The BMJPub Date : 2025-03-18DOI: 10.1136/bmj-2024-079839
Carole Lunny, J P T Higgins, Ian R White, Sofia Dias, B Hutton, J M Wright, Areti-Angeliki Veroniki, P F Whiting, A C Tricco
{"title":"Risk of Bias in Network Meta-Analysis (RoB NMA) tool","authors":"Carole Lunny, J P T Higgins, Ian R White, Sofia Dias, B Hutton, J M Wright, Areti-Angeliki Veroniki, P F Whiting, A C Tricco","doi":"10.1136/bmj-2024-079839","DOIUrl":"https://doi.org/10.1136/bmj-2024-079839","url":null,"abstract":"Systematic reviews with network meta-analysis (NMA) have potential biases in their conduct, analysis, and interpretation. If the results or conclusions of an NMA are integrated into policy or practice without any consideration of risks of bias, decisions could unknowingly be based on incorrect results, which could translate to poor patient outcomes. The RoB NMA (Risk of Bias in Network Meta-Analysis) tool answers a clearly defined need for a rigorously developed tool to assess risk of bias in NMAs of healthcare interventions. In this guidance article, we describe and provide a justification for the tool’s 17 items, their mechanism of bias, pertinent examples, and how to assess an NMA based on each response option. A network meta-analysis (NMA) is a type of quantitative analysis that can be performed as part of a systematic review.1234 An NMA is an extension of a pairwise meta-analysis that compares the effects of multiple interventions simultaneously on one clinical, public health, or policy question.1 NMAs provide coherent estimates of comparative effectiveness for all pairs of interventions in the network, including interventions that have never been previously compared in a head-to-head study. Furthermore, NMAs allow for the ranking of all interventions in a network of studies.5 Systematic reviews with NMA have potential biases in their conduct, analysis, and interpretation.67 Quality assessment of the evidence is integral to the practice of evidence based medicine. If the results or conclusions of an NMA are integrated into policy or practice without any consideration of the risks of bias, decisions could unknowingly be based on incorrect results, with the potential for these to translate to poor patient outcomes. Therefore, NMAs should be assessed in terms of potential for bias. The Risk of Bias in Network Meta-Analysis (RoB NMA) tool was developed because no …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Body cameras and panic alarms for doctors could help deter violence and harassment","authors":"Caroline Kamau-Mitchell","doi":"10.1136/bmj.r529","DOIUrl":"https://doi.org/10.1136/bmj.r529","url":null,"abstract":"Body cameras and panic alarms in healthcare settings could act as deterrents and reactive solutions to abusive incidents, writes Caroline Kamau-Mitchell Doctors and healthcare staff need better protection from violence and harassment—many have lost their lives or been injured around the world. For example, in 2022, a patient murdered a doctor in Italy with an axe.1 In 2024, doctors and nurses in Italy barricaded themselves in a room after a mob of about 50 people connected with a patient attacked them.1 In August 2024, a female doctor in India was raped and murdered in hospital, and thousands of doctors went on strike in protest.2 These are only a few examples of the widespread violence that healthcare staff face globally. Body cameras and panic alarms could deter potential offenders34 and provide valuable evidence in cases of abuse.5 Global meta-analyses report that 15% of doctors have experienced physical violence from patients or visitors,6 and 45% have experienced sexual harassment.7 An investigation by The BMJ and the Guardian revealed that, in a five year period, there were over 20 000 cases of healthcare staff being abused by …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rammya Mathew: Abolishing NHS England is a reckless gamble with uncertain returns","authors":"Rammya Mathew","doi":"10.1136/bmj.r536","DOIUrl":"https://doi.org/10.1136/bmj.r536","url":null,"abstract":"The sudden and unexpected announcement that NHS England is being abolished has left many of us in NHS leadership roles feeling deeply unsettled. The language used by the prime minister, Keir Starmer, and the health and social care secretary, Wes Streeting—referring to NHS England as “the world’s largest quango”1—was not only offensive but also dismissive of the vast and essential work carried out by people in the organisation. These are the same individuals who orchestrated the most significant vaccination campaign of our lifetime during the covid pandemic, yet they now find their work reduced to mere “needless bureaucracy” while simultaneously learning that their jobs are on the line. Even more concerning is …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Julia Ruth Hamilton","authors":"Sara Smith","doi":"10.1136/bmj.r514","DOIUrl":"https://doi.org/10.1136/bmj.r514","url":null,"abstract":"Julia was born and raised in Northern Ireland and studied medicine at Queens University, Belfast. Having decided on a career in general practice, she undertook her registrar year at the Whitefriars Green Practice surgery in Perth and became a partner on qualifying. She remained with the practice for the duration of her career, eventually becoming senior partner. Julia was …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How can I boost team morale?","authors":"Abi Rimmer","doi":"10.1136/bmj.r444","DOIUrl":"https://doi.org/10.1136/bmj.r444","url":null,"abstract":"When teams are stretched it is important to foster a supportive working environment, Abi Rimmer hears Billy Palmer, Nuffield Trust senior fellow, says, “We know from our analysis of staff survey data that the gulf in job satisfaction between the NHS’s youngest and oldest staff is widening.1 Clinicians aged 21-30 are far less likely to look forward to going to work than those of a similar age a decade ago, whereas this has plateaued or improved for all other age categories. A lack of satisfaction with pay and work-life balance, as well as increasingly feeling unwell because of work related stress, seem to be contributing to the negativity for this younger age group. “While many studies on improving morale lack methodological rigour, there seems to be reasonable weight behind many interventions, with some of those long standing. A 2006 literature review on nursing morale highlighted the importance of both intrinsic (professional respect, skill development, workplace relationships, patient care) and extrinsic (organisational structures, leadership approaches, communication, staffing) factors.2 “Influencing morale is complex, however. It is generated not only within a team but also at individual, professional, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Partha Kar: The RCP leadership elections are an opportunity for a fresh start","authors":"Partha Kar","doi":"10.1136/bmj.r519","DOIUrl":"https://doi.org/10.1136/bmj.r519","url":null,"abstract":"The year 2024 could be described as an annus horribilis for the Royal College of Physicians (RCP). There’s no question about the impact the debate around physician associates has had on the college’s reputation. In the broader scheme of things this could have been a minor issue, but the way it was handled has taken a toll—including a lack of transparency, a damaging extraordinary general meeting called by fellows, and the resignations of many senior leaders. Further problems have continued to brew, such as the recent disaster involving exams for membership of the RCP.1 Amid all this controversy, we can hope that the college’s 2025 elections will be a turning point. But it’s astonishing that, even in these fractious times, RCP members …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oliver T Mytton, Denise Campbell-Scherer, Ian Reckless, Clare Llewellyn
{"title":"Diagnosing and defining obesity","authors":"Oliver T Mytton, Denise Campbell-Scherer, Ian Reckless, Clare Llewellyn","doi":"10.1136/bmj.r460","DOIUrl":"https://doi.org/10.1136/bmj.r460","url":null,"abstract":"New criteria come amid discussion of access to weight loss drugs One billion children and adults have obesity.1 Getting the diagnosis of obesity right matters for people and for healthcare systems, particularly when considering prescription of expensive obesity drugs.2 The concept of obesity as excess body fat accumulation may be straightforward,13 but its diagnosis is not. Body mass index (BMI) has been widely used for clinical diagnosis, but cut-off points for BMI can both underestimate and overestimate adiposity and might poorly identify health risk at the individual level.3 Regardless of how adiposity is measured, it is unclear what can be defined as “abnormal” and “normal.” In the quest to prevent illness, the medical community may choose ever lower thresholds, but in doing so, society is medicalising problems rather than tackling the underlying societal causes of illness.4 The latest attempt to define obesity is from the Lancet Diabetes and Endocrinology Commission, a group of 58 international experts selected to have global reach and differing clinical expertise.35 Consensus was achieved through monthly online evidence presentations and a Delphi process. Many of the commissioners declare funding from or other relationships with drug companies. Scientific or medical bodies and patient organisations were asked to endorse (but could not alter) the guidance, with 76 bodies endorsing …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"When I use a word . . . The funniest medical words","authors":"Jeffrey K Aronson","doi":"10.1136/bmj.r533","DOIUrl":"https://doi.org/10.1136/bmj.r533","url":null,"abstract":"Some words are beautiful, or are thought to be; they may be phonologically attractive, or they may conjure up beautiful thoughts, or both. Conversely, some words are ugly, or are thought to be; they may be phonologically unattractive, or they may conjure up unpleasant thoughts, or both. But most words are neither beautiful nor ugly. Many words cut across this classification, having other characteristics. Some, for example, are regarded as funny, whether funny-ha-ha or funny-peculiar, sometimes both. I have analysed 708 words that have been regarded as funny by people who have published lists of them. The words are heterogeneous—many different factors determine whether a word makes it onto the list.. They tend to be polysyllabic and, whether monosyllabic or not, they tend to be pronounced with the stress on the first syllable. They contain certain letters more often than expected,. for example /b/, /f/, and /g/ as initial letters and the letter /o/ anywhere in a word, particularly when reduplicated as /oo/. The letters /k/ and hard /c/, often considered by comedians to be the letters that make words funny, are common, as is the combination /ck/. Some letters occur repeatedly throughout a word, as in abracadabra and blubberbutt. Reduplicative words, such as hoity-toity and helter-skelter, are common, and some appear in the list because they evoke topics about which people are likely to snigger, including bodily functions and sex, even when they actually have nothing to do with those topics. Some words are included simply because they are unfamiliar, often dialect or foreign words or obsolete ones. A few words are listed because they were specifically invented to be humorous, like Jabberwocky and Snark. And some listed words do not appear to be funny in any way; perhaps they were included as in-jokes. But, as Dorothy Parker once …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antiracism in medicine: what is it?","authors":"Aisha Majid","doi":"10.1136/bmj.r362","DOIUrl":"https://doi.org/10.1136/bmj.r362","url":null,"abstract":"Aisha Majid reports on the efforts being made to go beyond EDI initiatives and confront racism head on “I don’t think he realised how offensive it was,” says Desire Onwochei, recounting an exchange with a fellow anaesthetist at a conference. He had decided to share his opinion that black people don’t enjoy cycling. Also present during the exchange between the white anaesthetist and Onwochei, who is a black consultant at Guy’s and St Thomas’ NHS Foundation Trust, was one of her white female colleagues. “Later on that evening my colleague told me how uncomfortable she had felt in that conversation,” says Onwochei. “She said she felt bad that she hadn’t said anything but that she didn’t know what to say.” Data and lived experiences1 unequivocally show that staff from ethnic minority backgrounds have a poorer experience of working in the NHS, from being more likely to be referred to the regulator than their white counterparts2 to being less likely to be appointed to a post after shortlisting.3 The NHS has long had strategies aiming for equality, diversity, and inclusion (EDI), but since the tragic murder of George Floyd in 2020 and the subsequent boost in the Black Lives Matter movement, more organisations are talking about being “antiracist.” For Onwochei, her white colleague’s reaction was an example of being antiracist. Even though her colleague didn’t know what to say, she still “wanted to let me know that she didn’t think that what happened was right.” She adds, “It made me feel like she actually understands, and, for me, that was being antiracist—her identifying with me and showing her support to me.” But what does antiracism mean, and what makes it more than just an elevated term for EDI? Anton Emmanuel led NHS England’s Workforce Race Equality Standard (WRES) …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"David Oliver: Abolishing NHS England is no panacea for the NHS’s woes","authors":"David Oliver","doi":"10.1136/bmj.r526","DOIUrl":"https://doi.org/10.1136/bmj.r526","url":null,"abstract":"On 13 March the prime minister, Keir Starmer, announced that NHS England (NHSE) was being abolished. He described it as the “world’s biggest quango,” saying that he wanted to “bring the NHS back into democratic control” and to “cut bureaucracy,” as “the state” had become “flabby and unfocused.”1 But is such a “big bang” structural reorganisation of central government agencies any solution to the NHS’s current problems—especially when the health and social care secretary, Wes Streeting, had said repeatedly that he didn’t want to pursue more structural reorganisation but wanted to focus instead on improving services?2 The service needs to tackle record waiting lists for elective care, long waiting times, overcrowding and unsafe bed occupancy in emergency care,3 record low satisfaction among patients and staff, workforce unrest (especially among younger employees),4 and wider issues around population health, inequalities,5 and social care.6 While Starmer’s sudden announcement was a surprise even to the health policy community, it followed the replacement of NHSE’s board chair and chief executive with Streeting’s own picks and the appointment of the former Labour health secretary Alan …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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