The BMJ最新文献

{"title":"Revolution in academic medicine: reducing bureaucratic barriers","authors":"Steven Thornton, Siobhan Quenby, N A B Simpson, Andrew Shennan, Phillip Bennett, C Williamson, A L David","doi":"10.1136/bmj.r499","DOIUrl":"https://doi.org/10.1136/bmj.r499","url":null,"abstract":"We support the BMJ Commission on the Future of Academic Medicine’s effort to tackle key challenges in clinical academia.1 One approach we have taken is to work across institutions—for example, in the development of the Tommy’s National Centre for Preterm Birth Research. This fosters cross institutional and interdisciplinary collaboration and helps develop future academics through leadership courses. We also include policy makers and the public to speed up implementation. We agree on many of your suggestions …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661303","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":"Surgical treatments for obesity . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r485","DOIUrl":"https://doi.org/10.1136/bmj.r485","url":null,"abstract":"Complete 10 year follow-up data were available only for 65% of the 300 adults randomised either to laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass for the treatment of obesity. Even so, it’s fairly clear that Roux-en-Y gastric bypass is the better option for sustained weight reduction and for causing fewer adverse effects. Gastroesophageal reflux was less common after gastric bypass than after sleeve gastrectomy ( JAMA Surg doi:10.1001/jamasurg.2024.7052). Guidelines recommend clinical surveillance rather than early surgery for patients with asymptomatic severe aortic stenosis and a normal left ventricular ejection …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661232","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":"Urinary problems in men: self-management advice is helpful","authors":"Helen Saul, Brendan Deeney, Laura Swaithes, Marcus Drake","doi":"10.1136/bmj.q2660","DOIUrl":"https://doi.org/10.1136/bmj.q2660","url":null,"abstract":"Worthington J, Frost J, Sanderson E, et al. Lower urinary tract symptoms in men: the TRIUMPH cluster RCT. Health Technology Assessment 2024;28:1-162. To read the full NIHR Alert, go to: <https://evidence.nihr.ac.uk/alert/urinary-problems-in-men-self-management-advice-is-helpful/>","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661260","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":"Multiple crusting plaques on the face secondary to burn injury","authors":"Mengdong Liu, Jun Li","doi":"10.1136/bmj-2024-082314","DOIUrl":"https://doi.org/10.1136/bmj-2024-082314","url":null,"abstract":"This man in his early 40s, who had no medical history, was referred to the burn clinic 20 days after being burned in a gasoline fire. Twelve days after the injury, he started to develop purulent …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661373","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 woman with enlarged hands and feet","authors":"Yuanhong Ge, Qingjia Lai, Xuejun Xu","doi":"10.1136/bmj-2024-083320","DOIUrl":"https://doi.org/10.1136/bmj-2024-083320","url":null,"abstract":"A woman in her 40s reported a two month history of her shoes and gloves becoming increasingly tight, headaches, blurred vision, and a tight sensation in her skin. She did not report any joint pain or limb numbness. She had experienced amenorrhoea for one year, which was treated with traditional Chinese medicine without improvement. She also had a one year history of hypertension, which was well controlled with amlodipine. On examination, her height was 145 cm, weight was 60 kg, and her body mass index (BMI) was 28.5. She had rough skin, an enlarged nose and tongue, thickened lips, and macrodactyly of the hands (fig 1) and feet. Her voice was deeper than it had been. Visual field testing indicated bitemporal hemianopia. Table 1 summarises the laboratory test results. Fig 1 Thickened dorsal hands, rough skin, and thickened fingers View this table: Table 1 Laboratory test results Acromegaly secondary to a growth hormone secreting pituitary adenoma. Acromegaly is caused by excessive secretion of growth …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661262","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":"Sonolysis during carotid endarterectomy: randomised controlled trial","authors":"David Školoudík, Tomáš Hrbáč, Martin Kovář, Vladimír Beneš, Jiří Fiedler, Mattia Branca, Jean-Benoit Rossel, David Netuka","doi":"10.1136/bmj-2024-082750","DOIUrl":"https://doi.org/10.1136/bmj-2024-082750","url":null,"abstract":"Objective To evaluate the effectiveness and safety of sonolysis using a low intensity 2 MHz pulsed wave ultrasound beam during carotid endarterectomy. Design Multicentre, phase 3, double blind, randomised controlled trial. Setting 16 European centres. Participants 1004 patients (mean age 68 years; 312 (31%) female) were enrolled in the study between 20 August 2015 and 14 October 2020 until the interim analysis was performed. Interventions Sonolysis (n=507) versus sham procedure (n=497). Main outcome measures The primary endpoint was the composite incidence of ischaemic stroke, transient ischaemic attack, and death within 30 days. The incidence of new ischaemic lesions on follow-up brain magnetic resonance imaging was the main substudy endpoint, and incidence of intracranial bleeding was the main safety endpoint. Results The results favoured the sonolysis group for the primary endpoint (11 (2.2%) v 38 (7.6%); risk difference −5.5%, 95% confidence interval (CI) −8.3% to −2.8%; P<0.001), as well as in the substudy for magnetic resonance imaging detected new ischaemic lesions (20/236 (8.5%) v 39/224 (17.4%); risk difference −8.9%, −15% to −2.8%; P=0.004). Sensitivity analysis resulted in a risk ratio for sonolysis of 0.25 (95% CI 0.11 to 0.56) for ischaemic stroke and 0.23 (0.07 to 0.73) for transient ischaemic attack within 30 days. Sonolysis was found to be safe, and 94.4% of patients in the sonolysis group were free from serious adverse events 30 days after the procedure. Conclusion Sonolysis was safe for patients undergoing carotid endarterectomy and resulted in a significant reduction in the composite incidence of ischaemic stroke, transient ischaemic attack, and death within 30 days. Trial registration Clinicaltrials.gov [NCT02398734][1]. Data will become available to interested investigators on submission of a reasonable research request by email to the corresponding author (skoloudik@email.cz) and approval by the steering committee of the trial. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02398734&atom=%2Fbmj%2F388%2Fbmj-2024-082750.atom","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661259","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":"Scarlett McNally: Schoolchildren give me hope for future generations of NHS staff","authors":"Scarlett McNally","doi":"10.1136/bmj.r516","DOIUrl":"https://doi.org/10.1136/bmj.r516","url":null,"abstract":"I recently had an amazing time when I was invited to speak at a primary school careers day. We played with plastic bones and passed around joint replacements and intramedullary nails. I explained that NHS staffing isn’t exactly what you see on TV: only 12% of NHS workers are doctors and 26% nurses.1 I explained that there are 14 allied health professions2 and that half of our 1.7 million staff have jobs involving computers, maintaining buildings, laundry, patient booking, catering, equipment, and organising other staff and procedures. We worked out that the number of workers needed to keep the NHS running would fill thousands of classrooms. The children were dressed up for their dream job. Aspiring astronauts, firefighters, and doctors asked insightful questions. After 30 years as a surgeon I found this …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661261","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":"Therapeutic ultrasound during carotid endarterectomy","authors":"Jesse A Columbo","doi":"10.1136/bmj.r385","DOIUrl":"https://doi.org/10.1136/bmj.r385","url":null,"abstract":"Intraoperative sonolysis reduces stroke complications Ultrasonography as a diagnostic modality for the diagnosis and surveillance of carotid stenosis has been a mainstay of clinical practice for decades.12 Ultrasound is non-invasive, does not use ionizing radiation or contrast media, and remains low cost, making it an integral evidence based tool for patients with carotid disease.3 Carotid endarterectomy is the surgical therapeutic gold standard to reduce long term stroke risk in patients with severe carotid stenosis. In the linked study (doi:10.1136/bmj-2024-082750), investigators in the SONOBIRDIE trial have tested a new application for ultrasound: prevention of thromboembolic complications during carotid endarterectomy.4 In a multicenter randomized trial of 1004 patients, investigators determined that intraoperative sonolysis with ultrasound at the time of carotid endarterectomy reduced the composite endpoint of transient ischemic attack, stroke, or death within 30 days from 7.6% to 2.2%, compared with sham sonolysis. These findings represent a potentially significant innovation in the application of ultrasound from its historical diagnostic role to now also …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661263","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":"Labour government scraps NHS England","authors":"Hugh Alderwick","doi":"10.1136/bmj.r537","DOIUrl":"https://doi.org/10.1136/bmj.r537","url":null,"abstract":"Performative politics that will disrupt the health service when patients most need it On 13 March, the UK prime minister announced that the Labour government will scrap NHS England—the national body responsible for the day-to-day management of the English NHS.1 Keir Starmer said the changes would cut bureaucracy and bring the health service “back into democratic control”—and form part of his broader plans to reshape the “flabby” UK state.2 The announcement marks the end of a 12 year experiment of trying to run the NHS more independently from politicians. NHS England was established under Andrew Lansley’s controversial NHS reforms in 2012. But its roots run deeper: throughout the NHS’s history, there have been unresolved questions about the right level of political involvement in managing the health service and attempts to split policy formulation and implementation at the top of government.3 On paper, Lansley’s reforms made this split a reality. Ministers and the Department of Health and Social Care are responsible for setting overall policy direction and defining NHS priorities. NHS England, meanwhile, sits at arm’s length from government and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640540","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":"Abolishing NHS England: risks and opportunities","authors":"Nigel Crisp","doi":"10.1136/bmj.r553","DOIUrl":"https://doi.org/10.1136/bmj.r553","url":null,"abstract":"NHS England (NHSE) was always an uneasy compromise, caught between the NHS and ministers. Designed as the NHS headquarters and free to operate without day-to-day political involvement, it is nevertheless accountable to ministers for NHS performance and achieving ministerial goals. Unsurprisingly this led to duplication of activities between NHSE and the Department of Health and Social Care (DHSC) which monitors it on behalf of ministers. Both organisations need expertise in relevant areas, and continuous supervision inevitably leads to tensions and rivalry. Part of NHSE’s role is to hold NHS organisations to account for performance and, again unsurprisingly, the same duplication, tensions, and rivalry occur. It is also no surprise that at this time of crisis and financial pressure politicians are frustrated and want to cut out this intermediary and take back direct control. There are, however, many risks and downsides. Success will depend on how this massive change is managed and on creating a workable future relationship between ministers and NHS organisations. Any reorganisation risks losing focus and vital skills and wasting time and money. Performance is likely to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653474","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}