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BMJ Open

Claire Duddy, Geoffrey Wong
INTRODUCTION: Studies have demonstrated the existence of significant variation in test-ordering patterns in both primary and secondary care, for a wide variety of tests and across many health systems. Inconsistent practice could be explained by differing degrees of underuse and overuse of tests for diagnosis or monitoring. Underuse of appropriate tests may result in delayed or missed diagnoses; overuse may be an early step that can trigger a cascade of unnecessary intervention, as well as being a source of harm in itself...
September 12, 2018: BMJ Open
Deogratius Bintabara, Keiko Nakamura, Kaoruko Seino
OBJECTIVE: This study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country. DESIGN: Population-based cross-sectional survey. SETTING: Nationwide representative data for women of reproductive age obtained from the 2015-2016 Tanzania Demographic and Health Survey were analysed. PRIMARY OUTCOME MEASURES: A composite variable, 'problems in accessing healthcare', with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone...
September 12, 2018: BMJ Open
Tasnim Hasan, Eric Au, Sharon Chen, Allison Tong, Germaine Wong
OBJECTIVE: Immunosuppressed individuals are at a high risk of latent tuberculosis infection (LTBI) and clinical practice guidelines for the screening and management of LTBI in at-risk patients have been developed. We assessed the scope, quality and consistency of clinical practice guidelines on screening for LTBI and the prevention of tuberculosis infection (TB) in high-risk patient populations. DESIGN: We conducted a systematic review of clinical practice guidelines...
September 12, 2018: BMJ Open
Qingtao Zhou, Meng Wang, Shuo Li, Jing Zhang, Qingbian Ma, Yanling Ding, Hongxia Ge, Ning Shen, Yaan Zheng, Yongchang Sun
OBJECTIVE: To evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis. DESIGN: A single-centre prospective cohort study conducted from May 2015 to April 2017. SETTING: A tertiary care university hospital in China. PARTICIPANTS: A total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included. MAIN OUTCOME MEASURES: The primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay...
September 12, 2018: BMJ Open
Rishi Mandavia, Alec Knight, Alexander W Carter, Connor Toal, Elias Mossialos, Peter Littlejohns, Anne Gm Schilder
OBJECTIVES: Hearing loss is an area of unmet need, and industry is targeting this field with a growing range of surgically implanted hearing devices. Currently, there is no comprehensive UK registry capturing data on these devices; in its absence, it is difficult to monitor clinical and cost-effectiveness and develop national policy. Recognising that developing such a registry faces considerable challenges, it is important to gather opinions from stakeholders and patients. This paper builds on our systematic review on surgical registry development and aims to identify the specific requirements for developing a successful national registry of auditory implants...
September 12, 2018: BMJ Open
Laura Thaeter, Hanna Schröder, Lina Henze, Jennifer Butte, Patrick Henn, Rolf Rossaint, Saša Sopka
OBJECTIVE: The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students' awareness, confidence and knowledge regarding handover. DESIGN: A controlled educational research study. SETTING: The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital...
September 12, 2018: BMJ Open
Musheer Abdulwahid Aljaberi, Muhamad Hanafiah Juni, Rasheed Addulsalam Al-Maqtari, Munn Sann Lye, Murad Abdu Saeed, Sami Abdo Radman Al-Dubai, Hayati Kadir Shahar
OBJECTIVE: The current study aimed to investigate the relationships among the perceived quality of healthcare services, satisfaction and behavioural intentions among international students in Kuala Lumpur, Malaysia. SETTING: A cross-sectional study on public universities in Kuala Lumpur, Malaysia. PARTICIPANTS: All participants in this study were international students joining public universities in Kuala Lumpur, Malaysia. PRIMARY INDEPENDENT VARIABLE: Perceived quality of healthcare services measured on a SERVQUAL scale...
September 12, 2018: BMJ Open
Antony J Mersiades, Annette Tognela, Paul S Haber, Martin Stockler, Nicholas Lintzeris, John Simes, Iain McGregor, Ian Olver, David J Allsop, Craig Gedye, Adrienne C Kirby, Rachael L Morton, Peter Fox, Stephen Clarke, Karen Briscoe, Morteza Aghmesheh, Nicole Wong, Anna Walsh, Carmel Hahn, Peter Grimison
INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) remains an important issue for patients receiving chemotherapy despite guideline-consistent antiemetic therapy. Trials using delta-9-tetrahydrocannabinol-rich (THC) products demonstrate limited antiemetic effect, significant adverse events and flawed study design. Trials using cannabidiol-rich (CBD) products demonstrate improved efficacy and psychological adverse event profile. No definitive trials have been conducted to support the use of cannabinoids for this indication, nor has the potential economic impact of incorporating such regimens into the Australian healthcare system been established...
September 12, 2018: BMJ Open
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September 11, 2018: BMJ Open
Oliver Rudolf Herber, Louise Atkins, Stefan Störk, Stefan Wilm
INTRODUCTION: Although international guidelines recommend self-care as an integral part of routine heart failure management, and despite evidence supporting the positive outcomes related to self-care, patients are frequently unable to adhere. Self-care can be modified through behaviour change interventions (BCIs). However, previous self-care interventions have shown limited success in improving adherence to self-care, because they were neither theory-based nor well defined, which precludes the identification of underlying causal mechanisms as well as reproducibility of the intervention...
September 11, 2018: BMJ Open
Long Sun, Jie Zhang, Dorian A Lamis
OBJECTIVE: Previous studies have implied that there were many Chinese suicide attempters who did not want to die by suicide. In the current study, we explored the factors which were associated with low levels of suicide intent. We also examined features for medically serious suicide attempters who do not have a strong intent to die in rural china. DESIGN: Cross-sectional study. SETTING: The interviews occurred between May 2012 and July 2013 in 13 rural counties in Shandong and Hunan provinces, China...
September 11, 2018: BMJ Open
Shinichiro Yamada, Atsushi Hashizume, Yasuhiro Hijikata, Tomonori Inagaki, Daisuke Ito, Fumie Kinoshita, Masahiro Nakatochi, Yumiko Kobayashi, Akihiro Hirakawa, Tomohiko Nakamura, Masahisa Katsuno
INTRODUCTION: Spinal and bulbar muscular atrophy (SBMA) is a slowly progressive neuromuscular disease. Cold exposure often leads to worsening of motor symptoms including paresis. Although mexiletine hydrochloride administration has been shown to be effective for the treatment of several muscular diseases, its effectiveness in SBMA has not been validated to date. The trial will test it as a symptomatic drug for cold paresis. This study is the first trial to evaluate the efficacy and safety of mexiletine hydrochloride administration in patients with SBMA...
September 11, 2018: BMJ Open
Lawrence Mbuagbaw, Dominik Mertz, Daeria O Lawson, Marek Smieja, Anita C Benoit, Elizabeth Alvarez, Lisa Puchalski Ritchie, Beth Rachlis, Carmen Logie, Winston Husbands, Shari Margolese, Lehana Thabane
INTRODUCTION: While access to antiretroviral therapy (ART) for people living with HIV has expanded in recent years, additional efforts are required to support adherence to medication and retention in care. Interventions should be applicable in real-world settings and amenable to widespread use. The objectives of this overview are to identify effective pragmatic interventions that increase adherence to ART and retention in care for people living with HIV at high risk for suboptimal adherence and retention in high-income countries...
September 11, 2018: BMJ Open
Iain M Carey, H Ross Anderson, Richard W Atkinson, Sean D Beevers, Derek G Cook, David P Strachan, David Dajnak, John Gulliver, Frank J Kelly
OBJECTIVE: To investigate whether the incidence of dementia is related to residential levels of air and noise pollution in London. DESIGN: Retrospective cohort study using primary care data. SETTING: 75 Greater London practices. PARTICIPANTS: 130 978 adults aged 50-79 years registered with their general practices on 1 January 2005, with no recorded history of dementia or care home residence. PRIMARY AND SECONDARY OUTCOME MEASURES: A first recorded diagnosis of dementia and, where specified, subgroups of Alzheimer's disease and vascular dementia during 2005-2013...
September 11, 2018: BMJ Open
Ettore Silvagni, Alessandra Bortoluzzi, Greta Carrara, Anna Zanetti, Marcello Govoni, Carlo Alberto Scirè
OBJECTIVE: These analyses aim to comparatively evaluate the persistence on treatment of different biological disease-modifying antirheumatic drugs (bDMARDs) when administered in monotherapy compared with combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in rheumatoid arthritis (RA) patients receiving first-line biologics. DESIGN: This is a retrospective observational study on Administrative Healthcare Databases. METHODS: Data were extracted from healthcare databases of the Lombardy Region, Italy (2004-2013), as a part of the RECord-linkage On Rheumatic Diseases study, on behalf of the Italian Society for Rheumatology...
September 11, 2018: BMJ Open
Alicja Beksinska, Ravi Prakash, Shajy Isac, H L Mohan, Lucy Platt, James Blanchard, Stephen Moses, Tara S Beattie
OBJECTIVES: Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence. METHODS: An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011...
September 11, 2018: BMJ Open
Young Ho Yun, Kyoung-Nam Kim, Jin-Ah Sim, Shin Hye Yoo, Miso Kim, Young Ae Kim, Beo Deul Kang, Hyun-Jeong Shim, Eun-Kee Song, Jung Hun Kang, Jung Hye Kwon, Jung Lim Lee, Eun Mi Nam, Chi Hoon Maeng, Eun Joo Kang, Young Rok Do, Yoon Seok Choi, Kyung Hae Jung
OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association...
September 11, 2018: BMJ Open
Wei-Chang Huang, Ching-Hsiao Lee, Ming-Feng Wu, Chen-Cheng Huang, Cheng-Hui Hsu, Hui-Chen Chen, Jeng-Yuan Hsu, Chieh-Chen Huang
OBJECTIVES: The clinical implications of blood eosinophil level in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission are still unknown. Thus, this study aimed to compare the features of such patients with and without blood eosinophilia. DESIGN: This was a retrospective case-control study. SETTING: An ICU of a medical centre in central Taiwan...
September 11, 2018: BMJ Open
Inge M Krul, Annemieke W J Opstal-van Winden, Josée M Zijlstra, Yolande Appelman, Sanne B Schagen, Lilian J Meijboom, Erik Serné, Cornelis B Lambalk, Paul Lips, Eline van Dulmen-den Broeder, Michael Hauptmann, Laurien A Daniëls, Berthe M P Aleman, Flora E van Leeuwen
INTRODUCTION: Hodgkin's lymphoma (HL) has become the prototype of a curable disease. However, many young survivors suffer from late adverse effects of treatment. Both chemotherapy (CT) and radiotherapy (RT) may induce primary ovarian insufficiency (POI), which has been associated with reduced bone mineral density (BMD), neurocognitive dysfunction and possibly cardiovascular disease (CVD). While the general assumption is that POI increases CVD risk, other hypotheses postulate reverse causality, suggesting that cardiovascular risk factors determine menopausal age or that biological ageing underlies both POI and CVD risk...
September 11, 2018: BMJ Open
Adam Todd, Nasima Akhter, Joanne-Marie Cairns, Adetayo Kasim, Nick Walton, Amanda Ellison, Paul Chazot, Sam Eldabe, Clare Bambra
OBJECTIVES: Our central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders. DESIGN: Cross-sectional study design using data from the Health Survey for England 2011...
September 11, 2018: BMJ Open
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