The BMJ最新文献

{"title":"Isolated femoral head destruction","authors":"Jiahao Meng, Shuguang Gao","doi":"10.1136/bmj-2024-080572","DOIUrl":"https://doi.org/10.1136/bmj-2024-080572","url":null,"abstract":"A previously well woman in her 60s presented with left hip pain, limited mobility, and unintentional weight loss of 5 kg. Her full blood count, C reactive protein, and alkaline phosphatase results were within normal limits, but erythrocyte sedimentation rate was raised, at 120 mm in the first …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610051","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":"One hundred years of electroencephalography . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.q2451","DOIUrl":"https://doi.org/10.1136/bmj.q2451","url":null,"abstract":"Data from nearly 30 000 participants in a Canadian longitudinal study of ageing suggest that people with epilepsy are around twice as likely to experience cardiovascular events (stroke, transient ischaemic attack, or myocardial infarction) as people of similar age without epilepsy ( JAMA Neurol doi:10.1001/jamaneurol.2024.3210). Exposure to drugs such as carbamazepine, phenytoin, and primidone, which induce cytochrome P450 enzymes, might be part of the explanation. This year marks the centenary of the first human electroencephalography (EEG) recording, made in 1924 by the German psychiatrist Hans Berger. EEG has made a substantial contribution to the diagnosis and classification of sleep disorders and epilepsy, but it hasn’t revolutionised neurology in …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610052","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":"Speaking up for science in an era of disinformation","authors":"Juliet Dobson","doi":"10.1136/bmj.q2503","DOIUrl":"https://doi.org/10.1136/bmj.q2503","url":null,"abstract":"On 6 November Donald Trump was re-elected president of the United States after an election campaign characterised by fear, lies, and disinformation. Trump’s campaign featured his insistence that he was cheated out of winning in 2020—a lie that has left many Americans distrustful of their voting system. Martin McKee and colleagues describe how the rapid spread of such disinformation, particularly on social media, poses a threat to societies and democracies everywhere (doi:10.1136/bmj.q2485). They argue that it can be countered only if social media platforms are adequately regulated and if we can effectively expose disinformation and not be afraid to speak out.1 Trump’s pre-election threats that he would curb press freedoms and target journalists suggest that speaking out may become harder (www.theguardian.com/us-news/2024/nov/10/trump-journalist-media-press-freedom …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"162 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610062","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":"Tackling heat stress: the urgent need for medical education reform","authors":"Giovanni Ghirga","doi":"10.1136/bmj.q2467","DOIUrl":"https://doi.org/10.1136/bmj.q2467","url":null,"abstract":"As global temperatures rise, the risks of heat stress are becoming a critical concern. The International Labour Organization reports that 2.4 billion people, or 71% of the global workforce, are exposed to excessive heat, resulting in millions of injuries and nearly 19 000 deaths annually.12 Tackling this “invisible killer” is imperative, including enhancing healthcare …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600974","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: GPs and geriatricians can help to improve shared decision making for surgical patients","authors":"Scarlett McNally","doi":"10.1136/bmj.q2478","DOIUrl":"https://doi.org/10.1136/bmj.q2478","url":null,"abstract":"At one of my first meetings as an elected council member of the Royal College of Surgeons of England, we approved a report called Access All Ages . It encouraged less ageist thinking and bias among healthcare staff that might lead to them denying older people surgery.1 But sometimes an operation isn’t the best option. Among patients who have surgery, 14% express regret and 15% experience complications, which are at least four times as likely if they’re frail or physically inactive.2 The Centre for Perioperative Care has published information on the importance of exercise before surgery,3 but that alone may not be enough. We need shared decision making,4 including asking patients what matters to them. The public should be primed to ask about BRAN—the benefits, risks, and alternatives to surgery and the likely result from doing nothing.4 A slew of data …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600972","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":"How outsourcing has contributed to England’s social care crisis","authors":"Benjamin Goodair, Adrienne McManus, Michelle Degli Esposti, Anders Bach-Mortensen","doi":"10.1136/bmj-2024-080380","DOIUrl":"https://doi.org/10.1136/bmj-2024-080380","url":null,"abstract":"Benjamin Goodair and colleagues argue that growth of private provision in adult social care in England has resulted in worse care and should be rolled back Adult social care in England is in crisis. Chronically underfunded services are struggling to accommodate unmet need, and inequalities are widening. The number of people applying and being rejected for care provision is rising year on year, and unmet need is twice as high in the most economically deprived areas compared with the least deprived.12 Meanwhile, 9 in 10 adult social service directors in England did not believe there was adequate funding or workforce to meet care needs of older and disabled people in their area.3 These deficiencies have seen the social care sector brought “to its knees.”4 Care for older people and people with physical and mental disabilities is facing record demand but performing worse than any time in recent history. One contributor to this is the outsourcing of care provision to the private sector. Although competition from private sector provision was championed as a solution to achieve cheaper and better quality care, evidence from the past few decades in the UK and elsewhere challenges this view.567 In England, in particular, adult social care now faces a reality where reform is needed but the capacity for change is constrained by a model of care where most providers are run by for-profit companies. Social care in England, sometimes referred to as community, residential, or personalised care, constitutes services that support people with activities of daily living and maintaining independence. In England, care services are largely divided between healthcare and social care, with local government responsible for organising and funding social care and the NHS a distinct service directly funded by central government. All health and social care …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610055","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 adverse events in the US","authors":"Helen Haskell","doi":"10.1136/bmj.q2437","DOIUrl":"https://doi.org/10.1136/bmj.q2437","url":null,"abstract":"After all these years, why has patient safety not improved? In late 1999, the US Institute of Medicine’s report “To Err is Human: Building a Safer Health System” galvanized the nascent patient safety movement into action with its assertion that as many as 98 000 Americans died annually from medical error.1 That alarming statistic was derived from the 1991 Harvard Medical Practice Study, a randomized chart review undertaken to create an evidence base for the controversy then raging around litigation against medical malpractice.2 That study found that 3.7% of patients in a sample of hospital admissions in New York state had experienced serious adverse events, more than one fourth of which the researchers considered legally compensable. Overall, 48% of the events were associated with surgical procedures. A related study in Colorado and Utah a few years later showed similar percentages of surgical error, whereas a targeted follow-up study found that surgery accounted for two thirds of adverse events in hospitals in the same two states.3 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"196 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610132","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":"Safety of inpatient care in surgical settings: cohort study","authors":"Antoine Duclos, Michelle L Frits, Christine Iannaccone, Stuart R Lipsitz, Zara Cooper, Joel S Weissman, David W Bates","doi":"10.1136/bmj-2024-080480","DOIUrl":"https://doi.org/10.1136/bmj-2024-080480","url":null,"abstract":"Objectives To estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned. Design Multicenter retrospective cohort study. Setting 11 US hospitals. Participants 1009 patients from a randomly selected sample of 64 121 adults admitted for surgery during 2018. Main outcome measures Adverse events during inpatient perioperative care were assessed using a trigger method, identifying information previously associated with similar events, and from a comprehensive review of electronic health records. Trained nurses reviewed all records and flagged admissions with possible adverse events, which were then adjudicated by physicians, who confirmed the occurrence and characteristics of the events. Adverse events were classified as major if they resulted in serious harm requiring substantial intervention or prolonged recovery, involved a life threatening event, or led to a fatal outcome. Potentially preventable events included those definitively, probably, or possibly preventable. Results Among 1009 patients reviewed, adverse events were identified in 38.0% (95% confidence interval 32.6 to 43.4), with major adverse events occurring in 15.9% (12.7 to 19.0). Of 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were related to surgical procedures (n=292, 49.3%), followed by adverse drug events (n=158, 26.6%), healthcare associated infections (n=74, 12.4%), patient care events (n=66, 11.2%), and blood transfusion reactions (n=3, 0.5%). Adverse events were most frequent in general care units (n=289, 48.8%), followed by operating rooms (n=155, 26.1%), intensive care units (n=77, 13.0%), recovery rooms (n=20, 3.3%), emergency departments (n=11, 1.8%), and other in-hospital locations (n=42, 7.0%). Professions most involved were attending physicians (n=531, 89.5%), followed by nurses (n=349, 58.9%), residents (n=294, 49.5%), advanced level practitioners (n=169, 28.5%), and fellows (n=68, 11.5%). Conclusions Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care. Supplementary method S3 shows the SAS code for data preparation and analysis. Owing to confidentiality requirements, the data for this project are primarily reserved for the immediate research team at Mass General Brigham. However, deidentified data can be accessed on secured servers by contacting the principal investigator (DWB). Additionally, the protocol and adverse events chart review training manual used for the project, along with further details about data management and analysis, are available to interested researchers.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610469","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":"Simple and cost effective solution to applying cold sensation in the assessment of regional anaesthesia","authors":"Callum H Weller","doi":"10.1136/bmj.q2469","DOIUrl":"https://doi.org/10.1136/bmj.q2469","url":null,"abstract":"Nichols and colleagues describe the use of reusable devices for applying cold sensation when assessing regional anaesthesia.1 I find the concept of these reusable devices commendable, but perhaps overly engineered. The financial and environmental costs associated with disposable cold sprays are indeed concerning. But the proposed solution …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601014","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":"Time to talk to patients about climate change","authors":"Enrique Falce","doi":"10.1136/bmj.q2444","DOIUrl":"https://doi.org/10.1136/bmj.q2444","url":null,"abstract":"The spread of misinformation and disinformation about climate change and health is of great concern to society.1 The healthcare community must engage in climate change education with at least as strong a resolve as it has with other major public health challenges (such as smoking cessation). Piatek …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601022","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}