Abstract:
INTRODUCTION:Cryptococcal meningitis is responsible for around 15% of all HIV-related deaths globally. Conventional treatment courses with amphotericin B require prolonged hospitalisation and are associated with multiple toxicities and poor outcomes. A phase II study has shown that a single high dose of liposomal amphotericin may be comparable to standard treatment. We propose a phase III clinical endpoint trial comparing single, high-dose liposomal amphotericin with the WHO recommended first-line treatment at six sites across five counties. An economic analysis is essential to support wide-scale implementation. METHODS AND ANALYSIS:Country-specific economic evaluation tools will be developed across the five country settings. Details of patient and household out-of-pocket expenses and any catastrophic healthcare expenditure incurred will be collected via interviews from trial patients. Health service patient costs and related household expenditure in both arms will be compared over the trial period in a probabilistic approach, using Monte Carlo bootstrapping methods. Costing information and number of life-years survived will be used as the input to a decision-analytic model to assess the cost-effectiveness of a single, high-dose liposomal amphotericin to the standard treatment. In addition, these results will be compared with a historical cohort from another clinical trial. ETHICS AND DISSEMINATION:The AMBIsome Therapy Induction OptimisatioN (AMBITION) trial has been evaluated and approved by the London School of Hygiene and Tropical Medicine, University of Botswana, Malawi National Health Sciences, University of Cape Town, Mulago Hospital and Zimbabwe Medical Research Council research ethics committees. All participants will provide written informed consent or if lacking capacity will have consent provided by a proxy. The findings of this economic analysis, part of the AMBITION trial, will be disseminated through peer-reviewed publications and at international and country-level policy meetings. TRIAL REGISTRATION:ISRCTN 7250 9687; Pre-results.
journal_name
BMJ Openjournal_title
BMJ openauthors
Ponatshego PL,Lawrence DS,Youssouf N,Molloy SF,Alufandika M,Bango F,Boulware DR,Chawinga C,Dziwani E,Gondwe E,Hlupeni A,Hosseinipour MC,Kanyama C,Meya DB,Mosepele M,Muthoga C,Muzoora CK,Mwandumba H,Ndhlovu CE,Rajasidoi
10.1136/bmjopen-2018-026288subject
Has Abstractpub_date
2019-04-01 00:00:00pages
e026288issue
4issn
2044-6055pii
bmjopen-2018-026288journal_volume
9pub_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:We piloted an intervention to determine if support from a case manager would assist adults being investigated for tuberculosis (TB) to link into TB and HIV care. DESIGN:Pilot interventional cohort study. PARTICIPANTS AND SETTING:Patients identified by primary healthcare clinic staff in South Africa as need...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-021111
更新日期:2018-05-24 00:00:00
abstract:INTRODUCTION:Chronic obstructive pulmonary disease (COPD) exacerbations progress the course of disease and impair lung function. Inhaled maintenance therapy reduces exacerbations. It is not yet established which inhaled therapy combination is best to reduce exacerbations, lung function decline and symptom burden. METH...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-025048
更新日期:2019-02-20 00:00:00
abstract:OBJECTIVE:To examine the role of dietary intake and physical activity in muscle strength among adolescents. DESIGN:Cross-sectional analysis. SETTING:The Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study. PARTICIPANTS:Fifteen-year-old secondary school children who have given consent and who ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-026275
更新日期:2019-06-27 00:00:00
abstract:OBJECTIVES:Sickness absence after mild traumatic brain injury (mTBI) is frequent due to postconcussive symptoms. We examined labour market attachment following mTBI up to 5 years postinjury. DESIGN AND SETTING:Nationwide cohort study with register follow-up. PARTICIPANTS:Patients between 18 and 60 years with mTBI (In...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2018-026104
更新日期:2019-04-11 00:00:00
abstract:OBJECTIVE:Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-bas...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-021388
更新日期:2018-04-12 00:00:00
abstract:INTRODUCTION:In Australia, an estimated 90% of those entering prison are current tobacco smokers and three-quarters of current prisoners are tobacco smokers. AIMS:To identify factors and their relative contributions to smoking cessation among male prisoners. METHODS:A total of 425 male tobacco smokers with a median a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034046
更新日期:2020-07-20 00:00:00
abstract:OBJECTIVE:In ST elevation myocardial infarction women received less evidence-based medicine and had worse outcome during the fibrinolytic era. With the shift to primary percutaneous coronary intervention (pPCI) as preferred reperfusion strategy, the authors aimed to investigate whether these gender differences has dimi...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2011-000726
更新日期:2012-03-27 00:00:00
abstract:OBJECTIVE:To map out the current provision of interventional oncology (IO) services in the UK. DESIGN:Cross-sectional multicentre study. SETTING:All National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards. PARTICIPANTS:Interventional radiology (IR) departments in all NH...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-016631
更新日期:2017-10-22 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The Kumamoto earthquakes struck Kumamoto prefecture, in the southwest part of Japan in April 2016. Physical and mental disorders presenting to hospital increased after the 2016 Kumamoto earthquakes. Impaired access to primary care due to the earthquakes may have contributed to this increase. H...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-021294
更新日期:2018-07-12 00:00:00
abstract:OBJECTIVE:To investigate the effects of congruence between preferred and perceived learning environments on learning outcomes of nursing students. SETTING:A nursing course at a university in central Taiwan. PARTICIPANTS:124 Taiwanese nursing students enrolled in a 13-week problem-based Fundamental Nursing curriculum....
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-009925
更新日期:2016-05-20 00:00:00
abstract:PURPOSE:Acute-on-chronic liver failure (ACLF) is a clinical syndrome with high short-term mortality, unclear mechanism and controversial diagnosis criteria. The Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study has been conducted in China to fill the gaps. In the first phase (the CATCH-LIFE investigation cohort...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-037793
更新日期:2021-01-08 00:00:00
abstract:INTRODUCTION:Returning to work can be problematic for cancer survivors due to suboptimal workplace support, a heavy workload, decreased physical functioning and fatigue. The timely and permanent return to work (RtW) of cancer patients favourably influences quality of life and economic independence. Multidisciplinary in...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001321
更新日期:2012-07-10 00:00:00
abstract:INTRODUCTION:Low vision and blindness adversely affect education and independence of children and young people. New 'assistive' technologies such as tablet computers can display text in enlarged font, read text out to the user, allow speech input and conversion into typed text, offer document and spreadsheet processing...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-015939
更新日期:2017-06-21 00:00:00
abstract:OBJECTIVE:To examine newspaper coverage of maternal health in three countries that have made varying progress towards Millennium Development Goal 5 (MDG 5): Bangladesh (on track), Rwanda (making progress, but not on track) and South Africa (no progress). DESIGN:We analysed each country's leading national English-langu...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2015-008837
更新日期:2016-01-13 00:00:00
abstract:INTRODUCTION:To advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elem...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-032788
更新日期:2019-11-06 00:00:00
abstract:INTRODUCTION:With the rapid ageing of the population in Europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged po...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-029338
更新日期:2019-06-20 00:00:00
abstract:OBJECTIVES:To compare the short-term and long-term effectiveness of human papillomavirus (HPV) tests in Norwegian Cervical Cancer Screening Programme (NCCSP). DESIGN:Nationwide register-based prospective follow-up study. SETTING:In 2005, the NCCSP implemented HPV testing in follow-up of unsatisfactory, atypical squam...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-003460
更新日期:2014-01-08 00:00:00
abstract:OBJECTIVES:To measure work-related burnout in all groups of health service staff during the COVID-19 pandemic and to identify factors associated with work-related burnout. DESIGN:Cross-sectional staff survey. SETTING:All staff grades and types across primary and secondary care in a single National Health Service orga...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-042591
更新日期:2021-01-28 00:00:00
abstract:OBJECTIVE:The evaluation of discomfort in paediatric research is scarcely evidence-based. In this study, we make a start in describing children's self-reported discomfort during common medical research procedures and compare this with discomfort during dental check-ups which can be considered as a reference level of a ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-016077
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:To synthesise qualitative studies on women's psychological experiences of physiological childbirth. DESIGN:Meta-synthesis. METHODS:Studies exploring women's psychological experiences of physiological birth using qualitative methods were eligible. The research group searched the following databases: MEDLINE,...
journal_title:BMJ open
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmjopen-2017-020347
更新日期:2018-10-18 00:00:00
abstract:OBJECTIVES:This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation. DESIGN:Population-based prospective cohort study. SETTING:ED of a large university hospital. PARTICIPANTS:A...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-026881
更新日期:2019-04-24 00:00:00
abstract:INTRODUCTION:Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of insomnia. A systematic review of the available literature on this topic is warranted. The systematic review described in this protocol aims to investigate the ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-029206
更新日期:2019-07-16 00:00:00
abstract:INTRODUCTION:The BCG vaccine is designed to protect against tuberculosis, but the vaccine may have broader effects. In 2014, the Strategic Advisory Group of Experts on Immunization reviewed the literature on non-specific effects of BCG, and concluded that the evidence was consistent with beneficial non-specific effects...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-025724
更新日期:2019-09-24 00:00:00
abstract:BACKGROUND:The last two decades have seen an increase in literature reporting an increase in knowledge and use of contraceptives among individuals and couples in Kenya, as in the rest of Africa, but there is a dearth of information regarding knowledge about benefits of family planning (FP) in Kenya. OBJECTIVES:To asse...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-004643
更新日期:2014-03-18 00:00:00
abstract:OBJECTIVES:To examine the association between smoking cessation attempts during the previous 12 months, motivators to quit smoking and nicotine dependence levels among current male smokers after Japan's massive 2010 tobacco tax increase. DESIGN:Cross-sectional study. SETTING:A self-reported questionnaire about smokin...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-006658
更新日期:2015-03-20 00:00:00
abstract:OBJECTIVE:To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon. DESIGN:A retrospective cohort study. SETTING:A tertiary care centre in Rotterdam. PARTICIPANTS:From January 2000 to December 2005, 6332 patients undergoing percutaneous c...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2011-000535
更新日期:2012-02-09 00:00:00
abstract:OBJECTIVE:The aim of the present study was to investigate the prevalence of abnormal cholesterol levels and to explore awareness of cholesterol values in an unselected sample of community-living adults. DESIGN:Cross-sectional survey. SETTING:Exhibitions, malls and health promotion campaigns across Italy. PARTICIPANT...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-021627
更新日期:2018-06-30 00:00:00
abstract:INTRODUCTION:Physical activity is an integral part of healthy ageing, yet the majority of older adults 65+ years are not sufficiently active. Web-based physical activity interventions hold much promise to reach older adults. Preliminary evidence suggests that web-based interventions with tailored advice and Fitbits may...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033305
更新日期:2019-12-23 00:00:00
abstract:INTRODUCTION:Physical activity (PA) has diverse benefits for physical and mental health and can reduce symptoms of mental illness. Adults with mental illness face practical, psychosocial and socioeconomic barriers to adopting and maintaining PA, and it is unclear how to effectively promote PA in this group. Supervised ...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2018-023460
更新日期:2018-09-08 00:00:00
abstract:INTRODUCTION:Falls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034279
更新日期:2020-02-25 00:00:00