Abstract:
INTRODUCTION:Children with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent-provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent-provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent-provider communication and visit satisfaction (secondary outcomes). METHODS/ANALYSIS:We will attempt to recruit all eligible paediatricians and nurse practitioners (currently 47) at an academic children's hospital and a private practice. Using a 1:1 randomisation, providers will be assigned to a higher intensity education and communication skills or lower intensity education-only intervention and trained accordingly. We will recruit 1600 eligible parent-child dyads. Parents of children ages 1-5 years who present with ARTI symptoms will be managed by providers trained in either the higher or lower intensity intervention. Before their consultation, all parents will complete a baseline survey and view a 90 s gain-framed antibiotic educational video. Parent-child dyads consulting with providers trained in the higher intensity intervention will, in addition, receive a gain-framed antibiotic educational brochure promoting cautious use of antibiotics and rate their interest in receiving an antibiotic which will be shared with their provider before the visit. All parents will complete a postconsultation survey and a 2-week follow-up phone survey. Due to the two-stage nested design (parents nested within providers and clinics), we will employ generalised linear mixed-effect regression models. ETHICS/DISSEMINATION:Ethical approval was obtained from the Children's Mercy Hospital Pediatric Institutional Review Board (#16060466). Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER:NCT03037112; Pre-results.
journal_name
BMJ Openjournal_title
BMJ openauthors
Goggin K,Bradley-Ewing A,Myers AL,Lee BR,Hurley EA,Delay KB,Schlachter S,Ramphal A,Pina K,Yu D,Weltmer K,Linnemayr S,Butler CC,Newland JGdoi
10.1136/bmjopen-2017-020981subject
Has Abstractpub_date
2018-05-09 00:00:00pages
e020981issue
5issn
2044-6055pii
bmjopen-2017-020981journal_volume
8pub_type
杂志文章,多中心研究,随机对照试验相关文献
BMJ Open文献大全abstract:OBJECTIVES:Worldwide, the Irish diaspora experience elevated mortality and morbidity across generations, not accounted for through socioeconomic position. The main objective of the present study was to assess if childhood disadvantage accounts for poorer mental and physical health in adulthood, in second-generation Iri...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001335
更新日期:2013-03-01 00:00:00
abstract:INTRODUCTION:As a combination of visual stimulation and motor imagery, mirror visual feedback (MVF) is an effective treatment for motor impairment after stroke; however, few studies have investigated its effects on relevant cognitive processes such as visual perception and motor imagery. Camera-based MVF (camMVF) overc...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022828
更新日期:2019-03-03 00:00:00
abstract:OBJECTIVES:To assess the effectiveness of a combined classroom curriculum and parental intervention (the Steps Towards Alcohol Misuse Prevention Programme (STAMPP)), compared with alcohol education as normal (EAN), in reducing self-reported heavy episodic drinking (HED) and alcohol-related harms (ARHs) in adolescents. ...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-019722
更新日期:2018-03-09 00:00:00
abstract:INTRODUCTION:Premature infants are particularly vulnerable to brain injuries with associated cognitive and behavioural deficits. The worldwide first randomised interventional multicentre trial investigating the neuroprotective effects of erythropoietin (entitled 'Does erythropoietin improve outcome in very preterm infa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022157
更新日期:2018-04-24 00:00:00
abstract:BACKGROUND:Substantial amounts of public funds are invested in health research worldwide. Publicly funded randomised controlled trials (RCTs) often recruit participants at a slower than anticipated rate. Many trials fail to reach their planned sample size within the envisaged trial timescale and trial funding envelope....
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2016-015276
更新日期:2017-03-20 00:00:00
abstract:BACKGROUND:More than two decades of conflict and natural disasters in Somalia have resulted in one of the longest running humanitarian crises in the world. Nutrition data have been collected over the years despite challenges to inform programmatic action. This paper explores malnutrition and morbidity trends in Somalia...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033148
更新日期:2020-02-17 00:00:00
abstract:OBJECTIVE:To explore factors associated with the psychological well-being of junior doctors in Australia. DESIGN:Qualitative study using semistructured interviews. SETTING:Three teaching hospitals in Brisbane, Queensland, Australia. PARTICIPANTS:Fifteen junior medical officers (postgraduate year 2 doctors) employed ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2018-027558
更新日期:2019-06-12 00:00:00
abstract:OBJECTIVE:To compare the benefits and harms of a Dutch 10-session Community Occupational Therapy programme for patients with Alzheimer's disease with the impact of a one session consultation at home in German routine healthcare. DESIGN:A seven-centre, parallel group, active controlled randomised controlled trial. Pati...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2011-000096
更新日期:2011-08-09 00:00:00
abstract:BACKGROUND:Health risk behaviours are prominent in late adolescence and young adulthood, yet UK population-level research examining the relationship between drug or alcohol use and sexual health and behaviour among young people is scarce, despite public health calls for an integrated approach to health improvement. Our...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011961
更新日期:2016-06-30 00:00:00
abstract:INTRODUCTION:Neurological injury remains the major cause of morbidity and mortality following open aortic arch repair. Systemic hypothermia along with antegrade cerebral perfusion (ACP) is the accepted cerebral protection approach, with axillary artery cannulation being the most common technique used to establish ACP. ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2016-014491
更新日期:2017-06-10 00:00:00
abstract:OBJECTIVES:To assess the current health of the Deaf community in the UK and compare with the general population. DESIGN:A quota sample of adult Deaf British Sign Language (BSL) users underwent a health assessment and interview in 2012-2013. Comparative data were obtained from the Health Survey for England (HSE) 2011 a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-006668
更新日期:2015-01-25 00:00:00
abstract:OBJECTIVES:To investigate the association between area deprivation at municipality level with low perceived social support, independent of individual socioeconomic position and demographic characteristics. To assess whether there are gender inequalities in this association. DESIGN:Cross-sectional multilevel analysis o...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-019973
更新日期:2018-04-12 00:00:00
abstract:INTRODUCTION:Depression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-026973
更新日期:2019-05-14 00:00:00
abstract:OBJECTIVES:This study examined patient adherence and persistence to oral bisphosphonates for the treatment of osteoporosis in real-world settings. METHODS:A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medical Literature Analysis and Retrieval Sys...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-027049
更新日期:2019-04-14 00:00:00
abstract:INTRODUCTION:Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of thi...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-025744
更新日期:2019-05-24 00:00:00
abstract:OBJECTIVE:To determine if low-dose weekly chloroquine (CQ) therapy improves recovery from malaria-associated anaemia. DESIGN:Proof of concept randomised clinical trial. SETTING:West Kiang District, Lower River Region, The Gambia. PARTICIPANTS:Children resident in participating communities, aged 12-72 months, with un...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-002666
更新日期:2013-07-04 00:00:00
abstract:INTRODUCTION:Perioperative benzodiazepines are used because of their anxiolytic, sedative and amnestic effects. Evidence has demonstrated an association of benzodiazepines with adverse neuropsychiatric effects. Nonetheless, because of their potential benefits, perioperative benzodiazepines continue to be used routinely...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031895
更新日期:2019-12-11 00:00:00
abstract:OBJECTIVE:Chronic kidney disease (CKD) is often a multimorbid condition and progression to more severe disease is commonly associated with increased management requirements, including lifestyle change, more medication and greater clinician involvement. This study explored patients' and kidney care team's perspectives o...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-042548
更新日期:2020-12-12 00:00:00
abstract:INTRODUCTION:Binge-eating disorder (BED) was included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An increasing number of treatment studies have been published, but an up-to-date comprehensive meta-analysis on diverse treatment approaches for B...
journal_title:BMJ open
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmjopen-2016-013655
更新日期:2017-03-29 00:00:00
abstract:OBJECTIVES:Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2019-031781
更新日期:2019-08-27 00:00:00
abstract:OBJECTIVE:Many studies have suggested exposure to secondhand smoke (SHS) is a risk factor for various somatic diseases, but only few studies based on small sample size or specific groups have explored the association between passive smoking and mental distress. We performed this study to examine the relationship betwee...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011671
更新日期:2016-07-29 00:00:00
abstract:INTRODUCTION:Anaemia is a major global health problem affecting about 43% of preschool children globally and 60% of 6-24-month-old children in rural Bangladesh, half of which is attributed to iron deficiency (ID). Although WHO recommends universal supplementation with iron or home fortification with iron-containing mul...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-018325
更新日期:2017-11-15 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) is associated with a high risk of stroke and may often be asymptomatic. AF is commonly undiagnosed until patients present with sequelae, such as heart failure and stroke. Stroke secondary to AF is highly preventable with the use of appropriate thromboprophylaxis. Therefore, early ide...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001355
更新日期:2012-06-25 00:00:00
abstract:OBJECTIVES:To assess the relationship between occupational health and safety (OH&S)-related behaviours of migrating workers in China and their knowledge regarding OH&S laws and regulations (L&Rs). MATERIALS AND METHODS:We sampled 1282 migrant workers from 12 labour-intensive manufacturers in Guangdong, China, with a r...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-040143
更新日期:2020-12-01 00:00:00
abstract:INTRODUCTION:Trauma to the nail bed is the most common surgically treated paediatric hand injury. The majority of surgeons replace the nail plate after repairing the nail bed despite a lack of evidence to do so. Replacing the nail plate may be associated with increased postoperative infection. We will investigate the i...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031552
更新日期:2019-12-04 00:00:00
abstract:OBJECTIVES:Determine how general practitioners (GPs) manage patients with cancer symptoms. DESIGN:GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to availabl...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-008525
更新日期:2015-09-14 00:00:00
abstract:OBJECTIVES:To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention called Emergency Contraception Mediated Pharmacy Access to Chlamydia Testing (ECOMPACT). DESIGN:Selective, opportunistic and cross-sectional study targeting asymptomatic women requesting emergency...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-003338
更新日期:2013-08-17 00:00:00
abstract:INTRODUCTION:Eye diseases and visual impairment more commonly affect elderly adults, thus, the majority of ophthalmic cohort studies have focused on older adults. Cohort studies on the ocular health of younger adults, on the other hand, have been few. The Raine Study is a longitudinal study that has been following a co...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033440
更新日期:2020-03-25 00:00:00
abstract:INTRODUCTION:Global multidrug-resistant tuberculosis (MDR-TB) treatment success rates remain suboptimal. Highly active WHO group A drugs moxifloxacin and levofloxacin show intraindividual and interindividual pharmacokinetic variability which can cause low drug exposure. Therefore, therapeutic drug monitoring (TDM) of f...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-035350
更新日期:2020-06-16 00:00:00
abstract:INTRODUCTION:Women at high inherited risk of ovarian cancer are advised to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 40-45 years or when their families are complete. Most women are premenopausal at this age, so RRBSO will induce surgical menopause. Despite the clear benefits of RRBSO for canc...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2017-018758
更新日期:2017-11-14 00:00:00