract":"<p><strong>Objectives: </strong>Patient activation (PAct)-a measure assessing an individual's perceived knowledge, skills and confidence in managing their health and well-being-is often used to personalise and evaluate care, although its causal link to self-management behaviours (SMBs) and clinical outcomes remains uncertain. We aimed to synthesise the evidence on the causal association between PAct, SMBs and clinical outcomes in type 2 diabetes (T2D).</p><p><strong>Design: </strong>Systematic review and narrative synthesis of data summarised in a harvest plot.</p><p><strong>Data sources: </strong>We searched Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL up to April 2024 for relevant English articles.</p><p><strong>Eligibility criteria: </strong>We included studies of any quantitative design that reported on the association of PAct with clinical outcomes or SMBs in adult patients with T2D.</p><p><strong>Data extraction and synthesis: </strong>Two independent reviewers were involved, and any disagreements were discussed and resolved collaboratively. Risk-of-bias (RoB) was assessed using an adapted RoB Assessment Tool for Nonrandomised Studies. Levels of evidence were evaluated for each T2D-related outcome.</p><p><strong>Results: </strong>We identified 21 studies published between 2009 and 2023, including 15 cross-sectional studies and no randomised controlled trials. Eleven studies were conducted in the USA. Seventeen studies used the Patient Activation Measure questionnaire. There is moderate evidence that higher PAct scores are associated with better glycated haemoglobin levels (studies reporting on this association, n=14). There is very limited evidence that PAct improves diet (n=5) and physical activity (n=6). All other clinical outcomes and SMBs had inconclusive results due to either inconsistent or insufficient evidence, or both.</p><p><strong>Conclusion: </strong>A causal relationship between PAct, clinical outcomes and SMBs in T2D cannot be established due to inconsistent evidence and a lack of high-quality studies. Thus, the use of PAct scores as a tailoring tool and an outcome measure in healthcare services requires further evaluation.</p><p><strong>Prospero registration number: </strong>CRD42021230727.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e095456"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Shared efforts, brighter smiles': a protocol for a randomised controlled study on the effectiveness of a parent-child orofacial myofunctional therapy programme post-adenoidectomy.","authors":"Haowei Du, Meng Zhao, Zhaoxia Wei, Jianhua Liu, Jianchun Zhao, Aimin Wang","doi":"10.1136/bmjopen-2024-095795","DOIUrl":"10.1136/bmjopen-2024-095795","url":null,"abstract":"<p><strong>Introduction: </strong>Adenoid hypertrophy has a high prevalence in children, often causing early orofacial muscle dysfunction that worsens facial deformities over time. While adenoidectomy (AT) alleviates airway obstruction, it only partially addresses the condition, leaving persistent neuromuscular habits. Orofacial myofunctional therapy is necessary for post-AT recovery but faces challenges such as poor adherence and ineffective parent-child communication. Dyadic interventions, which actively involve both parents and children, have shown advantages in improving treatment adherence and enhancing orofacial muscle function. Evidence suggests that dyadic intervention addresses both the child's recovery needs and the caregiving capacity of parents, offering a more comprehensive solution for long-term intervention. Therefore, our team developed a parent-child dyadic orofacial myofunctional therapy (PCD-OMT) programme, offering insights into its potential application in paediatric healthcare to support comprehensive family-centred care.</p><p><strong>Method and analysis: </strong>This two-arm, parallel-design, randomised controlled trial will recruit 80 dyads whose children performed AT from two hospitals in Qingdao, China. Dyads will be randomly allocated to two arms. Dyads randomly assigned to the intervention group will receive the PCD-OMT programme. Dyads randomly assigned to the control group will receive regular care. The primary outcomes are orofacial myofunction in children and parental care abilities. The secondary outcomes are children's engagement and parental functioning. A feasibility and acceptability process will be employed to evaluate the viability in clinical practice. Outcomes will be collected at three checkpoints: baseline (T0), postintervention (T1) and after a 12-week follow-up phase (T2).</p><p><strong>Ethics and dissemination: </strong>This study was approved by the Ethics Committee of Medical College of Qingdao University (QDU-HEC-2023216). The results will be published in peer-reviewed publications and presented in international conferences.</p><p><strong>Trial registration number: </strong>ChiCTR2400091466.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e095795"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taking action, return-to-work strategies used by Iranian cancer survivors: a qualitative study.","authors":"Vahid Zamanzadeh, Ali Sadeghian, Leila Valizadeh, Azad Rahmani, Robab Abbasdost, Mohammad Zirak","doi":"10.1136/bmjopen-2024-097932","DOIUrl":"10.1136/bmjopen-2024-097932","url":null,"abstract":"<p><strong>Objectives: </strong>The transition back to work after cancer is a significant milestone for many survivors, affecting their financial stability, psychological well-being and overall quality of life. Return-to-work (RTW) process is often complicated by lingering physical and cognitive impairments, changes in self-identity and workplace dynamics. Understanding how cancer survivors navigate this process is crucial for the development of effective support systems. This study aimed to explore strategies employed by cancer survivors in managing the RTW process.</p><p><strong>Design: </strong>This study employed a qualitative content analysis approach to explore RTW strategies used by cancer survivors.</p><p><strong>Setting: </strong>The study was conducted at a referral cancer centre and the workplaces of cancer survivors located in East Azerbaijan, Iran.</p><p><strong>Participants: </strong>A total of 22 cancer survivors were selected using purposive sampling. These participants had completed primary cancer treatment and had rich and diverse RTW-related experiences. Data were collected through semi-structured, face-to-face interviews and then analysed using the inductive content analysis approach described by Graneheim and Lundman (2004).</p><p><strong>Results: </strong>'Active Strategies for Returning to Work' constituted the main theme and consisted of three categories, including assessing the situation, self-accommodation and impressing the workplace.</p><p><strong>Conclusions: </strong>Cancer survivors actively engaged in RTW. They evaluate their situations before returning to work, seek to accommodate themselves to their circumstances and impress their workplaces to gain the necessary support. Healthcare providers, employers and families, as the most influential parties in the RTW process of cancer survivors, should recognise survivors' positive strategies and provide informational, financial, emotional and occupational support.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e097932"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explaining the multifaceted experiences of family caregivers of stroke survivors: a qualitative study in Iran.","authors":"Kosar Pourhasan, Parvaneh Vasli","doi":"10.1136/bmjopen-2024-097463","DOIUrl":"10.1136/bmjopen-2024-097463","url":null,"abstract":"<p><strong>Objectives: </strong>As the family caregivers of stroke survivors are typically subjected to care burden, spirituality has been advocated to protect them from its negative effects. The purpose of this study was to describe the caregiving experiences of family caregivers of stroke survivors.</p><p><strong>Design: </strong>This qualitative study was conducted from December 2023 to June 2024 in Iran. Data were analysed using the conventional content analysis method.</p><p><strong>Setting: </strong>The study was conducted in the neurology wards of two referral hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran.</p><p><strong>Participants: </strong>After meeting the inclusion criteria, a total of 17 family caregivers of stroke survivors were recruited using the purposive sampling technique with maximum variation. Data were then collected through 17 in-depth semistructured interviews, each lasting 30-60 min.</p><p><strong>Results: </strong>Four themes emerged from the study participants' statements: (1) 'challenges and struggles', (2) 'religious coping strategies', (3) 'psychological coping strategies' and (4) 'social and relational dynamics'. The core concept of 'balancing hope and hardship' was then introduced.</p><p><strong>Conclusion: </strong>The study findings highlight the need to develop comprehensive support programmes for family caregivers of stroke survivors to minimise their caregiving burden. Healthcare planners and providers are encouraged to use these findings to improve the health outcomes of these families and reduce the burden of caregiving.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e097463"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canakinumab for the treatment of postprandial hypoglycaemia: study protocol for a randomised, placebo-controlled, parallel-group, double-blind, multicentric, superiority trial-the CanpHy study.","authors":"Matthias Hepprich, Justus Fischer, Marco Cattaneo, Antonio Ferreira, David Herzig, Lia Bally, Marc Donath","doi":"10.1136/bmjopen-2024-097981","DOIUrl":"10.1136/bmjopen-2024-097981","url":null,"abstract":"<p><strong>Introduction: </strong>Postbariatric hypoglycaemia (PBH) is a complex medical condition with a significant impact on patients' quality of life. The underlying mechanisms remain to be elucidated. We have shown that food ingestion increases IL-1β and subsequently stimulates insulin secretion. We therefore hypothesised that overactivation of the IL-1β pathway could lead to PBH by promoting excessive insulin secretion after a meal. In a proof-of-concept study, we have shown that acute treatment with the IL-1 receptor antagonist anakinra can attenuate PBH after a single liquid mixed meal. This study aims to validate this therapeutic approach over a longer period of time using the long-acting anti-IL-1β antibody canakinumab.</p><p><strong>Methods and analysis: </strong>In this prospective, randomised, double-blind, placebo-controlled, multicentre trial, we plan to enrol 62 adult patients after bariatric surgery with frequent, postprandial hypoglycaemia (ie, <3.0 mmol/L and at least five hypoglycaemic episodes per week). Eligible subjects will be randomised to receive either single-dose 150 mg canakinumab (Ilaris, Novartis) subcutaneously (s.c.) or matched placebo (1.0 mL physiologic saline). For 28 days, patients are required to wear a blinded continuous glucose monitoring device (CGMS, Dexcom G6) and use a diary to track their hypoglycaemic episodes. Primary outcomes include health-related quality of life, measured by the SF-36, as well as postprandial hypoglycaemic events (glucose <3.0 mmol/L). A significant improvement in any one of these outcomes will be considered sufficient to demonstrate the clinical superiority of canakinumab over placebo. Secondary outcomes include patient-oriented measures such as postprandial hypoglycaemic symptoms, hypoglycaemia unawareness, fear of hypoglycaemia, as well as metabolic measures and safety assessments.</p><p><strong>Ethics and dissemination: </strong>The trial was approved by the Cantonal Ethics Committee 'Ethikkommission Nordwest- und Zentralschweiz' in January 2022 (#2021-02325), as well as by Swissmedic in April 2022 (#701280). Current, approved protocol version 1.3 of 28.03.2023. The study is actively recruiting. Results will be published in a relevant scientific journal and communicated to participants and relevant institutions through dissemination activities. Individual data are accessible on request.</p><p><strong>Trial registration: </strong>The study is registered with the www.</p><p><strong>Clinicaltrials: </strong>gov registry (NCT05401578) and the Swiss National Clinical Trials Portal (SNCTP) on www.kofam.ch (SNCTP000004838).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e097981"},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107564/pdf/","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":"OA","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107559/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}