The research team will disseminate results to study participants, research stakeholders (clinics, faith-based organisations and community-based organisation), the broader Marshallese community and fellow researchers. Results will be disseminated to study participants through a one-page summary that show the aggregated research results using plain language and infographics. The study used a community engaged approach approved by the University of Arkansas for Medical Sciences Institutional Review Board (#228023). The research team will disseminate results to study participants, research stakeholders (clinics, faith-based organisations and community-based organisation), the broader Marshallese community and fellow researchers. Results will be disseminated to study participants through a one-page summary that show the aggregated research results using plain language and infographics. This systematic review aimed to assess the role of physician's sex and gender in relation to processes of care and/or clinical outcomes within the context of cardiac operative care. A systematic review. Searches were conducted in PsycINFO, Embase and Medline from inception to 6 September 2018. The reference lists of relevant systematic reviews and included studies were also searched. Quantitative studies of any design were included if they were published in English or French, involved patients of any age undergoing a cardiac surgical procedure and specifically assessed differences in processes of care or clinical patient outcomes by physician's sex or gender. Studies were screened in duplicate by two pairs of independent reviewers. Processes of care, patient morbidity and patient mortality. The search yielded 2095 publications after duplicate removal, of which two were ultimately included. These studies involved various types of surgery, including cardiac. One study found that patients treated by ce and improve outcomes in this high-risk patient group. Some scaphoid fractures become visible on radiographs weeks after a trauma which makes normal radiographs directly after trauma unreliable. Untreated scaphoid fractures can lead to scaphoid non-union progressing to osteoarthritis. Therefore, the general treatment for patients with a clinically suspected scaphoid fracture and normal initial radiographs is immobilisation with below-elbow cast for 2 weeks. However, most of these patients are treated unnecessarily because eventually less than 10% of them are diagnosed with an occult scaphoid fracture. To reduce overtreatment and costs as a result of unnecessary cast treatment in patients with a clinically suspected scaphoid fracture and normal initial radiographs, we designed a study to compare below-elbow cast treatment with supportive bandage treatment. We hypothesise that the functional outcome after 3 months is not inferior in patients treated with supportive bandage compared to patients treated with below-elbow cast, but with lower costs in the supportive 76. NL6976. To evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT). Community pharmacies in Spain. 135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over. The intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators. The primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT. 55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min 6.2, max 9.3) out of 10. The integration mean score was 3.39 (SD 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed. The implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete. CGFTRA-2017-01. CGFTRA-2017-01. To integrate evidence from randomised controlled trials (RCTs) and observational studies on the efficacy of inhaled treatments for chronic obstructive pulmonary disease using network meta-analyses. Systematic searches MEDLINE and Embase based on predetermined criteria. https://www.selleckchem.com/products/gliocidin.html Network meta-analyses of RCTs investigated efficacy on exacerbations (long-term ≥20 weeks of treatment; short-term <20 weeks), lung function (≥12 weeks), health-related quality of life, mortality and adverse events. Qualitative comparisons of efficacies between RCTs and observational studies. 212 RCTs and 19 observational studies were included. Compared with combined long-acting beta-adrenoceptor agonists and long-acting muscarinic antagonists (LABA+LAMA), triple therapy (LABA+LAMA+inhaled corticosteroid) was significantly more effective at reducing exacerbations (long-term 0.85 (95% CI 0.78 to 0.94; short-term 0.67 (95% CI 0.49 to 0.92)) and mortality (0.72 (95% CI 0.59 to 0.89)) but was also associated with increased pneumonia (1.35 (95% CI 1.10 to 1.67)). No differences in lung function (0.02 (95% CI -0.10 to 0.14)), health-related quality of life (-1.12 (95% CI -3.83 to 1.59)) or other adverse events (1.02 (95% CI 0.96 to 1.08)) were found. Most of the observational evidence trended in the same direction as pooled RCT data. Further evidence, especially pragmatic trials, are needed to fully understand the characteristics of patient subgroups who may benefit from triple therapy and for those whom the extra risk of adverse events, such as pneumonia, may outweigh any benefits. CRD42018088013. CRD42018088013.