{"title":"Therapeutic ultrasound during carotid endarterectomy","authors":"Jesse A Columbo","doi":"10.1136/bmj.r385","DOIUrl":"https://doi.org/10.1136/bmj.r385","url":null,"abstract":"Intraoperative sonolysis reduces stroke complications Ultrasonography as a diagnostic modality for the diagnosis and surveillance of carotid stenosis has been a mainstay of clinical practice for decades.12 Ultrasound is non-invasive, does not use ionizing radiation or contrast media, and remains low cost, making it an integral evidence based tool for patients with carotid disease.3 Carotid endarterectomy is the surgical therapeutic gold standard to reduce long term stroke risk in patients with severe carotid stenosis. In the linked study (doi:10.1136/bmj-2024-082750), investigators in the SONOBIRDIE trial have tested a new application for ultrasound: prevention of thromboembolic complications during carotid endarterectomy.4 In a multicenter randomized trial of 1004 patients, investigators determined that intraoperative sonolysis with ultrasound at the time of carotid endarterectomy reduced the composite endpoint of transient ischemic attack, stroke, or death within 30 days from 7.6% to 2.2%, compared with sham sonolysis. These findings represent a potentially significant innovation in the application of ultrasound from its historical diagnostic role to now also …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661263","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":"Labour government scraps NHS England","authors":"Hugh Alderwick","doi":"10.1136/bmj.r537","DOIUrl":"https://doi.org/10.1136/bmj.r537","url":null,"abstract":"Performative politics that will disrupt the health service when patients most need it On 13 March, the UK prime minister announced that the Labour government will scrap NHS England—the national body responsible for the day-to-day management of the English NHS.1 Keir Starmer said the changes would cut bureaucracy and bring the health service “back into democratic control”—and form part of his broader plans to reshape the “flabby” UK state.2 The announcement marks the end of a 12 year experiment of trying to run the NHS more independently from politicians. NHS England was established under Andrew Lansley’s controversial NHS reforms in 2012. But its roots run deeper: throughout the NHS’s history, there have been unresolved questions about the right level of political involvement in managing the health service and attempts to split policy formulation and implementation at the top of government.3 On paper, Lansley’s reforms made this split a reality. Ministers and the Department of Health and Social Care are responsible for setting overall policy direction and defining NHS priorities. NHS England, meanwhile, sits at arm’s length from government and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640540","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":"Abolishing NHS England: risks and opportunities","authors":"Nigel Crisp","doi":"10.1136/bmj.r553","DOIUrl":"https://doi.org/10.1136/bmj.r553","url":null,"abstract":"NHS England (NHSE) was always an uneasy compromise, caught between the NHS and ministers. Designed as the NHS headquarters and free to operate without day-to-day political involvement, it is nevertheless accountable to ministers for NHS performance and achieving ministerial goals. Unsurprisingly this led to duplication of activities between NHSE and the Department of Health and Social Care (DHSC) which monitors it on behalf of ministers. Both organisations need expertise in relevant areas, and continuous supervision inevitably leads to tensions and rivalry. Part of NHSE’s role is to hold NHS organisations to account for performance and, again unsurprisingly, the same duplication, tensions, and rivalry occur. It is also no surprise that at this time of crisis and financial pressure politicians are frustrated and want to cut out this intermediary and take back direct control. There are, however, many risks and downsides. Success will depend on how this massive change is managed and on creating a workable future relationship between ministers and NHS organisations. Any reorganisation risks losing focus and vital skills and wasting time and money. Performance is likely to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653474","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":"Jillian Ann Jellicoe","authors":"Jenny Baxendale","doi":"10.1136/bmj.r512","DOIUrl":"https://doi.org/10.1136/bmj.r512","url":null,"abstract":"Jill, who was diminutive in stature with a large personality, was born in Liverpool. She studied medicine at Kings College London before house jobs in Hereford. She moved north and began training in anaesthesia at Whiston Hospital in Merseyside. Jill married Alan Fitzgerald in …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640542","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":"Trends in UK mortality reflect a public health failure","authors":"Lucinda Hiam, David Walsh, Gerry McCartney","doi":"10.1136/bmj.r525","DOIUrl":"https://doi.org/10.1136/bmj.r525","url":null,"abstract":"Austerity harms health and must be reversed The headline of a recent BBC article, “UK death rate ‘reaches record low,’” puts a positive spin on mortality data, suggesting the UK has emerged from a period of poor health.1 Based on unpublished analysis from the Continuous Mortality Investigation (CMI) at the Institute and Faculty of Actuaries, the article reports that standardised death rates in 2024 returned to pre-pandemic levels, below those in 2019, which had the previous lowest reported mortality. However, as the CMI data highlight, mortality improvements remain stagnant. Between 1974 and 2010 mortality improvements averaged 26 per 100 000 population a year, before dropping steeply to around 7 per 100 000 population for the past 15 years. Moreover, mortality has consistently increased for people living in the most disadvantaged areas2 and for working age adults during this period.3 The BBC article focuses on the contributions of specific conditions, such as cardiovascular disease and obesity, as explanations of the mortality trends, with only passing comment of the established leading cause—austerity. This misleading coverage of the causes of Britain’s poor health is not unique. For example, reporting …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640546","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":"Abolition of NHS England seeks to put ministers in control of the NHS","authors":"Chris Ham","doi":"10.1136/bmj.r554","DOIUrl":"https://doi.org/10.1136/bmj.r554","url":null,"abstract":"Reorganisation threatens to distract managers and staff from work to improve patient care In the end, enough was enough. Having promised not to undertake a top-down reorganisation of the NHS, that is exactly what Wes Streeting and Keir Starmer decided to do.1 NHS England is being abolished. The government’s decision was prompted by growing frustrations on the part of ministers at the duplication of responsibilities between NHS England and the Department of Health and Social Care and the need to find savings. Pressures on public finances have increased since last autumn’s budget, in part because of the government’s commitment to spend more on defence. With the Office for Budgetary Responsibility warning of the need to plan for increases in NHS spending to meet changing population needs, and the resources to do so shrinking, the government is acting to control NHS finances.2 A new leadership team in NHS England, led by Jim Mackey, has been …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653473","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}
The BMJPub Date : 2025-03-18DOI: 10.1136/bmj-2024-082639
Sudeep Adhikari, Sangeeta Bhusal, Md. Shabab Hossain, Buddha Basnyat
{"title":"Assessment and management of dengue","authors":"Sudeep Adhikari, Sangeeta Bhusal, Md. Shabab Hossain, Buddha Basnyat","doi":"10.1136/bmj-2024-082639","DOIUrl":"https://doi.org/10.1136/bmj-2024-082639","url":null,"abstract":"### What you need to know Dengue (dengue fever, breakbone fever), an arboviral infection transmitted by Aedes mosquitos, is endemic in more than 100 countries in the World Health Organisation (WHO) regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia, and the Western Pacific.1 Although most patients are asymptomatic or recover after a febrile phase, 2-5% develop severe disease and may require intensive care.2 Mortality is 5% among severe dengue.2 Distribution of the four dengue virus serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) varies geographically and over time.3 Previously limited to tropical regions, outbreaks now occur in subtropical and temperate regions, including high altitude areas (such as Kathmandu, Nepal).245 In North America and Europe, where dengue is a common cause of fever in travellers returning from endemic areas,67 autochthonous (locally acquired) cases have also been reported.8910 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640459","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 Ian Marshall","authors":"Michael Millar-Craig","doi":"10.1136/bmj.r515","DOIUrl":"https://doi.org/10.1136/bmj.r515","url":null,"abstract":"David was born in Broadstairs, Kent, and educated at Glenalmond school in Scotland. His father Gordon was a proud Scotsman who believed strongly in the importance of a Scottish boarding school education, despite the distance involved. Gordon was a single handed GP in Broadstairs, and it was always David’s intention to join his father in general practice. David qualified from St Bartholomew’s Hospital, like his father, but while doing senior house officer posts at Southend General Hospital in 1973, Gordon sustained an acute myocardial infarction and David took over his practice. At that time no formal training was required to enter general practice, but David became well established as a successful and popular GP. His …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640541","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}
The BMJPub Date : 2025-03-18DOI: 10.1136/bmj.q2829
Roshni Shastri, Crispin Wiles, Oliver Sweeney, Lucy Easton, Steven Jacques
{"title":"Is the dissection of cadavers a necessary part of medical education?","authors":"Roshni Shastri, Crispin Wiles, Oliver Sweeney, Lucy Easton, Steven Jacques","doi":"10.1136/bmj.q2829","DOIUrl":"https://doi.org/10.1136/bmj.q2829","url":null,"abstract":"Dissecting cadavers is a mainstay of medical education, but it relies on donors and poses ethical and other challenges. Roshni Shastri and Crispin Wiles argue that modern teaching has moved on, but Oliver Sweeney, Lucy Easton, and Steven Jacques say that it would be foolish to dispense with the practice entirely Traditionally, cadaveric dissection has been central to anatomy, and its historical significance in medical education is undeniable. But as curriculums evolve, its role, particularly in undergraduate education, can be increasingly questioned. We believe that high quality anatomy education depends not on any single type of approach to learning (such as dissection) but on thoughtful and educationally principled curricular design. This requires meaningful learning outcomes that are supported by a range of educational resources that will support learners in achieving them. Prosected or plastinated specimens, 3D models, surface anatomy training, and interactive tools can all be used effectively to provide inclusive, time- and cost-efficient alternatives to dissection. Cadaveric dissection poses three main challenges. First, cadaveric dissection is resource heavy, requiring specialised laboratories, embalming chemicals such as formaldehyde, and rigorous safety protocols.1 Institutions often lack the financial and spatial resources to maintain dissection labs, leading many to shift to prosection, where students observe pre-dissected specimens.2 Second, dissection (as opposed to prosection) is also time intensive, detracting from other aspects of increasingly packed medical curriculums. Although dissection is often romanticised for its perceived “hands-on” value, studies have shown that students spend disproportionate time identifying structures hidden under fat or connective tissue rather …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640543","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}
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}
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