The BMJ最新文献

{"title":"Coral Sharpe: GP who fought against the prejudices of her day to become a doctor","authors":"Anne Gulland","doi":"10.1136/bmj.r624","DOIUrl":"https://doi.org/10.1136/bmj.r624","url":null,"abstract":"St Bartholomew’s medical school had only been accepting female students for eight years when Coral Sharpe (née Knight) began studying in 1955. Sharpe was not an obvious trailblazer, but in her quiet, resolute way she was determined to study medicine and keep working as a doctor when society might have expected her to concentrate on being a wife and mother. Medicine was in Sharpe’s blood. Her father, Bryant, was a GP in north west London and the whole family was immersed in the practice—Sharpe’s mother, Gladys, was, in effect, the receptionist; the waiting room was in Sharpe’s bedroom; and Sharpe, along with her sister Heather and brother Anthony were born either above or next door to the surgery. Sharpe was, in the parlance of the time, a delicate child. She was prone to ear infections and sudden, mysterious fevers; she was also diagnosed with a heart murmur. Gladys’s letters to Bryant, who served as a captain in the Royal Army Medical Corps in North Africa and Italy during the second world war, are full of worries for her younger daughter’s health. Sharpe was a shy, unassuming child. When she went to see the doctor about the heart murmur she refused …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736643","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":"CONSORT 2010 extension: setting standards for reporting cluster randomised crossover trials","authors":"Joanne E McKenzie","doi":"10.1136/bmj.r637","DOIUrl":"https://doi.org/10.1136/bmj.r637","url":null,"abstract":"Extending the CONSORT 2010 statement for reporting cluster randomised crossover trials lays the foundation for improving the completeness and accuracy of reporting Over the past two decades my research has centred on systematic reviews. Developing and evaluating statistical and research methodology for reviews has been a focus, but I have also collaborated on many reviews. These collaborations inevitably reveal the importance of complete, clear, and accurate reporting of primary studies. At best, incomplete and inaccurate reporting wastes research investment—often substantial in the case of large randomised trials—and at worst, it may lead to incorrect conclusions with far reaching consequences. Primary studies that are reported well contribute maximally to the evidence base and can be fairly assessed. The opposite is true when reporting is unclear or incomplete. I have spent countless hours scouring trial reports for information that should be present but is not; trying to decipher unclear text; or trying to decide what to do when the information reported is inconsistent within or across reports of the same study. This time adds up and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736641","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":"Women are woefully under-researched—the Message project aims to redress the balance","authors":"Menaka Fry","doi":"10.1136/bmj.r581","DOIUrl":"https://doi.org/10.1136/bmj.r581","url":null,"abstract":"Medical research has traditionally studied men, with findings extrapolated to women. Project founder Kate Womersley talks to Menaka Fry about her attempts to change this When Susan Cole was pregnant with her third child her HIV viral load started to rise, even though she was continuing to take her antiretroviral treatment. “Initially I was told I probably wasn’t taking my treatment properly, but that wasn’t the case: there just wasn’t enough research about drug levels during pregnancy,” she says. Cole, a health equity writer and advocate, shared her experiences at a webinar organised by the Message project (Medical Science Sex and Gender Equity).1 The project aims to improve the integration of sex and gender considerations across data collection, analysis, and reporting in the UK’s biomedical, health, and care research. Cole’s lived experiences clearly highlight the problem that Message is trying to tackle. She says that a lack of research involving women affects their experiences of illness and treatment, as well as their outcomes. When it comes to guidance and policies on sex and gender equity in research, the UK lags behind the US, Canada, and some European countries.2 The Message project,3 funded by the Wellcome Trust, aims to redress this systemic imbalance. The project was cofounded in 2022 by Kate Womersley, a psychiatry trainee, and Robyn Norton, founding director of the George Institute for Global Health at Imperial College London. The project is now …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736692","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":"Refining DAPT strategies after drug coated balloon angioplasty","authors":"Ovidio De Filippo, Fabrizio D’Ascenzo, Gaetano Maria De Ferrari","doi":"10.1136/bmj.r507","DOIUrl":"https://doi.org/10.1136/bmj.r507","url":null,"abstract":"A step forward in de-escalating treatment The evolution of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) has been shaped by the continuous challenge of balancing ischaemic protection with bleeding risk. While prolonged DAPT confers thrombotic risk reduction, it invariably increases bleeding complications, which are themselves associated with adverse prognostic implications.1 This dilemma has prompted the exploration of de-escalation strategies—gradual tapering of antiplatelet intensity or duration—as a means of optimising patient outcomes. Currently, the concept of DAPT de-escalation refers to the strategy of discontinuing aspirin after a short period of dual antiplatelet therapy after PCI, leaving patients on monotherapy with a potent P2Y12 inhibitor—typically ticagrelor, as supported by available evidence.234 The rationale behind this approach is to maximise ischaemic protection during the initial months after PCI, when the thrombotic risk is highest, while simultaneously mitigating the bleeding risk, which remains relatively constant and is directly associated with DAPT duration.5 In a previous meta-analysis from our group, DAPT de-escalation was indeed associated with a significant reduction of bleeding events in patients with acute coronary syndrome compared with five alternative standard DAPT strategies, while not increasing the risk of ischaemic events, even rare ones, such as stent thrombosis.6 Cardiovascular research has struggled over the past decade to develop accurate scores to precisely estimate the trade-off between ischaemic and bleeding risks, even by means of artificial intelligence.789 However, most existing scores …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736645","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":"Stepwise dual antiplatelet therapy de-escalation in patients after drug coated balloon angioplasty (REC-CAGEFREE II): multicentre, randomised, open label, assessor blind, non-inferiority trial","authors":"Chao Gao, Bin Zhu, Fan Ouyang, Shangyu Wen, Yanmin Xu, Wenxia Jia, Ping Yang, Yuquan He, Yiming Zhong, Yimeng Zhou, Zhifu Guo, Guidong Shen, Likun Ma, Liang Xu, Yuzeng Xue, Tao Hu, Qiong Wang, Yi Liu, Ruining Zhang, Jianzheng Liu, Zhiwei Jiang, Jielai Xia, Scot Garg, Robert-Jan van Geuns, Davide Capodanno, Yoshinobu Onuma, Duolao Wang, Patrick Serruys, Ling Tao","doi":"10.1136/bmj-2024-082945","DOIUrl":"https://doi.org/10.1136/bmj-2024-082945","url":null,"abstract":"Objectives To investigate whether a less intense antiplatelet regimen could be used for people receiving drug coated balloons. Design Multicentre, randomised, open label, assessor blind, non-inferiority trial (REC-CAGEFREE II). Setting 41 hospitals in China between 27 November 2021 and 21 January 2023. Participants 1948 adults (18-80 years) with acute coronary syndrome who received treatment exclusively with paclitaxel-coated balloons according to the international drug coated balloon consensus. Interventions Participants were randomly assigned (1:1) to either the stepwise dual antiplatelet therapy (DAPT) de-escalation group (n=975) consisting of aspirin plus ticagrelor for one month, followed by five months of ticagrelor monotherapy, and then six months of aspirin monotherapy, or to the standard DAPT group (n=973) consisting of aspirin plus ticagrelor for 12 months. Main outcome measures The primary endpoint was net adverse clinical events (all cause death, stroke, myocardial infarction, revascularisation, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding) at 12 months in the intention-to-treat population. Non-inferiority was established if the upper limit of the one sided 95% confidence interval (CI) for the absolute risk difference was smaller than 3.2%. Results The mean age of participants was 59.2 years, 74.9% were men, 30.5% had diabetes, and 20.6% were at high bleeding risk. 60.9% of treated lesions were in small vessels, and 17.8% were in-stent restenosis. The mean drug coated balloon diameter was 2.72 mm (standard deviation 0.49). At 12 months, the primary endpoint occurred in 87 (8.9%) participants in the stepwise de-escalation group and 84 (8.6%) in the standard group (difference 0.36%; upper boundary of the one sided 95% CI 2.47%; Pnon-inferiority=0.013). In the stepwise de-escalation versus standard groups, BARC type 3 or 5 bleeding occurred in four versus 16 participants (0.4% v 1.6%, difference −1.19% (95% CI −2.07% to −0.31%), P=0.008), and all cause death, stroke, myocardial infarction, and revascularisation occurred in 84 versus 74 participants (8.6% v 7.6%, difference 1.05% (95% CI −1.37% to 3.47%), P=0.396). Treated as having hierarchical clinical importance by the win ratio method, more wins were noted with the stepwise de-escalation group (14.4% wins) compared with the standard group (10.1% wins) for the predefined hierarchical composite endpoint of all cause death, stroke, myocardial infarction, BARC type 3 bleeding, revascularisation, and BARC type 2 bleeding (win ratio 1.43 (95% CI 1.12 to 1.83), P=0.004). Results from the per-protocol and the intention-to-treat analysis were similar. Conclusions Among participants with acute coronary syndrome who could be treated by drug coated balloons exclusively, a stepwise DAPT de-escalation was non-inferior to 12 month DAPT for net adverse clinical events. Trial registration Clinicaltrials.gov [NCT04971356][1] The REC-CAGEFREE II trial is planning to continue fol","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736648","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":"Diversity, equity, and inclusion in research: a conversation with Wellcome’s CEO","authors":"Victor Adebowale, John-Arne Røttingen, Mun-Keat Looi","doi":"10.1136/bmj.r564","DOIUrl":"https://doi.org/10.1136/bmj.r564","url":null,"abstract":"How does racism and inequality affect medical research? Wellcome Trust CEO John-Arne Røttingen sits with Victor Adebowale , chair of the NHS Confederation, to discuss ### Biographies John-Arne Røttingen was appointed chief executive officer (CEO) of the Wellcome Trust in October 2023. A doctor-scientist, he was previously Norway’s ambassador for global health, chief executive of the Research Council of Norway, and was the founding CEO of the Coalition for Epidemic Preparedness Innovations. His research encompasses epidemiology, clinical trials, and global health policy. Victor Adebowale has been chair of the NHS Confederation in a personal capacity since April 2020. He is the former CEO of Turning Point, a social enterprise, and has been a crossbench peer at the House of Lords since 2001. He has led commissions on mental health and housing. He holds an MA in advanced organisational consulting from City University and the Tavistock Institute of Human Relations and founded the Race and Health Observatory. VA: You’ve had a distinguished career in research funding, including leading Norway’s research efforts. How did issues of race, diversity, and equity play out in that context? J-AR: That’s a great question to start with because the issues are the same, but the context is different. And context matters. In Norway, the major concern was gender disparity in research. We started early on to work on improving the pipeline of researchers . . . because we had quite a low proportion of female professors. The focus was on understanding why we were losing women in the research career path and what we could do about that. Regarding ethnicity, we didn’t have enough data, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723205","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":"Using natural experiments to evaluate population health and health system interventions: new framework for producers and users of evidence","authors":"Peter Craig, Mhairi Campbell, Manuela Deidda, Ruth Dundas, Judith Green, Srinivasa Vittal Katikireddi, Jim Lewsey, David Ogilvie, Frank de Vocht, Martin White","doi":"10.1136/bmj-2024-080505","DOIUrl":"https://doi.org/10.1136/bmj-2024-080505","url":null,"abstract":"Natural experiments are widely used to evaluate the impacts on health of changes in policies, infrastructure, and services. The UK Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR) have published a new framework for conducting and using evidence from natural experimental evaluations. The framework defines key concepts and describes recent advances in designing and planning evaluations of natural experiments, including the relevance of a systems perspective, mixed methods, and stakeholder involvement. It provides an overview of the strengths, weaknesses, applicability, and limitations of the range of methods now available, and makes good practice recommendations for researchers, funders, publishers, and users of evidence. Unlike true experiments that are conducted by researchers for scientific purposes, natural experiments occur when infrastructure, policies, or services are introduced or changed by governments or healthcare systems. Interventions of this kind are sometimes amenable to randomised controlled trials, for example, if the advantages of randomisation can be negotiated with policy makers or providers at the planning stage and the findings are likely to be transferable across several contexts. Although the randomised controlled trial remains an important method, there are occasions when a trial will not be appropriate or feasible for answering questions about infrastructure, policy, or service changes. However, provided that the intervention divides a population into groups that are otherwise similar, researchers can evaluate the health effects of the changes in a natural experimental evaluation. Natural experiments therefore generate valuable opportunities for evaluating population health, health systems, and other interventions, including those that are, for practical or ethical reasons, not suitable for investigation using randomised controlled trials. One example of a natural experiment is the introduction by the Scottish government in 2018 of a minimum price at which a unit of alcohol could legally be sold. This was expected to reduce …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723200","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":"Canada should seize the opportunity to lead on global health challenges and cooperation","authors":"Jocalyn Clark, Timothy Evans, Kelley Lee","doi":"10.1136/bmj.r620","DOIUrl":"https://doi.org/10.1136/bmj.r620","url":null,"abstract":"Greater cooperation in global health is needed to tackle challenges and to harness new opportunities. Canada should take a greater leadership role, write Jocalyn Clark , Timothy Evans , and Kelley Lee In the past two years we have been involved in an expert panel convened by the Royal Society of Canada and the Canadian Academy of Health Sciences on Canada’s past and future global health role. Our report, published on 27 March 2025, aims to provide strategic insights and advice on Canada’s role in global health for the next two decades.1 The need for global leadership in health is clear: growing economic and climate threats, divisive politics, backlash against human rights, and powerful waves of misinformation threaten past gains in global health and cooperation. As we enter a new era shaped by isolationist geopolitics and the US retreating in global affairs, Canada’s role as a middle power, actively engaged in multilateralism, is more important than ever.2 Greater clarity around Canada’s global health role is also relevant to current domestic affairs. The new leader of the Liberal party, Mark Carney, was appointed as the country’s prime minister in March 2025, after …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723202","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":"Evaluating patients with chest pain in the emergency department","authors":"Fernanda Bellolio, Michael Gottlieb, Richard Body, Martin P Than, Erik P Hess","doi":"10.1136/bmj.r136","DOIUrl":"https://doi.org/10.1136/bmj.r136","url":null,"abstract":"Identifying patients with chest pain that is of cardiac origin is crucial owing to the high mortality and morbidity of cardiovascular diseases. History, electrocardiogram, and cardiac biomarkers are the core elements of the assessment. High sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers for diagnosing acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury. However, elevations in hs-cTn can occur in patients who are not experiencing acute myocardial infarction. Therefore, it is important for clinicians to recognize how to integrate hs-cTn levels into their clinical decision making process. Structured risk assessments, using evidence based diagnostic protocols, should be employed to estimate the risk of acute coronary syndrome and adverse events in patients with chest pain. Clinical decision pathways should be used routinely in emergency departments. Patients at intermediate or high risk of obstructive coronary artery disease might benefit from cardiac imaging and further testing. Patients should be involved in decision making, with information provided about risks, radiation exposure, costs, and alternative options to facilitate informed decision making.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723208","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":"System-wide reform needed to tackle the root causes of burnout","authors":"Peter R McGhee","doi":"10.1136/bmj.r588","DOIUrl":"https://doi.org/10.1136/bmj.r588","url":null,"abstract":"Wilkinson rightly highlights the psychological toll of moral injury, where doctors feel powerless in a system that limits their ability to provide quality care.1 This crisis is deepening across the NHS, where burnout has become a systemic failure demanding urgent reform.2 General Medical Council reports show that rising burnout rates stem from workplace inefficiencies, overwhelming workloads, and role fragmentation rather than individual shortcomings. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723204","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}