BMJ Open最新文献

Introduction: For several years, studies have been conducted on the contribution of social robots as an intervention tool for children with autism spectrum disorder (ASD). One of the early intervention models recommended by the French National Authority for Health is the Early Start Denver Model, an individualised, intensive programme based on play activities chosen by the child. While studies published in recent years suggest that robots provide benefits for autistic children in learning social interactions within a clinical setting, there is no scientific consensus on the widespread contribution and maintenance of their effects over time. On the other hand, a robotic solution controlled directly by a practitioner (ie, on-site telepresence system) enables greater adaptability to children's responses and choices during interventions. We believe that such a solution would enable better assessment of progress in the fundamental skills of expressive communication and imitation as well as greater engagement during interventions.

Methods and analysis: This is a prospective, monocentric, descriptive and evaluative pilot study based on single-case experimental design (SCED) methodology. The study will recruit eight children diagnosed with ASD aged between 2 and 5 years. The intervention will take place 15 min after the usual weekly care. The SCED methodology is constructed in three stages: (A) 4 weekly sessions at baseline without the robot, (B) 9 weekly sessions with intervention modification using a social robot as cotherapist and (C) 4 weekly sessions without the robot for follow-up.

Ethics and dissemination: Ethical approval was obtained from the South East IV Ethics Committee (CPP Sud-Est IV) (number: 2023-A00895-40) in France. Explicit consent is required from all legal representatives (parents) of children participating in this study. We aim to disseminate the results of this study through national and international conferences, international peer-reviewed journals and social media.

Trial registration number: NCT05991791.

Objectives: Due to prognostic uncertainty and limited decision-making capacity, the choice to perform transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and comorbid dementia is challenging. This study explores older adults' perspectives on complex decision-making preceding TAVI in the hypothetical setting of comorbid dementia.

Design: Qualitative study entailing semistructured interviews. Analysis was by systematic text condensation. The interview guide addressed their attitudes regarding treatment dilemmas before TAVI in patients living with dementia.

Setting: Patients were recruited from the TAVI outpatient clinic at a university hospital performing TAVI.

Participants: A purposive sample of 10 older adults (5 women) with AS and without dementia (range 77-94 years), where 8/10 had undergone TAVI were included.

Results: Three main challenges were identified: (1) Risk assessment. Participants found it hard to compare the burden of aortic stenosis vs dementia. They acknowledged the dilemma of implanting a new heart valve to achieve symptom relief while risking severe dementia in the future due to prolonged life span. (2) Autonomous capacity. A profound uncertainty was described regarding who should participate in decision-making if the person was incapacitated due to dementia. (3) Customised information. Participants advocated for thorough information describing facts and uncertainty, aiming to protect and support the person living with dementia.

Conclusion: Older adults with severe aortic stenosis find it hard relating to dilemmas arising from providing TAVI in patients living with dementia. There is a need for tailor-made information to support autonomy and decision-making under uncertainty.

Objectives: There is evidence that general practitioners (GPs) can increase the uptake of weight management programmes that enhance weight loss compared with self-directed efforts, but the rate at which they do so is unclear. This study examined the prevalence of weight control efforts and practices, the reported frequency and impact of receipt of GP advice on weight loss attempts and perceptions of the appropriateness of health professionals delivering weight loss advice.

Design: A nationally representative cross-sectional survey.

Setting: England.

Participants: 1722 adults (≥16 years) surveyed in October 2018 (mean (SD) age=47.4 (19.2), 51.1% women).

Main outcome measures: Weight control efforts and practices, whether a GP gave advice or a specific referral/prescription medication, perception of the appropriateness of GP weight loss advice.

Results: Two-thirds (64.7% (95% CI 58.1% to 71.3%)) of people with obesity reported trying to lose weight. Of people with obesity who visited their GP in the past year, 40% (95% CI 32.2% to 47.7%) recalled receiving any advice on weight loss: 30.8% (95% CI 23.5% to 38.2%) general advice and 9.2% (95% CI 4.6% to 13.7%) a referral to a weight loss service or prescription medication for weight loss. Having received weight loss advice from a GP was strongly associated with a greater likelihood of trying to lose weight (general advice: OR_adj=4.49, 95% CI 2.52 to 8.00; referral/medication: OR_adj=9.25, 95% CI 2.65 to 32.3). Views on whether health professionals should deliver weight loss advice were mixed, with a substantial minority (19.4% (95% CI 17.5% to 21.4%)) finding it unacceptable. People with a BMI outside of the healthy weight range (underweight/overweight/obesity), women and those from more disadvantaged social grades were less likely to find it acceptable.

Conclusions: Most people with obesity reported trying to lose weight but less than half recalled receiving advice on weight loss from their GP in the past year and few were referred to community weight-loss programmes. Those who recalled receiving GP advice on weight loss were substantially more likely to report taking action to lose weight. One in five people thought GP advice on weight loss was inappropriate.

Objective: Pilot and feasibility studies are intended to ensure that subsequent randomised controlled trials (RCTs) are feasible, economical and rigorous, especially in a challenging research environment such as emergency medicine (EM). We aimed to evaluate the methodological quality in conducting and reporting randomised pilot and feasibility studies in the EM literature and propose recommendations to improve their quality.

Design: Methodological systematic review.

Data sources and eligibility: We searched MEDLINE and Embase (2018-29 September 2023) for pilot or feasibility RCTs published as full texts in the five top-ranked and other first-quartile EM journals according to Scimago.

Data extraction and analysis: We assessed their methodological features and reporting quality primarily based on the Consolidated Standards of Reporting Trials (CONSORT) extension.

Results: A total of 24 randomised trials identified as pilot (n=13), feasibility (n=3) or both (n=8) were included. At least one feasibility outcome was assessed in 9 trials (feasibility trials), while 15 others only focused on treatment efficacy (efficacy trials). Only three (12.5%) studies progressed to the main trials. Among 12 feasibility trials, 55.6% reported their outcomes with uncertainty estimates, and 33.3% had clear progression criteria. Efficacy trials tended to draw clinical implications on their results. Studies from the five top-ranked journals had better methodological and reporting quality than those from other first-quartile journals.

Conclusion: Main methodological concerns for pilot and feasibility studies in first-quartile EM literature include misconceptions, misuses and suboptimal design and reporting quality. These issues were more prominent in lower-ranked first-quartile journals. Our findings highlight the need for resources and training for researchers, journal editors and peer reviewers on the value, objectives and appropriate conduct of pilot and feasibility studies. The conceptual framework and standardised methodological components should be emphasised. EM journals should reinforce the reporting standards and support their publication. These actions can lead to more methodologically rigorous pilot and feasibility studies in EM.

Prospero registration number: CRD42023468437.

Objectives: To assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.

Design: An institution-based, cross-sectional survey was carried out from July to August 2023.

Setting: 10 governmental teaching hospitals in Tehran, Iran.

Participants: The study participants comprised a random sample of 186 nurses and 90 physicians who had worked for at least 6 months in their current hospitals.

Outcome measures: The primary outcome measures were mean and SD scores for individual items and the nine main patient safety domains assessed by the Attitudes Toward Patient Safety Questionnaire-III. The secondary outcome measure was the proportion of physicians and nurses who responded positively to each item, expressed as percentages for each group.

Results: Physicians and nurses exhibited moderately positive attitudes towards patient safety (mean scores of 3.79±0.33 and 3.83±0.36, respectively). Both professional groups reported the most positive attitudes in the same dimensions: 'team functioning' and 'working hours as a cause for error' (mean scores of >4 out of 5). Conversely, the lowest scores were observed in 'importance of patient safety in the curriculum', indicating potential gaps in their understanding of patient safety (mean scores of <3.5 out of 5). Physicians displayed significantly more positive attitudes in the domain of 'error inevitability', while nurses held more positive attitudes in 'error reporting confidence' and 'disclosure responsibility' (p<0.05). Multiple linear regression analysis demonstrated that the factors associated with more positive attitudes towards patient safety included lower workload (B=0.131; 95% CI 0.047 to 0.215; p=0.002), reporting of adverse events (B=0.100; 95% CI 0.009 to 0.191; p=0.030) and receiving patient safety training (B=0.134; 95% CI 0.019 to 0.249; p< 0.023).

Conclusion: Both professional groups demonstrated moderately positive attitudes towards patient safety. However, the findings highlighted the need for future patient safety training to prioritise enhancement of healthcare professionals' understanding of medical errors. Such training initiatives should be engaging and directly relevant to the specific needs of both nurses and physicians, ensuring its perceived value to their ongoing professional development. Furthermore, fostering a supportive and blame-free environment that encourages the reporting of medical errors is crucial.

Objective: To compare the risk of hospitalisation for conditions originating in the perinatal period between children conceived via assisted reproductive technology and those that are naturally conceived, differentiating by treatment type.

Study design, setting and participants: Population-based record-linkage study of children born after assisted reproduction in the UK between 2002 and 2009 (n=44 618), their naturally conceived siblings (n=8462) and matched naturally conceived population (n=89 072) controls linked to their hospital inpatient records up to 31 March 2016.

Primary and secondary outcome measures: Robust estimates of the overall and cause-specific risk of hospital admission for adverse perinatal events and the comparison of outcomes by type of treatment.

Results: Over the study period, 17 132 (38.40%) children conceived via assisted reproduction and 30 306 (34.02%) and 1738 (20.54%) naturally conceived population and sibling controls, respectively, were admitted to the hospital for severe perinatal events. Compared with the population controls, singletons (Risk ratio (95% CI 1.30 (1.26, 1.34))) and twins (1.01 (0.99, 1.03)) conceived via assisted reproduction exhibited a higher risk of hospitalisation for any adverse perinatal event. However, no such increase was observed in the within-sibling analysis (0.97 (0.84, 1.12)). Similar patterns were seen for diagnoses related to length of gestation and fetal growth (vs population controls: 1.37 (1.29, 1.46); vs siblings: 1.17 (0.86, 1.60)); birth trauma (vs population controls: 1.23 (1.04, 1.44); vs siblings: 0.78 (0.47, 1.30)); respiratory and cardiovascular disorders (vs population controls: 1.28 (1.20, 1.38); vs siblings: 0.72 (0.53, 0.98)); infections (vs population controls: 1.30 (1.06, 1.59); vs siblings: 0,68 (0.24, 1.90)) and several other conditions. Associations were similar when comparing in vitro fertilisation to intracytoplasmic sperm injection and were higher when comparing fresh to frozen embryo transfers.

Conclusion: Children conceived via assisted reproduction showed modest increases in the risk of hospitalisations for severe perinatal events when compared with population controls, although these findings were attenuated in the sibling analyses. The imprecision of within-sibling analyses highlights the need for larger studies to explore potential causal effects.

Objectives: This systematic review aims to identify, appraise and synthesise the findings of published qualitative research exploring the barriers and facilitators to self-management of chronic conditions reported by women.

Design: A systematic literature review and thematic synthesis of qualitative studies.

Data sources: A search of MEDLINE, CINAHL, Embase and PsycInfo was undertaken using the search terms 'Women', 'Woman' 'Female,' 'Chronic', 'Long-term', 'Disease', 'Illness', 'Condition' 'Health,' 'Self-management,' 'Qualitative,' 'Barrier' and 'Facilitator'. A hand search for literature was also performed.

Eligibility criteria: Studies published before 2005 and those not in English were excluded.

Data extraction and synthesis: Extracted data were analysed thematically and emerging and recurring themes identified. Themes were mapped to the six components of the COM-B model. Critical appraisal of included publications was undertaken using the CASP (Critical Appraisal Skills Programme) qualitative checklist and finding weighted on quality.

Results: Eighty-four publications were identified and eligible for inclusion within the review. Studies were conducted in five continents, with a focus on 20 different chronic conditions and included a total of 1788 women. Barriers and facilitators to physical capability, psychological capability, physical opportunity, social opportunity, autonomic motivation and reflective motivation were identified with a number of recurring themes found. Self-prioritisation, support and culture all had a significant impact on whether women followed self-management recommendations. Certain groups of women such as those living remotely, those with financial difficulties, migrants and those who do not speak the predominant language appear to face additional barriers to self-management.

Conclusions: This review highlights that to self-manage chronic conditions women have to overcome various cultural, financial and social barriers. Self-management programmes should be designed taking into account these factors in order to ensure women are better supported and enabled to improve their health outcomes.

Objectives: This study developed and investigated the possibility of using the walking and turning test (WTT) to indicate fall risk in community-dwelling older adults.

Design: Retrospective diagnostic study.

Setting: The study was carried out in a community setting.

Participants: The study focused on community-dwelling older Thai adults.

Primary and secondary outcome measures: The participants were assessed based on demographics, fear of falls using a 'yes/no' question and the Short Falls Efficacy Scale International, as well as fall data in the previous 6 months. The participants then performed the WTT, timed up and go test, five times sit-to-stand test and handgrip strength test (HG) in random order.

Results: There were a total of 86 participants with an average age of 69.95±6.10 years (range from 60 to 88 years), most of whom were female (67.44%). 40 participants (46.51%) reported that they had fallen at least once in the previous 6 months. A comparison of various physical ability tests revealed significant differences between faller and non-faller participants (p<0.001). The outcomes of the WTT showed significant correlations with fall variables, balance and muscle strength (0.394 to 0.853, p<0.001). Based on sensitivity, specificity and area under the curve, the cut-off score of 6.40 s showed the highest level of ability to indicate falls among community-dwelling older adults, with a sensitivity of 92.50% and a specificity of 78.26%.

Conclusions: The study suggests the clinical usefulness of the WTT in determining falls in older individuals. WTT is a physical ability measurement that indicates balance ability and muscle strength. The test is practical, requires little space and equipment and can be used in large populations.

Introduction: Optimal adherence to recommended diets is crucial to achieving long-term glycaemic control among individuals with type 2 diabetes (T2D) individuals. However, there is limited evidence on the effectiveness of interventions that target dietary adherence through social networks. Since social networks can influence individuals' health behaviours, it is important to thoroughly evaluate the impact of social network interventions on dietary adherence in adults with T2D. This systematic review protocol aimed to provide insights into future interventions and improve diabetes management strategies.

Method and analysis: PubMed, Embase, CINAHL Complete, Cochrane Central Register of Controlled Trials, ProQuest Dissertations and Theses and Google Scholar will be searched from inception to December 2023 for relevant randomised and non-randomised controlled trials of at least 3 months' duration. In addition, studies that compared interventions involving the social networks (families, friends and peers) of adults with T2D with usual care, no intervention or an intervention with no explicit social network component will be included. Two reviewers will independently screen search outputs according to inclusion and exclusion criteria, critically evaluate the selected literature and extract data on the study setting, design, participants' characteristics, interventions, controls, social network functions and duration of follow-up, using a standard data extraction form. Quantitative data analysis will be performed where studies are homogeneous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesised using narrative synthesis. Finally, trials will be assessed for bias risk and overall evidence certainty using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Ethics and dissemination: Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

Prospero registration number: CRD42023441223.