The BMJ最新文献

{"title":"Preventing sexually transmitted infection globally","authors":"Stellah W Bosire, Migai Akech","doi":"10.1136/bmj.q2347","DOIUrl":"https://doi.org/10.1136/bmj.q2347","url":null,"abstract":"End avoidable harm by tackling stigma and integrating services Despite decades of advances in prevention, diagnosis, and treatment worldwide, sexually transmitted infections (STIs) remain a major public health burden and eradication elusive.1 New cases of four curable STIs—chlamydia, gonorrhoea, syphilis, and trichomoniasis—together reach over 374 million annually.2 Africa accounts for nearly 18% of all global STI infections, with around 93 million new cases annually, positioning the region as a priority for global health interventions.3 Although progress has been made in expanding access to HIV testing and treatment, hepatitis C therapies, and vaccination programmes, the global response is currently off-track to meet the 2030 targets for reducing new infections and related mortality for gonorrhoea (90% reduction in incidence), congenital syphilis (50 cases/100 000 live births in 80% of countries), and HPV vaccination (90% coverage nationally).3 Barriers to preventive, curative, and supportive measures are deeply rooted in restrictive laws and policies, inadequate comprehensive sexuality education, weak surveillance, and fragmented service delivery, all of which contribute to the burden of sexually transmitted diseases and impact the rights, dignity, and wellbeing of affected …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796821","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":"Building infrastructure is key to unifying UK health data","authors":"Jessica Morley, Luc Rocher","doi":"10.1136/bmj.q2735","DOIUrl":"https://doi.org/10.1136/bmj.q2735","url":null,"abstract":"Technical, rather than bureaucratic, solutions are needed Reforming the NHS by shifting from analogue to digital, from treating sickness to prevention of disease, and from hospital to community care is a priority for the UK government.1 Better use of data will be central to achieving these shifts—revealing who is likely to become unwell, enabling predictive modelling, and simulating the effects of changing the location of care. The November 2024 publication of the Sudlow review of the UK’s health data systems2 is therefore timely. Commissioned by the chief medical officer for England, the review makes recommendations for overcoming barriers to linking and sharing data by streamlining control; standardising mechanisms, governance policies, and public engagement activities for data access; and broadening access to imaging and free text data. Currently, the UK’s health data infrastructure is outdated3 and fragmented, with datasets siloed across multiple locations4 and controlled by different entities that make inconsistent decisions about access.5 This slows down research and undermines public trust. Infrastructure needs to be consistent and better coordinated. Yet recommendations in the Sudlow review for creating “critical national infrastructure” over-rely on bureaucratic …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796822","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":"Doctors’ clinical judgment risks being sacrificed on the altar of protocol driven care","authors":"Zaid Al-Najjar","doi":"10.1136/bmj.q2723","DOIUrl":"https://doi.org/10.1136/bmj.q2723","url":null,"abstract":"Doctors’ diminishing clinical autonomy can have a series of knock-on effects, writes Zaid Al-Najjar In healthcare today, much of our work is driven by the need to fit neatly into a clinical pathway. This leaves many doctors feeling frustrated and mourning the loss of autonomy. Everything we do—from what we prescribe, the investigations that we order, to the referrals we make—seem governed by predefined pathways. It can feel like there is always someone ready to point out that what you thought was clinically necessary falls outside the pathway parameters and therefore shouldn’t have (or can’t be) done. When something goes wrong and our practice falls under the scrutiny of the medicolegal microscope, expert witnesses refer to best practice …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793423","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":"Assisted dying poses significant risks to disabled people","authors":"Tirion Hughes","doi":"10.1136/bmj.q2730","DOIUrl":"https://doi.org/10.1136/bmj.q2730","url":null,"abstract":"I’m concerned that disability isn’t mentioned in The BMJ ’s recent articles on assisted dying,1 although many important viewpoints have been considered, including palliative care underfunding and inaccuracies in estimating life expectancy. I’m not fundamentally opposed to assisted dying for terminally ill people (other arguments notwithstanding), but my experiences as a disabled person and doctor tell me this cannot be achieved in the current sociopolitical climate without putting disabled people at significant risk. Countries like Canada show a clear …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793420","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":"What, if any, should be the role of doctors in assisted dying?","authors":"H Lucy Thomas","doi":"10.1136/bmj.q2726","DOIUrl":"https://doi.org/10.1136/bmj.q2726","url":null,"abstract":"The BMJ ’s coverage on assisted dying1 ignores the key question for the medical profession: what, if any, should be the role of doctors? In Leadbeater’s bill our role is central and decisive: not only do medical criteria define what constitutes an acceptable reason to end one’s life, but doctors are both the arbiters and administrators. This has several deeply problematic implications. This bill would legally require doctors to treat a patient …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793424","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":"Non-expressing homozygous C282Y carriers and haemochromatosis","authors":"Paul C Adams","doi":"10.1136/bmj.q2704","DOIUrl":"https://doi.org/10.1136/bmj.q2704","url":null,"abstract":"Haemochromatosis related diabetes can occur without iron overload After the detailed description of 311 patients with iron overload by J H Sheldon in 1935,1 people assumed that iron overload and haemochromatosis were synonymous and that iron overload throughout the body defined and caused the clinical disease. Iron overload was determined by liver biopsy, autopsy, and response to therapeutic phlebotomy. In the 1970s, newer blood tests such as serum ferritin and transferrin saturation became part of the diagnostic testing for iron overload.23 In 2005 data from the Hemochromatosis and Iron Overload Screening (HEIRS) Study introduced genetic testing and showed that approximately 57% of female C282Y homozygotes and 20% of male C282Y homozygotes had a normal serum ferritin and/or transferrin saturation without apparent iron overload.4 Transferrin saturation was found to be highly variable within individuals,5 and serum ferritin had mostly false positive results in patients without iron overload. Magnetic resonance imaging became a new tool to assess iron overload in the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793428","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":"Management of pain and sedation in the intensive care unit","authors":"Christina Boncyk, Mark L Rolfsen, David Richards, Joanna L Stollings, Matthew F Mart, Christopher G Hughes, E Wesley Ely","doi":"10.1136/bmj-2024-079789","DOIUrl":"https://doi.org/10.1136/bmj-2024-079789","url":null,"abstract":"Advances in our approach to treating pain and sedation when caring for patients in the intensive care unit (ICU) have been propelled by decades of robust trial data, knowledge gained from patient experiences, and our evolving understanding of how pain and sedation strategies affect patient survival and long term outcomes. These data contribute to current practice guidelines prioritizing analgesia-first sedation strategies (analgosedation) that target light sedation when possible, use of short acting sedatives, and avoidance of benzodiazepines. Together, these strategies allow the patient to be more awake and able to participate in early mobilization and family interactions. The covid-19 pandemic introduced unique challenges in the ICU that affected delivery of best practices and patient outcomes. Compliance with best practices has not returned to pre-covid levels. After emerging from the pandemic and refocusing our attention on optimal pain and sedation management in the ICU, it is imperative to revisit the data that contributed to our current recommendations, review the importance of best practices on patient outcomes, and consider new strategies when advancing patient care.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"210 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793430","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":"Mortality and risk of diabetes, liver disease, and heart disease in individuals with haemochromatosis HFE C282Y homozygosity and normal concentrations of iron, transferrin saturation, or ferritin: prospective cohort study","authors":"Mathis Mottelson, Jens Helby, Børge Grønne Nordestgaard, Christina Ellervik, Thomas Mandrup-Poulsen, Jesper Petersen, Stig Egil Bojesen, Andreas Glenthøj","doi":"10.1136/bmj-2023-079147","DOIUrl":"https://doi.org/10.1136/bmj-2023-079147","url":null,"abstract":"Objectives To test whether haemochromatosis HFE C282Y homozygotes have increased risk of diabetes, liver disease, and heart disease even when they have normal plasma iron, transferrin saturation, or ferritin concentrations and to test whether C282Y homozygotes with diabetes, liver disease, or heart disease have increased mortality compared with non-carriers with these diseases. Design Prospective cohort study. Setting Three Danish general population cohorts: the Copenhagen City Heart Study, the Copenhagen General Population Study, and the Danish General Suburban Population Study. Participants 132 542 individuals genotyped for the HFE C282Y and H63D variants, 422 of whom were C282Y homozygotes, followed prospectively for up to 27 years after study enrolment. Main outcome measure Hospital contacts and deaths, retrieved from national registers, covering all hospitals and deaths in Denmark. Results Comparing C282Y homozygotes with non-carriers, hazard ratios were 1.72 (95% confidence interval (CI) 1.24 to 2.39) for diabetes, 2.22 (1.40 to 3.54) for liver disease, and 1.01 (0.78 to 1.31) for heart disease. Depending on age group, the absolute five year risk of diabetes was 0.54-4.3% in C282Y homozygous women, 0.37-3.0% in non-carrier women, 0.86-6.8% in C282Y homozygous men, and 0.60-4.80% in non-carrier men. When studied according to levels of iron, transferrin saturation, and ferritin in a single blood sample obtained at study enrolment, risk of diabetes was increased in C282Y homozygotes with normal transferrin saturation (hazard ratio 2.00, 95% CI 1.04 to 3.84) or ferritin (3.76, 1.41 to 10.05) and in C282Y homozygotes with normal levels of both ferritin and transferrin saturation (6.49, 2.09 to 20.18). C282Y homozygotes with diabetes had a higher risk of death from any cause than did non-carriers with diabetes (hazard ratio 1.94, 95% CI 1.19 to 3.18), but mortality was not increased in C282Y homozygotes without diabetes. The percentage of all deaths among C282Y homozygotes that could theoretically be prevented if excess deaths in individuals with a specific disease were eliminated (the population attributable fraction) was 27.3% (95% CI 12.4% to 39.7%) for diabetes and 14.4% (3.1% to 24.3%) for liver disease. Risk of diabetes or liver disease was not increased in H63D heterozygotes, H63D homozygotes, C282Y heterozygotes, or C282Y/H63D compound heterozygotes. Conclusions Haemochromatosis C282Y homozygotes with normal transferrin saturation and/or ferritin, not recommended for HFE genotyping according to most guidelines, had increased risk of diabetes. Furthermore, C282Y homozygotes with diabetes had higher mortality than non-carriers with diabetes, and 27.3% of all deaths among C282Y homozygotes were potentially attributable to diabetes. These results indicate that prioritising detection and treatment of diabetes in C282Y homozygotes may be relevant. Statistical code or technical details can be made available from the corresponding author at andre","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793426","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":"John Hunter Dagg","authors":"Archie Prentice","doi":"10.1136/bmj.q2665","DOIUrl":"https://doi.org/10.1136/bmj.q2665","url":null,"abstract":"John Dagg graduated from Glasgow University in 1958, proceeding through training positions in Glasgow and Edinburgh. From 1962 he held research posts at Glasgow University, then took up a senior fellowship in haematology in Seattle, returning to a Medical Research Council senior fellowship at Glasgow in 1967. From 1968 to 1972 he was a senior Wellcome fellow in clinical science at the Western Infirmary. In 1970 he took charge of clinical haematology and in 1972 was appointed a consultant in medicine, a position he held until his …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793425","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":"Drug use: how can policies reduce the harms of both consumption and criminalisation?","authors":"Carla Delgado","doi":"10.1136/bmj.q2738","DOIUrl":"https://doi.org/10.1136/bmj.q2738","url":null,"abstract":"A former UN high commissioner for human rights tells The BMJ that the war on drugs has “completely failed” and that a public health focused approach is needed “The criminalisation of drugs doesn’t break dependence, but it deters people from seeking help,” says Louise Arbour. “It’s a completely self-defeating public policy.” Arbour, a former United Nations high commissioner for human rights, is a member of the Global Commission on Drug Policy—an independent panel of world leaders and political, economic, and cultural experts who advocate for drug policies grounded in scientific evidence and human rights. Their report, published this week, finds that over 40% of the world’s known executions in 2023 were for drug offences.1 The commission says that the prohibition focused approach that’s been a hallmark of the “war on drugs” for the past 50 years has failed to curtail the production and consumption of drugs such as cannabis, opiates, and heroin. Meanwhile, illegal drug markets controlled by organised crime have grown dramatically.2 An estimated nine in 10 people who use illegal drugs don’t experience dependence. The commission urges governments to tackle the underlying issues that may trigger drug use and dependence, such as trauma, homelessness, and self-medication, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793427","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}