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BMJ Open

Young Hee Nam, Warren B Bilker, Charles E Leonard, Michelle L Bell, Sean Hennessy
OBJECTIVE: Heat is associated with elevated all-cause mortality, and furosemide-induced potassium depletion might be worsened by heat-induced sweating. Because empiric potassium is associated with a marked survival benefit in users of furosemide at a dose of ≥40 mg/day, we hypothesised that this empiric potassium's survival benefit would increase with higher temperature (≥24°C). DESIGN: Cohort study. SETTING: Outpatient setting, captured by Medicaid claims, supplemented with Medicare claims for dual enrollees, from 5 US states from 1999 to 2010, linked to meteorological data...
February 18, 2019: BMJ Open
Wei Du, Danijela Gnjidic, Sallie-Anne Pearson, Sarah N Hilmer, Andrew J McLachlan, Fiona Blyth, Rosalie Viney, Grace Joshy, Cathy Day, Emily Banks
OBJECTIVES: To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. DESIGN: Prospective cohort analysis. SETTINGS, PARTICIPANTS, MEASUREMENTS: Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014...
February 15, 2019: BMJ Open
Adam Reuben, Andrew Appelboam, Andy Barton, Patricia Jane Vickery, Richard Body, Malcolm Hilton, Jason Coppell, Paul Ewings
INTRODUCTION: Patients presenting to emergency departments (EDs) with epistaxis uncontrolled by subsequent simple first aid measures or application of topical vasoconstrictors will typically undergo anterior nasal packing. Packing is effective, but can be extremely painful and unpleasant and patients usually need hospital admission. Tranexamic acid (TXA) is a cheap, safe, readily available antifibrinolytic agent known to be beneficial in a variety of clinical settings where uncontrolled bleeding may be a problem...
February 15, 2019: BMJ Open
David Wiljer, Rebecca Charow, Helen Costin, Lydia Sequeira, Melanie Anderson, Gillian Strudwick, Tim Tripp, Allison Crawford
INTRODUCTION: The notion of compassion and compassionate care is playing an increasingly important role in health professional education and in the delivery of high-quality healthcare. Digital contexts, however, are not considered in the conceptualisation of compassionate care, nor is there guidance on how compassionate care is to be exercised while using digital health technologies. The widespread diffusion of digital health technologies provides new contexts for compassionate care, with both opportunities for new forms and instantiations of compassion as well as new challenges...
February 15, 2019: BMJ Open
Anne Conrad, Mathilde Boccard, Florent Valour, Vincent Alcazer, Aydee-Tamara Tovar Sanchez, Christian Chidiac, Frédéric Laurent, Philippe Vanhems, Gilles Salles, Karen Brengel-Pesce, Boris Meunier, Sophie Trouillet-Assant, Florence Ader
INTRODUCTION: Immune reconstitution after haematopoietic stem cell transplantation (HSCT) is a complex and dynamic process, varying from a state of nearly complete immunosuppression to an expected full immune recovery. Specific vaccination guidelines recommend reimmunisation after HSCT but data regarding vaccine efficacy in this unique population are scarce. New immune functional assays could enable prediction of vaccine response in the setting of HSCT. METHODS AND ANALYSIS: A prospective, longitudinal single-centre cohort study of autologous and allogeneic HSCT recipients was designed in order to determine the vaccine response to five vaccine targets (pneumococcus, hepatitis B virus, Haemophilus Influenzae type b, tetanus and diphtheria) and to correlate it to immune function parameters...
February 15, 2019: BMJ Open
Bridie Angela Evans, Alan Brown, Jenna Bulger, Greg Fegan, Simon Ford, Katy Guy, SIan Jones, Leigh Keen, Ashrafunnesa Khanom, Mirella Longo, Ian Pallister, Nigel Rees, Ian T Russell, Anne C Seagrove, Alan Watkins, Helen Snooks
OBJECTIVES: To explore paramedics' experience of delivering fascia iliaca compartment block ( FICB) to patients with suspected hip fracture at the scene of injury. DESIGN: Focus groups within a randomised controlled trial. SETTING: Paramedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and trained in a feasibility study about an alternative to routine prehospital pain management for patients with suspected hip fracture...
February 15, 2019: BMJ Open
Oriana Ciani, Maria Cucciniello, Francesco Petracca, Giovanni Apolone, Giampaolo Merlini, Silvia Novello, Paolo Pedrazzoli, Nicoletta Zilembo, Chiara Broglia, Enrica Capelletto, Marina Garassino, Elena Nicod, Rosanna Tarricone
INTRODUCTION: Mobile health technologies may enhance patient empowerment and data integration along the whole care continuum. However, these interventions pose relatively new regulatory, organisational and technological challenges that limit appropriate evaluation. Lung Cancer App (LuCApp) is a mobile application developed by researchers and clinicians to promote real-time monitoring and management of patients' symptoms. This protocol illustrates a clinical trial designed to evaluate the usability, effectiveness and cost-effectiveness of LuCApp versus standard of care...
February 15, 2019: BMJ Open
Clément Ferrier, Ferdinand Dhombres, Babak Khoshnood, Hanitra Randrianaivo, Isabelle Perthus, Lucie Guilbaut, Isabelle Durand-Zaleski, Jean-Marie Jouannic
OBJECTIVE: To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France. DESIGN: A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed). SETTING: Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France...
February 15, 2019: BMJ Open
Raymond O'Connor, Jane O'Doherty, Andrew O'Regan, Aoife O'Neill, Claire McMahon, Colum P Dunne
OBJECTIVES: The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral. DESIGN: Cross-sectional design. SETTING: One urban primary care OOH facility located in the midwest of Ireland...
February 15, 2019: BMJ Open
Amber E Young, Anna Davies, Sophie Bland, Sara Brookes, Jane M Blazeby
INTRODUCTION: Systematic reviews collate trial data to provide evidence to support clinical decision-making. For effective synthesis, there must be consistency in outcome reporting. There is no agreed set of outcomes for reporting the effect of burn care interventions. Issues with outcome reporting have been identified, although not systematically investigated. This study gathers empirical evidence on any variation in outcome reporting and assesses the need for a core outcome set for burn care research...
February 15, 2019: BMJ Open
Lisa-Christine Girard, Chamarrita Farkas
IMPORTANCE: Potential effects of breast feeding on children's behaviour remains an elusive debate given inherent methodological challenges. Propensity score matching affords benefits by ensuring greater equivalence on observable social and health determinants, helping to reduce bias between groups. OBJECTIVES: We examined whether the duration of breast feeding had an impact on children's externalising and internalising behaviours. STUDY DESIGN: A cohort study (Encuesta Longitudinal de la Primera Infancia cohort) that included 3037 Chilean families who were enrolled in 2010...
February 15, 2019: BMJ Open
Sanjeewa Kularatna, Sameera Senanayake, Nalika Gunawardena, Nicholas Graves
OBJECTIVES: The aim of this study was to compare utility weights of EuroQoL-five-dimension-3 levels (EQ-5D-3L) and Short-Form six-dimension (SF-6D) in a representative cohort of patients with chronic kidney disease (CKD). A cost-utility analysis (CUA) is designed to report the change to costs required to achieve an estimated change to quality-adjusted life years (QALYs). The quality component of a QALY is measured by utility. Utility represents the preference of general population for a given health state...
February 15, 2019: BMJ Open
Kristina M Kokorelias, Sarah Munce, Kathy S McGilton, Shawna M Cronin, Chen D Wang, Parvin Eftekhar, Darren K Cheng, Shirin Vellani, Susan Jaglal, Nancy M Salbach, Pia Kontos, Tracey J F Colella, Alisa Grigorovich, Jill I Cameron
INTRODUCTION: Although a growing number of frail adults can benefit from rehabilitation services, few are included in rehabilitation services, and reasons for their exclusion are not well understood. To inform research directions in rehabilitation for all adults (aged 18 years and older), we will conduct a scoping review to describe (1) the characteristics of frail adult individuals included in rehabilitation interventions (eg, age range, inclusion and exclusion criteria that are applied), (2) the type of rehabilitation interventions that are used for individuals who are considered frail and (3) the commonly reported outcome measures used for these rehabilitation interventions...
February 15, 2019: BMJ Open
Changyu Deng, Zan Ding, Liujiu Li, Yanfang Wang, Pi Guo, Shaoyi Yang, Ju Liu, Yue Wang, Qingying Zhang
OBJECTIVE: To examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China. METHODS: Using daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature-mortality association with the assessment of attributable fraction and number...
February 15, 2019: BMJ Open
Per Andrén, Kristina Aspvall, Lorena Fernández de la Cruz, Paulina Wiktor, Sofia Romano, Erik Andersson, Tara Murphy, Kayoko Isomura, Eva Serlachius, David Mataix-Cols
OBJECTIVE: Behaviour therapy (BT) for Tourette's disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format. DESIGN: A pilot, single-blind, parallel group randomised controlled trial. SETTING: A specialist outpatient clinic in Sweden...
February 15, 2019: BMJ Open
Jessica Steffany Miranda, Luciana Patricia Fernandes Abbade, Arthur Pollo Deonizio, Joelcio Francisco Abbade, Lawrence Mbuagbaw, Lehana Thabane
Pressure ulcers (PUs) have a high incidence, especially in hospital units. Randomised clinical trials (RCTs) of therapeutic interventions for PU should include a clear description of the outcomes and results to enhance transparency and replicability. OBJECTIVES: The primary objective of this study is to assess the completeness of the descriptions of the outcomes of therapeutic interventions in RCTs in adult patients with PU. The secondary objectives are to evaluate the types of reported primary outcomes, measurement methods or tools used to evaluate the outcomes and the results of reported outcomes...
February 15, 2019: BMJ Open
Subashnie Devkaran, Patrick N O'Farrell, Samer Ellahham, Randy Arcangel
OBJECTIVE: To evaluate whether hospital re-accreditation improves quality, patient safety and reliability over three accreditation cycles by testing the accreditation life cycle model on quality measures. DESIGN: The validity of the life cycle model was tested by calibrating interrupted time series (ITS) regression equations for 27 quality measures. The change in the variation of quality over the three accreditation cycles was evaluated using the Levene's test. SETTING: A 650-bed tertiary academic hospital in Abu Dhabi, UAE...
February 15, 2019: BMJ Open
David A Carver, Andrew W Kirkpatrick, Tammy L Eberle, Chad G Ball
INTRODUCTION: Abdominal wall hernias are a common source of morbidity and mortality. The use of biological mesh has become an important adjunct in successful abdominal wall reconstruction. There are a variety of biological mesh products available; however, there is limited evidence supporting the use of one type over another. This study aims to compare the performance (eg, the rate of hernia recurrence) of either a crosslinked biological mesh product or a non-crosslinked product in patients undergoing abdominal wall reconstruction...
February 15, 2019: BMJ Open
Lesley M McGregor, Hanna Skrobanski, Mary Ritchie, Lindy Berkman, Hayley Miller, Madeleine Freeman, Nishma Patel, Stephen Morris, Colin Rees, Christian von Wagner
OBJECTIVE: To determine the feasibility of specialist screening practitioners (SSPs) offering patient navigation (PN) to facilitate uptake of bowel scope screening (BSS) among patients who do not confirm or attend their appointment. DESIGN: A single-stage phase II trial. SETTING: South Tyneside District Hospital, Tyne and Wear, England, UK. PARTICIPANTS: Individuals invited for BSS at South Tyneside District Hospital during the 6-month recruitment period were invited to participate in the study...
February 15, 2019: BMJ Open
Martin Geoffrey Thomas, Carrie Bayliss, Simon Bond, Francis Dowling, James Galea, Vipul Jairath, Christopher Lamb, Christopher Probert, Elizabeth Timperley-Preece, Alastair Watson, Lynne Whitehead, John G Williams, Miles Parkes, Arthur Kaser, Tim Raine
INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a severe manifestation of ulcerative colitis (UC) that warrants hospitalisation. Despite significant advances in therapeutic options for UC and in the medical management of steroid-refractory ASUC, the initial treatment paradigm has not changed since 1955 and is based on the use of intravenous corticosteroids. This treatment is successful in approximately 50% of patients but failure of this and subsequent medical therapy still occurs, with colectomy rates of up to 40% reported...
February 15, 2019: BMJ Open
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