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Vocal hygiene for chronic laryngitis
Philippa Ratcliffe, consultant speech therapist at University College London Hospitals NHS Foundation Trust, gives some lifestyle advice for patients who are suffering from chronic laryngitis. Vocal hygiene refers to measures such as voice rest, hydration, humidification, and limiting caffeine intake. These measures are invaluable in the symptomatic treatment of laryngeal inflammation associated with chronic laryngitis. Care of the voice should be recommended to all presenting with vocal difficulties as this provides symptomatic relief and is good practice to carry forward, even as laryngitis resolves. Read The BMJ's full clinical review on laryngitis: http://www.bmj.com/content/349/bmj.g5827
Просмотров: 10372 The BMJ
Stopping smoking linked to improved mental health
Read the full open access research:http://www.bmj.com/content/348/bmj.g1151 Quitting smoking is associated with an improvement in mental health in comparison with continuing to smoke, suggests a study published on bmj.com. The researchers say the effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders. It is well known that stopping smoking substantially reduces major health risks, such as the development of cancers, cardiovascular and respiratory diseases. But the association between smoking and mental health is less clear cut. Many smokers want to stop but continue smoking as they believe smoking has mental health benefits. And health professionals are sometimes reluctant to deal with smoking in people with mental disorders in case stopping smoking worsens their mental health. So researchers from the universities of Birmingham, Oxford, and King's College London set out to investigate changes in mental health after smoking cessation compared with continuing to smoke. They analysed the results of 26 studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation in the general population and clinical populations (patients with chronic psychiatric and/or physical conditions). Differences in study design and quality were taken into account to minimise bias. Measures of mental health included anxiety, depression, positivity, psychological quality of life, and stress. Participants had an average age of 44, smoked around 20 cigarettes a day, and were followed up for an average of six months. The research team found consistent evidence that stopping smoking is associated with improvements in depression, anxiety, stress, psychological quality of life, and positivity compared with continuing to smoke. The strength of association was similar for both the general population and clinical populations, including those with mental health disorders. And there was no evidence that study differences could have skewed the results.
Просмотров: 15106 The BMJ
Palliative care from diagnosis to death
Many people still associate palliative care with care in the terminal stage of cancer, and patients with cancer remain more likely to receive it than those with other illnesses. It is often delayed until the last weeks or days of life once the illness is advanced and disease focused treatments are no longer effective. However, late palliative care is a missed opportunity to do better for patients, families, and health services. Scott Murray, professor of primary palliative care at the university of Edinburgh, and colleagues set out a rationale for early palliative care based on the three typical trajectories of functional decline towards the end of life (rapid, intermittent, and gradual)
Просмотров: 11045 The BMJ
Richard Doll: The man who stopped smoking
Richard Doll was a luminary of clinical research whose case control study, published in the BMJ in 1950, first identified smoking as an important cause of cancer and other diseases. He carried his research out on doctors in the UK who smoked, and tracked their mortality over the course of 50 years. The latest paper being published in the BMJ in 2004.
Просмотров: 11508 The BMJ
Celebrities and health: The good, the bad, and the ugly
Read the full research online: http://www.bmj.com/content/347/bmj.f7151 A paper published in the Christmas edition of The BMJ asks why so many people follow medical advice from celebrities when so much of it is ill-informed and some of it is potentially harmful. Celebrities can generate a large amount of publicity for health campaigns. For example, Michael J Fox's foundation has raised over $350 million for Parkinson's research and singer Sir Elton John's charity has raised more than $300 million to fight HIV/AIDs. But their efforts are not always helpful. Sometimes the advice given by celebrities conflicts with recommendations from health professionals and research evidence and poses a public health hazard. Examples include former Playboy model Jenny McCarthy's incorrect messages about vaccines causing autism; Katie Couric's recent alarmist coverage of the HPV vaccine; and TV broadcaster Sir Michael Parkinson claiming that "if you can pee against a wall from two feet, you haven't got it [prostate cancer]." Researchers from McMaster University in Canada looked at how celebrities gain credibility as medical advisors and why the public can fall under their influence when making important health decisions. They analysed economic, marketing, psychology and sociology studies from 1806 to the present day. The researchers give several explanations for how celebrities gain credibility as medical advisors. One explanation is "herding", which is people's natural tendency to make decisions based on what others have done in similar situations. Another explanation is celebrities' "halo effect" which, as the researchers say, gives celebrities a "cloak of generalised trustworthiness which extends well-beyond their industry or expertise". Wanting to follow in their favourite celebrities' footsteps, consumers ignore other information and instead imitate the celebrity's health choices. Celebrities also portray themselves as having an authentic connection to the product or behaviour they are promoting so are perceived as having greater credibility than their non-celebrity counterparts, despite having less medical knowledge and experience. Another theory explaining celebrities' influence is that consumers want to purchase "social capital" from celebrities by acquiring their products, mimicking their lifestyles and taking their medical advice. For people seeking to raise their social status, one strategy is to imitate celebrity behaviours. Furthermore, consumers have a "self esteem motive" as they follow advice from celebrities who match how they want to perceive themselves and feel like they can become more like their favourite celebrity by purchasing products they have endorsed. The study says health professionals can counter celebrities' negative influences by speaking to their patients about the validity of celebrity advice and cement themselves as sources of reputable health information. Lead author Steven J Hoffman said: "We need to rethink and better understand where people obtain their health information and what makes them act upon it. Understanding why people follow celebrities' medical advice represents a good start."
Просмотров: 5124 The BMJ
Medical innovations: Adaptive eyewear
First in a series of films looking at the technologies that could most effect health care in the future. In this first one Prof. Josh Silver from the Centre for Vision in the Developing World introduces adjustable eyewear that can be made for £1 and fitted by patients themselves..
Просмотров: 5583 The BMJ
¿Desea publicar sus artículos de investigación en importantes revistas científicas?
Desarrolle sus capacidades de investigación con Research to Publication, la herramienta que le ayudará a publicar sus articulos de investigacion. http://rtop.bmj.com
Просмотров: 5965 The BMJ
Exercise induced asthma
Asthma doesn't preclude success, as gold medal winning runner Liz McColgan explains in this video. We also look at why this condition is so common in Olympic teams and how it is diagnosed and treated in athletes.
Просмотров: 81214 The BMJ
Alice Stewart: The woman who knew too much
Alice Stewart was one of Britain's foremost epidemiologists. However her recognition came late in her career, having spent her life fighting the establishment's enshrined views. In the 1950s when she started her work, x-rays were routinely used in foetal monitoring. It was Stewart who first showed the link between the practice and childhood leukemia. She went on to look at the effects of low-level radiation exposure - uncovering the true adverse effects of chronic exposure, and thus earning herself the enmity of the nuclear industry.
Просмотров: 4858 The BMJ
Joseph Lister: Surgery Transformed
Joseph Lister published his first paper in the BMJ in 1867 and carried on publishing in the journal for over 40 years, and now all of his articles can be accessed for free online in the BMJ archive. Lister is the father of antiseptic surgery, and his pioneering techniques transformed the survival rates of patients. Until Lister introduced methods to prevent infection, almost 50% of patients who went under the knife would die as a result.
Просмотров: 67591 The BMJ
Education and coronary heart disease: mendelian randomisation study
Read the full open access research: http://www.bmj.com/content/358/bmj.j3542 Staying in education is associated with a lower risk of developing heart disease, finds a study published by The BMJ today. The findings provide the strongest evidence to date that increasing the number of years that people spend in the education system may lower their risk of developing coronary heart disease by a substantial amount, say the authors. Many studies have found that people who spend more time in education have a lower risk of developing coronary heart disease. However, this association may be due to confounding from other factors, such as diet or physical activity. To date, it has been unclear if spending more time in education has any causal impact on heart disease--in other words, whether increasing education might prevent it. To better understand the nature of this association, and help inform public policy, a team of international researchers from University College London, the University of Lausanne, and the University of Oxford set out to test whether education is a risk factor for the development of coronary heart disease. They analysed 162 genetic variants already shown to be linked with years of schooling from 543,733 men and women, predominantly of European origin, using a technique called mendelian randomisation. This technique uses genetic information to avoid some of the problems that afflict observational studies, making the results less prone to confounding from other factors, and therefore more likely to be reliable in understanding cause and effect. The authors found that genetic predisposition towards more time spent in education was associated with a lower risk of coronary heart disease. More specifically, 3.6 years of additional education, which is similar to an undergraduate university degree, would be predicted to translate into about a one third reduction in the risk of coronary heart disease. Genetic predisposition towards longer time spent in education was also associated with less likelihood of smoking, lower body mass index (BMI), and a more favourable blood fat profile. And the authors suggest that these factors could account for part of the association found between education and coronary heart disease. The results remained largely unchanged after further sensitivity analyses and are in line with findings from other studies, and the effect of raising the minimum school leaving age. The authors outline some study limitations. For example, it is not fully understood how genetic variants cause changes to the length of time spent in education, and this could have introduced bias.
Просмотров: 932 The BMJ
Cliff and C. diff - Smelling the diagnosis
Sniffer dogs are often seen in airports, but Cliff, the beagle from Amsterdam, is more at home in a hospital. Cliff has been trained to sniff out the bacteria clostridium difficile, which is highly infectious and can cause outbreaks of diarrhoea on the ward. Scientists at the VU University Medical Centre in Amsterdam studied how effective Cliff was, and found that he can sniff out Clostridium difficile infections in stool samples and even in the air surrounding patients in hospital with a very high degree of accuracy. You can read the research behind Cliff on bmj.com - http://www.bmj.com/cgi/doi/10.1136/bmj.e7396
Просмотров: 50540 The BMJ
Late mortality after sepsis
Read the full open access paper: http://www.bmj.com/content/353/bmj.i2375 Sepsis, an inflammatory response to infection, is a leading cause of admission to hospital in the developed world. While mortality in hospital is falling, longer term mortality after sepsis has remained high as many patients die in the subsequent months. Some argue that this late mortality is simply a reflection of the underlying comorbidity burden of patients who develop sepsis, whereas others argue it is the result of sepsis itself. Previous studies have provided evidence on both sides of the debate. Several studies explicitly assert that late mortality after critical illness is largely because of pre-existing comorbid disease. Quartin and colleagues, however, showed that risk of mortality remained higher for up to five years after sepsis, even compared with carefully matched controls in hospital with similar burden of comorbidity at baseline. To guide the development of future treatments, we measured the excess late (31 days to two years) mortality directly attributable to sepsis—and not to the comorbidities and sociodemographic factors that predispose one to developing sepsis. We looked at patients with sepsis compared with three control groups: adults not currently in hospital, patients in hospital with non-sepsis infection, and patients in hospital with an acute sterile inflammatory process. These comparisons allowed us to determine the excess mortality associated with sepsis (including that associated with admission to hospital) and the incremental excess mortality associated with sepsis, beyond what is associated with admission for the two cardinal features of sepsis: infection (by comparing sepsis with inflammatory conditions not caused by infection) and inflammation (by comparing sepsis with infections without evidence of inflammatory storm). We examined an ongoing longitudinal prospective cohort, in which we could assess the health of a national sample of older Americans independent of whether they were admitted to hospital for sepsis. This allowed us to assess not just traditional risk factors for sepsis but also a range of potential confounders.
Просмотров: 2765 The BMJ
Harms of overtreatment
Reporter Jeanne Lenzer investigates overtreatment at the heart of healthcare. Overly aggressive treatment is estimated to cause 30 000 deaths among Medicare recipients alone each year. Overall, unnecessary interventions are estimated to account for 10-30% of spending on healthcare in the US, or $250bn-800bn (£154bn-490bn; €190bn-610bn) annually. This video features Shannon Brownlee, acting director of the New America Health Policy Program and author of Overtreated: How Too Much Medicine is Making Us Sicker and Poorer, David Himmelstein, professor at the City University of New York School of Public Health, and Vikas Saini, a Harvard cardiologist and president of the Lown Cardiovascular Research Foundation. Read more about the problems of overtreatment in Jeanne Lenzer's feature article Unnecessary care: are doctors in denial and is profit driven healthcare to blame? http://www.bmj.com/content/345/bmj.e6230
Просмотров: 7815 The BMJ
Antipsychotic drug use in pregnancy
There has been a considerable rise in antipsychotic medication use in pregnancy, from 3 per 1000 pregnancies in 2001 to 8 per 1000 in 2007. Case reports, case series, voluntary registries, and small cohort studies suggest that antipsychotic drug exposure in pregnancy is unlikely to cause congenital anomalies but may be associated with preterm birth, low birth weight for gestational age, and neonatal withdrawal effects. However, most data were based on the older, “typical” antipsychotic drugs, which are now less commonly used. Second generation antipsychotic drugs were first introduced in the early 1990s and differ from earlier agents in terms of their side effects, especially their potentially higher risk of metabolic syndrome and venous thromboembolism. The few studies that have evaluated atypical antipsychotic drugs in pregnancy were limited in sample size, and in the handling of confounding by indication. Accordingly, these studies may not have been equipped to evaluate the impact of antipsychotic drug use in pregnancy on important maternal medical and perinatal conditions. In this study, the researchers evaluated maternal medical and perinatal outcomes associated with antipsychotic drug use in pregnancy in multiple linked population health administrative databases in the entire province of Ontario, Canada. Read the full research: http://www.bmj.com/content/350/bmj.h2298
Просмотров: 2123 The BMJ
Pokemon Go and physical activity
Read the full open access paper: http://www.bmj.com/content/355/bmj.i6270 But the effect was not sustained beyond 6 weeks of game playing Pokémon Go improves physical activity among adults who use the game, but the effect is moderate and not sustained over time, finds a study published in The BMJ Christmas issue this week. Results show that the daily average steps during the first week of installation increased by 955 additional steps - equivalent to half of the World Health Organization’s (WHO) recommendation for physical activity per week. The following weeks saw a gradual reduction in the number of steps, and this effect was lost after six weeks of game playing. Pokémon GO is an augmented reality game that projects graphics onto the real world using smartphones, and has been downloaded over 500 million times since its launch in July 2016. It has been suggested that the game can increase physical activity and promote public health, because it incentivizes walking. However, these claims are based on anecdotal evidence. So researchers from Harvard University, co-led by Katherine Howe, Christian Suharlim, and Peter Ueda, set out to determine whether playing the game had any effect on physical activity among young adults in the United States. They conducted an online survey of 1,182 participants, aged 18-35, who used iPhone 6 series smartphones, during August 2016. In total, 560 (47.4%) of the participants reported playing Pokémon GO at “trainer level” of 5 or more, which is reached after walking for around two hours. Data were analysed from automatically recorded step count from the participants’ iPhones and used to estimate the change in daily steps after installation of the game. The findings show the daily average steps during the first week of installation increased by 955 additional steps. Assuming steps of 0.8 m at a pace of 4 km/h, the change would translate into 11 minutes of additional walking daily - around half of the WHO’s recommendation of 150 or more minutes weekly. However, the number of steps gradually decreased over the following five weeks, and by the sixth week the number had returned to pre-installation levels. The results remained the same even after accounting for a number of factors that may have influenced the findings, such as age, sex, race, weight status, and walkability of the area of residence. The authors write: “Our results indicate that the health impact of Pokémon GO might be moderate. Even if smaller amounts of physical activity might also be important for health outcomes, the increase in steps from Pokémon GO, as with many physical activity interventions, was not sustained over time.” However, they remain optimistic. In an accompanying video, senior author Eric Rimm, says: "What we found were exciting new findings that over a 6 week period you can do a lot to increase physical activity, we just have to be more creative about finding ways to get people to keep exercising.” They note that steps were recorded when the iPhone was carried, which may have led to overestimation of the game’s effect on physical activity among the study participants, and the sample may not be representative of the general population. Furthermore, they add that the effect of Pokémon GO on physical activity might be different in children, and there might also be other potential benefits associated with the game, such as increased social connectedness and improved mood.
Просмотров: 6025 The BMJ
Survival - neglected diseases in Africa
A report on the community project to help eliminate Schistosomiasis (bilharzia), Lymphatic filariasis (Elephantiasis), Trachoma an 2 other tropical diseases, in Niger, West Africa.
Просмотров: 15471 The BMJ
John Crofton: The TB trials
John Crofton pioneered the randomised controlled trial in a 1948 BMJ paper which looked at the antibiotic streptomycin to treat TB. Now in his 90s, Dr Crofton talks to Colin Blakemore about the importance of randomisation and blinding, and how it has helped to make medicine more evidence based.
Просмотров: 4667 The BMJ
Beethoven's deafness and his three styles
That Beethoven suffered from deafness is well known, but how did the progression of the condition affect his composition? In this video the Isolo string quartet demonstrate how his style changed over time. Read about the science behind the video in the paper, Beethoven's deafness and his three styles, http://www.bmj.com/content/343/bmj.d7589.
Просмотров: 10093 The BMJ
Research to Publication - making medical research better
http://rtop.bmj.com The Research to Publication programme is part of The BMJ's commitment to building medical research capabilities around the world. Created in collaboration with the University of California San Francisco (UCSF), the programme is designed to be modular and new courses will be added over the coming months. We expect the full programme to be available in early 2016. Our first two modules, How to Write and Publish a Study Protocol and Introduction to Randomized Blinded Trials, are FREE but other modules will require a subscription. It is possible for individuals and/or institutions to purchase whole courses or access to the complete programme. Prices will be affordable and will include unlimited access to course materials and activities, as well as a signed, personalised certificate of completion from The BMJ's Editor in Chief, Fiona Godlee and UCSF's Professor Deborah Grady. For further information about the programme and to find out more about institutional subscriptions, please contact the Research to Publication team. http://learning.bmj.com/learning/rtop/contact.html?locale=en_GB
Просмотров: 3926 The BMJ
Where does the fat go?
Considering the soaring overweight and obesity rates and strong interest in this topic, there is surprising ignorance and confusion about the metabolic process of weight loss among the general public and health professionals alike. Ruben Meerman and Andrew Brown, from the school of Biotechnology and Biomolecular Sciences, University of New South Wales in Sydney encountered widespread misconceptions about how humans lose weight among general practitioners, dietitians, and personal trainers. Find out where the fat goes in this paper from The BMJ: http://www.bmj.com/content/349/bmj.g7257
Просмотров: 109388 The BMJ
Interview with Prof. Sir Michael Marmot
Interview with Prof. Sir Michael Marmot - Chair of the Commission on Social Determinants of Health, about how the credit crunch will effect global health.
Просмотров: 12688 The BMJ
Migraine: The pressure and the pain
We present some of the latest research into the causes of this debilitating condition. Highlight the current best practice for drug therapy, and discuss whether complementary therapies can play a role in treatment.
Просмотров: 7574 The BMJ
Alexander technique: part 1
How does the Alexander Technique work? What are the authors findings about the clinical and cost effectiveness of the treatment? Watch this video to find out. Part 1 of 2 Part 2 here - http://uk.youtube.com/watch?v=BXmimtk381U
Просмотров: 73591 The BMJ
What to drink with a Swiss cheese fondue
There are conflicting claims about the pros and cons of drinking alcoholic beverages with food, especially high fat and high energy meals such as cheese fondue. A team from the University Hospital of Zurich studied 20 people who drank either wine or black tea with this famous Swiss dish, followed by kirsch schnapps or water as a digestive. Find out more about their randomised controlled crossover trial in this nine minute video, which is also available in German.
Просмотров: 9437 The BMJ
Be Active, Eat Well
a report on the town of Colac, Australia, where they're trialling a new initiative to fight childhood obesity.
Просмотров: 8980 The BMJ
AGREE Reporting Checklist Video Abstract
Read the full summary: http://www.bmj.com/content/352/bmj.i1152 AGREE II is a widely used standard for assessing the methodological quality of practice guidelines. This article describes the development of the AGREE Reporting Checklist, which was designed to improve the quality of practice guideline reporting and aligns with AGREE II in its structure and content. AGREE II has become an internationally accepted standard for evaluation of the methodological quality of clinical practice guidelines AGREE II items and criteria have been reformatted to create a reporting guide called the AGREE Reporting Checklist The AGREE Reporting Checklist is intended to improve the comprehensiveness, completeness, and transparency of reporting in practice guidelines The AGREE Reporting Checklist can be used by practice guideline developers, guideline users, funders, peer reviewers, and journal editors
Просмотров: 2093 The BMJ
The overtreatment of mild hypertension
Stephen Martin, an associate professor at the University of Massachusetts Medical School, thinks we're overtreating otherwise healthy patients who have mild hypertension. In this video explains why prescribing drugs to these people may actually be doing more harm than good. Read the full analysis article: http://www.bmj.com/cgi/doi/10.1136/bmj.g5432
Просмотров: 1603 The BMJ
Medical innovations: Shit matters
Community led total sanitation may not sound like the most cutting edge medical science, but the potential impact of this initiative is huge. Contact with faeces spreads human disease, and this technique helps villagers around the world understand how the practice of open defecation means that they're, literally, in the shit. You can hear more from Kamal Kar, inventor of Community Led Total Sanitation on the BMJ podcast http://tinyurl.com/8edkef5 There is also a book on the Community-Led Total Sanitation project, available from http://developmentbookshop.com/shit-matters.html This book demonstrates that Community-led Total Sanitation (CLTS) is a powerful way to tackle the sanitation crisis and also address several Millennium Development Goals (MDGs). However, like any development success story challenges still remain regarding scaling up with quality, inclusion of the poorest and sustainability and there is a danger that accounts of success may be exaggerated. This book addresses both the potential and challenges of CLTS by drawing on research in Bangladesh, India and Indonesia as well as experiences from Africa. With chapters by leading scholars and practitioners in sanitation policy and practice as well as critical reflections from key players in CLTS, Shit Matters offers important insights into the workings of CLTS on the ground, covering critical aspects of the social, ecological, technological, financial and institutional dynamics surrounding CLTS. It will be essential reading for anyone interested in development, health, public policy and sanitation issues 'Truly a vast oak tree has grown from a very small acorn. And Shit matters tells the story extremely well.' Peregrine Swann, WHO Senior Adviser to GLAAS (The UN-Water Global Annual Assessment of Sanitation and Drinking-Water) 'A "must read" for anyone who believes that a world in which over one billion people defecate in the open is a world not fit to live in.' Sanjay Wijesekera, Team Leader: Water and Sanitation, DFID 'There has been so much excitement around CLTS -- and not a little scepticism -- that we needed a sober assessment. Here it is. Absolutely invaluable.' Maggie Black, co-author The Last Taboo
Просмотров: 4362 The BMJ
Death at the Swedish House
This video matches the historical theme of this year's Christmas BMJ. We follow an intrepid group of Norwegian scientists and historians as they travel to the frozen tundra of Svalbard, an island in the Arctic Ocean. There they investigate the death of a group of seal hunters who were stranded on the island in 1872 the official cause of death was scurvy, but Ulf Aasebø and his team reach a different conclusion.
Просмотров: 1856 The BMJ
Medical innovations: Biobank
When it comes to doing epidemiological studies, numbers matter. We find out about the UK's biobank - a project to collect information and samples from 500,000 volunteers, which should help scientists look for links between lifestyle and health.
Просмотров: 7632 The BMJ
How we make a rapid rec
New BMJ collaboration accelerates evidence into practice to answer the questions that matter quickly and transparently through trustworthy recommendations Find out more: http://www.bmj.com/content/354/bmj.i5191
Просмотров: 997 The BMJ
Radical prostatectomy or radiotherapy for treatment of prostate cancer
Read the full open access research: http://www.bmj.com/content/348/bmj.g1502 Prostate cancer is the commonest non-dermatological cancer and the second leading cause of cancer related death in men in the Western world. In more than 90% of cases the cancer is localised, and radical prostatectomy, radiotherapy, and active surveillance represent the main treatment options. In this nationwide population based cohort study the researchers assessed prostate cancer related mortality in patients in the Swedish national prostate cancer registry, who underwent radical prostatectomy or radiotherapy as their primary treatment. Linkage with other healthcare and demographic databases enabled reduction of potential confounding through statistical techniques as well as adjustment for competing risks of mortality, as many men with prostate cancer are known to die of other causes. The authors hypothesised that survival differences would vary by treatment, and that age and the burden from comorbidities would have an impact on survival.
Просмотров: 1555 The BMJ
Interview with Lord Ara Darzi
Interview with Lord Ara Darzi - UK Government Health Minister - about his report into quality and healthcare in England and Wales.
Просмотров: 7691 The BMJ
Find and treat
TB is on the increase in London, and is especially prevalent in the homeless population, where other underlying conditions, and the use of alcohol and drugs, can mask symptoms. In this film we look at the work of the Find and Treat mobile unit - a dedicated team which scours the streets for cases of TB in the homeless. This also links to an economic analysis, published in the BMJ, which finds this is a very cost effective way of treatment and helps prevent further infections. BMJ research paper is free to access - Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation
Просмотров: 1215 The BMJ
Ben Goldacre
Просмотров: 569 The BMJ
Smoking cessation treatment and risk of depression, suicide, and self harm
Read the full open access research: http://www.bmj.com/content/347/bmj.f5704 Smoking is a major cause of premature mortality and preventable morbidity in the United Kingdom and worldwide.Treatments such as varenicline, bupropion, and nicotine replacement therapy, along with advice and referral to smoking cessation services, are recommended by the National Institute for Health and Care Excellence as options for smokers who want to quit smoking. Since their launch, there have been concerns from spontaneous reporting systems that varenicline and bupropion could increase the risk of fatal and non-fatal self harm; these have resulted in safety warnings by regulatory agencies, including the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK and the Food and Drug Administration in the United States. In this study the authors set out to compare the risk of suicide, self harm, and depression in patients prescribed varenicline or bupropion with those prescribed nicotine replacement therapy using a prospective cohort in the UK.
Просмотров: 2703 The BMJ
Study raises questions over possible discrimination in GP exam
Read the full research online: http://www.bmj.com/content/347/bmj.f5662 The researchers say they cannot rule out "subjective bias owing to racial discrimination" in the exam and call for additional training for international medical graduates to help them adapt to the UK health care system. In order to practise as an accredited general practitioner (family physician) in the UK, doctors must pass the MRCGP (Membership of the Royal College of General Practitioners) examination. But concerns have been raised about the high failure rate of ethnic minority candidates. And it has been questioned whether the clinical skills assessment part of the exam discriminates against these individuals. With continuing dependence on international medical graduates in meeting the workforce needs of many developed countries, including the UK, understanding the barriers that these doctors face in entering and completing specialist medical training is important. So researchers at the University of Manchester analysed data for 5,095 candidates sitting the applied knowledge test and clinical skills assessment components of the MRCGP examination between 2010 and 2012 -- to determine the difference in failure rates by ethnic or national background. A further analysis was carried out on 1,175 candidates not trained in the UK, who sat an English language capability test (IELTS) and the Professional and Linguistic Assessment Board (PLAB) examination, as required for full medical registration. The data was provided by the Royal College of General Practitioners and the General Medical Council. After controlling for age, sex, and performance in the applied knowledge test, significant differences persisted between white UK graduates and other candidates. British black and minority ethnic graduates were more likely to fail the clinical skills assessment at their first attempt than their white UK colleagues (17% v 4.5%). Black and minority ethnic candidates who trained abroad were also more likely to fail the clinical skills assessment than their white UK colleagues (65% v 4.5%). For candidates not trained in the UK, black or minority ethnic candidates were more likely to fail than white candidates, but this difference was no longer significant after controlling for scores in the applied knowledge test, IELTS, and PLAB examinations. The authors say they "cannot exclude subjective bias owing to racial discrimination in the marking of the clinical skills assessment as a reason for these differential outcomes." They say previous training experience and cultural factors could help explain these differences, but point out that they "cannot explain differences between white candidates and black and minority ethnic candidates who have trained in the UK, and who would have had similar training experiences and language proficiency." They suggest that changes to the clinical skills assessment "could improve the perception of the examination as being biased against black and minority ethnic candidates" and recommend additional training for international medical graduates "to enable their adaption to the UK health care system."
Просмотров: 1521 The BMJ
Treatments for pyoderma gangrenosum: the STOP GAP RCT
Pyoderma gangrenosum is a rare inflammatory disorder that causes progressive necrotising ulceration. A retrospective cohort study of UK cases reported an age and sex adjusted incidence of 0.63 per 100,000 person years. Currently there are no national or international guidelines covering the management of pyoderma gangrenosum. Patient information issued by the British Association of Dermatologists describes topical and systemic treatment options, as well as lesser used options such as intravenous steroids or biologics. The most commonly prescribed topical treatments for pyoderma gangrenosum are potent steroid preparations and calcineurin inhibitors, and commonly prescribed systemic treatments include steroids and immunosuppressants. In the STOP GAP study, the researchers set out to determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum. Read the full research: http://www.bmj.com/content/350/bmj.h2958
Просмотров: 4162 The BMJ
Why Rudolph's nose is red
In the arctic, reindeer have evolved to keep warm - but like all animals, sometimes they need to cool down. Unlike humans, they cannot sweat, so have to use their nose as a heat exchanger. Medical researchers from Rotterdam, in The Netherlands, and zoophisiologists from Tromsø, in Norway, have collaborated to have a look at the blood vessel structures within the nose which allow the reindeer to do that. Watch the video to find out how studying this microcirculation is helping with our understanding of disease, as well as thermoregulation. Read the science behind the story: http://www.bmj.com/cgi/doi/10.1136/bmj.e8311
Просмотров: 13112 The BMJ
TIDieR: Better reporting of interventions
Read the full reporting guideline: http://www.bmj.com/content/348/bmj.g1687 Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide.
Просмотров: 1985 The BMJ
Defining safe criteria to diagnose miscarriage
Read the full open access article: http://www.bmj.com/content/351/bmj.h4579 Current national guidelines on the diagnosis of miscarriage may still be associated with misdiagnoses, and should be reviewed in light of new evidence, suggests a study published in The BMJ today. The Royal College of Obstetrics and Gynaecologists (RCOG) guidelines recommend a miscarriage diagnosis based on an ultrasound scan measurement of the gestational sac diameter (GSD) and the embryo's crown-rump length (CRL). Guidelines on the cut off values for these measurements were updated in 2011 following concerns that the older recommendations were based on inadequate evidence and leading to misdiagnoses. These changes have been shown to be safe, according to a new study by Professor Tom Bourne at Imperial College London and colleagues. But they argue that the guidelines now also need to be updated with new criteria for when the initial scan is inconclusive and a repeat scan is needed, as a result of the embryonic and gestational sac sizes being too small. A repeat scan is recommended, usually 1-2 weeks later, but this guidance is based on expert opinion rather than evidence. So the team of authors also set out to determine new recommendations for the second scan. They examined the ultrasound scans of 2,845 women admitted to seven early pregnancy units in the UK during 2011-2013. Women were admitted due to vaginal bleeding, pain, severe morning sickness or a previous miscarriage or ectopic pregnancy. Based on the examination of these ultrasound scans, the authors make specific recommendations for a repeat scan between 7 and 14 days after the initial scan depending on the size of the GSD, CRL and presence or absence of a heartbeat.
Просмотров: 809 The BMJ
Concern over inappropriate use of psychotropic drugs in people with  intellectual disability
Read the full open access research: http://www.bmj.com/content/351/bmj.h4326 Over 70% of prescriptions are given to those without a record of mental illness The proportion of people with intellectual disability in the UK who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness, finds a study published by The BMJ today. This suggests that, in some cases, these drugs are being used to manage challenging behaviour rather than for mental illness, say the researchers. They call for changes in the prescribing of psychotropic drugs for people with intellectual disability as well as more evidence on their safety in this group. People with intellectual disability develop severe mental illness at higher rates than do the general population and may show challenging behaviour. Concern has existed for many years that psychotropic drugs in general - and antipsychotics in particular (mainly used to treat schizophrenia and bipolar disorder) - are overused in people with intellectual disability, but accurate estimates have been difficult to obtain. So a team of researchers based at University College London set out to describe rates of recorded mental illness, challenging behaviour, and use of psychotropic drugs in people with intellectual disability in UK primary care. They analysed data from 571 UK general practices using the The Health Improvement Network (THIN), a large database of electronic health records, and identified 33,016 people with a record of intellectual disability. Average age at study entry was 36 years and average follow-up was five and a half years. Of 9,135 participants treated with antipsychotic drugs by the end of the study period, 6,503 (71%) did not have a record of severe mental illness. Of the 11,915 with a record of challenging behaviour, 5,562 (47%) had received antipsychotic drugs, whereas only 1,421 (12%) had a record of severe mental illness. And of those with a record of prescription of antipsychotics, 26% did not have a record of severe mental illness or challenging behaviour. New prescriptions for antipsychotics were significantly more common in older people and in those with a record of challenging behaviour, severe mental illness, depression, anxiety, autism, dementia, and epilepsy. People with a record of challenging behaviour were more than twice as likely to receive a prescription for antipsychotics compared with those without a record of challenging behaviour, say the authors. Prescription of antipsychotic drugs is disproportionate to the level of recorded severe mental illness and is associated with the presence of challenging behaviour, older age, and diagnoses of autism and dementia, they add.
Просмотров: 1032 The BMJ
Specific SSRIs and birth defects:  interpreting new data in the context of previous reports
Read the full open access research: http://www.bmj.com/content/351/bmj.h3190 The association between maternal use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), during pregnancy and birth defects in the infants has been the topic of much discussion in recent years. After initial reports of an association between paroxetine and heart defects, the US Food and Drug Administration published an advisory warning of this potential association in December 2005. Recent meta-analyses and systematic reviews combining data from more than 20 epidemiological studies have reached conflicting conclusions and this uncertainty influences perceptions of the safety of antidepressant use in pregnancy. In this study, the authors set out to follow up on previously reported associations between periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and specific birth defects using an expanded dataset from the National Birth Defects Prevention Study. They conclude that these data provide reassuring evidence for some SSRIs but suggest that some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy.
Просмотров: 2310 The BMJ
Medical innovations: Gentamicin calculator
Gentamicin is an antibiotic that is widely used in hospitals, but calculating the correct dose to give to patients can cause problems for doctors. One junior doctor, Imran Qureshi, used his computer science background to create a simple to use gentamicin calculator.
Просмотров: 4865 The BMJ
Heart attack survivors who eat lots of fibre live longer
Read the open access research: http://www.bmj.com/content/348/bmj.g2659 Diet plays an important role in the etiology of atherosclerosis and coronary heart disease, yet secondary prevention guidelines generally emphasize pharmaceutical management owing to the lack of evidence to guide diet and lifestyle recommendations. The need for better lifestyle guidelines for survivors of myocardial infarction (MI) is profound especially because a substantial drop in the case fatality rate has increased the number of survivors in the United States. Compared with the general population, this growing patient population is at higher risk for mortality and may be more motivated to change their lifestyle habits. Evidence as to whether and to what extent dietary changes from before to after MI improve prognosis is, however, insufficient. Greater intake of dietary fiber improves glycemic response and insulin sensitivity, increases the production of short chain fatty acids, and increases satiety to help control overall energy intake. Dietary fiber is inversely associated with risk of dyslipidemia, hypertension, obesity, diabetes, peripheral vascular disease, coronary heart disease, and stroke. Here the researchers set out to evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality.
Просмотров: 1214 The BMJ
How accurate are online symptom checkers?
Read the full open access research: http://www.bmj.com/content/351/bmj.h3480 Members of the public are increasingly using the internet to research their health concerns. For example, the United Kingdom’s online patient portal for national health information, NHS Choices, reports over 15 million visits per month, and more than a third of adults in the United States regularly use the internet to self diagnose their ailments, using it both for non-urgent symptoms and for urgent symptoms such as chest pain. Using computerized algorithms, symptom checkers ask users a series of questions about their symptoms or require users to input details about their symptoms themselves. One symptom checker, iTriage, reports 50 million uses each year. 23 symptom checkers that were in English and provided advice across a range of conditions were checked using 45 standardized patient vignettes - which are often used to test medical students knowledge. They concluded that symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.
Просмотров: 2206 The BMJ
Safety and efficacy of intravenous iron therapy in reducing  blood transfusion
Read the full research online: http://www.bmj.com/content/347/bmj.f4822 Iron is essential for the production of red blood cells and is the most common nutritional deficiency worldwide, both in developed and developing countries. Though allogeneic red blood cell transfusion might be lifesaving for the management of acute severe blood loss, there are increasing concerns about associated serious adverse events, costs, and scarcity. Safe and effective strategies to reduce such transfusions are urgently needed. Researchers from the University of Western Australia set out to find out how safe and effective these intravenous iron infusions are. They carried out a systematic review and meta-analysis of randomised controlled trials, and found that intravenous iron therapy is effective in increasing haemoglobin concentration and reducing the risk of allogeneic red blood cell transfusion and could have broad applicability to a range of acute care settings. This potential benefit is counterbalanced by a potential increased risk of infection.
Просмотров: 4745 The BMJ
Clinical risk factors for pre-eclampsia determined in early pregnancy
Read the full article: http://www.bmj.com/content/353/bmj.i1753 Pre-eclampsia is a common condition of pregnancy, marked by the onset of hypertension and proteinuria. At least 75 randomized controlled trials have shown that antiplatelet agents— especially aspirin—effectively and safely prevent pre-eclampsia among women at moderate or high risk of developing the condition. Meta-analyses have shown a 53% reduction in relative risk for pre-eclampsia when aspirin is started at 12-16 weeks’ gestation among high risk women. Internationally published clinical practice guidelines strongly recommend that physicians and midwives use aspirin to treat women at high risk of pre-eclampsia. These guidelines suggest choosing from a list of single risk factors to identify women at high risk or from a combination of moderate risk factors, but the derivation of this partial list was neither systematic nor based on clinical risk factors that are available up to 16 weeks’ gestation. Focus on those at high risk of pre-eclampsia avoids the treatment of healthy women, who gain little or no benefit from aspirin prophylaxis. Many randomized controlled trials of aspirin prophylaxis did not describe the criteria they used to define a woman as high risk, and others used abnormal findings on uterine artery Doppler ultrasonography, which has limited sensitivity, is rarely done before 16 weeks, and has limited availability among midwives and family practitioners. Other studies have proposed several risk factors to characterize women at high risk of pre-eclampsia, including nulliparity, older age, chronic hypertension, and prepregnancy diabetes mellitus. Yet again, the absolute and relative importance of one risk factor over another has not been systematically assessed. Given the limitations and variability in the current criteria used to identify women at high risk of pre-eclampsia, there is a need for a clear, concise, and evidence based list of indicators to estimate a woman’s risk. These indicators should consider events in any previous pregnancy as well as current pregnancy factors that can be efficiently gathered at an early prenatal visit. To generate this list, we completed a meta-analysis of large cohort studies of one or more risk factors for pre-eclampsia. To generate three practical estimates, we determined the absolute risk of developing pre-eclampsia in the presence versus absence of a given risk factor; the relative risk of developing pre-eclampsia in the presence versus absence of a given risk factor; and the population attributable fraction for pre-eclampsia in relation to each risk factor. The first two metrics are useful to clinicians, and the third metric can help guide public health policy at the population level. Finally, we outlined how our generated list of individual risk factors might be applied to identify “high risk” women, such as those who could benefit from aspirin prophylaxis.
Просмотров: 2604 The BMJ