BMJ : British Medical Journal最新文献

{"title":"Improving NHS management: first fix the hostility to good management.","authors":"Stephen Black","doi":"10.1136/bmj.r1757","DOIUrl":"https://doi.org/10.1136/bmj.r1757","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1757"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meet the new editorial scholar: Zaynah Khan.","authors":"George Webster","doi":"10.1136/bmj.r1764","DOIUrl":"https://doi.org/10.1136/bmj.r1764","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1764"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partha Kar: The Super Six diabetes care model offers lessons for shifting care into the community.","authors":"Partha Kar","doi":"10.1136/bmj.r1727","DOIUrl":"https://doi.org/10.1136/bmj.r1727","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1727"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"John Launer: How the term \"psychodiversity\" can help us understand what it means to be human.","authors":"John Launer","doi":"10.1136/bmj.r1731","DOIUrl":"https://doi.org/10.1136/bmj.r1731","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1731"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gaza: Thousands of UK doctors urge royal colleges to unite to advocate for Palestinian health workers and civilians.","authors":"Adrian O'Dowd","doi":"10.1136/bmj.r1780","DOIUrl":"https://doi.org/10.1136/bmj.r1780","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1780"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternity care: national failures-not local issues-are to blame for poor care, patient safety body warns.","authors":"Adrian O'Dowd","doi":"10.1136/bmj.r1781","DOIUrl":"https://doi.org/10.1136/bmj.r1781","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1781"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mounjaro: UK price set to rise by up to 170% after Trump complaint-will patients have to pay?","authors":"Kate Bowie","doi":"10.1136/bmj.r1776","DOIUrl":"https://doi.org/10.1136/bmj.r1776","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1776"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 2 diabetes: SGLT-2 inhibitors to be offered as first line treatment in major guidance \"shake-up\".","authors":"Kate Bowie","doi":"10.1136/bmj.r1777","DOIUrl":"https://doi.org/10.1136/bmj.r1777","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1777"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral positioning to minimize postoperative hypoxemia.","authors":"Marcos F Vidal Melo, Matthias Eikermann","doi":"10.1136/bmj.r1773","DOIUrl":"https://doi.org/10.1136/bmj.r1773","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"r1773"},"PeriodicalIF":42.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial.","authors":"Hui Ye, Li-Hua Chu, Guo-Hao Xie, Ye-Jing Hua, Yi Lou, Qiao-Hong Wang, Zhi-Xin Xu, Meng-Yan Tang, Bing-Duo Wang, Hui-Yi Hu, Jing Ying, Tian Yu, Hai-Ying Wang, Yuan Wang, Zhi-Jian Ye, Xiao-Fang Bao, Ming-Cang Wang, Ling-Yang Chen, Xiao-Xia Wang, Xing-Bo Zhang, Chang-Shun Huang, Jun Wang, Ya-Ping Lu, Fo-Quan Luo, Wang Zhou, Chuan-Guang Wang, Hao Cheng, Wen-Jie Liu, Jie Luo, Yan-Qin Wu, Ru-Ru Li, Dong Wang, Ling-Qian Hou, Lu Shi, Jun Zhang, Kun Wang, Xin Pi, Rong Zhou, Qin-Qin Yang, Pei-Ling Wan, Hui Li, Shui-Jing Wu, Sheng-Wen Song, Ping Cui, Liqi Shu, Nazrul Islam, Xiang-Ming Fang","doi":"10.1136/bmj-2025-084539","DOIUrl":"10.1136/bmj-2025-084539","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of lateral versus supine positioning on incidence of hypoxaemia in sedated patients and to provide evidence based recommendations for respiratory strategies.</p><p><strong>Design: </strong>Prospective, multicentre, randomised controlled trial.</p><p><strong>Setting: </strong>14 tertiary hospitals in China, July to November 2024.</p><p><strong>Participants: </strong>2159 adults (≥18 years) who underwent sedation.</p><p><strong>Interventions: </strong>Sedated patients were randomly assigned (1:1) to receive either lateral positioning or conventional supine positioning, stratified by study centres.</p><p><strong>Main outcome measures: </strong>The primary outcome was incidence of hypoxaemia (peripheral oxygen saturation (SpO<sub>2</sub>) ≤90%) within the first 10 minutes after positioning. Secondary outcomes included airway rescue interventions, incidence of severe hypoxaemia (SpO<sub>2</sub> ≤85%), lowest oxygen saturation recorded, length of stay in the post-anaesthesia care unit, and safety measures (eg, bradycardia, tachycardia, hypotension, new onset arrhythmia). Analyses were performed on an intention-to-treat basis.</p><p><strong>Results: </strong>Of 2159 patients randomised, 2143 were included in the primary analysis. The mean age of the patients was 53.1 years, mean body mass index was 23.9, and 53.7% (1150/2143) were women. The incidence of hypoxaemia was significantly lower in the lateral group compared with supine group (5.4% (58/1073) <i>v</i> 15.0% (161/1070); adjusted risk ratio 0.36, 95% confidence interval (CI) 0.27 to 0.49; P<0.001). Compared with patients in the supine group, patients in the lateral group required fewer airway rescue interventions (6.3% (68/1073) <i>v</i> 13.8% (148/1070); adjusted risk ratio 0.46, 0.34 to 0.61; P<0.001), had a lower incidence of severe hypoxaemia (0.7% (8/1073) <i>v</i> 4.8% (51/1070); adjusted risk ratio 0.16, 0.07 to 0.33; P<0.001), and had a higher mean lowest SpO<sub>2</sub> level (96.9% <i>v</i> 95.7%, absolute adjusted mean difference 1.20%, 95% CI 0.87% to 1.54%; P<0.001). Additionally, length of stay in the post-anaesthesia care unit was shorter in the lateral group (38.2 <i>v</i> 40.5 minutes; absolute adjusted mean difference -2.22 minutes; 95% CI -3.63 to -0.80; P=0.002). Safety outcomes were comparable between the groups, but tachycardia was less frequent in the lateral group.</p><p><strong>Conclusions: </strong>Placing sedated adults in the lateral position significantly reduces the incidence and severity of hypoxaemia and decreases the need for airway rescue interventions without compromising safety. Given its simplicity and low cost, lateral positioning could offer advantages in remote or resource constrained clinical settings. Further replication studies targeting patients with advanced age and high body mass index are needed to improve the generalisability of the findings.</p><p><strong>Trial registration: </strong>ClinicalTr","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"390 ","pages":"e084539"},"PeriodicalIF":42.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}