BMJ Open最新文献

Introduction: The aim of this systematic review protocol is to provide the current reported level of diagnostic performance of ultra-low field MRI (ULF-MRI) in brain imaging of both paediatrics (including neonates and infants) and adults from a range of neurological conditions.

Methods and analysis: We will use the population/problem, intervention, comparison and outcome framework to break down the keywords to search PubMed, Medline, CINHAL, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled Trials and Google Scholar without restriction of geographical location, study design and publication status. Other sources such as the reference list of selected studies will also be searched, and the search will be documented with a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. The Quality Assessment of Diagnostic Accuracy Studies 3 tool will be used to assess the quality of the retrieved studies. After screening the studies, a meta-analysis for the primary outcome of individual and pooled diagnostic accuracy will be conducted using Meta-DiSc V1.4. Results expressed as forest plots, pooled heterogeneity values, 95% CIs, probability values and summary receiver operating characteristic curve plots will be used for data synthesis. The review commenced in January 2026 and is anticipated to conclude in June 2026. At the time of protocol submission, study identification, screening, data extraction, quality assessment and evidence synthesis have not yet commenced.

Ethics and dissemination: The results of this systematic review will be disseminated in a peer-reviewed journal and presented at a relevant conference. Data do not include animal or human participant recruitment or personal individual data. All data are already published in the public domain; therefore, ethical approval is not required.

Prospero registration number: PROSPERO 1308164.

Introduction: Clinical reasoning is an essential competency for all physicians, and fostering this skill in medical students is a primary objective of medical education. Currently, clinical reasoning is predominantly cultivated through experiences in clinical settings; however, this approach presents certain limitations. The emergence of innovative medical simulation teaching methods has led to the increasing utilisation of standardised patient (SP) simulations in medical education. However, the specific contribution of the SP teaching method to the development of clinical reasoning skills in medical students remains unclear. Therefore, we propose a systematic review to summarise the impact of the SP teaching method on the clinical reasoning competence of medical students.

Methods and analysis: This systematic review protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines for reporting results. A comprehensive literature search will be conducted across five major online databases: PubMed, Embase, Web of Science, Education Research Complete and the Cochrane Library. The screening process comprises an initial review of titles and abstracts to identify relevant studies efficiently, followed by a full-text assessment of the selected articles. Two reviewers will independently conduct study selection, data extraction and risk of bias assessment. Data extraction will be performed using a standardised form. The primary outcome is clinical reasoning competence, and secondary outcomes are communication skills and student satisfaction. The risk of bias in included studies will be evaluated using the Cochrane Risk of Bias tool 2. Depending on the literature search results and the characteristics of the selected studies, a meta-analysis will be conducted where feasible. Otherwise, a narrative synthesis will be performed.

Ethics and dissemination: This study presents a protocol for a systematic review and does not involve human subjects. The findings will be disseminated through publication as a manuscript submitted to a peer-reviewed journal.

Prospero registration number: CRD420251163882.

Introduction: Decisions regarding life-sustaining treatment and end-of-life care are among the most ethically complex and emotionally challenging decisions encountered in emergency departments and intensive care units. Such decisions frequently involve uncertainty regarding prognosis, limited time for deliberation and situations in which patients may lack decision-making capacity, requiring family members or surrogate decision-makers to participate in the decision-making process. Shared decision-making (SDM) has increasingly been recommended as an approach to align treatment decisions with patients' values and preferences. Decision aids are evidence-based tools designed to support informed and value-congruent healthcare decisions by presenting available options, potential benefits and harms and opportunities for values clarification. Although decision aids have been extensively studied in chronic disease management and preference-sensitive healthcare decisions, their use in life-sustaining treatment and end-of-life care in emergency and intensive care settings remains fragmented and has not yet been comprehensively mapped. This scoping review aims to identify and map the existing literature on decision aids and related interventions that support SDM for life-sustaining treatment and end-of-life care in emergency and intensive care settings.

Methods and analysis: This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Electronic searches will be performed in PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and Ichushi-Web. Studies published in English or Japanese from January 2000 onwards will be eligible. Quantitative, qualitative, mixed-methods and descriptive studies addressing decision aids or related interventions designed to support SDM regarding life-sustaining treatment and end-of-life care among adult patients, family members, surrogate decision-makers or healthcare professionals in emergency and intensive care settings will be included. Two reviewers will independently screen studies, assess eligibility and chart data. Findings will be synthesised descriptively and presented in narrative and tabular formats.

Ethics and dissemination: Ethics approval is not required because this review will analyse data from publicly available literature and will not involve human participants. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant scientific conferences.

Objectives: To assess the implementation of infection prevention and control (IPC) measures and associated factors in healthcare in low-resource settings during the COVID-19 pandemic.

Design: Multinational cross-sectional study.

Setting: The study was conducted from February to November 2022 in Côte d'Ivoire, Democratic Republic of Congo, Madagascar and Nigeria.

Participants: A total of 6749 healthcare workers (HCWs) at 324 healthcare facilities (HCFs) were enrolled from different levels of care and types.

Primary and secondary outcomes: Standardised HCW and HCF questionnaires assessed COVID-19-related exposures and IPC measures and descriptive analyses were conducted overall and by country and HCF. Partial proportional odds models were used to assess factors associated with HCW compliance to hand hygiene and mask wearing.

Results: Among 324 HCFs, the reported presence of IPC programmes ranged from 51.4% (n=111) at primary non-hospitals to 83.3% (n=18) at tertiary HCFs. More than half reported no patient or HCW screening (57.4%, n=186). Only 19.8% (n=64) reported handrub at point of care in every room. Among 6749 enrolled HCWs, 54.0% were working in high-risk patient care. More HCWs reported sufficient availability of masks (62.7%, n=4231) compared with respirators (28.5%, n=1926). HCW compliance with hand hygiene and mask wearing, respectively, was improved by presence of an IPC programme (OR: 1.3, 95% CI 1.2 to 1.5; OR: 1.4, 95% CI 1.2 to 1.6), IPC training received by the HCW (OR: 1.5, 95% CI 1.3 to 1.7; OR: 1.3, 95% CI 1.2 to 1.5) and availability of handrub and masks, respectively (OR: 5.9, 95% CI 4.1 to 8.4; OR: 2.3, 95% CI 2.0 to 2.7).

Conclusions: We conducted a large survey including HCFs across levels of care and type in urban and rural regions in sub-Saharan Africa. Critical gaps in IPC programmes and access to IPC equipment during the COVID-19 pandemic hindered HCW compliance with recommended IPC practices. To improve general infection control and pandemic preparedness in low-resource settings, continued focus on strengthening IPC programmes and ensuring access to materials/equipment is essential.

Introduction: Sleep is an important natural process carried out by the human body. It allows the body to rest and the brain to process information attained over the course of the day. Sleep is intrinsically linked to mental health, with those with mental illness more likely to require support in attaining adequate sleep. Recently, the College of Psychiatrists in Ireland's REFOCUS committee has sought to co-design an information leaflet for those with mental illness detailing the latest recommendations from the literature regarding sleep for this population, regardless of whether or not they take psychotropic medications. Given the rapidly expanding research focus on this topic, there are many published systematic reviews on the subject. As such, this proposed umbrella review seeks to collate the existing qualitative-based systematic reviews into sleep and mental illness and synthesise them in order to draw out the key recommendations that can be used by the committee to co-design an information leaflet to be used in practice to support service users with sleep disturbance.

Method and analysis: This proposed review aims to explore how service users of mental health services experience sleep with and without the medication used to treat mental illness. An umbrella review that is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is proposed. Search terms are stated, and a variety of databases(Medline, Embase, CINAHL, Web of Science, Scopus) will be searched. The search range is from 1 January 2016 to present (2026).

Ethics and dissemination: Given that this paper presents a protocol for an umbrella review into sleep and mental illness, no ethical approval was required. The proposed umbrella review has been registered with the repository: PROSPERO on 18 March 2026 where it is freely available. The results of the umbrella review will be disseminated through both a peer reviewed publication and through an information leaflet co-designed by the College of Psychiatrists in Ireland's REFOCUS committee. This protocol and subsequent umbrella review is and will be co-designed by psychiatrists, service users and family members of those with mental illness. Such individuals are named authors on this protocol and will be named authors on the proposed umbrella review as well.

Prospero registration: CRD420261343674.

Background: Maternity Waiting Homes (MWHs) are a key strategy for improving maternal health by bringing expectant women closer to health facilities and skilled birth attendants. Despite their potential benefits, a woman's stay is shaped by various factors, including emotional, social and logistical aspects.

Objectives: This study aimed to explore the lived experiences of pregnant women using maternity waiting homes in the Ari zone public health facilities, Ethiopia.

Design: A qualitative phenomenological study, grounded in a descriptive (Husserlian) phenomenological orientation and analysed using Colaizzi's seven-step framework.

Setting: Public health facilities providing MWH services in the Ari zone, southern Ethiopia, ranging from a zonal hospital to primary health centres.

Participants: 15 pregnant women, who had stayed in an MWH for at least 1 week during their current pregnancy, selected using purposive sampling until data saturation was reached.

Methods: We conducted in-depth interviews from 15 June 2025 to 15 July 2025 to match the Study Area and Period section. The data were transcribed, translated and thematically analysed with Open Code software V.4.02 to identify key themes and subthemes. The rigour of the study was ensured by applying Guba's trustworthiness criteria, with a focus on credibility, transferability, dependability and confirmability.

Results: Based on the findings, the experiences of women in maternity waiting homes centred on four main themes. Emotionally, women faced both isolation and anxiety from being away from home but also felt comfort and relief from being near medical care. Socially, they found support from other women and were influenced by the attitudes of health staff while also carrying the burden of family and cultural concerns. Practical challenges included significant financial burdens, lack of food and inadequate facilities. Despite these difficulties, women ultimately valued the homes for the increased confidence and improved access to skilled care they provided for a safer birth.

Conclusions: A woman's experience in an MWH is shaped by a mix of emotional, social, infrastructural and cultural factors. To improve the use of MWHs and maternal health outcomes, it is crucial to enhance the quality of these facilities, offer psychosocial support and involve communities. Future intervention studies should test whether targeted psychosocial and food-security support measurably improve women's experiences and MWH uptake.

Purpose: The North West London Diabetes Cohort is established to provide systematic characterisation of a large diabetes population as a foundation for complications research and prognostic modelling. Many predictive modelling studies neglect the essential descriptive characterisation of underlying cohorts, focusing narrowly on model accuracy. This cohort profile addresses this gap by comprehensively describing the demographic composition, clinical characteristics and complication incidence patterns. The notably diverse, multiethnic population enables examination of ethnic disparities and supports future development of reliable prognostic models and evidence-based prevention strategies for diabetes complications.

Participants: At baseline, 337 271 patients with diabetes were identified. It includes 279 067 patients with type 2 diabetes, 17 638 with type 1 diabetes, 33 590 with gestational diabetes and 6916 with unspecified diabetes. The earliest diabetes diagnosis dates to January 1932, with data updated to 27 May 2025.

Findings to date: This cohort profile describes baseline characteristics of patients with comprehensive data collected on demographics (age, sex, Deprivation Index, ethnicity), clinical measures (glycated haemoglobin, body mass index, blood pressure, lipids and estimated glomerular filtration rate) and 14 major diabetes complications tracked longitudinally. Key findings for patients with type 2 diabetes reveal diabetic retinopathy as the most common complication (74.6 per 1000 person-years), followed by hypertension (51.0) and kidney disease (31.4). Cumulative incidence analyses using the Aalen-Johansen estimator, which accounts for mortality as a competing risk, demonstrated significant ethnic disparities, with black, Asian, mixed and other ethnic groups showing elevated risk compared with white patients. Time-varying Cox models identified strong clustering between cardiovascular and renal complications, confirming a cardiometabolic-renal syndrome. Mental health conditions (depression and anxiety) were prevalent throughout the disease timeline, occurring both before and after diabetes diagnosis.

Future plans: This cohort will be used as a platform for developing and validating prognostic models for diabetes complications, enabling risk stratification and targeted interventions. Future work will incorporate medication data to refine diabetes type classification, examine the effectiveness of antidiabetic medications in preventing different complications and address demographic differences in prognostic model performance and prediction accuracy. To better characterise lifestyle, further interrogation of electronic health record data will examine recording of advice given, including dietary advice, referral to weight management schemes and presence of alcohol consumption codes.

Objective: Mental health disorders among children and young people are a substantial global public health concern. Barriers to accessing specialist mental health services, particularly long waiting times, can exacerbate poor mental health. Recently, there has been an increase in the adoption of social prescribing to support children and young people to address this concern; however, the evidence of its impact on mental health remains limited. The key objective of this study was to explore how children, young people and their families experience the impact of a new social prescribing service in the Northwest of England.

Design: The qualitative study adopted an Interpretive Description (ID) approach defined by Sally Thorne. Reporting of the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Participants and setting: Semistructured interviews were conducted with 15 children and young people aged 8-17 years who had accessed the social prescribing service. In addition, 27 parents and caregivers of children and young people who had accessed the service were also interviewed. This study formed part of an independent evaluation of the service in which interviews took place both face to face and online.

Data analysis: Inductive reflexive thematic analysis outlined by Braun and Clarke was employed to analyse the data.

Results: Five themes emerged which described the perceived impact of the service and the key mechanisms of how the impact may have been achieved. Children and young people described feeling less emotional distress, lower levels of anxiety and increased social confidence. The impact extended beyond those in direct receipt of the service, reducing parental stress, improving family interaction and strengthening relationships. Key mechanisms underpinning the impact included a trusting relationship with a link worker and the learning of cognitive coping strategies that were employed to help overcome emotional distress.

Conclusions: The findings suggest that social prescribing may function as a relational early intervention that supports emotional stabilisation and re-engagement with education and social contexts. However, further research is needed to confirm and quantify the effectiveness across different service models and settings.

Objectives: The transition into fatherhood is considered a profound life stage, involving personal development, lifestyle and emotional adjustments. Fathers' mental health can be adversely impacted by this transition. Fathers express isolation, exclusion and limited support within perinatal services. Restricted emotional support for fathers presents negative consequences for the whole family dynamic. Limited research has explored father and professional input associated with paternal perinatal support and how healthcare services and child and family services can respond to engaging fathers and their mental and emotional support needs. This qualitative study aims to explore fathers' mental health and well-being experiences (referring to emotional or/and social well-being) and support needs within the perinatal period, as well as current viewpoints of perinatal services (maternity, healthcare and social care services) from both fathers' and professionals' perspectives.

Design: In-depth semistructured interviews and focus groups were carried out as part of a qualitative study.

Setting: Fathers' resident within the North East and North Cumbria (NENC) and services and organisations from the voluntary, community and social enterprise (VCSE) sector and social care services across the NENC, who associate with supporting families and children, and perinatal mental health.

Participants: Fathers (n=21) and professionals (VCSE and social care services) (n=9).

Results: Reflexive thematic analysis of 30 participants' accounts identified two main themes and five subthemes: (1) 'The Pregnant and Postnatal Man' and (2) Removing the cloak of fatherhood invisibility. These themes centred around the isolation of fathers and limited emotional and mental support within the parenting transition.

Conclusions: The findings suggest that greater father inclusion within perinatal services, policies and antenatal education may help fathers feel more recognised and supported throughout the perinatal journey. Recognition of fathers' emotional well-being and mental health, by adopting a 'whole family' emotional support approach within perinatal services was considered important to support fathers and the family dynamic in facilitating a positive transition for the whole family.

Objectives: To compare receipt of guideline-informed myocardial infarction (MI) care by mental disorder and assess how the COVID-19 pandemic affected associations.

Design: A population-based cohort study using linked electronic health records.

Setting: England, November 2019 to February 2023.

Participants: 131 075 adults with non-ST-elevation MI (NSTEMI) and 79 045 adults with ST-elevation MI (STEMI) were identified from the Myocardial Ischaemia National Audit Project, and their prior diagnoses of mental disorder were ascertained from linked hospitalisation and primary care records.

Outcome measures: We compared guideline-informed care standards for each of NSTEMI and STEMI between people with schizophrenia, bipolar disorder or depression versus those without any of these disorders. We used logistic regression to adjust for confounders and investigate differences over time.

Results: Mental disorder disparities were more evident for NSTEMI than STEMI. Following NSTEMI, people with a mental disorder had lower odds of angiography eligibility and receipt, cardiac ward admission and cardiac rehabilitation referral. ORs (95% CIs) ranged from 0.25 (0.20 to 0.31) for angiography receipt for schizophrenia to 0.92 (0.89 to 0.96) for cardiac ward admission for depression. Following STEMI, people with bipolar disorder were less likely to meet the 150 min call-to-balloon target (OR 0.72; 95% CI 0.55 to 0.93), and people with schizophrenia were less likely to receive rehabilitation referral (OR 0.38; 95% CI 0.23 to 0.61) or indicated secondary prevention medication (OR 0.46, 95% CI 0.27 to 0.77). There was no clear evidence that the COVID-19 pandemic affected disparities.

Conclusions: People with a mental disorder are less likely to receive guideline-informed MI care, with disparities greatest following NSTEMI and for people with schizophrenia.