BMJ Open最新文献

{"title":"Protocol: what are the ethnic inequities in care outcomes related to haematological malignancies, treated with transplant/cellular therapies, in the UK? A systematic review.","authors":"Samuel Cusworth, Zareen Deplano, Alastair K Denniston, David Burns, Krishnarajah Nirantharakumar, Nicola Adderley, Joht Singh Chandan","doi":"10.1136/bmjopen-2025-099354","DOIUrl":"10.1136/bmjopen-2025-099354","url":null,"abstract":"<p><strong>Introduction: </strong>Haematological cancers are common in the UK, with a variety of morphologies. Stem cell transplants and chimeric antigen receptor (CAR) T-cell therapies provide significant options for hard to treat haematological cancers, although with difficult to predict outcomes. Research into the determinates of treatment efficacy, and access to treatments, is key to ensuring equal benefit across patients and patient safety. With this, there are concerns about the small representation of minority groups in related research. We aim to report on the current knowledge to guide future research.</p><p><strong>Methods and analysis: </strong>A variety of databases will be searched for literature on UK minority ethnic populations receiving haematopoietic stem cell transplant or CAR T-cell therapy. Searches will be restricted to the year 2011 or later. Many outcomes will be analysed, covering the patient care pathway for those of the target population, although with a focus on follow-up after therapy. Plans have been made to conduct narrative synthesis, with meta-analysis where applicable.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not required for this study. Outputs will be published in an appropriate journal and discussed with the wider National Institute for Health and Care Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics (BTRU) group. Discussions will also be undertaken with the BTRU patient partners group.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e099354"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118803","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":"Synthesis using prospective meta-analysis to reduce youths' e-cigarette use (SPARKE): a protocol for an individual participant data prospective meta-analysis (IPD PMA) examining interventions for the prevention of youth e-cigarette use.","authors":"Sam McCrabb, Kylie E Hunter, Heidi Turon, Courtney Barnes, Jonathan G Williams, Mason Aberoumand, Emily Banks, Serene Yoong, Andrew Milat, Rebecca K Hodder, Lauren A Gardner, Nicola Newton, Melissa A Little, Bonnie Halpern-Felsher, Christine Steeger, Kristen R Fox, Peter Wyman, Lydia Shrier, Sion Kim Harris, Lene Seidler, Luke Wolfenden","doi":"10.1136/bmjopen-2024-093028","DOIUrl":"10.1136/bmjopen-2024-093028","url":null,"abstract":"<p><strong>Introduction: </strong>Youth electronic cigarette (e-cigarette) use is a global health challenge, with multiple jurisdictions wrestling with appropriate responses, in the face of limited evidence available on effective interventions. Identifying and synthesising evidence on the effects of interventions to prevent youth e-cigarette use is required to inform prevention-focussed health policy and practice.</p><p><strong>Methods and analysis: </strong>We plan to undertake an individual participant data (IPD) prospective meta-analysis (PMA). We will conduct systematic searches to identify eligible planned or ongoing randomised controlled trials (RCTs) using trial registries via WHO ICTRP and ClinicalTrials.gov and databases Medline, Embase, CENTRAL, PsycINFO, Web of Science, CINAHL and Europe PMC. We will also search grant websites for additional studies. We will include any RCT of e-cigarette and cigarette prevention interventions for youth including non-smoking and non-vaping youth aged 10 to 19 years, with no intervention, waitlist, usual care or active control. Primary outcomes will be measures of current or ever e-cigarette use. Secondary outcomes include measures of current and ever cigarette (conventional cigarette) use.Investigators from relevant trials will be invited to join the Synthesis using Prospective meta-Analysis to Reduce youths' E-cigarette use (SPARKE) consortium prior to trial outcomes being known using harmonised methods. They are then asked to share their data within 12 months of trial completion.The primary outcomes will be analysed in a two-stage IPD meta-analysis model under an intention-to-treat framework. First, effect estimates and variances will be calculated for each trial with log-binomial regression models adjusting for key prognostic factors. For cluster RCTs, a nested random effect will be specified within trials to account for correlations within clusters. Second, effect estimates will be combined across trials in a random treatment effect, inverse variance meta-analysis model. Effect estimates will be reported as relative risk ratios with 95% CIs.</p><p><strong>Discussion: </strong>This study aims to generate and expedite the synthesis of data regarding prevention interventions for adolescent e-cigarette use to inform real-world decision making. Findings will be of interest to key stakeholders, including policy makers and research funders.</p><p><strong>Ethics and dissemination: </strong>Each trial will be responsible for obtaining their own ethics approval. While secondary analysis of data does not usually require ethics approval, we have received cross-institutional ethics approval from the University of Sydney (2023/714) and the University of Newcastle (H-2023-0389).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093028"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118855","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 of the triglyceride-glucose index with all-cause and cardiovascular mortality among individuals with cardiovascular-kidney-metabolic syndrome: a population-based cohort study using data from the US National Health and Nutrition Examination Survey, 1999-2018.","authors":"Songfeng Zhao, Jiayue Duan","doi":"10.1136/bmjopen-2024-093383","DOIUrl":"10.1136/bmjopen-2024-093383","url":null,"abstract":"<p><strong>Objective: </strong>The study investigated the association between the triglyceride-glucose (TyG) index (a surrogate measure for insulin resistance) and all-cause and cardiovascular disease (CVD) mortality among individuals with cardiovascular-kidney-metabolic syndrome.</p><p><strong>Design: </strong>Population-based cohort study.</p><p><strong>Setting: </strong>US National Health and Nutrition Examination Survey, 1999-2018.</p><p><strong>Participants: </strong>A total of 13 585 participants who had valid data were included in this analysis.</p><p><strong>Outcome measures: </strong>Data from the participants were linked to death certificates to obtain follow-up mortality information from the National Death Index. Cox proportional hazards models were used to assess the associations between the TyG index and all-cause and CVD mortality. Non-linear associations and threshold effects were investigated using restricted cubic spline regression and a two-piecewise Cox proportional hazards model.</p><p><strong>Results: </strong>During a median follow-up of 99 months, a total of 2876 (16.24%) deaths occurred, of which 961 were attributed to CVD. Each one-unit increase in the TyG index was associated with an 8.9% relative increase in the hazard of all-cause mortality (HR 1.089, 95% CI 1.013 to 1.171) and a 19.5% relative increase in the hazard of CVD mortality (HR 1.195, 95% CI 1.027 to 1.390). Non-linear relationships were identified between the TyG index and all-cause and CVD mortality, with threshold values of 8.97 and 8.81 for all-cause and CVD mortality, respectively. A significant interaction effect was found between age and the TyG index.</p><p><strong>Conclusion: </strong>There was a U-shaped relationship between the TyG index and both all-cause and CVD mortality. The thresholds of the TyG index may serve as potential tools for managing populations with cardiovascular-kidney-metabolic syndrome to reduce mortality risk.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093383"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118887","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":"Comorbid cardiovascular diseases and predictors among adults with type 2 diabetes in Bahir Dar city, Ethiopia: a multicentre hospital-based cross-sectional study.","authors":"Zemenu Addis, Alemeshet Yirga Berhie, Teshager Woldegiyorgis Abate, Bekalu Mekonen Belay, Habtam Wale, Ayenew Tega, Tamiru Alene","doi":"10.1136/bmjopen-2024-086054","DOIUrl":"10.1136/bmjopen-2024-086054","url":null,"abstract":"<p><strong>Objective: </strong>The burden of comorbid cardiovascular disease (CVD) and its preventable factors in type 2 diabetes is not well acknowledged in Ethiopia. Therefore, this study aimed to identify the magnitude of comorbidity of CVD and predictors among individuals with type 2 diabetes.</p><p><strong>Design: </strong>A multicentre hospital-based cross-sectional study.</p><p><strong>Setting: </strong>Bahir Dar city Administration Public Hospitals, Ethiopia.</p><p><strong>Methods: </strong>Data on comorbid CVDs among individuals with type 2 diabetes were collected through patient chart reviews. To identify predictors of CVDs in type 2 diabetes, information on lifestyle and psychosocial characteristics, medication and dietary adherence, and disease management status was collected using standardised questionnaires. Statistical analyses were performed using SPSS V.26. The level of statistical significance was set at p<0.05, with ORs and 95% CIs.</p><p><strong>Results: </strong>The participants' mean age (±SD) was 51.5±10.9 years. The overall prevalence of comorbid CVDs among type 2 diabetes was 27.9% (95% CI 23.6% to 32.3%). Factors that statistically predicted the occurrence of comorbid CVDs in type 2 diabetes were: age >60 years (adjusted ORs (AORs)=2.6, 95% CI 1.1 to 6.6), non-adherence to diabetes-friendly diet (AOR=4.0, 95% CI 1.9 to 8.2), low medication adherence (AOR=2.8, 95% CI 1.5 to 5.3), being overweight (AOR=5.3, 95% CI 2.9 to 9.8), and diabetes duration >10 years (AOR=3.7, 95% CI 1.7 to 8.1).</p><p><strong>Conclusion: </strong>Comorbid cardiovascular disease is a significant issue among type 2 diabetic patients. Its prevalence is higher in patients over 60 years of age, with modifiable factors identified as key contributors. Appropriate interventions are recommended, including educating type 2 diabetic patients on dietary regimens, medication adherence, weight management, and the benefits of timely healthcare for effective disease management.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e086054"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118835","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":"Trauma has an echo: a mixed methods study exploring barriers to routine healthcare for survivors of sexual violence in a UK higher education setting.","authors":"Laura Hooper, Jane Meyrick","doi":"10.1136/bmjopen-2025-102181","DOIUrl":"10.1136/bmjopen-2025-102181","url":null,"abstract":"<p><strong>Objectives: </strong>To explore barriers to healthcare among survivors of sexual violence (SV) and the behavioural pathways behind avoidance, focusing on survivor-led solutions.</p><p><strong>Design: </strong>A mixed methods study collated qualitative interviews/surveys to explore the lived experiences of survivors of SV. Data were analysed using both quantitative descriptors and qualitative thematic analysis to expand the mechanisms/solutions to reported rates.</p><p><strong>Setting: </strong>Higher education setting in the UK.</p><p><strong>Participants: </strong>Forty-two survivors of SV between the ages of 18 and 29 self-identified as female (36), male (4), genderfluid (1) and non-binary transmasculine (1), with 10 describing themselves as being from racially minoritised communities and 32 as White survivors.</p><p><strong>Results: </strong>Analysis found 86% of survivors completely or significantly avoided healthcare, particularly sexual and reproductive services. Three themes were identified: (1) wider societal blame/marginalisation of survivors hindered their ability to access care in what felt like 'a system of oppression'; (2) once past these barriers, direct experiences with professionals replicated trauma, exacerbating avoidance and health disparities through 'healthcare-induced re-traumatisation'; (3) survivors identified what they needed to re-engage in healthcare including trauma-informed professionals and compassionate services with 'survivor-centred care'.</p><p><strong>Conclusions: </strong>SV may deepen health inequalities as survivors avoid healthcare. Survivor-led reforms called for survivor-centred practices and encouraged systemic reflection on how healthcare systems may contribute to the broader marginalisation of survivors. Findings echo policy recommendations for co-produced services led by minoritised/marginalised patients and operationalise trauma-informed training for healthcare professionals. Additionally, access-focused psychological support could reduce the impact of sexual trauma on morbidity and mortality.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e102181"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118859","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":"Mesenchymal intravenous stromal cell infusions in children with recessive dystrophic epidermolysis bullosa: MissionEB protocol for a randomised, double-blinded, placebo-controlled, two-centre, crossover trial with an internal phase I dose de-escalation phase and open-label extension.","authors":"Maria L Bageta, Pablo López-Balboa, Munyaradzi Dimairo, Rachel Glover, Kate Hutchence, Diana Papaioannou, Cindy Cooper, Katie Biggs, Paul Tappenden, Katherine Ennis, Malobi Ogboli, Marie-Louise Lovgren, Pratima Poudel, Muna Nadeem, John A McGrath, Steven A Julious, Gabriela Petrof, Anna E Martinez","doi":"10.1136/bmjopen-2024-089857","DOIUrl":"10.1136/bmjopen-2024-089857","url":null,"abstract":"<p><strong>Introduction: </strong>Recessive dystrophic epidermolysis bullosa (RDEB) is a severe genetic mucocutaneous fragility disorder characterised by chronic blistering, slow wound healing and increased risk of squamous cell carcinoma. Current management options are very limited.</p><p><strong>Methods: </strong>This is a randomised (1:1), placebo-controlled, double-blinded crossover (A/B) trial with an internal phase I dose de-escalation (4+5 design) in the first 3 months and a 12-month continued treatment follow-on open-label study if 3-month outcome data from the crossover trial indicate safe and beneficial effects. RDEB is a rare condition, so we expect to recruit a maximum of 36 participants based on feasibility and not formal power considerations. Participants aged>6 months and <16 years will be recruited at Great Ormond Street Hospital and Birmingham Children's Hospital. They will receive 2-3×10⁶ cells/kg intravenous infusion of umbilical cord-derived mesenchymal stem cells or placebo at the start of each crossover period (day 0) and 14 days later. The dose will be de-escalated to 1-1.5×10⁶ cells/kg depending on observed toxicity. For the main crossover trial, the primary outcome is the change in disease severity as measured by the Epidermolysis Bullosa Disease Activity and Scarring Index at 3 months from day 0 infusion. Secondary outcomes measured at 3 and 6 months from day 0 infusion include changes in general clinical appearance of skin disease, pain and itch, and quality of life. Adverse events and serious adverse events will be monitored throughout the trial.</p><p><strong>Ethics and dissemination: </strong>North East-York Research Ethics Committee approved the protocol (ref: 21/NE/0016) on 16 March 2021. Findings will be published in peer-reviewed scientific journals, presented at relevant national and international conferences, and an open-access final report submitted to the funder.</p><p><strong>Trial registration number: </strong>ISRCTN14409785. Protocol V. 8.0, 14 November 2022.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e089857"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118796","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":"Assessing the association between drug use and ischaemic colitis: a retrospective pharmacovigilance study using FDA Adverse Event data.","authors":"Jie An, Kaiqi Wu, Teng Wu, Pengyang Xu, Chuanli Yang, Yunhe Fan, Qing Li, Xiushan Dong","doi":"10.1136/bmjopen-2024-088512","DOIUrl":"10.1136/bmjopen-2024-088512","url":null,"abstract":"<p><strong>Objective: </strong>Drug-induced ischaemic colitis is a significant adverse event (AE) in clinical practice. This study aimed to recognise the top drugs associated with the risk of ischaemic colitis based on the FDA Adverse Event Reporting System (FAERS) database.</p><p><strong>Design: </strong>A cross-sectional design.</p><p><strong>Setting: </strong>All data retrieved from the FAERS database from the first quarter of 2004 to the fourth quarter of 2023.</p><p><strong>Participants: </strong>A total of 5664 drug-induced ischaemic colitis AEs eligible for screening.</p><p><strong>Primary and secondary outcome measures: </strong>The Medical Dictionary for Regulatory Activities was used to identify ischaemic colitis (code: 10009895) cases. Disproportionality analysis for drug-associated ischaemic colitis signals.</p><p><strong>Results: </strong>Drug-induced ischaemic colitis AEs were more prevalent in females (60.12%) and individuals aged ≥65 years (34.25%). The common outcomes were hospitalisation (46.85%) and death (9.73%). Disproportionality analysis identified 91 ischaemic colitis signals and the top 30 drugs mainly involved in the gastrointestinal and nervous systems. The top five drugs with the highest reported OR, proportional reporting ratio, information component and the empirical Bayesian geometric mean, were alosetron, tegaserod, osmoprep, naratriptan and kayexalate. Additionally, 20 of the top 30 drugs did not have ischaemic colitis risk indicated in the package insert.</p><p><strong>Conclusions: </strong>This study identified key drugs associated with ischaemic colitis, particularly alosetron, tegaserod, osmoprep, naratriptan and kayexalate. Notably, two-thirds of these drugs lacked ischaemic colitis warnings in their package inserts. These findings underscore the need for greater clinical vigilance, improved regulatory oversight and further research to clarify underlying mechanisms and support safer medication use.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e088512"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118871","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":"Effects of different types of exercise intervention for alleviating breast cancer-related lymphedema: a systematic review protocol and network meta-analysis.","authors":"Ling Wang, Qingmei Huang, Tingting Cai, Yuanqi Ding, Changrong Yuan","doi":"10.1136/bmjopen-2024-098064","DOIUrl":"10.1136/bmjopen-2024-098064","url":null,"abstract":"<p><strong>Introduction: </strong>Exercise is the main treatment for patients with breast cancer-related lymphedema (BCRL) and different types of exercises were performed in these patients. However, it is unclear which type of exercise or combination of these is the most effective in reducing arm swelling and lymphedema-related symptoms, and quality of life in patients with BCRL.</p><p><strong>Aims: </strong>This study aimed to compare the relative efficacy of different types of exercise in treating BCRL and determine the most effective exercise therapy for patients with BCRL.</p><p><strong>Methods and analysis: </strong>This review will search English-language databases (Cochran Library, Cumulative Index to Nursing and Allied Health Literature, EBSCO, EMBASE, PubMed/Medline and Web of Science). The following Chinese-language databases will also be searched: Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Data and China Science and Technology Journal Database. The search was conducted up to 31 December 2024. Randomised controlled trials comparing different types of exercise on BCRL will be eligible. Data will be extracted from eligible trials by two independent researchers based on the selection criteria. Two reviewers will ascertain the risk of bias of the selected studies using a modified version of the Cochrane Risk of Bias Tool. The study's characteristics (study type, characteristics of the patients, intervention prescriptions) and primary outcomes (limb volume, physical function, physical and psychological symptoms) will be summarised in a narrative format. Meta-analyses (ie, network and pairwise) will be used to assess the indirect and direct effects of the exercise interventions. The relative effects of different types of exercise in treating BCRL will be examined by the surface under the cumulative ranking curve to calculate the ranking of treatments and determine the most effective intervention.</p><p><strong>Ethics and dissemination: </strong>This review does not require ethical approval. The findings will be submitted for peer-reviewed publication.</p><p><strong>Prospero registration number: </strong>The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (CRD42022370817).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e098064"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118753","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":"Building rural health research capacity: protocol for a realist review.","authors":"Christina Young, Christopher Patey, Paul Norman, Aswathy Geetha Manukumar, Dean B Carson, Michelle Swab, Shabnam Asghari","doi":"10.1136/bmjopen-2024-093994","DOIUrl":"10.1136/bmjopen-2024-093994","url":null,"abstract":"<p><strong>Introduction: </strong>While individuals living in rural areas often have poorer health outcomes and reduced access to healthcare services compared with those in urban areas, there is a disproportionate gap in research examining rural health issues and identifying solutions to healthcare challenges. This is likely due to the numerous barriers to conducting rural health research, including the centralisation of research in urban areas and limited trained personnel and resources to conduct research in rural communities. This realist review aims to identify articles focused on building rural health research capacity and develop an evidence-based framework to be used by researchers, clinicians and policymakers to improve rural health services and well-being for rural populations.</p><p><strong>Methods and analysis: </strong>We will conduct a realist review using the following steps: (1) develop a search strategy, (2) conduct article screening and study selection, (3) perform data extraction, quality appraisal and synthesis, (4) engage stakeholders for feedback on our findings and (5) report our findings and engage in knowledge translation. Search terms include variations of the terms 'research', 'capacity building' and 'rural'. Databases include (since inception) Ovid MEDLINE, Embase, CINAHL Plus, APA PsycINFO, ERIC and Scopus. A separate search of the same databases was also designed to identify relevant theories or frameworks related to research capacity building, using variations of the terms 'research', \"'capacity building', 'theory' and 'framework'. Studies will be screened by title and abstract and full text by two research team members and included based on their relevance to rural health research capacity building. We will exclude articles not published in English. We will also search the grey literature to identify rural health research centres, networks or training programmes that have not been described in the academic literature. Two research team members will extract relevant data from included studies and perform a qualitative analysis based on guidelines for realist reviews.</p><p><strong>Ethics and dissemination: </strong>This review does not require ethical approval as it draws on secondary data that is publicly available. The findings will be disseminated at academic conferences, published in peer-reviewed journals and summarised in a lay report for individuals interested in developing strategies, programmes or policies to improve rural health research. The results will inform individuals developing rural health research training programmes, establishing rural research centres, or others interested in building rural health research capacity.</p><p><strong>Prospero registration number: </strong>CRD42023444072.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093994"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118832","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":"What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis.","authors":"Hung-Yuan Cheng, Andrew David Beswick, Wendy Bertram, Mohammad Ammar Siddiqui, Rachael Gooberman-Hill, Michael R Whitehouse, Vikki Wylde","doi":"10.1136/bmjopen-2024-088975","DOIUrl":"10.1136/bmjopen-2024-088975","url":null,"abstract":"<p><strong>Objectives: </strong>To update our previous systematic review to synthesise latest data on the prevalence of long-term pain in patients who underwent total hip replacement (THR) or total knee replacement (TKR). We aim to describe the prevalence estimates and trends in this review.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>Update searches were conducted in MEDLINE and Embase databases from 1 January 2011 to 17 February 2024. Citation tracking was used to identify additional studies.</p><p><strong>Eligibility criteria: </strong>We included prospective cohort studies reporting long-term pain after THR or TKR at 3, 6, 12 and 24 months postoperative.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently identified studies as eligible. One reviewer conducted data extraction, checked by a second reviewer. The risk of bias assessment was performed using Hoy's checklist. Bayesian, random-effects meta-analysis was used to synthesise the results.</p><p><strong>Results: </strong>For TKR, 68 studies with 89 time points, including 598 498 patients, were included. Multivariate meta-analysis showed a general decrease in pain proportions over time: 21.9% (95% CrI 15.6% to 29.4%) at 3 months, 14.1% (10.9% to 17.9%) at 6 months, 12.6% (9.9% to 15.9%) at 12 months and 14.6% (9.5% to 22.4%) at 24 months. Considerable heterogeneity, unrelated to examined moderators, was indicated by substantial prediction intervals in the univariate models. Substantial loss to follow-up and risk of bias led to low confidence in the results. For THR, only 11 studies were included, so it was not possible to describe the trend. Univariate meta-analysis estimated 13.8% (8.5% to 20.1%) and 13.7% (4.8% to 31.0%) of patients experiencing long-term pain 6 and 12 months after THR, respectively, though concerns in risk of bias results reduced confidence in these findings.</p><p><strong>Conclusions: </strong>Our review suggests that approximately 22% of patients report pain 3 months post-TKR, with 12%-15% experiencing long-term pain up to 2 years. At least 14% report pain 6-12 months after THR. Given the prevalence of chronic postsurgical pain, implementing existing and developing new preventive and management strategies is crucial for optimal patient outcomes.</p><p><strong>Prospero registration number: </strong>CRD42023475498.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e088975"},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118875","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}