BMJ medicine最新文献

{"title":"Accumulation and attenuation of cardiovascular benefit with glucagon-like peptide 1 receptor agonists.","authors":"Jonathan A Batty, Tamara Del Toro, Marlous Hall","doi":"10.1136/bmjmed-2026-002704","DOIUrl":"10.1136/bmjmed-2026-002704","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002704"},"PeriodicalIF":9.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and inequalities in advice and guidance versus direct referral in NHS primary care, 2015-23: population based study.","authors":"Kayleigh J Mason, Kelvin P Jordan, James Bailey, Ram Bajpai, Lorna E Clarson, Alice Faux-Nightingale, Tina Hadley-Barrows, John K Haines, Rosie Harrison, Toby Helliwell, Samantha L Hider, Clare Jinks, Natalie Knight, Christian David Mallen, Victoria K Welsh, Claire Louise Burton","doi":"10.1136/bmjmed-2025-002201","DOIUrl":"10.1136/bmjmed-2025-002201","url":null,"abstract":"<p><strong>Objectives: </strong>To examine trends and variation in the use of advice and guidance compared with direct referrals in primary care, and to assess potential inequalities across population groups.</p><p><strong>Design: </strong>Population based study.</p><p><strong>Setting: </strong>Clinical Practice Research Datalink (CPRD) Aurum, an anonymised UK primary care database, 1 January 2015 to 31 December 2023.</p><p><strong>Participants: </strong>16 340 696 patients with electronic health record data registered in CPRD; 671 894 (4% of the registered population) had advice and guidance recorded and 9 719 796 (59% of the registered population) had a direct referral recorded.</p><p><strong>Main outcome measures: </strong>Annual prevalence of advice and guidance, and direct referrals, in each calendar year, grouped by age, sex, social deprivation, locality, and ethnic group. Mapping of clinical codes to determine target specialities for advice and guidance. Proportion of individuals recorded with advice and guidance and a direct referral within ±4 months.</p><p><strong>Results: </strong>16 340 696 registered patients were analysed between 2015 and 2023; 671 894 patients (4%) had advice and guidance recorded and 9.7 million (59%) had a direct referral. Use of advice and guidance increased 19-fold from 0.10% to 1.97% of the registered population, doubling between 2019 and 2020 during the covid-19 pandemic. Direct referral rates decreased from 23-25% before the pandemic to 18% in 2020, before recovering to 24% by 2023. Cardiology (21%), dermatology (7%) and ear, nose, and throat (5%) were the most common specialties linked to advice and guidance. Most patients receiving advice and guidance (86%) also had a direct referral within ±4 months. Inequities were evident: use of advice and guidance was higher among older, white, and less deprived patients, whereas minority ethnic and more deprived groups had slower recovery of direct referral rates after the pandemic.</p><p><strong>Conclusions: </strong>The study showed that the use of advice and guidance has increased substantially since 2015, accelerated by the covid-19 pandemic and maintained after, but has not displaced direct referrals. Direct referral often preceded advice and guidance, raising questions about efficiency and equity. Use of advice and guidance was higher among older, white, and less deprived individuals, whereas minority ethnic and more socially deprived groups were more likely to have direct referrals after advice and guidance, suggesting potential delays in access to specialist care. Policy should prioritise dealing with these inequalities and evaluate whether advice and guidance reduces unnecessary referrals or delays access to specialist care.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002201"},"PeriodicalIF":9.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of non-pharmacological interventions for fatigue in long term conditions: systematic review and network meta-analysis.","authors":"Joanna Leaviss, Jessica E Forsyth, Andrew Booth, David Coyle, George Daly, Sarah Davis, Helen Dawes, Vincent Deary, Kritica Dwivedi, Kate Fryer, Samantha McCormick, Marissa Martyn-St James, Julia Newton, Shijie Ren, Gillian Rooney, Anthea Sutton, Mon Mon-Yee, Christopher Burton","doi":"10.1136/bmjmed-2025-001746","DOIUrl":"10.1136/bmjmed-2025-001746","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the clinical effectiveness of non-pharmacological interventions for fatigue in adults with long term medical conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review and network meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Medline, Embase, CINAHL, APA PsycInfo, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials, from database inception to 28 September-3 October 2023, and updated 23-24 September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria for selecting studies: &lt;/strong&gt;Randomised controlled trials of non-pharmacological interventions for fatigue in long term medical conditions where fatigue was a criterion for inclusion, the primary target of the intervention, or the primary or co-primary outcome. Excluded were studies of fatigue in people with cancer, in relation to or after infection, or resulting from injuries or developmental disorders. Studies were limited to European-style healthcare systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;88 randomised controlled trials were included, comprising 6636 participants for the end of treatment analyses, 1849 participants for the short term (≤3 months after the end of treatment) analyses, and 2322 participants for the long term (&gt;3 months) analyses, allocated to one of 27 interventions. The most common condition studied was multiple sclerosis (51 studies). A range of interventions were identified, and heterogeneity was found within intervention groups and between individual interventions. Interventions varied by duration, delivery methods, and intensity. Compared with usual care, interventions based on cognitive behavioural therapy (CBT) significantly reduced fatigue at the end of treatment (standardised mean difference -0.63, 95% credible interval (CrI) -0.87 to -0.40, 17 studies) and at the long term follow-up (-0.40, -0.63 to -0.21, nine studies). Promotion of physical activity significantly reduced fatigue at all three time points: end of treatment (standardised mean difference -0.32, 95% CrI -0.62 to -0.01, seven studies), short term (-0.51, -0.84 to -0.17, one study), and long term (-0.52, -0.86 to -0.18, two studies). Self-management focusing on energy conservation was not significantly beneficial at the end of treatment (standardised mean difference -0.20, 95% CrI -0.52 to 0.12, 10 studies) or at the short term follow-up (-0.13, -0.51 to 0.25, seven studies) but at longer term follow-up, comparable benefit with other interventions was suggested (-0.42, -0.90 to 0.09, three studies). The standard deviation of the variation between studies in the end of treatment, short term, and long term network meta-analyses indicated moderate heterogeneity of studies in each of the analyses. No significant inconsistency was detected within the networks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Interventions that support individuals to increase physical activity or that are based on CBT were effective in reducing fatigue in people with long ","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001746"},"PeriodicalIF":9.3,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic oesophagitis: pathophysiology, diagnosis, and treatment.","authors":"Mark Mahon, Amanda B Muir, Kristle Lynch","doi":"10.1136/bmjmed-2025-001459","DOIUrl":"10.1136/bmjmed-2025-001459","url":null,"abstract":"<p><p>Eosinophilic oesophagitis is a chronic, immune mediated condition characterised by infiltration of eosinophils across the oesophageal mucosa and progressive oesophageal dysfunction. This specialist review explores the changes in understanding of eosinophilic oesophagitis across epidemiology, pathophysiology, diagnosis, and treatment. It highlights the interplay of genetic susceptibility, early life environmental exposures, and immune responses driven by type 2 helper T cells that underpin epithelial barrier dysfunction and fibrostenotic progression. Current diagnostic strategies rely on endoscopic biopsy, but emerging minimally invasive tests (including the oesophageal string test and transnasal endoscopy) offer promising alternatives for disease monitoring. Therapeutic approaches include dietary elimination, drug treatments (eg, proton pump inhibitors, topical corticosteroids), biologics (particularly dupilumab), and endoscopic dilation for fibrostenotic complications. Evidence from landmark trials and guidelines to support phenotype driven, patient centred management are also reviewed. As eosinophilic oesophagitis prevalence continues to rise globally, recent advances in targeted treatments and diagnostics are redefining long term care.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001459"},"PeriodicalIF":9.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making clinical guidelines work for people with multiple long term conditions: analysis and recommendations from review of single condition guidelines.","authors":"Sara Pretorius, Victoria Bartle, Sue Bellass, Ella-Rose Blackburn, Helen Bold, Rachel Cooper, Heather Cordell, Felicity Evison, Ray Holding, Nicola Howe, Emily Lam, Tom Marshall, Fiona Matthews, Paolo Missier, Ewan R Pearson, Chris Plummer, Gillian Richards, Sian M Robinson, Elizabeth Sapey, Thomas Scharf, Mervyn Singer, Jana Suklan, Phakapan Walker, James Wason, Avan A Sayer, Miles D Witham","doi":"10.1136/bmjmed-2025-001495","DOIUrl":"10.1136/bmjmed-2025-001495","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate how UK guidelines for individual health conditions consider coexisting multiple long term conditions and to propose improvements to guideline development processes so that guidelines appropriately account for and consider coexisting multiple long term conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Analysis and recommendations from review of single condition guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Clinical guidelines developed by the National Institute for Health and Care Excellence (NICE), UK, 1 January 2013 to 31 December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Population: &lt;/strong&gt;56 clinical guidelines developed by NICE covering a broad range of long term conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;The extent to which guideline recommendations consider multiple long term conditions and coexisting conditions, distinguishing between concordant conditions (those affecting the same organ system as the index condition) and discordant conditions (those affecting different systems).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All but one of the NICE guidelines (n=55, 98%) included some advice on managing the index condition in the presence of coexisting conditions, and 50 (89%) guidelines offered general guidance on tailoring care. Only 11 (20%) guidelines, however, explicitly referred to multiple long term conditions, and none included a dedicated section on multiple long term conditions or how care should be adapted in this context. 19 (34%) guidelines featured sections looking at specific coexisting conditions or coexisting conditions generally. Coverage of coexisting conditions varied widely across categories of conditions, with mental health guidelines dealing with the most coexisting conditions (median 10, interquartile range (IQR) 4.5-14.75) in contrast with guidelines on cancer and eye disease covering the fewest conditions (median 3, 1-4.5; median 3, 2.25-2.75, respectively). Of the 397 possible concordant pairings, 120 (30%) were referenced, whereas of the 3859 possible discordant pairings, 259 (7%) were referenced, indicating greater coverage of same system combinations. Data on the composition of guideline committees showed wide variation in size, disciplinary diversity, inclusion of generalist clinicians (eg, general practitioners, general physicians, or others with no single specialty focus), and public contributors, although lived experience of multiple long term conditions was rarely specified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite widespread acknowledgement of coexisting or multiple long term conditions, NICE guidelines are predominantly condition specific and offer limited tailored support for the care of multiple long term conditions. Recommendations rarely considered common condition clusters or the cumulative effect of multiple long term conditions. Structured improvements, such as clearer guidance on adapting care, broader cross condition referencing, and more transparent inclusion of lived experi","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001495"},"PeriodicalIF":9.3,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking care for multiple long term conditions: beyond guidelines for single diseases.","authors":"Barbara I Nicholl, Rachel Johnson, Felicity Dewhurst, Easter Joury","doi":"10.1136/bmjmed-2026-002605","DOIUrl":"10.1136/bmjmed-2026-002605","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002605"},"PeriodicalIF":9.3,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147292058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying and avoiding design related biases in observational studies using the target trial framework.","authors":"Harrison J Hansford, Nazrul Islam, Hopin Lee, Barbra A Dickerman, Aidan G Cashin","doi":"10.1136/bmjmed-2024-001280","DOIUrl":"10.1136/bmjmed-2024-001280","url":null,"abstract":"<p><p>Observational studies are necessary to provide evidence to inform decision making in the absence of a relevant randomised trial. Although commonly criticised for potential problems due to confounding bias, design related biases in observational studies are often overlooked yet highly prevalent. Design related biases occur because of decisions made by researchers during analyses of observational data. Common design related biases include bias related to selection and treatment misclassification, resulting from misalignment of eligibility ascertainment, treatment strategy assignment, and start of follow-up. Conceptualising the analysis of observational data to estimate the causal effects of interventions as an attempt to explicitly emulate a target trial can help avoid design related biases, so that investigators can instead focus on data related biases (eg, confounding, measurement error) not directly addressed by the framework. Target trial emulation may also help readers appraise an observational study when transparently reported. This article aims to help readers of observational studies identify and avoid design related biases to support the use of observational evidence to inform clinical and policy decision making.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001280"},"PeriodicalIF":9.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking cessation for people with severe mental illness: systematic review and network meta-analysis.","authors":"Geertruida E Bekkering, Johan Detraux, José A López-López, Marc De Hert, A Eden Evins, Anne-Catherine Vanhove, Hanne Cloetens, Abdullah M Algarni, Thomas Vandendriessche, Arnav Agarwal, Thomas Agoritsas, Bert Aertgeerts, Nicolas Delvaux, Mieke Vermandere","doi":"10.1136/bmjmed-2025-002190","DOIUrl":"10.1136/bmjmed-2025-002190","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the comparative effectiveness and safety of pharmacological and non-pharmacological smoking cessation interventions in people with severe mental illness.</p><p><strong>Design: </strong>Systematic review and network meta-analysis.</p><p><strong>Data sources: </strong>Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, from inception to 19 September 2024.</p><p><strong>Eligibility criteria for selecting studies: </strong>Trials enrolling adults who had established diagnoses of schizophrenia, bipolar disorder, recurrent or current severe major depressive disorder, or post-traumatic stress disorder, randomised to a smoking cessation intervention versus another active treatment, placebo, standard care, or no treatment.</p><p><strong>Results: </strong>74 randomised controlled trials (11 023 participants) evaluating nine smoking cessation interventions were included in the study. Compared with placebo or minimal care, varenicline (10 more per 100 achieving long term smoking abstinence, 95% confidence interval (CI) 5 to 16; high certainty evidence) and bupropion (5 more per 100, 1 to 10; moderate certainty evidence) increased long term abstinence. Effects on short term smoking abstinence were similar. Nicotine replacement therapy improved short term abstinence but with little or no long term abstinence benefit (moderate certainty evidence). Combination interventions (pharmacological with non-pharmacological interventions) may increase long term abstinence (6 more per 100, 95% CI 3 to 11; low certainty evidence). The certainty of evidence for other interventions was very low. Serious adverse event data were highly uncertain. Dropout from a trial because of harms was possibly no different for varenicline, bupropion, and nicotine replacement therapy compared with placebo or minimal care.</p><p><strong>Conclusions: </strong>Varenicline, bupropion, and nicotine replacement therapy likely improved smoking abstinence in people with severe mental illness compared with placebo or minimal care (moderate to high certainty evidence). Combined pharmacological and non-pharmacological approaches may offer more benefit (low certainty evidence), but the risk of serious adverse events for all interventions was very uncertain.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42022349498.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002190"},"PeriodicalIF":9.3,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12911838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When means and standard deviations are an incomplete summary of a continuous variable: problems, solutions, and utilising the reference ranges to check normality.","authors":"Dan J Green, Michael J Campbell, Eirini Koutoumanou","doi":"10.1136/bmjmed-2025-001796","DOIUrl":"10.1136/bmjmed-2025-001796","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001796"},"PeriodicalIF":9.3,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting kidney failure risk without albuminuria: implications in chronic kidney disease.","authors":"Heather Y Walker, Jennifer S Lees","doi":"10.1136/bmjmed-2026-002559","DOIUrl":"10.1136/bmjmed-2026-002559","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002559"},"PeriodicalIF":9.3,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}