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In the absence of guidance on PRO measure selection for CAR T-cell therapies, consensus-based methods represent an important step towards use of PROs with this clinical population. Modest sample size and representativeness of the patient subgroup are limitations of this study.
Objectives
Patient activation (PAct)—a measure assessing an individual’s perceived knowledge, skills and confidence in managing their health and well-being—is often used to personalise and evaluate care, although its causal link to self-management behaviours (SMBs) and clinical outcomes remains uncertain. We aimed to synthesise the evidence on the causal association between PAct, SMBs and clinical outcomes in type 2 diabetes (T2D).
Design
Systematic review and narrative synthesis of data summarised in a harvest plot.
Data sources
We searched Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL up to April 2024 for relevant English articles.
Eligibility criteria
We included studies of any quantitative design that reported on the association of PAct with clinical outcomes or SMBs in adult patients with T2D.
Data extraction and synthesis
Two independent reviewers were involved, and any disagreements were discussed and resolved collaboratively. Risk-of-bias (RoB) was assessed using an adapted RoB Assessment Tool for Nonrandomised Studies. Levels of evidence were evaluated for each T2D-related outcome.
Results
We identified 21 studies published between 2009 and 2023, including 15 cross-sectional studies and no randomised controlled trials. Eleven studies were conducted in the USA. Seventeen studies used the Patient Activation Measure questionnaire. There is moderate evidence that higher PAct scores are associated with better glycated haemoglobin levels (studies reporting on this association, n=14). There is very limited evidence that PAct improves diet (n=5) and physical activity (n=6). All other clinical outcomes and SMBs had inconclusive results due to either inconsistent or insufficient evidence, or both.
Conclusion
A causal relationship between PAct, clinical outcomes and SMBs in T2D cannot be established due to inconsistent evidence and a lack of high-quality studies. Thus, the use of PAct scores as a tailoring tool and an outcome measure in healthcare services requires further evaluation.
PROSPERO registration number
CRD42021230727.
Indagine Astraricerche per Unione Italiana Food
Circulation, Volume 151, Issue 21, Page 1541-1543, May 27, 2025.
This JAMA Patient Page describes atrial fibrillation and its symptoms, diagnosis, and treatment.
Manca diagnosi in 65% casi. Pediatri: ‘enuresi ha cause fisiche’
Manca diagnosi in 65% casi. Pediatri: ‘enuresi ha cause fisiche’
Alla 16ima settimana di gestazione con un esame del sangue
Objectives
To investigate temporal trends in the geographical variation in oral anticoagulant (OAC) treatment of patients with atrial fibrillation, to evaluate the extent to which regional differences in patient populations may explain this difference and to explore whether patient predictors of adherence may have a different impact across regions.
Design
Register-based cohort study from 1 January 2013 to 31 December 2022.
Setting
The study used data from nationwide health registers to explore differences in OAC adherence across the five administrative regions in Denmark.
Participants
Patients with atrial fibrillation and a CHA2DS2-VASc score ≥2 (n=291 666).
Outcome
Population adherence to OAC treatment operationalised as the proportion of days covered (PDC).
Results
A continuous rise in overall adherence (PDC) from 53% to 78% was observed during the study period. Concurrently, the predominant treatment shifted from vitamin K antagonists to direct OACs with a preference for rivaroxaban and apixaban. The adherence variation between the highest-performing and lowest-performing regions decreased from 18% in 2013 to 9% in 2022, whereas the relative between-regions rankings remained unchanged. Applying multivariate Poisson models adjusting for patient demographics, health status and socioeconomic factors did not substantially change the inter-regional variations; this suggests that different compositions of patient populations cannot explain these variations. However, the impact of socioeconomic factors and comorbidities among patients was unequal across regions. In regions with the lowest overall adherence, a higher risk of non-adherence was seen among patients having mental health disorders, low income and living alone.
Conclusions
The geographical variation in OAC adherence decreased over time as the overall adherence improved. However, substantial variation remained.
Objectives
Glycated albumin (GA) and body mass index (BMI) are associated with the risk of atherosclerotic cardiovascular disease (ASCVD). However, the role of BMI in the association between GA and 10-year ASCVD risk is still not fully understood.
Design
A retrospective cross-sectional study.
Setting
In this retrospective cross-sectional study, 4646 healthy subjects who received a full health examination at the Health Management Medical Center, Third Xiangya Hospital of Central South University, from 1 January 2022 to 30 December 2023 were initially identified. According to the exclusion criteria, 2107 participants were included in the final analysis.
Participants
The inclusion criteria for this study included (a) age is ≥18 years old and (b) subjects were long-term residents of Hunan province.
Primary and secondary outcome measures
The 10-year ASCVD risk was evaluated via the China-PAR equation. The link between GA and 10-year ASCVD risk was examined through a multivariable logistic regression model, and the dose–response relationship was demonstrated using the restricted cubic spline. The potential mediation effect of BMI on this association was explored, and the differences in this mediation effect across age and metabolic-associated fatty liver disease (MAFLD) subgroups were analysed.
Results
Elevated GA levels were positively linked to an intensified 10-year ASCVD risk (OR=1.160, 95% CI 1.055 to 1.276). Additionally, BMI was negatively linked to GA and 10-year ASCVD risk. BMI mediated 13.9% of the connection between GA and 10-year ASCVD risk. Specifically, the mediating effect of BMI remained significant in the 40–60-year age subgroup and non-MAFLD subgroup, with mediation ratios of 43.7% and 8.5%, respectively.
Conclusions
GA is a key predictor of 10-year ASCVD risk, and BMI partially mediates this relationship in healthy populations. Therefore, targeted weight management is recommended to reduce the adverse effect of GA on 10-year ASCVD risk in different populations.
Objectives
This study aimed to explore what intervention specificities or attributes newly diagnosed individuals with multiple sclerosis (MS) find important and to explore possible reasons behind their evaluations.
Design
A stepwise approach began with a systematic literature review to identify significant attributes. Patients with MS then assessed these attributes through an online survey, which included a ranking exercise and open-ended questions. Finally, the results were evaluated by the clinical team to select the most relevant factors for personalised care.
Setting and participants
From June 2023 to December 2023, all consecutive patients referred to the MS Center of Careggi University Hospital were screened for inclusion. Following recruitment, cognitive and physical assessments were administered at the Don Gnocchi Centre. All participants were interviewed by an experienced neuropsychologist.
Procedures
Participants were enrolled in the RELIABLE clinical trial, which included a ranking exercise and open-ended question. In the ranking exercise, patients prioritised levels of treatment attributes: treatment effects, methods of intervention, type of monitoring, monitoring, mode and mental support. The open-ended questions addressed the reasons behind the level rankings.
Results
Participants’ rankings revealed the most important levels of each attribute. The highest-ranked method of intervention was disease-modifying treatment, which received 164 points. For mental support, individual psychotherapy was deemed most important with 149 points. Preservation of cognitive function, a key treatment effect, received 144 points. Clinical check-ups were the top type of monitoring with 129 points. Lastly, the hybrid mode of monitoring (half remote/half in-person) was ranked with 77 points. Open-ended responses provided insights into the reasons behind these preferences, emphasising the importance of maintaining mobility, cognitive function and emotional well-being. The clinical team evaluated these findings, confirming that the selected attributes were both clinically relevant and aligned with patient priorities. This evaluation process ensured that the treatment specificities chosen for individualised care were comprehensive and reflective of patient needs.
Conclusions
By identifying and prioritising key treatment attributes, this research highlights the multifaceted nature of MS management and emphasises the importance of aligning treatment options with patient preferences. Addressing these factors through further quantitative preference assessments is essential for preventative MS care, improving patient outcomes and promoting a more patient-centred approach to treatment.
Introduction
Existing patient-reported outcome measures (PROMs) do not meet accepted international criteria for measuring health outcomes of hypospadias treatment. This protocol describes the qualitative development (phase I) of a novel PROM to evaluate outcomes of hypospadias treatments.
Methods and analysis
Participants aged 7 years and older with hypospadias and caregivers of children under 8 years seeking treatment at Boston Children’s Hospital, Children’s Hospital of Eastern Ontario (CHEO), Children’s Hospital of Philadelphia (CHOP) and McMaster Children’s Hospital), will be invited to participate in concept elicitation and cognitive interviews. Concept elicitation interviews will be in-depth and semi-structured to understand concepts important to patients seeking treatment for hypospadias. Cognitive interviews will be performed concurrently to ensure that the scale items, instructions and response options are relevant, understandable and comprehensive. Cognitive interviews will be complemented by expert input. Concept elicitation and cognitive interview transcripts will be coded line-by-line. Participant quotes will be categorised into top-level domains, themes and subthemes. The primary outcome of this research will be to develop a conceptual model representing the patient experience of hypospadias and a novel PROM.
Ethics and dissemination
Ethics approval was obtained from Boston Children’s Hospital’s Institutional Review Board (HHS Registration: IRB00000352; Protocol number IRB-P00042425). CHOP, McMaster and CHEO have reliance agreements with Boston Children’s Hospital. Findings from this research will be disseminated at national and international conferences and published in relevant peer-reviewed journals for the target audience.
Importance
Women are under-represented in senior roles within academic medicine, including as authors in high-impact journals.
Objective
To examine trends and predictors of female authorship in the Canadian Medical Association Journal (CMAJ) as the only high-impact Canadian journal over a 10-year period to understand gender balances in Canadian academic publishing.
Design
This cross-sectional study analysed trends and predictors of female authorship in articles published in CMAJ from 1 January 2013 to 31 December 2023.
Setting
Data were extracted from PubMed for CMAJ, the only high-impact Canadian medical journal (impact factor ≥10). Data extraction used the RISmed package in R Studio.
Participants
The study included articles published in CMAJ within the specified period. Author gender was predicted using the validated Genderize.io software. Articles where the gender of the authors could not be predicted were excluded from analysis.
Main outcomes and measures
The co-primary outcomes were proportions of female first and last authors. Statistical analyses included 2 tests comparing proportions, Jonckheere and linear regression models to evaluate trends. Among multiauthor articles, multivariable logistic regression models assessed predictors of female first and last authorship.
Results
From 5805 included articles, women comprised 47% of first authors and 43% of last authors (p
Objectives
To examine how relationships between physicians, pharmacists and patients associate with generic drug (GE) utilisation in Japan’s healthcare system.
Design
Observational study using longitudinal medical claims from April 2015 to March 2021.
Setting
Pharmacies across Japan serving beneficiaries of the National Health Insurance Association.
Participants
69 395 pharmacies, resulting in 322 097 pharmacy-year observations.
Main outcome measures
Quantity share of GEs dispensed by pharmacies.
Results
Higher hospital prescription concentration was consistently associated with increased GE usage (1.1–2.3 percentage points higher for moderate to very high concentrations compared with low). The relationship between patient prescription concentration and GE usage varied, showing a positive association (0.3–0.6 percentage points higher) overall, but negative in settings with low hospital concentration. Smaller pharmacies exhibited a stronger positive association between hospital concentration and GE usage, while larger pharmacies and those in less urbanised areas showed a stronger positive association between patient concentration and GE usage.
Conclusions
This study reveals that pharmacy-stakeholder relationships significantly influence GE utilisation in Japan’s healthcare system. Our findings demonstrate that hospital-pharmacy relationships consistently drive generic usage, while patient-pharmacy relationships show contextual effectiveness. By measuring these relationships through concentration rates, we provide evidence that stakeholder interactions may affect medication dispensing decisions. These findings suggest that policies promoting GEs may benefit from considering the specific characteristics of pharmacies and their existing relationships with hospitals and patients. These insights can inform more effective policy design for GE promotion across different healthcare contexts.
Tinnitus, defined by the perception of sounds such as buzzing or ringing in the absence of external noise, is particularly common in veterans due to military exposures to loud noises and chemicals. Although the majority of those with tinnitus aren’t bothered by it, the condition can be associated with insomnia, depression, anxiety, and reduced quality of life, noted a guideline based on a systematic review.
