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Background Most telephone quitlines provide free nicotine replacement therapy (NRT). An 8-week course is recommended, but few users complete it. Information is needed to help quitlines distribute NRT cost-effectively. Design Randomised two-group trial. Setting/participants Colorado QuitLine callers who smoked 16-20 cigarettes per day at enrolment and who were eligible for and agreed to receive free NRT. Intervention Provision of 4-week versus 8-week NRT supply; the 8-week supply was shipped in halves and required participants to request the second half (split-shipment protocol). Enrolment occurred during March 2010-February 2011, follow-up concluded in November 2011, and analysis was performed in 2012. Main outcome measures Point abstinence (7 and 30 day) and prolonged abstinence (6 month) from tobacco use. Results Overall, 1495 study participants were enrolled and 57.7% completed follow-up. Abstinence rates did not differ significantly between study conditions: 13.8% versus 12.4% in 4-week versus 8-week arms, respectively, (30-day point abstinence, non-respondents treated as smokers). NRT duration was similar in both groups, due in part to purchase of additional patches in the 4-week group. About one-third of the 8-week group requested the full 8-week supply and had higher abstinence rates. Cost per quit was lower in the 4-week (compared to 8-week) group. Conclusions A randomised trial did not find worse cessation outcomes among quitline users who received half the minimum recommended course of NRT, but offering the full recommended course using a split-shipment protocol may be reasonably cost-effective and supportive of NRT adherers. Trial registration number NCT01889771. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Can one tablet containing aspirin, statin, and blood pressure lowering agents improve adherence and risk factor control compared with usual care of patients at high risk of cardiovascular disease in primary care? SUMMARY ANSWER Fixed dose combination treatment improved adherence to all the recommended drugs, but improvements in clinical risk factors were small and did not reach statistical significance. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Two recent long term trials indicate large improvements in self reported adherence to the recommended drugs and modest improvements in risk factor control in high risk patients receiving fixed dose combination treatment. The main findings of this trial were consistent with those of the earlier trials, and acceptability for this treatment was high among general practitioners and patients. [ABSTRACT FROM AUTHOR]

The article discusses a randomised controlled trial to identify patients who may benefit from an endovascular strategy. Eligible patients with a clinical diagnosis of ruptured aneurysm were recruited at 29 vascular centers in Great Britain and one Canadian centre. It indicates that women appeared to benefit more than men from an endovascular strategy although there was no convincing differences with respect to Hardman index or age.

The article discusses various aspects of using financial incentives to encourage people with psychosis to adhere to maintenance treatment with antipsychotics. It highlights evidence supporting the idea that financial incentives have a beneficial effect on adherence to healthcare treatments. The authors describe the study design including the composition and characteristics of study subjects.

The article discusses research investigating feasibility and effectiveness of a local antibiotic prescribing campaign for outpatients in Italy. While the low-cost campaign focuses on the public, it also includes a newsletter containing information on antibiotic prescribing and antimicrobial resistance which aims to target both physicians and pharmacists. Brief details about the use of a social marketing approach, primary outcomes recorded, and other reasons for caution outlined are given.

The article offers information on a study on self management support for long term conditions in routine primary care. It informs that randomized controlled trial of 44 practices and 5599 patients with diabetes, chronic obstructive pul­monary disease and irritable bowel syndrome were carried out. It informs that no harm was reported on the study.

A summary of the article "Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial," by Simon Stewart et al. is presented. The changes in systolic and diastolic blood pressure according to individual blood pressure target at randomisation are recorded. In the study, 8.8% more participants in the intervention group achieved individualised blood pressure control.

OBJECTIVE To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. DESIGN The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators. Further, a systematic review and meta-analyses of randomized controlled trials that lowered serum cholesterol by providing vegetable oil rich in linoleic acid in place of saturated fat without confounding by concomitant interventions was conducted. SETTING One nursing home and six state mental hospitals in Minnesota, United States. PARTICIPANTS Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files. INTERVENTIONS Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings. MAIN OUTCOME MEASURES Death from all causes; association between changes in serum cholesterol and death; and coronary atherosclerosis and myocardial infarcts detected at autopsy. RESULTS The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline-13.8% y-1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol in covariate adjusted Cox regression models (hazard ratio 1.22, 95% confidence interval 1.14 to 1.32; P<0.001). There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts. Systematic review identified five randomized controlled trials for inclusion (n=10 808). In meta-analyses, these cholesterol lowering interventions showed no evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27). CONCLUSIONS Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid. [ABSTRACT FROM AUTHOR]

The article presents a study on patient controlled analgesia (PCA) in emergency department patients afflicted with non-traumatic abdominal pain. Topics include the Pain Solutions in the Emergency Setting (PASTIES), PCA's comparison to routine care, and an increased use of morphine in patients with PCA. It also features a table of the primary outcome of total pain experienced and secondary outcomes.

The article discusses research which compared effectiveness of ciclosporin and prednisolone in treating pyoderma gangrenosum. Topics explored include the speed of ulcer healing associated with these drugs, the daily drug dosage administered to research participants, and the adverse reactions recorded in both treatment groups such as acute kidney injury and infection.

The article examines the effectiveness of transcranial direct current stimulation (tDCS) preceding cognitive behavioral management for patients experiencing chronic low back pain. Topics discussed include pain intensity and disability as primary outcome measures and the staging of a double blind parallel group randomized controlled trial with a six month follow up. The inability of tDCS to pain or disability and the outcomes of a cognitive behavioral group program is mentioned.

The article discusses research which investigated effectiveness of a school-based education programme in reducing salt intake of children and their families. Topics explored include the measurement of salt intake through urinary sodium excretion measurement, the salt reduction message relayed to children and their families, and the salt intake changes recorded in both intervention and control groups studied.

The article presents a study on the effectiveness of integrated collaborative care in managing depression in people with multimorbidity. Topics covered include the reduction in depression severity at four months, the collaborative care integrative depression care in primary care, and the results of the complete case analyses.

The article presents a study on the occupational therapy intervention for residents with stroke related conditions in care homes in Great Britain. Topics covered include the Barthel index of activities of daily living, an individualized course of occupational therapy targeting stroke related disabilities, and cognitive impairment.

The article discusses research which examined the impact of financial incentives for smoking cessation in pregnancy in Great Britain. Topics covered include the cost of healthcare associated with smoking during pregnancy, the percentage of smokers in the incentives group who stopped smoking and the higher levels of nicotine dependence found in control group smokers.

The article discusses an Australian study which found that intervention families reported a greater decline in severity of attention deficit hyperactivity disorder (ADHD) symptoms and fewer moderate-severe sleep problems at three months and six months compared with the control families. It cites the involvement of 244 children aged 5-12 years with ADHD in the study. It also mentions the participation of parents and teachers in reporting the severity of ADHD symptoms.

The article discusses the clinical trials for the adult patients with a dorsally displaced fracture of the distal radius which require for surgical fixation in Great Britain. It examines the medical outcomes for the patients rated wrist evaluation (PRWE) score, the disabilities of arm, shoulder, and hand (DASH) and surgery complications. It also notes that the trials was conducted by the surgeons and specialists of the National Health Service (NHS) hospitals.

The article focuses on a study which assessed the effectiveness of Active for Life Year 5 (AFLY5), a school based intervention to increase physical activity, reduce sedentary behavior and increase fruit and vegetable consumption in children. Topics covered include the design of the randomized clinical trial, the participants and setting of the trial and the primary outcomes of the study. Offered as well are the bias, confounding and other reasons for caution for future studies.

The article summarizes a randomized controlled trial which investigated the effectiveness of helmet therapy in infants with positional skull deformation compared with the natural course of the condition. The observed primary outcome and results of the study cover the score for both plagiocephaly and brachycephaly, and the rate of patient recovery in the helmet therapy group compared to the natural course group.

The article describes the case study for determining if probiotic Lactobacillus reuteri DSM 17938 reduce crying or fussing in infants aged less than 3 months with colic. The case study performed a double blind, placebo controlled randomised trial of Lactobacillus reuteri DSM 17938, wherein randomisation was stratified by using block randomisation and computer generated allocation. It is determined that Lactobacillus reuteri treatment did not reduce crying of fussing in infants with colic.

The article discusses a multicentre, randomized, double blind, placebo controlled trial to determine whether 16 hour nicotine patches increase quit rate in pregnancy and birth weight compared with placebo patches. Participants included 476 women aged more than 18 between 12 and 20 weeks' gestation who smoked at least 5 cigarettes everyday and attended one of 23 maternity wards in France. It indicates uncertainty on whether other forms or nicotine replacement therapy will yield superior results.

The article discusses the Patient Engagement And Coaching for Health (PEACH) randomised controlled trial which involves use of telephone coaching by practice nurses for improving glycaemic control in type 2 diabetes patients. It describes implementation of this intervention in a primary care setting in Australia. It also reports details concerning study design, glycated haemoglobin differences observed between the intervention, and reasons for caution outlined.

The article discusses research investigating effectiveness of interdisciplinary primary care strategies in reducing disability and functional decline in frail elderly people. It reports use of a computer-generated list in the cluster randomised controlled trial. It describes participant selection process conducted, measurement of primary outcomes, and patient follow-up rates recorded. It also outlines disability scores gathered using the Groningen Activity Restriction Sale.

The article discusses a study which determined whether offering point of care (rapid) testing for HIV in a clinical setting to men who have sex with men increase their rate of HIV testing. Findings show that subjects who have access to rapid HIV testing do not have HIV tests at a significantly higher rate than men with access to conventional HIV testing over an 18 month period. Offering rapid HIV testing initially increased HIV testing frequency, but was not sustained over time.

The article investigates whether transcutaneous electrical nerve stimulation (TENS), as a patient-controlled adjunct to primary care management for tennis elbow, can solely provide superior pain relief to primary care management. Findings showed that TENS provided no additional clinical benefit over primary care management consisting of information and advice on analgesia and exercise for patients with tennis elbow, probably partly attributed to poor adherence to treatment suggestions.

In this article, the authors focus on the multicentre randomised controlled trial (ROSSINI Trial) related to the impact of a wound edge protection device (WEPD) on surgical site infection in patients after laparotomy. According to the trial, WEPDs are not useful in reducing the rate of surgical site infection and patients diagnosed with an infection experienced longer hospital stay. They also mention that they carried out secondary analyses on the basis of contamination during operation.

The article focuses on a study to investigate the role of a specialist medical and mental health unit (MMHU) in improving outcomes, experience, and satisfaction for older people with dementia or delirium admitted to an acute hospital as compared to standard care. A randomised controlled trial was compared with a specialist medical and mental health unit providing best practice care with standard hospital wards. The study took place in a single centre in Great Britain which provided sole acute hospital medical services for its population.

The article presents a study on the use of telemonitoring device for management of uncontrolled hypertension. It informs that a randomized controlled trial of 200 participants and primary outcome of data were collected for 90 percent patients. It informs that three patients in the intervention group described anxiety as a result of self monitoring.

The article offers information on a study of obesity management in younger children. It informs that a randomized control trial on body mass index (BMI) surveillance in 22 general practices in Mel­bourne, Australia on 1195 children aged 3-10 years over a 10 month period were carried out. It informs that the outcome had similar BMI and BMI z-scores.

The article discusses a study to evaluate the efficacy of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza. The participants included 326 patients including children and adults. The study concluded that oseltamivir was not found to be more effective than standard dose of oseltamivir in improving outcomes among those patients admitted to hospitals with severe influenza.

The article discusses a study to evaluate the efficacy of tranexamic acid in reducing mortality due to traumatic bleeding. The study found that tranexamic acid significantly reduced all cause mortality without any apparent increase in adverse thrombotic events. These effects do not seem to vary with baseline risk of death. The study thus provides suggestive evidence for the use of tranexamic acid in a wide range of patients with traumatic bleeding, otherwise used only in the most severe cases.

STUDY QUESTION: Does dietary n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation of pregnant women with a fetus at high risk of allergic disease reduce immunoglobulin E associated eczema or food allergy at 1 year of age? SUMMARY ANSWER: n-3 LCPUFA supplementation in pregnancy did not reduce the overall incidence of immunoglobulin E associated allergies in the first year of life, although immunoglobulin E associated eczema was lower. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Several mechanistic studies have suggested that higher intakes of n-3 LCPUFA during pregnancy modulate the neonatal immune response towards a less allergenic phenotype. n-3 LCPUFA supplementation in pregnancy did not reduce the incidence of immunoglobulin E associated food allergies in the first year of life, but the incidence of atopic eczema was lower. [ABSTRACT FROM AUTHOR]

The article presents a study which examined whether individuals at high risk of cardiovascular disease can be effectively managed by non-clinical staff through the use of digital health technologies and the telephone. Based on the results, participants who received intervention registered lower blood pressure and weight but not in cholesterol level, smoking status and cardiovascular risk. The other observed benefits include improved physical activity and drug adherence.

Background The benefits of correctly using size-appropriate restraints for children travelling in cars are well established, and considerable research has focused on the determinants of appropriate restraint choice. There are few studies of the factors associated with incorrect use. Objective To determine predictors of incorrect restraint use by child occupants and how these differ from inappropriate use. Methods A stratified multistage cluster sample of child occupants aged 0-10 years in New South Wales, Australia was used. Observation of restraint type and inspection of correctness of use was performed on arrival at schools, childcare centres, and child health clinics. An interview was conducted with the driver. Logistic regression was performed to estimate the effects of parental, family, and other characteristics on the likelihood of moderate or serious incorrect restraint use for restraint classes (rear/forward facing, booster, and seatbelt). Results Significant factors varied depending on age and restraint class. Older child restraint users (OR per year of age 0.27, 95% CI 0.07 to 0.98) and seatbelt users (OR per year of age 0.54, 95% CI 0.45 to 0.64) were less likely to be incorrectly using their restraints than younger users. Child restraint and booster users from non-English speaking families were more likely to be incorrectly using their restraints. Having more children in the car appeared to reduce incorrect use for booster (OR 0.18, 95% CI 0.06 to 0.57) and seatbelt users (OR 0.39, 95% CI 0.16 to 0.93). Conclusions There is a need to reduce incorrect restraint use by both education and improved restraint design. Education aimed at reducing incorrect use may need to be targeted differently to appropriate use programmes, as the predictive factors differ. [ABSTRACT FROM AUTHOR]