BMJ : British medical journal
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Multicenter Study
Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study.
To determine the association of non-invasive cardiac stress testing before elective intermediate to high risk non-cardiac surgery with survival and hospital stay. ⋯ Preoperative non-invasive cardiac stress testing is associated with improved one year survival and length of hospital stay in patients undergoing elective intermediate to high risk non-cardiac surgery. These benefits principally apply to patients with risk factors for perioperative cardiac complications.
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In older patients, the the D-dimer test for pulmonary embolism has reduced specificity and is therefore less useful. In this study a new, age dependent cut-off value for the test was devised and its usefulness with older patients assessed. ⋯ The age adjusted D-dimer cut-off point, combined with clinical probability, greatly increased the proportion of older patients in whom pulmonary embolism could be safely excluded.
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Multicenter Study
Equity in access to total joint replacement of the hip and knee in England: cross sectional study.
To explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery. ⋯ There is evidence of inequity in access to total hip and total knee replacement surgery by age, sex, deprivation, rurality, and ethnicity. Adjustment for hospital and distance did not attenuate these effects. Policy makers should examine factors at the level of patients or primary care to understand the determinants of inequitable provision.
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Multicenter Study
Risk factors at medical school for subsequent professional misconduct: multicentre retrospective case-control study.
To determine whether there are risk factors in a doctor's time at medical school that are associated with subsequent professional misconduct. ⋯ This small study suggests that male sex, a lower socioeconomic background, and early academic difficulties at medical school could be risk factors for subsequent professional misconduct. The findings are preliminary and should be interpreted with caution. Most doctors with risk factors will not come before the GMC's disciplinary panels.
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Multicenter Study
Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study.
To evaluate the effectiveness of a monovalent rotavirus vaccine against severe rotavirus disease and to assess its impact on diarrhoea in children aged less than 2 years after national introduction in El Salvador, a low-middle income country in Central America. ⋯ A monovalent rotavirus vaccine was highly effective against admissions for rotavirus diarrhoea in children aged less than 2 years in El Salvador and substantially reduced the number of such admissions in this low-middle income setting. The impact on disease epidemiology after vaccination, particularly among older children, warrants future attention.