BMJ (Clinical research ed.)最新文献

{"title":"Margaret McCartney: Promising miracle diet fixes isn't fair on anyone.","authors":"Margaret McCartney","doi":"10.1136/bmj.j4226","DOIUrl":"https://doi.org/10.1136/bmj.j4226","url":null,"abstract":"In the world of nutrition, “low carb and high fat” diets are a growing trend. Big claims are made, including from doctors, that these can “save your life,” “reverse type 2 diabetes,” and, of course, help you lose weight.1234 So, should GPs start recommending low carbohydrate diets to people who want to lose weight or who have type 2 diabetes?\u0000\u0000Criticism of the status quo is reasonable. By its nature, diet research contains many uncertainties, with few long term randomised controlled trials. But doctors, researchers, and guideline committees can surely aspire to do better.\u0000\u0000Many in the low carb lobby have been highly critical of current government dietary guidance. Some legitimately criticise conflicting or weak evidence underpinning …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4226"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35442608","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":"Painful red eyes in a contact lens wearer.","authors":"","doi":"10.1136/bmj.j4453","DOIUrl":"https://doi.org/10.1136/bmj.j4453","url":null,"abstract":"","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4453"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35442609","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":"Not all interventions for burnout cost money: the value of debrief groups.","authors":"Sara V Lightowlers, Mareike K Thompson, Susannah L Hunt","doi":"10.1136/bmj.j4377","DOIUrl":"https://doi.org/10.1136/bmj.j4377","url":null,"abstract":"Spurred on by a BMJ Careers article on Balint groups,1 and recognising rising stress in our peers, we started a monthly debrief group for oncology registrars in our centre, facilitated by a medically qualified chaplain (SLH).\u0000\u0000Topics have been wide ranging, reflecting all three dimensions of burnout (depersonalisation, exhaustion, and professional inefficacy),2 and have included high stress when …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4377"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35386441","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":"Efficacy of recommended drugs against soil transmitted helminths: systematic review and network meta-analysis.","authors":"Wendelin Moser, Christian Schindler, Jennifer Keiser","doi":"10.1136/bmj.j4307","DOIUrl":"10.1136/bmj.j4307","url":null,"abstract":"<p><p><b>Objective</b> To evaluate efficacies of anthelmintic drugs against soil transmitted helminths in terms of cure rates and egg reduction rates.<b>Design</b> Systematic review and network meta-analysis.<b>Data Sources</b> PubMed, ISI Web of Science, Embase, ScienceDirect, the Cochrane Central Register of Clinical Trials, and the World Health Organization library database from 1960 until 31 December 2016.<b>Study selection</b> Randomised controlled trials evaluating the efficacy of a single dose regimen of albendazole, mebendazole, levamisole, and pyrantel pamoate against <i>Ascaris lumbricoides</i>, hookworm (<i>Necator americanus</i> and <i>Ancylostoma duodenale</i>) and <i>Trichuris trichiura.</i> The primary outcomes included cure rates analysed by network meta-analysis with mixed logistic regression models and egg reduction rates with mixed linear models.<b>Results</b> 55 and 46 randomised controlled trials were included in the analysis of cure rates and egg reduction rates, respectively. All drugs were highly efficacious against <i>A lumbricoides</i> Albendazole showed the highest efficacy against hookworm infections with a cure rate of 79.5% (95% confidence interval 71.5% to 85.6%) and an egg reduction rate of 89.6% (81.9% to 97.3%). All drugs had low efficacy against <i>T trichiura</i>, with mebendazole showing the highest cure rate of 42.1% (25.9% to 60.2%) and egg reduction rate of 66.0% (54.6% to 77.3%). Estimates for the years 1995 and 2015 showed significant reductions in efficacy of albendazole against <i>T trichiura</i>: by 2015 the egg reduction rates fell from 72.6% (53.7% to 91.5%) to 43.4% (23.5% to 63.3%; P=0.049) and the cure rates fell from 38.6% (26.2% to 52.7%) to 16.4 (7.7% to 31.3%; P=0.027).<b>Conclusions</b> All four currently recommended drugs show limitations in their efficacy profile. While only albendazole showed good efficacy against hookworm infection, all drugs had low efficacy against <i>T trichiura</i> The decrease in efficacy of albendazole against <i>T trichiura</i> over the past two decades is of concern. The findings indicate the need for strengthening efforts to develop new drug treatments, with a particular focus on drugs against <i>T trichiura</i>.</p>","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4307"},"PeriodicalIF":0.0,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35445265","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":"The ward round is broken.","authors":"Matt Morgan","doi":"10.1136/bmj.j4390","DOIUrl":"https://doi.org/10.1136/bmj.j4390","url":null,"abstract":"Doctors’ way of working would not be accepted by businesses making decisions with far less impact","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4390"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35386438","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":"Is the \"burnout epidemic\" an academic fiction?","authors":"Renzo Bianchi","doi":"10.1136/bmj.j4389","DOIUrl":"https://doi.org/10.1136/bmj.j4389","url":null,"abstract":"In their editorial, Lemaire and Wallace1 say that burnout has reached epidemic levels among doctors. This “burnout epidemic,” although widely relayed in medical journals, is unsubstantiated.\u0000\u0000The prevalence of burnout cannot be estimated because diagnostic criteria do not exist.2 Estimates that have been made rely on categorisation criteria that are clinically and theoretically …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4389"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35387533","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":"UK government to reclassify pregabalin and gabapentin after rise in deaths.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.j4441","DOIUrl":"https://doi.org/10.1136/bmj.j4441","url":null,"abstract":"The UK government is to reclassify the prescription drug pregabalin as a class C controlled substance, after experts issued safety warnings following an increase in deaths linked to its use.\u0000\u0000A Home Office consultation, which also proposes reclassifying gabapentin, has been launched in response to growing pressure for the drug to be reclassified to tackle misuse and addiction.\u0000\u0000Last year the Advisory Council on the Misuse of …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4441"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35387512","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":"Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets.","authors":"Janice M Leung,&nbsp;Don D Sin","doi":"10.1136/bmj.j3772","DOIUrl":"https://doi.org/10.1136/bmj.j3772","url":null,"abstract":"<p><p>Asthma-COPD overlap syndrome (ACOS) or asthma-COPD overlap captures the subset of patients with airways disease who have features of both asthma and chronic obstructive pulmonary disease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflow limitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility. ACOS affects about a quarter of patients with COPD and almost a third of patients who previously had asthma. Compared with their counterparts with asthma or COPD alone, patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions. Whether this condition emerges after gradual shifts in airway remodelling and inflammation in a patient with COPD, as the result of noxious exposures in a patient with asthma, or even as a de novo disease with its own pathology is yet to be determined. Nevertheless, using treatments developed for asthma or COPD that target eosinophilic, neutrophilic, or paucigranulocytic airway inflammation may be a helpful approach to these patients until further clinical trials can be performed.</p>","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j3772"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j3772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35445262","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":"Three questions a patient should ask.","authors":"Huw Llewelyn","doi":"10.1136/bmj.j3988","DOIUrl":"https://doi.org/10.1136/bmj.j3988","url":null,"abstract":"Millenson says that “collaborative health” will expand so that patients’ advisers will not only be friends, relatives, nurses, doctors, and other health professionals but also electronic sources.1 This will make the medical record …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j3988"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j3988","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35446749","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":"Threat to human health from environmental plastics.","authors":"","doi":"10.1136/bmj.j4334","DOIUrl":"10.1136/bmj.j4334","url":null,"abstract":"","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4334"},"PeriodicalIF":0.0,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35544890","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}