The BMJ最新文献

{"title":"Matt Morgan: Pods and wards—flipping through rotations","authors":"Matt Morgan","doi":"10.1136/bmj.q2022","DOIUrl":"https://doi.org/10.1136/bmj.q2022","url":null,"abstract":"Some readers may remember Kathy. She filled my childhood Sunday afternoons as the main character in my favourite television show. She wasn’t a doctor; she wasn’t even a human. Kathy was an intelligent dolphin who helped solve local crimes like an underwater version of Lassie , in the 1960s series Flipper . But Kathy’s story had a difficult end because of the isolated, captive environment she lived and worked in. Dolphins, particularly bottlenose dolphins like Kathy, live in “fusion-fission” societies. These social structures have fluid group membership, with individuals frequently changing affiliation. Dolphins swim with one pod for a while before switching to a very different group, forming new alliances and relationships. This dynamic social structure allows them to adapt to changing environments, learn new skills, find mentors, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235016","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":"Peer review practices are \"delaying science,\" academic claims in lawsuit against six publishers.","authors":"Clare Dyer","doi":"10.1136/bmj.q2037","DOIUrl":"https://doi.org/10.1136/bmj.q2037","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245177","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":"Management of atrial fibrillation in older adults","authors":"Anna L Parks, David S Frankel, Dae H Kim, Darae Ko, Daniel B Kramer, Melis Lydston, Margaret C Fang, Sachin J Shah","doi":"10.1136/bmj-2023-076246","DOIUrl":"https://doi.org/10.1136/bmj-2023-076246","url":null,"abstract":"Most people with atrial fibrillation are older adults, in whom atrial fibrillation co-occurs with other chronic conditions, polypharmacy, and geriatric syndromes such as frailty. Yet most randomized controlled trials and expert guidelines use an age agnostic approach. Given the heterogeneity of aging, these data may not be universally applicable across the spectrum of older adults. This review synthesizes the available evidence and applies rigorous principles of aging science. After contextualizing the burden of comorbidities and geriatric syndromes in people with atrial fibrillation, it applies an aging focused approach to the pillars of atrial fibrillation management, describing screening for atrial fibrillation, lifestyle interventions, symptoms and complications, rate and rhythm control, coexisting heart failure, anticoagulation therapy, and left atrial appendage occlusion devices. Throughout, a framework is suggested that prioritizes patients’ goals and applies existing evidence to all older adults, whether atrial fibrillation is their sole condition, one among many, or a bystander at the end of life.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235045","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":"Doctor suicide: “All I could see were tasks mounting, appointments being booked, and people constantly knocking on my door”","authors":"Adele Waters","doi":"10.1136/bmj.q1879","DOIUrl":"https://doi.org/10.1136/bmj.q1879","url":null,"abstract":"A recent report has set out recommendations that could prevent doctors from taking their own lives. Adele Waters speaks to doctors and families touched by suicide Sarah Jacques remembers the day she came close to killing herself. The 46 year old former GP from Battle, East Sussex, says she “just snapped” one day at work, drove to the seafront, parked her car, and got out to watch the sea. She stayed there for six hours, thinking about drowning. “I just kept wanting to walk into the sea. I wouldn’t have tried to swim,” Jacques says. “Looking back, I don’t think I was conscious in that moment of how bad I was, how strong those feelings were. I just felt completely overwhelmed.” That morning—1 August 2022—began like any other, with a 7 30 am drive to her workplace, a surgery in Heathfield where she worked as a full time partner. “I suddenly found myself crying. I’d never done that before—cried as I drove to work,” she recalls. “I got to work and had to drag myself out of the car—I didn’t want to go in. And then it got to 11 am and even though I hadn’t stopped since 8 my screen was still full. It seemed like I hadn’t made any inroads into the workload. All I could see were tasks, instant messages, more appointments being booked, and people constantly knocking on my door for other things to be done. “I managed to type ‘help’ by instant message to one of the managers. She came to the room and found me in a distressed state. One of the partners came in and suggested I work from home, so I left. But I drove past my house and to Bexhill beach instead. “It’s hard to remember what stopped me from walking …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235021","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":"Helen Salisbury: Getting the best out of general practice","authors":"Helen Salisbury","doi":"10.1136/bmj.q2020","DOIUrl":"https://doi.org/10.1136/bmj.q2020","url":null,"abstract":"What would a more productive general practice look like? Of course, it’s hard to measure productivity when your job is mostly about preventing things from happening. If you’re a surgeon, you can count the number of operations completed (although variations in complexity will mean that a simple number isn’t an accurate reflection of the work done)—but if most of your role is to keep people well and out of hospital, it’s harder to show that you’re doing a good job. The stroke that didn’t happen because blood pressure was successfully controlled, or the mental health crisis averted by timely intervention, remains invisible and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235015","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":"Medical students face enough pressures—the “academic weapon” trend doesn’t help","authors":"Diana Dovgy","doi":"10.1136/bmj.q2027","DOIUrl":"https://doi.org/10.1136/bmj.q2027","url":null,"abstract":"The celebration of extreme study habits encourages an unhealthy attitude to learning and success, writes Diana Dovgy The term “academic weapon” went viral around two years ago, when a video on TikTok showed a university student sitting in the front row of a 700 person lecture.1 He shared that the key to acing the semester was to become an “absolute academic weapon,” which in his eyes meant approaching university with an extremely self-assured attitude and dominating the front row in lectures. Many viewers found the student’s attitude and advice humorous, which led to other users sampling the audio to create their own study hacks—both helpful and unserious. The term academic weapon originally emerged in the 2010s2 to mean a student who acquires traits seen by many as scholarly.3 Some students use TikTok to cast an ironic lens on this idea, but other “academic weapons” have garnered attention for their extreme depictions of scholarly dedication. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235017","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":"Valproate: Sanofi ordered to pay €285 000 to mother whose children had birth defects.","authors":"Barbara Casassus","doi":"10.1136/bmj.q2034","DOIUrl":"https://doi.org/10.1136/bmj.q2034","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245592","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 third of patients miss out on risk assessments before surgery.","authors":"Jacqui Wise","doi":"10.1136/bmj.q2035","DOIUrl":"https://doi.org/10.1136/bmj.q2035","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245593","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 importance of the day of embryo transfer during in vitro fertilisation","authors":"Simone Cornelisse, Liliana Ramos, Sebastiaan Mastenbroek","doi":"10.1136/bmj.q1703","DOIUrl":"https://doi.org/10.1136/bmj.q1703","url":null,"abstract":"The timing of embryo transfer, which aligns with different stages of embryo development, is an important element of in vitro fertilisation (IVF). This article briefly describes the main phases of IVF treatment, embryo development and transfer policies, cumulative live birth rates, and the key findings of the authors’ research. In vitro fertilisation (IVF) is a well established treatment for infertility and has been responsible for the birth of more than 10 million children worldwide since 1978.1 An IVF cycle includes ovarian hyperstimulation with hormones, oocyte retrieval, and then fertilisation and embryo culture in the laboratory.23 In most laboratories worldwide, embryos are cultured in vitro for three to six days, and the embryos with the highest chance of resulting in a live birth are selected for intrauterine transfer. Surplus embryos are cryopreserved for future use if a live birth is unsuccessful after an initial transfer or more children are planned. IVF, with or without intracytoplasmic sperm injection (ICSI), involves the handling of sperm cells and oocytes (gametes) and embryos outside the human body. In IVF, thousands of sperm cells are used to inseminate oocytes in the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235012","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":"Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial","authors":"Simone Cornelisse, Kathrin Fleischer, Lucette van der Westerlaken, Jan-Peter de Bruin, Carlijn Vergouw, Carolien Koks, Josien Derhaag, Jantien Visser, Jannie van Echten-Arends, Els Slappendel, Brigitte Arends, Moniek van der Zanden, Angelique van Dongen, Janneke Brink-van der Vlugt, Marcella de Hundt, Max Curfs, Harold Verhoeve, Maaike Traas-Hofmans, Yvonne Wurth, Petra Manger, Quirine Pieterse, Didi Braat, Madelon van Wely, Liliana Ramos, Sebastiaan Mastenbroek","doi":"10.1136/bmj-2024-080133","DOIUrl":"https://doi.org/10.1136/bmj-2024-080133","url":null,"abstract":"Objectives To evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and perinatal complications is increased compared with cleavage stage embryo transfers during in vitro fertilisation (IVF) treatment. Design Multicentre randomised controlled trial. Setting 21 hospitals and clinics in the Netherlands, 18 August 2018 to 17 December 2021. Participants 1202 women with at least four embryos available on day 2 after oocyte retrieval were randomly assigned to either blastocyst stage embryo transfer (n=603) or cleavage stage embryo transfer (n=599). Interventions In the blastocyst group and cleavage group, embryo transfers were performed on day 5 and day 3, respectively, after oocyte retrieval, followed by cryopreservation of surplus embryos. Analysis was on an intention-to-treat basis, with secondary analyses as per protocol. Main outcome measures The primary outcome was the cumulative live birth rate per oocyte retrieval, including results of all frozen-thawed embryo transfers within a year after randomisation. Secondary outcomes included cumulative rates of pregnancy, pregnancy loss, and live birth after fresh embryo transfer, number of embryo transfers needed, number of frozen embryos, and obstetric and perinatal outcomes. Results The cumulative live birth rate did not differ between the blastocyst group and cleavage group (58.9% (355 of 603) v 58.4% (350 of 599; risk ratio 1.01, 95% confidence interval (CI) 0.84 to 1.22). The blastocyst group showed a higher live birth rate after fresh embryo transfer (1.26, 1.00 to 1.58), lower cumulative pregnancy loss rate (0.68, 0.51 to 0.89), and lower mean number of embryo transfers needed to result in a live birth (1.55 v 1.82; P<0.001). The incidence of moderate preterm birth (32 to <37 weeks) in singletons was higher in the blastocyst group (1.87, 1.05 to 3.34). Conclusion Blastocyst stage embryo transfers resulted in a similar cumulative live birth rate to cleavage stage embryo transfers in women with at least four embryos available during IVF treatment. Trial registration International Clinical Trial Registry Platform NTR7034. Restricted access to the study data can be arranged on request to the corresponding author. Written proposals will be assessed by the ToF study group. A data sharing agreement including terms and conditions for authorship and publication will need to be signed before data are available.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235013","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}