BMJ : British medical journal
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Cluster randomised controlled trial to compare three methods of promoting secondary prevention of coronary heart disease in primary care.
To assess the effectiveness of three different methods of promoting secondary prevention of coronary heart disease in primary care. ⋯ Setting up a register and recall system improved patient assessment at 18 months' follow up but was not consistently better than audit alone in improving treatment or risk factor levels. Understanding the reasons for this is the key next step in improving the quality of care of patients with coronary heart disease.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain.
To compare patients' preference for transdermal fentanyl or sustained release oral morphine, their level of pain control, and their quality of life after treatment. ⋯ Transdermal fentanyl was preferred to sustained release oral morphine by patients with chronic non-cancer pain previously treated with opioids. The main reason for preference was better pain relief, achieved with less constipation and an enhanced quality of life.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial.
To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care. ⋯ Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence of indicators for serious spinal disease, even if it has persisted for at least six weeks. Patients receiving radiography are more satisfied with the care they received. The challenge for primary care is to increase satisfaction without recourse to radiography.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures.
To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the safety profile of the spray. ⋯ Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures. The diamorphine spray should be used in place of intramuscular morphine.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer.
To evaluate the effectiveness of nursing intervention for breathlessness in patients with lung cancer. ⋯ Most patients who completed the study had a poor prognosis, and breathlessness was typically a symptom of their deteriorating condition. Patients who attended nursing clinics and received the breathlessness intervention experienced improvements in breathlessness, performance status, and physical and emotional states relative to control patients.