Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials
Conclusions Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance. (Source: BMJ Open)
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Ahmed, H., Davies, F., Francis, N., Farewell, D., Butler, C., Paranjothy, S. Tags: Open access, Infectious diseases Research Source Type: research

A cross-sectional study on prevalence of chronic obstructive pulmonary disease (COPD) in India: rationale and methods
This study protocol is designed to address this knowledge gap and eventually to build a database to undertake long-term cohort studies to describe the phenotypic and genotypic heterogeneity among COPD patients in India. Objectives The primary objective is to estimate the prevalence of COPD among adults aged ≥25 years for each gender in India. The secondary objective is to identify the risk factors for COPD and important comorbid conditions such as asthma and post-tuberculosis sequelae. It is also proposed to validate the currently available definitions for COPD diagnosis in India. Methods and analysis A cross-sectiona...
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Rajkumar, P., Pattabi, K., Vadivoo, S., Bhome, A., Brashier, B., Bhattacharya, P., Mehendale, S. M. Tags: Open access, Respiratory medicine Protocol Source Type: research

Trends in alcohol-related injury admissions in adolescents in Western Australia and England: population-based cohort study
Conclusion Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in WA. Declining trends in England suggest that this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and on-going monitoring is required to assess the effectiveness of strategies. (Source: BMJ Open)
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: ODonnell, M., Sims, S., Maclean, M. J., Gonzalez-Izquierdo, A., Gilbert, R., Stanley, F. J. Tags: Open access, Public health Research Source Type: research

Relationship between dietary factors and the number of altered metabolic syndrome components in Chinese adults: a cross-sectional study using data from the China Health and Nutrition Survey
Conclusions Some foods and nutritional factors correlate with an increased number of altered MetS components in Chinese adults. More prospective, multicentre and clinical research work to further examine these associations is underway. (Source: BMJ Open)
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Cheng, M., Wang, H., Wang, Z., Du, W., Ouyang, Y., Zhang, B. Tags: Open access, Public health Research Source Type: research

Selection by a panel of clinicians and family representatives of important early morbidities associated with paediatric cardiac surgery suitable for routine monitoring using the nominal group technique and a robust voting process
Conclusion The inclusion of patient and family perspectives in identifying metrics for use in monitoring a specialised clinical service is challenging but feasible and can broaden notions of quality and how to measure it. (Source: BMJ Open)
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Pagel, C., Brown, K. L., McLeod, I., Jepps, H., Wray, J., Chigaru, L., McLean, A., Treasure, T., Tsang, V., Utley, M. Tags: Open access, Surgery Research Source Type: research

Physical activity, immune function and inflammation in kidney patients (the PINK study): a feasibility trial protocol
Introduction Patients with chronic kidney disease (CKD) display increased infection-related mortality and elevated cardiovascular risk only partly attributed to traditional risk factors. Patients with CKD also exhibit a pro-inflammatory environment and impaired immune function. Aerobic exercise has the potential to positively impact these detriments, but is under-researched in this patient population. This feasibility study will investigate the effects of acute aerobic exercise on inflammation and immune function in patients with CKD to inform the design of larger studies intended to ultimately influence current exercise r...
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Highton, P. J., Neale, J., Wilkinson, T. J., Bishop, N. C., Smith, A. C. Tags: Open access, Immunology (including allergy) Protocol Source Type: research

Validation of asthma recording in electronic health records: protocol for a systematic review
This study is a synthesis of previously published studies and, therefore, no ethical approval is required. The results will be submitted to a peer-reviewed journal for publication. Results from this systematic review can be used to study outcome research on asthma and can be used to identify case definitions for asthma. PROSPERO registration number CRD42016041798. (Source: BMJ Open)
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Nissen, F., Quint, J. K., Wilkinson, S., Mullerova, H., Smeeth, L., Douglas, I. J. Tags: Open access, Epidemiology Protocol Source Type: research

Optimisation and validation of a remote monitoring system (Onco-TreC) for home-based management of oral anticancer therapies: an Italian multicentre feasibility study
Introduction Despite the growing number of oral agents available for cancer treatment, their efficacy may be reduced due to the lack of adherence, inappropriate adverse event self-management and arbitrary dose adjustment. The management of anticancer therapies could exponentially benefit from the introduction of mobile health technologies in a highly integrated electronic oncology system. Methods and analysis We plan to customise and fine-tune an existing monitoring TreC platform used in different chronic diseases in the oncology setting. This project follows a multistep approach with two major purposes: 1. participatory ...
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Passardi, A., Rizzo, M., Maines, F., Tondini, C., Zambelli, A., Vespignani, R., Andreis, D., Massa, I., Dianti, M., Forti, S., Piras, E. M., Eccher, C. Tags: Open access, Oncology Protocol Source Type: research

Bone mineral density reference standards for Chinese children aged 3-18: cross-sectional results of the 2013-2015 China Child and Adolescent Cardiovascular Health (CCACH) Study
Conclusions This is the first study to present a sex-specific reference dataset for Chinese children aged 3–18 years. The data can help clinicians improve interpretation, assessment and monitoring of densitometry results. (Source: BMJ Open)
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Liu, J., Wang, L., Sun, J., Liu, G., Yan, W., Xi, B., Xiong, F., Ding, W., Huang, G., Heymsfield, S., Mi, J. Tags: Open access, Epidemiology Research Source Type: research

Navigating high-risk surgery: protocol for a multisite, stepped wedge, cluster-randomised trial of a question prompt list intervention to empower older adults to ask questions that inform treatment decisions
This article describes the protocol for a multisite, cluster-randomised trial that uses a stepped wedge design to test a patient-driven question prompt list (QPL) intervention aimed to improve preoperative decision making and inform postoperative expectations. Methods and analysis This Patient-Centered Outcomes Research Institute-funded trial will be conducted at five academic medical centres in the USA. Study participants include surgeons who routinely perform vascular or oncological surgery, their patients and families. We aim to enrol 40 surgeons and 480 patients over 24 months. Patients age 65 or older who see a study...
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Taylor, L. J., Rathouz, P. J., Berlin, A., Brasel, K. J., Mosenthal, A. C., Finlayson, E., Cooper, Z., Steffens, N. M., Jacobson, N., Buffington, A., Tucholka, J. L., Zhao, Q., Schwarze, M. L. Tags: Open access, Surgery Protocol Source Type: research

The association between human herpesvirus infections and stroke: a systematic review protocol
Introduction After primary infection, human herpesviruses establish latency and persist lifelong. Periodic virus reactivation can lead to serious inflammatory complications. Recent research suggests that herpesvirus reactivation may also be linked to acute stroke. An improved understanding of this relationship is vital to inform public health prevention strategies. We will review the evidence regarding the role of human herpesviruses in triggering stroke. Methods and analysis A systematic literature review of published and grey literature studies with a human herpesvirus (infection or reactivation) as an exposure and stro...
Source: BMJ Open - May 29, 2017 Category: General Medicine Authors: Forbes, H. J., Benjamin, L., Breuer, J., Brown, M. M., Langan, S. M., Minassian, C., Smeeth, L., Thomas, S. L., Warren-Gash, C. Tags: Open access, Epidemiology Protocol Source Type: research

Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study
Conclusions Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations. Registration Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR). (Source: BMJ Open)
Source: BMJ Open - May 28, 2017 Category: General Medicine Authors: Lee, K. Y., Ong, T. K., Low, E. V., Liow, S. Y., Anchah, L., Hamzah, S., Liew, H. B., Ali, R. M., Ismail, O., Ahmad, W. A. W., Said, M. A., Dahlui, M. Tags: Open access, Health economics Research Source Type: research

Simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE): protocol for a randomised evaluation
Introduction African countries are rapidly adopting guidelines to offer antiretroviral therapy (ART) to all HIV-infected individuals, regardless of CD4 count. For this policy of ‘treat all’ to succeed, millions of new patients must be initiated on ART as efficiently as possible. Studies have documented high losses of treatment-eligible patients from care before they receive their first dose of antiretrovirals (ARVs), due in part to a cumbersome, resource-intensive process for treatment initiation, requiring multiple clinic visits over a several-week period. Methods and analysis The Simplified Algorithm for Tre...
Source: BMJ Open - May 28, 2017 Category: General Medicine Authors: Rosen, S., Fox, M. P., Larson, B. A., Brennan, A. T., Maskew, M., Tsikhutsu, I., Bii, M., Ehrenkranz, P. D., Venter, W. F. Tags: Open access, HIV AIDS Protocol Source Type: research

Chest pain and shortness of breath in cardiovascular disease: a prospective cohort study in UK primary care
Conclusions Potentially modifiable characteristics are associated with the experience of chest pain and SoB. Identified symptom trajectories may facilitate tailored care to improve outcomes in patients with CVD. (Source: BMJ Open)
Source: BMJ Open - May 25, 2017 Category: General Medicine Authors: Barnett, L. A., Prior, J. A., Kadam, U. T., Jordan, K. P. Tags: Open access, Cardiovascular medicine Research Source Type: research

The SUPER study: protocol for a randomised controlled trial comparing follicle-stimulating hormone and clomiphene citrate for ovarian stimulation in intrauterine insemination
Objective To study the effectiveness of four cycles of intrauterine insemination (IUI) with ovarian stimulation (OS) by follicle-stimulating hormone (FSH) or by clomiphene citrate (CC), and adherence to strict cancellation criteria. Setting Randomised controlled trial among 22 secondary and tertiary fertility clinics in the Netherlands. Participants 732 women from couples diagnosed with unexplained or mild male subfertility and an unfavourable prognosis according to the model of Hunault of natural conception. Interventions Four cycles of IUI–OS within a time horizon of 6 months comparing FSH 75 IU with CC 100 mg. ...
Source: BMJ Open - May 25, 2017 Category: General Medicine Authors: Danhof, N., van Wely, M., Koks, C., Gianotten, J., de Bruin, J., Cohlen, B., van der Ham, D., Klijn, N., van Hooff, M., Broekmans, F., Fleischer, K., Janssen, C., Rijn van Weert, J., van Disseldorp, J., Twisk, M., Traas, M., Verberg, M., Pelinck, M., Viss Tags: Open access, Reproductive medicine Protocol Source Type: research

Longitudinal assessment of brain-derived neurotrophic factor in Sardinian psychotic patients (LABSP): a protocol for a prospective observational study
This study protocol was approved by the University of Cagliari Health Agency Ethics Committee (NP2016/5491). The study will be conducted in accordance with the principles of good clinical practice, in the Declaration of Helsinki in compliance with the regulations. Participation will be voluntary and written informed consent will be obtained for each participant upon entry into the study. We plan to disseminate the results of our study through conference presentations and publication in international peer-reviewed journals. Access to raw data will be available in anonymised form upon request to the corresponding author. (Source: BMJ Open)
Source: BMJ Open - May 25, 2017 Category: General Medicine Authors: Primavera, D., Manchia, M., Deriu, L., Tusconi, M., Collu, R., Scherma, M., Fadda, P., Fratta, W., Carpiniello, B. Tags: Open access, Mental health Protocol Source Type: research

Effects of continuous positive airway pressure on neurocognitive architecture and function in patients with obstructive sleep apnoea: study protocol for a multicentre randomised controlled trial
This study will be a multicentre, randomised, controlled trial with allocation concealment and assessor blinding. A total of 148 eligible patients with moderate to severe OSA will be enrolled from five sleep centres and randomised to receive CPAP with best supportive care (BSC) intervention or BSC intervention alone. Cognitive function, structure and function of brain regions, gut microbiota, metabolites, biochemical variables, electrocardiography, echocardiography, pulmonary function and arterial stiffness will be assessed at baseline before randomisation and at 3, 6 and 12 months. Ethics and dissemination This study has...
Source: BMJ Open - May 25, 2017 Category: General Medicine Authors: Xu, H., Wang, H., Guan, J., Yi, H., Qian, Y., Zou, J., Xia, Y., Fu, Y., Li, X., Jiao, X., Huang, H., Dong, P., Yu, Z., Yang, J., Xiang, M., Li, J., Chen, Y., Wang, P., Sun, Y., Li, Y., Zheng, X., Jia, W., Yin, S. Tags: Open access, Ear, nose and throat/otolaryngology Protocol Source Type: research

Translation, adaptation and validation of two versions of the Chronic Liver Disease Questionnaire in Malaysian patients for speakers of both English and Malay languages: a cross-sectional study
Objective We aimed to adapt, translate and validate the Chronic Liver Disease Questionnaire (CLDQ) in Malaysian patients with chronic liver diseases of various aetiologies. Setting Tertiary level teaching institution in Malaysia. Participants The validation process involved 211 adult patients (English language n=101, Malay language n=110) with chronic liver disease. Characteristics of the study subjects were as follows: mean (SD) age was 56 (12.8) years, 58.3% were male and 41.7% female. The inclusion criteria were patients 18 years or older with chronic hepatitis and/or liver cirrhosis of any aetiology. The exclusion cr...
Source: BMJ Open - May 25, 2017 Category: General Medicine Authors: Khairullah, S., Mahadeva, S. Tags: Open access, Gastroenterology and hepatology Research Source Type: research

Measuring ability to assess claims about treatment effects: a latent trait analysis of items from the 'Claim Evaluation Tools database using Rasch modelling
Conclusion Most of the items conformed well to the Rasch model’s expectations. Following revision of some items, we concluded that most of the items were suitable for use in an outcome measure for evaluating the ability of children or adults to assess treatment claims. (Source: BMJ Open)
Source: BMJ Open - May 25, 2017 Category: General Medicine Authors: Austvoll-Dahlgren, A., Guttersrud, O., Nsangi, A., Semakula, D., Oxman, A. D., on behalf of the IHC Group Tags: Open access, Patient-centred medicine Research Source Type: research

38 A 5 year comparison of public recognition and willingness to perform bystander CPR in a metropolitan city
Aim Bystander cardiopulmonary resuscitation (CPR) plays an important role in improving survival rate of sudden cardiac arrest patients. Various measures can be implemented to achieve better outcome in bystander CPR. We aimed to compare CPR willingness, public CPR recognition, and CPR education between a 5 year interval. Nationwide and regional public interventions involving public education, research, and automated defibrillator (AED) installation were made during the period. Methods Two surveys separated with a 5 year gap were done using structured questionnaires, targeting a total of 2141 citizens in a single metropolit...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Moon, S., Ryoo, H., Lee, D., Kim, J., Ryu, H. Source Type: research

37 Emergency medical dispatchers perception of barriers in handling emergency calls. a qualitative study
Conclusion The results indicate factors influencing the medical dispatch process, as perceived by medical dispatchers. Callers lack knowledge about best utilisation of the emergency number and the medical dispatching process, which can be improved by public awareness campaigns and incorporation of knowledge in first aid courses. For medical dispatchers the most potent modifiable factors were based upon the continuous professional development of the medical dispatchers and the system that supports them. Conflict of interest None declared. Funding EMS, Copenhagen receives centre support from the Laerdal Foundation for Acut...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Moller, T., Jensen, H. G., Viereck, S., Lippert, F., Ostergaard, D. Source Type: research

36 Not transporting all paediatric out-of-hospital setting patients by ambulance seems to be safe
Conclusion Transporting selectively those paediatric patients by ambulance, who need transportation the most, appears to be safe in the light of this dataset. Reference Finnish Official Statistics – Suomen virallinen tilasto (SVT): Väestörakenne [verkkojulkaisu]. ISSN=1797-5379. Helsinki: Tilastokeskus [Internet]. [cited 2017 Jan 15]. Available from: http://www.stat.fi/til/vaerak/tau.html Conflict of interest None declared. Funding Helsinki University Central Hospital, The Finnish Society of Anaesthesiologists (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Oulasvirta, J., Harve-Rytsälä, H., Kuisma, M. Source Type: research

35 Manual versus semi-automatic rhythm analysis and defibrillation for out-of-hospital cardiac arrest
Aim Although manual and semi-automatic external defibrillation (SAED) are commonly used in the management of cardiac arrest, the optimal strategy is not known. We hypothesised that SAED would reduce the time to first shock and increase survival compared to a manual strategy. Methods Between 2005 and 2015, we included adult out-of-hospital cardiac arrests (OHCA) of presumed cardiac aetiology. On October 2012, a treatment protocol utilising SAED was introduced following years of manual defibrillation by paramedics. The effect of SAED implementation on patient outcomes was assessed using adjusted interrupted time series mode...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Nehme, Z., Andrew, E., Nair, R., Bernard, S., Smith, K. Source Type: research

34 Characteristics of repeated EMS users in the north denmark region
Conclusion Repeated EMS users constituted 16.8% of patients (34.8% of ambulances). Compared to one-time users, repeated users were more often male, had higher comorbidity, were more often diagnosed with mental and respiratory illnesses, and less often with injuries, poisoning, and external causes. References Christensen EF, Larsen TM, Jensen FB, Bendtsen MD, Hansen PA, Johnsen SP, et al. Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study. BMJ Open2016;6(7):e011558. Scott J, Strickland AP, Warner K, Dawson P. Frequent callers to and users o...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Bendtsen, M., Sovso, M., Larsen, T., Lindskou, T., Hansen, P., Jensen, F., Holdgaard, H., Stegger, J., Christensen, E. Source Type: research

33 Characteristics of patients undergoing pre-hospital rapid sequence intubation by intensive care flight paramedics in victoria, australia
Aim Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. The role of RSI in the pre-hospital setting, and who should perform the procedure remains controversial. In Victoria, Intensive Care Flight Paramedics (ICFPs) have a broad scope of practice for RSI, including high Glasgow Coma Score (≥10). We sought to describe the success rates and characteristics of patients receiving RSI by highly trained ICFPs in Victoria, Australia. Methods A retrospective data review was conducted of adult (≥16 years) patients who received RSI by an ICFP between the 1st January 2011 and ...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Delorenzo, A., Clair, S. T., Andrew, E., Bernard, S., Smith, K. Source Type: research

32 Treat-and-release EMS patients in the north denmark region: identification and vital signs
Conclusion Treat-and-leave patients constituted 15.3% of all emergency ambulances, and the documentation of civil registration number was poor. Vital signs and/or GCS were documented in less than half of the patients, only partly explained by including death on scene. Reference Christensen EF, Larsen TM, Jensen FB, Bendtsen MD, Hansen PA, Johnsen SP, et al. Diagnosis and mortality in prehospital emergency patients transported to hospital: a population-based and registry-based cohort study. BMJ Open2016;6(7):e011558. Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Larsen, T., Bendtsen, M., Sovso, M., Lindskou, T., Hansen, P., Jensen, F., Holdgaard, H., Stegger, J., Christensen, E. Source Type: research

31 Intraosseous access is effective whilst wearing CBRN protective equipment
Conclusion Intraosseous access can be effectively and promptly achieved whilst wearing CBRN PPE. IO access took an additional 9.4 s whilst wearing CBRN PPE which can provide fast and efficient vascular access during a CBRN incident. References Garside J, et al. Intraosseous vascular access in critically ill adults: a review of the literature. Nursing in Critical Care 2016;3:167–177. Suyama J. IO versus IV access whilst wearing personal protective equipment in a hazmat scenario. Prehospital Emergency Care 2007;11:467–472. Conflict of interest The author is an employee for Teleflex Medical Practicing critical ...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Collins, T. Source Type: research

30 A study of the prevalence of impaired awareness of hypoglycaemia in people who have had a severe hypoglycaemic emergency and been attended by the ambulance service
Aim To investigate the prevalence of Impaired Awareness of Hypoglycaemia in patients who require ambulance service attendance due to severe hypoglycaemia. Methods We undertook a national cross-sectional survey of the prevalence of Impaired Awareness of Hypoglycaemia (IAH). An a priori target sample size of 415 was set to allow estimation of proportions of IAH within a 5% margin of error (99% CI). From January–June 2016, patients (>16 years) attended by the Scottish Ambulance Service due a Diabetes related emergency with a blood glucose
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Duncan, E., Fitzpatrick, D., Evans, J. Source Type: research

29 Investigating the population characteristics, processes and outcomes of pre-hospital psychiatric and self-harm emergencies in scotland: a national record linkage study
Conclusion While linked data analysis may not identify all relevant cases, it provides important information to guide the development and evaluation of evidence-based interventions. Ambulance service and ED are missing opportunities to improve outcomes for people who experience a psychiatric emergency or who self-harm. New interventions could lead to decreases in the number of suicides, episodes of self-harm and levels of patient distress; and ambulance and ED service use. Reference Information Services Division (NHS Scotland) (2016) Unscheduled Care Datamart Background Paper. Accessible at http://www.isdscotland.org/Heal...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Duncan, E., Best, C., Dougall, N., Skar, S., Fitzpatrick, D., Evans, J., Corfield, A., Goldie, I., Maxwell, M., Snooks, H., Stark, C., White, C., Wojcik, W. Source Type: research

28 The difference between physician assistants and ambulance nurses as solo emergency care providers in EMS, a cross sectional study
Aim The aim of the study is to compare the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by the physician assistant (PA) and ambulance nurse (RN) in emergency medical services (EMS) in the Netherlands. Methods In a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n=493) and 23 RNs (n=498). Data were drawn from predefined and free text fields in the electronic patient records and analysed using descriptive statistics. We used 2 and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical sig...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Berben, S., Bloemhoff, A., Schoonhoven, L., Kreek, A. d., Grunsven, P. v., Laurant, M. Source Type: research

27 Implementation, temporal changes, and follow-up of a nationwide AED-network
Conclusion The number of public available AEDs in Denmark has markedly increased from 2007–2015, with companies/offices, school/education facilities, and sport facilities as most frequent places of AED deployment. However, only 14.8% of AEDs placed at companies/offices had 24/7 accessibility. Conflict of interest None declared. Funding Dr. Karlsson is supported by a fund from The Danish foundation TrygFonden, who has no influence on study design; in the collection, analysis, or interpretation of data. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Karlsson, L., Hansen, C., Wissenberg, M., Hansen, S., Lippert, F., Rajan, S., Kragholm, K., Moller, S., Gislason, G., Torp-Pedersen, C., Folke, F. Source Type: research

26 Systematic influences of the implementation of a comprehensive 24/7-telemedicine system into emergency medical service
Aim Demographic changes, decreasing availability of general practitioners, and at least regional shortage of qualified emergency medical service (EMS) physicians led to increasing arrival times and quality problems. Telemedical solutions could help to solve some of the problems. Methods Overall safety and feasibility of prehospital telemedically guided care was already proven in two research projects from 2007 to 2013.1–3 Their results led to implementation of a multifunctional mobile telemedicine system in the city of Aachen, Germany. From 04/2014 to 03/2015 all ambulances were equipped with a telemedicine system c...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Beckers, S., Bergrath, S., Hirsch, F., Felzen, M., Rossaint, R. Source Type: research

25 Machine learning - a novel approach to increase recognition of out of hospital cardiac arrest during calls to emergency medical dispatch centres
Conclusion These early results show that a Machine Learning model based on neural networks has potential to improve recognition of OHCA. The results are thought-provoking and invites to further research. Reference Viereck S, Moller TP, Rothman JP, Folke F, Lippert F. Recognition of out-of-hospital cardiac arrest during emergency calls – a systematic review of observational studies. 2017. Ref Type: Submitted article in review Conflict of interest None declared. Funding Emergency Medical Services Copenhagen has received an unrestricted research grant from the Laerdal Foundation. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Blomberg, N., Folke, F., Moller, T., Lippert, F. Source Type: research

24 Citizens utilisation and satisfaction with a novel organisational structure of prehospital access to hospital care
Aim The ambulance service (EMS) and out-of-hours service (OOH) of Capital Region of Copenhagen (EMS Copenhagen) was united January 1st 2014, featuring only two phone numbers to call in case of acute illness or injury: 112 for life threatening conditions, and 1813 for non-urgent conditions. All prehospital access to in-hospital acute care is pre-assessed and guided to the nearest appropriate hospital with least waiting time (capacity controlling). The aim of this study was to describe citizens’ utilisation and satisfaction with the Copenhagen-Model (CM). Methods Data was delivered by the Emergency Departments (ED) da...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Gamst-Jensen, H., Blomberg, N., Folke, F., Lippert, F. Source Type: research

23 Helicopter emergency medical services in major incident management: national norwegian cross-sectional survey
Conclusion HEMS/SAR crewmembers have infrequent exposure to MI management. Communication remains a challenge. Training on frequent scenarios with other agencies is called for. Reference Johnsen AS, Fattah S, Sollid SJM, Rehn M. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review. BMJ Open. 2016;6(2):e010307. Conflict of interest None declared. Funding All authors are employed by Norwegian Air Ambulance Foundation. However, the NAAF played no part in study design, data collection, analysis, writing or submitting to publication. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Johnsen, A., Sollid, S., Vigerust, T., Jystad, M., Rehn, M. Source Type: research

22 Out-of-hospital cardiac arrest as a mandatory reportable disease - first experiences from norway
Conclusion Establishing mandatory reporting is valuable when creating a population based registry. Regional variations inspire further work to improve reporting and quality. Close involvement of the local registrars and feeding back the results to local EMS are our main strategies. Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Kramer-Johansen, J., Tjelmeland, I., Langorgen, J., Soreide, E. Source Type: research

21 Prehospital national early warning score (NEWS) does not predict one day mortality
Conclusion In our retrospective cohort study, prehospital NEWS did not predict mortality within one day of EMS dispatch. References Williams B, Alberti G, Ball C, Bell D, Binks R, Durham L. National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. London: The Royal College of Physicians; 2012 Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation2013;84:465–70. Silcock DJ, Corfie...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Pirneskoski, J., Nurmi, J., Olkkola, K., Kuisma, M. Source Type: research

20 Hygiene in the emergency medical services (EMS) calls for attention
Conclusion Microbial contamination and related challenges in the EMS calls for further attention. Several sites were contaminated with healthcare associated pathogens, but neither time from cleaning, number of patients nor area of service were of influence on the degree of contamination. Future research on hygienic challenges and routes of transmission is recommended. References Dancer SJ. Controlling hospital-acquired infection: focus on the role of the ?environment and new technologies for decontamination. Clinical microbiology reviews. 2014;27(4):665–90. Alter SM, Merlin MA. Nosocomial and community-acquired inf...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Vikke, H., Giebner, M., Kolmos, H. Source Type: research

19 Pre-hospital oxygen therapy and co2 retention in patients admitted through the emergency department
Aim Patients with severe COPD are at risk of CO2 retention, due to uncontrolled oxygen administration. In Denmark, emergency medical service (EMS) care only offers respiratory support with 100% oxygen and treatment with fractionated oxygen is limited. In this retrospective study we sought to clarify the extend at which patients with hypercapnic acidosis, due to excessive pre-hospital oxygen therapy, were admitted through the emergency department (ED). Methods Patients admitted through the ED were divided according to triage score. Venous blood samples were collected from all patients and arterialised using the venous to a...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Lumholdt, M., Cresciolo, E., Monti, A., Sorensen, L., Damgaard, K. Source Type: research

18 'Tell me whats happened: when linguistic choices affect efficiency of ambulance dispatch for cardiac arrest
This study analyses the effect of this change on the way callers describe the emergency. Methods Using a mixed-methods analysis combining Conversation Analysis and Corpus Linguistics, we analysed 184 calls from paramedic-confirmed out-of-hospital cardiac arrests in Perth (Western Australia) in 2014–2015. We coded each call for its use of tense in the prompt and the format of the response as either a report (focusing on symptoms) or a narrative2 (containing irrelevant background details) and we timed the callers’ responses. Results The use of report response was much more frequent when call-takers chose the pr...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Riou, M., Whiteside, A., Ball, S., Williams, T., OHalloran, K., Perkins, G., Bray, J., Cameron, P., Smith, K., Fatovich, D., Inoue, M., Brink, D., Bailey, P., Finn, J. Source Type: research

17 Accuracy in emergency medical dispatch
Conclusion The new dispatch protocol RETTS-A, had a lower accuracy for priority level than the protocol in current use, Medical Index, and a higher level of under triage. This is the first large study evaluating Medical Index. Despite Medical Index being the superior tool it has a low overall accuracy. Conflict of interest K. Bohm and K. Olanders has consult missions at the EMCC organisation SOS Alarm Sverige AB. No other conflicts of interest. Funding K. Bohm has unrestricted grant from SOS Alarm Sverige AB. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Torlen, K., Kurland, L., Castren, M., Olanders, K., Bohm, K. Source Type: research

16 Feasibility of a prehospital acute dyspnoea score - a pilot study
Aim Dyspnoea is frequent symptom among patients in ambulances after calling the emergency number, and mortality is high (1). However, knowledge regarding patient experience is sparse. As a first step in assessing subjective intensity of acute dyspnoea, we performed a pilot study in a prehospital setting. Methods A one-month pilot study in the Thy-Mors region of the North Denmark region. Emergency ambulance patients with difficulties breathing were asked to use a verbal rating scale to assess their dyspnoea at; 1) first arrival at patient, 2) approximately halfway to hospital, and 3) arrival at hospital. Results We includ...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Lindskou, T., Sorensen, A., Laursen, B., Weinreich, U., Christensen, E. Source Type: research

15 The importance of staying on the call: recognition of cardiac arrest after initial dispatch
Conclusion Nearly one third of call-taker recognition of OHCA occurs after initial dispatch. The higher survival probability of patients recognised by secondary recognition is consistent with those patients arresting more recently relative to the timing of the call. For many cases of OHCA, the call-taker’s ability to stay on the call and remain alert to the possibility of OHCA may strengthen the chain of survival. Conflict of interest A. Whiteside and D. Brink receive full salary support, and P. Bailey, M. Inoue and J. Finn receive partial salary support from St John Ambulance. Funding Funding for this research was...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Ball, S., Whiteside, A., Inoue, M., Bray, J., Fatovich, D., Cameron, P., Williams, T., Smith, K., OHalloran, K., Brink, D., Perkins, G., Tohira, H., Bailey, P., Riou, M., Finn, J. Source Type: research

14 Initial prehospital vital signs to predict subsequent adverse hospital outcomes
Aim There is growing interest to improve identification of the critically ill patient in the prehospital setting.1–3 We aimed to assess whether initial vital physiological signs in the prehospital setting can predict subsequent adverse hospital outcomes, defined as intensive care (ICU) admission or death in the emergency department (ED). Methods The initial prehospital physiological data of all adult patients, transported by the St John Ambulance Service to the metropolitan public EDs were linked to the ED information system in this retrospective cohort study. Cardiac arrest unwitnessed by paramedics, rural, inter-h...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Williams, T., Ho, K., Tohira, H., Fatovich, D., Bailey, P., Brink, D., Gowens, P., Perkins, G., Finn, J. Source Type: research

13 Annual tourniquet use in UK ambulance services for major haemorrhage control
Conclusion There is a significant lack of data regarding UK ambulance service tourniquet use and this should be urgently increased to improve both research and clinical governance. Many (45%) patients are already in significant levels of shock prior to application of tourniquet use which is associated with very high levels of mortality2 and only further data collection will help to understand and ultimately address the reasons underlying this. References Bulger EM, Snyder D, & Schoelles K, et al. An evidence-based prehospital guideline for external haemorrhage control: American College of Surgeons Committee on Trauma....
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Bessant, G., Dharmaratne, S. Source Type: research

12 Outcomes and modifiable resuscitative characteristics amongst pan-asian out-of-hospital cardiac arrest occuring at night - a multinational, prosepctive, observationel study
This study aimed to elucidate the circadian variation in OHCA Methods This was a prospective, observational study of OHCA cases across multinational Pan-Asian sites. We excluded traumatic cases, less than 18 year-old, cases where resuscitation was not attempted or started but terminated before arrival at Emergency Department, and missing time-of-call-received data. Cases were divided according to time call received by dispatch centres into day (0700 H-1900H) and night (1900 H-0659H). Primary outcome was 30 day survival. Secondary outcomes were prehospital and hospital modifiable resuscitative characteristics. Results 558...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Ong, M., Ho, A., Hao, Y., Pek, P., Shahidah, N., Yap, S., Ng, Y., Kwanhatha, D., Lee, E., Khruekarnchana, P., Wah, W., Liu, N., Tanaka, H., Shin, S., Ma, M., Ong, M. Source Type: research

11 Increase in BYSTANDER-CPR in sweden is associated with increased rates of compression-only CPR
Conclusion Increase in bystander CPR during the last 15 years in Sweden was associated with an increase in CO-CPR. Overall 30 day survival was not different when comparing CO-CPR to S-CPR. Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Riva, G., Hollenberg, J., Svensson, L., Ring, M., Rubertsson, S., Nordberg, P., Claesson, A., Djärv, T., Herlitz, J. Source Type: research

10 Prehospital critical care team attendance increases the survival of major trauma patients: national registry data
Conclusion In major trauma patients in Scotland, the addition of prehospital critical care to standard ambulance care results in an increase in patient survival. This study adds to the growing body of evidence supporting the utility of prehospital critical care, especially in the most severely injured patients. Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Maddock, A., Corfield, A., Donald, M., Hearns, S., Lyon, R., Fitzpatrick, D., Sinclair, N. Source Type: research

9 Audit of morphine administration by east midlands ambulance service (EMAS)
Conclusion There is potential for improved adherence to JRCALC guidelines through increased awareness and education. We will trial this at EMAS through staff notices followed by a re-audit in 4–6 months. Ideally, audits within other ambulance services with more patients would be undertaken for widespread quality improvement. Reference Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2016). UK Ambulance Services Clinical Practice Guidelines2016. Bridgwater: Class Professional Publishing. Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Winter, S., Jootun, R. Source Type: research

8 Genuine illness and injury during europes largest emergency service major incident exercise
Conclusion Patient presentation rate was in line with previous research1. However, we believe this is the first study to report similar data for a mass emergency service exercise. Our findings regarding the factors and pre-existing illnesses/conditions that contributed to individuals seeking medical help will be valuable in planning future large-scale exercises. Reference Alguthami, A., Pines, J., 2014. A systematic review of noncommunicable health issues in mass gatherings. Prehosp Disaster Med, 29(2), 167–75. Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Cannon, E., Edwards, T., Fothergill, R. Source Type: research