Objectives We sought to identify groups of high-need high-cost (HNHC) patients with distinct cost trajectories and describe the sociodemographic and clinical characteristics associated with group membership. Design A population-based retrospective cohort study, using administrative health data. Setting British Columbia, Canada. Participants People who were HNHC in 2017, defined as incurring health system costs in the top 5% of the population, and were continuously registered in the Medical Service Plan from January 2015 to December 2019 and alive at the end of the study period. Outcome measures The primary objective was to identify longitudinal patterns of healthcare costs using group-based trajectory modelling. Adopting a health sector perspective, we conducted person-level costing for hospital episodes, day surgeries, physician services, prescription medications, and home and community care services. The secondary objective was to explore sociodemographic and clinical characteristics

Introduction Out-of-hospital cardiac arrest is a public health concern with a high mortality rate. Hypoxic ischaemic brain injury is the primary cause of death in patients admitted to the intensive care unit (ICU) after return of spontaneous circulation (ROSC). Several systemic factors, such as hypotension, can exacerbate brain injuries. International guidelines recommend targeting a mean arterial pressure (MAP) of at least 65 mm Hg. Several observational studies suggest that a higher MAP may be associated with better outcomes, but no randomised trials have shown an effect of higher MAP. The ongoing METAPHORE (mean arterial pressure after out-of-hospital cardiac arrest) trial aims to compare a standard MAP threshold (MAP ≥65 mm Hg) with a high MAP threshold (MAP ≥90 mm Hg) to evaluate whether implementing a higher MAP threshold can improve neurological outcomes in patients admitted to ICU after cardiac arrest. Methods and analysis METAPHORE is a randomised, controlled, multicentre, ope

Editorial policies and instructions for authors looking to publish their work in BMJ Open

Objective This study aimed to explore the predictive value of severe burnout complaints, symptom dimension of burnout and depressive symptoms for subsequent all-cause medically certified sickness absence (ACMCSA) during the pandemic among physicians in Sweden. Design A 1 year follow-up panel cohort observational study—the Longitudinal Occupational Health Survey for HealthCare in Sweden. At baseline (February–May 2021), a representative sample of 6699 physicians was drawn from the Swedish occupational register and invited to participate in the study. At follow-up (March–May 2022), the full sample (excluding those who died, retired, stopped working as a physician or migrated, n=94) was invited to answer the survey. Setting Swedish primary and specialist healthcare. Participants At baseline, the response rate was 41.3% (n=2761) of which 1575 also answered at follow-up. Primary and secondary outcome measures ACMCSA data came from the Swedish Social Insurance Agency. The Burnout Assessment

Objective This study aimed to explore the use, experiences and perceptions of diet in psoriasis management among adults with lived experience in the UK. Design Qualitative. Data were analysed thematically using a reflexive thematic approach. Setting Online discussions with adults living with psoriasis in the UK. Participants Nine adults (two men, seven women) ≥18 years of age, living in the UK, English speaking, with a diagnosis of psoriasis of any severity. Results Four key themes were generated: (1) impact of diet, (2) dietary modification, (3) dietary information and (4) dietary support. Overall, the majority (n=8) perceived that diet had an impact on their psoriasis. Most participants (n=7) reported trying restrictive diets including dairy free, gluten free and ‘cleanses’ to help manage their psoriasis with limited success. A perceived lack of dietary support resulted in participants relying on social media and online forums for dietary information. Participants reported a high cog

Objective Falling is common among older adults in residential aged care facilities (RACFs) and potential inappropriate psychotropic medicines (PIPMs) use may increase the risk of falling. This study aimed to determine the impact of PIPMs on falls using longitudinal observational data. Methods A retrospective longitudinal cohort study was conducted using routinely collected electronic health data from 23 RACFs in Sydney, New South Wales, Australia. The study included 3064 permanent residents aged ≥65 (2020–2021). PIPMs were identified using updated Beers criteria 2023. We considered three fall outcome groups: all falls, injurious falls and falls requiring hospitalisation. The falls incidence rates (IRs) were calculated for overall residents in RACFs as well as for central nervous system (CNS)-PIPM users and non-users. We applied a zero-inflated negative binomial regression model to assess the association between falls and CNS-PIPMs. Results A total of 40% (n=1224) of long-term care resi

Objectives This study assessed the health-related quality of life (HRQoL) and its relationship with clinical factors and comorbidities in people with type 2 diabetes mellitus (T2DM) treated in primary care settings. Design Cross-sectional study design: This study assessed the HRQoL using a 36-item Short Form Survey (SF-36) tool in eight domains. The HRQoL scores ranged from 0% to 100% for each domain, with higher scores indicating better HRQoL. Linear regression was used to assess the association of HRQoL domain scores with clinical covariates and comorbidities. Setting A countrywide study was conducted on individuals with established T2DM (N=635) attending primary healthcare services for various conditions across nine federal states of Austria from 2021 to 2023. Participants A total of 635 individuals, aged above 50 years and diagnosed with T2DM, were recruited by the attending physician to evaluate their HRQoL in relation to T2DM and its associated comorbidities. Results The mean SF-