Abstract:
OBJECTIVE:To investigate the impact of patients' preferences for the treatment of atrial fibrillation, by using individualised decision analysis combining probability and utility assessments into a decision tree. DESIGN:Observational study based on interviews with patients. SETTING:Eight general practices in Avon. PARTICIPANTS:260 randomly selected patients aged 70-85 years with atrial fibrillation. MAIN OUTCOME MEASURES:Patients' treatment preferences regarding anticoagulation treatment (warfarin) after individualised decision analysis; comparison of these preferences with treatment guidelines on the basis of comorbidity and absolute risk and compared with current prescription. RESULTS:Of 195 eligible patients, 97 participated in decision making using decision analysis. Among these 97, the decision analysis indicated that 59 (61%; 95% confidence interval 50% to 71%) would prefer anticoagulation treatment-considerably fewer than those who would be recommended treatment according to guidelines. There was marked disagreement between the decision analysis and guideline recommendations (kappa=0.25 or less). Of 38 patients whose decision analysis indicated a preference for anticoagulation, 17 (45%) were being prescribed warfarin; on the other hand, 28 (47%) of 59 patients were not being prescribed warfarin although the results of their decision analysis suggested they wanted to be. CONCLUSIONS:In the context of shared decision making, individualised decision analysis is valuable in a sizeable proportion of elderly patients with atrial fibrillation. Taking account of patients' preferences would lead to fewer prescriptions for warfarin than under published guideline recommendations. Decision analysis as a shared decision making tool should be evaluated in a randomised controlled trial.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Protheroe J,Fahey T,Montgomery AA,Peters TJdoi
10.1136/bmj.320.7246.1380keywords:
subject
Has Abstractpub_date
2000-05-20 00:00:00pages
1380-4issue
7246eissn
0959-8138issn
1756-1833journal_volume
320pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To estimate the risk of having a low birthweight infant associated with changes in social, environmental, and genetic factors. DESIGN:Population based, historical cohort study using the Danish medical birth registry and Statistic Denmark's fertility database. SUBJECTS:All women who had a low birthweight inf...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7121.1498
更新日期:1997-12-06 00:00:00
abstract:OBJECTIVE:To compare incidences of perinatal mortality and severe perinatal morbidity between low risk term pregnancies supervised in primary care by a midwife and high risk pregnancies supervised in secondary care by an obstetrician. DESIGN:Prospective cohort study using aggregated data from a national perinatal regi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c5639
更新日期:2010-11-02 00:00:00
abstract:OBJECTIVE:To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN:Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING:All 95 general practices in Grampian region (313 gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6830.816
更新日期:1992-03-28 00:00:00
abstract:OBJECTIVE:To assess the risk of adverse perinatal events of vaccination of pregnant women with an MF59 adjuvanted vaccine. DESIGN:Cross sectional multicentre study. SETTING:49 public hospitals in major cities in Argentina, from September 2010 to May 2011. PARTICIPANTS:30,448 mothers (7293 vaccinated) and their 30,76...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.f393
更新日期:2013-02-04 00:00:00
abstract:OBJECTIVES:To evaluate the risk of venous thromboembolic events associated with the use of progestin-only contraception and whether that risk differs with the mode of drug delivery (oral, intrauterine, or depot injection). DESIGN:Systematic review and meta-analysis of randomised controlled trials and observational stu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.e4944
更新日期:2012-08-07 00:00:00
abstract:OBJECTIVE:To compare perinatal outcomes in births of women with versus without a history of bariatric surgery. DESIGN:Population based matched cohort study. SETTING:Swedish national health service. PARTICIPANTS:1,742,702 singleton births identified in the Swedish medical birth register between 1992 and 2009. For eac...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f6460
更新日期:2013-11-12 00:00:00
abstract:OBJECTIVE:To examine association of different measures of serum lipid concentration and obesity with mortality in women. DESIGN:Prospective observational study initiated in 1968-9, follow up examination after 12 years, and follow up study based on death certificates after 20 years. SETTING:Gothenburg, Sweden. SUBJEC...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6916.1385
更新日期:1993-11-27 00:00:00
abstract:OBJECTIVE:To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity. DESIGN:Population based cohort study. SETTING:Sweden. PARTICIPANTS:1 551 436 non-malformed live singleton infants, born at term (≥37 weeks' gestation) between 1999 and ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.l1656
更新日期:2019-05-07 00:00:00
abstract:OBJECTIVE:To examine the effectiveness of parenteral corticosteroids for the relief of acute severe migraine headache and prevention of recurrent headaches. DESIGN:Meta-analysis. DATA SOURCES:Electronic databases (Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, and CINAHL), conference proceed...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.39566.806725.BE
更新日期:2008-06-14 00:00:00
abstract:OBJECTIVE:To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. DESIGN:Pragmatic, open, multicentre, randomised controlled trial. SETTING:11 hospitals in ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38849.478299.7C
更新日期:2006-06-17 00:00:00
abstract::Objective To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.Design Mendelian randomisation study, using genetic data as proxies for education to minimise confounding.Setting The main analysis used genetic data from two large consortia (CARDIoGRAMplusC4D an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3542
更新日期:2017-08-30 00:00:00
abstract:OBJECTIVE:To determine whether a relation between urinary retention and temporal rhythms exists. DESIGN:Retrospective analysis of patients presenting over three years. SETTING:Urology departments in two hospitals. PATIENTS:815 Patients presenting as emergency admissions with urinary retention and requiring immediate...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6715.1560
更新日期:1989-12-23 00:00:00
abstract::In the existing WHO guidelines, complementary feeding at 4-6 months is advocated. However, many nutrition specialists believe that these guidelines lead to complementary foods being offered from the age of 3 months, or even earlier, subsequently suggesting that the WHO should change its recommendations to about 6 mon...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:
更新日期:2000-09-09 00:00:00
abstract:OBJECTIVE:To identify historical and clinical findings at emergency department presentation associated with severe H1N1 outcome in children presenting with influenza-like illness. DESIGN:Multicentre retrospective case-control study. SETTING:79 emergency departments of hospitals associated with the Pediatric Emergency...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.f4836
更新日期:2013-08-12 00:00:00
abstract::Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7024.169
更新日期:1996-01-20 00:00:00
abstract:OBJECTIVE:To determine the effect of four monthly vitamin D supplementation on the rate of fractures in men and women aged 65 years and over living in the community. DESIGN:Randomised double blind controlled trial of 100 000 IU oral vitamin D3 (cholecalciferol) supplementation or matching placebo every four months ove...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.326.7387.469
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:To examine changes in representation of women among first authors of original research published in high impact general medical journals from 1994 to 2014 and investigate differences between journals. DESIGN:Observational study. STUDY SAMPLE:All original research articles published in Annals of Internal Med...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.i847
更新日期:2016-03-02 00:00:00
abstract:OBJECTIVE:To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN:Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING:England and Wales. SUBJECTS:Children aged 0-15 years. MAIN OU...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7060.784
更新日期:1996-09-28 00:00:00
abstract:OBJECTIVE:To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children. Design Randomised controlled clinical trial in collaboration with family paediatricians over 12 months. SETTING:Primary care. PARTICIPANTS:Children aged 3-36 months visiting a famil...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.39272.581736.55
更新日期:2007-08-18 00:00:00
abstract:OBJECTIVE:To describe and quantify patterns of injury from antipersonnel mines in terms of distribution of injury, drain on surgical resources, and residual disability. DESIGN:Retrospective analysis. SETTING:Two hospitals for patients injured in war. SUBJECTS:757 patients with injuries from antipersonnel mines. MAI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6816.1509
更新日期:1991-12-14 00:00:00
abstract:OBJECTIVE:To determine whether rates of suicide changed in Toronto after a barrier was erected at Bloor Street Viaduct, the bridge with the world's second highest annual rate of suicide by jumping after Golden Gate Bridge in San Francisco. DESIGN:Natural experiment. SETTING:City of Toronto and province of Ontario, Ca...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c2884
更新日期:2010-07-06 00:00:00
abstract::Current services for those with mental disorders show two trends. Psychiatric services are becoming concentrated on the care of those with "severe mental illness," largely (but unjustifiably) synonymous with chronic psychosis. The retreat of psychiatry from the care of those with non-psychotic mental disorders has hel...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7050.158
更新日期:1996-07-20 00:00:00
abstract:OBJECTIVE:To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. DESIGN:Prospective comparison of patients with postviral fatigue syndrome with two control groups. SETTING:Department of neurology, University of Glasgow, Southern General Hospital; depar...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6833.1010
更新日期:1992-04-18 00:00:00
abstract:OBJECTIVE:To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN:Retrospective data on primary care were collected over a 4.5 year period fro...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7073.38
更新日期:1997-01-04 00:00:00
abstract:OBJECTIVES:To investigate trends in the incidence of acute pancreatitis resulting in admission to hospital, and mortality after admission, from 1963 to 1998. DESIGN:Analysis of hospital inpatient statistics for acute pancreatitis, linked to data from death certificates. SETTING:Southern England. SUBJECTS:5312 people...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.328.7454.1466
更新日期:2004-06-19 00:00:00
abstract:OBJECTIVE:To establish the extent to which systematic reviews and meta-analyses of individual participant data (IPD) are being used to inform the recommendations included in published clinical guidelines. DESIGN:Descriptive study. SETTING:Database maintained by the Cochrane IPD Meta-analysis Methods Group, supplement...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h1088
更新日期:2015-03-06 00:00:00
abstract:OBJECTIVE:To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. DESIGN:Systematic review. ELIGIBILITY CRITERIA:Studies that compared the association between conflicts of interest and favour...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m4234
更新日期:2020-12-09 00:00:00
abstract:OBJECTIVE:To compare the prevalence of antibody to and proviral DNA of the retrovirus HTLV-I in relatives of 11 British patients with tropical spastic paraparesis who had migrated from Jamaica before they developed symptoms, and to examine factors possibly related to transmission of HTLV-I. DESIGN:Migrant, family stud...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6720.300
更新日期:1990-02-03 00:00:00
abstract:OBJECTIVE:To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35. DESIGN:Randomised, phase III...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.k3478
更新日期:2018-09-12 00:00:00
abstract:OBJECTIVE:To determine whether diurnal variation occurs in the onset of stroke. DESIGN:Community based study over four years. SETTING:Oxfordshire, United Kingdom. SUBJECTS:105,000 people, of whom 675 had a first ever stroke. 545 had a cerebral infarction, 66 had primary intracerebral haemorrhage, 33 had subarachnoid...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6820.155
更新日期:1992-01-18 00:00:00