BMC Medicine最新文献

{"title":"Exploration of treatment burden through examination of workload and patient capacity during transition onto kidney replacement therapy: a systematic review of qualitative research.","authors":"Catrin Jones, Ross Cairns, Heather Walker, Silje Welsh, Benjamin Edgar, Karen Stevenson, Bhautesh D Jani, Patrick B Mark, David Kingsmore, Katie I Gallacher","doi":"10.1186/s12916-025-03904-7","DOIUrl":"10.1186/s12916-025-03904-7","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced chronic kidney disease requiring initiation of kidney replacement therapy (KRT) are frequently asked to enact complex management plans. Treatment burden has been defined as the effect of healthcare workload and the capacity a person has to manage this workload has on wellbeing. The aim of this review is to examine the experience of healthcare workload and the factors that affect capacity to meet that workload for people transitioning onto KRT for the first time, using a framework synthesis of published literature informed by normalisation process theory (NPT) and theory of patient capacity (TPC).</p><p><strong>Methods: </strong>Medline, Scopus and CINAHL were systematically searched with manual citation and reference searching. Studies were included if meeting the criteria of adults aged 18 or over transitioning for the first time onto any modality of KRT (haemodialysis, peritoneal dialysis or kidney transplantation), using qualitative methodologies to describe any aspect of experiences of healthcare workload or any factors that affect capacity to manage workload were included. Abstracts and full papers were independently screened by two reviewers and data extraction and quality appraisal were also independently conducted by two reviewers. Qualitative data were analysed using framework synthesis informed by NPT and TPC.</p><p><strong>Results: </strong>A total of 24,380 studies were screened, 406 full texts were reviewed and 18 studies were included. There were four broad categories of workload described: making sense of KRT, working out what to do and how to do it, meeting the challenges of KRT, and reflecting on work done. Patient capacity influenced the experience of all types of workload and the treatment burden generated by the work.</p><p><strong>Conclusions: </strong>Transitioning onto KRT is a period of very high healthcare workload and potentially high treatment burden. The relationship between healthcare workload and capacity to handle workload is complex, multifactorial and changes over time. By better understanding workload, capacity and burden during transition, we can develop better ways of measuring these important aspects of care and develop interventions to reduce treatment burden in those transitioning onto KRT.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"61"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global cervical cancer elimination: quantifying the status, progress, and gaps.","authors":"Liangru Zhou, Yi Li, Hongyun Wang, Ruixi Qin, Zhen Han, Ruifeng Li","doi":"10.1186/s12916-025-03897-3","DOIUrl":"10.1186/s12916-025-03897-3","url":null,"abstract":"<p><strong>Background: </strong>To address the public health concern of cervical cancer (CC), 194 countries committed to eliminate it at the initiative of the World Health Organization (WHO). We summarised quantitative results concerning CC elimination across these countries, including the progress in implementing three prevention levels (human papillomavirus [HPV] vaccination, CC screening, and treatment for patients with CC) and achievement of interim Global Strategy for Cervical Cancer Elimination targets.</p><p><strong>Methods: </strong>Data were obtained from the International Agency for Research on Cancer, WHO, United Nations International Children's Emergency Fund, and country responses to the WHO National Capacity Survey on Non-Communicable Diseases. This retrospective analysis examined data from 194 countries and regions, stratified by national income (high-income countries (HICs) vs low- and middle-income countries (LMICs)) and geographic location (continents such as Europe, Asia, and North America). A quantitative assessment evaluated global progress in primary, secondary, and tertiary CC prevention.</p><p><strong>Results: </strong>By 2020, four countries had achieved Target 1 (90% of girls fully vaccinated against HPV by age 15). A total of 115 countries (51 (44.35%) HICs and 64 (55.65%) LMICs)) included HPV vaccination in their national immunisation programs. As of 2021, 133 countries (50 (37.59%) HICs and 83 (62.41%) LMICs)) implemented CC screening programs. Most of these were in Europe (41, 30.83%), Asia (32, 24.06%), and North America (20, 15.04%). Additionally, 126 countries (44 (34.92%) HICs and 82 (65.08%) LMICs)) had published national guidelines on CC management. These countries were primarily in Asia (32, 25.40%) and Europe (32, 25.40%). Furthermore, 69 countries provided palliative care under both scenarios. The 10 countries with the highest annual opioid consumption (excluding methadone) for CC, in oral morphine equivalence per capita (2017), were all HICs.</p><p><strong>Conclusions: </strong>Major inequalities persist in CC vaccination and screening across 194 countries, and access to these services is limited in most LMICs. Focusing on vulnerable populations with lower incomes and regions with stunted economic growth may help alleviate inequity and accelerate CC elimination. We also found that tertiary prevention was achieved in most LMICs, but the indicator-reported annual opioid consumption in oral morphine equivalents indirectly illustrates the under-utilisation of cancer treatment services.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"67"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive hepatitis B surface antigen leads to a decrease in ovarian reserve in infertile patients receiving first in vitro fertilization treatment.","authors":"Yutao Li, Xuejiao Wang, Ye Jiang, Qun Lv, Yi Zhang, Yu Wang","doi":"10.1186/s12916-025-03905-6","DOIUrl":"10.1186/s12916-025-03905-6","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the impact of chronic hepatitis B virus (HBV) infection on ovarian reserve in women.</p><p><strong>Methods: </strong>We analyzed data from 38,861 infertile women undergoing their first in vitro fertilization (IVF) treatment (2016-2022), including 1574 HBsAg-positive cases. A control group of 1574 HBsAg-negative women was matched by age and body mass index (BMI). Comparison of clinical characteristics, antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH)/FSH ratio, anti-Müllerian hormone (AMH), gonadotropins (Gn) days, total Gn dosage, number of retrieved oocytes, number of mature metaphase II (MII) oocytes, and the proportion of patients with diminished ovarian reserve (DOR; AMH < 1.1 ng/ml) between two groups.</p><p><strong>Results: </strong>HBsAg-positive women showed lower basal AFC and AMH, higher basal FSH, received more Gn, and had fewer retrieved and MII oocytes than HBsAg-negative women. No significant differences in ovarian reserve or stimulation outcomes were found between e antigen-positive and e antigen-negative HBV-infected groups. DOR was less prevalent in HBsAg-negative women, and logistic regression indicated a higher DOR risk with HBV infection.</p><p><strong>Conclusions: </strong>HBsAg positivity significantly impairs ovarian reserve in women, but e antigen status does not notably affect it among HBV-infected individuals.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"58"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did the resurgence of childhood lower respiratory infections offset the initial benefit of COVID-19-related non-pharmaceutical interventions in children? A time-series analysis.","authors":"Inès Fafi, Zein Assad, Léa Lenglart, Zaba Valtuille, Florentia Kaguelidou, Camille Aupiais, Aurélie Bourmaud, Alexis Rybak, Stéphane Bechet, Corinne Levy, Robert Cohen, Bruno Frandji, Andreas Werner, François Angoulvant, Romain Basmaci, Naïm Ouldali","doi":"10.1186/s12916-025-03885-7","DOIUrl":"10.1186/s12916-025-03885-7","url":null,"abstract":"<p><strong>Background: </strong>Following non-pharmaceutical interventions (NPI) lifting in 2021, an important surge in childhood lower respiratory tract infections (LRTI) was reported in several countries, raising major concerns about the middle-term consequences of such interventions. Whether this recent upsurge overwhelms the initial benefit of NPI remains unknown.</p><p><strong>Methods: </strong>We conducted an interrupted time-series analysis based on exhaustive national surveillance systems. All hospitalisations from January 2015 to March 2023 and all ambulatory visits for LRTI from a network of 110 paediatricians from June 2017 to March 2023 were included. The main outcome was the monthly incidence of children hospitalised for LRTI per 100,000 over time, assessed by a seasonally adjusted quasi-Poisson regression model.</p><p><strong>Results: </strong>We included 845,047 hospitalisations. The incidence of hospitalisation for LRTI significantly decreased during the NPI period (- 61.7%, 95% CI - 98.4 to - 24.9) and rebounded following NPI lifting, exceeding the pre-NPI baseline trend (+ 12.8%, 95% CI 6.7 to 19.0). We observed similar trends for hospitalisation due to bronchiolitis, pneumonia and pneumonia with pleural effusion, along with ambulatory LRTI. Overall, despite the recent rebound, 31,777 (95% CI, 25,375 to 38,179) hospitalisations for paediatric LRTI were averted since NPI implementation up to 2023.</p><p><strong>Conclusions: </strong>Three years after their implementation, despite an increase in LRTI incidence, the middle-term impact of NPI remains highly beneficial in preventing overall paediatric LRTI. The implementation of some societally acceptable NPI, particularly during epidemics, may be considered in the future to further reduce the burden of paediatric LRTI.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"66"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021.","authors":"Xing Chen, Luying Zhang, Wen Chen","doi":"10.1186/s12916-025-03890-w","DOIUrl":"10.1186/s12916-025-03890-w","url":null,"abstract":"<p><strong>Background: </strong>Adolescent diabetes is one of the major public health problems worldwide. This study aims to estimate the burden of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in adolescents from 1990 to 2021, and to predict diabetes prevalence through 2030.</p><p><strong>Methods: </strong>We extracted epidemiologic data from the Global Burden of Disease (GBD) on T1DM and T2DM among adolescents aged 10-24 years in 204 countries and territories worldwide. This study calculated the age-standardized prevalence rate (ASPR) and age-standardized DALY rate (ASDR) in adolescents based on the world standard population for cross-country comparisons. Average annual percentage changes (AAPC) in age-standardized rate were calculated by linkage point regression. Correlation analyses were used to identify the relationship between age-standardized rate and sociodemographic index (SDI). The Bayesian age-period-cohort (BAPC) model was used to predict changes in the diabetes prevalence among adolescents from 2022 to 2030.</p><p><strong>Results: </strong>In 2021, 3.4 million adolescents were living with T1DM, with an ASPR of 180.96 (95% CI 180.77-181.15), and 14.6 million were living with T2DM, with ASPR of 1190.73 (1190.13-1191.34). As national and territory SDI levels rise, the prevalence rate of T1DM increases (r = 0.44, p < 0.01), and the prevalence rate of T2DM decreases (r = - 0.18, p < 0.01). Compared with males, females had a greater age-standardized prevalence of T1DM (185.49 [185.21-185.76] vs. 176.66 [176.39-176.92]), whereas males had a greater ASPR of T2DM than females did (1241.45 [1240.58-1242.31] vs. 1138.24 [1137.40-1139.09]). This study found a negative correlation between the SDI and the ASDR for both T1DM (r = - 0.51, p < 0.01) and T2DM (r = - 0.62, p < 0.01) in adolescents. For T2DM patients, 32.84% of DALYs were attributed to high BMI, which increased by 40.78% during the study period. By 2030, 3.7 million people are projected to have T1DM, and 14.6 million are projected to have T2DM.</p><p><strong>Conclusions: </strong>Among adolescents, the burden of T1DM and T2DM is increasing and varies by region, sex, and SDI. Therefore, targeted interventions based on regional features are needed to prevent and control adolescent diabetes. Moreover, more efforts are needed to control climate change and obesity to reduce the adolescent diabetes burden.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"48"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar.","authors":"G Anil Kumar, Sibin George, Moutushi Majumder, S Siva Prasad Dora, Md Akbar, Tanmay Mahapatra, Rakhi Dandona","doi":"10.1186/s12916-025-03894-6","DOIUrl":"10.1186/s12916-025-03894-6","url":null,"abstract":"<p><strong>Background: </strong>We synthesised the current evidence in coverage and quality of delivery care, change in neonatal mortality (NMR), and causes of neonatal death in the private sector deliveries in the Indian state of Bihar from 2011 to 2021.</p><p><strong>Methods: </strong>Women aged 15-49 years with livebirths were interviewed in three household surveys involving state-representative samples in 2011, 2016 and 2020-2021 designed to document the coverage of maternal and newborn health services and change in NMR over time. Verbal autopsy interviews were used to assign the cause of neonatal death. The coverage of private sector facilities for livebirths in each survey and the percent change over time by 38 districts in the state and select socio-demographic characteristics, along with trends in NMR and causes of neonatal death across years are reported.</p><p><strong>Results: </strong>Private sector delivery coverage was 17.3% (95% CI = 16.6-17.9), 16.7% (95% CI = 16.2-17.2) and 26.1 (95% CI = 25.6-26.6) in 2011, 2016 and 2020-2021, respectively. A significant increase of 56.3% (95% CI = 49.3 to 63.3) in this coverage was documented between 2016 and 2020-2021 with the highest increase in the lowest wealth index quartile in urban areas. The district-wise coverage of private sector delivery ranged from 4.6% to 34.9%, 5.5% to 40.7%, and 5.9% to 62.0% in 2011, 2016 and 2020-2021, respectively. NMR was estimated at 41.3 (95% CI = 31.4-51.2), 36.6 (95% CI = 29.4-43.8), 38.6 (95% CI = 34.4-43.3) per 1000 livebirths in 2011, 2016 and 2020-2021, with no significant change over the years. Birth asphyxia was the leading cause of death in 2016 (37.8%) and 2020-2021 (33.9%) followed by preterm delivery and neonatal pneumonia; a statistically significant reduction was seen in meningitis/sepsis between 2016 and 2020-2021 (77.8%; 95% CI = - 145.4 to - 10.1).</p><p><strong>Conclusions: </strong>This analysis contributes to a nuanced understanding of the changes in the private sector delivery in a given population over time to facilitate appropriate actions and interventions to improve newborn survival and maternal services.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"50"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual biopsy for non-invasive identification of follicular lymphoma histologic transformation using radiomics-based imaging biomarker from PET/CT.","authors":"Chong Jiang, Chunjun Qian, Qiuhui Jiang, Hang Zhou, Zekun Jiang, Yue Teng, Bing Xu, Xin Li, Chongyang Ding, Rong Tian","doi":"10.1186/s12916-025-03893-7","DOIUrl":"10.1186/s12916-025-03893-7","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to construct a radiomics-based imaging biomarker for the non-invasive identification of transformed follicular lymphoma (t-FL) using PET/CT images.</p><p><strong>Methods: </strong>A total of 784 follicular lymphoma (FL), diffuse large B-cell lymphoma, and t-FL patients from 5 independent medical centers were included. The unsupervised EMFusion method was applied to fuse PET and CT images. Deep-based radiomic features were extracted from the fusion images using a deep learning model (ResNet18). These features, along with handcrafted radiomics, were utilized to construct a radiomic signature (R-signature) using automatic machine learning in the training and internal validation cohort. The R-signature was then tested for its predictive ability in the t-FL test cohort. Subsequently, this R-signature was combined with clinical parameters and SUVmax to develop a t-FL scoring system.</p><p><strong>Results: </strong>The R-signature demonstrated high accuracy, with mean AUC values as 0.994 in the training cohort and 0.976 in the internal validation cohort. In the t-FL test cohort, the R-signature achieved an AUC of 0.749, with an accuracy of 75.2%, sensitivity of 68.0%, and specificity of 77.5%. Furthermore, the t-FL scoring system, incorporating the R-signature along with clinical parameters (age, LDH, and ECOG PS) and SUVmax, achieved an AUC of 0.820, facilitating the stratification of patients into low, medium, and high transformation risk groups.</p><p><strong>Conclusions: </strong>This study offers a promising approach for identifying t-FL non-invasively by radiomics analysis on PET/CT images. The developed t-FL scoring system provides a valuable tool for clinical decision-making, potentially improving patient management and outcomes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"49"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the local-level variations in seasonality of human respiratory syncytial virus infection: a systematic analysis.","authors":"Sheng Ye, Shuyu Deng, Yumeng Miao, David Torres-Fernandez, Quique Bassat, Xin Wang, You Li","doi":"10.1186/s12916-025-03888-4","DOIUrl":"10.1186/s12916-025-03888-4","url":null,"abstract":"<p><strong>Background: </strong>While previous reports characterised global and regional variations in RSV seasonality, less is known about local variations in RSV seasonal characteristics. This study aimed to understand the local-level variations in RSV seasonality and to explore the role of geographical, meteorological, and socio-demographic factors in explaining these variations.</p><p><strong>Methods: </strong>We conducted a systematic literature review to identify published studies reporting data on local-level RSV season onset, offset, or duration for at least two local sites. In addition, we included three datasets of RSV activity from Japan, Spain, and Scotland with available site-specific data. RSV season onset, offset, and duration were defined using the annual cumulative proportion method. We estimated between-site variations within a region using the earliest onset, the earliest offset, and the shortest duration of RSV season of that region as the references and synthesised the variations across regions by a multi-level mixed-effects meta-analysis. Using the three datasets from Japan, Spain and Scotland, we applied linear regression models with clustered standard errors to explore the association of geographical, meteorological, and socio-demographic factors with the season onset and offset, respectively.</p><p><strong>Results: </strong>We included 7 published studies identified from the systematic literature search. With the additional 3 datasets, these data sources covered 888,447 RSV-positive cases from 101 local study sites during 1995 to 2020. Local-level variations in RSV season within a region were estimated to be 6 weeks (41 days, 95% CI: 25-57) for season onset, 5 weeks (32 days, 13-50) for season offset, and 6 weeks (40 days, 20-59) for season duration, with substantial differences across years. Multiple factors, such as temperature, relative humidity, wind speed, annual household income, population size, latitude, and longitude, could jointly explain 66% to 84% and 35% to 49% of the variations in season onset and offset, respectively, although their individual effects varied by individual regions.</p><p><strong>Conclusions: </strong>Local-level variations in RSV season onset could be as much as 6 weeks, which could be influenced by meteorological, geographical, and socio-demographic factors. The reported variations in this study could have important implications for local-level healthcare resources planning and immunisation strategy.</p><p><strong>Trial registration: </strong>PROSPERO CRD42023482432.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"55"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a clinical decision support system to reduce excess driving pressure: the ALARM trial.","authors":"Ursula Burger-Klepp, Mathias Maleczek, Robin Ristl, Bettina Kroyer, Marcus Raudner, Claus G Krenn, Roman Ullrich","doi":"10.1186/s12916-025-03898-2","DOIUrl":"10.1186/s12916-025-03898-2","url":null,"abstract":"<p><strong>Background: </strong>Patients at need for ventilation often are at risk of acute respiratory distress syndrome (ARDS). Although lung-protective ventilation strategies, including low driving pressure settings, are well known to improve outcomes, clinical practice often diverges from these strategies. A clinical decision support (CDS) system can improve adherence to current guidelines; moreover, the potential of a CDS to enhance adherence can possibly be further increased by combination with a nudge type intervention.</p><p><strong>Methods: </strong>A prospective cohort trial was conducted in patients at risk of ARDS admitted to an intensive care unit (ICU). Patients were assigned to control or intervention by their date of admission: First, the control group was included without changing anything in clinical practice. Next, the CDS was activated showing an alert in the patient data management system if driving pressure exceeded recommended values; additionally, data on the performance of the wards were sent to the healthcare professionals as the nudge intervention. The main hypothesis was that this combined intervention would lead to a significant decrease in excess driving pressure.</p><p><strong>Results: </strong>The 472 included patients (230 in the control group and 242 in the intervention group) consisted of 33% females. The median age was 64 years; median Sequential Organ Failure Assessment score was 8. There was a significant reduction in excess driving pressure in the augmented ventilation modes (0.28 ± 0.67 mbar vs. 0.14 ± 0.45 mbar, p = 0.012) but not the controlled mode (0.37 ± 0.83 mbar vs. 0.32 ± 0.8 mbar, p = 0.53). However, there was no significant difference between groups in mechanical power, the number of ventilator-free days, or the percentage of patients showing progression to ARDS. Although there was no difference in progression to ARDS, 28-day mortality was higher in the intervention group. Notably, the mean overall driving pressure across both groups was low (12.02 mbar ± 2.77).</p><p><strong>Conclusions: </strong>In a population at risk of ARDS, a combined intervention of a clinical decision support system and a nudge intervention was shown to reduce the excessive driving pressure above 15 mbar in augmented but not in controlled modes of ventilation.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"52"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial treatment with a single capsule containing half-dose quadruple therapy vs standard-dose dual therapy in hypertensive patients (QUADUAL): a randomized, blinded, crossover trial.","authors":"Xiexiong Zhao, Tao Liu, Qiong Yang, Guoping Yang, Xingli Li, Xiaohong Tang, Jingle Li, Zhongshu Liang, Anying Li, Lixiong Zeng, Juan Wen, Xiaoyan Wang, Liping Peng, Wenjuan Wang, Jingjing Cai, Ye Chen, Miao Huang, Ruixuan Li, Ru Fu, Lin Zhao, Xiaogang Li, Weihong Jiang","doi":"10.1186/s12916-025-03892-8","DOIUrl":"10.1186/s12916-025-03892-8","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recognized dual combination in initial antihypertensive therapy. Studies found that low-dose quadruple combination were superior to monotherapy. However, whether low-dose quadruple therapy is better than dual combination is unknown.</p><p><strong>Methods: </strong>A randomized blinded crossover trial was conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg + metoprolol 23.75 mg + amlodipine 2.5 mg + indapamide 1.25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg + amlodipine 5 mg), both in a single pill, in the initial treatment of patients with mild to moderate hypertension. Patients were randomly assigned in a 1:1 ratio to two crossover sequences. Each sequence received four-weeks of either half-dose quadruple antihypertensives or standard-dose dual antihypertensives, followed by a two-week washout and crossover for four-weeks. Participants and researchers were blinded. The main outcomes were the reduction of blood pressure and safety outcomes. Analyses were per intention to treat.</p><p><strong>Results: </strong>A total of 90 eligible participants were randomized between July 13, 2022, and April 20, 2023. The mean age was 43.88 years (SD 10.31), and 25.6% were women. The mean baseline 24-h blood pressure was 145.59/93.84 mm Hg. Compared to the standard-dose dual treatment, the half-dose quadruple treatment resulted in a further reduction in mean 24-h blood pressure by 4.72/4.17 mm Hg (P < 0.001 for both systolic and diastolic blood pressure), mean daytime blood pressure by 5.52/4.73 mm Hg (P < 0.001 for both), mean nighttime blood pressure by 2.37/2.25 mm Hg (P = 0.034 and 0.014, respectively), and mean office blood pressure by 2.91/1.73 mm Hg (P < 0.001 and 0.014, respectively). Apart from significant increases of fasting blood glucose (P = 0.029) and blood uric acid (P < 0.001) in the half-dose quadruple group, no other adverse events or changes in laboratory values differed significantly between the two treatments.</p><p><strong>Conclusions: </strong>Initiating treatment with half-dose quadruple combination therapy was more effective in lowering blood pressure than standard-dose dual therapy. The safety of half-dose quadruple therapy was comparable.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05377203.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"56"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}