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BMJ Open

Ruth Abrams, Geoffrey Wong, Kamal Ram Mahtani, Stephanie Tierney, Anne-Marie Boylan, Nia Roberts, Sophie Park
INTRODUCTION: In western countries, early visiting services (EVS) have been proposed as a recent intervention to reduce both general practitioner workload and hospital admissions among housebound individuals experiencing a healthcare need within the community. EVS involves the delegation of the patient home visits to other staff groups such as paramedics or nursing staff. However, the principles of organising this care are unknown and it remains unclear how different contexts, such as patient conditions and the processes of organising EVS influence care outcomes...
November 13, 2018: BMJ Open
Claudia Gulea, Rosita Zakeri, Jennifer K Quint
INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) who have a clinical indication for beta-blocker therapy, are often not prescribed such medication, despite evidence suggesting that beta-blockers are not associated with adverse respiratory outcomes. The primary objective of this systematic review and meta-analysis is to examine the class effect of beta-blocker use in patients with COPD. We will focus on a broad range of endpoints including, clinical, safety, and patient-centric outcomes such as health related quality of life (HRQoL) and functional capacity...
November 13, 2018: BMJ Open
Gorkem Sezgin, Andrew Georgiou, Rae-Anne Hardie, Ling Li, Lisa G Pont, Tony Badrick, Guilherme S Franco, Johanna I Westbrook, Natalie Rinehart, Adam McLeod, Christopher Pearce, Marianne Shearer, Robin Whyte, Elizabeth Deveny
INTRODUCTION: In Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice...
November 13, 2018: BMJ Open
Mete Erdogan, Nelofar Kureshi, Saleema A Karim, John M Tallon, Mark Asbridge, Robert S Green
OBJECTIVES: Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing...
November 13, 2018: BMJ Open
Sara Lena Schröder, Astrid Fink, Matthias Richter
OBJECTIVES: This qualitative study aims to analyse socioeconomic differences in patients' experiences along the treatment pathway for coronary heart disease (CHD). DESIGN: A longitudinal qualitative study using in-depth semistructured interviews to explore patients' experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives...
November 13, 2018: BMJ Open
Astrid Ledgaard Holm, Gregers Stig Andersen, Marit E Jørgensen, Finn Diderichsen
OBJECTIVE: The study aimed at analysing whether the 'Rule of Halves' framework applies for diabetes care in the Danish healthcare system with high levels of accessibility and equity. The Rule of Halves states that only one-half of people with a particular chronic condition are diagnosed; one-half of those diagnosed get treatment, and one-half of treated achieve desired therapeutic goals. DESIGN: The analysis is cross sectional based on available surveys, register data and clinical databases covering the adult population in Copenhagen...
November 13, 2018: BMJ Open
Anders Winther Voldby, Anne Albers Aaen, Ann Merete Møller, Birgitte Brandstrup
INTRODUCTION: Intravenous fluid therapy during gastrointestinal surgery is a life-saving part of the perioperative care. Too little fluid may lead to hypovolaemia, decreased organ perfusion and circulatory shock. Excessive fluid administration increases postoperative complications, worsens pulmonary and cardiac function as well as the healing of surgical wounds. Intraoperative individualised goal-directed fluid therapy (GDT) and zero-balance therapy (weight adjusted) has shown to reduce postoperative complications in elective surgery, but studies in urgent gastrointestinal surgery are sparse...
November 13, 2018: BMJ Open
Yaxin Zhu, Jie Liu, Bo Qu, Zhe Yi
OBJECTIVES: The 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. DESIGN: Cross-sectional study. SETTING: Communities in Dandong city, Liaoning province, China. PARTICIPANTS: Sample of 732 older people aged 60 and older who were living in Dandong, Liaoning province, China. METHODS: A questionnaire was administered to the participants face-to-face...
November 13, 2018: BMJ Open
Michelle Odlum, Nicole Davis, Otis Owens, Michael Preston, Russell Brewer, Danielle Black
OBJECTIVE: To understand the gender-specific factors that uniquely contribute to successful ageing in a US population of men and women, 57-85 years of age. This was achieved through the examination of the correlates of subjective well-being defined by health-related quality of life (HRQoL), across several biological and psychosocial determinants of health. DESIGN: Cross-sectional study. SETTING: The National Social Life, Health and Ageing Project (NSHAP), 2010-2011 a representative sample of the US population...
November 13, 2018: BMJ Open
Shuang-Fei Xu, Jun-Qing Wu, Yu-Yan Li, Chuan-Ning Yu, Rui Zhao, Ying Zhou, Yi-Ran Li, Jun-Guo Zhang, Meng-Hua Jin
OBJECTIVE: With the increased population mobility and the transition in population policy, scholars are quite concerned about family planning/sexual and reproductive health (SRH) and related factors among internal migrant population of reproductive age. Therefore, the proposed study was designed to explore the association between factors related to family planning/SRH and contraceptive use as well as consistent condom use among the above-described population in China. DESIGN: Cross-sectional study...
November 13, 2018: BMJ Open
Anna Holst, Annika Ginter, Cecilia Björkelund, Dominique Hange, Eva-Lisa Petersson, Irene Svenningsson, Jeanette Westman, Malin André, Carl Wikberg, Lars Wallin, Christina Möller, Mikael Svensson
OBJECTIVE: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective. DESIGN: Cost-effectiveness analysis. SETTING: 23 PCCs in two Swedish regions. PARTICIPANTS: Patients with depression (n=342). MAIN OUTCOME MEASURES: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months...
November 12, 2018: BMJ Open
Marvin A H Berrevoets, Anke J M Oerlemans, Mirjam Tromp, Bart Jan Kullberg, Jaap Ten Oever, Jeroen A Schouten, Marlies E Hulscher
OBJECTIVES: Current outpatient parenteral antimicrobial therapy (OPAT) guidelines recommend delivering patient-centred care. However, little is known about what patients define as good quality of OPAT care and what their needs and preferences are.The aim of this qualitative study is to explore the patients' perspective on high-quality care, and to explore what patient-centred care means to adult OPAT patients. DESIGN AND SETTING: This is an explorative, descriptive study using qualitative methods...
November 12, 2018: BMJ Open
Senada Hajdarevic, Birgit H Rasmussen, Trine L Overgaard Hasle, Sue Ziebland
OBJECTIVES: To compare and examine whether, when and how patients with lung cancer in three countries, with different survival rates, talk about cigarette smoking and its relationship with help-seeking. DESIGN: A qualitative cross-country comparison with analysis of narrative interviews. SETTING: Participants in Sweden, Denmark and England were interviewed during 2015-2016. Interviews, using a narrative approach, were conducted in participants' home by trained and experienced qualitative researchers...
November 12, 2018: BMJ Open
Gijs Van Pottelbergh, Pavlos Mamouris, Nele Opdeweegh, Bert Vaes, Geert Goderis, Marjan Van Den Akker
OBJECTIVES: To examine if the estimated glomerular filtration rate (eGFR) slope over a 5-year period is related to incident cardiovascular (CV) events in the following 5 years. DESIGN: Retrospective cohort study. SETTING: Primary care. PARTICIPANTS: All patients aged ≥50 years with at least four eGFR measurements between 01 January 2006 and 31 December 2010 were included in the study. OUTCOME MEASURES: During the follow-up period (01 January 2011 until 31 December 2015), CV events (acute myocardial infarction, stroke (cerebrovascular accident (CVA)/transient ischemic attack (TIA)), peripheral arterial disease and acute heart failure) were identified...
November 12, 2018: BMJ Open
Reena Devi, Julienne Meyer, Jay Banerjee, Claire Goodman, John Raymond Fletcher Gladman, Tom Dening, Neil Chadborn, Kathryn Hinsliff-Smith, Annabelle Long, Adeela Usman, Gemma Housley, Clive Bowman, Finbarr Martin, Phillipa Logan, Sarah Lewis, Adam Lee Gordon
INTRODUCTION: This protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation...
November 12, 2018: BMJ Open
Doreen Busingye, Monique F Kilkenny, Tara Purvis, Joosup Kim, Sandy Middleton, Bruce C V Campbell, Dominique A Cadilhac
OBJECTIVE: Spending at least 90% of hospital admission in a stroke unit (SU) is a recommended indicator of receiving high-quality stroke care. However, whether this makes a difference to patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in an SU, compared with those having less time in the SU. DESIGN: Observational study using cross-sectional data. SETTING: Data from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU...
November 12, 2018: BMJ Open
Stanley Kam Chung Chan, Dexing Zhang, Susan M Bögels, Christian Shaunlyn Chan, Kelly Yee Ching Lai, Herman Hay Ming Lo, Benjamin Hon Kei Yip, Elsa Ngar Sze Lau, Tiffany Ting Gao, Samuel Yeung Shan Wong
INTRODUCTION: Mindfulness is one of the potential alternative interventions for children with attention-deficit hyperactivity disorder (ADHD). Some evidence suggests that mindfulness is related to changes in brain regions associated with ADHD. The potential benefits of mindfulness on children with ADHD, as well as the feasibility of this intervention approach, are warranted through prior local and foreign studies. This study aims to evaluate the effect of mindfulness-based group intervention for children with ADHD and their respective parents through a robust research design...
November 12, 2018: BMJ Open
Jemima Scott, Amanda Owen-Smith, Sarah Tonkin-Crine, Hugh Rayner, Paul Roderick, Ikumi Okamoto, Geraldine Leydon, Fergus Caskey, Shona Methven
OBJECTIVE: To explore dialysis decision-making for adults who lack capacity due to cognitive impairment, a common and under-recognised condition in those with advanced chronic kidney disease (CKD). DESIGN: Secondary analysis of qualitative data collected during the Conservative Kidney Management Assessment of Practice Patterns Study programme of research was performed. Sixty semistructured interviews were conducted with multiprofessional team members from UK renal centres...
November 12, 2018: BMJ Open
Daniel Penn-Newman, Sarah Shaw, Donna Congalton, Sofia Strommer, Taylor Morris, Wendy Lawrence, Debbie Chase, Cyrus Cooper, Mary Barker, Janis Baird, Hazel Inskip, Christina Vogel
OBJECTIVES: (1) To identify national policies for England and local policies for Southampton City that are relevant to maternal and child health. (2) To quantify the extent to which these policies meet the international standards for nutrition and physical activity initiatives set out in the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases (WHO Action Plan). DESIGN: The policy appraisal process involved three steps: (1) identifying policy documents relevant to maternal and infant health, (2) developing a policy appraisal framework from the WHO Action Plan, and (3) analysing the policies using the framework...
November 12, 2018: BMJ Open
Lina Li, Chenwen Zhong, Jie Mei, Yuan Liang, Li Li, Li Kuang
OBJECTIVE: Current healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care. DESIGN: A cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP...
November 12, 2018: BMJ Open
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