BMJ Open最新文献

Objectives: Cancer in adolescents and young adults (AYAs; ages 15-39 years) is a rising global epidemic. Yet, AYAs remain an understudied population, and little is known about what research topics should be prioritised according to those with lived experience. The AYA Cancer Priority Setting Partnership (PSP) was established to identify the top 10 research priorities for AYA cancer in Canada according to patients, caregivers, and clinicians.

Design: This project followed the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology that included two national cross-sectional surveys and a final priority setting workshop following an adapted nominal group technique.

Setting: A national sample was recruited to participate from across Canada.

Participants: Participants were patients, caregivers, and clinicians with lived personal and/or professional experience of AYA cancer in Canada.

Outcome measures: In the first survey, open-ended responses were collected from participants about questions they would like answered by research. Responses were collated into overarching summary questions and a literature search was undertaken to verify if questions were true uncertainties and not fully answered by existing evidence. Unanswered questions were ranked by participants in a second survey. The top-ranked questions were prioritised through consensus at the final priority setting workshop. The final outcome was the top 10 priorities for AYA cancer research in Canada.

Results: In the initial survey, 1916 potential research questions were submitted by 275 patients, caregivers, and clinicians. Following data processing, summary question formation, and the evidence check, 58 questions were put forward for interim prioritisation in a second survey (n=285 patients, caregivers, and clinicians). The top 20 questions from the interim prioritisation were ranked at the final priority setting workshop attended by a diverse group of 23 patients, caregivers and clinicians from across Canada. The resulting top 10 priorities reflect topics across the cancer continuum including: diagnostic delays, screening and early detection, novel therapies, psychosocial impacts, end-of-life concerns, and survivorship issues.

Conclusions: This patient-directed research agenda will guide researchers, funding agencies, and policymakers to ensure that future research is aligned with what matters most to the AYA cancer community.

Objectives: To evaluate the longitudinal association between medication adherence and glycaemic control among patients with Type 2 diabetes (T2D) in Luzhou City, identify modifiable factors and provide actionable evidence to inform targeted diabetes management strategies.

Design: Retrospective cohort study.

Setting: Western China.

Participants: Data from 30 508 T2D patients in the Luzhou City Health Information Management System (2018-2023).

Primary and secondary outcome measures: Primary outcome measure: glycaemic control rate.

Secondary outcome measures: medication adherence, hypertension comorbidity and lifestyle factors.

Results: Patients with consistent adherence achieved significantly higher glycaemic control rates (39.6%, 95% CI 38.8% to 40.4%) compared with intermittent adherents (20.8%, 95% CI 19.9% to 21.7%, p<0.001). Poor adherence to medical advice is a major barrier to effective blood glucose control, particularly among intermittent adherents, reducing their success rate by 29.4% (adjusted odds ratio (aOR)=0.706, 95% CI 0.643 to 0.774). Conversely, male gender (aOR=0.879, 95% CI 0.813 to 0.950) and higher educational attainment (aOR=1.004, 95% CI 1.002 to 1.007) were positively associated with glycaemic control. Additionally, temporary residence status provided a marginal benefit (aOR=1.064, 95% CI 1.013 to 1.117), suggesting potential disparities in access to medical resources between urban and rural areas.

Conclusions: While medication adherence remains fundamental for glycaemic control, its association with glycaemic control varied according to hypertension comorbidity and lifestyle factors. These findings advocate for integrated care models that simultaneously address cardiovascular risk factors and promote behavioural modifications, particularly in resource-constrained settings experiencing rapid epidemiological transitions.

Objectives: To assess the relation between component rotation in total knee replacement and clinical outcomes.

Design: Prospective, observational cohort study.

Setting: Deventer hospital, Deventer, The Netherlands.

Participants: 498 adults aged 18 years and older undergoing total knee replacement.

Interventions: Participants underwent Persona posterior stabilised total knee replacement. Femoral and tibial component rotation was measured using low-dose CT scans.

Main outcome measures: The primary outcome was the change in Oxford Knee Score from baseline to 1 year, analysed in relation to femoral, tibial and combined component rotation.

Results: Binary logistic regression analysis showed no statistically significant association between femoral component rotation (OR=1.04, 95% CI 0.89 to 1.21, p=0.644), tibial component rotation (OR=0.99, 95% CI 0.94 to 1.03, p=0.467), or combined rotation (OR=0.99, 95% CI 0.95 to 1.03, p=0.552), and achievement of the minimal clinically important difference of 5 points for the 48-point Oxford Knee Score.

Conclusions: This prospective study of 498 patients undergoing total knee replacement did not provide evidence of a relation between the rotational alignment of total knee arthroplasty components and clinical outcomes. These findings do not support routine evaluation of rotational alignment as a basis for revision surgery in patients with persistent pain in the absence of mechanical problems.

Trial registration number: Dutch Trial registry ID: 23362.

Objectives: To investigate whether women who experienced pelvic girdle pain (PGP) during pregnancy were able to engage in meaningful activities at 4 months and 3 years post partum, and to identify factors associated with long-term functional outcomes.

Design: Long-term follow-up of a randomised controlled trial comparing acupuncture and transcutaneous electrical nerve stimulation for pregnancy-related PGP.

Setting: Physiotherapy outpatient clinics in Sweden.

Participants: In total, 113 pregnant women with clinically verified PGP were randomised in the original trial; 86 participated in the initial study phase, 77 attended the 4-month follow-up and 57 completed the 3-year follow-up questionnaire.

Primary and secondary outcome measures: The primary outcome was functioning, assessed using the Patient-Specific Functional Scale (PSFS). Secondary outcomes included self-reported PGP, overall functioning and the prognostic value of pelvic pain provocation tests at 4 months post partum for persistent PGP at 3 years.

Results: 3 years post partum, the mean PSFS score was 8.64, and 45.6% of the participants scored 10, indicating full return to baseline activities. In repeated linear regression analyses, estimated PSFS scores were approximately 3 points lower at baseline and post-treatment compared with the 3-year follow-up (both p<0.001), indicating improved functioning over time, with no differences between treatment groups. Higher pain-related concern and higher Pelvic Girdle Questionnaire scores were associated with greater activity limitations (estimate -0.21, p=0.019 and -0.06, p<0.001, respectively). Logistic regression showed that the number of positive pelvic provocation tests at 4 months post partum significantly predicted self-reported PGP at 3 years (OR 2.98, 95% CI 1.26 to 7.05, p=0.013).

Conclusions: Most women with pregnancy-related PGP regained functioning by 4 months post partum, and this recovery was sustained at 3 years. The number of positive pelvic provocation tests at 4 months post partum predicted persistent pain at 3 years, suggesting potential prognostic value for identifying women at risk of long-term PGP and informing postpartum follow-up strategies.

Trial registration number: In 'FoU i Sverige' (R&D in Sweden) No. 12726. https://www.researchweb.org/is/sverige/project/127261.

Objectives: To translate and culturally adapt six self-report measures for depression, anxiety, post-traumatic stress disorder (PTSD) and somatic symptom disorder into Hindi and determine their diagnostic accuracy against a diagnostic clinical interview.

Design: Cross-sectional validation study.

Setting: Rural Kangra, Himachal Pradesh, northern India.

Participants: 480 perinatal (pregnant or within 12 months postpartum) and non-perinatal (not currently pregnant and not given birth within 12 months) women at one tertiary hospital and district-level Anganwadi (community health) centres.

Primary and secondary outcome measures: Symptom endorsement; and discriminant validity, sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) of the Kessler Scale of Psychological Distress (K10), Patient Health Questionnaire (PHQ9), Edinburgh Postnatal Depression Scale (EPDS), Generalised Anxiety Disorder Scale (GAD7), Perinatal Anxiety Screening Scale (PASS), PTSD Checklist (PCL-5) and Scale for the Assessment of Somatic Symptoms (SASS).

Results: Complete data were available for 443 participants. Tiredness and body weakness were the most commonly endorsed symptoms among participants with common mental disorders. Among perinatal participants, the AUROC was highest for the GAD7 (0.88, 95% CI 0.79 to 0.96) and SASS (0.84, 95% CI 0.71 to 0.96). Among non-perinatal participants, the AUROC was highest for the SASS (0.92, 95% CI 0.88 to 0.97) and PHQ9 (0.91, 95% CI 0.86 to 0.96).

Conclusions: Measures which assess for fatigue, tiredness and somatic symptoms may help to identify women experiencing common mental disorders in this setting. Small numbers of participants with clinically diagnosed mental disorders in our sample mean results must be interpreted cautiously.

Trial registration number: NCT05485701.

Objective: To explore the association between COVID-19 bed utilisation and changes in rehabilitation service provision in Japan, focusing on cerebrovascular, musculoskeletal and respiratory rehabilitation in the pre-COVID-19, during-COVID-19 and post-COVID-19 periods.

Design: Retrospective study using seasonal autoregressive integrated moving average model to predict expected values, which were compared with actual values to calculate observed-to-expected (OE) ratios.

Setting: Acute care hospitals in Kanagawa Prefecture, which has the second largest population in Japan after Tokyo, covering April 2014 to March 2024.

Participants: Patients aged 0-74 years who were enrolled in the National Health Insurance of Kanagawa Prefecture and underwent the studied types of rehabilitation.

Exposure: COVID-19 pandemic waves and associated bed utilisation rates, with multiple distinct peaks.

Outcome measures: The difference between the predicted and actual values of the volume of rehabilitation services provided and the number of patients per insured person calculated as OE ratios during periods of peak bed utilisation for COVID-19.

Results: The OE ratio of inpatient rehabilitation services for cerebrovascular showed a significant decrease after five waves at -14.3%, and musculoskeletal conditions showed a similar decline during periods of high COVID-19 bed utilisation. Outpatient services experienced sharp declines initially but showed differential recovery patterns. Respiratory rehabilitation displayed unique patterns, with inpatient services increasing up to 62.4% above expected levels until September 2021, before sharply declining. By March 2024, musculoskeletal rehabilitation demonstrated complete recovery, cerebrovascular rehabilitation showed partial recovery, while respiratory rehabilitation exhibited mixed patterns with persistent outpatient deficits.

Conclusions: Rehabilitation services in Japan showed substantial changes associated with the COVID-19 pandemic, with inpatient services for cerebrovascular and musculoskeletal conditions being particularly vulnerable to disruptions during high COVID-19 bed utilisation periods. The differential recovery patterns across rehabilitation types, with some structural changes persisting beyond the acute pandemic phase, indicate the need for flexible healthcare systems to deal with future healthcare crises. These findings underscore the importance of developing strategies to maintain essential rehabilitation services during public health emergencies, especially considering the ageing global population and rising demand for rehabilitation.

Introduction: Adverse neurological complications, including postoperative delirium (POD) and stroke, remain one of the major risks after cardiac surgery. A lack of comprehensive knowledge about their causes and neuroprotective strategies has hindered the development of effective interventions to reduce these events. Personalised cerebral autoregulation (CA)-oriented blood pressure monitoring aims to identify blood pressure targets tailored to each individual patient, thereby reducing brain injury. The PRECISION study aims to assess whether perioperative duration and magnitude of mean arterial pressure (MAP) deviation from an individual's CA limits are associated with adverse neurological complications.

Methods and analysis: This international, multicentre, prospective cohort study is conducted at two Swiss and one British hospital. Patients aged 65 years or older undergoing elective primary or re-operative coronary artery bypass graft and/or valvular and/or ascending aorta surgery requiring cardiopulmonary bypass are included. Preoperatively, the patient's baseline of physical, cognitive and mental status is established. Intraoperatively, near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) are recorded in real-time to generate NIRS-derived and TCD-derived CA indices. The primary endpoint is POD, assessed daily on postoperative days 0 to 7 or up to discharge, whichever occurs earlier with the 3D-Confusion Assessment Method (3D-CAM) or CAM-Intensive Care Unit. Secondary endpoints include a composite neurological outcome of POD and overt stroke, postoperative neurocognitive disorders, major morbidity and mortality. Associations between neurologic outcomes, neurobiomarkers and genetic variation will be explored.A total of 500 participants is required to achieve 90% power to find a statistically significant effect of the area under the curve MAP

Ethics and dissemination: Ethical approval has been obtained from all responsible ethics committees (Swiss lead ethics committee EKNZ 2022-01457 and Health Research Authority and Health and Care Research Wales, UK, REC 23/SW/0076). Results will be disseminated at national and international conferences and published in peer-reviewed journals.

Trial registration number: NCT05595954.

Objectives: To identify multifactorial contributors to treatment-seeking delays among Chinese young and middle-aged stroke patients using socioecological model.

Design: Descriptive phenomenological interview study.

Setting: A tertiary hospital in China.

Participants: Twenty acute stroke patients with treatment-seeking delays and 16 family members were recruited for dyadic semistructured interviews.

Primary and secondary outcome measures: Barriers influencing treatment-seeking delays across individual, interpersonal and systemic levels. And how do interlevel interactions shape decision-making trajectories?

Results: Data analysis revealed 5 overarching themes encompassing 12 subthemes: (1) limited stroke-specific health literacy; (2) psychological barriers at symptom onset; (3) inadequate interpersonal support systems; (4) structural impediments to timely care; (5) decision-making dynamics across levels. Delay was characterised as a sequential cascade mediated by cognitive misattribution, emotional paralysis, relational dependency, institutional constraints and cross-level feedback loops. Two dominant pathways, silent progression and diverted seeking, were identified.

Conclusion: Treatment-seeking delay among young and middle-aged stroke patients arises through dynamic interactions across socioecological strata rather than isolated factors. Integrated interventions targeting public awareness, familial preparedness, workplace policies and healthcare accessibility are required to disrupt this cascade.