7 Dispatch of fire-fighters and police officers in out-of-hospital cardiac arrest: a nationwide prospective cohort trial
Aim Dual dispatch of cardiopulmonary resuscitation (CPR) -trained fire-fighters or police officers equipped with automated external defibrillators (AEDs) in addition to emergency medical services (EMS) in out-of-hospital cardiac arrest (OHCA) has in some minor cohort studies been associated with improved survival. The aim of this study was to evaluate the association between dual dispatch and survival in OHCA at a national level. Methods This prospective, cohort study was conducted January 1st, 2012, to December 31st, 2014. OHCA victims in nine Swedish counties covered by dual dispatch and resuscitation by first responder...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Hasselqvist-Axe, I., Nordberg, P., Herlitz, J., Svensson, L., Jonsson, M., Lindqvist, J., Ringh, M., Claesson, A., Björklund, J., Andersson, J., Ericson, C., Lindblad, P., Engerström, L., Rosenqvist, M., Hollenberg, J. Source Type: research

6 Characteristics of thunderstorm asthma EMS attendances in victoria, australia
Aim Thunderstorm Asthma (TA) occurs when a dangerous mix of pollen and severe weather trigger acute respiratory distress symptoms in people with allergic rhinitis and asthma. We sought to describe the characteristics of patients attended by emergency medical services (EMS) during the largest global epidemic of TA which occurred in Melbourne on 21/11/2016. Methods A retrospective observational study of electronic EMS patient care records was conducted for all cases occurring during TA, between 1800hrs on 21/11/2016 and 2359 hours on 22/11/2016 (30 hours). Results were compared with a standard comparator period defined as t...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Andrew, E., Nehme, Z., Bernard, S., Smith, K. Source Type: research

5 Mental health-related presentations to emergency medical services in victoria, australia
Aim Recent increases in demand for mental health services have not been matched with community resources, resulting in increased demand on emergency medical services (EMS). We sought to describe the clinical profile, demand patterns and care provided to mental health patients accessing EMS in ?Victoria, Australia. Methods We conducted a retrospective observational study of cases occurring between January and December 2015. Computer Aided Dispatch and electronic patient care record data were extracted from the Ambulance Victoria data warehouse. Characteristics of mental health presentations were described using descriptive...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Andrew, E., Roggenkamp, R., Nehme, Z., Cox, S., Smith, K. Source Type: research

4 Revising EMS dispatch procedures to manage growing demand in victoria, australia
This study aimed to increase the proportion of low-acuity calls diverted to secondary triage and onto an alternative service provider (ASP), ultimately reducing EMS demand. Methods A review of the level of EMS response assigned to AMPDS ET was conducted using research, audit and clinical expertise. Existing ‘time-critical’ and ‘acute but not time-critical’ ETs were assessed for suitability against the assigned level of EMS response and existing dispatch rules. An analysis of events occurring pre-reform (8 Feb–8 May 2016) and post-reform (9 May–8 Aug 2016) was conducted. Results A total...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Andrew, E., Smith, K. Source Type: research

3 Choking children - should we be scared?
Conclusion Choking in children is an uncommon emergency with only 0,14% of all contacts. We found like others2 that BLS solves most cases before arrival of EMS. This demonstrates the importance of immediate initiation of BLS and keeping the chain of survival as a concept. Death to choking is rare among small children. Near fatal choking resolves with skills and routine in advanced airway management and advanced life support. References Maconochie IK, Bingham R, Eich C, López-Herce J4, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D: European Resuscitation Council Guidelines f...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Hojgaard, H. F., Köhler, D. Source Type: research

2 Does current pre-hospital analgesia effectively reduce pain in children caused by trauma within a UK ambulance service: a service evaluation
Aim Analgesic treatment of pre-hospital injured children is viewed as ‘suboptimal’ with few receiving analgesia. The aim of this study was to explore current analgesia given to traumatically injured children in the pre-hospital setting and examine whether a clinically meaningful reduction in pain was achieved. Methods We evaluated electronic patient report forms over a two year period (2013 and 2014) within a UK ambulance service NHS trust. All traumatically injured children within the age range of 1 to 17 with a clinical impression of a fracture, dislocation, wound or burn were included. Patients with a Glasgow Coma Scale of
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Whitley, G., Bath-Hextall, F. Source Type: research

1 The use and impact of 12-lead electrocardiograms in acute stroke patients: a systematic review
Conclusion Future studies should be based in the prehospital environment and should investigate whether undertaking an electrocardiogram in the prehospital setting affects clinical management decisions or has an association with mortality or morbidity. Conflict of interest None declared Funding This work was supported by School of Health Sciences PhD bursary – University of Surrey, and South East Coast Ambulance Service NHS Foundation Trust. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Munro, S., Quinn, T., Cooke, D., Joy, M. Source Type: research

46 Forecasting the demand profile for a physician-led pre-hospital care service using a mathematical model
Conclusion Our model was able to correctly predict the number of pre-hospital primary retrieval missions undertaken by the ScotSTAR Emergency Medical Retrieval Service (EMRS) by demonstrating no statistically significant differences to the real-world mission numbers or distribution. This suggests that a queueing theory derived model is able to accurately replicate, and forecast, the real-world performance of ScotSTAR EMRS operations. This finding presents useful implications for resource utilisation, asset allocation and investigating system capability. Reference Kendall DG. Stochastic Processes Occurring in the Theory of...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Moultrie, C., Corfield, A., Pell, J., Mackay, D. Source Type: research

45 Frontiers of performance: using a mathematical model to discover unobservable performance limits in a pre-hospital and retrieval service
Conclusion These results provide a useful insight into potential system performance, and its limitations. When combined with forecasting of service growth and demand, they provide useful guidance on what a service may be able to achieve. By knowing the limits of achievable performance, we can also work to derive an absolute number of missions as a specification limit. Furthermore, they illustrate the importance of maintaining relatively low service utilisation in order to achieve rapid response to critically ill or injured patients. Conflict of interest None declared. Funding Scottish Ambulance Service ScotSTAR (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Moultrie, C., Corfield, A., Pell, J., Mackay, D. Source Type: research

44 Point-of-care analysis of lactate from intraosseous samples during resuscitation
Conclusion Intraosseous lactate values showed good agreement with arterial and venous values before cardiac arrest, but IO values were clearly higher during VF and CPR. During resuscitation IO lactate values seem to represent better the metabolic state at tissue level than arterial or venous lactate. Reference Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet1986;1:307–10 Conflict of interest None declared. Funding None declared. (Source: BMJ Open)
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Jousi, M., Nelskylä, A., Skrifvars, M., Ristagno, G., Nurmi, J. Source Type: research

43 Time delay to contact the medical dispatch - eurocall study in romania
Aim To assess the time to connect the telephone call to emergency medical dispatch. Methods Regional randomised study as a part of a prospective, multicenter study was conducted in April 2013 within the Medical Dispatch, Iasi, Romania. The distribution of the 112 calls followed a diurnal distribution using a computer generated sets of random numbers. We analysed the time to contact medical dispatch and its components (Time to first beep, First beep to 112 operator answer,First beep to medical dispatch answer). Results There were planned to do 180 calls (6 calls/24 hour) and we performed only 129 calls (71,66%). The avera...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Cimpoesu, D., Popa, O., Popa, G. Source Type: research

42 Straight line vs true distance to nearest aed - does it matter for cardiac arrest coverage?
Conclusion Using true instead of straight line distance provides a more realistic estimation of AED coverage and could help improve public access defibrillation programs. Conflict of interest None declared. Funding Dr. L. I. M. 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., Sondergaard, K., Hansen, C., Wissenberg, M., Hansen, S., Lippert, F., Rajan, S., Kragholm, K., Moller, S., Gislason, G., Torp-Pedersen, C., Folke, F. Source Type: research

41 New methods for diagnosis of thoracic trauma in prehospital care
Conclusion EBI and MW are promising technologies for prehospital diagnosis of thoracic injuries. References Buendia, et al. Electrical bioimpedance for diagnosing thoracic injuries: Test on a porcine pneumothorax and hemothorax model. (2016) Short Communications From AAAM’s 60th Annual Scientific Conference, Traffic Injury Prevention, 17:supp 1, 175–218. Oveland, et al.: A wearable microwave detector for diagnosing thoracic injuries-test on a porcine pneumothorax model. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2015;23(Suppl 2):A20. Conflict of interest None declared. Funding The a...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Candefjord, S., Buendia, R., Caragounis, E., Oveland, N., Sjöqvist, B., Oropeza-Moe, M., Elam, M., Persson, M., Fhager, A. Source Type: research

40 Comprehensive efficacy and integrated safety results from the late-phase clinical program of the sufentanil sublingual tablet 30 MCG
Aim The sufentanil sublingual tablet system (Zalviso) is a non-invasive, patient-controlled analgesia product recently approved in Europe for treatment of acute post-operative pain. A second sufentanil product, a 30 mcg tablet (SST 30 mcg) dispensed sublingually by a healthcare professional, recently completed Phase 3 development for treatment of pain in settings such as the emergency department and EMS. The primary objective of this presentation will be to review key efficacy and safety data from all four late-phase trials. Methods The late-phase program consisted of two randomised, placebo-controlled studies and two, op...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Leto, R., Miner, J., Rafique, Z., Tyler, M. Source Type: research

39 Heliport proximity is crucial in reducing treatment delay in patients with st-elevation myocardial infarction transported by helicopter - heliproxy study
In this study, we compared the time delay from landing to arrival at the catheterization laboratory in patients with ST Elevation Myocardial Infarction (STEMI) accepted for primary Percutaneous Coronary Intervention (pPCI) at one of the four centres in Denmark. We hypothesised that heliport proximity strongly influence the LTT. Methods We prospectively recorded the time from the landing at the heliport to arrival at the catheterization laboratory from October 1st 2014 to December 31st 2016 in all STEMI patients transported by HEMS Denmark. LTT was compared between two centres with heliports at the hospital, and two centre...
Source: BMJ Open - May 21, 2017 Category: General Medicine Authors: Hansen, P., Terkelsen, C., Riddervold, I., Knudsen, L. Source Type: research

Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada
Objectives Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. Design From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gather...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Arain, M. A., Deutschlander, S., Charland, P. Tags: Open access, Health services research Source Type: research

Post-authorisation passive enhanced safety surveillance of seasonal influenza vaccines: protocol of a pilot study in England
This study builds on a feasibility study carried out at the start of the 2015/2016 influenza season. We will report influenza vaccine exposure and any AEIs reported via ADR card or recorded directly into the EHR, from the commencement of influenza vaccination and ends as specified by EMA (30 November 2016). Setting Ten volunteer English general practices, primarily using the GSK influenza vaccines. They had selected this vaccine in advance of the study. Participants People who receive a seasonal influenza vaccine, in each age group defined in EMA interim guidance: 6 months to 5 years, 6–12 years, 13–17 years,...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: de Lusignan, S., Dos Santos, G., Correa, A., Haguinet, F., Yonova, I., Lair, F., Byford, R., Ferreira, F., Stuttard, K., Chan, T. Tags: Open access, Epidemiology Protocol Source Type: research

Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: protocol for a systematic review
Introduction Models that have so far been used to estimate and project the prevalence and disease burden of asthma are in most cases inadequately described and irreproducible. We aim systematically to describe and critique the existing models in relation to their strengths, limitations and reproducibility, and to determine the appropriate models for estimating and projecting the prevalence and disease burden of asthma. Methods We will search the following electronic databases to identify relevant literature published from 1980 to 2017: Medline, Embase, WHO Library and Information Services and Web of Science Core Collectio...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Bhuia, M. R., Nwaru, B. I., Weir, C. J., Sheikh, A. Tags: Open access, Epidemiology Protocol Source Type: research

Cost-effectiveness of therapist-guided internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: results from a randomised controlled trial
Conclusions The results suggest that therapist-guided ICBT is a cost-effective treatment and results in societal cost savings, compared with patients who do not receive evidence-based treatment. Since, at present, most patients with OCD do not have access to evidence-based treatments, the results have important implications for the increasingly strained national and healthcare budgets. Future studies should compare the cost-effectiveness of ICBT with regular face-to-face CBT. Trial registration number NCT02191631. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Lenhard, F., Ssegonja, R., Andersson, E., Feldman, I., Rück, C., Mataix-Cols, D., Serlachius, E. Tags: Open access, Mental health Research Source Type: research

Cohort profile: internal migration in sub-Saharan Africa--The Migration and Health in Malawi (MHM) study
Purpose The Migration and Health in Malawi (MHM) study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. The MHM study uses a longitudinal panel premigration and postmigration study design (with a non-migrant comparison group) to measure and/or control for important characteristics that affect both migration and health outcomes. Participants Data are available for two waves. The MHM interviewed 398 of 715 migrants in 2007 (55.7%) and...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Anglewicz, P., VanLandingham, M., Manda-Taylor, L., Kohler, H.-P. Tags: Open access, Epidemiology Cohort profile Source Type: research

Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments
Conclusions Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully repor...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Harrison, M., Milbers, K., Hudson, M., Bansback, N. Tags: Open access, Patient-centred medicine Research Source Type: research

Cost-effectiveness of telehealthcare to patients with chronic obstructive pulmonary disease: results from the Danish 'TeleCare North cluster-randomised trial
Conclusions Telehealthcare is unlikely to be a cost-effective addition to usual care, if it is offered to all patients with chronic obstructive pulmonary disease and if the willingness-to-pay threshold values from the National Institute for Health and Care Excellence are applied. Trial registration Clinicaltrials.gov, NCT01984840, 14 November 2013. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Witt Udsen, F., Lilholt, P. H., Hejlesen, O., Ehlers, L. Tags: Open access, Health economics Research Source Type: research

Study protocol for a transversal study to develop a screening model for excessive gambling behaviours on a representative sample of users of French authorised gambling websites
This study was approved by the local Research Ethics Committee (GNEDS) on 25 March 2015. Results will be presented in national and international conferences, submitted to peer-reviewed journals and will be part of a PhD thesis. A final report with the study results will be presented to the ARJEL, especially the final screening model. Trial registration number NCT02415296. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Perrot, B., Hardouin, J.-B., Costes, J.-M., Caillon, J., Grall-Bronnec, M., Challet-Bouju, G. Tags: Open access, Addiction Protocol Source Type: research

Socially disparate trends in lifespan variation: a trend study on income and mortality based on nationwide Danish register data
Conclusion The study demonstrates that the increasing social gap in mortality appears differently in the change of the age-at-death distribution. Thus, no compression of mortality was seen in the lowest income quartile. The results do not provide support for a uniformly extension of pension age for all. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Bronnum-Hansen, H. Tags: Open access, Public health Research Source Type: research

Interaction of ACE genotype and salt intake on hypertension among Chinese Kazakhs: results from a population-based cross-sectional study
Objectives To explore the effect of interaction between ACE genotype and salt intake on hypertension among Chinese Kazakhs, and to compare applications of interactions between logistic model and generalised partially linear tree-based regression (GPLTR) model. Design Population-based cross-sectional study. Setting Hong Dun, North Xinjiang, China. Participants Non-consanguineous Chinese Kazakh participants (n=916, 342 men and 574 women) aged ≥30 years. Main outcome measures Association between ACE genotype and hypertension, association between salt intake and hypertension, and interaction of ACE genotype and salt int...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Wang, Y., Zhang, B., Hou, L., Han, W., Xue, F., Wang, Y., Tang, Y., Liang, S., Wang, W., Asaiti, K., Wang, Z., Hu, Y., Wang, L., Qiu, C., Zhang, M., Jiang, J. Tags: Open access, Epidemiology Research Source Type: research

10-year trends in statin utilization in Taiwan: a retrospective study using Taiwans National Health Insurance Research Database
Conclusion Atorvastatin was the most commonly used statin in Taiwan during 2002–2011. While patients with history of CVD were more likely to be prescribed higher intensity statins compared with those without, this difference was not found comparing those with and without diabetes. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Hsieh, H.-C., Hsu, J. C., Lu, C. Y. Tags: Open access, Evidence based practice Research Source Type: research

Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001-2014
Conclusions SES had a stronger impact on major CVD risk factors among Korean women than men. Moreover, socioeconomic inequalities in smoking, obesity and diabetes worsened among Korean women over time. Public policies to prevent smoking, obesity and diabetes in women with lower SES are needed to address inequalities. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Kim, Y. J., Lee, J. S., Park, J., Choi, D. S., Kim, D. M., Lee, K.-H., Kim, H. Y., Kim, S. G., Lee, J. Tags: Open access, Epidemiology Research Source Type: research

Reducing social isolation and loneliness in older people: a systematic review protocol
Introduction Social isolation and loneliness affect approximately one-third to one-half of the elderly population and have a negative impact on their physical and mental health. Group-based interventions where facilitators are well trained and where the elderly are actively engaged in their development seem to be more effective, but conclusions have been limited by weak study designs. We aim to conduct a systematic review to assess the effectiveness of health promotion interventions on social isolation or loneliness in older people. Methods and analysis A systematic review was conducted in Medline, Embase, PsycINFO, Cumul...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Landeiro, F., Barrows, P., Nuttall Musson, E., Gray, A. M., Leal, J. Tags: Open access, Public health Protocol Source Type: research

Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach
Conclusions Stillbirth is unequally distributed among Iranian women and is mostly concentrated among low economic status people. Mother-related factors had the highest positive and negative contributions to inequality, highlighting specific interventions for mothers to redress inequality. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Almasi-Hashiani, A., Sepidarkish, M., Safiri, S., Khedmati Morasae, E., Shadi, Y., Omani-Samani, R. Tags: Open access, Public health Research Source Type: research

The job content questionnaire in various occupational contexts: applying a latent class model
Conclusion The four job types proposed by the JSM were identified among primary healthcare and petroleum industry workers—groups with relatively high levels of skill discretion and decision authority. Three job types were identified for teachers and urban workers; however, passive job situations were not found within these groups. The latent class analysis enabled us to describe the conditional standard responses of the job types proposed by the model, particularly in relation to active jobs and high and low strain situations. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Santos, K. O. B., Araujo, T. M. d., Carvalho, F. M., Karasek, R. Tags: Open access, Mental health Research Source Type: research

Trends and population-attributable risk estimates for predictors of early neonatal mortality in Nigeria, 2003-2013: a cross-sectional analysis
Objectives To assess trends in early neonatal mortality (ENM) and population-attributable risk (PAR) estimates for predictors of ENM in Nigeria. Design, setting and participants A cross-sectional data on 63 844 singleton live births within the preceding 5 years from the 2003, 2008 and 2013 Nigeria Demographic and Health Surveys were used. Adjusted PARs were used to estimate the number of early neonatal deaths attributable to each predictor in the final multivariable Cox regression model. Main outcome measures ENM, defined as the death of a live-born singleton between birth and 6 days of life. Results The ENM rate slight...
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Ezeh, O. K. Tags: Open access, Public health Research Source Type: research

Modeling lifetime costs and health outcomes attributable to secondhand smoke exposure at home among Korean adult women
Conclusion Life expectancy might underestimate the impact of SHS exposure on health outcomes, especially if the time horizon of the analysis is not long enough. Early intervention on smoking behaviour could substantially reduce direct healthcare costs and improve quality of life attributable to SHS exposure. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Lee, J., Han, A. R., Choi, D., Lim, K.-M., Bae, S. Tags: Open access, Public health Research Source Type: research

Health assets in older age: a systematic review
Conclusions Implementing an asset-based approach to health promotion uncovers the skills, knowledge, connections and potential of the individual and the community. This approach is an ideal opportunity for government health bodies and their partners to respond to the challenges faced by global ageing. Factors are often interdependent and cumulative, suggesting the potential for an instrument to measure the accumulated effect of health assets on health status in older adults. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Hornby-Turner, Y. C., Peel, N. M., Hubbard, R. E. Tags: Open access, Geriatric medicine Research Source Type: research

Measuring ability to assess claims about treatment effects: the development of the 'Claim Evaluation Tools
Conclusions The Claim Evaluation Tools database is a flexible resource from which researchers, teachers and others can design measurement instruments to meet their own requirements. These evaluation tools are being managed and made freely available for non-commercial use (on request) through Testing Treatments interactive (testingtreatments.org). Trial registration numbers PACTR201606001679337 and PACTR201606001676150; Pre-results. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Austvoll-Dahlgren, A., Semakula, D., Nsangi, A., Oxman, A. D., Chalmers, I., Rosenbaum, S., Guttersrud, O., The IHC Group, Cusack, Glenton, Hoffmann, Kaseje, Lewin, Marende, Morrelli, Mugisha, Nyirazinyoye, Olsen, Oxman, Sewamkambo, Uwitonze Tags: Open access, Health policy, Patient-centred medicine, Public health, Research methods Source Type: research

Distribution and extent of electronic medical record utilisation in eye units across the United Kingdom: a cross-sectional study of the current landscape
Conclusions EMR has the potential to address current limitations of patient information transfer and sharing in ophthalmology. It is pleasing to see a significant proportion of units already engaging with EMR or having plans to do so in the near future. However, differing EMR systems and lack of remote access mean further optimisation of these record systems are needed to allow data transfer between units. (Source: BMJ Open)
Source: BMJ Open - May 17, 2017 Category: General Medicine Authors: Lim, S. B., Shahid, H. Tags: Open access, Ophthalmology Research Source Type: research

A scoping review protocol on social participation of indigenous elders, intergenerational solidarity and their influence on individual and community wellness
Conclusion The innovative methodological framework proposed in this scoping review protocol will yield richer information on the contribution of elders to community wellness. This work is an essential preliminary step towards developing research involving indigenous communities, drawing on the social participation of elders and intergenerational solidarity. (Source: BMJ Open)
Source: BMJ Open - May 12, 2017 Category: General Medicine Authors: Viscogliosi, C., Asselin, H., Basile, S., Couturier, Y., Drolet, M.-J., Gagnon, D., Torrie, J., Levasseur, M. Tags: Open access, Public health Protocol Source Type: research

The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study
Conclusion Job satisfaction, work stress, work–family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention. (Source: BMJ Open)
Source: BMJ Open - May 12, 2017 Category: General Medicine Authors: Lu, Y., Hu, X.-M., Huang, X.-L., Zhuang, X.-D., Guo, P., Feng, L.-F., Hu, W., Chen, L., Zou, H., Hao, Y.-T. Tags: Open access, Health services research Source Type: research

Integrating culturally informed approaches into the physiotherapy assessment and treatment of chronic pain: protocol for a pilot randomised controlled trial
Introduction There is strong evidence that biopsychosocial approaches are efficacious in the management of chronic pain. However, implementation of these approaches in clinical practice is known not to account for the beliefs and values of culturally and linguistically diverse (CALD) patients. This limitation in translation of research contributes to the disparities in outcomes for CALD patients with chronic pain adding to the socioeconomic burden of this prevalent condition. Cultural adaptation of chronic pain assessment and management is urgently required. Thus, the aim of this pilot randomised controlled trial (RCT) is ...
Source: BMJ Open - May 12, 2017 Category: General Medicine Authors: Brady, B., Veljanova, I., Schabrun, S., Chipchase, L. Tags: Open access, Rehabilitation medicine Protocol Source Type: research

Haemodynamic analysis for recanalisation of intracranial aneurysms after endovascular treatment: an observational registry study in China
Introduction Recanalisation of intracranial aneurysms following endovascular treatment is a major issue. Many factors, including aneurysm morphology, the method of treatment, and haemodynamics, are considered to be associated with recanalisation. However, the underlying haemodynamic mechanisms are not completely understood. Methods and analysis This is a prospective, observational, registry study for patients with intracranial aneurysms who are treated endovascularly. It will enrol 200 eligible patients. Data on morphological, haemodynamic, and treatment factors will be collected prospectively. The advanced virtual stenti...
Source: BMJ Open - May 12, 2017 Category: General Medicine Authors: Liu, J., Zhang, Y., Wang, A., Zhang, Y., Li, Y., Yang, X. Tags: Open access, Neurology, Radiology and imaging Protocol Source Type: research

Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in Nigeria: a systematic review and meta-analysis
Conclusion Our findings suggest an increasing burden of T2DM in Nigeria with many persons currently undiagnosed, and few known cases on treatment. (Source: BMJ Open)
Source: BMJ Open - May 11, 2017 Category: General Medicine Authors: Adeloye, D., Ige, J. O., Aderemi, A. V., Adeleye, N., Amoo, E. O., Auta, A., Oni, G. Tags: Open access, Diabetes and Endocrinology Research Source Type: research

Trends in the supply of Californias emergency departments and inpatient services, 2005-2014: a retrospective analysis
We described recent statewide trends in the capacity of ED and inpatient hospital services from 2005 to 2014. Design Retrospective analysis. Setting Using California hospital data, we examined the absolute and per admission changes in ED beds and inpatient beds in all hospitals from 2005 to 2014. Participants Our sample consisted of all patients inpatient and outpatient) from 501 hospital facilities over 10-year period. Outcome measures We analysed linear trends in the total annual ED visits, ED beds, licensed and staffed inpatient hospital beds and bed types, ED beds per ED visit, and inpatient beds per admission (ED ...
Source: BMJ Open - May 11, 2017 Category: General Medicine Authors: Chow, J. L., Niedzwiecki, M. J., Hsia, R. Y. Tags: Open access, Press releases, Health services research Source Type: research

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review
Conclusions Over the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function. Trial registration number PROSPERO CRD42016046242. (Source: BMJ Open)
Source: BMJ Open - May 11, 2017 Category: General Medicine Authors: Brignardello-Petersen, R., Guyatt, G. H., Buchbinder, R., Poolman, R. W., Schandelmaier, S., Chang, Y., Sadeghirad, B., Evaniew, N., Vandvik, P. O. Tags: Open access, Evidence based practice, General practice / Family practice, Rheumatology, Sports and exercise medicine, Surgery Research Source Type: research

Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations
Conclusions We were able to distinguish between more and less credible MID estimates and provide best estimates for key instruments that informed evidence presentation in the associated systematic review and judgements made by the Rapid Recommendation panel. Trial registration number CRD42016047912. (Source: BMJ Open)
Source: BMJ Open - May 11, 2017 Category: General Medicine Authors: Devji, T., Guyatt, G. H., Lytvyn, L., Brignardello-Petersen, R., Foroutan, F., Sadeghirad, B., Buchbinder, R., Poolman, R. W., Harris, I. A., Carrasco-Labra, A., Siemieniuk, R. A. C., Vandvik, P. O. Tags: Open access, Evidence based practice, Rheumatology, Surgery Research Source Type: research

Automated control of mechanical ventilation during general anaesthesia: study protocol of a bicentric observational study (AVAS)
Introduction Automated control of mechanical ventilation during general anaesthesia is not common. A novel system for automated control of most of the ventilator settings was designed and is available on an anaesthesia machine. Methods and analysis The ‘Automated control of mechanical ventilation during general anesthesia study’ (AVAS) is an international investigator-initiated bicentric observational study designed to examine safety and efficacy of the system during general anaesthesia. The system controls mechanical breathing frequency, inspiratory pressure, pressure support, inspiratory time and trigger sen...
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Schädler, D., Miestinger, G., Becher, T., Frerichs, I., Weiler, N., Hörmann, C. Tags: Open access, Anaesthesia Protocol Source Type: research

Value of pulmonary artery pressure in predicting in-hospital and one-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease: an observational study
Objectives To investigate the role of pulmonary artery pressure (PAP) in predicting in-hospital death after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease. Design An observational study. Setting Guangdong General Hospital, China. Participants 1639middle-aged and aged patients (mean age 57±6 years) diagnosed with rheumatic mitral disease, undergoing valve replacement surgery and receiving coronary angiography and transthoracic echocardiography before operation, were enrolled. Interventions All participants underwent valve replacement surgery and received coronary angiogra...
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Jiang, L., Wei, X.-b., He, P.-c., Feng, D., Liu, Y.-h., Liu, J., Chen, J.-y., Yu, D.-q., Tan, N. Tags: Open access, Rheumatology Research Source Type: research

Randomised controlled trial of online continuing education for health professionals to improve the management of chronic fatigue syndrome: a study protocol
Introduction Chronic fatigue syndrome (CFS) is a serious and debilitating illness that affects between 0.2%–2.6% of the world’s population. Although there is level 1 evidence of the benefit of cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for some people with CFS, uptake of these interventions is low or at best untimely. This can be partly attributed to poor clinician awareness and knowledge of CFS and related CBT and GET interventions. This trial aims to evaluate the effect of participation in an online education programme, compared with a wait-list control group, on allied health profess...
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Li, S. H., Sandler, C. X., Casson, S. M., Cassar, J., Bogg, T., Lloyd, A. R., Barry, B. K. Tags: Open access, Medical education and training Protocol Source Type: research

Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study
Objectives To describe low-density lipoprotein (LDL) cholesterol management and lipid-lowering treatment patterns in patients with a cardiovascular (CV) event. Design Retrospective cohort study using Clinical Practice Research Datalink records linked with Hospital Episode Statistics data. Setting Routine clinical practice in the UK from 2006 to 2012. Participants Individuals ≥18 years were selected at their first CV-related hospitalisation (first event cohort) if they had received ≥2 lipid-lowering therapy prescriptions within 180 days beforehand. Patients were stratified into four mutually exclusive subgroups bas...
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Danese, M. D., Gleeson, M., Kutikova, L., Griffiths, R. I., Khunti, K., Seshasai, S. R. K., Ray, K. K. Tags: Open access, Health services research Source Type: research

Comparison of enteral versus intravenous potassium supplementation in hypokalaemia in paediatric patients in intensive care post cardiac surgery: open-label randomised equivalence trial (EIPS)
Conclusion EPR may be an equally efficacious alternative first-line therapy in treating hypokalaemia after surgery in selective patients with congenital heart disease. Ethics and dissemination This study has been approved by Ethics Review Committee at AKU. Trial registration number NCT02015962. (Source: BMJ Open)
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Rehman Siddiqu, N. u., Merchant, Q., Hasan, B. S., Rizvi, A., Amanullah, M., Rehmat, A., ul Haq, A. Tags: Open access, Cardiovascular medicine Research Source Type: research

Determinants of treatment duration in the prevention of recurrent venous thromboembolism: a protocol for a balanced vignette experiment
Introduction Venous thromboembolism (VTE) is a condition that annually occurs in approximately 1 of the world’s population. Patients who have already had a VTE are at elevated risk for a recurrent VTE. Recurrent events increase the risk of long-term sequelae and can be fatal. Adequate secondary prophylaxis is thus needed to prevent such events. Patients with VTE are often prone to bleeding, and pharmacological prophylaxis exacerbates bleeding risk. Expert opinions on the optimum duration of secondary prophylaxis in VTE still vary substantially. The existence of treatment guidelines has not led to uniformity of VTE se...
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Ten Cate, V., Essers, B. A., Prins, M. H. Tags: Open access, Research methods Protocol Source Type: research

Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory
Conclusions Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation. (Source: BMJ Open)
Source: BMJ Open - May 10, 2017 Category: General Medicine Authors: Jeffries, M., Phipps, D., Howard, R. L., Avery, A., Rodgers, S., Ashcroft, D. Tags: Open access, General practice / Family practice Research Source Type: research