BMJ Open

Furukawa, Toshi A; Karyotaki, Eirini; Suganuma, Aya; Pompoli, Alessandro; Ostinelli, Edoardo G; Cipriani, Andrea; Cuijpers, Pim; Efthimiou, Orestis

doi: 10.1136/bmjopen-2018-026137pmid: 30798295

IntroductionPsychotherapy is a complex intervention, consisting of various components and being implemented flexibly in consideration of individual patient’s characteristics. It is then of utmost importance to know which of the various components or combinations thereof are more efficacious, what their specific effect sizes are and which types of patients may benefit more from different components or their combinations.Methods and analysisInternet-delivered cognitive–behavioural therapy (iCBT) offers a unique opportunity to systematically review and quantitatively disentangle the efficacy of various components because, unlike face-to-face cognitive–behavioural therapy, it allows identification of constituent components that are actually delivered to patients. We will systematically identify all randomised controlled trials that compared any form of iCBT against another form or a control intervention in the acute phase treatment of adult depression. We will apply component network meta-analysis (cNMA) to dismantle efficacy of individual components. We will use individual participant data in the cNMA to identify participant-level prognostic factors and effect modifiers for different components.Ethics and disseminationThe investigators of the primary trials will have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.PROSPERO registration numberCRD42018104683.

Contandriopoulos, Damien; Perroux, Mélanie; Duhoux, Arnaud

doi: 10.1136/bmjopen-2018-025007pmid: 30478127

ObjectiveWhile there is consensus on the need to strengthen primary care capacities to improve healthcare systems’ performance and sustainability, there is only limited evidence on the best way to organise primary care teams. In this article, we use a conceptual framework derived from contingency theory to analyse the structures and process optimisation of multiprofessional primary care teams.DesignWe focus specifically on inter-relationships between three dimensions: team size, formalisation of care processes and nurse autonomy. Interview-based qualitative data for each of these three dimensions were converted into ordinal scores. Data came from eight pilot sites in Quebec (Canada).ResultsWe found a positive association between team size and formalisation (correlation score 0.55) and a negative covariation (correlation score −0.64) between care process formalisation and nurses’ autonomy/subordination. Despite the study being exploratory in nature, such relationships validate the idea that these dimensions should be analysed conjointly and are coherent with our suggestion that using a framework derived from a contingency approach makes sense.ConclusionsThe results provide insights about the structural design of nurse-intensive primary care teams. Non-physicians’ professional autonomy is likely to be higher in smaller teams. Likewise, a primary care team that aims to increase nurses’ and other non-physicians’ professional autonomy should be careful about the extent to which it formalises its processes.

Faith, Trevor D; Flournoy-Floyd, Minnjuan; Ortiz, Kasim; Egede, Leonard E; Oates, Jim C; Williams, Edith M

doi: 10.1136/bmjopen-2018-022701pmid: 30413505

ObjectiveThe current article seeks to examine the ways in which African-American women with systemic lupus erythematosus (SLE) describe their disease experience and how they cope with their disease. This qualitative study provides deeper insight into whether experiences of African-American women with SLE differ from previous qualitative study findings.MethodsQualitative data were gathered using interviews and a focus group, from participants in the Peer Approaches to Lupus Self-management (PALS) programme. Data were analysed for themes related to disease experience and how participants cope with their disease. Twenty-seven African-American women with SLE were recruited into the peer mentoring programme, of which 7 served as mentors and 20 served as mentees. A 12-week peer mentoring intervention delivered by phone and based on the Chronic Disease Self-Management and Arthritis Self-Management Programs.ResultsThree categories encompassing a total of 10 subcategories emerged from analyses: (A) interpersonal, familialandromantic relationships; (B) individual experiences of living with SLE; and (C) physician–patient relationships.ConclusionWe gained insight on several issues related to patient perspectives of African-American women with SLE, and the context surrounding their thoughts and feelings related to lupus, including their providers, families and other social support networks. Additional research efforts could explore and address the thematic domains and respective subthemes identified here. Although limited due to the preliminary nature of the study, this information can be used to create future evidence-based interventions to decrease the impact of SLE on African-American patients.

Petrova, Dafina; Joeris, Alexander; Sánchez, María-José; Salamanca-Fernández, Elena; Garcia-Retamero, Rocio

doi: 10.1136/bmjopen-2018-025047pmid: 30478128

PurposeThe numerical format in which risks are communicated can affect risk comprehension and perceptions of medical professionals. We investigated what numerical formats are used to report absolute risks in empirical articles, estimated the frequency of biasing formats and rated the quality of figures used to display the risks.DesignDescriptive study of reporting practices.MethodWe randomly sampled articles published in seven leading orthopaedic surgery journals during a period of 13 years. From these, we selected articles that reported group comparisons on a binary outcome (eg, revision rates in two groups) and recorded the numerical format used to communicate the absolute risks in the results section. The quality of figures was assessed according to published guidelines for transparent visual aids design.Outcome measuresPrevalence of information formats and quality of figures.ResultsThe final sample consisted of 507 articles, of which 14% reported level 1 evidence, 13% level 2 and 73% level 3 or lower. The majority of articles compared groups of different sizes (90%), reported both raw numbers and percentages (64%) and did not report the group sizes alongside (50%). Fifteen per cent of articles used two formats identified as biasing: only raw numbers (8%, ‘90 patients vs 100 patients’) or raw numbers reported alongside different group sizes (7%, ‘90 out of 340 patients vs 100 out of 490 patients’). The prevalence of these formats decreased in more recent publications. Figures (n=79) had on average two faults that could distort comprehension, and the majority were rated as biasing.ConclusionAuthors use a variety of formats to report absolute risks in scientific articles and are likely not aware of how some formats and graph design features can distort comprehension. Biases can be reduced if journals adopt guidelines for transparent risk communication but more research is needed into the effects of different formats.

Walter, Matthias; Ramirez, Andrea L; Lee, Amanda HX; Rapoport, Daniel; Kavanagh, Alex; Krassioukov, Andrei V

doi: 10.1136/bmjopen-2018-024084pmid: 30467135

IntroductionManaging and preventing risk factors associated with cardiovascular and cerebrovascular impairment is well studied in able-bodied individuals. However, individuals with spinal cord injury (SCI) at or above the spinal segment T6 are prone to experience autonomic dysreflexia (AD) but also to suffer from neurogenic detrusor overactivity (NDO). Treatment of NDO would not only improve lower urinary tract function but could also reduce the severity and frequency of life-threatening episodes of AD. Fesoterodine, an antimuscarinic drug, has been successfully employed as a first-line treatment for detrusor overactivity in individuals without an underlying neurological disorder. Thus, our aim is to investigate the efficacy of fesoterodine to improve NDO and ameliorate AD in individuals with SCI.Methods and analysisThis phase II, open-label exploratory, non-blinded, non-randomised, single-centre study will investigate the efficacy of fesoterodine to improve NDO and ameliorate AD in individuals with chronic SCI at or above T6. During screening, we will interview potential candidates (with a previous history of NDO and AD) and assess their injury severity. At baseline, we will perform cardiovascular and cerebrovascular monitoring (blood pressure (BP), heart rate and cerebral blood flow velocity) during urodynamics (UDS) and 24-hour ambulatory BP monitoring (ABPM) during daily life to assess severity and frequency of AD episodes (ie, maximum increase in systolic BP). The primary outcome is a reduction of artificially induced (during UDS) and spontaneous (during daily life) episodes of AD as a display of treatment efficacy. To answer this, we will repeat UDS and 24-hour ABPM during the last cycle of the treatment phase (12 weeks overall, ie, three cycles of 4 weeks each). At the end of each treatment cycle, participants will be asked to answer standardised questionnaires (AD symptoms and quality of life) and present bladder and bowel diaries, which will provide additional subjective information.Ethics and disseminationThe University of British Columbia Research Ethics Boards (H15-02364), Vancouver Coastal Health Research Institute (V15-02364) and Health Canada (205857) approved this study. The findings of the study will be published in peer-reviewed journals and presented at national and international scientific meetings. This protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials and CONsolidated Standards Of Reporting Trials statements.Trial registration number NCT02676154; Pre-results.

Rigabert, Alina; Motrico, Emma; Moreno-Peral, Patricia; Resurrección, Davinia M; Conejo-Cerón, Sonia; Navas-Campaña, Desirée; Bellón, Juan Á

doi: 10.1136/bmjopen-2018-022012pmid: 30498036

IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing depression, little is known about its prevention through online interventions. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials assessing the effectiveness of online interventions in preventing depression in heterogeneous populations.Methods and analysisWe will conduct a systematic review and meta-analysis of randomised controlled trials that will be identified through searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Australia New Zealand Clinical Trials Register . We will also search the reference lists provided in relevant studies and reviews. Experts in the field will be contacted to obtain more references. Two independent reviewers will assess the eligibility criteria of all articles, extract data and determine their risk of bias (Cochrane Collaboration Tool). Baseline depression will be required to have been discarded through standardised interviews or validated self-reports with standard cut-off points. The outcomes will be the incidence of new cases of depression and/or the reduction of depressive symptoms as measured by validated instruments. Pooled standardised mean differences will be calculated using random-effect models. Heterogeneity and publication bias will be estimated. Predefined sensitivity and subgroup analyses will be performed. If heterogeneity is relevant, random-effect meta-regression will be performed.Ethics and disseminationThe results will be disseminated through peer-reviewed publication and will be presented at a professional conference. Ethical assessment is not required as we will search and assess existing sources of literature.Trial registration numberCRD42014014804; Results.

doi: 10.1136/bmjopen-2017-019138corr1pmid: 30798296

Hamoen, Marleen; Vergouwe, Yvonne; Wijga, Alet H; Heymans, Martijn W; Jaddoe, Vincent W V; Twisk, Jos W R; Raat, Hein; de Kroon, Marlou L A

doi: 10.1136/bmjopen-2018-023912pmid: 30467134

ObjectivesTo develop a dynamic prediction model for high blood pressure at the age of 9–10 years that could be applied at any age between birth and the age of 6 years in community-based child healthcare.Design, setting and participantsData were used from 5359 children in a population-based prospective cohort study in Rotterdam, the Netherlands.Outcome measureHigh blood pressure was defined as systolic and/or diastolic blood pressure ≥95th percentile for gender, age and height. Using multivariable pooled logistic regression, the predictive value of characteristics at birth, and of longitudinal information on the body mass index (BMI) of the child until the age of 6 years, was assessed. Internal validation was performed using bootstrapping.Results227 children (4.2%) had high blood pressure at the age of 9–10 years. Final predictors were maternal hypertensive disease during pregnancy, maternal educational level, maternal prepregnancy BMI, child ethnicity, birth weight SD score (SDS) and the most recent BMI SDS. After internal validation, the area under the receiver operating characteristic curve ranged from 0.65 (prediction at age 3 years) to 0.73 (prediction at age 5–6 years).ConclusionsThis prediction model may help to monitor the risk of developing high blood pressure in childhood which may allow for early targeted primordial prevention of cardiovascular disease.

Keen, Justin; Nicklin, Emma; Wickramasekera, Nyantara; Long, Andrew; Randell, Rebecca; Ginn, Claire; McGinnis, Elizabeth; Willis, Sean; Whittle, Jackie

doi: 10.1136/bmjopen-2018-022921pmid: 30478113

ObjectiveTo assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.SettingFour acute National Health Service hospitals in England.Participants111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff.ResultsThere were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff.ConclusionsThe findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.

Zhu, Yaxin; Liu, Jie; Qu, Bo; Yi, Zhe

doi: 10.1136/bmjopen-2018-021822pmid: 30429143

ObjectivesThe aim of the study was to examine the relations among quality of life (QOL), loneliness and health-related characteristics in a sample of Chinese older people.DesignCross-sectional study.SettingCommunities in Dandong city, Liaoning province, China.ParticipantsSample of 732 older people aged 60 and older who were living in Dandong, Liaoning province, China.MethodsA questionnaire was administered to the participants face-to-face. The questionnaire contained four sections: demographic characteristics, health-related characteristics, the EQ-5D Scale and the UCLA Loneliness Scale. The t-test, F-test and multivariable linear regression analyses were performed to individually test associations between the demographic data, health-related characteristics, loneliness and QOL.ResultsChronic diseases, loneliness, age and smoking status were negatively associated with QOL (p<0.05). Satisfaction with health services, income and physical activity were positively associated with QOL (p<0.05).ConclusionsLoneliness, chronic diseases and health service satisfaction were important factors related to low QOL among older people in China. The findings indicate that reducing loneliness, managing chronic diseases and improving the health service may help to improve the QOL for older people.