{"title":"Nipah virus: Kerala reports second death in four months.","authors":"Kamala Thiagarajan","doi":"10.1136/bmj.q2058","DOIUrl":"https://doi.org/10.1136/bmj.q2058","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273436","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}
Ann Robinson reviews the latest research Many women experience genitourinary symptoms during and after the menopause, but only in the past decade has the term genitourinary syndrome of menopause been used to describe the symptoms that result from falling oestrogen and androgen levels: dry vagina, painful and unfulfilling sex, low libido, urinary frequency, recurrent urinary tract infections, and labial and clitoral atrophy. Depending on who and how you ask, 13-87% of menopausal women report some degree of genitourinary syndrome of menopause. Unlike hot flushes, genitourinary syndrome of menopause doesn’t improve with age and often gets worse. This extensive systematic review looked at the effectiveness of vaginal oestrogen, non-oestrogen hormone therapies, and vaginal moisturisers for treatment of symptoms. It used eight core patient-reported outcomes that patients and clinicians agreed were most relevant. There was some evidence of modest benefit against placebo for vaginal oestrogen, the androgen dehydroepiandrosterone (DHEA), oral ospemifene (a selective oestrogen …
{"title":"Genitourinary syndrome of menopause … and other research","authors":"Ann Robinson","doi":"10.1136/bmj.q2025","DOIUrl":"https://doi.org/10.1136/bmj.q2025","url":null,"abstract":"Ann Robinson reviews the latest research Many women experience genitourinary symptoms during and after the menopause, but only in the past decade has the term genitourinary syndrome of menopause been used to describe the symptoms that result from falling oestrogen and androgen levels: dry vagina, painful and unfulfilling sex, low libido, urinary frequency, recurrent urinary tract infections, and labial and clitoral atrophy. Depending on who and how you ask, 13-87% of menopausal women report some degree of genitourinary syndrome of menopause. Unlike hot flushes, genitourinary syndrome of menopause doesn’t improve with age and often gets worse. This extensive systematic review looked at the effectiveness of vaginal oestrogen, non-oestrogen hormone therapies, and vaginal moisturisers for treatment of symptoms. It used eight core patient-reported outcomes that patients and clinicians agreed were most relevant. There was some evidence of modest benefit against placebo for vaginal oestrogen, the androgen dehydroepiandrosterone (DHEA), oral ospemifene (a selective oestrogen …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245321","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}
This image shows an inverted papilloma of the bladder, a rare benign tumour consisting of uniform urothelial cells with an inverted configuration and a normal or hyperplastic urothelial lining (fig 1).12 The patient, a …
{"title":"Tumour next to the internal urethral orifice","authors":"Zhiwei Xie, Jizhou Shi","doi":"10.1136/bmj-2023-078250","DOIUrl":"https://doi.org/10.1136/bmj-2023-078250","url":null,"abstract":"This image shows an inverted papilloma of the bladder, a rare benign tumour consisting of uniform urothelial cells with an inverted configuration and a normal or hyperplastic urothelial lining (fig 1).12 The patient, a …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245323","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}
The BMA and the UK government have finally agreed about something—two things, in fact: a new pay deal and the need for major reform of the NHS. After 44 days of strike action over the past two years, resident doctors (as junior doctors will now be known) have voted to accept the government’s latest pay offer, with two thirds of those who voted backing the deal (doi:10.1136/bmj.q2038).1 The BMA and the government also agreed that Ara Darzi’s report on the state of the health service in England underlines the fact that far reaching change is needed (doi:10.1136/bmj.q2001 doi:10.1136/bmj.q2032 doi:10.1136/bmj.q2009).234 “Without radical action, the NHS won’t …
{"title":"Any NHS reform has to avoid a repeat of 2012","authors":"Tom Moberly","doi":"10.1136/bmj.q2041","DOIUrl":"https://doi.org/10.1136/bmj.q2041","url":null,"abstract":"The BMA and the UK government have finally agreed about something—two things, in fact: a new pay deal and the need for major reform of the NHS. After 44 days of strike action over the past two years, resident doctors (as junior doctors will now be known) have voted to accept the government’s latest pay offer, with two thirds of those who voted backing the deal (doi:10.1136/bmj.q2038).1 The BMA and the government also agreed that Ara Darzi’s report on the state of the health service in England underlines the fact that far reaching change is needed (doi:10.1136/bmj.q2001 doi:10.1136/bmj.q2032 doi:10.1136/bmj.q2009).234 “Without radical action, the NHS won’t …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245326","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":"Two thirds of maternity units fail to meet safety standards as poor care is \"normalised,\" says regulator.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.q2051","DOIUrl":"https://doi.org/10.1136/bmj.q2051","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273428","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}
Analysis of the results of nearly 400 000 gastroscopies carried out in the UK for common gastrointestinal symptoms shows that only one in 10 reveals anything other than normal findings or minor pathology. The chances of finding cancer were greatest in older male patients, those over 50 with dysphagia, and those with weight loss in addition to symptoms, but the overall likelihood of diagnosis of malignancy was 1%. Among patients under 50, less than 1% were diagnosed with cancer, regardless of symptoms ( Gut doi:10.1136/gutjnl-2024-332071). Food allergy is becoming commoner, according to an analysis of 8 million individual records in an English primary care database. Between …
{"title":"Gastroscopy findings . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.q1992","DOIUrl":"https://doi.org/10.1136/bmj.q1992","url":null,"abstract":"Analysis of the results of nearly 400 000 gastroscopies carried out in the UK for common gastrointestinal symptoms shows that only one in 10 reveals anything other than normal findings or minor pathology. The chances of finding cancer were greatest in older male patients, those over 50 with dysphagia, and those with weight loss in addition to symptoms, but the overall likelihood of diagnosis of malignancy was 1%. Among patients under 50, less than 1% were diagnosed with cancer, regardless of symptoms ( Gut doi:10.1136/gutjnl-2024-332071). Food allergy is becoming commoner, according to an analysis of 8 million individual records in an English primary care database. Between …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245324","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}
For Peter Cole, an anaesthetist at St Bartholomew’s Hospital in London, the life of a conventional hospital consultant would never have satisfied his intellectual curiosity. He had a busy brain and was keen to push scientific boundaries, and so alongside his clinical work he embarked on a long academic career—at a time when few anaesthetists were engaged in research. Described by Charles Hinds, one of Cole’s trainees and now emeritus professor of intensive care at Barts, as an “original thinker and true pioneer,” Cole established an innovative research laboratory with “no visible, to us at least, source of funding; his enthusiasm and determination overcoming all the many obstacles he encountered along the way.” His research covered both anaesthesia and many other topics that interested him, including studying the effects of air pollution and cigarette smoking by measuring carbon monoxide levels in the blood. “He performed these measurements in smokers and non-smokers, police on point duty, manual and desk bound city workers, and, ingeniously, residents of the Isle of Sark, where there were no cars but plenty of extremely cheap duty free cigarettes,” said Hinds. In the early 1970s he began researching the effects of passive smoking, a matter that at this time was not widely recognised as a problem. In one study he persuaded 12 non-smokers to sit in an unventilated room for …
{"title":"Peter Cole: anaesthetist and researcher who highlighted the dangers of passive smoking years before it was considered a public health threat","authors":"Anne Gulland","doi":"10.1136/bmj.q2033","DOIUrl":"https://doi.org/10.1136/bmj.q2033","url":null,"abstract":"For Peter Cole, an anaesthetist at St Bartholomew’s Hospital in London, the life of a conventional hospital consultant would never have satisfied his intellectual curiosity. He had a busy brain and was keen to push scientific boundaries, and so alongside his clinical work he embarked on a long academic career—at a time when few anaesthetists were engaged in research. Described by Charles Hinds, one of Cole’s trainees and now emeritus professor of intensive care at Barts, as an “original thinker and true pioneer,” Cole established an innovative research laboratory with “no visible, to us at least, source of funding; his enthusiasm and determination overcoming all the many obstacles he encountered along the way.” His research covered both anaesthesia and many other topics that interested him, including studying the effects of air pollution and cigarette smoking by measuring carbon monoxide levels in the blood. “He performed these measurements in smokers and non-smokers, police on point duty, manual and desk bound city workers, and, ingeniously, residents of the Isle of Sark, where there were no cars but plenty of extremely cheap duty free cigarettes,” said Hinds. In the early 1970s he began researching the effects of passive smoking, a matter that at this time was not widely recognised as a problem. In one study he persuaded 12 non-smokers to sit in an unventilated room for …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245322","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}
Raised expectations of treatment effect do not justify the cost The UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved the monoclonal antibody lecanemab for treatment of patients in the early stages of Alzheimer’s disease who have one or no copies of the apolipoprotein E4 (APOE4) gene.1 However, at the same time, the National Institute for Health and Care Excellence (NICE) issued draft guidance against using the drug in the NHS.2 NICE concluded that the treatment effect was “small but meaningful” but that uncertainty remains about long term effects and the economic model for use in practice. NICE is seeking additional information from lecanemab’s manufacturer, Eisai, and NHS England on identified uncertainties and will consider this information together with other stakeholder comments at a second meeting.3 The decision was met with outraged headlines: “Alzheimer’s wonder drug blocked for use on NHS.”4 These largely reflect the collision between raised expectations around this class of drugs and the tiny treatment benefits, serious safety risks, and high costs of the drug and its administration. Attempts to communicate the true magnitude of treatment …
{"title":"Lecanemab’s benefits are too small and uncertain","authors":"Robert Howard","doi":"10.1136/bmj.q2044","DOIUrl":"https://doi.org/10.1136/bmj.q2044","url":null,"abstract":"Raised expectations of treatment effect do not justify the cost The UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved the monoclonal antibody lecanemab for treatment of patients in the early stages of Alzheimer’s disease who have one or no copies of the apolipoprotein E4 (APOE4) gene.1 However, at the same time, the National Institute for Health and Care Excellence (NICE) issued draft guidance against using the drug in the NHS.2 NICE concluded that the treatment effect was “small but meaningful” but that uncertainty remains about long term effects and the economic model for use in practice. NICE is seeking additional information from lecanemab’s manufacturer, Eisai, and NHS England on identified uncertainties and will consider this information together with other stakeholder comments at a second meeting.3 The decision was met with outraged headlines: “Alzheimer’s wonder drug blocked for use on NHS.”4 These largely reflect the collision between raised expectations around this class of drugs and the tiny treatment benefits, serious safety risks, and high costs of the drug and its administration. Attempts to communicate the true magnitude of treatment …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245325","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":"England and Wales see sharp rise in health related benefit claims.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.q2062","DOIUrl":"https://doi.org/10.1136/bmj.q2062","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273438","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}
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