Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial

Abstract Objective To determine the association between high flow supplementary oxygen and 30 day mortality in patients presenting with a suspected acute coronary syndrome (ACS). Design Pragmatic, cluster randomised, crossover trial. Setting Four geographical regions in New Zealand. Participants 40 872 patients with suspected or confirmed ACS included in the All New Zealand Acute Coronary Syndrome Quality Improvement registry or ambulance ACS pathway during the study periods. 20 304 patients were managed using the high oxygen protocol and 20 568 were managed using the low oxygen protocol. Final diagnosis of ST elevation myocardial infarction (STEMI) and non-STEMI were determined from the registry and ICD-10 discharge codes. Interventions The four geographical regions were randomly allocated to each of two oxygen protocols in six month blocks over two years. The high oxygen protocol recommended oxygen at 6-8 L/min by face mask for ischaemic symptoms or electrocardiographic changes, irrespective of the transcapillary oxygen saturation (SpO 2 ). The low oxygen protocol recommended oxygen only if SpO 2 was less than 90%, with a target SpO 2 of less than 95%. Main outcome measure 30 day all cause mortality determined from linkage to administrative data. Results Personal and clinical characteristics of patients managed under both oxygen protocols were well matched. For patients with suspected ACS, 30 day mortality for the high and low oxygen groups was 613 (3.0%) and 642 (3.1%), respectively (odds ratio 0.97, 95% confidence interval 0.86 to 1.08). For 4159 (10%) patients with STEMI, 30 day mortality for the high and low oxygen groups was 8.8% (n=178) and 10.6% (n=225), respectively (0.81, 0.66 to 1.00) and for 10 218 (25%) patients with non-STEMI was 3.6% (n=187) and 3.5% (n=176), respectively (1.05, 0.85 to 1.29). Conclusion In a large patient cohort presenting with suspected ACS, high flow oxygen was not associated with an increase or decrease in 30 day mortality. Trial registration ANZ Clinical Trials ACTRN12616000461493.

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Emergency contraception: barrier or bridge to effective contraception?

Contraception ◽

10.1016/j.contraception.2007.05.041 ◽

2007 ◽

Vol 76 (2) ◽

pp. 167

Author(s):

Caroline Moreau ◽

James Trussell ◽

Francois Michelot ◽

Nathalie Bajos

Keyword(s):

Emergency Contraception ◽

Effective Contraception

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Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus : cluster randomised crossover trial

BMJ ◽

10.1136/bmj.39525.579063.be ◽

2008 ◽

Vol 336 (7650) ◽

pp. 927-930 ◽

Cited By ~ 97

Author(s):

Dakshika Jeyaratnam ◽

Christopher J M Whitty ◽

Katie Phillips ◽

Dongmei Liu ◽

Christina Orezzi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Crossover Trial ◽

Screening Tests ◽

Rapid Screening ◽

Cluster Randomised

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Emergency Contraception Access and Counseling in Urban Pharmacies: A Comparison between States with and without Pharmacist Prescribing

Pharmacy ◽

10.3390/pharmacy8020105 ◽

2020 ◽

Vol 8 (2) ◽

pp. 105 ◽

Cited By ~ 1

Author(s):

Rebecca H. Stone ◽

Sally Rafie ◽

Dennia Ernest ◽

Brielle Scutt

Keyword(s):

Continuing Education ◽

San Francisco ◽

Emergency Contraception ◽

Primary Source ◽

Community Pharmacies ◽

Patient Access ◽

Patient Counseling ◽

The Public ◽

Adult Females ◽

Primary Endpoints

Pharmacists are often the primary source of emergency contraception (EC) access and patient information. This study aims to identify differences in pharmacist-reported EC access and counseling between states which do or do not permit pharmacist-prescribed EC. This prospective, mystery caller study was completed in California (CA), which permits pharmacist-prescribed EC after completion of continuing education, and Georgia (GA), which does not. All community pharmacies that were open to the public in San Diego and San Francisco, CA, and Atlanta, GA were called by researchers who posed as adult females inquiring about EC via a structured script. Primary endpoints were EC availability and counseling. Statistical analyses completed with SPSS. Researchers called 395 pharmacies, 98.2% were reached and included. Regarding levonorgestrel (LNG), CA pharmacists more frequently discussed (CA 90.4% vs. GA 81.2%, p = 0.02), stocked (CA 89.5% vs. GA 67.8%, p < 0.01), and correctly indicated it “will work” or “will work but may be less effective” 4 days after intercourse (CA 67.5% vs. GA 17.5%, p < 0.01). Ulipristal was infrequently discussed (CA 22.6% vs. GA 3.4%, p < 0.01) and rarely stocked (CA 9.6% vs. GA 0.7%, p < 0.01). Pharmacists practicing in states which permit pharmacist-prescribed EC with completion of required continuing education may be associated with improved patient access to oral EC and more accurate patient counseling.

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Opportunities for antibiotic optimisation and outcome improvement in patients with negative blood cultures: study protocol for a cluster-randomised crossover trial, the NO-BACT study

BMJ Open ◽

10.1136/bmjopen-2019-030062 ◽

2019 ◽

Vol 9 (12) ◽

pp. e030062

Author(s):

Silvia Jiménez-Jorge ◽

Zaira R Palacios-Baena ◽

Clara M Rosso-Fernández ◽

José A Girón-Ortega ◽

Jesús Rodriguez-Baño ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Crossover Trial ◽

Length Of Hospital Stay ◽

Blood Cultures ◽

Second Phase ◽

Antimicrobial Use ◽

Cluster Randomised ◽

Registration Number ◽

Outcome Improvement

IntroductionPatients with negative blood cultures (BCx) represent 85%–90% of all patients with BCx taken during hospital admission. This population usually includes a heterogeneous group of patients admitted with infectious diseases or febrile syndromes that require a blood culture. There is very little evidence of the clinical characteristics and antibiotic treatment given to these patients.Methods and analysisIn a preliminary exploratory prospective cohort study of patients with BCx taken, the clinical/therapeutic characteristics and outcomes/antimicrobial stewardship opportunities of a population of patients with negative BCx will be analysed. In the second phase, using a cluster randomised crossover design, the implementation of an antimicrobial stewardship intervention targeting patients with negative BCx will be evaluated in terms of quality of antimicrobial use (duration and de-escalation), length of hospital stay and mortality.Ethics and disseminationThis study has been and registered with clinicaltrials.gov. The findings of our study may support the implementation in clinical practice of an antimicrobial stewardship intervention to optimise the use of antibiotics in patients with negative BCx. The results of this study will be published in peer-reviewed journals and disseminated at national and international conferences.Trial registration numberNCT03535324.

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