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Sanchez A, Pijoan JI, Sainz de Rozas R, Lekue I, San Vicente R, Quindimil JA, Rotaeche R, Etxeberria A, Mozo C, Martinez-Cengotitabengoa M, Monge M, Gómez-Ramírez C, Samper R, Ogueta Lana M, Celorrio S, Merino-Inda N, Llarena M, Gonzalez Saenz de Tejada M, García-Alvarez A, Grandes G. De-imFAR phase II project: a study protocol for a cluster randomised implementation trial to evaluate the effectiveness of de-implementation strategies to reduce low-value statin prescribing in the primary prevention of cardiovascular disease. BMJ Open 2024; 14:e078692. [PMID: 38631840 PMCID: PMC11029292 DOI: 10.1136/bmjopen-2023-078692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This study aims to reduce potentially inappropriate prescribing (PIP) of statins and foster healthy lifestyle promotion in cardiovascular disease (CVD) primary prevention in low-risk patients. To this end, we will compare the effectiveness and feasibility of several de-implementation strategies developed following the structured design process of the Behaviour Change Wheel targeting key determinants of the clinical decision-making process in CVD prevention. METHODS AND ANALYSIS A cluster randomised implementation trial, with an additional control group, will be launched, involving family physicians (FPs) from 13 Integrated Healthcare Organisations (IHOs) of Osakidetza-Basque Health Service with non-zero incidence rates of PIP of statins in 2021. All FPs will be exposed to a non-reflective decision assistance strategy based on reminders and decision support tools. Additionally, FPs from two of the IHOs will be randomly assigned to one of two increasingly intensive de-implementation strategies: adding a decision information strategy based on knowledge dissemination and a reflective decision structure strategy through audit/feedback. The target population comprises women aged 45-74 years and men aged 40-74 years with moderately elevated cholesterol levels but no diagnosed CVD and low cardiovascular risk (REGICOR<7.5%), who attend at least one appointment with any of the participating FPs (May 2022-May 2023), and will be followed until May 2024. We use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes. The main outcome will be the change in the incidence rate of PIP of statins and healthy lifestyle counselling in the study population 12 and 24 months after FPs' exposure to the strategies. Moreover, FPs' perception of their feasibility and acceptability, and patient experience regarding the quality of care received will be evaluated. ETHICS AND DISSEMINATION The study was approved by the Basque Country Clinical Research Ethics Committee and was registered in ClinicalTrials.gov (NCT04022850). Results will be disseminated in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04022850.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Jose Ignacio Pijoan
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Clinical Epidemiology Unit, Osakidetza-Basque Health Service, Barakaldo, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Rita Sainz de Rozas
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Itxasne Lekue
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo San Vicente
- Zumarraga Health Center, Goierri-Alto Urola Integrated Health Organization, Osakidetza-Basque Health Service, Zumarraga, Spain
| | - Jose Antonio Quindimil
- Sestao Health Center, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Sestao, Spain
| | - Rafael Rotaeche
- Primary Care Research Unit of Gipuzkoa, Organization of Integrated Health Services of Gipuzkoa, Osakidetza-Basque Health Service, Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Spain
| | - Arritxu Etxeberria
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Carmela Mozo
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Monica Martinez-Cengotitabengoa
- School of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
- Primary Care Pharmacy Unit, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Monica Monge
- Muskiz Health Center, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Muskiz, Spain
| | - Cristina Gómez-Ramírez
- Cardiology Department, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo Samper
- Corporate Pharmacy Service, Directorate of Healthcare Assistance, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Mikel Ogueta Lana
- Subdirectorate of Quality and Health Information Systems, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Sara Celorrio
- Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | | | - Marta Llarena
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Marta Gonzalez Saenz de Tejada
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Arturo García-Alvarez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
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Pimentel MAF, Johnson A, Darbyshire JL, Tarassenko L, Clifton DA, Walden A, Rechner I, Watkinson PJ, Young JD. Development of an enhanced scoring system to predict ICU readmission or in-hospital death within 24 hours using routine patient data from two NHS Foundation Trusts. BMJ Open 2024; 14:e074604. [PMID: 38609314 PMCID: PMC11029184 DOI: 10.1136/bmjopen-2023-074604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 03/05/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Intensive care units (ICUs) admit the most severely ill patients. Once these patients are discharged from the ICU to a step-down ward, they continue to have their vital signs monitored by nursing staff, with Early Warning Score (EWS) systems being used to identify those at risk of deterioration. OBJECTIVES We report the development and validation of an enhanced continuous scoring system for predicting adverse events, which combines vital signs measured routinely on acute care wards (as used by most EWS systems) with a risk score of a future adverse event calculated on discharge from the ICU. DESIGN A modified Delphi process identified candidate variables commonly available in electronic records as the basis for a 'static' score of the patient's condition immediately after discharge from the ICU. L1-regularised logistic regression was used to estimate the in-hospital risk of future adverse event. We then constructed a model of physiological normality using vital sign data from the day of hospital discharge. This is combined with the static score and used continuously to quantify and update the patient's risk of deterioration throughout their hospital stay. SETTING Data from two National Health Service Foundation Trusts (UK) were used to develop and (externally) validate the model. PARTICIPANTS A total of 12 394 vital sign measurements were acquired from 273 patients after ICU discharge for the development set, and 4831 from 136 patients in the validation cohort. RESULTS Outcome validation of our model yielded an area under the receiver operating characteristic curve of 0.724 for predicting ICU readmission or in-hospital death within 24 hours. It showed an improved performance with respect to other competitive risk scoring systems, including the National EWS (0.653). CONCLUSIONS We showed that a scoring system incorporating data from a patient's stay in the ICU has better performance than commonly used EWS systems based on vital signs alone. TRIAL REGISTRATION NUMBER ISRCTN32008295.
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Affiliation(s)
| | - Alistair Johnson
- Institute of Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
| | | | - Ian Rechner
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Gao Y, Liu Z, Cao R, Feng Y, Tao L, Su C, Guan X, Fang R, Deng Y, Xiang W, Fei Y. Reporting form and content of research priorities identified in knee osteoarthritis clinical practice guidelines: a methodological literature analysis. BMJ Open 2024; 14:e076107. [PMID: 38604638 PMCID: PMC11015183 DOI: 10.1136/bmjopen-2023-076107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Clinical practice guideline (CPG) developers conduct systematic summaries of research evidence, providing them great capacity and ability to identify research priorities. We systematically analysed the reporting form and content of research priorities in CPGs related to knee osteoarthritis (KOA) to provide a valuable reference for guideline developers and clinicians. DESIGN A methodological literature analysis was done and the characteristics of the reporting form and the content of the research priorities identified in KOA CPGs were summarised. DATA SOURCES Six databases (PubMed, Embase, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang and Chinese Biomedical Literature Database) were searched for CPGs published from 1 January 2017 to 4 December 2022. The official websites of 40 authoritative orthopaedic societies, rheumatology societies and guideline development organisations were additionally searched. ELIGIBILITY CRITERIA We included all KOA CPGs published in English or Chinese from 1 January 2017 that included at least one recommendation for KOA. We excluded duplicate publications, older versions of CPGs as well as guidance documents for guideline development. DATA EXTRACTION AND SYNTHESIS Reviewers worked in pairs and independently screened and extracted the data. Descriptive statistics were used, and absolute frequencies and proportions of related items were calculated. RESULTS 187 research priorities reported in 41 KOA CPGs were identified. 24 CPGs reported research priorities, of which 17 (41.5%) presented overall research priorities for the entire guideline rather than for specific recommendations. 110 (58.8%) research priorities were put forward due to lack of evidence. Meanwhile, more than 70% of the research priorities reflected the P (population) and I (intervention) structural elements, with 135 (72.2%) and 146 (78.1%), respectively. More than half of the research priorities (118, 63.8%) revolved around evaluating the efficacy of interventions. Research priorities primarily focused on physical activity (32, 17.3%), physical therapy (30, 16.2%), surgical therapy (27, 14.6%) and pharmacological treatment (26, 14.1%). CONCLUSIONS Research priorities reported in KOA CPGs mainly focused on evaluating non-pharmacological interventions. There exists considerable room for improvement for a comprehensive and standardised generation and reporting of research priorities in KOA CPGs.
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Affiliation(s)
- Yicheng Gao
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhihan Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Rui Cao
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuting Feng
- Beijing University of Chinese Medicine, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Chengyuan Su
- Beijing University of Chinese Medicine, Beijing, China
| | - Xinmiao Guan
- Beijing University of Chinese Medicine, Beijing, China
| | - Rui Fang
- Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yingjie Deng
- Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenyuan Xiang
- Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yutong Fei
- Beijing University of Chinese Medicine, Beijing, China
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Doctor JN, Meeker D, Fox CR, Persell SD, Wagner Z, Bouskill KE, Zanocco KA, Romanelli RJ, Brummett CM, Kirkegaard A, Watkins KE. A call for community-shared decisions. BMJ Evid Based Med 2024:bmjebm-2023-112641. [PMID: 38604618 DOI: 10.1136/bmjebm-2023-112641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Jason N Doctor
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | | | - Craig R Fox
- University of California Los Angeles Anderson School of Management, Los Angeles, California, USA
| | - Stephen D Persell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Kyle A Zanocco
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Chad M Brummett
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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Sertorio ES, Colugnati FAB, Denhaerynck K, De Smet S, Medina JOP, Reboredo MM, De Geest S, Sanders-Pinheiro H, On Behalf Of The Adhere Brazil Study Team. Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study. Phys Ther 2024:pzae058. [PMID: 38591795 DOI: 10.1093/ptj/pzae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/27/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. METHODS This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. RESULTS At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97-6.06), obesity (odds ratio = 1.79; 95% CI = 1.26-2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20-8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17-2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48-0.90), and student status (odds ratio = 0.58; 95% CI = 0.37-0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46-0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01-2.13). CONCLUSIONS This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. IMPACT In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.
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Affiliation(s)
- Emiliana S Sertorio
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Stefan De Smet
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jose O P Medina
- Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Maycon M Reboredo
- School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil, and Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
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McVeigh TP, Monahan KJ, Christopher J, West N, Scott M, Murray J, Hanson H. Extent of investigation and management of cases of 'unexplained' mismatch repair deficiency (u-dMMR): a UK Cancer Genetics Group consensus. J Med Genet 2024:jmg-2024-109886. [PMID: 38531626 DOI: 10.1136/jmg-2024-109886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Mismatch repair deficiency (dMMR) is a characteristic feature of cancers linked to Lynch syndrome. However, in most cases, it results from sporadic somatic events rather than hereditary factors. The term 'Lynch-like syndrome' (LLS) has been used to guide colorectal cancer surveillance for relatives of individuals with a dMMR tumour when somatic and germline genomic testing is uninformative. As the assessment of mismatch repair through immunohistochemistry and/or microsatellite instability is increasingly applied across various tumour types for treatment planning, dMMR is increasingly detected in tumours where suspicion of hereditary aetiology is low. Our objective was to establish current practices and develop national guidance for investigating, and managing relatives of, patients with cancers demonstrating unexplained dMMR. METHODS This was achieved through a virtual consensus meeting involving key stakeholders from the UK, through premeeting surveys, structured discussions and in-meeting polling to formulate best practice guidance. RESULTS We identified variability in the availability of diagnostic technologies across specialist centres. It was agreed that equitable access to baseline testing is required, acknowledging the need for a pragmatic approach to investigating dMMR cancers not traditionally associated with Lynch syndrome. Factors such as family history, age, tumour type, protein loss pattern and extent of the investigation were deemed crucial in guiding family management. The term 'unexplained dMMR' was recommended over LLS. CONCLUSION Decisions regarding investigations and future cancer risk management in patients and relatives should be nuanced, considering factors like clinical suspicion of hereditary predisposition to allocate limited resources efficiently and avoid unnecessary investigations in low-suspicion families.
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Affiliation(s)
- Terri Patricia McVeigh
- Cancer Genetics Unit, Royal Marsden Hospital NHS Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Kevin J Monahan
- St Mark's Academic Institute Polyposis Registry, Harrow, UK
- Imperial College London, London, UK
| | - Joseph Christopher
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Nick West
- University of Leeds, Leeds, UK
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Malcolm Scott
- Familial Cancer Clinic, Department of Gynaecology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennie Murray
- Southeast Scotland Genetics Service, Western General Hospital, Edinburgh, UK
| | - Helen Hanson
- Peninsula Regional Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
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Albutt A, Hardman J, McVey L, Odo C, Paleri V, Patterson J, Webb S, Rousseau N, Kellar I, Randell R. Qualitative study exploring the design of a patient-reported symptom-based risk stratification system for suspected head and neck cancer referrals: protocol for work packages 1 and 2 within the EVEREST-HN programme. BMJ Open 2024; 14:e081151. [PMID: 38582535 PMCID: PMC11002383 DOI: 10.1136/bmjopen-2023-081151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/19/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Between 2009/2010 and 2019/2020, England witnessed an increase in suspected head and neck cancer (sHNC) referrals from 140 to 404 patients per 100 000 population. 1 in 10 patients are not seen within the 2-week target, contributing to patient anxiety. We will develop a pathway for sHNC referrals, based on the Head and Neck Cancer Risk Calculator. The evolution of a patient-reported symptom-based risk stratification system to redesign the sHNC referral pathway (EVEREST-HN) Programme comprises six work packages (WPs). This protocol describes WP1 and WP2. WP1 will obtain an understanding of language to optimise the SYmptom iNput Clinical (SYNC) system patient-reported symptom questionnaire for sHNC referrals and outline requirements for the SYNC system. WP2 will codesign key elements of the SYNC system, including the SYNC Questionnaire, and accompanying behaviour change materials. METHODS AND ANALYSIS WP1 will be conducted at three acute National Health Service (NHS) trusts with variation in service delivery models and ensuring a broad mixture of social, economic and cultural backgrounds of participants. Up to 150 patients with sHNC (n=50 per site) and 15 clinicians (n=5 per site) will be recruited. WP1 will use qualitative methods including interviews, observation and recordings of consultations. Rapid qualitative analysis and inductive thematic analysis will be used to analyse the data. WP2 will recruit lay patient representatives to participate in online focus groups (n=8 per focus group), think-aloud technique and experience-based codesign and will be analysed using qualitative and quantitative approaches. ETHICS AND DISSEMINATION The committee for clinical research at The Royal Marsden, a research ethics committee and the Health Research Authority approved this protocol. All participants will give informed consent. Ethical issues of working with patients on an urgent cancer diagnostic pathway have been considered. Findings will be disseminated via journal publications, conference presentations and public engagement activities.
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Affiliation(s)
- Abigail Albutt
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Lynn McVey
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Chinasa Odo
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | | | | | - Sarah Webb
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Rebecca Randell
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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Wickbom F, Calcagnile O, Marklund N, Undén J. Validation of the Scandinavian guidelines for minor and moderate head trauma in children: protocol for a pragmatic, prospective, observational, multicentre cohort study. BMJ Open 2024; 14:e078622. [PMID: 38569695 DOI: 10.1136/bmjopen-2023-078622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Mild traumatic brain injury is common in children and it can be challenging to accurately identify those in need of urgent medical intervention. The Scandinavian guidelines for management of minor and moderate head trauma in children, the Scandinavian Neurotrauma Committee guideline 2016 (SNC16), were developed to aid in risk stratification and decision-making in Scandinavian emergency departments (EDs). This guideline has been validated externally with encouraging results, but internal validation in the intended healthcare system is warranted prior to broad clinical implementation. OBJECTIVE We aim to validate the diagnostic accuracy of the SNC16 to predict clinically important intracranial injuries (CIII) in paediatric patients suffering from blunt head trauma, assessed in EDs in Sweden and Norway. METHODS AND ANALYSIS This is a prospective, pragmatic, observational cohort study. Children (aged 0-17 years) with blunt head trauma, presenting with a Glasgow Coma Scale of 9-15 within 24 hours postinjury at an ED in 1 of the 16 participating hospitals, are eligible for inclusion. Included patients are assessed and managed according to the clinical management routines of each hospital. Data elements for risk stratification are collected in an electronic case report form by the examining doctor. The primary outcome is defined as CIII within 1 week of injury. Secondary outcomes of importance include traumatic CT findings, neurosurgery and 3-month outcome. Diagnostic accuracy of the SNC16 to predict endpoints will be assessed by point estimate and 95% CIs for sensitivity, specificity, likelihood ratio, negative predictive value and positive predictive value. ETHICS AND DISSEMINATION The study is approved by the ethical board in both Sweden and Norway. Results from this validation will be published in scientific journals, and a tailored development and implementation process will follow if the SNC16 is found safe and effective. TRIAL REGISTRATION NUMBER NCT05964764.
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Affiliation(s)
- Fredrik Wickbom
- Department of Clinical Sciences, Malmö, Lund University Faculty of Medicine, Lund, Sweden
- Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden
| | - Olga Calcagnile
- Department of Paediatric Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences, Lund University, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital Lund, Lund, Sweden
| | - Johan Undén
- Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden
- Lund University, Lund, Sweden
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Fereydooni S, Lorenz K, Azarfar A, Luckett T, Phillips JL, Becker W, Giannitrapani K. Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers. BMJ Open 2024; 14:e082033. [PMID: 38514141 PMCID: PMC10961503 DOI: 10.1136/bmjopen-2023-082033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. METHODS We conducted a secondary analysis of the raw semistructured interview data gathered from 42 prescribers who participated in one of two aligned concurrent qualitative studies in the USA and Australia. We conducted a two-part analysis of the interview: first identifying all factors influencing long-term prescribing and second open coding-related content for themes. RESULTS Factors that influence long-term opioid prescribing for cancer-related pain clustered under three key domains (patient-related, provider-related and practice-related factors) each with several themes. Domain 1: Patient factors related to provider-patient continuity, patient personality, the patient's social context and patient characteristics including racial/ethnic identity, housing and socioeconomic status. Domain 2: Provider-related factors centred around provider 'personal experience and expertise', training and time availability. Domain 3: Practice-related factors included healthcare interventions to promote safer opioid practices and accessibility of quality alternative pain therapies. CONCLUSION Despite the differences in the contexts of the two countries, providers consider similar patient, provider and practice-related factors when long-term prescribing opioids for patients with cancer. Some of these factors may be categorised as cognitive biases that may intersect in an already disadvantaged patient and exacerbate disparities in the treatment of their pain. A more systematic understanding of these factors and how they impact the quality of care can inform appropriate interventions.
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Affiliation(s)
| | - Karl Lorenz
- Stanford University, Stanford, California, USA
| | - Azin Azarfar
- University of Florida, Gainesville, Florida, USA
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology, Sydney, New South Wales, Australia
| | - William Becker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Karleen Giannitrapani
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Durand MA, Selby K, Okan Y. Visualisation of evidence for shared decision making. BMJ Evid Based Med 2024; 29:117-120. [PMID: 37968088 DOI: 10.1136/bmjebm-2023-112565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Marie-Anne Durand
- Centre d'Epidémiologie et de Recherche en santé des Populations, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kevin Selby
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
| | - Yasmina Okan
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
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Scheibler F, Geiger F, Wehkamp K, Danner M, Debrouwere M, Stolz-Klingenberg C, Schuldt-Joswig A, Sommer CG, Kopeleva O, Bünzen C, Wagner-Ullrich C, Koch G, Coors M, Wehking F, Clayman M, Weymayr C, Sundmacher L, Rüffer JU. Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial. BMJ Evid Based Med 2024; 29:87-95. [PMID: 37890982 PMCID: PMC10982630 DOI: 10.1136/bmjebm-2023-112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM). DESIGN Pre-post study. SETTING University Hospital Schleswig-Holstein (UKSH), Kiel Campus. PARTICIPANTS Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH. INTERVENTIONS The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate. MAIN OUTCOME MEASURES In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre-post comparisons were done using t-tests. RESULTS The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDM showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects. CONCLUSIONS The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
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Affiliation(s)
- Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
| | - Friedemann Geiger
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marion Danner
- DARUM Marion Danner und Anne Rummer GbR, Cologne, Germany
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Constanze Stolz-Klingenberg
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Anja Schuldt-Joswig
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christina Gesine Sommer
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Olga Kopeleva
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
- Department of General Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Claudia Bünzen
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christine Wagner-Ullrich
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Gerhard Koch
- Department for Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
| | - Marie Coors
- Department of Health Economics, Technical University of Munich, München, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Marla Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christian Weymayr
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, München, Germany
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Otte JA, Llargués Pou M. Enablers and barriers to a quaternary prevention approach: a qualitative study of field experts. BMJ Open 2024; 14:e076836. [PMID: 38508616 PMCID: PMC10952943 DOI: 10.1136/bmjopen-2023-076836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE There is a growing concern about the sustainability of healthcare and the impacts of 'overuse' on patients and systems. Quaternary prevention (P4), a concept promoting the protection of patients from medical interventions in which harms outweigh benefits, is well positioned to stimulate reflection and inspire solutions, yet has not been widely adopted. We sought to identify enablers and barriers to a P4 approach, according to field experts and advocates in one health system. DESIGN Qualitative methodology, using semistructured interviews and a grounded theory approach facilitated thematic analysis and development of a conceptual model. SETTING Virtual interviews, conducted in British Columbia, Canada. PARTICIPANTS 12 field experts, recruited based on their interest and work related to P4 and related concepts. RESULTS Four factors were seen as promoting or hindering P4 efforts depending on context: relationship between patient and clinician, education of clinicians and the public, health system design and influencers. We extracted four broad enablers of P4: evidence-based medicine, personal experiences and questioning attitude, public P4 campaigns and experience in resource-poor contexts. There were six barriers: peer pressure between clinicians, awareness and screening campaigns, cognitive biases, cultural factors, complexity of the problem and industry influence. CONCLUSIONS Elicited facilitators and impediments to the application of P4 were similar to those seen in existing literature but framed uniquely; our findings place increased emphasis on the clinician-patient relationship as central to decision-making and position other drivers as influencing this relationship. A transition to a model of care that explicitly integrates conscious protection of patients by reducing overtesting, overdiagnosis and overtreatment will require changes across health systems and society.
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Affiliation(s)
- Jessica Anneliese Otte
- Department of Family Practice and Division of Palliative Care, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Maria Llargués Pou
- Sta. Mª de Palautordera Primary Healthcare Center (CAP) - Baix Montseny Primary Healthcare Team (EAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
- Emergency Department, University General Hospital of Granollers, Barcelona, Catalonia, Spain
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Macpherson D, Hutchinson A, Bloomer MJ. Factors that influence critical care nurses' management of sedation for ventilated patients in critical care: A qualitative study. Intensive Crit Care Nurs 2024; 83:103685. [PMID: 38493573 DOI: 10.1016/j.iccn.2024.103685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce. AIM To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making. DESIGN Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis. SETTING AND PARTICIPANTS This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate. FINDINGS Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation. CONCLUSION Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns. IMPLICATIONS FOR CLINICAL PRACTICE Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making.
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Affiliation(s)
- Danielle Macpherson
- Intensive Care Unit, Epworth HealthCare Richmond, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, Victoria, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.
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Maitland A, Fowkes R, Maitland S. Can ChatGPT pass the MRCP (UK) written examinations? Analysis of performance and errors using a clinical decision-reasoning framework. BMJ Open 2024; 14:e080558. [PMID: 38490655 PMCID: PMC10946340 DOI: 10.1136/bmjopen-2023-080558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE Large language models (LLMs) such as ChatGPT are being developed for use in research, medical education and clinical decision systems. However, as their usage increases, LLMs face ongoing regulatory concerns. This study aims to analyse ChatGPT's performance on a postgraduate examination to identify areas of strength and weakness, which may provide further insight into their role in healthcare. DESIGN We evaluated the performance of ChatGPT 4 (24 May 2023 version) on official MRCP (Membership of the Royal College of Physicians) parts 1 and 2 written examination practice questions. Statistical analysis was performed using Python. Spearman rank correlation assessed the relationship between the probability of correctly answering a question and two variables: question difficulty and question length. Incorrectly answered questions were analysed further using a clinical reasoning framework to assess the errors made. SETTING Online using ChatGPT web interface. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the score (percentage questions correct) in the MRCP postgraduate written examinations. Secondary outcomes were qualitative categorisation of errors using a clinical decision-making framework. RESULTS ChatGPT achieved accuracy rates of 86.3% (part 1) and 70.3% (part 2). Weak but significant correlations were found between ChatGPT's accuracy and both just-passing rates in part 2 (r=0.34, p=0.0001) and question length in part 1 (r=-0.19, p=0.008). Eight types of error were identified, with the most frequent being factual errors, context errors and omission errors. CONCLUSION ChatGPT performance greatly exceeded the passing mark for both exams. Multiple choice examinations provide a benchmark for LLM performance which is comparable to human demonstrations of knowledge, while also highlighting the errors LLMs make. Understanding the reasons behind ChatGPT's errors allows us to develop strategies to prevent them in medical devices that incorporate LLM technology.
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Affiliation(s)
- Amy Maitland
- Health Education England North East, Newcastle upon Tyne, UK
| | - Ross Fowkes
- Health Education England North East, Newcastle upon Tyne, UK
| | - Stuart Maitland
- The Newcastle Upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
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van Munster J, Noordenbos MW, Halperin IJY, van den Hout WB, van Benthem PP, Seinen I, Moojen WA, Peul W. Impact of evidence-based guidelines on healthcare utilisation and costs for disc related sciatica in the Netherlands: a population-based, cross-sectional study. BMJ Open 2024; 14:e078459. [PMID: 38471686 DOI: 10.1136/bmjopen-2023-078459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess the impact of high-quality evidence supporting surgical treatment of lumbar disc herniation (LDH) on healthcare practice in the Netherlands by examining changes in healthcare utilisation, including the timing of surgery, and the healthcare costs for patients with LDH. DESIGN A retrospective, cross-sectional study was performed using population-based, longitudinal data obtained from the Dutch Healthcare Authority (2007-2020) and NIVEL's primary care (2012-2020) administrative databases. SETTING The study was conducted within the healthcare system of the Netherlands. PARTICIPANTS We included adults (≥18 years) who visited a Dutch hospital or a general practitioner (GP) for lumbar degenerative disc disease. Patients with LDH were identified based on registered diagnosis code, type of surgery (discectomy) and age (<56 years). MAIN OUTCOME MEASURES The primary outcome measure was the difference in the annual number of LDH procedures following the publication of evidence-based guidelines in 2009 (comparing the periods 2007-2009 to 2017-2019). Secondary outcome measures focused on the timing of surgery and associated healthcare costs. To validate the outcomes, secondary outcomes also include the number of discectomies and the number of procedures in the younger age group (discectomies, laminectomies, and fusion surgery). RESULTS The number of patients suffering from LDH increased from 55 581 to 68 997 (+24%) between 2007 and 2019. A decrease was observed in the annual number of LDH procedures (-18%), in the number of discectomies (-22%) and in the number of procedures for patients aged <56 years (-18%). This resulted in lower healthcare costs by €10.5 million annually. In 2012, 31% of all patients <56 years had surgery before 12 weeks from diagnosis at the GP, whereas 20% did in 2019. CONCLUSIONS Healthcare utilisation for LDH changed tremendously in the Netherlands between 2007 and 2020 and seemed to be associated with the publication and implementation of evidence-based guidelines. The observed decrease in the number of procedures has been accompanied by a corresponding reduction in healthcare costs. These findings underscore the importance of adhering to evidence-based guidelines to optimise the management of patients with LDH.
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Affiliation(s)
- Juliëtte van Munster
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - I J Y Halperin
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Peter Paul van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid Seinen
- Dutch Healthcare Authority, Utrecht, The Netherlands
| | - Wouter A Moojen
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
- Neurosurgery, HAGA hospital, The Hague, The Netherlands
| | - Wilco Peul
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
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Shi X, Wu H, Liu J, Zhu J, Zhang L. Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study. BMJ Open 2024; 14:e081550. [PMID: 38458810 DOI: 10.1136/bmjopen-2023-081550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE This study aimed to introduce a novel laparoscopic haemostasis for myomectomy and investigate the independent risk factors for uterine fibroid recurrence. DESIGN A retrospective cohort study. SETTING Following strengthening the reporting of observational studies in epidemiology (STROBE) criteria, a retrospective study of prospectively collected available data of the consecutive patients who underwent the myomectomy in the department of obstetrics and gynaecology of the single centre between February 2018 and December 2020. PARTICIPANTS 177 patients who underwent laparoscopic myomectomy resection were enrolled in the present cohort study. MATERIALS AND METHODS Patients were classified into two groups according to their different methods of haemostasis in laparoscopic surgery. Recurrence-free survival was compared between the groups during an average follow-up of nearly 2 years. RESULTS Of the 177 patients from 672 consecutive patients in the retrospective cohort, laparoscopic circular suture and baseball suture were carried out in 102 (57.6%) and 75 (42.4%) patients, respectively. The total amount of blood lost during surgery varied significantly (37.6 vs 99.5 mL) (p<0.001). Univariable analyses identified that age ≥40 years, position at intramural myoma, multiple fibroids and largest fibroid volume ≥50 mm3 (HR 2.222, 95% CI 1.376 to 3.977, p=0.039; HR 3.625, 95% CI 1.526 to 6.985, p=0.003; HR 3.139, 95% CI 1.651 to 5.968, p<0.001; HR 2.328, 95% CI 0.869 to 3.244, p=0.040, respectively) are independent risk factor of the recurrence of uterine fibroids. The formula of the nomogram prediction model was established as the practical clinical tool. CONCLUSION The laparoscopic continuous seromuscular circumsuture for myomectomy can effectively reduce the amount of surgical bleeding and accelerate the perioperative recovery for surgical safety. The main factors affecting the recurrence of uterine fibroids were age, location, number and volume of uterine fibroids. The nomogram can more straightforwardly assist clinicians to determine the risk of recurrence after laparoscopic myomectomy.
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Affiliation(s)
- Xueqin Shi
- Department of Obstetrics and Gynecology, Jianhu Clinical Medical College, Yangzhou University, Jianhu, Jiangsu, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Jinmei Liu
- Department of Obstetrics and Gynecology, Jianhu Clinical Medical College, Yangzhou University, Jianhu, Jiangsu, China
| | - Jianhua Zhu
- Department of Obstetrics and Gynecology, Jianhu Clinical Medical College, Yangzhou University, Jianhu, Jiangsu, China
| | - Linyan Zhang
- Department of Obstetrics and Gynecology, Jianhu Clinical Medical College, Yangzhou University, Jianhu, Jiangsu, China
- Jianhu Clinical College, Jiangsu Vocational College of Medicine, Jianhu, Jiangsu, China
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Müskens JL, Kool RB, Westert GP, Zaal M, Muller H, Atsma F, van Dulmen SA. Non-indicated vitamin B 12- and D-testing among Dutch hospital clinicians: a cross-sectional analysis in data registries. BMJ Open 2024; 14:e075241. [PMID: 38418241 PMCID: PMC10910490 DOI: 10.1136/bmjopen-2023-075241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 02/15/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To assess the extent of non-indicated vitamin B12- and D-testing among Dutch clinicians and its variation among hospitals. DESIGN Cross-sectional study using registration data from 2015 to 2019. PARTICIPANTS Patients aged between 18 and 70 years who received a vitamin B12- or D-test. PRIMARY AND SECONDARY OUTCOME MEASURES The proportion of non-indicated vitamin B12- and D-testing among Dutch clinicians and its variation between hospitals (n=68) over 2015-2019. RESULTS Between 2015 and 2019, at least 79.0% of all vitamin B12-tests and 82.0% of vitamin D-tests lacked a clear indication. The number of vitamin B12-tests increased by 2.0% over the examined period, while the number of D-tests increased by 12.2%. The proportion of the unexplained variation in non-indicated vitamin B12- and D-tests that can be ascribed to differences between hospitals remained low. Intraclass correlation coefficients ranged between 0.072 and 0.085 and 0.081 and 0.096 for non-indicated vitamin B12- and D-tests, respectively. The included casemix variables patient age, gender, socioeconomic status and hospital size only accounted for a small part of the unexplained variation in non-indicated testing. Additionally, a significant correlation was observed in non-indicated vitamin B12- and D-testing among the included hospitals. CONCLUSION Hospital clinicians order vitamin B12- and D-tests without a clear indication on a large scale. Only a small proportion of the unexplained variation could be attributed to differences between hospitals.
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Affiliation(s)
- Joris Ljm Müskens
- IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rudolf Bertijn Kool
- IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gert P Westert
- IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Hein Muller
- Dutch Hospital Data, Utrecht, The Netherlands
| | - Femke Atsma
- IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S A van Dulmen
- IQ Health science department, Radboud University Medical Centre, Nijmegen, The Netherlands
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Yang Y, Long Z, Lei B, Liu W, Ye J. Clinical decision support system based on deep learning for evaluating implantable collamer lens size and vault after implantable collamer lens surgery: a retrospective study. BMJ Open 2024; 14:e081050. [PMID: 38365302 PMCID: PMC10875548 DOI: 10.1136/bmjopen-2023-081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES To aid doctors in selecting the optimal preoperative implantable collamer lens (ICL) size and to enhance the safety and surgical outcomes of ICL procedures, a clinical decision support system (CDSS) is proposed in our study. DESIGN A retrospective study of patients after ICL surgery. SETTING China Tertiary Myopia Prevention and Control Center. PARTICIPANTS 2772 eyes belonging to 1512 patients after ICL surgery. Data were collected between 2018 and 2022. OUTCOME MEASURES A CDSS is constructed and used to predict vault at 1 month postoperatively and preoperative ICL dimensions using various artificial intelligence methods. Accuracy metrics as well as area under curve (AUC) parameters are used to determine the CDSS prediction methods. RESULTS Among the ICL size prediction models, conventional neural networks (CNNs) achieve the best prediction accuracy at 91.37% and exhibit the highest AUC of 0.842. Regarding the prediction model for vault values 1 month after surgery, CNN surpasses the other methods with an accuracy of 85.27%, which has the uppermost AUC of 0.815. Thus, we select CNN as the prediction algorithm for the CDSS. CONCLUSIONS This study introduces a CDSS to assist doctors in selecting the optimal ICL size for patients while improving the safety and postoperative outcomes of ICL surgery.
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Affiliation(s)
- Yixuan Yang
- Department of Ophthalmology, The Third Hospital Affiliated to the Third Military Medical University Department of Ophthalmology, Chongqing, China
| | - Zhengqin Long
- Chongqing University Qianjiang Hospital, Chongqing, China
| | - Bo Lei
- Department of Ophthalmology, The Third Hospital Affiliated to the Third Military Medical University Department of Ophthalmology, Chongqing, China
| | - Wei Liu
- Department of Ophthalmology, The Third Hospital Affiliated to the Third Military Medical University Department of Ophthalmology, Chongqing, China
| | - Jian Ye
- Department of Ophthalmology, The Third Hospital Affiliated to the Third Military Medical University Department of Ophthalmology, Chongqing, China
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Chess J, Roberts G, McLaughlin L, Williams G, Noyes J. What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales. BMJ Open 2024; 14:e082386. [PMID: 38355196 PMCID: PMC10868286 DOI: 10.1136/bmjopen-2023-082386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To identify the factors that determine treatment choices following pre-dialysis education. DESIGN Retrospective cohort study using data linkage with univariate and multivariate analyses using linked data. SETTING Secondary care National Health Service Wales healthcare system. PARTICIPANTS All people in Wales over 18 years diagnosed with established kidney disease, who received pre-dialysis education between 1 January 2016 and 12 December 2018. MAIN OUTCOME MEASURES Patient choice of dialysis modality and any kidney replacement therapy started. RESULTS Mean age was 67 years; n=1207 (60%) were male, n=878 (53%) had ≥3 comorbidities, n=805 (66%) had mobility problems, n=700 (57%) had pain symptoms, n=641 (52%) had anxiety or were depressed, n=1052 (61.6%) lived less than 30 min from their treatment centre, n=619 (50%) were on a spectrum of frail to extremely vulnerable. n=424 (25%) chose home dialysis, n=552 (32%) chose hospital-based dialysis, n=109 (6%) chose transplantation, n=231 (14%) chose maximum conservative management and n=391 (23%) were 'undecided'. Main reasons for not choosing home dialysis were lack of motivation/low confidence in capacity to self-administer treatment, lack of home support and unsuitable housing. Patients who choose home dialysis were younger, had lower comorbidities, lower frailty and higher quality of life scores. Multivariate analysis found that age and frailty were predictors of choice, but we did not find any other demographic associations. Of patients who initially chose home dialysis, only n=150 (54%) started on home dialysis. CONCLUSION There is room for improvement in current pre-dialysis treatment pathways. Many patients remain undecided about dialysis choice, and others who may have chosen home dialysis are still likely to start on unit haemodialysis.
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Affiliation(s)
- James Chess
- Renal Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | | | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Gail Williams
- Welsh Kidney Network (Retired), NHS Wales Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Fu H, Novak A, Robert D, Kumar S, Tanamala S, Oke J, Bhatia K, Shah R, Romsauerova A, Das T, Espinosa A, Grzeda MT, Narbone M, Dharmadhikari R, Harrison M, Vimalesvaran K, Gooch J, Woznitza N, Salik N, Campbell A, Khan F, Lowe DJ, Shuaib H, Ather S. AI assisted reader evaluation in acute CT head interpretation (AI-REACT): protocol for a multireader multicase study. BMJ Open 2024; 14:e079824. [PMID: 38346874 PMCID: PMC10862304 DOI: 10.1136/bmjopen-2023-079824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION A non-contrast CT head scan (NCCTH) is the most common cross-sectional imaging investigation requested in the emergency department. Advances in computer vision have led to development of several artificial intelligence (AI) tools to detect abnormalities on NCCTH. These tools are intended to provide clinical decision support for clinicians, rather than stand-alone diagnostic devices. However, validation studies mostly compare AI performance against radiologists, and there is relative paucity of evidence on the impact of AI assistance on other healthcare staff who review NCCTH in their daily clinical practice. METHODS AND ANALYSIS A retrospective data set of 150 NCCTH will be compiled, to include 60 control cases and 90 cases with intracranial haemorrhage, hypodensities suggestive of infarct, midline shift, mass effect or skull fracture. The intracranial haemorrhage cases will be subclassified into extradural, subdural, subarachnoid, intraparenchymal and intraventricular. 30 readers will be recruited across four National Health Service (NHS) trusts including 10 general radiologists, 15 emergency medicine clinicians and 5 CT radiographers of varying experience. Readers will interpret each scan first without, then with, the assistance of the qER EU 2.0 AI tool, with an intervening 2-week washout period. Using a panel of neuroradiologists as ground truth, the stand-alone performance of qER will be assessed, and its impact on the readers' performance will be analysed as change in accuracy (area under the curve), median review time per scan and self-reported diagnostic confidence. Subgroup analyses will be performed by reader professional group, reader seniority, pathological finding, and neuroradiologist-rated difficulty. ETHICS AND DISSEMINATION The study has been approved by the UK Healthcare Research Authority (IRAS 310995, approved 13 December 2022). The use of anonymised retrospective NCCTH has been authorised by Oxford University Hospitals. The results will be presented at relevant conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT06018545.
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Affiliation(s)
- Howell Fu
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Novak
- Emergency Medicine Research Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Jason Oke
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kanika Bhatia
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruchir Shah
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Tilak Das
- Department of Clinical Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Abdalá Espinosa
- Emergency Medicine Research Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Mark Harrison
- Emergency Department, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - Kavitha Vimalesvaran
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Gooch
- College of Health, Psychology & Social Care, University of Derby, Derby, UK
| | - Nicholas Woznitza
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | | | - Alan Campbell
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farhaan Khan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Haris Shuaib
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarim Ather
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Chuang YH, Wang CC, Hsiao CY, Lu CY, Wu JC, Hou WH. Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study. BMJ Open 2024; 14:e075693. [PMID: 38309751 PMCID: PMC10840022 DOI: 10.1136/bmjopen-2023-075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN In-depth interviews and thematic analysis. SETTING Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei, Taiwan
| | - Chih-Chien Wang
- College of Management, Da-Yeh University, Changhua, Taiwan
- Graduate Institute of Information Management, National Taipei University, Taipei, Taiwan
| | - Chih-Yin Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yeh Lu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Kwon H, Lee D. Clinical decision support system for clinical nurses' decision-making on nurse-to-patient assignment: a scoping review protocol. BMJ Open 2024; 14:e080208. [PMID: 38296282 PMCID: PMC10831424 DOI: 10.1136/bmjopen-2023-080208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Optimal nurse-to-patient assignment plays a crucial role in healthcare delivery, with direct implications for patient outcomes and the workloads of nursing staff. However, this process is highly intricate, involving a multitude of factors that must be carefully considered. The application of a clinical decision support system (CDSS) to support nursing decision-making can have a positive impact not only on patient outcomes but also on nursing efficiency. This scoping review aims to explore the implementation of CDSS in the decision process of optimal nurse-patient assignment (NPA). METHODS AND ANALYSIS This scoping review will follow a stage of the Arksey and O'Malley framework. It will also be based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews' (PRISMA-ScR) guidelines. The research primarily aims to identify studies' findings on applying CDSSs in the NPA process. Hence, academic and grey literature articles from six international bibliographic databases (ie, MEDLINE via PubMed, EMBASE via Ovid, CINAHL via EBSCOhost, IEEE Xplore, Scopus, ProQuest Dissertations and Theses Global) will be considered, where search strategies will be tailored to each database. The literature search will be conducted in February 2024, and the identified studies will be independently screened by two primary reviewers. After extracting data, the qualitative data will be analysed thematically, and the quantitative data will be subjected to descriptive statistics. The research is scheduled to conclude in December 2024. ETHICS AND DISSEMINATION Ethical approval is not required as primary data will not be collected in this study. The findings of this study will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Hyunjeong Kwon
- Research Institute of Nursing Science, Seoul National University, Jongno-gu, Korea
| | - Dayeon Lee
- College of Nursing, Seoul National University, Seoul, Korea
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23
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Álvaro de la Parra JA, Del Olmo Rodríguez M, Caramés Sánchez C, Blanco Á, Pfang B, Mayoralas-Alises S, Fernandez-Ferro J, Calvo E, Gómez Martín Ó, Fernández Tabera J, Plaza Nohales C, Nieto C, Short Apellaniz J. Effect of an algorithm for automatic placing of standardised test order sets on low-value appointments and attendance rates at four Spanish teaching hospitals: an interrupted time series analysis. BMJ Open 2024; 14:e081158. [PMID: 38267242 PMCID: PMC10824031 DOI: 10.1136/bmjopen-2023-081158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Reducing backlogs for elective care is a priority for healthcare systems. We conducted an interrupted time series analysis demonstrating the effect of an algorithm for placing automatic test order sets prior to first specialist appointment on avoidable follow-up appointments and attendance rates. DESIGN Interrupted time series analysis. SETTING 4 academic hospitals from Madrid, Spain. PARTICIPANTS Patients referred from primary care attending 10 033 470 outpatient appointments from 16 clinical specialties during a 6-year period (1 January 2018 to 30 June 2023). INTERVENTION An algorithm using natural language processing was launched in May 2021. Test order sets developed for 257 presenting complaints from 16 clinical specialties were placed automatically before first specialist appointments to increase rates of diagnosis and initiation of treatment with discharge back to primary care. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included rate of diagnosis and discharge to primary care and follow-up to first appointment index. The secondary outcome was trend in 'did not attend' rates. RESULTS Since May 2021, a total of 1 175 814 automatic test orders have been placed. Significant changes in trend of diagnosis and discharge to primary care at first appointment (p=0.005, 95% CI 0.5 to 2.9) and 'did not attend' rates (p=0.006, 95% CI -0.1 to -0.8) and an estimated attributable reduction of 11 306 avoidable follow-up appointments per month were observed. CONCLUSION An algorithm for placing automatic standardised test order sets can reduce low-value follow-up appointments by allowing specialists to confirm diagnoses and initiate treatment at first appointment, also leading to early discharge to primary care and a reduction in 'did not attend' rates. This initiative points to an improved process for outpatient diagnosis and treatment, delivering healthcare more effectively and efficiently.
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Affiliation(s)
| | - Marta Del Olmo Rodríguez
- Quirónsalud, Madrid, Spain
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Cristina Caramés Sánchez
- Quirónsalud, Madrid, Spain
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | | | - Bernadette Pfang
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jose Fernandez-Ferro
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Neurology Department, Hospital Universitario Rey Juan Carlos, Mostoles, Spain
| | - Emilio Calvo
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Óscar Gómez Martín
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Fernández Tabera
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Villalba General University Hospital, Collado Villalba, Spain
| | - Carmen Plaza Nohales
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Mostoles, Spain
| | - Carlota Nieto
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jorge Short Apellaniz
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Kohut K, Speight B, Young J, Way R, Wiggins J, Monje-Garcia L, Eccles DM, Foster C, Turner L, Snape K, Hanson H. Co-design of patient information leaflets for germline predisposition to cancer: recommendations for clinical practice from the UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar Programme and the Association of Genetic Nurse Counsellors (AGNC). J Med Genet 2024; 61:142-149. [PMID: 38050080 DOI: 10.1136/jmg-2023-109440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/27/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Testing for germline pathogenic variants (GPVs) in cancer predisposition genes is increasingly offered as part of routine care for patients with cancer. This is often urgent in oncology clinics due to potential implications on treatment and surgical decisions. This also allows identification of family members who should be offered predictive genetic testing. In the UK, it is common practice for healthcare professionals to provide a patient information leaflet (PIL) at point of care for diagnostic genetic testing in patients with cancer, after results disclosure when a GPV is identified, and for predictive testing of at-risk relatives. Services usually create their own PIL, resulting in duplication of effort and wide variability regarding format, content, signposting and patient input in co-design and evaluation. METHODS Representatives from UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar programme and Association of Genetic Nurse Counsellors (AGNC) held a 2-day meeting with the aim of making recommendations for clinical practice regarding co-design of PIL for germline cancer susceptibility genetic testing. Lynch syndrome and haematological malignancies were chosen as exemplar conditions. RESULTS Meeting participants included patient representatives including as co-chair, multidisciplinary clinicians and other experts from across the UK. High-level consensus for UK recommendations for clinical practice was reached on several aspects of PIL using digital polling, including that PIL should be offered, accessible, co-designed and evaluated with patients. CONCLUSIONS Recommendations from the meeting are likely to be applicable for PIL co-design for a wide range of germline genetic testing scenarios.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Beverley Speight
- Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Rosalind Way
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Jennifer Wiggins
- Cancer Genetics, The Royal Marsden NHS Foundation Trust, London, UK
| | - Laura Monje-Garcia
- The St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Diana M Eccles
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | | | - Katie Snape
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Helen Hanson
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
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Riganti P, Kopitowski KS, McCaffery K, van Bodegom-Vos L. The paradox of using SDM for de-implementation of low-value care in the clinical encounter. BMJ Evid Based Med 2024; 29:14-16. [PMID: 37080738 DOI: 10.1136/bmjebm-2022-112201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Paula Riganti
- Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Karin Silvana Kopitowski
- Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Kirsten McCaffery
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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Stokke Hunskaar B, Løvsletten PO, Muller A, Vandvik PO. Interpretation and use of a decision support tool for multiple treatment options: a combined randomised controlled trial and survey of medical students. BMJ Evid Based Med 2024; 29:29-36. [PMID: 37833036 PMCID: PMC10850623 DOI: 10.1136/bmjebm-2023-112370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES To investigate medical students' ability to interpret evidence, as well as their self-assessed understandability, perceived usefulness and preferences for design alternatives in an interactive decision support tool, displaying GRADE evidence summaries for multiple treatment options (Making Alternative Treatment CHoices Intuitive and Trustworthy, MATCH-IT). DESIGN A combined randomised controlled trial and survey. Participants were presented with a clinical scenario and randomised to one of two versions of the MATCH-IT tool (A/B), instructed to explore the evidence and decide on a recommendation. Participants answered a questionnaire assessing interpretation, treatment recommendation self-assessed understandability and perceived usefulness before exposure to the other MATCH-IT version and asked questions on design preferences. SETTING Online lecture in an evidence-based medicine (EBM) introductory course. PARTICIPANTS 149 third-year medical students. 52% (n=77) had 6 months of clinical training and 48% (n=72) had preclinical training only. INTERVENTIONS The MATCH-IT tool version A uses colour coding to categorise interventions by magnitude and direction of effects and displays all outcomes in a table on entry. Version B has no colour coding, and the user must decide which outcomes to display in the table. MAIN OUTCOME MEASURES Interpretation of evidence, treatment recommendation, perceived usefulness and understandability, preference for format and design alternatives. RESULTS 82.5% (n=123) of medical students correctly answered ≥4 out of 5 multiple choice questions assessing interpretation of data. 75.8% (n=114) of students made a treatment recommendation in accordance with an expert panel for the same clinical scenario. 87.2% (n=130) found the tool understandable while 91.9% perceived the tool as useful in addressing the clinical scenario. CONCLUSION Medical students with no prior training in EBM can interpret and use the MATCH-IT tool. Certain design alternatives were preferred but had no bearing on interpretation of evidence or understandability of the tool.
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Affiliation(s)
- Birk Stokke Hunskaar
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Per Olav Løvsletten
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Ashley Muller
- Norwegian Centre for Addiction Research, University of Oslo Faculty of Medicine, Oslo, Norway
- Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
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Dietrich F, Zeller A, Hersberger KE, Arnet I. Adherence Monitoring Package (AMoPac) in patients suspected of non-response to antihypertensive treatment: perceived usefulness by general practitioners. BMJ Open Qual 2024; 13:e002451. [PMID: 38216295 PMCID: PMC10806575 DOI: 10.1136/bmjoq-2023-002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Non-adherence to antihypertensive agents is common, mainly because of the low perceived burden of high blood pressure. General practitioners (GPs) are unable to predict whether patients are adhering to a recommended treatment. Knowledge about adherence might be of clinical interest in patients non-responding to antihypertensive treatment. AIM To assess the usefulness of an Adherence Monitoring Package (AMoPac) to identify non-adherence in patients non-responding to antihypertensive treatment. METHODS AMoPac consists of (1) 4 weeks of electronic adherence monitoring, (2) pharmacist's feedback on patient's intake behaviour and (3) adherence metrics including clinical-pharmaceutical recommendations to the GP. AMoPac-HYP ('Adherence Monitoring Package to identify non-adherence in ambulatory HYPertensive patients') is an observational study among GPs and ambulatory patients with hypertension in a real-world setting. The primary outcome was GPs' perceived usefulness of AMoPac. Secondary outcomes were (1) frequency of medication problems and prescribing errors; (2) types of pharmacist's' recommendations; (3) acceptance of the recommendations by GPs; (4) medication adherence and (5) patients' satisfaction. Outcomes are reported descriptively. Data were collected with questionnaires and electronic monitoring of medicine intake. RESULTS Fifteen GPs and 15 patients with hypertension participated in the AMoPac-HYP Study. Patients were on average 62 years old, and mean blood pressure was 137/83 mmHg. All GPs rated AMoPac as useful. The most frequently mentioned use was excluding non-adherence in patients with hypertension (93%). Medication problems and prescribing errors were observed in 80% of the patients. The study pharmacist recommended adherence support (N=9 patients) and treatment optimisation (N=8 patients). The recommendations were accepted and implemented in 10 of 17 cases by the GP. Patients' mean taking and timing adherence were 90% and 86%, respectively. Satisfaction with the study procedures among patients was high. CONCLUSION AMoPac was rated as useful for identifying and excluding non-adherence in patients with hypertension and was highly accepted among patients. Including adherence data in clinical decision-making could contribute to optimising patient care.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | | | - Isabelle Arnet
- Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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van Eijk J, Luijken K, Jaarsma T, Reitsma JB, Schuit E, Frederix GWJ, Derks L, Schaap J, Rutten FH, Brugts J, de Boer RA, Asselbergs FW, Trappenburg JCA. RELEASE-HF study: a protocol for an observational, registry-based study on the effectiveness of telemedicine in heart failure in the Netherlands. BMJ Open 2024; 14:e078021. [PMID: 38176879 PMCID: PMC10773380 DOI: 10.1136/bmjopen-2023-078021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Meta-analyses show postive effects of telemedicine in heart failure (HF) management on hospitalisation, mortality and costs. However, these effects are heterogeneous due to variation in the included HF population, the telemedicine components and the quality of the comparator usual care. Still, telemedicine is gaining acceptance in HF management. The current nationwide study aims to identify (1) in which subgroup(s) of patients with HF telemedicine is (cost-)effective and (2) which components of telemedicine are most (cost-)effective. METHODS AND ANALYSIS The RELEASE-HF ('REsponsible roLl-out of E-heAlth through Systematic Evaluation - Heart Failure') study is a multicentre, observational, registry-based cohort study that plans to enrol 6480 patients with HF using data from the HF registry facilitated by the Netherlands Heart Registration. Collected data include patient characteristics, treatment information and clinical outcomes, and are measured at HF diagnosis and at 6 and 12 months afterwards. The components of telemedicine are described at the hospital level based on closed-ended interviews with clinicians and at the patient level based on additional data extracted from electronic health records and telemedicine-generated data. The costs of telemedicine are calculated using registration data and interviews with clinicians and finance department staff. To overcome missing data, additional national databases will be linked to the HF registry if feasible. Heterogeneity of the effects of offering telemedicine compared with not offering on days alive without unplanned hospitalisations in 1 year is assessed across predefined patient characteristics using exploratory stratified analyses. The effects of telemedicine components are assessed by fitting separate models for component contrasts. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee 2021 of the University Medical Center Utrecht (the Netherlands). Results will be published in peer-reviewed journals and presented at (inter)national conferences. Effective telemedicine scenarios will be proposed among hospitals throughout the country and abroad, if applicable and feasible. TRIAL REGISTRATION NUMBER NCT05654961.
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Affiliation(s)
- Jorna van Eijk
- General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Luijken
- Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tiny Jaarsma
- General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ewoud Schuit
- Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert W J Frederix
- Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lineke Derks
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
- Dutch Network for Cardiovascular Research, WCN, Utrecht, The Netherlands
| | - Frans H Rutten
- General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jasper Brugts
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Jaap C A Trappenburg
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Zhang WW, Wang S, Li Y, Dong X, Zhao L, Li Z, Liu Q, Liu M, Zhang F, Yao G, Zhang J, Liu X, Liu G, Zhang X, Reddy S, Yu YH. Development and validation of a model to predict mortality risk among extremely preterm infants during the early postnatal period: a multicentre prospective cohort study. BMJ Open 2023; 13:e074309. [PMID: 38154879 PMCID: PMC10759098 DOI: 10.1136/bmjopen-2023-074309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Recently, with the rapid development of the perinatal medical system and related life-saving techniques, both the short-term and long-term prognoses of extremely preterm infants (EPIs) have improved significantly. In rapidly industrialising countries like China, the survival rates of EPIs have notably increased due to the swift socioeconomic development. However, there is still a reasonably lower positive response towards the treatment of EPIs than we expected, and the current situation of withdrawing care is an urgent task for perinatal medical practitioners. OBJECTIVE To develop and validate a model that is practicable for EPIs as soon as possible after birth by regression analysis, to assess the risk of mortality and chance of survival. METHODS This multicentre prospective cohort study used datasets from the Sino-Northern Neonatal Network, including 46 neonatal intensive care units (NICUs). Risk factors including maternal and neonatal variables were collected within 1 hour post-childbirth. The training set consisted of data from 41 NICUs located within the Shandong Province of China, while the validation set included data from 5 NICUs outside Shandong Province. A total of 1363 neonates were included in the study. RESULTS Gestational age, birth weight, pH and lactic acid in blood gas analysis within the first hour of birth, moderate-to-severe hypothermia on admission and adequate antenatal corticosteroids were influencing factors for EPIs' mortality with important predictive ability. The area under the curve values for internal validation of our prediction model and Clinical Risk Index for Babies-II scores were 0.81 and 0.76, and for external validation, 0.80 and 0.51, respectively. Moreover, the Hosmer-Lemeshow test showed that our model has a constant degree of calibration. CONCLUSIONS There was good predictive accuracy for mortality of EPIs based on influencing factors prenatally and within 1 hour after delivery. Predicting the risk of mortality of EPIs as soon as possible after birth can effectively guide parents to be proactive in treating more EPIs with life-saving value. TRIAL REGISTRATION NUMBER ChiCTR1900025234.
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Affiliation(s)
- Wen-Wen Zhang
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shaofeng Wang
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuxin Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoyu Dong
- Shandong University Affiliated to Shandong Province Maternal and Child Health Care Hospital, Jinan, Shandong, China
| | - Lili Zhao
- Liaocheng People's Hospital, Liaocheng City, Shandong, China
| | - Zhongliang Li
- Weifang Maternal and Child Health Hospital, Weifang, China
| | - Qiang Liu
- Linyi People's Hospital, Linyi, Shandong, China
| | - Min Liu
- Linyi Maternal and Child Health Care Hospital, Linyi, Shandong, China
| | - Fengjuan Zhang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Guo Yao
- Taian City Central Hospital, Taian, Shandong, China
| | - Jie Zhang
- Hebei Medical University Petroleum Clinical Medical College, Langfang, Hebei, China
| | - Xiaohui Liu
- Shi Jiazhuang Maternity and Child Health Care Hospital, Shi Jiazhuang, China
| | - Guohua Liu
- Linfen Maternal and Child Health Hospital, Linfen, China
| | - Xiaohui Zhang
- Qindao University Medical College Affiliated to Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong-Hui Yu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Karunananthan S, Rahgozar A, Hakimjavadi R, Yan H, Dalsania KA, Bergman H, Ghose B, LaPlante J, McCutcheon T, McIsaac DI, Abbasgholizadeh Rahimi S, Sourial N, Thandi M, Wong ST, Liddy C. Use of Artificial Intelligence in the Identification and Management of Frailty: A Scoping Review Protocol. BMJ Open 2023; 13:e076918. [PMID: 38154888 PMCID: PMC10759108 DOI: 10.1136/bmjopen-2023-076918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to support the early identification and management of frailty. In order to provide a comprehensive overview of current evidence regarding the development and use of AI technologies including machine learning and deep learning for the identification and management of frailty, this protocol outlines a scoping review aiming to identify and present available information in this area. Specifically, this protocol describes a review that will focus on the clinical tools and frameworks used to assess frailty, the outcomes that have been evaluated and the involvement of knowledge users in the development, implementation and evaluation of AI methods and tools for frailty care in clinical settings. METHODS AND ANALYSIS This scoping review protocol details a systematic search of eight major academic databases, including Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ageline, Web of Science, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore using the framework developed by Arksey and O'Malley and enhanced by Levac et al and the Joanna Briggs Institute. The search strategy has been designed in consultation with a librarian. Two independent reviewers will screen titles and abstracts, followed by full texts, for eligibility and then chart the data using a piloted data charting form. Results will be collated and presented through a narrative summary, tables and figures. ETHICS AND DISSEMINATION Since this study is based on publicly available information, ethics approval is not required. Findings will be communicated with healthcare providers, caregivers, patients and research and health programme funders through peer-reviewed publications, presentations and an infographic. REGISTRATION DETAILS OSF Registries (https://doi.org/10.17605/OSF.IO/T54G8).
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Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Arya Rahgozar
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramtin Hakimjavadi
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hui Yan
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kunal A Dalsania
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bishwajit Ghose
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Québec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Manpreet Thandi
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Zhao Z, Chen T, Zhou Z, Guo R, Liu Q. Cost-effectiveness of camrelizumab combined with chemotherapy in the first-line treatment of recurrent or metastatic nasopharyngeal carcinoma in China. BMJ Open 2023; 13:e071832. [PMID: 38110377 DOI: 10.1136/bmjopen-2023-071832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the cost-effectiveness of adding Chinese-developed anti-PD-1 antibody camrelizumab to first-line platinum-doublet chemotherapy in patients with recurrent or metastatic nasopharyngeal carcinoma (L/M NPC) from the perspective of Chinese healthcare system. DESIGN A Markov model consisting of four health states, progression-free survival, first progression survival, second progression survival and death, was built to simulate 3-week patient transitions over a 20-year horizon. A direct comparison between first-line camrelizumab in combination with gemcitabine plus cisplatin and gemcitabine plus cisplatin was performed by calculating transition probabilities from the CAPTAIN-1st trial. Costs and utilities were collected from the local public database and literature. One-way and probabilistic sensitivity analyses were employed to evaluate the robustness of the model. SETTING The Chinese healthcare system perspective. PARTICIPANTS A hypothetical cohort of Chinese patients with pathologically diagnosed L/M NPC who had an Eastern Cooperative Oncology Group performance status of 0 or 1. INTERVENTIONS First-line camrelizumab in combination with camrelizumab and gemcitabine plus cisplatin (CGP) versus gemcitabine plus cisplatin (GP). PRIMARY OUTCOME MEASURE Cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER). RESULTS The baseline analysis demonstrated that, compared with first-line GP, first-line CGP yields an effectiveness increase of 0.26 QALY, accompanied by an increment of US$6137.59 in healthcare cost. This results in an ICER of US$23 482.32/QALY. With the willingness-to-pay (WTP) threshold for a QALY set at US$37 654.50, first-line CGP proves to be cost-effective in 97.20% of the iterations. Deterministic sensitivity analyses indicated that the uncertainty in model parameters had no substantial effect on our results. Probability sensitivity analysis indicated that CGP was cost-effective at the assumed WTP threshold. CONCLUSION For Chinese patients with L/M NPC, adding Chinese-developed anti-PD-1 antibody camrelizumab to the first-line GP chemotherapy may be cost-effective.
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Affiliation(s)
- Ziying Zhao
- Department of Pharmacy, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Tongfeng Chen
- Department of Structural Heart Disease, Fuwai Central China Cardiovascular Hospital/Heart Center of Henan Provincial People's Hospital/Henan Key Laboratory of Coronary Heart Disease Control/Henan Research Center for Cardiovascular Epidemiology, Zhengzhou, Henan, China
| | - Zhen Zhou
- University of Tasmania Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - Rui Guo
- Department of Pharmacy, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Zhang J, Hu X, Jiang J, Lu D, Guo L, Peng X, Pan Y, He W, Li J, Zhou H, Huang J, Jiang F, Pu J, Cheng Z, Yang B, Ma J, Chen P, Liu Q, Song D, Lu L, Li S, Fan Y, Meng Z, Tang L, Shin ES, Tu S, Koo BK, Wang J. Rationale and design of a comparison of angiography-derived fractional flow reserve-guided and intravascular ultrasound-guided intervention strategy for clinical outcomes in patients with coronary artery disease: a randomised controlled trial (FLAVOUR II). BMJ Open 2023; 13:e074349. [PMID: 38072492 PMCID: PMC10729220 DOI: 10.1136/bmjopen-2023-074349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) guided by coronary angiography-derived fractional flow reserve (FFR) or intravascular ultrasound (IVUS) has shown improved clinical outcomes compared with angiography-only-guided PCI. In patients with intermediate stenoses, FFR resulted in fewer coronary interventions and was non-inferior to IVUS with respect to clinical outcomes. However, whether this finding can be applied to angiography-derived FFR in significant coronary artery disease (CAD) remains unclear. METHOD AND ANALYSIS The comparison of angiography-derived FFR-guided and IVUS-guided intervention strategies for clinical outcomes in patients with coronary artery disease (FLAVOUR II) trial is a multicentre, prospective, randomised controlled trial. A total of 1872 patients with angiographically significant CAD (stenoses of at least 50% as estimated visually through angiography) in a major epicardial coronary artery will be randomised 1:1 to receive either angiography-derived FFR-guided or IVUS-guided PCI. Patients will be treated with second-generation drug-eluting stent according to the predefined criteria for revascularisation: angiography-derived FFR≤0.8 and minimal lumen area (MLA)≤3 mm2 or 3 mm270%. The primary endpoint is a composite of all-cause death, myocardial infarction and revascularisation at 12 months after randomisation. We will test the non-inferiority of the angiography-derived FFR-guided strategy compared with the IVUS-guided decision for PCI and the stent optimisation strategy.The FLAVOUR II trial will provide new insights into optimal evaluation and treatment strategies for patients with CAD. ETHICS AND DISSEMINATION FLAVOUR II was approved by the institutional review board at each participating site (The Second Affiliated Hospital of Zhejiang University School of Medicine Approval No: 2020LSYD410) and will be conducted in line with the Declaration of Helsinki. Informed consent would be obtained from each patient before their participation. The study results will be submitted to a scientific journal. TRIAL REGISTRATION NUMBER NCT04397211.
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Affiliation(s)
- Jinlong Zhang
- The Second Affiliated Hospital of Zhejiang University School of Medicine; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China
| | - Xinyang Hu
- The Second Affiliated Hospital of Zhejiang University School of Medicine; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China
| | - Jun Jiang
- The Second Affiliated Hospital of Zhejiang University School of Medicine; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China
| | | | - Lijun Guo
- Peking University Third Hospital, Beijing, China
| | - Xiaoping Peng
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yibin Pan
- Jinhua Central Hospital, Jinhua, China
| | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Jilin Li
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hao Zhou
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital, Hangzhou, China
| | - Fan Jiang
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jun Pu
- Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Bin Yang
- Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianliang Ma
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Peng Chen
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiang Liu
- The Fourth People's Hospital of Jinan, Jinan, China
| | - Daqing Song
- Jining No.1 People's Hospital, Jining, China
| | - Liang Lu
- Dongyang People's Hospital, Jinhua, China
| | - Shiqiang Li
- Zhejiang Greentown Cardiovascular Hospital, Hangzhou, China
| | - Yongzhen Fan
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhaohui Meng
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (the Republic of)
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Jianan Wang
- The Second Affiliated Hospital of Zhejiang University School of Medicine; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China
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Hamer O, Bray EP, Harris C, Blundell A, Kuroski JA, Schneider E, Watkins C, Clegg A. Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review protocol. BMJ Open 2023; 13:e075364. [PMID: 38149427 PMCID: PMC10711885 DOI: 10.1136/bmjopen-2023-075364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/31/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies, focusing on psychological factors that may underpin overweight and obesity. Psychological therapy interventions are gaining recognition for their effectiveness in addressing underlying emotional factors and promoting weight loss. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction and sustained weight reduction in adults with overweight or obesity. METHODS AND ANALYSIS The review will combine the methodology outlined by Arksey and O'Malley with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A total of six databases will be searched using a comprehensive search strategy. Intervention studies will be included if participants are 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m2), and have received a psychological therapy intervention. The review will exclude studies that are not available in English, not full text, none peer reviewed or combine a lifestyle and/or pharmacological intervention with a psychological intervention. Data will be synthesised using a narrative synthesis approach. ETHICS AND DISSEMINATION Ethical approval is not required to conduct this scoping review. The findings will be disseminated through journal publication(s), social media and a lay summary for key stakeholders.
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Affiliation(s)
| | - Emma P Bray
- University of Central Lancashire, Preston, UK
| | - Cath Harris
- University of Central Lancashire, Preston, UK
| | | | | | - Emma Schneider
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Dietzel M, Bernathova M, Clauser P, Kapetas P, Uder M, Baltzer PAT. Added value of clinical decision rules for the management of enhancing breast MRI lesions: A systematic comparison of the Kaiser score and the Göttingen score. Eur J Radiol 2023; 169:111185. [PMID: 37939606 DOI: 10.1016/j.ejrad.2023.111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE We investigated the added value of two internationally used clinical decision rules in the management of enhancing lesions on breast MRI. METHODS This retrospective, institutional review board approved study included consecutive patients from two different populations. Patients received breast MRI according to the recommendations of the European Society of Breast Imaging (EUSOBI). Initially, all examinations were assessed by expert readers without using clinical decision rules. All lesions rated as category 4 or 5 according to the Breast Imaging Reporting and Data System were histologically confirmed. These lesions were re-evaluated by an expert reader blinded to the histology. He assigned each lesion a Göttingen score (GS) and a Kaiser score (KS) on different occasions. To provide an estimate on inter-reader agreement, a second fellowship-trained reader assessed a subset of these lesions. Subgroup analyses based on lesion type (mass vs. non-mass), size (>1 cm vs. ≤ 1 cm), menopausal status, and significant background parenchymal enhancement were conducted. The areas under the ROC curves (AUCs) for the GS and KS were compared, and the potential to avoid unnecessary biopsies was determined according to previously established cutoffs (KS > 4, GS > 3) RESULTS: 527 lesions in 506 patients were included (mean age: 51.8 years, inter-quartile-range: 43.0-61.0 years). 131/527 lesions were malignant (24.9 %; 95 %-confidence-interval: 21.3-28.8). In all subgroups, the AUCs of the KS (median = 0.91) were higher than those of the GS (median = 0.83). Except for "premenopausal patients" (p = 0.057), these differences were statistically significant (p ≤ 0.01). Kappa agreement was higher for the KS (0.922) than for the GS (0.358). CONCLUSION Both the KS and the GS provided added value for the management of enhancing lesions on breast MRI. The KS was superior to the GS in terms of avoiding unnecessary biopsies and showed superior inter-reader agreement; therefore, it may be regarded as the clinical decision rule of choice.
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Affiliation(s)
- Matthias Dietzel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
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Hebert R, Cullinan N, Armstrong L, Blood KA, Brossard J, Brunga L, Cacciotti C, Caswell K, Cellot S, Coltin H, Deyell RJ, Felton K, Fernandez CV, Fleming AJ, Gibson P, Hammad R, Jabado N, Johnston DL, Lafay-Cousin L, Larouche V, Leblanc-Desrochers C, Michaeli O, Perrier R, Pike M, Say J, Schiller I, Toupin AK, Vairy S, van Engelen K, Waespe N, Villani A, Foulkes WD, Malkin D, Reichman L, Goudie C. Performance of the eHealth decision support tool, MIPOGG, for recognising children with Li-Fraumeni, DICER1, Constitutional mismatch repair deficiency and Gorlin syndromes. J Med Genet 2023; 60:1218-1223. [PMID: 37460202 DOI: 10.1136/jmg-2023-109376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Cancer predisposition syndromes (CPSs) are responsible for at least 10% of cancer diagnoses in children and adolescents, most of which are not clinically recognised prior to cancer diagnosis. A variety of clinical screening guidelines are used in healthcare settings to help clinicians detect patients who have a higher likelihood of having a CPS. The McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) is an electronic health decision support tool that uses algorithms to help clinicians determine if a child/adolescent diagnosed with cancer should be referred to genetics for a CPS evaluation. METHODS This study assessed MIPOGG's performance in identifying Li-Fraumeni, DICER1, Constitutional mismatch repair deficiency and Gorlin (nevoid basal cell carcinoma) syndromes in a retrospective series of 84 children diagnosed with cancer and one of these four CPSs in Canadian hospitals over an 18-year period. RESULTS MIPOGG detected 82 of 83 (98.8%) evaluable patients with any one of these four genetic conditions and demonstrated an appropriate rationale for suggesting CPS evaluation. When compared with syndrome-specific clinical screening criteria, MIPOGG's ability to correctly identify children with any of the four CPSs was equivalent to, or outperformed, existing clinical criteria respective to each CPS. CONCLUSION This study adds evidence that MIPOGG is an appropriate tool for CPS screening in clinical practice. MIPOGG's strength is that it starts with a specific cancer diagnosis and incorporates criteria relevant for associated CPSs, making MIPOGG a more universally accessible diagnostic adjunct that does not require in-depth knowledge of each CPS.
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Affiliation(s)
- Robyn Hebert
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Genetic Counselling Services, Sudbury Regional Hospital, Sudbury, Ontario, Canada
| | - Noelle Cullinan
- Department of Paediatric Haematology-Oncology, Children's Health Ireland, Dublin, Ireland
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linlea Armstrong
- Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine A Blood
- Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
- Hereditary Cancer Program, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Josee Brossard
- Division of Pediatric Hematology-Oncology, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ledia Brunga
- Department of Genetics and Genome Biology, University of Toronto, Toronto, Ontario, Canada
| | - Chantel Cacciotti
- Department of Pediatric Hematology-Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Kimberly Caswell
- Department of Genetics and Genome Biology, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Cellot
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Hallie Coltin
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kathleen Felton
- Pediatric Hematology/Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Conrad V Fernandez
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Adam J Fleming
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Paul Gibson
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Rawan Hammad
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Haematology, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lucie Lafay-Cousin
- Section of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Valérie Larouche
- Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Cassandra Leblanc-Desrochers
- Centre de recherche du CHUS, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Orli Michaeli
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Renee Perrier
- Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Meghan Pike
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jemma Say
- Paediatric Haematology/Oncology Programme, Bristol Royal Hospital for Children, Bristol, UK
| | - Ian Schiller
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Annie-Kim Toupin
- Department of Medicine, University Laval, Québec, Québec, Canada
| | - Stéphanie Vairy
- Division of Pediatric Hematology-Oncology, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Kalene van Engelen
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Nicolas Waespe
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatric Oncology and Hematology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Anita Villani
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William D Foulkes
- Departments of Human Genetics, Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lara Reichman
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Catherine Goudie
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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Hyam LE, Phillips M, Gracie L, Allen K, Schmidt U. Clinical staging across eating disorders: a scoping review protocol. BMJ Open 2023; 13:e077377. [PMID: 37993158 PMCID: PMC10668169 DOI: 10.1136/bmjopen-2023-077377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Clinical staging models in psychiatry assert that there are earlier, less severe or more malleable forms of illness that are distinguishable from later, more chronic forms of illness, and that these stages may have different prognostic and treatment implications. Previous reviews on clinical staging in eating disorders (EDs) suggest a staging heuristic could be useful for anorexia nervosa, but less research is available on how this applies to other EDs. An up-to-date review is required to synthesise new and heterogenous avenues of research. This scoping review aims to explore the extent and types of evidence in relation to illness staging for EDs and how these concepts are associated with treatment response and outcomes. METHODS AND ANALYSIS This protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. We will consider any documents providing evidence for clinical staging such as those which describe full or partial staging models, for all EDs, across various domains of assessment and functioning. Participants will include clinical or non-clinical population samples with full-syndrome EDs or disordered eating behaviour. PubMed, PsycINFO, MEDLINE and Web of Science databases will be systematically searched for relevant literature. Two authors will export documents and screen titles, abstracts and full texts. Data will be extracted into a charting form drafted by the authors. A narrative summary of the documents will be conducted in line with the study aims. Finally, clinical and research recommendations will be outlined. ETHICS AND DISSEMINATION Ethical approval will not be required to synthesise published and unpublished literature. The study will be published in a peer-reviewed journal and shared at conferences, via social media, and in other communications.
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Affiliation(s)
- Lucy Elizabeth Hyam
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matthew Phillips
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Lara Gracie
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham Medical School, Birmingham, UK
| | - Karina Allen
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
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Jacobs BKM, Keter AK, Henriquez-Trujillo AR, Trinchan P, de Rooij ML, Decroo T, Lynen L. Piloting a new method to estimate action thresholds in medicine through intuitive weighing. BMJ Evid Based Med 2023; 28:392-398. [PMID: 37648419 DOI: 10.1136/bmjebm-2023-112350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES In clinical decision-making, physicians take actions such as prescribing treatment only when the probability of disease is sufficiently high. The lowest probability at which the action will be considered, is the action threshold. Such thresholds play an important role whenever decisions have to be taken under uncertainty. However, while several methods to estimate action thresholds exist, few methods give satisfactory results or have been adopted in clinical practice. We piloted the adapted nominal group technique (aNGT), a new prescriptive method based on a formal consensus technique adapted for use in clinical decision-making. DESIGN, SETTING AND PARTICIPANTS We applied this method in groups of postgraduate students using three scenarios: treat for rifampicin-resistant tuberculosis (RR-TB), switch to second-line HIV treatment and isolate for SARS-CoV-2 infection. INTERVENTIONS The participants first summarise all harms of wrongly taking action when none is required and wrongly not taking action when it would have been useful. Then they rate the statements on these harms, discuss their importance in the decision-making process, and finally weigh the statements against each other. MAIN OUTCOME MEASURES The resulting consensus threshold is estimated as the relative weights of the harms of the false positives divided by the total harm, and averaged out over participants. In some applications, the thresholds are compared with an existing method based on clinical vignettes. RESULTS The resulting action thresholds were just over 50% for RR-TB treatment, between 20% and 50% for switching HIV treatment and 43% for COVID-19 isolation. These results were considered acceptable to all participants. Between sessions variation was low for RR-TB and moderate for HIV. Threshold estimates were moderately lower with the method based on clinical vignettes. CONCLUSIONS The aNGT gives sensible results in our pilot and has the potential to estimate action thresholds, in an efficient manner, while involving all relevant stakeholders. Further research is needed to study the value of the method in clinical decision-making and its ability to generate acceptable thresholds that stakeholders can agree on.
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Affiliation(s)
- Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alfred Kipyegon Keter
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
| | - Aquiles Rodrigo Henriquez-Trujillo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
- Facultad de Medicina, Universidad de Las Américas, Quito, Ecuador
| | - Paco Trinchan
- Health Services Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Madeleine L de Rooij
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Mander ES, Merrick CB, Nicholson HA, Lord HK, Ferguson MJ, Smith G. Pembrolizumab monotherapy for non-small cell lung cancer (NSCLC): can patient stratification be improved in the UK Tayside population? A retrospective cohort study. BMJ Open 2023; 13:e076715. [PMID: 37989364 PMCID: PMC10668179 DOI: 10.1136/bmjopen-2023-076715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Pembrolizumab is a programmed cell death protein-1 (PD-1) inhibitor used to treat advanced patients with non-small cell lung cancer (NSCLC) with a programmed cell death ligand-1 (PD-L1) tumour proportion score (TPS) ≥50. Further sub-division of TPS-based stratification has not been evaluated in the UK, although smoking-induced tumour mutational burden and the immunogenic effects of prior radiotherapy are suggested to improve response. AIMS To investigate if PD-L1 TPS ≥80%, smoking status or radiotherapy before or within 2 months of treatment influenced progression-free survival (PFS) in patients with NSCLC treated with pembrolizumab monotherapy. METHODS PD-L1 TPS, smoking status and radiotherapy exposure were compared in patients with NSCLC in National Health Service (NHS) Tayside (n=100) treated with pembrolizumab monotherapy between 1 November 2017 and 18 February 2022. Survival estimates were compared using log-rank analysis, and Cox proportional hazards analysis was used to investigate the influence of potential confounding factors, including tumour stage and performance status. RESULTS PFS was not significantly different (log-rank HR=0.330, p=0.566) comparing patients with PD-L1 TPS 50-79% and PD-L1 TPS ≥80%. Smokers had significantly improved PFS (log-rank HR=4.867, p=0.027), while patients receiving radiotherapy had significantly decreased PFS (log-rank HR=6.649, p=0.012). A Cox regression model confirmed that both radiotherapy (p=0.022) and performance status (p=0.009) were independent negative predictors of PFS. CONCLUSIONS More rigorous PD-L1 TPS stratification did not influence survival outcomes. Smoking history improved PFS, although it was not an independent response predictor, while radiotherapy and performance status independently influenced clinical response. We suggest that further stratification of PD-L1 TPS is not warranted, while performance status and radiotherapy treatment may be additional clinically useful biomarkers of response to pembrolizumab in patients with NSCLC.
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Affiliation(s)
| | | | | | | | | | - Gillian Smith
- School of Medicine, University of Dundee, Dundee, UK
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Würtz HJ, Rahr HB, Lindebjerg J, Edwards A, Steffensen KD. Impact of an in-consult patient decision aid on treatment choices and outcomes of management for patients with an endoscopically resected malignant colorectal polyp: a study protocol for a non-randomised clinical phase II study. BMJ Open 2023; 13:e073900. [PMID: 37963688 PMCID: PMC10649383 DOI: 10.1136/bmjopen-2023-073900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/22/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Management of an endoscopically resected malignant colorectal polyps can be challenging due to the risk of residual tumour and lymphatic spread. International studies have shown, that of those choosing surgical management instead of surveillance strategy, there are between 54% and 82% of bowel resections without evidence of residual tumour or lymphatic spread. As surgical management entails risks of complications and surveillance strategy entails risks of residual tumour or recurrence, a clinical dilemma arises when choosing a management strategy. Shared decision-making is a concept that can be used in preference-sensitive decision-making to facilitate patient involvement and empowerment to facilitate active patient participation in the decision-making process. METHODS AND ANALYSIS This study protocol describes our clinical multi-institutional, non-randomised, interventional phase II study at Danish surgical departments planned to commence in the second quarter of 2024. The aim of this study is to examine whether shared decision-making and using a patient decision aid in consultations affect patients' choice of management, comparing with retrospective data. The secondary aim is to investigate patients' experiences, perceived involvement, satisfaction, decision conflict and other outcomes using questionnaire feedback directly from the patients. ETHICS AND DISSEMINATION There are no conflicts of interest for principal or local investigators in any of the study sites. All results will be published at Danish and international meetings, and in English language scientific peer-reviewed journals. Our study underwent evaluation by the Regional Committees on Health Research Ethics for Southern Denmark (file number 20232000-47), concluding that formal approval was not required for this kind of research. TRIAL REGISTRATION NUMBER NCT05776381.
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Affiliation(s)
- Helene Juul Würtz
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Hans Bjarke Rahr
- Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jan Lindebjerg
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Pathology at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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Nessle CN, Njuguna F, Dettinger J, Koima R, Nyamusi L, Kisembe E, Kinja S, Ndung'u M, Njenga D, Langat S, Olbara G, Moyer C, Vik T. Barriers to and facilitators of effective management of fever episodes in hospitalised Kenyan children with cancer: protocol for convergent mixed methods study. BMJ Open 2023; 13:e078124. [PMID: 37918936 PMCID: PMC10626801 DOI: 10.1136/bmjopen-2023-078124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Febrile neutropenia is an oncological emergency in children with cancer, associated with serious infections and complications. In low-resourced settings, death from infections in children with cancer is 20 times higher than in high-resourced treatment settings, thought to be related to delays in antibiotic administration and management. The barriers to effective management of fever episodes in children with cancer have not previously been described. This convergent mixed-methods study will provide the evidence to develop fever treatment guidelines and to inform their effective implementation in children with cancer at Moi Teaching and Referral Hospital (MTRH), a level 6 referral hospital in western Kenya. METHODS AND ANALYSIS Prospective data collection of paediatric patients with cancer with new fever episodes admitted to MTRH will be performed during routine treatment. Clinical variables will be collected from 50 fever episodes, including cancer diagnosis and infectious characteristics of the fever episode, and elapsed time from fever onset to various milestones in the management workflow. Semistructured qualitative interviews with healthcare providers (estimated 20 to reach saturation) will explore the barriers to and facilitators of appropriate management of fever episodes in children with cancer. The interview guide was informed by a theoretical framework and Consolidated Framework for Implementation Research. A mixed-methods analysis use of joint display tables and process mapping will link and integrate the two types of data with meta-inferences. ETHICS AND DISSEMINATION Institutional review board approval was obtained from the MTRH (0004273) and the University of Michigan (HUM0225674), and the study was registered with National Commission for Science Technology and Innovation (P/23/22885). Written consent will be obtained from all participants. Results will be formally shared with local and national policy leadership and local end users, presented at relevant national academic conferences and submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Charles Nathaniel Nessle
- Department of Pediatrics, Division of Hematology-Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Fogarty International Center, National Institute of Health, Bethesda, Maryland, USA
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Raphael Koima
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Lenah Nyamusi
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Evelynn Kisembe
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
- Behavioral and Social Science Research, Moi University, Eldoret, Kenya
| | - Sarah Kinja
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Mercy Ndung'u
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Dennis Njenga
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Cheryl Moyer
- Medical School, Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Terry Vik
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
- Department of Pediatrics, Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Macken AA, Macken LC, Oosterhoff JHF, Boileau P, Athwal GS, Doornberg JN, Lafosse L, Lafosse T, van den Bekerom MPJ, Buijze GA. Developing a machine learning algorithm to predict the probability of aseptic loosening of the glenoid component after anatomical total shoulder arthroplasty: protocol for a retrospective, multicentre study. BMJ Open 2023; 13:e074700. [PMID: 37852772 PMCID: PMC10603397 DOI: 10.1136/bmjopen-2023-074700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Despite technological advancements in recent years, glenoid component loosening remains a common complication after anatomical total shoulder arthroplasty (ATSA) and is one of the main causes of revision surgery. Increasing emphasis is placed on the prevention of glenoid component failure. Previous studies have successfully predicted range of motion, patient-reported outcomes and short-term complications after ATSA using machine learning methods, but an accurate predictive model for (glenoid component) revision is currently lacking. This study aims to use a large international database to accurately predict aseptic loosening of the glenoid component after ATSA using machine learning algorithms. METHODS AND ANALYSIS For this multicentre, retrospective study, individual patient data will be compiled from previously published studies reporting revision of ATSA. A systematic literature search will be performed in Medline (PubMed) identifying all studies reporting outcomes of ATSA. Authors will be contacted and invited to participate in the Machine Learning Consortium by sharing their anonymised databases. All databases reporting revisions after ATSA will be included, and individual patients with a follow-up less than 2 years or a fracture as the indication for ATSA will be excluded. First, features (predictive variables) will be identified using a random forest feature selection. The resulting features from the compiled database will be used to train various machine learning algorithms (stochastic gradient boosting, random forest, support vector machine, neural network and elastic-net penalised logistic regression). The developed and validated algorithms will be evaluated across discrimination (c-statistic), calibration, the Brier score and the decision curve analysis. The best-performing algorithm will be used to create an open-access online prediction tool. ETHICS AND DISSEMINATION Data will be collected adhering to the WHO regulation on data sharing. An Institutional Review Board review is not applicable. The study results will be published in a peer-reviewed journal.
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Affiliation(s)
- Arno Alexander Macken
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
| | - Loïc C Macken
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacobien H F Oosterhoff
- Department of Engineering Systems and Services, Delft University of Technology, Delft, The Netherlands
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Locomoteur & Sport, Centre Hospitalier Universitaire de Nice, Nice, France
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Job N Doornberg
- Orthopaedic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
| | - Thibault Lafosse
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Geert Alexander Buijze
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
- Department of Orthopedic Surgery, Hôpital Lapeyronie, Montpellier, France
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Kisch R, Grill E, Müller M, Pietzner J, Paulus AC, Weigl M. Second opinion and time to knee arthroplasty: a prospective cohort study of 142 patients. BMJ Open 2023; 13:e073497. [PMID: 37827748 PMCID: PMC10582995 DOI: 10.1136/bmjopen-2023-073497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the impact of obtaining a second opinion consultation on time to knee arthroplasty (KA). We further examined the frequency of KA and the determinants of KA following the second opinion. DESIGN Prospective cohort study. SETTING The second opinion programme was implemented at the Ludwig Maximilian University Hospital in Munich. PARTICIPANTS Participants comprised patients with knee osteoarthritis who were insured with one of the largest statutory health insurance Allgemeine Ortskrankenkasse Bayern (mean age 64.3±9.6 years). Patients participated in a second-opinion programme and completed questionnaires on site before and after personal presentation for the second opinion consultation. Follow-up questionnaires were delivered by post at 3 and 12 months after the second opinion consultation. Of the 142 patients included in the study, 47 (33.1%) underwent KA within 12 months after obtaining the second opinion. PRIMARY OUTCOME MEASURES Primary outcome measure was time until patients received KA. Cox proportional hazard modelling was used to calculate the associations between the selected predictors and time that elapsed between receipt of the second opinion to KA. RESULTS Mean time until KA was 17 weeks. Kaplan-Meier curves showed significant differences in time to KA according to the recommendation given at second opinion consultation, knee-related quality of life and Kellgren-Lawrence grade. In multivariate Cox proportional hazard modelling, second opinion recommendation (HR 5.33, 95% CI 1.16, 24.41) and knee-related quality of life (HR 1.03, 95% CI 1.01, 1.06) were significant predictors of time from second opinion to KA. CONCLUSIONS Obtaining a second opinion had significant impact on time to knee replacement. Those who were recommended immediate surgery also underwent surgery more quickly after the second opinion. The effect of knee-related quality of life supports the importance of patient-reported outcome measures in the decision for or against KA.
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Affiliation(s)
- Rebecca Kisch
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital Munich, Munchen, Germany
| | - Martin Müller
- Department for Primary Care and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Jens Pietzner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital Munich, Munchen, Germany
| | - Alexander C Paulus
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital Munich, Munchen, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital Munich, Munchen, Germany
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Shang W, Wei L, Liu Y, Pu H, Li X, Niu J, Ge L, Lu C, Yang K. Impact of the COVID-19 pandemic on the conduct of non-COVID-19 clinical trials: protocol for a scoping review. BMJ Open 2023; 13:e074128. [PMID: 37816556 PMCID: PMC10565133 DOI: 10.1136/bmjopen-2023-074128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic posed a detrimental impact on the conduct of non-COVID-19 related clinical trials, raising concerns about the completeness of these studies and waste of resources. While several measures and strategies have been suggested to address these issues, a thorough and timely summarisation is still lacking. Therefore, our aim is to conduct a scoping review to summarise the negative effects of COVID-19 on non-COVID-19 clinical trials, outline the effective measures for mitigating these impacts, and provide insights for future pandemics. METHODS AND ANALYSIS This scoping review will be conducted in line with the Joanna Briggs Institute's scoping review methodological framework, and the results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Relevant articles will be searched in PubMed, Embase and the Cochrane Library from 1 December 2019 to 1 July 2023. We will also screen the reference lists of the included studies manually to identify more potentially relevant articles. Articles focusing on the adverse impacts of COVID-19 on non-COVID-19 clinical trials and effective measures for mitigating them will be included. Two investigators will perform study selection and data extraction independently. A narrative summary as well as a descriptive analysis of the basic characteristics and key results of the included studies will be performed. ETHICS AND DISSEMINATION Ethical approval is not required, as this scoping review will be completed based only on published literature. The findings of this scoping review will be disseminated through a peer-reviewed publication and/or conference presentations.
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Affiliation(s)
- Wenru Shang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, P. R. China
- Collaborative Innovation Center, First Hospital of Lanzhou University, Lanzhou, P.R.China
| | - Lili Wei
- School of Business and Management, Gansu University of Traditional Chinese Medicine, Lanzhou, P. R. China
| | - Yujia Liu
- First school of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, P. R. China
| | - Haosheng Pu
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
| | - Xiuxia Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, P. R. China
- Collaborative Innovation Center, First Hospital of Lanzhou University, Lanzhou, P.R.China
| | - Junqiang Niu
- Collaborative Innovation Center, First Hospital of Lanzhou University, Lanzhou, P.R.China
- Traditional Chinese Medicine Department, First Hospital of Lanzhou University, Lanzhou, P. R. China
| | - Long Ge
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, P. R. China
- Collaborative Innovation Center, First Hospital of Lanzhou University, Lanzhou, P.R.China
| | - Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Lanzhou, P. R. China
| | - Kehu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, P. R. China
- Collaborative Innovation Center, First Hospital of Lanzhou University, Lanzhou, P.R.China
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Fernholm R, Wannheden C, Trygg Lycke S, Riggare S, Pukk Harenstam K. Patients' and clinicians' views on the appropriate use of safety-netting advice in consultations-an interview study from Sweden. BMJ Open 2023; 13:e077938. [PMID: 37798020 PMCID: PMC10565180 DOI: 10.1136/bmjopen-2023-077938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND A promising approach to manage clinical uncertainty and thereby reduce the risk of preventable diagnostic harm is to use safety-netting advice (ie, communicating structured information to patients about when and where to reconsult healthcare). AIM To explore clinicians' and patients' views on when and how safety-netting can be successfully applied in primary-care and emergency-care settings. DESIGN AND SETTING An exploratory qualitative research design; we performed focus groups and interviews in a Swedish setting. PARTICIPANTS Nine physicians working in primary or emergency care and eight patients or caregivers participated. The participants were an ethnically homogeneous group, originating from Western European or Australian backgrounds. METHOD Data were analysed inductively, using the framework method. The results are reported according to the Standards for Reporting Qualitative Research guidelines for reporting qualitative research. RESULTS In order to manage diagnostic uncertainty using safety-netting, clinicians and patients emphasised the need to understand the preconditions for the consultation (ie, the healthcare setting, the patient's capacity and existing power imbalance). Furthermore, participants raised the importance of establishing a mutual understanding regarding the patient's perspective and the severity of the situation before engaging in safety-netting advice. CONCLUSION The establishment of a shared mental model between clinician and patient of the preconditions for the clinical encounter is a vital factor affecting how safety-netting advice is communicated and received and its ability to support patients in problem detection and planning after the visit. We suggest that successful safety-netting can be viewed as a team activity, where the clinician and patient collaborate in monitoring how the patient's condition progresses after the care visit. Furthermore, our findings suggest that to be successfully implemented, safety-netting advice needs to be tailored to the clinical context in general and to the patient-clinician encounter in particular.
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Affiliation(s)
- Rita Fernholm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Trygg Lycke
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sara Riggare
- Department of Women's and Children's Health, Participatory eHealth and Health Data, Uppsala University, Uppsala, Sweden
| | - Karin Pukk Harenstam
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Universitetssjukhuset, Stockholm, Sweden
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Alwadhi V, Bajpayee D, Kumar N, Mohanty JS, Mukherji K, Saboth PK, Sinha A, Prasad A, Kumar H. E-IMNCI: a novel clinical diagnostic support system approach to strengthen effectiveness and quality of IMNCI implementation in India. BMJ Open Qual 2023; 12:e001857. [PMID: 37863509 PMCID: PMC10603548 DOI: 10.1136/bmjoq-2022-001857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/25/2023] [Indexed: 10/22/2023] Open
Abstract
Integrated management of childhood illness is a globally proven primary care strategy to improve child survival and is being implemented worldwide in countries with high burden of child mortality. Its implementation as Integrated Management of Newborn and Childhood Illness (IMNCI) in India has been challenging.The primary objective of the present work was to assess the feasibility, acceptability and use of an adapted Integrated E Diagnostic Approach (IeDA) that provides e-Learning and improved clinical practices of the primary level health service provider auxiliary nurse midwives (ANMs) to deliver IMNCI services. This India-specific approach was contextualised to the Indian IMNCI programme based on 7 years of IeDA implementation learning from West Africa.The Integrated Management of Neonatal and Childhood Illness pilot was implemented across 80 front-line workers, 70 ANMs and 10 medical officers) in 55 facilities of 3 blocks of Ranchi district, Jharkhand. This report evaluated the feasibility of its use by ANMs only. Based on the results, it can be concluded that it is possible to implement the newly developed application. A total of 2500 cases were managed by ANMs using the application till May 2020. All ANMs used it to provide treatment to the children. 63% of ANMs used it to provide medications, 83% for counselling and 71% for follow-up as per the recommendations. The app is highly acceptable to ANMs for use as a clinical case management tool for childhood illness. There were some improvements in case management in both the age group (0-59 days and 2-12 months) of children. 78% of caregivers responded with their desire to revisit the health facility in future, highlighting the contribution of an e-tool in improving the perception of the caregiver.
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Affiliation(s)
- Vaishali Alwadhi
- Department of Community Medicine, St Stephen's Hospital, Delhi, India
| | - Devina Bajpayee
- Health Nutrition & WASH, IPE Global Limited, New Delhi, India
| | - Nandan Kumar
- Monitoring & Evaluation, Terre des Hommes Foundation, Kolkata, India
| | | | - Kallol Mukherji
- Department of Health, Terre des Hommes Foundation, Dhaka, Bangladesh
| | | | - Ankita Sinha
- Communication (Health, Nutrition & WASH), IPE Global Limited, New Delhi, India
| | - Ajit Prasad
- Health Services, Government of Jharkhand, Ranchi, Jharkhand, India
| | - Harish Kumar
- Health Nutrition & WASH, IPE Global Limited, New Delhi, India
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Stiggelbout A, Griffioen I, Brands J, Melles M, Rietjens J, Kunneman M, van der Kolk M, van Eijck C, Snelders D. Metro Mapping: development of an innovative methodology to co-design care paths to support shared decision making in oncology. BMJ Evid Based Med 2023; 28:291-294. [PMID: 37236775 PMCID: PMC10579511 DOI: 10.1136/bmjebm-2022-112168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Anne Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Erasmus School Of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ingeborg Griffioen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Design Studio Panton, Deventer, The Netherlands
| | | | - Marijke Melles
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Judith Rietjens
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Marion van der Kolk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Casper van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk Snelders
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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Ooms A, Al-Mossawi H, Bennett L, Bogale M, Bowness P, Francis A, Goodyear C, Kirkham BW, Lalnunhlimi S, McInnes IB, Richards D, Siebert S, Taams LS, Tulunay Virlan A, Yager N, Coates LC. Optimising psoriatic arthritis therapy with immunological methods to increase standard evaluation: the protocol of an open-label multicentre, parallel-group, two-arm randomised controlled study evaluation precision medicine approach in the treatment of psoriatic arthritis. BMJ Open 2023; 13:e078539. [PMID: 37770264 PMCID: PMC10546161 DOI: 10.1136/bmjopen-2023-078539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) affects around 150 000 people in the UK of whom around 50% require treatment with biologics. The most used biologics for PsA target tumour necrosis factor (TNF) or interleukin-17A (IL-17A). About 50% of patients respond to each, but it is not currently possible to predict response for individual patients, necessitating sequential treatment steps. A recent proof of concept study in PsA suggested that using peripheral immunophenotype to choose therapy could improve time to treatment response.This study will test the hypothesis, within an open-label parallel-group biomarker-stratified multicentre randomised controlled trial, which the baseline proportion of CD4+T cells with an activated type 17 immunophenotype (Th17 levels) predicts response to IL-17A or TNF inhibitors in PsA. Additional analyses will identify if the model can be refined by combining additional clinical and immunophenotypic factors. Statistical modelling will be used to predict the likely effectiveness of these approaches compared with standard care. METHODS AND ANALYSIS Patients with PsA eligible to start their first biologic as part of standard care are recruited and baseline blood tests are taken for immunophenotyping. Participants are stratified equally by Th17 levels and randomised 1:1 to receive either TNF (adalimumab) or IL-17A (secukinumab) inhibitors. The primary analysis will establish the interaction between baseline immunophenotype and treatment on the primary outcome (achievement of minimal disease activity criteria at week 24). In secondary analysis, modelling will identify if this prediction model can be optimised further by incorporating clinical phenotypes and additional immunophenotyping techniques. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the North West Preston Research Ethics Committee (ref 21/NW/0016). Dissemination will be via conference presentations and peer-reviewed publications, aiming to impact on treatment guidelines. TRIAL REGISTRATION NUMBER ISRCTN17228602.
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Affiliation(s)
- Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Hussein Al-Mossawi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | | | - Mimi Bogale
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Paul Bowness
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Anne Francis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | | | - Bruce W Kirkham
- Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sylvine Lalnunhlimi
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| | - Iain B McInnes
- MVLS College Office, University of Glasgow, Glasgow, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Duncan Richards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| | | | - Nicole Yager
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
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Li W, Wan L. Cost-effectiveness analysis of adding transarterial chemoembolisation to lenvatinib as first-line treatment for advanced hepatocellular carcinoma in China. BMJ Open 2023; 13:e074245. [PMID: 37751954 PMCID: PMC10533713 DOI: 10.1136/bmjopen-2023-074245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the comparative cost-effectiveness of lenvatinib (LEN) plus transarterial chemoembolisation (TACE) (LEN-TACE) and LEN alone to treat advanced hepatocellular carcinoma (HCC) from the perspective of the Chinese healthcare system. DESIGN A three-state partitioned survival model using clinical survival data from a phase III LAUNCH trial, a 5-year time horizon for costs and quality-adjusted life years (QALYs) was constructed to analyse the cost-effectiveness of LEN-TACE. Clinical inputs were extracted from the LAUNCH trial, with outcomes extrapolated using standard and flexible parametric survival models. Costs and utilities derived from published literature were discounted at an annual rate of 5%. Sensitivity analyses and scenario analyses were conducted to test the robustness of the model. SETTING The Chinese healthcare system perspective. PARTICIPANTS A hypothetical Chinese cohort of patients with advanced HCC. INTERVENTIONS TACE plus LEN versus LEN. PRIMARY OUTCOME MEASURE Costs, QALYs, incremental cost-effectiveness ratio (ICER). RESULTS Base-case analysis revealed that LEN-TACE would be cost-effective in China at the willingness-to-pay (WTP) threshold of $37 663 per QALYs, with improved effectiveness of 0.382 QALYs and additional cost of $12 151 (ICER: $31 808 per QALY). The probabilistic sensitivity analysis suggested that LEN-TACE had a 93.5% probability of cost-effectiveness at WTP threshold of three times gross domestic product per capital ($37 663). One-way deterministic sensitivity analysis indicated that the duration of LEN treatment in both two arms, utility of progression-free survival and the cost of TACE had a greater impact on the stability of ICER values. Scenario analyses results were in line with base-case analysis. CONCLUSIONS LEN-TACE might be a cost-effective strategy compared with LEN for the first-line treatment of patients with advanced HCC in China.
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Affiliation(s)
- Wei Li
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Wan
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wiest NE, Nasir A, Bui A, Karime C, Chase RC, Barrios MS, Hunter R, Jones SM, Moktan VP, Creager JG, Shirazi E, Mohseni MM, Dawson NL. Improving management of hyponatraemia by increasing urine testing in the emergency department. BMJ Open Qual 2023; 12:e002326. [PMID: 37758666 PMCID: PMC10537979 DOI: 10.1136/bmjoq-2023-002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Hyponatraemia on hospital admission is associated with increased length of stay, healthcare expenditures and mortality. Urine studies collected before fluid or diuretic administration are essential to diagnose the underlying cause of hyponatraemia, thereby empowering admitting teams to employ the appropriate treatment. A multidisciplinary quality improvement (QI) team led by internal medicine residents performed a QI project from July 2020 through June 2021 to increase the rate of urine studies collected before fluid or diuretic administration in the emergency department (ED) in patients admitted with moderate to severe hyponatraemia. We implemented two plan-do-study-act (PDSA) cycles to address this goal. In PDSA Cycle #1, we displayed an educational poster in employee areas of the ED and met with nursing staff at their monthly meetings to communicate the project and answer questions. We also obtained agreement from ED attending physicians and nursing leaders to support the project. In PDSA Cycle #2, we implemented a structural change in the nursing triage process to issue every patient who qualified for bloodwork with a urine specimen container labelled with a medical record number on registration so that the patient could provide a sample at any point, including while in the waiting area. After PDSA Cycle #1, urine specimen collection increased from 34.5% to 57.5%. After PDSA Cycle #2, this increased further to 59%. We conclude that a combination of educational and structural changes led to a significant increase in urine specimen collection before fluid or diuretic administration among patients presenting with moderate-to-severe hyponatraemia in the ED.
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Affiliation(s)
- Nathaniel E Wiest
- Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Ayan Nasir
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - Albert Bui
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - Christian Karime
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - R Christopher Chase
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - Maria S Barrios
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Ryan Hunter
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Samuel M Jones
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Varun P Moktan
- Internal Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica G Creager
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Ehsan Shirazi
- Department of Emergency Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Michael M Mohseni
- Department of Emergency Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Nancy L Dawson
- Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
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Mason T, Kelly KM, Eckert G, Dean JA, Dundar MM, Turkkahraman H. A machine learning model for orthodontic extraction/non-extraction decision in a racially and ethnically diverse patient population. Int Orthod 2023; 21:100759. [PMID: 37196482 DOI: 10.1016/j.ortho.2023.100759] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION The purpose of the present study was to create a machine learning (ML) algorithm with the ability to predict the extraction/non-extraction decision in a racially and ethnically diverse sample. METHODS Data was gathered from the records of 393 patients (200 non-extraction and 193 extraction) from a racially and ethnically diverse population. Four ML models (logistic regression [LR], random forest [RF], support vector machine [SVM], and neural network [NN]) were trained on a training set (70% of samples) and then tested on the remaining samples (30%). The accuracy and precision of the ML model predictions were calculated using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. The proportion of correct extraction/non-extraction decisions was also calculated. RESULTS The LR, SVM, and NN models performed best, with an AUC of the ROC of 91.0%, 92.5%, and 92.3%, respectively. The overall proportion of correct decisions was 82%, 76%, 83%, and 81% for the LR, RF, SVM, and NN models, respectively. The features found to be most helpful to the ML algorithms in making their decisions were maxillary crowding/spacing, L1-NB (mm), U1-NA (mm), PFH:AFH, and SN-MP(̊), although many other features contributed significantly. CONCLUSIONS ML models can predict the extraction decision in a racially and ethnically diverse patient population with a high degree of accuracy and precision. Crowding, sagittal, and vertical characteristics all featured prominently in the hierarchy of components most influential to the ML decision-making process.
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Affiliation(s)
- Taylor Mason
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, US
| | - Kynnedy M Kelly
- Indiana University School of Dentistry, Indianapolis, IN, US
| | - George Eckert
- Department of Biostatistics and Health Data Science, Indianapolis, Indiana University School of Medicine, IN, US
| | - Jeffrey A Dean
- Department of Pediatric Dentistry, Indiana University School of Dentistry, Indianapolis, IN, US
| | - M Murat Dundar
- Department of Computer & Information Science, Indiana University Purdue University at Indianapolis, School of Science, Indianapolis, IN, US
| | - Hakan Turkkahraman
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, US.
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