The BMJ最新文献

{"title":"Confronting the shortcomings of covid-19 vaccination will help us in future pandemics","authors":"Samantha Vanderslott","doi":"10.1136/bmj.r590","DOIUrl":"https://doi.org/10.1136/bmj.r590","url":null,"abstract":"We must learn from the successes and failures of the covid-19 vaccination programme if we are to prepare for the next pandemic, writes Samantha Vanderslott Vaccination has been so successful in protecting whole populations from disease that it is now an often-repeated phrase that vaccines are victims of their own success. As vaccination rates rise, vaccine-preventable diseases become less common within society, creating the illusion that vaccination against these diseases is no longer necessary. This means that the more successful vaccines are, the harder health authorities must work to make their value apparent. During the covid-19 pandemic the need to vaccinate against SARS-CoV-2 was paramount, but uptake was nevertheless a challenge. It would be wrong, however, to view vaccination failures as being only the fault of those who do not want to vaccinate. Government failings should also be considered. These failings have been highlighted by the ongoing UK covid inquiry. Module four, which focused on vaccines and treatments, concluded in January 2025.1 The inquiry emphasised that the covid-19 vaccination is a success story from the pandemic, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723203","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":"“Massive retrogression”: USAID cuts affect global morbidity and mortality","authors":"Heather Rilkoff","doi":"10.1136/bmj.r585","DOIUrl":"https://doi.org/10.1136/bmj.r585","url":null,"abstract":"The US government has unleashed a whirlwind of public service cuts—those to international aid are already having life threatening consequences. Heather Rilkoff reports “What has happened has the potential to bring about massive retrogression. I’m very, very scared for the future,” Deborah Ikeh, executive director of the Debriche Health Development Centre, a non-governmental organisation (NGO) that supports community led monitoring of tuberculosis (TB) in Nigeria, says about US cuts to foreign aid. On 20 January President Donald Trump signed an executive order pausing foreign development assistance, including the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), for 90 days, pending a programme by programme review. A brief respite came a week later when the US State Department signed a waiver preserving funding for “life saving humanitarian assistance.” But then in late February the Trump administration added further confusion by terminating nearly 10 000 contracts, including some with organisations that had previously been covered under the waiver. The result is panic and uncertainty. Johns Hopkins University is reportedly being forced to make job cuts and cancel health projects—many global in scope—because of the loss of USAID funding, on top of cuts from the National Institutes of Health.1 And, says Chris Beyrer, director of the Global Health Institute at Duke University, “USAID was the implementing agency for a wide array of health and humanitarian programmes, including PEPFAR, the President’s Malaria Initiative, programmes for maternal and child health, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723206","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":"Seeking lightbulb moments","authors":"Tom Moberly","doi":"10.1136/bmj.r617","DOIUrl":"https://doi.org/10.1136/bmj.r617","url":null,"abstract":"Decades of improvements in mortality are coming undone as public health funding is eroded and trust in evidence based treatment is undermined. At the same time, commercial interests are pushing people away from healthy lifestyles, as companies work to ensure that government policies don’t undermine their business models (doi:10.1136/bmj.r487).1 And millions of the most powerless people in the world will be harmed in the wake of the US’s sudden withdrawal of foreign aid (doi:10.1136/bmj.r518).2 Can some of the new ideas and technological advances …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712822","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":"“Hello, my name is” introductions and badges need updating to include full name, title, and role","authors":"Tim Cook","doi":"10.1136/bmj.r607","DOIUrl":"https://doi.org/10.1136/bmj.r607","url":null,"abstract":"Staff should introduce themselves with their title, name, and role and have badges clearly detailing this to avoid confusion and misdirection, writes Tim Cook The “Hello, my name is” campaign, set up by geriatrician and cancer patient Kate Granger in 2015, encourages all staff to introduce themselves to patients.12 The campaign stemmed from her experience as a patient and the lack of introductions she received from the healthcare staff looking after her.3 It reflected the simple need to know who was providing her care. However, it is now often conflated with use of the first name of healthcare professionals, both in introductions and on name badges, which can cause confusion about names, titles, and roles. The “Hello, my name is” campaign needs updating. Names matter for patients, but introductions using first names alone are insufficient. Introductions and badges should include a healthcare professional’s full name, title, and role. Healthcare delivery has diversified, so role recognition is more difficult and important than ever. Like Kate Granger,1 my …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712821","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":"Approaches to children’s smartphone and social media use must go beyond bans","authors":"Victoria A Goodyear, Carrie James, Amy Orben, Mikael Quennerstedt, Gilson Schwartz, Miranda Pallan","doi":"10.1136/bmj-2024-082569","DOIUrl":"https://doi.org/10.1136/bmj-2024-082569","url":null,"abstract":"Supporting the healthy development of children requires an approach to smartphone and social media use underpinned by age appropriate design and education, argue Victoria Goodyear and colleagues Children commonly use their smartphones to access social media, play games, and interact with others, accounting for the majority of overall screen use, particularly in the 8-17 age group.1 Most recently, banning or restricting children’s (under age 182) access to smartphones and social media has grasped the attention of policy makers, schools, and parents. Several countries, including France, Turkey, Norway, Sweden, as well as regions of the US and Canada, have introduced laws, policies, or guidance for schools to ban or heavily restrict the use of phones in schools.3 In Australia, new legislation prohibits social media use for children under age 16. In the US, the surgeon general called for warning labels on social media apps.4 Such restrictions lie within broader narratives that smartphones and social media are not safe environments for children. Moreover, bans are responses to increased public pressure to mitigate the potential harmful effects of smartphones and social media on health, wellbeing, and other associated outcomes—for example, academic performance, disruptive behaviours, and bullying.5 There are, however, no simple, one-size-fits-all answers. Although many policy makers, schools, and parents are primed to believe arguments that smartphones and social media are inherently harmful, the evidence about their overall effect on children is not clear cut.67 Smartphone bans have the advantage of being immediately actionable and relatively straightforward to enforce. However, despite positive anecdotal data, we do not have the evidence to establish the types of bans that are effective and what works best for children of different ages.89 A recent evaluation of school smartphone policies in England reported that restricted smartphone use in schools …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723207","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":"In a healthcare system under increasing pressure, can a palliative care commission drive meaningful change?","authors":"Irene J Higginson, Natalie Ramjeeawon","doi":"10.1136/bmj.r610","DOIUrl":"https://doi.org/10.1136/bmj.r610","url":null,"abstract":"In November 2024, the Terminally Ill Adults (End of Life) Bill was passed in the UK House of Commons by a majority of 330 to 275. One key consensus in the debates surrounding the bill was that while palliative care in the UK can be excellent, its provision and funding are often inconsistent, inadequate, and must be improved. In response, a commission on palliative care has been established by Rachael Maskell MP to drive improvements in palliative and end-of-life care in the UK. More recently the Expert Panel of the parliamentary Health and Social Care Committee has announced it is undertaking an independent evaluation of the state of palliative care in England. The 1946 NHS Act established a health service focused on improving physical and mental health and treating illness. This wording led many to assume that palliative care, which puts the person and their concerns before their illness, was excluded. It was not until the 2022 Health and Care Act that palliative care, along with care after illness, was introduced as a requirement. Despite the UK’s pioneering role, the provision, quality, and outcomes of palliative care remains inconsistent. Many people, along with their families who provide crucial support, miss out on …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723201","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":"Computer aided detection and diagnosis of polyps in adult patients undergoing colonoscopy: a living clinical practice guideline","authors":"Farid Foroutan, Per Olav Vandvik, Lise M Helsingen, Mette Kalager, Matt Rutter, Kevin Selby, Nastazja Dagny Pilonis, Joseph C Anderson, Annette McKinnon, Jonathan M Fuchs, Casey Quinlan, Maaike Buskermolen, Carlo Senore, Pu Wang, Joseph J Y Sung, Ulrike Haug, Silje Bjerkelund, Konstantinos Triantafyllou, Dennis L Shung, Natalie Halvorsen, Thomas McGinn, Tandekile Lubelwana Hafver, Valerie Reinthaler, Gordon Guyatt, Thomas Agoritsas, Shahnaz Sultan","doi":"10.1136/bmj-2024-082656","DOIUrl":"https://doi.org/10.1136/bmj-2024-082656","url":null,"abstract":"Clinical question In adult patients undergoing colonoscopy for any indication (screening, surveillance, follow-up of positive faecal immunochemical testing, or gastrointestinal symptoms such as blood in the stools) what are the benefits and harms of computer-aided detection (CADe)? Context and current practice Colorectal cancer (CRC), the third most common cancer and the second leading cause of cancer-related death globally, typically arises from adenomatous polyps. Detection and removal of polyps during colonoscopy can reduce the risk of cancer. CADe systems use artificial intelligence (AI) to assist endoscopists by analysing real-time colonoscopy images to detect potential polyps. Despite their increasing use in clinical practice, guideline recommendations that carefully balance all patient-important outcomes remain unavailable. In this first iteration of a living guideline, we address the use of CADe at the level of an individual patient. Evidence Evidence for this recommendation is drawn from a living systematic review of 44 randomised controlled trials (RCTs) involving more than 30 000 participants and a companion microsimulation study simulating 10 year follow-up for 100 000 individuals aged 60-69 years to assess the impact of CADe on patient-important outcomes. While no direct evidence was found for critical outcomes of colorectal cancer incidence and post-colonoscopy cancer incidence, low certainty data from the trials indicate that CADe may increase positive endoscopy findings. The microsimulation modelling, however, suggests little to no effect on CRC incidence, CRC-related mortality, or colonoscopy-related complications (perforation and bleeding) over the 10 year follow-up period, although low certainty evidence indicates CADe may increase the number of colonoscopies performed per patient. A review of values and preferences identified that patients value mortality reduction and quality of care but worry about increased anxiety, overdiagnosis, and more frequent surveillance. Recommendation For adults who have agreed to undergo colonoscopy, we suggest against the routine use of CADe (weak recommendation). How this guideline was created An international panel, including three patient partners, 11 healthcare providers, and seven methodologists, deemed by MAGIC and The BMJ to have no relevant competing interests, developed this recommendation. For this guideline the panel took an individual patient approach. The panel started by defining the clinical question in PICO format, and prioritised outcomes including CRC incidence and mortality. Based on the linked systematic review and microsimulation study, the panel sought to balance the benefits, harms, and burdens of CADe and assumed patient preferences when making this recommendation Understanding the recommendation The guideline panel found the benefits of CADe on critical outcomes, such as CRC incidence and post-colonoscopy cancer incidence, over a 10 year follow up period to be highly unce","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143713075","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":"Sharp Scratch Episode 131: Are you really listening?","authors":"George Webster","doi":"10.1136/bmj.r433","DOIUrl":"https://doi.org/10.1136/bmj.r433","url":null,"abstract":"In this episode of Sharp Scratch, the panel got together to discuss the importance of properly listening to patients. The panel was joined by guest Rageshri Dhairyawan to explore how medical students and doctors can work …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143703332","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":"Children will suffer from changes to US research system","authors":"Colleen A Kraft, Michael Weitzman, Donna Koller, Jeffrey Goldhagen, Francis Rushton","doi":"10.1136/bmj.r572","DOIUrl":"https://doi.org/10.1136/bmj.r572","url":null,"abstract":"As paediatricians working in the US, we view the changes being made to our healthcare and education systems, research enterprise, and regulatory agencies1 as truly dystopian. The damage is clear to us. The breakdown of information from the Centers for Disease Control and Prevention; unjustified firing of workers from the National Science Foundation, US Department of Agriculture, Food and Drug Administration, and Environmental Protection Agency; decreasing the funding of university …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143703287","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":"Development of ROBUST-RCT: Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials","authors":"Ying Wang, Sheri Keitz, Matthias Briel, Paul Glasziou, Romina Brignardello-Petersen, Reed A C Siemieniuk, Dena Zeraatkar, Elie A Akl, Susan Armijo-Olivo, Dirk Bassler, Carrol Gamble, Lise Lotte Gluud, Jane Luise Hutton, Luz M Letelier, Philippe Ravaud, Kenneth F Schulz, David J Torgerson, Gordon H Guyatt","doi":"10.1136/bmj-2024-081199","DOIUrl":"https://doi.org/10.1136/bmj-2024-081199","url":null,"abstract":"Recent innovations in evidence based medicine methods, in particular instruments assessing risk of bias in randomised trials, have focused on methodological rigour at the expense of simplicity and practicability. Such a focus could lead to challenges in application and loss of reliability of instruments. To deal with these shortcomings, the Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials (ROBUST-RCT) was created—a rigorously developed, simply structured, and user friendly instrument for assessing risk of bias of randomised controlled trials included in systematic reviews. This paper describes the development of ROBUST-RCT and provides associated documents and a manual of instructions. Although systematic reviews of randomised controlled trials provide the best evidence for the effects of healthcare interventions,1 flaws in trial design and conduct may result in biased estimates of effects, and hence misleading conclusions.2 As a result, risk of bias assessment of randomised controlled trials has become an essential step in the systematic review process. Furthermore, risk of bias represents one domain in the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system of rating certainty of evidence, and trial limitations resulting in risk of bias may lead authors of systematic reviews to rate down the certainty of evidence.34 Although many instruments for assessing risk of bias in randomised controlled trials are available,5 most have important limitations. A systematic survey found that existing instruments often include items that do not deal with risk of bias.5 To be suitable for use in systematic reviews, risk of bias instruments should include only items that deal with risk of bias problems rather than other GRADE domains.3 The most popular and rigorously developed instruments include those offered by the Cochrane Collaboration. The first Cochrane risk of bias instrument6 included an “unclear” response option that …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695505","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}