Abstract:
PROBLEM:Despite widespread acceptance of the Ottawa ankle rules for assessment of acute ankle injuries, their application varies considerably. DESIGN:Before and after study. BACKGROUND AND SETTING:Emergency departments of a tertiary teaching hospital and a community hospital in Australia. KEY MEASURES FOR IMPROVEMENT:Documentation of the Ottawa ankle rules, proportion of patients referred for radiography, proportion of radiographs showing a fracture. STRATEGIES FOR CHANGE:Education, a problem specific radiography request form, reminders, audit and feedback, and using radiographers as "gatekeepers." EFFECTS OF CHANGE:Documentation of the Ottawa ankle rules improved from 57.5% to 94.7% at the tertiary hospital, and 51.6% to 80.8% at the community hospital (P<0.001 for both). The proportion of patients undergoing radiography fell from 95.8% to 87.2% at the tertiary hospital, and from 91.4% to 78.9% at the community hospital (P<0.001 for both). The proportion of radiographs showing a fracture increased from 20.4% to 27.1% at the tertiary hospital (P=0.069), and 15.2% to 27.2% (P=0.002) at the community hospital. The missed fracture rate increased from 0% to 2.9% at the tertiary hospital and from 0% to 1.6% at the community hospital compared with baseline (P=0.783 and P=0.747). LESSONS LEARNT:Assessment of case note documentation has limitations. Clinician groups seem to differ in their capacity and willingness to change their practice. A multifaceted change strategy including a problem specific radiography request form can improve the selection of patients for radiography.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Bessen T,Clark R,Shakib S,Hughes Gdoi
10.1136/bmj.b3056subject
Has Abstractpub_date
2009-08-12 00:00:00pages
b3056eissn
0959-8138issn
1756-1833journal_volume
339pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To study the relation between low walking speed and the risk of death in older people, both overall and with regard to the main causes of death. DESIGN:Prospective cohort study. SETTING:Dijon centre (France) of the Three-City study. PARTICIPANTS:3208 men and women aged >or=65 living in the community, recru...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b4460
更新日期:2009-11-10 00:00:00
abstract:OBJECTIVES:To provide insight into factors that contribute to the anxiety reported in a quantitative study of the psychological effect of screening for type 2 diabetes. To explore expectations of and reactions to the screening experience of patients with positive, negative, and intermediate results. DESIGN:Prospective...
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.39308.392176.BE
更新日期:2007-09-08 00:00:00
abstract:OBJECTIVE:To investigate the contribution of neuroleptic drugs to cognitive decline in dementia. DESIGN:Two year prospective, longitudinal study consisting of interviews every four months, with necropsy follow up. SETTING:Community settings in Oxfordshire. SUBJECTS:71 subjects with dementia, initially living at home...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7076.266
更新日期:1997-01-25 00:00:00
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. P...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.320.7246.1380
更新日期:2000-05-20 00:00:00
abstract:OBJECTIVE:To review the evidence base from randomised controlled trials of combined cardiac resynchronisation therapy and implantable cardioverter defibrillator therapy in left ventricular impairment and symptomatic heart failure. DESIGN:Bayesian network meta-analysis. DATA SOURCES:Medline, Embase, and Cochrane datab...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.39343.511389.BE
更新日期:2007-11-03 00:00:00
abstract:OBJECTIVES:To determine the prevalence and associations of symptoms of fatigue. DESIGN:Questionnaire survey. SETTING:London general practice. PARTICIPANTS:611 General practice attenders. MAIN OUTCOME MEASURES:Scores on a fatigue questionnaire and reasons given for fatigue. RESULTS:10.2% Of men (17/167) and 10.6% o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6762.1199
更新日期:1990-11-24 00:00:00
abstract:OBJECTIVE:To determine whether inhaled salmeterol, a new long acting inhaled beta adrenergic agonist, reduces nocturnal bronchoconstriction and improves sleep quality in patients with nocturnal asthma. DESIGN:Randomised, double blind, placebo controlled crossover study. SETTING:Hospital outpatient clinics in Edinburg...
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.301.6765.1365
更新日期:1990-12-15 00:00:00
abstract:OBJECTIVE:To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice. DESIGN:Randomised controlled trial with 18 month follow up in which women received routine follow up ...
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.313.7058.665
更新日期:1996-09-14 00:00:00
abstract:OBJECTIVES:To investigate potential determinants of severe hypoglycaemia, including baseline characteristics, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the association of severe hypoglycaemia with levels of glycated haemoglobin (haemoglobin A(1C)) achieved during therapy. DESIGN:Post ...
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.b5444
更新日期:2010-01-08 00:00:00
abstract:OBJECTIVE:To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN:Population based, prospective cohort study with follow-up over 15 years. SETTING:New South Wales, Australia. PARTICIPANTS:1642 men with localised prostate cancer, aged less than 70, an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2020-10-07 00:00:00
abstract:OBJECTIVES:To identify and calculate the prevalence of spin in studies of spin. DESIGN:Meta-research analysis (research on research). SETTING:35 studies of spin in the scientific literature. MAIN OUTCOME MEASURES:Spin, categorised as: reporting practices that distort the presentation and interpretation of results, c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
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更新日期:2019-12-18 00:00:00
abstract:OBJECTIVES:To evaluate the use of a maternity unit run by general practitioners and midwives, describing the outcome of labour in an unselected group of women and quantifying the contribution made by general practitioners. DESIGN:Retrospective population based review of obstetric patients who had access to an isolated...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1996-01-27 00:00:00
abstract:OBJECTIVES:To assess the associations between both uric acid levels and hyperuricaemia, with ischaemic heart disease and blood pressure, and to explore the potentially confounding role of body mass index. DESIGN:Mendelian randomisation analysis, using variation at specific genes (SLC2A9 (rs7442295) as an instrument fo...
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pub_type: 杂志文章
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更新日期:1999-04-03 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.300.6716.25
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更新日期:2009-07-28 00:00:00
abstract:OBJECTIVE:To analyse the cost effectiveness of a national programme to screen blood donors for infection with the human T cell leukaemia/lymphoma virus. DESIGN:Three models for calculating the costs and benefits of screening were developed. The first model analysed the cost of continuously testing all donations; the s...
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pub_type: 杂志文章
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abstract::South African Health Minister Dr. Manto Tshabalala-Msimang was accused of human rights abuse for refusing to supply zidovudine to all HIV-positive pregnant women. The accusations were laid by Dr. Costa Gazi, a South African doctor employed in the state health system with the Human Rights Commission. Dr. Gazi believe...
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pub_type: 新闻
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更新日期:2000-01-29 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2001-11-24 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1990-03-03 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1997-11-08 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2006-06-17 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
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更新日期:2005-04-23 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6910.982
更新日期:1993-10-16 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
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更新日期:2009-05-22 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
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更新日期:2009-03-05 00:00:00