BMJ Open

INTRODUCTION: The decisions of withholding or withdrawing life-sustaining treatments are difficult to make in the context of emergency departments (EDs) because most patients are unable to communicate. Relatives are thus asked to participate in the decision-making process, although they are unprepared to face such situations. We therefore aimed to develop a standardised intervention for announcing decisions of withholding or withdrawing life-sustaining treatments in EDs and assess the efficacy of the intervention on the stress of relatives...

OBJECTIVE: To measure the 1 year cumulative incidence of and analyse the risk factors associated with workplace violence directed towards the ambulance service in a Swedish region. DESIGN: Prospective cohort study. SETTING: The ambulance services in Örebro County Council (Sweden) contain approximately 300 000 inhabitants. PARTICIPANTS: All ambulance missions during the period of 12 months (n=28 640) were assessed...

OBJECTIVES: The purpose of this study was to describe the experiences and actions of part-time firefighters' family members in rural areas in Sweden. DESIGN: The study had an inductive descriptive design and used the critical incident technique. SETTING: Rural areas, primarily served by a part-time fire station, across Sweden. PARTICIPANTS: The study included 25 participants (21 females and 4 males) with experiences of being a family member of a part-time firefighter...

OBJECTIVE: This study aimed to assess nurses' perceptions of patient safety culture (PSC) and its relationship with adverse events in Hail City, Saudi Arabia. DESIGN: A cross-sectional study was conducted between 1 August 2023 and the end of November 2023 at 4 governmental hospitals and 28 primary healthcare centres. SETTING: Hail City, Saudi Arabia. PARTICIPANTS: Data were collected from 336 nurses using 3 instruments: demographic and work-related questions, PSC and adverse events...

OBJECTIVE: To understand the current status of occupational stress, occupational burn-out and sleep quality among ambulance drivers in Hengyang, China and to analyse the relationship between occupational stress, occupational burn-out and sleep quality of ambulance drivers. DESIGN: A cross-sectional study. SETTING: Prehospital emergency centre of third-class hospital in Hengyang, China. PARTICIPANTS: From October 2023 to December 2023, a cross-sectional survey was conducted, with 213 ambulance drivers from Hengyang, China, selected as participants...

OBJECTIVES: This study aimed to compare demographic and surgical characteristics between patients who do and do not achieve minimal important change (MIC) in the Knee injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation (Sport/Rec) and Quality of Life (QoL) subscales 1 year after anterior cruciate ligament reconstruction. DESIGN: Comparative cross-sectional. SETTING: The MIC for the KOOS Sport/Rec subscale was ≥12.1 and ≥18...

INTRODUCTION: Missed fractures are the most frequent diagnostic error attributed to clinicians in UK emergency departments and a significant cause of patient morbidity. Recently, advances in computer vision have led to artificial intelligence (AI)-enhanced model developments, which can support clinicians in the detection of fractures. Previous research has shown these models to have promising effects on diagnostic performance, but their impact on the diagnostic accuracy of clinicians in the National Health Service (NHS) setting has not yet been fully evaluated...

INTRODUCTION: In the USA, up to 95% of individuals harbouring cancer-predisposing germline pathogenic variants have not been identified despite recommendations for screening at the primary care level. METHODS AND ANALYSIS: Our primary objective is to use a two-arm, single-institution randomised controlled trial to compare the proportion of eligible patients that are recommended genetic testing for hereditary cancer syndromes using a digital tool versus clinician interview for genetic cancer risk assessment in an urban academic gynaecology clinic...

BACKGROUND: Assessing multidisciplinary prehabilitation strategies becomes crucial to pre-emptively counter the physical, psychological and social negative impacts experienced during an allogenic haematopoietic stem cell transplant (allo-HSCT) among acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients. Current evidence is restricted to studies during induction chemotherapy, omitting rehabilitation interventions and predominantly using exercise-only approaches without a multidisciplinary framework...

OBJECTIVES: To explore the acceptability and feasibility of detection of atrial fibrillation (AF) by emergency medical services (EMS) and identify potential barriers and facilitators to implementing a formal pathway to facilitate follow-up in primary care, which could reduce the risk of AF-related stroke. DESIGN: Qualitative study using focus groups and one-to-one interviews guided by a semistructured topic guide. SETTING: North East England...

INTRODUCTION: Hypertension is a major cause of premature death worldwide as it is an important risk factor for coronary artery disease, myocardial infarction, heart failure and stroke. Although an estimated 1.3 billion adults suffer from hypertension, less than half of them are diagnosed correctly and therefore receive sufficient treatment. Furthermore, only one fifth of those treated reach the therapy target of normotension. This significant deficit underlines the need for new therapy concepts to improve long-term health outcomes...

OBJECTIVES: Despite global research on early detection of age-related macular degeneration (AMD), not enough is being done for large-scale screening. Automated analysis of retinal images captured via smartphone presents a potential solution; however, to our knowledge, such an artificial intelligence (AI) system has not been evaluated. The study aimed to assess the performance of an AI algorithm in detecting referable AMD on images captured on a portable fundus camera. DESIGN, SETTING: A retrospective image database from the Age-Related Eye Disease Study (AREDS) and target device was used...

OBJECTIVE: WHO recommends the use of the Robson's 'Ten Groups Classification' for monitoring and assessing caesarean section (CS) rates. The aim of this study was to investigate the rates, indications and outcomes of CS using Robson classification in a tertiary hospital in Sierra Leone. DESIGN: Cross-sectional study. SETTING: Princess Christian Maternity Hospital (PCMH), Freetown, Sierra Leone. PARTICIPANTS: All women who gave birth in PCMH from 1 October 2020 to 31 January 2021...

OBJECTIVES: To investigate the relationship among patients' apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS). DESIGN: A cross-sectional study design was used. SETTING: The study was conducted at a tertiary hospital in Wuhan, Hubei, China. PARTICIPANTS: A total of 109 patients with ALS and their caregivers were included. OUTCOME MEASURES: Patients with ALS were screened using the Edinburgh Cognitive and Behavioural Screen, Beck Depression Inventory-II, Generalised Anxiety Disorder-7 and Apathy Scale to assess their cognition, depression, anxiety and apathy, respectively...

Online healthcare information has the potential to improve health outcomes via the widespread, cost-effective translation of research evidence into practice by healthcare professionals and use by consumers. However, comparatively little is known about how healthcare professionals and consumers engage with healthcare websites, or whether the knowledge that is made available through digital platforms is translated into better health outcomes. To realise the potential of such resources, we argue that an evidence-based framework-grounded in a nuanced understanding of how audiences engage with and use information provided by healthcare websites-is needed...

OBJECTIVE: The chronic pain syndromes (CPS) include syndromes such as chronic widespread pain (CWP), dry eye disease (DED) and irritable bowel syndrome (IBS). Highly prevalent and lacking pathognomonic biomarkers, the CPS are known to cluster in individuals in part due to their genetic overlap, but patient diagnosis can be difficult. The success of quantitative sensory testing (QST) and inflammatory biomarkers as phenotyping tools in conditions such as painful neuropathies warrant their investigation in CPS...

OBJECTIVE: The objective is to evaluate the diagnostic effectiveness of contrast-enhanced spectral mammography (CESM) in the diagnosis of breast cancer. DESIGN: DATA SOURCES: PubMed, Embase and Cochrane libraries up to 18 June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included trials studies, compared the results of different researchers on CESM in the diagnosis of breast cancer, and calculated the diagnostic value of CESM for breast cancer...

OBJECTIVES: We aimed to explore the lived experiences and needs of women after a recent stillbirth event. DESIGN: Qualitative phenomenological study. SETTING: The current study was conducted in a tertiary obstetric hospital in East China between 25 January 2024 and 29 March 2024. PARTICIPANTS: 14 women having experienced a stillbirth within the last 6 months. RESULTS: Researchers agreed on four key themes including individual variations in emotional reaction and recovery, physical recovery and concerns about future pregnancies, the critical role of social support systems and variations in perceptions of stillbirth as the death of a fetus versus a human being, along with related mourning rituals...

INTRODUCTION: Genetic testing is used across medical disciplines leading to unprecedented demand for genetic services. This has resulted in excessive waitlists and unsustainable pressure on the standard model of genetic healthcare. Alternative models are needed; e-health tools represent scalable and evidence-based solution. We aim to evaluate the effectiveness of the Genetics Navigator, an interactive patient-centred digital platform that supports the collection of medical and family history, provision of pregenetic and postgenetic counselling and return of genetic testing results across paediatric and adult settings...

OBJECTIVE: To describe trends in the organisational structure, workforce and recorded appointments by role in English general practice. DESIGN: Retrospective longitudinal study. SETTING: English general practice. DATA SOURCES AND PARTICIPANTS: NHS England, Office for Health Improvement and Disparities and Care Quality Commission national administrative datasets covering between 5 to 10 years from 2013 to 2023. RESULTS: Between 2013 and 2023, the number of general practices fell by 20% from 8044 to 6419; the average practice list size increase by 40% from 6967 to 9724 patients...