The BMJ最新文献

{"title":"John Alexander Thomson","authors":"Jim McKillop, Harry Gray","doi":"10.1136/bmj.q2306","DOIUrl":"https://doi.org/10.1136/bmj.q2306","url":null,"abstract":"John Thomson (widely known as JAT) graduated in medicine from Glasgow University in 1956. He saw national service in Germany and Malaya, then trained in endocrinology at Glasgow Royal Infirmary in the 1960s, where he contributed to the early stages of the development of nuclear medicine. To complete his academic training and credentials in endocrinology, John and his family spent a year’s sabbatical at Harvard University in Boston on a US Public Health Service fellowship. He studied the biochemistry of thyroglobulin with Irving Goldberg. John returned to Glasgow in 1967 and in 1968 was appointed senior lecturer with special responsibility …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487227","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":"Medical school fitness to practise: the challenge of competing interests and responsibilities","authors":"Dominic Johnson, Faye Gishen","doi":"10.1136/bmj.q2077","DOIUrl":"https://doi.org/10.1136/bmj.q2077","url":null,"abstract":"UK medical schools are required by the regulator, the General Medical Council (GMC), to only graduate students who are fit to practise.1 The responsibility for this is divested to medical schools who sit within the framework of higher education institutions (HEIs). This contrasts with qualified doctors whose fitness to practise is considered within the Medical Practitioner Tribunal Service (MPTS) which, while separate from the GMC, sits under its auspices and governance. Other countries have equivalent systems around regulating and maintaining professional standards, as do other professional groups, such as nursing. While at its core, fitness to practise is intended as a supportive and developmental process, there are cases of students not being fit to practise who are consequently prevented from progressing with their studies.2 Sitting at the complex intersection of healthcare and higher education, medical schools are presented with an inherent dichotomy.3 In holding responsibility for educating and supporting their students to become doctors, alongside potentially preventing them from doing so through their responsibility to graduate only those who are fit to practise, competing interests may arise.4 We have heard this described as akin to being “poacher and gamekeeper.” As a senior undergraduate medical educator with substantial experience in fitness to practise and a head of a UK medical school, we are …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487681","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":"Intensive chemotherapy versus standard chemotherapy among patients with high risk, operable, triple negative breast cancer based on integrated mRNA-lncRNA signature (BCTOP-T-A01): randomised, multicentre, phase 3 trial","authors":"Min He, Yi-Zhou Jiang, Yue Gong, Lei Fan, Xi-Yu Liu, Yin Liu, Li-Chen Tang, Miao Mo, Yi-Feng Hou, Gen-Hong Di, Guang-Yu Liu, Ke-Da Yu, Jiong Wu, Xia Yan, Xiao-Hua Zeng, De-Yuan Fu, Chuan-Gui Song, Zhi-Gang Zhuang, Ke-Jin Wu, Jie Wang, Zhong-Hua Wang, Zhi-Ming Shao","doi":"10.1136/bmj-2024-079603","DOIUrl":"https://doi.org/10.1136/bmj-2024-079603","url":null,"abstract":"Objective To evaluate the feasibility of using a multigene signature to tailor individualised adjuvant therapy for patients with operable triple negative breast cancer. Design Randomised, multicentre, open label, phase 3 trial. Setting 7 cancer centres in China between 3 January 2016 and 17 July 2023. Participants Female patients aged 18-70 years with early triple negative breast cancer after definitive surgery. Interventions After risk stratification using the integrated signature, patients at high risk were randomised (1:1) to receive an intensive adjuvant treatment comprising four cycles of docetaxel, epirubicin, and cyclophosphamide followed by four cycles of gemcitabine and cisplatin (arm A; n=166) or a standard treatment of four cycles of epirubicin and cyclophosphamide followed by four cycles of docetaxel (arm B; n=170). Patients at low risk received the same adjuvant chemotherapy as arm B (arm C; n=168). Main outcome measures The primary endpoint was disease-free survival in the intention-to-treat analysis for arm A versus arm B. Secondary endpoints included disease-free survival for arm C versus arm B, recurrence-free survival, overall survival, and safety. Results Among the 504 enrolled patients, 498 received study treatment. At a median follow-up of 45.1 months, the three year disease-free survival rate was 90.9% for patients in arm A and 80.6% for patients in arm B (hazard ratio 0.51, 95% confidence interval (CI) 0.28 to 0.95; P=0.03). The three year recurrence-free survival rate was 92.6% in arm A and 83.2% in arm B (hazard ratio 0.50, 95% CI 0.25 to 0.98; P=0.04). The three year overall survival rate was 98.2% in arm A and 91.3% in arm B (hazard ratio 0.58, 95% CI 0.22 to 1.54; P=0.27). The rates of disease-free survival (three year disease-free survival 90.1% v 80.6%; hazard ratio 0.57, 95% CI 0.33 to 0.98; P=0.04), recurrence-free survival (three year recurrence-free survival 94.5% v 83.2%; 0.42, 0.22 to 0.81; P=0.007), and overall survival (three year overall survival 100% v 91.3%; 0.14, 0.03 to 0.61; P=0.002) were significantly higher in patients in arm C than in those in arm B with the same chemotherapy regimen. The incidence of grade 3-4 treatment related adverse events were 64% (105/163), 51% (86/169), and 54% (90/166) for arms A, B, and C, respectively. No treatment related deaths occurred. Conclusions The multigene signature showed potential for tailoring adjuvant chemotherapy for patients with operable triple negative breast cancer. Intensive regimens incorporating gemcitabine and cisplatin into anthracycline/taxane based therapy significantly improved disease-free survival with manageable toxicity. Trial registration ClinicalTrials.gov [NCT02641847][1]. Requests for individual de-identified participant data that underlie the results reported in this article will be considered. Qualified researchers should submit a proposal to the corresponding author outlining the reasons for requesting the data. The leading clinical site","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488865","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":"Risk prediction in early triple negative breast cancer","authors":"Sofia Mason","doi":"10.1136/bmj.q2088","DOIUrl":"https://doi.org/10.1136/bmj.q2088","url":null,"abstract":"Multigene RNA signature signals benefit from intensified chemotherapy for a high risk group Triple negative breast cancer is an aggressive subtype of breast cancer characterised by a lack of oestrogen, progesterone, and HER2 receptors which, if present, would guide the use of targeted therapies. This disease lacks validated prospective biomarkers predicting response to treatment and outcomes beyond basic staging information. The traditional mainstay of systemic treatment for triple negative breast cancer has been chemotherapy. We need to develop methods to guide treatment decisions in an increasingly complex therapeutic landscape in operable triple negative breast cancer. Enhanced understanding of risk of recurrence and sensitivity to treatment, as is the aim of the linked randomised trial by He and colleagues (BCTOP-T-A01) (doi:10.1136/bmj-2024-079603),1 can inform decisions about who needs intensive treatment and who might be spared therapies with serious and often permanent toxicities. The BCTOP-T-A01 trial is the first to prospectively validate a multigene tumour RNA signature to guide choice of chemotherapy in patients with early triple negative breast cancer.1 This …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488921","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":"Doctor suicide: reflections from an occupational health doctor","authors":"Harj K Kaul","doi":"10.1136/bmj.q2286","DOIUrl":"https://doi.org/10.1136/bmj.q2286","url":null,"abstract":"I agree with Ananta Dave’s clear report and 10 recommendations for preventing doctors from dying by suicide,1 but, as an in-house NHS occupational health doctor with 30 years of experience working with medical students, residents, salaried general practitioners, and consultants sharing their suicidal ideation concerns, I have a few reflections to add. Medical …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487367","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":"Environmental changes in South Sudan are changing the fabric of people’s lives and steering humanitarian operations","authors":"Elizabeth Wait","doi":"10.1136/bmj.q2324","DOIUrl":"https://doi.org/10.1136/bmj.q2324","url":null,"abstract":"> “People don’t want to leave their homes but they have to move because of water” > > Murle community representative during a Médecins Sans Frontières (MSF) operational assessment, Lola village, Labarab Payam\u0000When our team travelled to Labarab Payam in South Sudan to prepare for a multi-antigen vaccination campaign, we saw how communities had been made to up-end their way of life because of climate change. Environmental changes had forced subsistence farmers to switch their formerly sedentary lifestyle to seasonal movement, in patterns that resembled semi-nomadism. It was March 2024 when Médecins Sans Frontiers (MSF) arrived and many rivers were bone dry from the record-breaking 43°C heat.1 “We are forced to move from our homes to search for water,” grieved a woman during one of MSF’s operational assessments in Batalu village, Labarab Payam. The skin conditions of tinea capitis and tinea corporis are highly prevalent in the region, along with low breastmilk production, morbidities that are exacerbated by water scarcity. MSF has drilled several boreholes to improve water access,2 countering some of the negative health implications of climate change, but many more are needed. Soaring daytime temperatures are creating additional barriers to healthcare for pregnant women from semi-nomadic pastoralist communities who must travel …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488872","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":"Doctor suicide: doctors need a robust support system","authors":"Dominic Corrigan","doi":"10.1136/bmj.q2291","DOIUrl":"https://doi.org/10.1136/bmj.q2291","url":null,"abstract":"The BMJ ’s commentary on doctor suicide in the UK is both timely and critical.1 In the US, one doctor dies by suicide every day. These largely preventable deaths emphasise the need for high quality mental health support for doctors. Untreated mental illness is the most common factor in doctor suicides, making accessible clinical care essential to save lives. The NHS Practitioner …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487229","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":"KlimaSeniorinnen v Switzerland: the European Court of Human Rights leads the way on climate action","authors":"Petra Minnerop, Andy Haines","doi":"10.1136/bmj.q2156","DOIUrl":"https://doi.org/10.1136/bmj.q2156","url":null,"abstract":"Legal standards for countries’ obligations to tackle the climate emergency develop through two key avenues. One avenue comprises law making processes. This happens either via national parliaments and devolved governments, or at the level of international law through treaty making and sub-treaty rules. The other avenue is through courts. Although the separation of powers between the different branches of government forbids judicial law making, courts are often using scientific evidence when they review either administrative decisions—for example, planning permissions for infrastructure projects, or for the scrutiny of the lawfulness of specific measures taken by governments to mitigate against the climate emergency. The integration of scientific evidence helps shape legal standards for governments, state authorities, and corporations. Until recently courts often seemed reluctant to enter into the area of climate change and exercised judicial restraint to avoid tension with other branches of government. They have now firmly entered into this area, however. The total number of legal cases related to the climate crisis has more than doubled from 884 in 2017 to 2180 in 2022.1 Some courts have begun to seriously engage with climate science, referencing reports by the Intergovernmental Panel on Climate Change (IPCC) and case specific studies. In some instances, courts are paying attention to and expanding each other’s reasoning in this emerging inter-jurisdictional judicial discourse.2 In the recent case of KlimaSeniorinnen v Switzerland , the European Court of Human Rights (ECtHR) substantially expanded on its existing environmental case law. The ECtHR developed a set of criteria at the science-health-law interface with which states that are party to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487224","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":"Doctor suicide: carers need to feel cared for to keep on caring","authors":"Niall A Holland","doi":"10.1136/bmj.q2289","DOIUrl":"https://doi.org/10.1136/bmj.q2289","url":null,"abstract":"Doctors are tasked with responding to the needs of patients with knowledge, skill, and care. Knowledge and skill can both be delivered with little depletion and are usually enhanced by practice. Caring is different. It is a limited, depletable resource that, without renewal, can lead to the extreme distress described by Waters.1 Carers need to feel cared for to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487682","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 Sarginson","authors":"Andrea Sarginson, Julia Sarginson","doi":"10.1136/bmj.q2287","DOIUrl":"https://doi.org/10.1136/bmj.q2287","url":null,"abstract":"John Sarginson was a community physician who believed in the principles of evidence based medicine, the greatest good for the greatest number, realism, and speaking his mind when he needed to. John was born in 1930 in Middlesbrough where he grew up in a terraced house, with his father’s barber shop in the front room. In September 1939 he was evacuated for 18 months to Cold Kirby, a hilltop farming village in North Yorkshire. Here he had a happy time learning the ways of farm life and exploring the wildflower strewn valleys. Vivid memories include the night a German bomber jettisoned its load near the village and the day of the pig slaughter. He attended Middlesbrough Grammar School and was the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487226","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}