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Self-reported sexually transmitted infections and associated factors among sexually active men in East Africa: a multilevel analysis of recent demographic and health surveys.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-085628
Yohannes Mekuria Negussie, Bezawit Melak Fente, Zufan Alamrie Asmare, Angwach Abrham Asnake, Meklit Melaku Bezie, Hiwot Atlaye Asebe, Beminate Lemma Seifu

Background: Sexually transmitted infections (STIs) are a significant global health challenge, demanding attention and intervention. Despite many STIs being manageable, their asymptomatic nature poses a formidable threat to both mental and physical well-being. This silent impact can lead to substantial morbidity and mortality, which is particularly pronounced in East Africa.

Objective: To investigate the prevalence and factors associated with self-reported STIs among sexually active men in East Africa.

Design: Cross-sectional study design.

Setting: 10 East African countries.

Participants: 66 833 sexually active men.

Primary outcome measure: Self-reported STI in the 12 months preceding the survey. A multilevel mixed-effects logistic regression model was fitted to identify factors associated with self-reported STIs. An adjusted OR with the corresponding 95% CI was used to estimate the strength of the association, and statistical significance was set at a p value <0.05.

Results: The pooled prevalence of self-reported STIs among sexually active men in East Africa was 5.22% (95% CI: 5.34, 5.69). Being married, having multiple sexual partners excluding a spouse and being informed about STIs were significantly associated with higher odds of self-reported STIs. However, being aged 44 years and above, having a higher education level, starting sex after the age of 20, being circumcised and being a rural resident were associated with lower odds of self-reported STIs.

Conclusion: The prevalence of self-reported STIs was higher than the findings from most previous studies. It is essential to educate men about STIs and increase awareness of the risks associated with having multiple sexual partners. Implementing targeted public health initiatives for men with lower education levels, as well as devising strategies to address factors that elevate the risk of STI contraction, is also crucial.

{"title":"Self-reported sexually transmitted infections and associated factors among sexually active men in East Africa: a multilevel analysis of recent demographic and health surveys.","authors":"Yohannes Mekuria Negussie, Bezawit Melak Fente, Zufan Alamrie Asmare, Angwach Abrham Asnake, Meklit Melaku Bezie, Hiwot Atlaye Asebe, Beminate Lemma Seifu","doi":"10.1136/bmjopen-2024-085628","DOIUrl":"10.1136/bmjopen-2024-085628","url":null,"abstract":"<p><strong>Background: </strong>Sexually transmitted infections (STIs) are a significant global health challenge, demanding attention and intervention. Despite many STIs being manageable, their asymptomatic nature poses a formidable threat to both mental and physical well-being. This silent impact can lead to substantial morbidity and mortality, which is particularly pronounced in East Africa.</p><p><strong>Objective: </strong>To investigate the prevalence and factors associated with self-reported STIs among sexually active men in East Africa.</p><p><strong>Design: </strong>Cross-sectional study design.</p><p><strong>Setting: </strong>10 East African countries.</p><p><strong>Participants: </strong>66 833 sexually active men.</p><p><strong>Primary outcome measure: </strong>Self-reported STI in the 12 months preceding the survey. A multilevel mixed-effects logistic regression model was fitted to identify factors associated with self-reported STIs. An adjusted OR with the corresponding 95% CI was used to estimate the strength of the association, and statistical significance was set at a p value <0.05.</p><p><strong>Results: </strong>The pooled prevalence of self-reported STIs among sexually active men in East Africa was 5.22% (95% CI: 5.34, 5.69). Being married, having multiple sexual partners excluding a spouse and being informed about STIs were significantly associated with higher odds of self-reported STIs. However, being aged 44 years and above, having a higher education level, starting sex after the age of 20, being circumcised and being a rural resident were associated with lower odds of self-reported STIs.</p><p><strong>Conclusion: </strong>The prevalence of self-reported STIs was higher than the findings from most previous studies. It is essential to educate men about STIs and increase awareness of the risks associated with having multiple sexual partners. Implementing targeted public health initiatives for men with lower education levels, as well as devising strategies to address factors that elevate the risk of STI contraction, is also crucial.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e085628"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063714","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}
引用次数: 0
How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-086212
Lilian Peters, Ank de Jonge, Michiel de Boer, Soo Downe, Hannah G Dahlen

Objectives: In this descriptive study, we aimed to assess how the index mode of birth and subsequent birth modes vary over time for public and private hospital maternity care funding models. The second aim was to determine to what extent the index mode of birth predicts subsequent birth modes in general and whether this differs in public versus private hospital maternity care funding models. With our aim, we have an innovative approach, specifically the women's life course approach, which is hypothesis-generating and can be assessed in future studies.

Design, setting and participants: New South Wales population-linked data of low-risk women were analysed (2001-2016). Demographics and public/private care were recorded. Modes of the index birth and subsequent modes of second and third births (ie, spontaneous vaginal, instrumental vaginal elective/emergency caesarean birth) were registered. For those with 2 births and 3 births, 16 and 64 subsequent births patterns were created.

Primary and secondary outcome measures: Trend of index modes of birth and subsequent modes of birth over time and the prediction of subsequent birth modes based on the index birth. These outcomes were stratified for the initial maternity care funding model.

Results: In total, 172 041 low-risk nulliparous women were included in the initial cohort, 54.1% had a spontaneous index vaginal birth and 71% had their index birth in public hospitals. During the study period, 131 675 women had 2 births and 44 677 of these women had 3 births, respectively. Among women birthing in public hospitals, higher proportions of index and subsequent vaginal births were observed than in private hospitals, with fewer instrumental vaginal births and caesarean sections. Large differences were observed for birth patterns: vaginal-vaginal (public 55.8% vs private 36.8%) and vaginal-vaginal-vaginal (public 57.2% vs private 38.8%). Women with an index spontaneous vaginal birth showed a high probability (91.3%) of subsequent spontaneous vaginal births. When stratified by maternity care funding model, the probabilities were similar: 91.6% in public hospitals and 90.2% in private hospitals.

Conclusions: Our study of low-risk Australian women (2001-2011) found that those giving birth in public hospitals had higher proportions of spontaneous vaginal births compared with private hospitals, where caesarean sections were more common. Women with an index spontaneous vaginal birth had a very high probability to have subsequent vaginal births. These findings suggest that index mode of birth may be a predictor for subsequent modes of birth.

{"title":"How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study.","authors":"Lilian Peters, Ank de Jonge, Michiel de Boer, Soo Downe, Hannah G Dahlen","doi":"10.1136/bmjopen-2024-086212","DOIUrl":"10.1136/bmjopen-2024-086212","url":null,"abstract":"<p><strong>Objectives: </strong>In this descriptive study, we aimed to assess how the index mode of birth and subsequent birth modes vary over time for public and private hospital maternity care funding models. The second aim was to determine to what extent the index mode of birth predicts subsequent birth modes in general and whether this differs in public versus private hospital maternity care funding models. With our aim, we have an innovative approach, specifically the women's life course approach, which is hypothesis-generating and can be assessed in future studies.</p><p><strong>Design, setting and participants: </strong>New South Wales population-linked data of low-risk women were analysed (2001-2016). Demographics and public/private care were recorded. Modes of the index birth and subsequent modes of second and third births (ie, spontaneous vaginal, instrumental vaginal elective/emergency caesarean birth) were registered. For those with 2 births and 3 births, 16 and 64 subsequent births patterns were created.</p><p><strong>Primary and secondary outcome measures: </strong>Trend of index modes of birth and subsequent modes of birth over time and the prediction of subsequent birth modes based on the index birth. These outcomes were stratified for the initial maternity care funding model.</p><p><strong>Results: </strong>In total, 172 041 low-risk nulliparous women were included in the initial cohort, 54.1% had a spontaneous index vaginal birth and 71% had their index birth in public hospitals. During the study period, 131 675 women had 2 births and 44 677 of these women had 3 births, respectively. Among women birthing in public hospitals, higher proportions of index and subsequent vaginal births were observed than in private hospitals, with fewer instrumental vaginal births and caesarean sections. Large differences were observed for birth patterns: vaginal-vaginal (public 55.8% vs private 36.8%) and vaginal-vaginal-vaginal (public 57.2% vs private 38.8%). Women with an index spontaneous vaginal birth showed a high probability (91.3%) of subsequent spontaneous vaginal births. When stratified by maternity care funding model, the probabilities were similar: 91.6% in public hospitals and 90.2% in private hospitals.</p><p><strong>Conclusions: </strong>Our study of low-risk Australian women (2001-2011) found that those giving birth in public hospitals had higher proportions of spontaneous vaginal births compared with private hospitals, where caesarean sections were more common. Women with an index spontaneous vaginal birth had a very high probability to have subsequent vaginal births. These findings suggest that index mode of birth may be a predictor for subsequent modes of birth.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e086212"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063783","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}
引用次数: 0
Differential attainment at national selection for higher surgical training: a retrospective cohort study.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-091796
Ricky Ellis, Yasin Al-Tawarah, Peter Brennan, Amanda Lee, John Hines, Jennifer Cleland

Objectives: National selection for higher surgical specialty training (HST) in the UK is a high-stakes gatekeeping assessment. If barriers, such as differential attainment, exist at HST selection for some groups and not others, then this will have a significant and lasting impact on trainees' career progression and the diversity of the workforce, which should reflect the population it provides care for. The objective of this study was to characterise the relationship between candidate sociodemographic factors and performance at National Selection for HST in the UK.

Design: A retrospective cohort study.

Setting: National Selection for HST in the UK.

Participants: All UK graduates in the UKMED database (https://www.ukmed.ac.uk) who underwent selection for HST from 2012 to 2019.

Outcomes and measures: Performance at HST Selection for each surgical specialty is measured by assessment of the candidate's academic portfolio and multiple objective structured clinical examination style stations testing knowledge and skills. Univariate analysis identified differences in success rates at first application. Logistic regression models identified sociodemographic predictors of success after adjusting for prior academic attainment (Membership of the Royal College of Surgeons (MRCS) performance).

Results: Of all applications to HST (n=2875), 66.5% were successful at the first attempt. Females were 32% more likely than males to be successful at selection for HST (OR 1.32 (95% CI 1.05 to 1.67)). MRCS performance was found to be a strong independent predictor of future success at HST selection. Females were more likely to be successful at general surgery selection (OR 2.69 (95% CI 1.63 to 4.45)), older candidates (graduates) were less likely to be successful at ENT selection (OR 0.21 (95% CI 0.05 to 0.95)), and candidates that were the first in their family to attend University were less likely to be successful at urology selection (OR 0.41 (95% CI 0.21 to 0.78)).

Conclusions: Our findings highlight few statistically significant associations and no consistent patterns between sociodemographic factors and performance at HST selection once we adjusted for prior academic attainment. This suggests that differences in performance on selection into HST may be more likely due to individual rather than group-level differences.

{"title":"Differential attainment at national selection for higher surgical training: a retrospective cohort study.","authors":"Ricky Ellis, Yasin Al-Tawarah, Peter Brennan, Amanda Lee, John Hines, Jennifer Cleland","doi":"10.1136/bmjopen-2024-091796","DOIUrl":"10.1136/bmjopen-2024-091796","url":null,"abstract":"<p><strong>Objectives: </strong>National selection for higher surgical specialty training (HST) in the UK is a high-stakes gatekeeping assessment. If barriers, such as differential attainment, exist at HST selection for some groups and not others, then this will have a significant and lasting impact on trainees' career progression and the diversity of the workforce, which should reflect the population it provides care for. The objective of this study was to characterise the relationship between candidate sociodemographic factors and performance at National Selection for HST in the UK.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>National Selection for HST in the UK.</p><p><strong>Participants: </strong>All UK graduates in the UKMED database (https://www.ukmed.ac.uk) who underwent selection for HST from 2012 to 2019.</p><p><strong>Outcomes and measures: </strong>Performance at HST Selection for each surgical specialty is measured by assessment of the candidate's academic portfolio and multiple objective structured clinical examination style stations testing knowledge and skills. Univariate analysis identified differences in success rates at first application. Logistic regression models identified sociodemographic predictors of success after adjusting for prior academic attainment (Membership of the Royal College of Surgeons (MRCS) performance).</p><p><strong>Results: </strong>Of all applications to HST (n=2875), 66.5% were successful at the first attempt. Females were 32% more likely than males to be successful at selection for HST (OR 1.32 (95% CI 1.05 to 1.67)). MRCS performance was found to be a strong independent predictor of future success at HST selection. Females were more likely to be successful at general surgery selection (OR 2.69 (95% CI 1.63 to 4.45)), older candidates (graduates) were less likely to be successful at ENT selection (OR 0.21 (95% CI 0.05 to 0.95)), and candidates that were the first in their family to attend University were less likely to be successful at urology selection (OR 0.41 (95% CI 0.21 to 0.78)).</p><p><strong>Conclusions: </strong>Our findings highlight few statistically significant associations and no consistent patterns between sociodemographic factors and performance at HST selection once we adjusted for prior academic attainment. This suggests that differences in performance on selection into HST may be more likely due to individual rather than group-level differences.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e091796"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063690","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}
引用次数: 0
Development and validation of a novel risk-predicted model for early sepsis-associated acute kidney injury in critically ill patients: a retrospective cohort study.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-088404
Cong-Cong Zhao, Zi-Han Nan, Bo Li, Yan-Ling Yin, Kun Zhang, Li-Xia Liu, Zhen-Jie Hu

Objectives: This study aimed to develop a prediction model for the detection of early sepsis-associated acute kidney injury (SA-AKI), which is defined as AKI diagnosed within 48 hours of a sepsis diagnosis.

Design: A retrospective study design was employed. It is not linked to a clinical trial. Data for patients with sepsis included in the development cohort were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The least absolute shrinkage and selection operator regression method was used to screen the risk factors, and the final screened risk factors were constructed into four machine learning models to determine an optimal model. External validation was performed using another single-centre intensive care unit (ICU) database.

Setting: Data for the development cohort were obtained from the MIMIC-IV 2.0 database, which is a large publicly available database that contains information on patients admitted to the ICUs of Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA, from 2008 to 2019. The external validation cohort was generated from a single-centre ICU database from China.

Participants: A total of 7179 critically ill patients with sepsis were included in the development cohort and 269 patients with sepsis were included in the external validation cohort.

Results: A total of 12 risk factors (age, weight, atrial fibrillation, chronic coronary syndrome, central venous pressure, urine output, temperature, lactate, pH, difference in alveolar-arterial oxygen pressure, prothrombin time and mechanical ventilation) were included in the final prediction model. The gradient boosting machine model showed the best performance, and the areas under the receiver operating characteristic curve of the model in the development cohort, internal validation cohort and external validation cohort were 0.794, 0.725 and 0.707, respectively. Additionally, to aid interpretation and clinical application, SHapley Additive exPlanations techniques and a web version calculation were applied.

Conclusions: This web-based clinical prediction model represents a reliable tool for predicting early SA-AKI in critically ill patients with sepsis. The model was externally validated using another ICU cohort and exhibited good predictive ability. Additional validation is needed to support the utility and implementation of this model.

{"title":"Development and validation of a novel risk-predicted model for early sepsis-associated acute kidney injury in critically ill patients: a retrospective cohort study.","authors":"Cong-Cong Zhao, Zi-Han Nan, Bo Li, Yan-Ling Yin, Kun Zhang, Li-Xia Liu, Zhen-Jie Hu","doi":"10.1136/bmjopen-2024-088404","DOIUrl":"10.1136/bmjopen-2024-088404","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to develop a prediction model for the detection of early sepsis-associated acute kidney injury (SA-AKI), which is defined as AKI diagnosed within 48 hours of a sepsis diagnosis.</p><p><strong>Design: </strong>A retrospective study design was employed. It is not linked to a clinical trial. Data for patients with sepsis included in the development cohort were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The least absolute shrinkage and selection operator regression method was used to screen the risk factors, and the final screened risk factors were constructed into four machine learning models to determine an optimal model. External validation was performed using another single-centre intensive care unit (ICU) database.</p><p><strong>Setting: </strong>Data for the development cohort were obtained from the MIMIC-IV 2.0 database, which is a large publicly available database that contains information on patients admitted to the ICUs of Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA, from 2008 to 2019. The external validation cohort was generated from a single-centre ICU database from China.</p><p><strong>Participants: </strong>A total of 7179 critically ill patients with sepsis were included in the development cohort and 269 patients with sepsis were included in the external validation cohort.</p><p><strong>Results: </strong>A total of 12 risk factors (age, weight, atrial fibrillation, chronic coronary syndrome, central venous pressure, urine output, temperature, lactate, pH, difference in alveolar-arterial oxygen pressure, prothrombin time and mechanical ventilation) were included in the final prediction model. The gradient boosting machine model showed the best performance, and the areas under the receiver operating characteristic curve of the model in the development cohort, internal validation cohort and external validation cohort were 0.794, 0.725 and 0.707, respectively. Additionally, to aid interpretation and clinical application, SHapley Additive exPlanations techniques and a web version calculation were applied.</p><p><strong>Conclusions: </strong>This web-based clinical prediction model represents a reliable tool for predicting early SA-AKI in critically ill patients with sepsis. The model was externally validated using another ICU cohort and exhibited good predictive ability. Additional validation is needed to support the utility and implementation of this model.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e088404"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063677","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}
引用次数: 0
Clinicopathological and prognostic significance of the microcystic elongated and fragmented pattern in endometrial cancer: a systematic review and meta-analysis.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-092006
Peng Jia, Baofeng Duan, Yan Zhang

Objective: The presence of the microcystic elongated and fragmented (MELF) pattern, distinguished by its microcystic, elongated and fragmented attributes, constitutes a common manifestation of myometrial invasion (MI) within endometrial carcinoma. However, the prognostic significance of this pattern has not been definitively established. Consequently, this research aimed to clarify the prognostic implications of the MELF pattern for individuals diagnosed with endometrial carcinoma.

Design: Systematic review and meta-analysis of observational clinical studies.

Data sources: An extensive review of the literature was conducted using reputable databases such as PubMed, Embase, Web of Science and the Cochrane Library, covering the period from January 2003 to October 2023. Search terms encompassed endometrial cancer and the MELF pattern.

Eligibility criteria for selecting studies: The inclusion criteria were patients who had undergone hysterectomy and whose pathology confirmed endometrial endometrioid carcinoma, with or without MELF infiltration.

Data extraction and synthesis: Two reviewers performed data extraction separately. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Stata V.17.0 software was used for statistical analysis.

Results: The meta-analysis incorporated 16 retrospective cohort studies. Employing a fixed-effects approach, the analysis demonstrated an association of the MELF pattern with reduced overall survival (HR 2.21, 95% CI 1.50-3.25, p=0.000) and lower disease-free survival rates among patients with endometrial cancer (HR 1.72, 95% CI 1.17 to 2.55, p=0.006). Furthermore, aggregated data revealed a linkage between the MELF pattern and significant MI, nodal metastasis, involvement of the lymphovascular space, penetration of the cervical stroma and progression to advanced stages of endometrial carcinoma.

Conclusion: The MELF pattern serves as a significant adverse prognostic factor in endometrial cancer, warranting increased attention.

{"title":"Clinicopathological and prognostic significance of the microcystic elongated and fragmented pattern in endometrial cancer: a systematic review and meta-analysis.","authors":"Peng Jia, Baofeng Duan, Yan Zhang","doi":"10.1136/bmjopen-2024-092006","DOIUrl":"10.1136/bmjopen-2024-092006","url":null,"abstract":"<p><strong>Objective: </strong>The presence of the microcystic elongated and fragmented (MELF) pattern, distinguished by its microcystic, elongated and fragmented attributes, constitutes a common manifestation of myometrial invasion (MI) within endometrial carcinoma. However, the prognostic significance of this pattern has not been definitively established. Consequently, this research aimed to clarify the prognostic implications of the MELF pattern for individuals diagnosed with endometrial carcinoma.</p><p><strong>Design: </strong>Systematic review and meta-analysis of observational clinical studies.</p><p><strong>Data sources: </strong>An extensive review of the literature was conducted using reputable databases such as PubMed, Embase, Web of Science and the Cochrane Library, covering the period from January 2003 to October 2023. Search terms encompassed endometrial cancer and the MELF pattern.</p><p><strong>Eligibility criteria for selecting studies: </strong>The inclusion criteria were patients who had undergone hysterectomy and whose pathology confirmed endometrial endometrioid carcinoma, with or without MELF infiltration.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers performed data extraction separately. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Stata V.17.0 software was used for statistical analysis.</p><p><strong>Results: </strong>The meta-analysis incorporated 16 retrospective cohort studies. Employing a fixed-effects approach, the analysis demonstrated an association of the MELF pattern with reduced overall survival (HR 2.21, 95% CI 1.50-3.25, p=0.000) and lower disease-free survival rates among patients with endometrial cancer (HR 1.72, 95% CI 1.17 to 2.55, p=0.006). Furthermore, aggregated data revealed a linkage between the MELF pattern and significant MI, nodal metastasis, involvement of the lymphovascular space, penetration of the cervical stroma and progression to advanced stages of endometrial carcinoma.</p><p><strong>Conclusion: </strong>The MELF pattern serves as a significant adverse prognostic factor in endometrial cancer, warranting increased attention.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e092006"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063164","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}
引用次数: 0
Facilitators and barriers to parental involvement in neonatal pain management in the NICU: a scoping review.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-085881
Lu Feng, Jie Jing, Min Shi, Binzhi Tang, Linli Xie

Objectives: Neonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role in infant development and parental well-being. However, the process of parental involvement faces constant challenges. To help structure and implement a family engagement programme in neonatal pain management in the neonatal intensive care unit (NICU), we conducted a scoping review to identify facilitators and barriers to parental involvement in neonatal pain management.

Methods: We conducted the scoping review using the Arksey and O'Malley framework. PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, Wanfang database (Chinese), CNKI (Chinese), VIP database(Chinese) and SinoMed (Chinese) were searched systematically for relevant studies published in English and Chinese from inception up to October 2023. We categorised the facilitators and barriers based on the socioecological model and analysed the results thematically in each category.

Results: Ten English qualitative studies were included in the final analysis. The 34 facilitators and 41 barriers extracted were grouped into 4 domains of the socioecological model framework. Of the 10 facilitator themes, the most critical theme was informational and emotional support. Of the 10 barrier themes, the most frequently reported theme was restricted policies and resources.

Conclusions: Our review highlights the essential roles of intrapersonal and interpersonal factors in parental involvement in pain management while suggesting the interconnectedness of factors in various domains within the context of the socioecological model. It implies that most interventions require development and administration at both intrapersonal and interpersonal levels. Regarding the macrolevel, a broad programme with clear regulatory approaches and targeted guidelines could be developed in the future to drive innovations in NICU pain management mode.

{"title":"Facilitators and barriers to parental involvement in neonatal pain management in the NICU: a scoping review.","authors":"Lu Feng, Jie Jing, Min Shi, Binzhi Tang, Linli Xie","doi":"10.1136/bmjopen-2024-085881","DOIUrl":"10.1136/bmjopen-2024-085881","url":null,"abstract":"<p><strong>Objectives: </strong>Neonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role in infant development and parental well-being. However, the process of parental involvement faces constant challenges. To help structure and implement a family engagement programme in neonatal pain management in the neonatal intensive care unit (NICU), we conducted a scoping review to identify facilitators and barriers to parental involvement in neonatal pain management.</p><p><strong>Methods: </strong>We conducted the scoping review using the Arksey and O'Malley framework. PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, Wanfang database (Chinese), CNKI (Chinese), VIP database(Chinese) and SinoMed (Chinese) were searched systematically for relevant studies published in English and Chinese from inception up to October 2023. We categorised the facilitators and barriers based on the socioecological model and analysed the results thematically in each category.</p><p><strong>Results: </strong>Ten English qualitative studies were included in the final analysis. The 34 facilitators and 41 barriers extracted were grouped into 4 domains of the socioecological model framework. Of the 10 facilitator themes, the most critical theme was informational and emotional support. Of the 10 barrier themes, the most frequently reported theme was restricted policies and resources.</p><p><strong>Conclusions: </strong>Our review highlights the essential roles of intrapersonal and interpersonal factors in parental involvement in pain management while suggesting the interconnectedness of factors in various domains within the context of the socioecological model. It implies that most interventions require development and administration at both intrapersonal and interpersonal levels. Regarding the macrolevel, a broad programme with clear regulatory approaches and targeted guidelines could be developed in the future to drive innovations in NICU pain management mode.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e085881"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063636","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}
引用次数: 0
Self-reported determinants for subjective financial distress: a qualitative interview study with German cancer patients.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2023-081432
Andrea Züger, Viktoria Mathies, Katja Mehlis, Sophie Pauge, Luise Richter, Bastian Surmann, Thomas Ernst, Natalja Menold, Wolfgang Greiner, Eva Winkler

Objectives: Patient-reported financial effects of a tumour disease in a universal healthcare setting are a multidimensional phenomenon. Actual and anticipated objective financial burden caused by direct medical and non-medical costs as well as indirect costs such as loss of income can lead to subjective financial distress. To better understand subjective financial distress, the presented study explores self-reported determinants for subjective financial distress in German patients with cancer, aiming to inform a new German-language patient-reported outcome measure for determining the financial effects of a tumour disease.

Design: Semistructured interviews with n=18 patients with cancer were conducted between May 2021 and December 2021. Patients were recruited based on a purposive sampling strategy in outpatient and inpatient settings. The interviews were audiorecorded, transcribed verbatim and analysed using qualitative content analysis.

Setting: Participants were recruited from two German academic cancer centres, that is, the National Center for Tumor Diseases Heidelberg and Jena University Hospital.

Participants: 18 patients who had undergone cancer-related therapy for at least 2 months were interviewed (10 females).

Results: Based on the results of the qualitative content analysis, we developed a multicomponent construct of determinants that could influence subjective financial distress. The self-reported determinants can be classified into material (savings, good salary, shared rent through shared living, employed partner, paid-off house, potential financial support from family and friends, work-related specifics, consumer restrictions, out-of-pocket-costs and anticipated financial changes), social (social support from friends and family), systemic (administrative hurdlers and insurance cover) and inner personal determinants (coping strategies, change of attitude, character traits).

Conclusion: Subjective financial distress depends not only on material but also on social, systemic and inner personal determinants. Knowledge of these determinants can inform a new comprehensive German-language instrument for measuring self-reported financial effects of a tumour disease.

Trial registration number: NCT05319925.

{"title":"Self-reported determinants for subjective financial distress: a qualitative interview study with German cancer patients.","authors":"Andrea Züger, Viktoria Mathies, Katja Mehlis, Sophie Pauge, Luise Richter, Bastian Surmann, Thomas Ernst, Natalja Menold, Wolfgang Greiner, Eva Winkler","doi":"10.1136/bmjopen-2023-081432","DOIUrl":"10.1136/bmjopen-2023-081432","url":null,"abstract":"<p><strong>Objectives: </strong>Patient-reported financial effects of a tumour disease in a universal healthcare setting are a multidimensional phenomenon. Actual and anticipated objective financial burden caused by direct medical and non-medical costs as well as indirect costs such as loss of income can lead to subjective financial distress. To better understand subjective financial distress, the presented study explores self-reported determinants for subjective financial distress in German patients with cancer, aiming to inform a new German-language patient-reported outcome measure for determining the financial effects of a tumour disease.</p><p><strong>Design: </strong>Semistructured interviews with n=18 patients with cancer were conducted between May 2021 and December 2021. Patients were recruited based on a purposive sampling strategy in outpatient and inpatient settings. The interviews were audiorecorded, transcribed verbatim and analysed using qualitative content analysis.</p><p><strong>Setting: </strong>Participants were recruited from two German academic cancer centres, that is, the National Center for Tumor Diseases Heidelberg and Jena University Hospital.</p><p><strong>Participants: </strong>18 patients who had undergone cancer-related therapy for at least 2 months were interviewed (10 females).</p><p><strong>Results: </strong>Based on the results of the qualitative content analysis, we developed a multicomponent construct of determinants that could influence subjective financial distress. The self-reported determinants can be classified into material (<i>savings, good salary, shared rent through shared living, employed partner, paid-off house, potential financial support from family and friends, work-related specifics, consumer restrictions, out-of-pocket-costs and anticipated financial changes</i>), social (<i>social support from friends and family</i>), systemic (<i>administrative hurdlers and insurance cover</i>) and inner personal determinants (<i>coping strategies, change of attitude, character traits</i>).</p><p><strong>Conclusion: </strong>Subjective financial distress depends not only on material but also on social, systemic and inner personal determinants. Knowledge of these determinants can inform a new comprehensive German-language instrument for measuring self-reported financial effects of a tumour disease.</p><p><strong>Trial registration number: </strong>NCT05319925.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e081432"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063699","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}
引用次数: 0
Remote symptom monitoring with patient-reported outcomes and nudges during lung cancer immunotherapy in China (PRO-NET): protocol for a randomised controlled trial.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-093374
Yiqi Xia, Xiaolong Guan, Zhenyu Shi, Yanan Luo, Ping He

Introduction: Lung cancer is the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising the majority of cases. For advanced NSCLC, immunotherapy offers substantial survival benefits but is often accompanied by severe immune-related adverse events symptoms, significantly affecting health-related quality of life (HRQoL). Routinely collection of patient-reported outcomes (PROs) followed by automated alerts has been shown to improve overall survival and HRQoL for cancers. However, there is limited evidence for PRO-based symptom monitoring on advanced NSCLC during immunotherapy. This study proposes an electronic PRO-based symptom tracking intervention, integrated with reactive alerts and nudges (PRO-NET) to improve HRQoL for advanced NSCLC patients receiving immunotherapy in China. Secondary objectives include assessing the effect of PRO-symptom monitoring on survival, physical function, symptom control, mental health, cost-effectiveness and implementation fidelity.

Methods and analysis: The PRO-NET study is a two-arm, parallel randomised controlled trial. The study will enrol at least 300 advanced NSCLC patients undergoing immunotherapy in China. Participants will be randomly assigned to either the intervention or control group in a ratio of 1:1 via PRO-NET programme. The intervention involves weekly electronic collection of immune-related PROs and reactive alerts sent directly to patients, combined with nudges over a 6-month period. Patients in the control group will follow usual care and will not trigger the alerts. Both the intervention and control groups will receive outcome assessments at baseline, 3 months and 6 months. Primary outcome focuses on HRQoL, while secondary outcomes include survival, physical function, symptom burden, mental health, cost-effectiveness and implementation fidelity. Differences in HRQoL between the groups will be compared using general linear mixed model, accounting for potential confounding.

Ethics and dissemination: The study was approved by the Institutional Review Board of the Peking University protocol on 21 July 2024 (No. IRB 00001052-24066). This protocol is based on V2.0, 6 July 2024 of the protocol. The results of this study will be disseminated through peer-reviewed publications and academic conferences.

Trials registration number: ChiCTR2400088408.

{"title":"Remote symptom monitoring with patient-reported outcomes and nudges during lung cancer immunotherapy in China (PRO-NET): protocol for a randomised controlled trial.","authors":"Yiqi Xia, Xiaolong Guan, Zhenyu Shi, Yanan Luo, Ping He","doi":"10.1136/bmjopen-2024-093374","DOIUrl":"10.1136/bmjopen-2024-093374","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer is the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising the majority of cases. For advanced NSCLC, immunotherapy offers substantial survival benefits but is often accompanied by severe immune-related adverse events symptoms, significantly affecting health-related quality of life (HRQoL). Routinely collection of patient-reported outcomes (PROs) followed by automated alerts has been shown to improve overall survival and HRQoL for cancers. However, there is limited evidence for PRO-based symptom monitoring on advanced NSCLC during immunotherapy. This study proposes an electronic PRO-based symptom tracking intervention, integrated with reactive alerts and nudges (PRO-NET) to improve HRQoL for advanced NSCLC patients receiving immunotherapy in China. Secondary objectives include assessing the effect of PRO-symptom monitoring on survival, physical function, symptom control, mental health, cost-effectiveness and implementation fidelity.</p><p><strong>Methods and analysis: </strong>The PRO-NET study is a two-arm, parallel randomised controlled trial. The study will enrol at least 300 advanced NSCLC patients undergoing immunotherapy in China. Participants will be randomly assigned to either the intervention or control group in a ratio of 1:1 via PRO-NET programme. The intervention involves weekly electronic collection of immune-related PROs and reactive alerts sent directly to patients, combined with nudges over a 6-month period. Patients in the control group will follow usual care and will not trigger the alerts. Both the intervention and control groups will receive outcome assessments at baseline, 3 months and 6 months. Primary outcome focuses on HRQoL, while secondary outcomes include survival, physical function, symptom burden, mental health, cost-effectiveness and implementation fidelity. Differences in HRQoL between the groups will be compared using general linear mixed model, accounting for potential confounding.</p><p><strong>Ethics and dissemination: </strong>The study was approved by the Institutional Review Board of the Peking University protocol on 21 July 2024 (No. IRB 00001052-24066). This protocol is based on V2.0, 6 July 2024 of the protocol. The results of this study will be disseminated through peer-reviewed publications and academic conferences.</p><p><strong>Trials registration number: </strong>ChiCTR2400088408.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e093374"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063697","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}
引用次数: 0
Improving the diagnostic accuracy of referrals for papilloedema (DIPP) study: protocol for a mixed-methods study.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-090521
Alyson Huntley, Olivia Skrobot, Matthew J Ridd, Mary-Ann Sherratt, Marcia Lucraft, Christina Stokes, Michael Bowen, Beth Stuart, Samuel William David Merriel, Denize Atan

Introduction: Papilloedema can be the first sign of life-threatening disease, for example, brain tumours. Due to the potential seriousness of this clinical sign, the detection of papilloedema would normally prompt urgent hospital referral for further investigation. The problem is that many benign structural variations of optic nerve anatomy can be mistaken for papilloedema, so-called pseudopapilloedema. The consequence is that many people are referred to hospital because they are incorrectly identified to have papilloedema when they don't. As a result, hospital referrals of people with suspected papilloedema in England have increased sharply, leading to increased demand for overstretched hospital services and potentially longer waiting times for hospital appointments for those who do have papilloedema.The work programme is aimed at the development of guidelines and educational materials that will help support health professionals to correctly identify people with papilloedema. This article describes the protocol for gathering evidence of current referral practices and pathways for people suspected to have papilloedema in England and the development of guidelines based on this evidence and extensive engagement with community- and hospital-based healthcare professionals, patients, and the public.

Methods and analysis: Both qualitative and quantitative data will be collected from Freedom of Information requests to Integrated Care Boards across England about how they organise their community and hospital services for people with suspected papilloedema, with and without headache. Surveys and qualitative interviews of relevant community and hospital healthcare professionals based in England will collect data on how and when people with papilloedema and pseudopapilloedema with or without headache are currently identified and referred to hospital, if needed. This information will be used to inform a Delphi process with the aim of reaching consensus among health professional experts, commissioners and patients on what the most evidence-based and safe diagnostic and referral practices should be for people with suspected papilloedema. The tailored guidelines will be written for healthcare professionals and patients. We will create a range of educational materials and a website designed for health professionals and patients to support the national roll-out and implementation of DIPP study guidelines.

Ethics and dissemination: Ethical approval was granted by the University of Bristol Faculty of Health Sciences Ethics committee (FREC reference: 12457) and Health Research Authority (IRAS no.: 320395). Results of the study will be published on our DIPP study website and disseminated to our stakeholder groups through peer-reviewed journal publications and conference presentations.

{"title":"Improving the diagnostic accuracy of referrals for papilloedema (DIPP) study: protocol for a mixed-methods study.","authors":"Alyson Huntley, Olivia Skrobot, Matthew J Ridd, Mary-Ann Sherratt, Marcia Lucraft, Christina Stokes, Michael Bowen, Beth Stuart, Samuel William David Merriel, Denize Atan","doi":"10.1136/bmjopen-2024-090521","DOIUrl":"10.1136/bmjopen-2024-090521","url":null,"abstract":"<p><strong>Introduction: </strong>Papilloedema can be the first sign of life-threatening disease, for example, brain tumours. Due to the potential seriousness of this clinical sign, the detection of papilloedema would normally prompt urgent hospital referral for further investigation. The problem is that many benign structural variations of optic nerve anatomy can be mistaken for papilloedema, so-called pseudopapilloedema. The consequence is that many people are referred to hospital because they are incorrectly identified to have papilloedema when they don't. As a result, hospital referrals of people with suspected papilloedema in England have increased sharply, leading to increased demand for overstretched hospital services and potentially longer waiting times for hospital appointments for those who do have papilloedema.The work programme is aimed at the development of guidelines and educational materials that will help support health professionals to correctly identify people with papilloedema. This article describes the protocol for gathering evidence of current referral practices and pathways for people suspected to have papilloedema in England and the development of guidelines based on this evidence and extensive engagement with community- and hospital-based healthcare professionals, patients, and the public.</p><p><strong>Methods and analysis: </strong>Both qualitative and quantitative data will be collected from Freedom of Information requests to Integrated Care Boards across England about how they organise their community and hospital services for people with suspected papilloedema, with and without headache. Surveys and qualitative interviews of relevant community and hospital healthcare professionals based in England will collect data on how and when people with papilloedema and pseudopapilloedema with or without headache are currently identified and referred to hospital, if needed. This information will be used to inform a Delphi process with the aim of reaching consensus among health professional experts, commissioners and patients on what the most evidence-based and safe diagnostic and referral practices should be for people with suspected papilloedema. The tailored guidelines will be written for healthcare professionals and patients. We will create a range of educational materials and a website designed for health professionals and patients to support the national roll-out and implementation of DIPP study guidelines.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was granted by the University of Bristol Faculty of Health Sciences Ethics committee (FREC reference: 12457) and Health Research Authority (IRAS no.: 320395). Results of the study will be published on our DIPP study website and disseminated to our stakeholder groups through peer-reviewed journal publications and conference presentations.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e090521"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063784","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}
引用次数: 0
Lived experiences of patients with advanced pancreatic cancer on patient-reported outcomes (PROs) management: a qualitative phenomenological study in Southwest China.
IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-28 DOI: 10.1136/bmjopen-2024-084259
Ping Chen, Wanting Hou, Changlin Li, Qingyue Liang, Li Ma, Xiumei Zhao, Cheng Yi

Objectives: To explore the lived experiences of patients with advanced pancreatic cancer enrolled in a patient-reported outcomes (PROs) management programme and to preliminarily understand how PROs management influences various aspects of patient care and overall quality of life.

Design: A qualitative phenomenological study.

Setting: A national cancer care centre in Southwest China specialised in cancer care, with a comprehensive PROs management programme.

Participants: 15 participants diagnosed with advanced pancreatic cancer.

Results: Five key themes emerged from our interviews, including enhanced communication with healthcare providers, attributed to the structured nature of PROs; increased perceived sense of care, with patients feeling more valued and heard; PROs management facilitated better treatment decision-making, with patients feeling more involved and empowered; improved communication with family members, aiding in better understanding and support; and varied perceptions of the impact on quality of life, with some noting improvements in specific aspects like symptom management, while others were uncertain about the overall benefit.

Conclusions: PROs management plays a significant role in improving communication between patients with advanced pancreatic cancer and their healthcare providers, enhancing patients' involvement in treatment decisions, and potentially improving family dynamics. However, the impact of PROs management on the overall quality of life of patients remains complex and individualised. The findings suggest that further research with a more diverse patient population is needed to fully understand the implications of PROs management in advanced cancer care.

{"title":"Lived experiences of patients with advanced pancreatic cancer on patient-reported outcomes (PROs) management: a qualitative phenomenological study in Southwest China.","authors":"Ping Chen, Wanting Hou, Changlin Li, Qingyue Liang, Li Ma, Xiumei Zhao, Cheng Yi","doi":"10.1136/bmjopen-2024-084259","DOIUrl":"10.1136/bmjopen-2024-084259","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the lived experiences of patients with advanced pancreatic cancer enrolled in a patient-reported outcomes (PROs) management programme and to preliminarily understand how PROs management influences various aspects of patient care and overall quality of life.</p><p><strong>Design: </strong>A qualitative phenomenological study.</p><p><strong>Setting: </strong>A national cancer care centre in Southwest China specialised in cancer care, with a comprehensive PROs management programme.</p><p><strong>Participants: </strong>15 participants diagnosed with advanced pancreatic cancer.</p><p><strong>Results: </strong>Five key themes emerged from our interviews, including enhanced communication with healthcare providers, attributed to the structured nature of PROs; increased perceived sense of care, with patients feeling more valued and heard; PROs management facilitated better treatment decision-making, with patients feeling more involved and empowered; improved communication with family members, aiding in better understanding and support; and varied perceptions of the impact on quality of life, with some noting improvements in specific aspects like symptom management, while others were uncertain about the overall benefit.</p><p><strong>Conclusions: </strong>PROs management plays a significant role in improving communication between patients with advanced pancreatic cancer and their healthcare providers, enhancing patients' involvement in treatment decisions, and potentially improving family dynamics. However, the impact of PROs management on the overall quality of life of patients remains complex and individualised. The findings suggest that further research with a more diverse patient population is needed to fully understand the implications of PROs management in advanced cancer care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e084259"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063786","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}
引用次数: 0
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