The BMJPub Date : 2025-01-23DOI: 10.1136/bmj-2024-079567
Yan Jing Chen, Ling Wang
{"title":"Linear erythematous plaques","authors":"Yan Jing Chen, Ling Wang","doi":"10.1136/bmj-2024-079567","DOIUrl":"https://doi.org/10.1136/bmj-2024-079567","url":null,"abstract":"This middle aged woman presented with a 40 year history of a gradually expanding itchy rash on her left leg. She had no relevant personal or family history and took no regular medications. On examination, extensive well defined, erythematous, plaques with raised edges and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020424","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 : 2025-01-23DOI: 10.1136/bmj-2024-082028
Jiahao Meng, Pan Liu, Shuguang Gao
{"title":"Skin puckering of the upper arm","authors":"Jiahao Meng, Pan Liu, Shuguang Gao","doi":"10.1136/bmj-2024-082028","DOIUrl":"https://doi.org/10.1136/bmj-2024-082028","url":null,"abstract":"A teenage boy presented to the emergency department three hours after he injured his left shoulder when he fell while running. He had persistent pain and was unable to move his left shoulder. There was noticeable skin puckering at the proximal end of the humerus near the shoulder, accompanied by subcutaneous bruising (fig 1). On examination there was tenderness in the shoulder joint, limited shoulder movement, weakness in forearm flexion, normal distal arterial pulse, and no sensory abnormalities. No emptiness in the shoulder socket was detected on palpation, and the humeral head could not be felt beneath the anterior-inferior aspect of the coracoid process. The patient’s temperature and other vital signs were normal, as was sensation in other areas. A radiograph of the left shoulder joint was taken on initial examination (fig 2). Fig 1 General appearance of left shoulder …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020426","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 : 2025-01-23DOI: 10.1136/bmj.q2656
Katharine Lang
{"title":"Can weight loss drugs like Ozempic treat obesity in children?","authors":"Katharine Lang","doi":"10.1136/bmj.q2656","DOIUrl":"https://doi.org/10.1136/bmj.q2656","url":null,"abstract":"GLP-1 agonists for weight loss are now commonly used for adults, but might they also be an effective treatment for younger people? Katharine Lang reports Obesity in children and adolescents is a growing problem. In 2022, according to NHS data, 15% of children aged between 2 and 15 were living with obesity in the UK.1 In the US the figure is closer to 20%, or one in five of those aged under 19.2 Untreated obesity in children and adolescents can lead to lifelong health problems, including type 2 diabetes, chronic kidney disease, and cardiovascular disease, as well as mental health problems.34 Glucagon-like peptide-1 (GLP-1) receptor agonist drugs such as liraglutide (Saxenda) and semaglutide (Ozempic, Wegovy) are being hailed as game changers in treating adult obesity, and possibly many other health conditions.5 Could they be equally useful in the treatment of younger people with obesity? Yes, says Julian Hamilton-Shield, professor in diabetes and medical endocrinology at the University of Bristol. “It’s certainly the case that adolescents and children seem to respond to these drugs in the same way that adults do, in that they lose large amounts of weight, it reduces their appetite, and they’re able to leave food on a plate which they have never been able to do before. I would argue that the evidence is, overall, that they are clinically very effective.” GLP-1 agonists are not yet widely available for children and adolescents, however, as the National Institute for Health and Care Excellence (NICE) has yet to publish guidance on their use in this age group. NICE told The BMJ that it is “unable to make a recommendation on liraglutide for managing obesity in those aged 12 to 17 because manufacturers Novo Nordisk did not provide an evidence submission.”6 NICE is also …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020425","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 : 2025-01-23DOI: 10.1136/bmj.q2526
Helen Saul, Samantha Cassidy, Laura Swaithes, Trisha Greenhalgh, Rebecca Payne
{"title":"How to make remote consultations safer","authors":"Helen Saul, Samantha Cassidy, Laura Swaithes, Trisha Greenhalgh, Rebecca Payne","doi":"10.1136/bmj.q2526","DOIUrl":"https://doi.org/10.1136/bmj.q2526","url":null,"abstract":"Payne R, Clarke A, Swann N, et al. Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis. BMJ Quality and Safety 2023;0:1–14. To read the full NIHR Alert, go to: <https://evidence.nihr.ac.uk/alert/how-to-make-remote-consultations-safer/>","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020681","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":"Exercise training in heart failure … and other research","authors":"Tom Nolan","doi":"10.1136/bmj.r65","DOIUrl":"https://doi.org/10.1136/bmj.r65","url":null,"abstract":"Tom Nolan reviews this week’s research Exercise for 30 minutes three times a week on an exercise bike for a month; then make the sessions an hour long and add resistance training with two sets of 12-15 reps on seven different weight machines, and keep that up for a whole year. No, this isn’t my overly ambitious new year’s fitness regimen, but the intervention in a study of combined endurance and resistance exercise training in heart failure with preserved ejection fraction. Unsurprisingly, most of the 83 people randomised to exercise training weren’t able to adhere to this (although 47.5% managed at least two sessions a week). At the end of the study there was no difference in modified Packer score, which incorporates mortality and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020682","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":"Richard Cash: public health doctor whose salt and sugar solution for cholera patients is estimated to have saved 70 million lives","authors":"Joanne Silberner","doi":"10.1136/bmj.r120","DOIUrl":"https://doi.org/10.1136/bmj.r120","url":null,"abstract":"BRAC In 1967 newly qualified doctor Richard Cash was sent to East Pakistan (now Bangladesh) to respond to one of the many cholera epidemics that swept through the region. The treatment at the time was intravenous therapy to replace lost fluids, but such a resource intensive process was inappropriate in a country where funding and trained personnel were not available at anywhere near the scale needed. A simple, inexpensive, and easy to administer treatment did, however, exist: oral rehydration therapy (ORT), just salt and sugar in clean water. This had already been shown to be effective in laboratory studies but Cash and David Nalin, his colleague at the US National Institutes for Health, decided to test it on a much larger scale. They faced objections from colleagues who weren’t sure patients would be able to swallow the fluid or that the treatment would work—but their multiple clinical trials of ORT proved the doubters wrong.1 Cash went on to work closely with the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020422","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":"Sudden cardiac death . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r35","DOIUrl":"https://doi.org/10.1136/bmj.r35","url":null,"abstract":"The UK government’s Eatwell Guide advises that people drink six to eight glasses of water or sugar free liquids per day (https://www.gov.uk/government/publications/the-eatwell-guide). Given the wide individual variation in size, weight, activity, and health—not to mention the numerous physiological mechanisms that regulate fluid balance—a single recommendation on the optimal amount of water to be consumed seems a doubtful idea. A systematic review, which identified 18 randomised trials of increased water intake, finds that the supporting evidence is generally weak. Some trials suggested that a high water intake was beneficial for …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020423","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":"The review of physician and anaesthesia associate roles will be transparent and evidence based","authors":"Gillian Leng","doi":"10.1136/bmj.r145","DOIUrl":"https://doi.org/10.1136/bmj.r145","url":null,"abstract":"The role of physician associate is not new. It was first introduced in the US more than 50 years ago. The model has since been adopted in many countries, alongside other medical associate professional roles (MAPs). In the UK, PAs were first mentioned in the NHS Plan 20001 and these and other MAPs have been part of workforce transformation since 2013. In all healthcare economies, medical associate professionals have the same basic aim of working alongside doctors with supervision. Although not always explicitly articulated, one fundamental driver for the introduction of these associates seems to be economic pressures. Cutting costs and driving efficiencies are essential for any large business or organisation to remain viable and the NHS is no different. That said, our health service has the added challenge of doing so without compromising patient safety, professional integrity, or service quality. Like many others in the UK, I watched the debate about physician and anaesthesia associates from the sidelines. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020421","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":"Radiology’s role in humanising mortality","authors":"Susan Shelmerdine, Natasha Davendralingam","doi":"10.1136/bmj.r127","DOIUrl":"https://doi.org/10.1136/bmj.r127","url":null,"abstract":"Articles in The BMJ ’s Christmas issue rightly call for death to be demedicalised, urging healthcare systems to focus on compassion and care for people who are dying.1 This conversation has centred on palliative care, but an important specialty is often overlooked—radiology. Postmortem imaging, using computed tomography and magnetic resonance imaging, is a non-invasive way to determine causes of death.2 Conventional autopsies are invasive and emotionally distressing for grieving …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020675","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":"A warning sign from a system in serious trouble","authors":"Juliet Dobson","doi":"10.1136/bmj.r135","DOIUrl":"https://doi.org/10.1136/bmj.r135","url":null,"abstract":"It’s been a tough start to the year for the NHS. This month, 24 NHS trusts in England declared a critical incident owing to overwhelming demand in emergency departments. Pressures were exacerbated by a “quad-demic” of winter viruses, particularly rising rates of flu (doi:10.1136/bmj.r99 doi:10.1136/bmj.r77).12 A report by the Royal College of Nursing showed the extent of the crisis.1 More than 400 pages of testimony by 5408 nursing staff describe how corridor care—treating patients in temporary escalation spaces—isn’t just a problem confined to winter but is becoming normal all year round. The survey detailed the system’s lack of capacity to cope when seasonal viruses hit. It’s not possible to provide high quality, safe care in a corridor, but is …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020431","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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