BMJ Open最新文献

{"title":"What are the expectations of patients regarding the communication of nuclear imaging results? Insights from a French national survey of 723 patients.","authors":"Sandra Gonzalez, Pierre Le Coz, Jean-Marc Israël, Frédéric Comte, Fabrice Rezungles, Hamza Benjelloun, Julien Mancini, David Taieb","doi":"10.1136/bmjopen-2025-099484","DOIUrl":"10.1136/bmjopen-2025-099484","url":null,"abstract":"<p><strong>Objectives: </strong>There are still some controversies regarding the role of nuclear medicine practitioners in delivering imaging findings to the patients as well as content and magnitude of information to be delivered. The aim of the study was to identify the expectations of patients regarding the communication of results from a nuclear imaging examination.</p><p><strong>Design: </strong>A national survey was conducted among patients who underwent a nuclear imaging examination. In each participating centre, a questionnaire was administered to the patients.</p><p><strong>Setting: </strong>Primary care in France.</p><p><strong>Participants: </strong>The study involved 723 patients from 12 French Nuclear Medicine departments (university hospitals, general hospitals, comprehensive cancer centres and private centres).</p><p><strong>Outcome measure: </strong>The primary endpoint was to determine the proportion of patients expressing a wish to consult a nuclear medicine physician at the end of the imaging session and to assess the rationale underlying this preference.</p><p><strong>Results: </strong>Our results indicate that a significant majority (73.2%) of patients prefer to meet primarily with the nuclear medicine physician to receive an explanation of the imaging findings. Concerning the disclosure of these results, 66.1% of the patients prefer to receive an explanation from the nuclear medicine physician, either alongside or instead of the requesting physician alone. Furthermore, nearly all patients (96.1%) who wish to meet with the nuclear medicine physician also indicate their willingness to receive the examination results, even if they are unfavourable.</p><p><strong>Conclusions: </strong>This study underscores the clear preference of patients to interact with nuclear medicine specialists and benefit from their expertise, irrespective of whether the results are positive or negative. This emphasises the critical need for implementing standardised recommendations across countries and ensuring adequate training for nuclear physicians to actually meet this demand. This aspect is likely to distinguish a nuclear medicine physician from a scan interpreter.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099484"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483146","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":"Continuity of care and medication adherence in patients with angina: a retrospective cohort study using Korea's National Health Insurance data.","authors":"Dayea Kim, Jaewoo Cha","doi":"10.1136/bmjopen-2025-098903","DOIUrl":"10.1136/bmjopen-2025-098903","url":null,"abstract":"<p><strong>Background: </strong>Angina, a major manifestation of ischaemic heart disease, affects 3-7% of adults and is a leading cause of cardiovascular morbidity. As an ambulatory care-sensitive condition, its outcomes can be improved through proactive outpatient management. However, the real-world impact of continuity of care (COC) and medication adherence, measured by the medication possession ratio (MPR)-on angina complications in South Korea remains poorly understood.</p><p><strong>Objective: </strong>This study evaluated the effectiveness of COC and MPR in patients with angina using comprehensive national data and examined the outcomes at the hospital level.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the National Health Insurance Service of Korea between 2002 and 2019. We identified 11 127 patients aged >30 years newly diagnosed with angina, applying strict exclusion criteria to ensure cohort validity. COC was categorised as high (COC index=1.0) or low (<1.0), and MPR was classified as excellent (≥80%), good (60%-79%) or poor (<60%). Complications, defined as the onset of coronary artery disease (International Classification of Diseases, 10th Revision: I20-I25), were analysed using Kaplan-Meier survival curves and Cox proportional hazards models, adjusting for key sociodemographic and clinical covariates.</p><p><strong>Results: </strong>Among the study cohort (mean age 63.4 years; 54.3% female), 64.2% had low COC. While patients with low COC had a 20% higher risk of complications compared with those with high COC (HR: 1.20; 95% CI: 0.87 to 1.65; p=0.266), this was not statistically significant. Similarly, patients with poor MPR had a modestly elevated but non-significant risk (HR: 0.96; 95% CI: 0.67 to 1.36). Subgroup analysis revealed significantly elevated complication risk in patients ≥80 years with low COC (HR: 2.00; 95% CI: 1.67 to 2.32; p=0.04). The lowest complication rates were observed in patients receiving care from clinics with high COC and excellent MPR.</p><p><strong>Conclusions: </strong>Higher levels of COC and MPR were associated with reduced angina-related complications, underscoring their importance in chronic disease management. However, the inconsistent statistical significance suggests disease-specific strategies may be needed to optimise continuity and adherence interventions. These findings have implications for refining ambulatory care models and enhancing chronic disease policies within Korea's single-payer system.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e098903"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483158","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":"Remote ischaemic preconditioning in cemented hip arthroplasty (the PRINCIPAL study)-randomised controlled trial: study protocol.","authors":"Kaarel Ernits, Aare Märtson, Jaak Kals, Aili Tagoma, Katre Maasalu, Anneli Aus, Kristi Vent, Kaspar Tootsi","doi":"10.1136/bmjopen-2024-096433","DOIUrl":"10.1136/bmjopen-2024-096433","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) is an effective treatment for severe osteoarthritis. However, THA has a high surgical risk for patients with concomitant diseases and is associated with several serious complications, such as myocardial infarction, acute kidney injury and cognitive dysfunction. This study will explore the potential protective effects of remote ischaemic preconditioning (RIPC) in cemented THA patients.</p><p><strong>Methods and analysis: </strong>The PRINCIPAL study is designed as a randomised, controlled, parallel-group, blinded trial to assess the impact of RIPC in cemented THA patients. The study will compare two patient groups-one group will have the RIPC procedure, and the second will have the sham procedure. The primary outcome is the peak troponin T concentration during the three postoperative days. Secondary outcomes include markers of arterial stiffness (augmentation index (AIx), carotid-femoral pulse wave velocity, central blood pressures), neural (neuron-specific enolase, S100B) and renal injury biomarkers (estimated glomerular filtration rate, creatinine, cystatin C), markers of systemic inflammation (hypoxia-inducible factor 1-alpha, interleukin (IL)-6, IL-1β, tumour necrosis factor-alpha, IL-10) and oxidative stress (total peroxide concentration, total antioxidant capacity), as well as clinical outcome measures such as major adverse cardiovascular events and all-cause mortality.</p><p><strong>Ethics and dissemination: </strong>The ethical board of the University of Tartu has granted approval for the study (no. 384T-26). The results of this study will be disseminated in international peer-reviewed journals.</p><p><strong>Trial registration number: </strong>NCT06323018.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e096433"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474041","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":"Principal investigators' experience of COVID-19 therapeutic clinical trials in Japan: a qualitative study.","authors":"Satoko Horii, Hiroki Saito, Taro Shibata, Miwa Sonoda, Tatsuo Iiyama, Kazuaki Jindai","doi":"10.1136/bmjopen-2024-097611","DOIUrl":"10.1136/bmjopen-2024-097611","url":null,"abstract":"<p><strong>Objective: </strong>During the COVID-19 pandemic, many clinical trials were conducted to identify effective COVID-19 therapeutics. However, while a large amount of resources was invested and significant numbers of patients participated, this did not necessarily have an impact on clinical practice. To face these issues, initiatives such as the 100 Days Mission have been set out globally. Yet, limited data exist on the context surrounding the implementation of clinical trials at a national level during a health emergency. The study explored experiences and perceptions of principal investigators in conducting clinical trials for COVID-19 therapeutics in Japan.</p><p><strong>Design: </strong>A qualitative study was conducted using semistructured interviews. The obtained data were inductively analysed using thematic analysis.</p><p><strong>Setting and participants: </strong>We interviewed 15 principal investigators between September and November 2022 who conducted investigator-initiated clinical trials on the development of COVID-19 therapeutics in Japan.</p><p><strong>Results: </strong>Three themes were generated: <b>structural barriers</b>, <b>fragmented efforts</b> and <b>limited evidence generation</b>. <b>Structural barriers</b> and <b>fragmented efforts</b> comprised four subthemes: individual, institutional, interinstitutional and policy/regulatory levels. <b>Structural barriers</b> at all levels included (1) limitations of individual capabilities, (2) the double burden of clinical practice and research, (3) inefficient interinstitutional collaboration and (4) regulatory frameworks and available resources that interrupt stakeholders' actions, leading to <b>limited evidence generation</b> despite the <b>fragmented efforts</b> of principal investigators and other stakeholders.</p><p><strong>Conclusions: </strong>This study illustrated that the efforts of Japanese principal investigators did not necessarily pay off in identifying therapeutics. A strategic and systematic approach for an improved national clinical trial ecosystem must be sought during the interpandemic period to overcome structural barriers in harmonisation with the global stakeholders.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097611"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483166","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":"Community-based type 2 diabetes screening programmes designed for priority populations: a scoping review protocol.","authors":"Muhanad Ahmed Ali, Fatema Mahad Ali, David Gerstle, Aimen Zehra, Ghazal S Fazli","doi":"10.1136/bmjopen-2024-090787","DOIUrl":"10.1136/bmjopen-2024-090787","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes is a growing public health concern, and it continues to disproportionately impact priority populations. Although earlier and more frequent screening of diabetes promotes early detection to prevent adverse outcomes, this is a significant barrier for priority populations due to inequities that hinder access to critical preventive screening in primary care settings. The purpose of this scoping review is to better understand the design and implementation of screening and early detection of type 2 diabetes in community settings for priority populations to reduce missed or delayed diagnoses and future potential adverse outcomes.</p><p><strong>Methods: </strong>This scoping review will adopt the methodological framework of Arksey and O'Malley and be enhanced using Levac <i>et al</i> recommendations. A search strategy was designed using insights from experienced librarians through the Peer Review for Electronic Search Strategies to conduct a comprehensive search using the following databases: Medline, Embase, PsycINFO, Web of Science, Scopus, CINAHL and Google. The search will capture studies focused on community-based diabetes screening using point-of-care testing and deployed in community settings serving priority populations with undiagnosed diabetes. Studies will be excluded if priority populations were not a focus, individuals living with diabetes, the intervention is not implemented in a community setting and did not use point-of-care screening. Two authors will independently review and screen the articles (title, abstract and full-text), while a team-based approach will be applied to chart the data. A thematic analysis will be used to identify emerging themes and subthemes according to barriers and enablers of implementing an equitable community-based diabetes screening intervention.</p><p><strong>Ethics and dissemination: </strong>The findings from this review will inform future diabetes screening interventions in community settings to enable an equity-informed approach in the design, planning and implementation of such strategies. Equally important, it will inform a larger project, in which the team plans to implement a community-based diabetes screening programme in Ontario, Canada.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e090787"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474030","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":"Vacation and back-to-school effect on influenza transmission among school-age children in Guangzhou, China: an ecological study from 2010 to 2023.","authors":"Yanhui Liu, Zhitao Chen, Meiqi Zhang, Dedong Wang, Mengmeng Ma, Pengzhe Qin, Lei Luo, Di Wu","doi":"10.1136/bmjopen-2024-096341","DOIUrl":"10.1136/bmjopen-2024-096341","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether influenza transmission risk decreased during summer and winter vacations and increased after vacations and statutory holiday.</p><p><strong>Design: </strong>An ecological study.</p><p><strong>Setting: </strong>Guangzhou, Guangdong Province of China.</p><p><strong>Participants: </strong>A total of 458 343 influenza cases in school-aged children were included, including 160 067 (35.05%) in kindergarten, 223 817 (48.83%) in primary school, 50 053 (10.92%) in middle school and 23 801 (5.19%) in high school.</p><p><strong>Data and methods: </strong>Data on influenza cases were obtained from the Notifiable Infectious Disease Surveillance System operated by Guangzhou Centre for Disease Control and Prevention. Influenza incidence rate ratio (IRR) by negative binomial regression model was used to analyse the influenza risk of school-age children during/after vacation to before/during breaks.</p><p><strong>Results: </strong>In all four groups, there was significantly lower incidence of influenza during winter and summer vacations compared with the 4 weeks preceding vacations. Compared with the 2 weeks preceding return, kindergarten students experienced the highest influenza risk in the third week after summer vacation (IRR=3.40, 95% CI 2.43to 4.79). Primary school students had the highest risk in the fourth week after winter vacation (IRR=9.59, 95% CI 6.71 to 13.87). Middle school students had the highest risk in the fourth week after summer (IRR=11.60, 95% CI 6.17 to 22.62). High school students also experienced the highest risk in the fourth week following summer (IRR=17.96, 95% CI 8.10 to 42.05). Despite the risk of influenza increasing after returning to school, it remained lower compared with before vacations and holidays.</p><p><strong>Conclusions: </strong>Due to changes in contact patterns, influenza incidence was high towards the end of term, significantly decreased during vacations and started to rise on returning to school, peaking in the third or fourth week. These findings suggested using holiday periods strategically to promote influenza vaccination and implementing enhanced non-pharmaceutical interventions on students returning to school.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e096341"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473953","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":"Exploring multilevel determinants of stillbirth: a comprehensive analysis across sub-Saharan African countries.","authors":"Khadijat Adeleye, Oluwabunmi Ogungbe, Yvette Yeboah-Kordieh, Ashley Gresh, Favorite Iradukunda","doi":"10.1136/bmjopen-2024-089371","DOIUrl":"10.1136/bmjopen-2024-089371","url":null,"abstract":"<p><strong>Background: </strong>Stillbirths and associated outcomes remain a significant concern in sub-Saharan Africa (SSA), with approximately 41% of global stillbirths.</p><p><strong>Design: </strong>Our cross-sectional analysis included a weighted sample of women aged 15-49 years who had given birth or experienced stillbirth.</p><p><strong>Setting: </strong>Sub-Saharan African Countries.</p><p><strong>The main outcome measures: </strong>Determinants of stillbirth among women in 29 SSA countries.</p><p><strong>Result: </strong>Among a sample of 197 328, stillbirth prevalence was 8.4/1000 live births. Among individual-level factors, the risk increased with age. Higher maternal educational levels were significantly associated with decreased stillbirth risk (aOR=0.62, 95%CI: 0.44 to 0.89, higher versus no education). Single women had significantly lower odds of stillbirth compared with those who no longer lived together or were separated from their partners (aOR=0.38, 95%CI: 0.25 to 0.60). Contextually, women with a job had an increased risk compared with women without a job (aOR=1.19, 95%CI: 1.06 to 1.34), and living in a rural residential area was a significant factor (aOR=1.30, 95%CI: 1.13 to 1.50).</p><p><strong>Conclusion: </strong>The complex interplay between individual-level and contextual factors continues to influence stillbirth outcomes in SSA. Cross-sector integrative care approaches to maternal and neonatal health are needed to address the multifaceted determinants of stillbirths.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e089371"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474034","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":"Hyperangulated videolaryngoscope for difficult airway management: a protocol for a systematic review with meta-analysis and trial sequential analysis.","authors":"Yujie Huang, Li Du, Dan Liu, Weiyi Zhang, Tingting Li, Jianqiao Zheng","doi":"10.1136/bmjopen-2024-098508","DOIUrl":"10.1136/bmjopen-2024-098508","url":null,"abstract":"<p><strong>Introduction: </strong>Videolaryngoscopes are recommended as the top preference for tracheal intubation in adults, children, infants and neonates, and even in patients with anticipated difficult airways, since they are generally easier to use and quicker to master than fibreoptic bronchoscopes. Compared with standard videolaryngoscopes, hyperangulated videolaryngoscopes possess a more sharply curved blade or blade tip, resulting in a higher first-attempt success rate among patients with anticipated difficult airways. However, hyperangulated videolaryngoscopes also pose challenges in advancing the tracheal tube, which decreases the first-attempt success rate while increasing the tracheal intubation time when the tracheal tube introducer is unsuitable. Hence, controversy still remains regarding the efficiency of hyperangulated videolaryngoscopes as first-line devices in patients with anticipated difficult airways, owing to the inconsistent clinical findings. Consequently, we will conduct a protocol for a systematic review and meta-analysis to determine the usefulness of hyperangulated videolaryngoscopes in patients with anticipated difficult airways.</p><p><strong>Methods and analysis: </strong>English-language databases (Web of Science, Cochrane Library, PubMed, Embase and Ovid Medline), Chinese electronic databases (VIP database, China National Knowledge Infrastructure, and Wanfang database) and clinical trial registry platforms will be scoured from their inception to May 2025 to locate randomised controlled trials of hyperangulated videolaryngoscopes in patients with anticipated difficult airways. For continuous data, mean differences or standardised mean differences, accompanied by their 95% CIs, and for dichotomous data, the risk ratio, accompanied by its 95% CI, will be calculated using Review Manager V.5.4. Either a fixed-effects model or a random-effects model will be used depending on the magnitude of statistical heterogeneity as evaluated via the I² test. The risk of bias will be assessed via the Cochrane risk-of-bias tool 2. Additionally, the quality of evidence regarding each outcome will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation. The reliability of all outcomes will be appraised via trial sequential analysis. Moreover, the publication bias of all outcomes will be examined using Funnel plots and Egger's regression test.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications.</p><p><strong>Prospero registration number: </strong>CRD42024627484.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e098508"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474035","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":"Prevalence and severity of coronary artery disease in asymptomatic military air crew in the Netherlands: a prospective, cross-sectional study (SUSPECT).","authors":"Erik Frijters, Hendrik Nathoe, Remco Grobben, Lysette Broekhuizen, Rienk Rienks, Birgitta Velthuis","doi":"10.1136/bmjopen-2025-100250","DOIUrl":"10.1136/bmjopen-2025-100250","url":null,"abstract":"<p><strong>Objective: </strong>Coronary artery disease (CAD) is a main cause of incapacitating adverse cardiac events in aviation. Military aircrew ≥40 years in the Netherlands undergo a 5-year exercise ECG (X-ECG), which lacks precision to identify relevant CAD. The study aim was to identify the screening value of cardiac CT (CCT) in asymptomatic military aircrew.</p><p><strong>Design: </strong>Prospective, single-centre, cross-sectional study.</p><p><strong>Setting: </strong>Conducted at the Centre for Man in Aviation, Royal Netherlands Air Force. CT scans were performed at the University Medical Centre, Utrecht.</p><p><strong>Participants: </strong>Asymptomatic military aircrew ≥40 years were asked to undergo CCT, with coronary artery calcium score (CACS) and coronary CT angiography (CCTA), following their aeromedical exam. CCT was performed in 211 participants (median age 49.3 years (43.6-52.8), 98% men, 65% pilots).</p><p><strong>Outcome measures: </strong>The main objective was to determine the prevalence of relevant CAD. Clinically relevant CAD (CR-CAD) is defined as CACS ≥100 and/or a stenosis ≥50%. Aeromedically relevant CAD (AR-CAD) includes CR-CAD and/or a left main stenosis >30% or an aggregate stenosis ≥120%. Secondary objectives included assessing the prevalence of mild coronary stenosis (defined as 25%-49% stenosis), the presence of high-risk plaque (HRP) features and CCT safety.</p><p><strong>Results: </strong>CR-CAD was found in 25 male aircrew (12%), with a CACS of ≥100 in 21 (10%) and a stenosis ≥50% in 10 (5%), including two with CACS 0. Two additional men had ≥120% aggregate stenosis, bringing total AR-CAD to 27 (13%). Twenty-nine men (14%) had mild stenosis. HRP features were present in 44 (21%). There were no CT-related complications. Of 196 participants who underwent X-ECG, seven showed abnormal results; one had relevant CAD.</p><p><strong>Conclusions: </strong>Contrast-enhanced CCTA provides additional information both on high-risk features and obstructive CAD compared with CACS only. CCT is safe and is of additional value to X-ECG in a low-risk population with a high-hazard occupation.</p><p><strong>Trial registration number: </strong>NCT05508893.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e100250"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474038","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":"Clinically directed initiation versus routine use of amoxicillin-clavulanate and the risk of local complications among patients with haemotoxic snakebite envenomation treated at a teaching hospital in southern India: a randomised, non-inferiority trial.","authors":"Aditya Gautam, Malayil B Indu, Akinchan Bhardwaj, Paramasivam Sabitha, Surendran Deepanjali, Bettadpura Shamanna Suryanarayana, Chanaveerappa Bammigatti, Tamilarasu Kadhiravan","doi":"10.1136/bmjopen-2024-094409","DOIUrl":"10.1136/bmjopen-2024-094409","url":null,"abstract":"<p><strong>Objective: </strong>Amoxicillin-clavulanate is commonly used to prevent infections following snakebites despite the lack of clinical evidence. We aimed to demonstrate that clinically directed initiation of amoxicillin-clavulanate would be non-inferior to routine use in this setting.</p><p><strong>Design: </strong>Open-label, randomised, non-inferiority trial with blinded adjudication of endpoints.</p><p><strong>Setting: </strong>Emergency department of a teaching hospital in southern India.</p><p><strong>Participants: </strong>Adults with local swelling following snakebites within 24 hours of bite.</p><p><strong>Interventions: </strong>In the routine use strategy, intravenous followed by oral amoxicillin-clavulanate was administered for at least 5 days. In the clinically directed strategy, the antibiotic was only initiated for clinical failures.</p><p><strong>Primary and secondary outcome measures: </strong>Primary outcomes were protocol-defined clinical failure and total antibiotic consumption. Non-inferiority margin was prespecified as 10%. Secondary outcomes were the length of hospital stay, total antivenom consumption, new-onset organ failure, bleeding requiring transfusion, death/need for surgical intervention and drug-related adverse events.</p><p><strong>Results: </strong>The trial was prematurely stopped due to the COVID-19 situation after randomising 66 patients-34 to clinically directed initiation and 32 to routine use arms. Russell's viper was the most common (21 (32%)) biting snake species identified; 52 (79%) patients had evidence of haemotoxic envenomation at baseline, and 24 (36%) patients developed AKI. There were 10 clinical failures-six in the clinically directed initiation arm and four in the routine use arm. The difference in clinical failure between the two arms was 5.2% (-12.0%-21.7%; p=0.291); the upper bound of the CI exceeded the prespecified non-inferiority margin. Total antibiotic consumption, expressed in DDDs, was significantly lower in the clinically directed initiation arm (0 (0-1) vs 5.31 (4.67-6.17); p<0.001). Three serious adverse events resulting in two deaths (one in each arm) were observed.</p><p><strong>Conclusions: </strong>We could not demonstrate the non-inferiority of clinically directed initiation compared with routine use of amoxicillin-clavulanate among patients with local swelling caused by haemotoxic snakebites. However, the frequency of clinical failures was similar, and antibiotic consumption was substantially lower with the clinically directed initiation strategy.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov; NCT02570347.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e094409"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474029","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}