BMJ : British medical journal
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Randomized Controlled Trial Multicenter Study
Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): economic evaluation of a randomised controlled trial.
To estimate the cost to the NHS and to parents and carers of treating febrile preschool children with paracetamol, ibuprofen, or both, and to compare these costs with the benefits of each treatment regimen. ⋯ There is no strong evidence of a difference in cost between the treatments, but clinical and cost data together indicate that using both drugs together may be most cost effective over the course of the illness. This treatment option performs best and is no more expensive because of less use of healthcare resources, resulting in lower costs to the NHS and to parents.
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Multicenter Study
Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study.
To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care. ⋯ In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.
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Randomized Controlled Trial Multicenter Study Comparative Study
Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trial.
To determine the relative benefits and risks of laparoscopic fundoplication surgery as an alternative to long term drug treatment for chronic gastro-oesophageal reflux disease (GORD). ⋯ At least up to 12 months after surgery, laparoscopic fundoplication significantly increased measures of health status in patients with GORD.
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Multicenter Study
Quality of clinical aspects of call handling at Dutch out of hours centres: cross sectional national study.
To assess the quality of telephone triage by following the consecutive phases of its care process and the quality of the clinical questions asked about the patient's clinical condition, of the triage outcome, of the content of the home management advice, and of the safety net advice given at out of hours centres. ⋯ In determining the outcome of the care process, triagists often reached a conclusion after asking a minimal number of questions. By analysing the quality of different phases within the process of telephone triage, evaluation of whether an appropriate triage outcome has been arrived at by means of good clinical reasoning or by an educated guess is possible. In terms of enhancing the overall clinical safety of telephone triage, apart from obtaining an appropriate clinical history, adequate home management and safety net advice must also be given.
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Multicenter Study Comparative Study
Patient safety indicators for England from hospital administrative data: case-control analysis and comparison with US data.
To assess the feasibility of deriving patient safety indicators for England from routine hospital data and whether they can indicate adverse outcomes for patients. ⋯ Hospital administrative data provide a potentially useful low burden, low cost source of information on safety events. Indicators can be derived with English data and show that cases have poorer outcomes than matched controls. These data therefore have potential for monitoring safety events. Further validation, for example, of individual cases, is needed and levels of event recording need to improve. Differences between England and the US might reflect differences in the depth of event coding and in health systems and patterns of healthcare provision.