BMJ : British medical journal
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Multicenter Study
The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study.
To assess the thrombotic risk associated with oral contraceptive use with a focus on dose of oestrogen and type of progestogen of oral contraceptives available in the Netherlands. ⋯ Currently available oral contraceptives still have a major impact on thrombosis occurrence and many women do not use the safest brands with regard to risk of venous thrombosis.
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Multicenter Study
Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support.
To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor. ⋯ Trainees consider not only clinical implications but also professional credibility when requesting support from clinical supervisors. Exposing the complexity of this process provides the opportunity to make changes to training programmes to promote timely supervision and provides a framework for further exploration of the impact of clinical training on quality of care of patients.
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Randomized Controlled Trial
Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial.
To determine the risk of colorectal cancer after screening with flexible sigmoidoscopy. ⋯ A reduction in incidence of colorectal cancer with flexible sigmoidoscopy screening could not be shown after 7 years' follow-up. Mortality from colorectal cancer was not significantly reduced in the screening group but seemed to be lower for attenders, with a reduction of 59% for any location of colorectal cancer and 76% for rectosigmoidal cancer in per protocol analysis, an analysis prone to selection bias.
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Multicenter Study
Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis.
To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6. ⋯ Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study.
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Multicenter Study
A multifaceted strategy for implementation of the Ottawa ankle rules in two emergency departments.
Despite widespread acceptance of the Ottawa ankle rules for assessment of acute ankle injuries, their application varies considerably. ⋯ Assessment of case note documentation has limitations. Clinician groups seem to differ in their capacity and willingness to change their practice. A multifaceted change strategy including a problem specific radiography request form can improve the selection of patients for radiography.