The BMJ最新文献

{"title":"Acute abdominal pain in a young woman","authors":"Wenwen Ni, Timothy Shao Ern Tan","doi":"10.1136/bmj-2025-086952","DOIUrl":"https://doi.org/10.1136/bmj-2025-086952","url":null,"abstract":"A woman in her 20s presented to the emergency department with a one day history of severe lower abdominal pain and vaginal bleeding. Her previous menstrual period was 5 weeks earlier. She was not using any form of contraception, and had no relevant medical, gynaecological, or surgical history apart from a previous caesarean section. On admission, her temperature was 37.4°C. Her heart rate was 100 bpm with a blood pressure of 102/65 mm Hg. Abdominal examination revealed tenderness over the suprapubic region on deep palpation. Speculum examination showed a closed cervical os with no bleeding or retained product of conception. A urine pregnancy test was positive and her serum β human chorionic gonadotropin (hCG) level was 1724.2 IU/L (normal range <5 IU/L). Other laboratory tests showed a haemoglobin level of 114 g/L (normal range 120-160 g/L), white blood cell count of 17.27×10 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246579","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":"Rupa Tewari: classical Indian singer and sexual health doctor who championed women and children","authors":"Rebecca Wallersteiner","doi":"10.1136/bmj.r2094","DOIUrl":"https://doi.org/10.1136/bmj.r2094","url":null,"abstract":"In the 1990s, when there were few female Indian doctors in Scotland, Rupasree Tewari wore a sari to work every day, describing it as her version of a business suit. Although she found attitudes towards immigrant doctors challenging, she persisted. For more than 20 years she worked in sexual and reproductive health, child protection, and school medicine. She led clinics for contraception, family planning, and menopause and pre-termination counselling. She trained in video colposcopy for the medical examination of victims of sexual abuse and organised Saturday morning drop-in clinics for teenagers. She also served as senior clinical medical officer in community child health, overseeing the care of around 5000 children as school doctor of institutions around Kirkcaldy. Her former colleague Linda Gillespie, a school nurse, said, “I remember Rupa as a professional and compassionate person. The young people often commented on how kind and gentle she was.” Tewari also tutored medical students, GP trainees, and nurses from the universities of Edinburgh, Dundee, St Andrews, and Sheffield in contraceptive counselling, intrauterine device and implant …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246811","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":"Compression stockings for vasovagal syncope . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r2046","DOIUrl":"https://doi.org/10.1136/bmj.r2046","url":null,"abstract":"Many characteristics track from early life into adulthood. Tall children, for example, tend to grow into tall adults. The same seems to be true for raised blood pressure and its consequences. In a large sample of US children born between 1959 and 1966, higher blood pressure at age 7 carried an increased risk of cardiovascular mortality when they reached their mid 50s ( JAMA doi:10.1001/jama.2025.14405) Wearing thigh length compression stockings reduces venous pooling in the lower limbs and ought to be an …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246575","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":"Prostate specific antigen retesting intervals and trends in England: population based cohort study","authors":"Kiana K Collins, Jason L Oke, Pradeep S Virdee, Rafael Perera, Brian D Nicholson","doi":"10.1136/bmj-2024-083800","DOIUrl":"https://doi.org/10.1136/bmj-2024-083800","url":null,"abstract":"Objective To characterise the use of the prostate specific antigen (PSA) test in primary care in England. Design Population based open cohort study. Setting England. Participants 10 235 805 male patients older than 18 years and registered at 1442 general practices that contributed to the Clinical Practice Research Datalink between 2000 and 2018. Data were linked to the National Cancer Registry, Hospital Episode Statistics, and Office for National Statistics. Main outcome measures Population based temporal trends and annual percentage changes were analysed using age standardised PSA testing rates. Mixed effects negative binomial regression models investigated individual patient rate ratios of PSA testing. Linear mixed effects models examined factors associated with an individual patient’s length of PSA retesting intervals. All results were analysed by region, deprivation, age, ethnicity, family history of prostate cancer, symptom presentation, and PSA value. Results 1 521 116 patients had at least one PSA test, resulting in 3 835 440 PSA tests overall. 48.4% (735 750) of these patients had multiple tests and 72.8% (535 990) of them never presented with a PSA value above the age specific referral threshold. The median retesting interval overall was 12.6 months (interquartile range 6.2-27.5). Testing rates varied by region, deprivation, ethnicity, family history, age, PSA value, and symptoms. Once tested, patients had shorter retesting intervals if they were older, were of an ethnicity other than white, had a family history of prostate cancer, or had previously raised PSA levels. Despite considerable variation in testing rates by region and deprivation, the length of retesting intervals was similar across these groups. Conclusions PSA testing before a diagnosis of prostate cancer in primary care in England varied. Among patients who underwent multiple tests, many were tested more frequently than recommended, raising concerns about overtesting. PSA retesting is occurring in patients without recorded symptoms and in those with low PSA values. To ensure maximum benefit to patients while reducing the risk of overtesting, research is urgently needed to determine appropriate evidence based PSA retesting intervals. This study is based on CPRD data and is subject to a full licence agreement, which does not permit data sharing outside of the research team. Code lists are available in supplementary file 4. The R code used for analysis is available on GitHub: <https://github.com/kiana-k-collins/PSA-testing-and-retesting-trends-in-primary-care-in-England-between-2000-and-2018>.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":"e083800"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246571","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":"Sixty seconds on . . . protein bars.","authors":"Rebecca Coombes","doi":"10.1136/bmj.r2111","DOIUrl":"https://doi.org/10.1136/bmj.r2111","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"1 1","pages":"r2111"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246588","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 Launer: The pluripotent consultation","authors":"John Launer","doi":"10.1136/bmj.r2001","DOIUrl":"https://doi.org/10.1136/bmj.r2001","url":null,"abstract":"Every time I teach, I try to introduce an exercise I’ve never done before. I hope this ensures that people are less likely to be bored if they’ve already been to one of my workshops, but it also keeps me on my toes. Occasionally I try out things that are quite risky. I did this recently when teaching GP residents about uncertainty in the consultation. I’d realised that the day was my late mother’s birthday, so I started my presentation by putting up a slide of her in her 50s, looking rather thoughtful. I explained who she was and gave the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241885","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":"Addressing uncertainty in PSA screening and testing intervals","authors":"Juan VA Franco, Timothy J Wilt, Philipp Dahm","doi":"10.1136/bmj.r2065","DOIUrl":"https://doi.org/10.1136/bmj.r2065","url":null,"abstract":"Practice does not reflect evidence or guidelines Testing for prostate specific antigen (PSA) remains controversial, as reflected in clinical guidelines and different—and at times contradictory—recommendations. Testing, if recommended, is suggested for one of two indications: screening asymptomatic men to detect prostate cancer at an early stage amenable to curative treatment,1 and diagnostic testing among men with symptoms potentially attributable to prostate cancer, such as haematuria, lower urinary tract symptoms, erectile dysfunction, low back pain, or weight loss. Notably, the National Institute for Health and Care Excellence (NICE) guideline does not recommend prostate cancer screening but rather sees its main role, alongside digital rectal examination, as a diagnostic test for men with symptoms or those considered at increased risk based on family history.2 Current guidelines disagree about whether screening has benefits that exceed harms. Guidelines recommending screening differ on age, PSA threshold for abnormality, and rescreening interval. Consensus is, however, growing that decision making about screening (and diagnostic testing) should be based on shared decision making that engages patients in conversations about benefits and harms, and their preferences and values for outcomes associated with the testing cascade. Indeed, almost no European country has population based screening programmes.3 While some guideline recommendations, such as those of the US Preventive Services Task Force, have changed over time, NICE guidelines have changed little since 2015 and focus on PSA testing for diagnostic purposes. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"106 1","pages":"r2065"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246577","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":"Heart attack care: Gender gap in Australia won't close for a decade without action, researchers warn.","authors":"Jacqui Wise","doi":"10.1136/bmj.r2123","DOIUrl":"https://doi.org/10.1136/bmj.r2123","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"11 1","pages":"r2123"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246589","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":"Memorial to aid workers is unveiled in London amid record high killings worldwide.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.r2093","DOIUrl":"https://doi.org/10.1136/bmj.r2093","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":"r2093"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246731","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 chest pain tells an emotional truth","authors":"Helen Watkins","doi":"10.1136/bmj.r1898","DOIUrl":"https://doi.org/10.1136/bmj.r1898","url":null,"abstract":"Helen Watkins shares the physical symptoms brought on by heartache and what healthcare professionals can do to recognise a person’s emotional pain Six years ago, I went to the emergency department with chest pain. I had experienced severe pain during the previous night, pain which radiated to my back and ears. I didn’t disturb my husband, as we had arrived home in the UK from Australia only a few days earlier and were both still tired with jetlag. I told him the next morning, and we decided I should see my GP that day. The GP sent me to hospital to have my heart and troponin levels checked. My ECG showed no evidence of a heart attack and the blood tests were fine. I was discharged with a diagnosis of chest pain with an unknown cause, with a secondary provisional diagnosis of acid reflux. But I knew the real diagnosis was, quite …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"128 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241883","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}