BMJ Open最新文献

Objectives: The primary aim of this research is to uncover the underlying factors that shape hospital selection criteria among individuals in Lebanon.

Design: Cross-sectional study.

Setting: A survey was circulated across social media platforms and messaging applications in Lebanon from February to May 2023. This questionnaire aimed to gauge participants' opinions on the importance of various factors in their hospital selection process.

Participants: A total of 746 participants filled out the survey. We targeted Lebanese adults who were not hospitalised at the time of survey submission.

Main outcome measures: We performed an exploratory factor analysis to examine the underlying structure of our 70-question survey. Reliability analysis was conducted using Cronbach's alpha and McDonald's omega. Factor scores were derived by aggregating raw scores and computing the mean.

Results: The survey results identified eight key factors that accounted for 58.02% of the total variance, with excellent sampling adequacy (Kaiser-Meyer-Olkin=0.921, Bartlett's p<0.001). These factors exhibited good internal consistency, as indicated by Cronbach's alpha values for each factor. Ranked by importance for hospital selection, the factors are: staff qualities (α=0.773), administrative services (α=0.801), reputation (α=0.773), ease of access (α=0.704), room attributes (α=0.796), architectural and physical surroundings (α=0.828), luxury amenities (α=0.849) and affiliation and ownership (α=0.661).

Conclusion: This paper highlights the hospital characteristics that people may value before selecting a hospital. This insight provides an opportunity for hospital managers to refine their services, ensuring better resonance with people's anticipations. Beyond this, it sheds light on areas where hospitals could strategically invest to elevate their competitive edge in the healthcare market.

Introduction: Post-intensive care syndrome (PICS) seriously affects the quality of life of intensive care unit (ICU) survivors, their ability to return to work and society and the quality of life of their families, increasing overall care costs and healthcare expenditures. ICU follow-up services have important potential to improve PICS. However, the best clinical practice model of ICU follow-up service has not been fully defined and its benefits for ICU survivors are not clear. This review will synthesise and map the current types of follow-up services for ICU survivors and summarise the impact of follow-up services on PICS.

Methods and analysis: This scoping review will be conducted by applying the five-stage protocol proposed by Arksey and O'Malley in an updated version of the Joanna Briggs Institute. Eight academic databases including the Cochrane Library, MEDLINE, Web of Science, Embase, EBSCO Academic, CINAHL, PsycInfo and SinoMed (China Biology Medicine) will be systematically searched from inception to the present. Peer-reviewed literature and grey literature will be included. Qualitative, quantitative and mixed methods studies will be included. Studies published in English or Chinese will be included. There will be no time restriction. Two reviewers will screen and select the articles independently and if there is any disagreement, the two reviewers will discuss or invite a third reviewer to make decisions together. Descriptive analysis will be used to conduct an overview of the literature. The results will be presented in a descriptive format in response to the review questions accompanied by the necessary tables or charts.

Ethics and dissemination: Ethical approval is not required for this scoping review because data could be obtained by reviewing published primary study results and do not involve human participants. Findings should be disseminated at scientific meetings and published in peer-reviewed journals.

Introduction: Asthma exacerbations or 'attacks' can vary in severity from mild worsening of symptoms to life-threatening changes that require urgent hospital care. Understanding these exacerbations is crucial to improving treatment and support for patients. Electronic health records (EHR) using anonymised data from people with asthma in primary and secondary care can be used to understand exacerbations and outcomes. However, previous studies found significant heterogeneity in the algorithms used to define asthma exacerbations. Validating definitions of asthma exacerbations in EHR will lead to more robust and comparable evidence in future research.

Methods and analysis: Medline and Embase will be searched for the key concepts relating to asthma exacerbations, EHR and validation. All studies that validate exacerbations of asthma in EHR and administrative claims databases published before 30 May 2024 and written in English will be considered. Validated algorithms for asthma exacerbations or attacks must be compared against a reference or gold standard definition, and a measure of validity must be included. Articles will be screened for inclusion by two independent reviewers with any disagreements resolved by consensus or arbitration by a third reviewer. Study details will be extracted, and the risk of bias will be assessed using a QUADAS-2 tailored to this review.

Ethics & dissemination: No ethical approval is required as this is a review of previously published literature. Results will be disseminated in a peer-reviewed journal with the aim of being used in future research to help identify asthma exacerbation in EHR.

Prospero registration number: CRD42024545081.

Objectives: In Tanzania, only 45% of babies are still exclusively breast feeding at 4-5 months of age and maternal employment contributes to suboptimal breastfeeding practices. The objective of this study was to determine the prevalence and factors associated with exclusive breast feeding up to 6 months among mothers in formal employment in Dar es Salaam, Tanzania.

Design: This was a cross-sectional study.

Setting: The study was conducted at reproductive and child health clinics of three hospitals in Dar es Salaam, Tanzania.

Participants: 327 mothers in formal employment were recruited during their infants' 9-month vaccination visit.

Primary and secondary outcome measures: A self-administered questionnaire was used to collect data on exclusive breast feeding and associated factors. Pearson's χ² was used to test for association and multivariable logistic regression was used to determine independent variables associated with exclusive breast feeding.

Results: The prevalence of exclusive breast feeding up to 6 months was 38.5% (95% CI 33%, 44%). Having rooms to express milk, breastfeeding policies and flexible work schedules were associated with exclusive breast feeding in χ² analysis. In multivariable analysis, mothers who had flexible schedules were two times more likely to practice exclusive breast feeding compared with those who did not have flexible schedules: aOR 2.58 (95% CI 1.15, 5.78).

Conclusion: Rates of exclusive breast feeding among mothers in formal employment are lower than the national average. Policies and programmes that offer flexible work schedules to this population can support exclusive breast feeding.

Objectives: To explore the barriers and facilitators to help-seeking behaviour for symptoms among patients with ovarian cancer in China.

Design: This semistructured interview-based study used a descriptive phenomenological research method.

Setting: The study was conducted in China.

Participants: 17 patients with ovarian cancer were selected based on the principle of maximum differentiation.

Outcome measures and analysis: The study followed the consolidated criteria for reporting qualitative research. Data were analysed using the Colaizzi's seven-step method.

Results: Three main themes were identified: (1) low level of symptom perception and cancer risk awareness: unawareness of early non-specific symptoms, mistaken attribution of symptoms and delay caused by a previous diagnosis of benign tumours; (2) cognitive factors influencing help-seeking behaviour: positive health beliefs, perceived benefits of help-seeking, previous adverse medical experiences, stigma and restrained self-disclosure and medical treatment accompanied by distress and (3) practical factors affecting help-seeking behaviour: time pressure caused by social role burden, financial burden, lack of informal carers and mismatch between medical resources and patients' needs.

Conclusion: This study shows that help-seeking behaviour for symptoms among patients with ovarian cancer is not valued. The importance of early symptom recognition, the psychosocial needs of patients and practical barriers must be considered to develop interventions to promote help-seeking behaviour.

Objectives: The significance of the systemic inflammation response index (SIRI) for predicting prognostic outcomes in patients with non-small cell lung cancer (NSCLC) has been analysed in previous studies, but no consistent conclusions have been obtained. Consequently, the present meta-analysis was performed to identify the significance of SIRI in predicting the prognosis of NSCLC.

Design: This study followed the PRISMA guidelines.

Data sources: PubMed, Web of Science and Embase databases were searched between their inception and 26 November 2023.

Eligibility criteria for selecting studies: Studies investigating the relationship between SIRI and survival outcomes of patients with NSCLC were included.

Data extraction and synthesis: The value of SIRI in predicting prognosis in NSCLC cases was predicted using combined hazard ratios (HRs) and 95% CIs.

Results: Nine articles with 3728 cases were enrolled in this study. Based on our combined data, a higher SIRI value was markedly linked with poor overall survival (OS) (HR=2.08, 95% CI 1.68 to 2.58, p<0.001) and inferior progression-free survival (PFS) (HR=1.74, 95% CI 1.47 to 2.07, p<0.001) of NSCLC. According to the subgroup analysis, country, history and cut-off value did not affect the significance of SIRI in predicting OS and PFS in NSCLC (p<0.05).

Conclusions: A higher SIRI value was significantly associated with both OS and PFS in patients with NSCLC. Moreover, SIRI had a stable prognostic efficiency for NSCLC in various subgroups.

Objectives: Optimising postoperative pain following knee replacement is important for patients, healthcare professionals and healthcare funders. Adductor canal blocks (ACB) are widely used but there is uncertainty about their efficacy when combined with local infiltration analgesia (LIA) compared with either LIA or ACB alone.

Design: A systematic review and meta-analyses of randomised controlled. The primary outcome was pain over the first 72 hours. Secondary outcomes included morphine use, range of movement, distance walked, length of hospital stay, health economic outcomes and reported adverse events.

Data sources: MEDLINE, Embase, EB Health - KSR Evidence, Cochrane Central Register of Controlled Trials, CINAHL, International HTA database, ClinicalTrials.gov and the International Clinical Trials Registry Platform (WHO) were searched up to June 2023.

Eligibility criteria: Randomised controlled trials involving patients undergoing primary total knee replacement comparing LIA combined with ACB to either LIA or ACB alone.

Data extraction and synthesis: All eligible studies were data extracted independently by two reviewers. Studies were pooled for each outcome at each timepoint in a random effects meta-analysis.

Results: We identified 13 completed studies including 1154 participants. 12 studies compared LIA vs combination and 5 compared ACB vs combination. We identified that participants receiving the combination had lower pain scores at rest at 24 hours compared with LIA alone (SMD 0.42, 95% CI 0.20 to 0.64) or ACB alone (SMD 0.63, 95% CI 0.42 to 0.83). Pain on movement at 24 hours was also lower for patients with combination vs LIA alone (SMD 0.37, 95% CI 0.01 to 0.73) or ACB alone (SMD 0.81, 95% CI 0.35 to 1.26). We also identified that patients on combination used less morphine than on LIA alone (MD 1.06, 95% CI -0.09 to 2.20) or ACB alone (MD 5.94, 95% CI -2.41 to 14.29). The same was seen with range of motion at 24 hours with combination having a larger improvement than LIA alone (MD -5.19, 95% CI -5.55 to -4.83) or ACB alone (MD -3.80, 95% CI -4.37 to -3.23). These findings were consistent across all time points; however, there were no studies deemed to be at a low risk of bias.

Conclusions: Further well-designed and conducted randomised controlled trials are needed to confirm if a combination of LIA and ACB is superior to either option alone for patients undergoing primary total knee arthroplasty.

Prospero registration number: CRD42023436895.

Purpose: The FUPEC (Follow-Up Pre-EClampsia) study aims to investigate the presence and development of cardiovascular risk factors, cardiovascular disease, as well as cardiovascular health following a pregnancy complicated by severe pre-eclampsia.

Participants: The FUPEC study is an open-cohort study conducted within routine care at the FUPEC clinic at Erasmus Medical Center in the Netherlands. This clinic is specifically designed for the cardiovascular follow-up of patients who have experienced severe pre-eclampsia. Women with a history of severe pre-eclampsia are invited to the FUPEC clinic at 6 weeks, 3 months, 1 year and every 2 years thereafter postpartum until they are 50 years of age. Clinical and biochemical data are routinely collected, encompassing pregnancy characteristics and outcomes, anthropometric measurements, cardiovascular risk factors, cardiovascular health scores, carotid intima-media thickness-including vascular age and ambulatory blood pressure measurements. Additionally, blood and urine samples are collected and stored in a biobank.

Findings to date: The first patient was enrolled in April 2011. As of March 2024, a total number of 1268 women have been enrolled in the FUPEC study, with an annual enrolment rate of 100-150 new patients. At inclusion, women had a median age of 33.5 years (IQR 30.1-37.9). At their first FUPEC visit, women were a median of 4.9 months (1.9-29.4) after delivery. At the first visit, the median body mass index was 25.7 (IQR 23.0-29.9) kg/m², 23.4% of participants were using antihypertensive medication and 6.4% were smoking. Preliminary analyses of 24-hour blood pressure patterns and carotid intima-media thickness have previously been conducted on a subset of the cohort, with details provided in the 'Findings to Date' section.

Future plans: The FUPEC cohort serves as a robust clinical data source and biobank that can be used for future studies and collaborative research answering, for example, questions on the aetiology, risk factors and short-term and long-term complications of pregnancies complicated by severe pre-eclampsia. Since the FUPEC cohort is integrated with routine care, there is no strict completion of data collection, allowing for flexible data acquisition.

Objective: This study explores the cost-effectiveness of atezolizumab monotherapy compared with chemotherapy as first-line treatment for stage IIIB or IV non-small cell lung cancer (IIIB/IV-NSCLC) ineligible for platinum-based chemotherapy from a US payer perspective.

Design: This is based on the IPSOS clinical trial. We conducted a comprehensive assessment of the cost-effectiveness of atezolizumab monotherapy versus single-agent chemotherapy over a 15-year duration. Employing a robust Markov model incorporating data from 453 patients, we calculated total costs, life-years (LYs), quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of $150 000 per QALY. We performed one-way, two-way and probabilistic sensitivity analyses to validate our model.

Setting: The US payer perspective.

Participants: A cohort with NSCLC ineligible for treatment with a platinum-containing regimen from IPSOS clinical trial.

Interventions: Atezolizumab monotherapy versus chemotherapy.

Primary outcome measure: Cost, QALYs, LYs and ICER.

Result: Chemotherapy resulted in an average survival of 0.930 QALYs (1.528 LYs) per patient at an average cost of $67 579. Atezolizumab treatment provided an additional 0.309 QALYs but incurred an extra cost of $66 472, leading to an ICER of $215 069 per QALY compared with chemotherapy. The cost of atezolizumab had the most significant impact on the model outcomes. Probabilistic sensitivity analysis showed that atezolizumab had a 30.2% probability of being considered cost-effective at a WTP threshold of $150 000 per QALY in the USA. These results remained consistent across various scenarios and sensitivity analyses employing both deterministic and probabilistic approaches.

Conclusion: The current price of atezolizumab renders it an unlikely cost-effective treatment option for patients with IIIB/IV-NSCLC from the payer's perspective in the USA. To achieve cost-effectiveness, substantial discounts are necessary.

Trial registration number: The IMpower-110, an open-label, randomised, phase 3 clinical trial (NCT02409342). The IPSOS clinical trial (NCT03191786).

Objectives: To appraise and synthesise qualitative literature identifying: (a) fathers' concerns and challenges during the transition to fatherhood that may be impacting mental health and well-being experiences; and (b) fathers' experiences of antenatal programmes, and psychological and social support, to understand how we can better support fathers in addressing these concerns.

Design: International, qualitative evidence synthesis, scoping review.

Data sources: Six electronic databases (Medline, Embase, PsycINFO, CINAHL, Scopus, ASSIA) alongside 'grey' and supplementary searches were conducted March 2024.

Eligibility criteria: Qualitative studies and qualitative data extracted from mixed methods studies focusing on fathers' mental health within the perinatal period globally were included.

Data extraction and synthesis: The recommended Joanna Briggs Institute data extraction and critical appraisal tools were used, and an inductive thematic synthesis approach employed.

Results: 37 qualitative studies were included: UK (n=11), Europe (n=9), Australia (n=7) and Asia (n=6), USA (n=1), Canada (n=1) and the Middle East (n=2). Quality appraisal scores were moderate to high (5-10). Four analytical themes and eight subthemes were generated: (1) diminished partner relationship, (2) provider or protector? Multiplicity of fatherhood identification, (3) forgotten entity within the perinatal experience and (4) "I try to battle it myself," masculine ideals within fatherhood. The findings highlighted that fathers found the transition to be difficult, compounded by insecurity within their role as both partner and father. Fathers found a paucity of paternally focused support and antenatal programmes, not addressing fathers' needs within the transition.

Conclusions: The many concerns and challenges highlighted in the review demonstrate the importance of understanding the negative impact of the transition on fathers' mental health and well-being. There is a need for greater attention to fathers' experiences of paternal perinatal support and programmes through research and practise to inform future interventional development.

Trial registration: PROSPERO: CRD4202231381.