BMJ open
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Randomized Controlled Trial
Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms.
During a 'cannot intubate, cannot oxygenate' situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient's life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a 'cannot intubate, cannot oxygenate' situation. ⋯ Cricothyrotomy, which is the most crucial treatment for cardiac arrest in a 'cannot intubate, cannot oxygenate' situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.
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Peer reviewers of biomedical journals are expected to perform a large number of roles and tasks, some of which are seemingly contradictory or demonstrate incongruities between the respective positions of peer reviewers and journal editors. Our aim was to explore the perspectives, expectations and understanding of the roles and tasks of peer reviewers of journal editors from general and specialty biomedical journals. ⋯ These journal editors' accounts reveal issues of a social nature within the peer-review process related to missed opportunities for journal editors to engage with peer reviewers to clarify the expected roles and tasks.Further research is needed on actual performance of peer reviewers looking into the content of peer-reviewer reports to inform meaningful training interventions, journal policies and guidelines.
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To evaluate the cost-effectiveness of the 9-valent human papillomavirus (HPV) vaccine for the prevention of cervical cancer in China. ⋯ At the current price, the 9-valent HPV vaccine is not cost-effective compared with the quadrivalent and the bivalent vaccines for young girls in China who had not been previously infected with HPV. Policymakers and clinicians should keep potential vaccine recipients informed about the economic profile of the 9-valent vaccine and carefully consider expanding its use in China at the current price.
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Physicians often suffer from burnout and stress, not only affecting themselves, but also their patients and the healthcare system in general. An increasing number of studies suggest that mindfulness-based interventions improve physicians' well-being as well as the quality of care they deliver. However, the evidence is scattered, and a systematic review and meta-analysis is lacking. To the best of our knowledge, this systematic review and meta-analysis will be the first to assess the effectiveness of mindfulness-based interventions in reducing burnout and stress among physicians. Further, it aims to uncover potential moderators of intervention effectiveness. ⋯ CRD42019133077.
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Multicenter Study
Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study.
To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality. ⋯ In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.