BMJ (Clinical research ed.)最新文献

{"title":"Put more trust in the trustworthy and less in the untrustworthy to improve judgement of medicines.","authors":"","doi":"10.1136/bmj.j4446","DOIUrl":"https://doi.org/10.1136/bmj.j4446","url":null,"abstract":"An editorial error changed the meaning in this letter “Put more trust in the trustworthy and less in the untrustworthy to improve judgement of medicines” by Mary Madden (BMJ 2017;358:j4202, doi:10.1136/bmj.j4202). The penultimate sentence should have read, “Pervasive use of a ‘deficit model,’ which implies that all public and professional scepticism of science is unfounded and that corrective communication by experts is necessary, is unhelpful” [not “Pervasive discussion of the ‘deficit model,’ which implies that all public and professional scepticism of science is unfounded and that corrective communication by experts is necessary, is unhelpful,” as published].","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4446"},"PeriodicalIF":105.7,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35445267","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":"Trends for prevalence and incidence of resistant hypertension: population based cohort study in the UK 1995-2015.","authors":"Sarah-Jo Sinnott, Liam Smeeth, Elizabeth Williamson, Ian J Douglas","doi":"10.1136/bmj.j3984","DOIUrl":"10.1136/bmj.j3984","url":null,"abstract":"<p><p><b>Objective</b> To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015.<b>Design</b> Cohort study.<b>Setting</b> Electronic health records from the UK Clinical Practice Research Datalink in primary care.<b>Participants</b> 1 317 290 users of antihypertensive drugs with a diagnosis of hypertension.<b>Main outcome measures</b> Resistant hypertension was defined as concurrent use of three antihypertensive drugs inclusive of a diuretic, uncontrolled hypertension (≥140/90 mm Hg), and adherence to the prescribed drug regimen, or concurrent use of four antihypertensive drugs inclusive of a diuretic and adherence to the prescribed drug regimen. To determine incidence, the numerator was new cases of resistant hypertension and the denominator was person years of those with treated hypertension and at risk of developing resistant hypertension. To determine prevalence, the numerator was total number of cases with resistant hypertension and the denominator was those with treated hypertension. Prevalence and incidence were age standardised to the 2015 hypertensive population.<b>Results</b> The age standardised incidence of resistant hypertension increased from 0.93 cases per 100 person years (95% confidence interval 0.87 to 1.00) in 1996 to a peak level of 2.07 cases per 100 person years (2.03 to 2.12) in 2004. Incidence then decreased to 0.42 cases per 100 person years (0.40 to 0.44) in 2015. Age standardised prevalence increased from 1.75% (95% confidence interval 1.66% to 1.83%) in 1995 to a peak of 7.76% (7.70% to 7.83%) in 2007. Prevalence then plateaued and subsequently declined to 6.46% (6.38% to 6.54%) in 2015. Compared with patients aged 65-69 years, those aged 80 or more years were more likely to have prevalent resistant hypertension throughout the study period.<b>Conclusions</b> Prevalent resistant hypertension has plateaued and decreased in recent years, consistent with a decrease in incidence from 2004 onwards. Despite this, resistant hypertension is common in the UK hypertensive population. Given the importance of hypertension as a modifiable risk factor for cardiovascular disease, reducing uncontrolled hypertension should remain a population health focus.</p>","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j3984"},"PeriodicalIF":0.0,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35438401","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":"Modern complex care needs longer consulting times.","authors":"Peter J O'Donnell","doi":"10.1136/bmj.j4373","DOIUrl":"https://doi.org/10.1136/bmj.j4373","url":null,"abstract":"GPs are always running late1 because they think they can deal with patients’ problems in the 10 minute slot allocated to them. They cling to this belief despite years and even decades of experience telling them otherwise. \u0000\u0000I struggled to run on time and knew GPs who always finished their surgeries 1-2 hours late. …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4373"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35538136","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":"Campaigners call for better services for language disorder that affects two children in every classroom.","authors":"","doi":"10.1136/bmj.j4417","DOIUrl":"https://doi.org/10.1136/bmj.j4417","url":null,"abstract":"","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4417"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35379327","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":"Junior doctor is cleared of wrongdoing after patient \"misremembered\" events.","authors":"Clare Dyer","doi":"10.1136/bmj.j4425","DOIUrl":"https://doi.org/10.1136/bmj.j4425","url":null,"abstract":"A junior doctor who was accused of wrongly telling a patient that he had cancer has been exonerated after a medical practitioners tribunal found that the patient had become flustered at the mention of the word “cancer” and misunderstood the doctor’s comments.\u0000\u0000Richard Schofield, who qualified in 2011, waited nearly three years for his hearing, only for the General Medical Council’s case against him to swiftly unravel.\u0000\u0000The two expert witnesses, one for the GMC and one for Schofield, wrote in a joint statement, “The experts agree that in their experience it is common for patients of all ages, when faced with ‘bad’ news (including, for example, the possibility that they may have cancer), to become less receptive to receiving information. Both experts have witnessed this phenomenon in their working lives.”\u0000\u0000Schofield, …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4425"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35538299","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":"Last ditch effort to repeal Obamacare gathers steam.","authors":"Owen Dyer","doi":"10.1136/bmj.j4429","DOIUrl":"https://doi.org/10.1136/bmj.j4429","url":null,"abstract":"The Affordable Care Act, Barack Obama’s signature health reform, faces a real and fast developing threat from a fourth Senate repeal bill.\u0000\u0000As September began, Senate Republicans’ efforts to undo Obamacare were given a small chance of success. But the prospect of definitive failure seems to have galvanized the party, and leaders are sounding increasingly confident, with President Donald Trump and the Senate majority leader, Mitch McConnell, asserting that their new version of “Trumpcare” will pass.\u0000\u0000The bill, called Cassidy-Graham, is effectively the last chance this Congress will have to repeal Obamacare before the midterm elections in November 2018. Under Senate rules, after 30 September it will require an unattainable 60 vote majority to pass. Until 30 September it may pass as a budget measure with a simple majority. In a 50-50 Senate split the vice president, Mike Pence, would …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4429"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35440300","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":"Women still not being told about pregnancy risks of valproate.","authors":"Jacqui Wise","doi":"10.1136/bmj.j4426","DOIUrl":"https://doi.org/10.1136/bmj.j4426","url":null,"abstract":"Two thirds of women who take the antiepileptic drug sodium valproate said they had not received new safety warnings about the dangers of taking it during pregnancy, a survey carried out by epilepsy charities has found. A similar survey last year found that half of women taking the drug were unaware it could harm their fetus.1\u0000\u0000The new results are to be presented at a public hearing on the safety of valproate drugs organised by the European Medicines Agency on 26 September in London. This is the first time that the EMA has held a public hearing as part of the safety review of a drug, and it will …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4426"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35432667","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":"Should we abandon \"finishing the course\" of antimicrobials?","authors":"Chris Del Mar,&nbsp;David F M Looke","doi":"10.1136/bmj.j4170","DOIUrl":"https://doi.org/10.1136/bmj.j4170","url":null,"abstract":"It depends on the type of infection","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4170"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35432668","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":"NHS bosses reject GPs' request to close patient lists.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.j4433","DOIUrl":"https://doi.org/10.1136/bmj.j4433","url":null,"abstract":"A group of general practices in Folkestone, Kent, that applied to formally close their practice lists because of safety concerns have had their request knocked back by NHS bosses, The BMJ has learnt.\u0000\u0000Earlier this month seven of eight practices in the town applied for permission to close their patient lists on the basis that they were “unable to take on more patients safely.” The action was triggered after one local practice was forced to hand its contract back to South Kent Coast Clinical Commissioning Group in May, prompting the CCG to order that the practice’s 4700 patients be reallocated to other local practices.\u0000\u0000But the CCG rejected the practices’ application after a meeting held on Thursday 21 September. …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4433"},"PeriodicalIF":105.7,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35431038","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":"BMA urges more career flexibility and better occupational support to fight workforce crisis.","authors":"Abi Rimmer","doi":"10.1136/bmj.j4381","DOIUrl":"https://doi.org/10.1136/bmj.j4381","url":null,"abstract":"Doctors’ career flexibility must be increased, such as more options to work part time, and their health and wellbeing services improved to stop the staff shortage worsening, the BMA has said in a new briefing on the state of medical recruitment.1\u0000\u0000To tackle what it described as a workforce crisis in medicine, the BMA also said that after Brexit the immigration system should enable the UK to recruit and retain the numbers of doctors it required if it couldn’t find enough in the country.\u0000\u0000The BMA has gathered figures …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4381"},"PeriodicalIF":105.7,"publicationDate":"2017-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35534563","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}