12,557 results match your criteria BMJ quality & safety[Journal]


Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey.

BMJ Glob Health 2020 07;5(7)

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States.

Introduction: Prolonged obstructed labour often results from lack of access to timely obstetrical care and affects millions of women. Current burden of disease estimates do not include all the physical and psychosocial sequelae from prolonged obstructed labour. This study aimed to estimate the prevalence of the full spectrum of maternal and newborn comorbidities, and create a more comprehensive burden of disease model. Read More

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http://dx.doi.org/10.1136/bmjgh-2020-002520DOI Listing

Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy.

BMJ Open 2020 Jul 6;10(7):e038843. Epub 2020 Jul 6.

National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy.

Introduction: The overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to the fact that around 90% of antibiotics are prescribed by general practitioners (GPs), this study aims to measure the impact of knowledge, attitudes and sociodemographic and workplace-related factors on the quality of antibiotic prescriptions filled by GPs in the Italian Region of Sardinia. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-038843DOI Listing

High INtensity Interval Training In pATiEnts with intermittent claudication (INITIATE): protocol for a multicentre, proof-of-concept, prospective interventional study.

BMJ Open 2020 Jul 6;10(7):e038825. Epub 2020 Jul 6.

Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.

Introduction: The first-line recommended treatment for patients with intermittent claudication (IC) is a supervised exercise programme (SEP), which includes a minimum of 2-hours of exercise per week over a 12-week period. However, provision, uptake and adherence rates for these SEP programmes are poor, with time constraints cited as a common participant barrier. High-intensity interval training (HIIT) is more time-efficient and therefore has the potential to overcome this barrier. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-038825DOI Listing

Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Protocol for a rapid realist review.

BMJ Open 2020 Jul 6;10(7):e037846. Epub 2020 Jul 6.

Mid Sussex Child Development Centre, Sussex Community NHS Foundation Trust, Haywards Heath, West Sussex, UK.

Introduction: The National Health Service (NHS) Long-Term Plan (2019) acknowledges that children and young people with suspected autism wait too long for diagnostic assessment and sets out to reduce waiting times. However, diagnostic pathways vary with limited evidence on what model works best, for whom and in what circumstances. The National Autism Plan for Children (2003) recommended that assessment should be completed within 13 weeks but referral to diagnosis can take as long as 799 days. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037846DOI Listing

Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol.

BMJ Open 2020 Jul 6;10(7):e037833. Epub 2020 Jul 6.

University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom

Introduction: Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037833DOI Listing

How do patients and the public understand overtesting and overdiagnosis? A protocol for a thematic meta-synthesis of qualitative research.

BMJ Open 2020 Jul 6;10(7):e037283. Epub 2020 Jul 6.

Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, Victoria, Australia.

Introduction: Examining patient and public understanding of overtesting and overdiagnosis (OverTD) is vital for reducing the burden of OverTD. Studies from disparate contexts, disciplines and focusing on disparate healthcare issues have examined patient and public understanding of OverTD. A synthesis is needed to bring this literature together, examine common themes, strengthen conclusions and identify gaps. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037283DOI Listing

Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review.

BMJ Open 2020 Jul 6;10(7):e036151. Epub 2020 Jul 6.

RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia.

Objective: Primary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes.

Design: Systematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-036151DOI Listing

Protocol for a phase IV, open-label feasibility study investigating non-invasive markers of hepatic fibrosis in people living with HIV-1 and non-alcoholic fatty liver disease randomised to receiving optimised background therapy (OBT) plus maraviroc or OBT alone.

BMJ Open 2020 Jul 6;10(7):e035596. Epub 2020 Jul 6.

Brighton and Sussex Medical School, Brighton, UK.

Introduction: At least 30% of people living with HIV (PLWH) infection have non-alcoholic fatty liver disease (NAFLD), which has now become a leading cause of hepatic fibrosis and cirrhosis. Management is based largely on lifestyle modifications, which are difficult to achieve, and therapeutic options are urgently needed. Maraviroc (MVC), through antagonism of CCR5 receptors, may reduce hepatic fibrosis progression and could be an effective treatment for NAFLD. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035596DOI Listing

From kamishibai card to key card: a family-targeted quality improvement initiative to reduce paediatric central line-associated bloodstream infections.

BMJ Qual Saf 2020 Jul 7. Epub 2020 Jul 7.

Pediatrics, NYU Winthrop Hospital, Mineola, New York, USA.

Background: Central line-associated bloodstream infections (CLABSIs) are major contributors to preventable harm in the inpatient paediatric setting. Despite multiple guidelines to reduce CLABSI, sustaining reliable central line maintenance bundle compliance remains elusive. We identified frontline and family engagement as key drivers for this initiative. Read More

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http://dx.doi.org/10.1136/bmjqs-2019-010666DOI Listing

Rammya Mathew: We must let patients choose how to access primary care.

Authors:
Rammya Mathew

BMJ 2020 07 7;370:m2654. Epub 2020 Jul 7.

London.

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http://dx.doi.org/10.1136/bmj.m2654DOI Listing

Comparative effectiveness of biological medicines in rheumatoid arthritis: systematic review and network meta-analysis including aggregate results from reanalysed individual patient data.

BMJ 2020 07 7;370:m2288. Epub 2020 Jul 7.

Drug Assessment Department, Institute for Quality and Efficiency in Health Care, Im Mediapark 8, Cologne 50670, Germany

Objective: To assess the comparative effectiveness of biological medicines in rheumatoid arthritis in sufficiently similar patient populations, based on the current definitions of key outcomes.

Design: Systematic review and network meta-analysis including aggregate results from reanalysed individual patient data.

Data Sources: Clinical study reports and aggregate results from reanalyses of individual patient data on key outcomes for rheumatoid arthritis provided by study sponsors for studies conducted up to 2017, and several databases and registries from inception up to February 2017. Read More

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http://dx.doi.org/10.1136/bmj.m2288DOI Listing

Milestones: a mixed methods study of an educational intervention to improve care of the dying.

BMJ Support Palliat Care 2020 Jul 6. Epub 2020 Jul 6.

UCLPartners, London, UK

Background: Approximately 460 000 people die annually in England. Three-quarters of these deaths are expected. Health Education England is prioritising upskilling of clinical staff in response to reports of poor care quality in the last days of life in acute hospitals, where almost half of all deaths occur. Read More

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http://dx.doi.org/10.1136/bmjspcare-2020-002212DOI Listing

Meaning in life and quality of life: palliative care patients versus the general population.

BMJ Support Palliat Care 2020 Jul 6. Epub 2020 Jul 6.

Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Background And Objectives: Meaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL).

Methods: A cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). Read More

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http://dx.doi.org/10.1136/bmjspcare-2020-002211DOI Listing

What is a good death? A critical discourse policy analysis.

Authors:
Erica Borgstrom

BMJ Support Palliat Care 2020 Jul 6. Epub 2020 Jul 6.

School of Health, Wellbeing and Social Care, Open University, Milton Keynes, UK

Objective: The concept of a good death is a motivating factor for end of life care policy; this article examines what English end-of-life care (EOLC) policy defines as a good death.

Methods: Critical discourse analysis of policy documents and policy-promoting materials published between 2008 and 2016.

Results: Policy explicitly defines a good death as having the following attributes: being treated as an individual, with dignity and respect; being without pain and other symptoms; being in familiar surroundings and being in the company of close family and/or friends. Read More

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http://dx.doi.org/10.1136/bmjspcare-2019-002173DOI Listing

ARTP statement on pulmonary function testing 2020.

BMJ Open Respir Res 2020 Jul;7(1)

Department of Respiratory Medicine, Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK.

The Association for Respiratory Technology & Physiology (ARTP) last produced a statement on the performance of lung function testing in 1994. At that time the focus was on a practical statement for people working in lung function laboratories. Since that time there have been many technological advances and alterations to best practice in the measurement and interpretation of lung function assessments. Read More

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http://dx.doi.org/10.1136/bmjresp-2020-000575DOI Listing

Visual impairment and social isolation, depression and life satisfaction among older adults in Ghana: analysis of the WHO's Study on global AGEing and adult health (SAGE) Wave 2.

BMJ Open Ophthalmol 2020 29;5(1):e000492. Epub 2020 Jun 29.

Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.

Aim: To estimate the prevalence of visual impairment (VI) and associated factors and further quantify its association with social isolation, depression and life satisfaction among older adults in Ghana.

Methods: WHO Study on Global AGEing and Adult Health Ghana dataset for older adults 50 years and above was used for this study. Social isolation, depression and life satisfaction were our primary outcomes with VI being our secondary outcome. Read More

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http://dx.doi.org/10.1136/bmjophth-2020-000492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326267PMC

Fostering global primary care research: a capacity-building approach.

BMJ Glob Health 2020 07;5(7)

General Practice, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.

The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research-a core element of high-quality PHC-in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Read More

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http://dx.doi.org/10.1136/bmjgh-2020-002470DOI Listing

How good is online information on fibromyalgia? An analysis of quality and readability of websites on fibromyalgia in Spanish.

BMJ Open 2020 Jul 5;10(7):e037065. Epub 2020 Jul 5.

FPSM Research Group-Physical Therapy Department, University of Alcalá de Henares, Madrid, Spain.

Objective: To assess the content, quality and readability of websites with information on fibromyalgia in Spanish.

Methods: Websites were retrieved entering the keyword 'fibromyalgia' in Google, Yahoo! and Bing, and by searching records of patients associations in Spain and Latin America. The Bermúdez-Tamayo and DISCERN questionnaires were employed for evaluating quality and content, and INFLESZ for readability. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037065DOI Listing

Safety and effectiveness of a Tai Chi-based cardiac rehabilitation programme for chronic coronary syndrom patients: study protocol for a randomised controlled trial.

BMJ Open 2020 Jul 5;10(7):e036061. Epub 2020 Jul 5.

College of Physical Education and Sports, Beijing Normal University, Beijing, China

Introduction: Preliminary evidence from clinical observations suggests that Tai Chi exercise may offer potential benefits for patients with chronic coronary syndrom (CCS). However, the advantages for CCS patients to practice Tai Chi exercise as rehabilitation have not been rigorously tested and there is a lack of consensus on its benefits. This study aims to develop an innovative Tai Chi Cardiac Rehabilitation Program (TCCRP) for CCS patients and to assess the efficacy, safety and acceptability of the programme. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-036061DOI Listing

Is reduction of routine radiograph use in patients with distal radius fractures cost effective? Analysis of data from the multicentre, randomised controlled WARRIOR trial.

BMJ Open 2020 Jul 5;10(7):e035370. Epub 2020 Jul 5.

Health Sciences, Faculty of Science, Amsterdam Movement Sciences research institute, Vrije Universiteit, Amsterdam, The Netherlands.

Objective: To assess the cost effectiveness of a reduced imaging follow-up protocol of distal radius fractures compared with usual care.

Design: An economical evaluation conducted alongside a multicentre randomised controlled trial (RCT).

Setting: Four level-one trauma centres in the Netherlands. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035370DOI Listing

Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis.

BMJ Open 2020 Jul 5;10(7):e035094. Epub 2020 Jul 5.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Introduction: Carotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid-lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035094DOI Listing

Breast cancer application protocol: a randomised controlled trial to evaluate a self-management app for breast cancer survivors.

BMJ Open 2020 Jul 5;10(7):e034655. Epub 2020 Jul 5.

Consultant in Cancer Survivorship, Gaithersburg, Maryland, USA.

Introduction: The eHealth technologies that are being designed for chronic disease constitute a global trend towards health assessment and self-management. However, most of these approaches tend to focus on a single symptom or problem rather than on the multiple problems that are characteristic of many of these chronic illnesses. The aim of this study is to examine the effectiveness of and adherence to a self-management application (app) that identifies multiple problem areas related to surviving breast cancer as the targeted chronic illness. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-034655DOI Listing

Who gets referred for knee or hip replacement? A theoretical model of the potential impact of evidence-based referral thresholds using data from a retrospective review of clinic records from an English musculoskeletal referral hub.

BMJ Open 2020 Jul 2;10(7):e028915. Epub 2020 Jul 2.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK.

Objectives: To estimate the relationship between patient characteristics and referral decisions made by musculoskeletal hubs, and to assess the possible impact of an evidence-based referral tool.

Design: Retrospective analysis of medical records and decision tree model evaluating policy changes using local and national data.

Setting: One musculoskeletal interface clinic (hub) in England. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-028915DOI Listing

Prevalence and predictors of road crash involvement among medical doctors in Malaysia: a cross-sectional study protocol.

BMJ Open 2020 Jul 2;10(7):e037653. Epub 2020 Jul 2.

Department of Research, Islamic Medical Association Malaysia, Cheras, Malaysia.

Introduction: Medical doctors are often subjected to long working hours with minimal rest in between the shifts. This has led to many fatal and non-fatal road crash involvement (RCI). This study aims to determine the prevalence and predictors of RCI among medical doctors in Malaysia. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333866PMC

Knowledge and attitude of healthcare professionals to frailty screening in primary care: a systematic review protocol.

BMJ Open 2020 Jul 2;10(7):e037523. Epub 2020 Jul 2.

Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK.

Introduction: Frailty is an increasingly common condition in which physiological decline as a result of accumulated deficits renders older people more vulnerable to adverse outcomes. An increasing range of frailty screening programmes have been introduced in primary care to identify frail older people in order to deliver appropriate interventions. However, limited information on the knowledge and attitude of healthcare professionals (HCPs) with respect to frailty screening is known. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333811PMC

Impact of a nutritional supplement (Impryl) on male fertility: study protocol of a multicentre, randomised, double-blind, placebo-controlled clinical trial (SUppleMent Male fERtility, SUMMER trial).

BMJ Open 2020 Jul 2;10(7):e035069. Epub 2020 Jul 2.

Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands.

Introduction: Infertility is a worldwide problem and about 10%-15% of all couples will be affected by the inability to have children. In approximately 50% of infertile couples, a male factor is involved. Most of the male infertile cases are characterised as 'idiopathic', except for a small percentage of cases which are causative by a genetic aetiology. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333867PMC

Prior surgical uterine evacuation of pregnancy and infertility: protocol for systematic review and meta-analysis.

BMJ Open 2020 Jul 2;10(7):e034837. Epub 2020 Jul 2.

National Research Institute for Family Planning, Beijing, China

Introduction: Prior surgical uterine evacuation is associated with an increased risk of infertility. However, findings are inconsistent, highlighting the need for a clear consensus on the effect of prior surgical uterine evacuation on the risk of infertility. Therefore, the aim of this systematic review and meta-analysis is to summarise the available evidence examining the association between prior surgical uterine evacuation and the risk of infertility. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-034837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333799PMC

Is there an association between long-term antibiotics for acne and subsequent infection sequelae and antimicrobial resistance? A systematic review protocol.

BMJ Open 2020 Jul 2;10(7):e033662. Epub 2020 Jul 2.

Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.

Introduction: Antimicrobial resistance (AMR) is a global health emergency. Acne vulgaris is a highly prevalent condition and the dominant role antibiotics play in its treatment is a major concern. Antibiotics are widely used in the treatment of acne predominantly for their anti-inflammatory effect, hence their use in acne may not be optimal. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-033662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333805PMC

Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review.

BMJ Glob Health 2020 07;5(7)

École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada.

Background: Drug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care. Read More

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http://dx.doi.org/10.1136/bmjgh-2019-002280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333807PMC

Cohort profile: Resettlement in Uprooted Groups Explored (REFUGE)-a longitudinal study of mental health and integration in adult refugees from Syria resettled in Norway between 2015 and 2017.

BMJ Open 2020 Jul 1;10(7):e036101. Epub 2020 Jul 1.

Department of Health Sciences, Red Cross University College, Stockholm, Sweden.

Purpose: In the field of forced migration and mental health research, longitudinal studies with large sample sizes and rigorous methodology are lacking. Therefore, the Resettlement in Uprooted Groups Explored (REFUGE)-study was initiated in order to enhance current knowledge on mental health, quality of life and integration among adult refugees from Syria resettled in Norway. The main aims of the study are to investigate risk and protective factors for mental ill health in a longitudinal perspective; to trace mental health trajectories and investigate important modifiers of these trajectories and to explore the association between mental health and integration in the years following resettlement. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-036101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332190PMC

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region-a qualitative study.

BMJ Open 2020 Jul 1;10(7):e035634. Epub 2020 Jul 1.

Social Work, San Diego State University, San Diego, California, USA.

Objectives: Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US-Mexico border region. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332198PMC

International prospective observational study investigating the disease course and heterogeneity of paediatric-onset inflammatory bowel disease: the protocol of the PIBD-SETQuality inception cohort study.

BMJ Open 2020 Jul 1;10(7):e035538. Epub 2020 Jul 1.

Department of Paediatric Gastroenterology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands

Introduction: Patients with paediatric-onset inflammatory bowel disease (PIBD) may develop a complicated disease course, including growth failure, bowel resection at young age and treatment-related adverse events, all of which can have significant and lasting effects on the patient's development and quality of life. Unfortunately, we are still not able to fully explain the heterogeneity between patients and their disease course and predict which patients will respond to certain therapies or are most at risk of developing a more complicated disease course. To investigate this, large prospective studies with long-term follow-up are needed. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-035538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332186PMC

Improving diagnostic specimen management systems in an oral medicine department.

BMJ Open Qual 2020 Jul;9(3)

Oral Medicine, Dental Hospital, Cardiff and Vale University Health Board, Cardiff, UK.

Histological, haematological and microbiological investigations are essential in the field of oral medicine and are a crucial adjunct to clinical findings, often being relied on to obtain a definitive diagnosis. Importantly, in some cases, these investigations can help exclude or confirm the presence of malignancy. This project highlighted some problems regarding labelling and recording of specimens in an oral medicine department and a lack of clear specimen management processes. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332196PMC

Evaluation of a learning collaborative to advance team-based care in Federally Qualified Health Centers.

BMJ Open Qual 2020 Jul;9(3)

Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA.

Practising team-based primary care allows Federally Qualified Health Centers (FQHC) in the USA to be accredited as patient-centred medical homes, positioning them for value-based models of shared savings in healthcare costs. Team-based care (TBC) involves redesign of staff roles and care delivery processes to improve efficiency and effectiveness, which requires a systematic and supportive approach to practice change over time. Thirteen FQHC primary care teams participated in an 8-month learning collaborative with a goal of providing teams with the knowledge, skills and coaching support needed to advance TBC in their organisations. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332191PMC

Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis.

BMJ 2020 07 1;370:m2516. Epub 2020 Jul 1.

Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada

Objective: To determine the diagnostic accuracy of serological tests for coronavirus disease-2019 (covid-19).

Design: Systematic review and meta-analysis.

Data Sources: Medline, bioRxiv, and medRxiv from 1 January to 30 April 2020, using subject headings or subheadings combined with text words for the concepts of covid-19 and serological tests for covid-19. Read More

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http://dx.doi.org/10.1136/bmj.m2516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327913PMC

User-testing guidelines to improve the safety of intravenous medicines administration: a randomised in situ simulation study.

BMJ Qual Saf 2020 Jun 30. Epub 2020 Jun 30.

Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.

Background: User-testing and subsequent modification of clinical guidelines increases health professionals' information retrieval and comprehension. No study has investigated whether this results in safer care.

Objective: To compare the frequency of medication errors when administering an intravenous medicine using the current National Health Service Injectable Medicines Guide (IMG) versus an IMG version revised with user-testing. Read More

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http://dx.doi.org/10.1136/bmjqs-2020-010884DOI Listing

Variation in tonsillectomy cost and revisit rates: analysis of administrative and billing data from US children's hospitals.

BMJ Qual Saf 2020 Jun 30. Epub 2020 Jun 30.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States.

Background: Tonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital.

Methods: We conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US children's hospitals using an administrative and billing data source. Read More

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http://dx.doi.org/10.1136/bmjqs-2019-010730DOI Listing

Antipsychotic pitfalls: idiopathic intracranial hypertension and antipsychotic-induced weight gain.

Authors:
Hirofumi Namiki

BMJ Case Rep 2020 Jun 30;13(6). Epub 2020 Jun 30.

Tokachi-Ikeda Community Center, Japan Association for Development of Community Medicine, Ikeda-cho, Nakagawa-gun, Hokkaido, Japan

Idiopathic intracranial hypertension (IIH) is a condition associated with poor vision and headaches that can cause disability and reduced quality of life. The onset of IIH is typically associated with sudden weight gain and obesity, which may be due to first-generation or second-generation antipsychotics. This case involved the use of quetiapine in an obese, 28-year-old woman; she gained significant weight after starting the antipsychotic and later developed headaches and blurred vision. Read More

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http://dx.doi.org/10.1136/bcr-2020-236161DOI Listing

Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis.

BMJ Open 2020 Jun 30;10(6):e038401. Epub 2020 Jun 30.

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.

Objective: To systematically review the literature exploring the associations between multimorbidity (the presence of two or more long-term conditions (LTCs)) and adverse clinical outcomes in patients with chronic kidney disease (CKD).

Design: Systematic review and meta-analysis.

Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Library and SCOPUS (1946-2019). Read More

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http://dx.doi.org/10.1136/bmjopen-2020-038401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328898PMC

Global PRoMiSe (Perioperative Recommendations for Medication Safety): protocol for a mixed-methods study.

BMJ Open 2020 Jun 30;10(6):e038313. Epub 2020 Jun 30.

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.

Introduction: Medication errors (MEs), which occur commonly in the perioperative period, have the potential to cause patient harm or death. Many published recommendations exist for preventing perioperative MEs; however, many of these recommendations conflict and are often not applicable to middle-income and low-income countries. The goal of this study is to develop and disseminate consensus-based recommendations for perioperative medication safety that are tailored to country income level. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-038313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328805PMC

mary care anagement of lower rinary tract ymptoms in men: protocol for development and validation of a diagnostic and clinical decision support tool (the PriMUS study).

BMJ Open 2020 Jun 30;10(6):e037634. Epub 2020 Jun 30.

Division of Population Medicine, Cardiff University, Cardiff, South Glamorgan, UK.

Introduction: Lower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology specialists who often recommend treatments that could have been initiated in primary care. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328815PMC

Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study.

BMJ Open 2020 Jun 30;10(6):e037385. Epub 2020 Jun 30.

Neurocritical Care Department and Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Introduction: Chronic subdural haematoma (cSDH) tends to occur in older patients, often with significant comorbidity. The incidence and effect of medical complications as well as the impact of intraoperative management strategies are now attracting increasing interest.

Objectives: We used electronic health record data to study the profile of in-hospital morbidity and examine associations between various intraoperative events and postoperative stay. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328896PMC

Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department.

BMJ Open 2020 Jun 30;10(6):e036982. Epub 2020 Jun 30.

Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA.

Introduction: Emergency department (ED) visits for behavioural conditions are rising, with 1.7 million associated episodes of patient agitation occurring annually in acute care settings. When de-escalation techniques fail during agitation management, patients are subject to use of physical restraints and sedatives, which are associated with up to 37% risk of hypotension, apnoea and physical injuries. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-036982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328814PMC

Relationship of CT densitometry to lung physiological parameters and health status in alpha-1 antitrypsin deficiency: initial report of a centralised database of the NIHR rare diseases translational research collaborative.

BMJ Open 2020 Jun 30;10(6):e036045. Epub 2020 Jun 30.

University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK

Objectives: To establish a database network for the study of alpha-1 antitrypsin deficiency (AATD) and compare the results to CT lung density as the most direct measure of emphysema.

Design: A central electronic database was established to permit the upload of anonymised patient data from remote sites. Prospectively collected CT data were recorded onto disc, anonymised, analysed at the coordinating centre and compared with the clinical features of the disease. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-036045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328802PMC

Elastic-band resistance exercise or vibration treatment in combination with hydroxymethylbutyrate (HMB) supplement for management of sarcopenia in older people: a study protocol for a single-blinded randomised controlled trial in Hong Kong.

BMJ Open 2020 Jun 30;10(6):e034921. Epub 2020 Jun 30.

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.

Introduction: Sarcopenia is a geriatric syndrome characterised by progressive loss of skeletal muscle mass and function with risks of adverse outcomes and becomes more prevalent due to ageing population. Elastic-band exercise, vibration treatment and hydroxymethylbutyrate (HMB) supplementation were previously proven to have positive effects on the control of sarcopenia. The purpose of this study is to evaluate the effectiveness of elastic-band exercise or vibration treatment with HMB supplementation in managing sarcopenia. Read More

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http://dx.doi.org/10.1136/bmjopen-2019-034921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328808PMC

Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China.

BMJ Glob Health 2020 06;5(6)

Duke Global Health Institute, Duke University, Durham, North Carolina, USA

China has the highest number of hepatitis B and C cases globally. Despite remarkable achievements, China faces daunting challenges in achieving international targets for hepatitis elimination. As part of a large-scale project assessing China's progress in achieving health-related Sustainable Development Goals using quantitative, qualitative data and mathematical modelling, this paper summarises the achievements, gaps and challenges, and proposes options for actions for hepatitis B and C control. Read More

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http://dx.doi.org/10.1136/bmjgh-2020-002306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328743PMC

Lessons learned: using adverse incident reports to investigate the characteristics and causes of prescribing errors.

BMJ Open Qual 2020 Jun;9(2)

Department of Medical Education, NHS Lanarkshire, Bothwell, Scotland, UK.

Introduction: Prescribing errors are a principal cause of preventable harm in healthcare. This study aims to establish a systematic approach to analysing prescribing-related adverse incident reports, in order to elucidate the characteristics and contributing factors of common prescribing errors and target multifaceted quality improvement initiatives.

Methods: All prescribing-related adverse incident reports submitted across one NHS board over 12 months were selected. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326251PMC

Colorectal cancer survivors' quality of life: a qualitative study of unmet need.

BMJ Support Palliat Care 2020 Jun 29. Epub 2020 Jun 29.

School of Nursing and Midwifery, Trinity College Dublin, Dublin, Dublin 2, Ireland.

Objective: Cancer survivors' perceptions of healthcare have been identified as a predictor of quality of life (QoL) outcomes. This study aims to explore colorectal cancer (CRC) survivors' perceptions of how cancer-related healthcare affects their QoL.

Methods: Semistructured interviews were conducted with 22 CRC survivors receiving follow-up care between 1 and 5 years post diagnosis. Read More

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http://dx.doi.org/10.1136/bmjspcare-2020-002190DOI Listing

Observational study on the current status of thalassaemia in Malaysia: a report from the Malaysian Thalassaemia Registry.

BMJ Open 2020 Jun 29;10(6):e037974. Epub 2020 Jun 29.

Department of Paediatrics, UKM Medical Centre, The National University of Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia

Objective: Thalassaemia is the most common inherited blood disorder in Malaysia. This study aims to report the current status of thalassaemia in Malaysia and provide a comprehensive understanding of the disease through data obtained from the Malaysian Thalassaemia Registry.

Design: Data were extracted from the Malaysian Thalassaemia Registry, a web-based system accessible to enrolled users through www. Read More

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http://dx.doi.org/10.1136/bmjopen-2020-037974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328811PMC