brind20240916.f1 In the months before she died Alison Brind self-published a book called I Never Stop , detailing her many sporting exploits. In the introduction she wrote, “I never stop and will only stop when I can do nothing.” As a mantra, “I never stop” summed up Brind’s attitude to life perfectly. The consultant hepatologist spent barely any time at home—instead she was to be found either pounding up and down the wards as a hepatologist at the Royal Stoke University Hospital or pounding the streets, fells, or mountains on one of her many long distance runs. When she was appointed consultant gastroenterologist in 1997 she was the first liver specialist the gastroenterology unit at Stoke had recruited. And she was one of just four consultants in a unit that covered a population of more than half a million people. Brind quickly established herself, treating patients with …
{"title":"Alison Mary Brind: liver disease specialist and ultra marathon runner","authors":"Anne Gulland","doi":"10.1136/bmj.q2031","DOIUrl":"https://doi.org/10.1136/bmj.q2031","url":null,"abstract":"<graphic>brind20240916.f1</graphic> In the months before she died Alison Brind self-published a book called I Never Stop , detailing her many sporting exploits. In the introduction she wrote, “I never stop and will only stop when I can do nothing.” As a mantra, “I never stop” summed up Brind’s attitude to life perfectly. The consultant hepatologist spent barely any time at home—instead she was to be found either pounding up and down the wards as a hepatologist at the Royal Stoke University Hospital or pounding the streets, fells, or mountains on one of her many long distance runs. When she was appointed consultant gastroenterologist in 1997 she was the first liver specialist the gastroenterology unit at Stoke had recruited. And she was one of just four consultants in a unit that covered a population of more than half a million people. Brind quickly established herself, treating patients with …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236634","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}
William K Karlsson, Edoardo G Ostinelli, Zixuan A Zhuang, Lili Kokoti, Rune H Christensen, Haidar M Al-Khazali, Christina I Deligianni, Anneka Tomlinson, Håkan Ashina, Elena Ruiz de la Torre, Hans-Christoph Diener, Andrea Cipriani, Messoud Ashina
Objective To compare all licensed drug interventions as oral monotherapy for the acute treatment of migraine episodes in adults. Design Systematic review and network meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, ClinicalTrials.gov, EU Clinical Trials Register, WHO International Clinical Trials Registry Platform, as well as websites of regulatory agencies and pharmaceutical companies without language restrictions until 24 June 2023. Methods Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Random effects network meta-analyses were conducted for the primary analyses. The primary outcomes were the proportion of participants who were pain-free at two hours post-dose and the proportion of participants with sustained pain freedom from two to 24 hours post-dose, both without the use of rescue drugs. Certainty of the evidence was graded using the confidence in network meta-analysis (CINeMA) online tool. Vitruvian plots were used to summarise findings. An international panel of clinicians and people with lived experience of migraine co-designed the study and interpreted the findings. Eligibility criteria for selecting studies Double blind randomised trials of adults (≥18 years) with a diagnosis of migraine according to the International Classification of Headache Disorders. Results 137 randomised controlled trials comprising 89 445 participants allocated to one of 17 active interventions or placebo were included. All active interventions showed superior efficacy compared with placebo for pain freedom at two hours (odds ratios from 1.73 (95% confidence interval (CI) 1.27 to 2.34) for naratriptan to 5.19 (4.25 to 6.33) for eletriptan), and most of them also for sustained pain freedom to 24 hours (odds ratios from 1.71 (1.07 to 2.74) for celecoxib to 7.58 (2.58 to 22.27) for ibuprofen). In head-to-head comparisons between active interventions, eletriptan was the most effective drug for pain freedom at two hours (odds ratios from 1.46 (1.18 to 1.81) to 3.01 (2.13 to 4.25)), followed by rizatriptan (1.59 (1.18 to 2.17) to 2.44 (1.75 to 3.45)), sumatriptan (1.35 (1.03 to 1.75) to 2.04 (1.49 to 2.86)), and zolmitriptan (1.47 (1.04 to 2.08) to 1.96 (1.39 to 2.86)). For sustained pain freedom, the most efficacious interventions were eletriptan and ibuprofen (odds ratios from 1.41 (1.02 to 1.93) to 4.82 (1.31 to 17.67)). Confidence in accordance with CINeMA ranged from high to very low. Sensitivity analyses on Food and Drug Administration licensed doses only, high versus low doses, risk of bias, and moderate to severe headache at baseline confirmed the main findings for both primary and secondary outcomes. Conclusions Overall, eletriptan, rizatriptan, sumatriptan, and zolmitriptan had the best profiles and they were more efficacious than the recently marketed drugs lasmiditan, rimegepant, and ubrogepant. Although cost effectiveness analyses are warranted and
{"title":"Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis","authors":"William K Karlsson, Edoardo G Ostinelli, Zixuan A Zhuang, Lili Kokoti, Rune H Christensen, Haidar M Al-Khazali, Christina I Deligianni, Anneka Tomlinson, Håkan Ashina, Elena Ruiz de la Torre, Hans-Christoph Diener, Andrea Cipriani, Messoud Ashina","doi":"10.1136/bmj-2024-080107","DOIUrl":"https://doi.org/10.1136/bmj-2024-080107","url":null,"abstract":"Objective To compare all licensed drug interventions as oral monotherapy for the acute treatment of migraine episodes in adults. Design Systematic review and network meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, ClinicalTrials.gov, EU Clinical Trials Register, WHO International Clinical Trials Registry Platform, as well as websites of regulatory agencies and pharmaceutical companies without language restrictions until 24 June 2023. Methods Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Random effects network meta-analyses were conducted for the primary analyses. The primary outcomes were the proportion of participants who were pain-free at two hours post-dose and the proportion of participants with sustained pain freedom from two to 24 hours post-dose, both without the use of rescue drugs. Certainty of the evidence was graded using the confidence in network meta-analysis (CINeMA) online tool. Vitruvian plots were used to summarise findings. An international panel of clinicians and people with lived experience of migraine co-designed the study and interpreted the findings. Eligibility criteria for selecting studies Double blind randomised trials of adults (≥18 years) with a diagnosis of migraine according to the International Classification of Headache Disorders. Results 137 randomised controlled trials comprising 89 445 participants allocated to one of 17 active interventions or placebo were included. All active interventions showed superior efficacy compared with placebo for pain freedom at two hours (odds ratios from 1.73 (95% confidence interval (CI) 1.27 to 2.34) for naratriptan to 5.19 (4.25 to 6.33) for eletriptan), and most of them also for sustained pain freedom to 24 hours (odds ratios from 1.71 (1.07 to 2.74) for celecoxib to 7.58 (2.58 to 22.27) for ibuprofen). In head-to-head comparisons between active interventions, eletriptan was the most effective drug for pain freedom at two hours (odds ratios from 1.46 (1.18 to 1.81) to 3.01 (2.13 to 4.25)), followed by rizatriptan (1.59 (1.18 to 2.17) to 2.44 (1.75 to 3.45)), sumatriptan (1.35 (1.03 to 1.75) to 2.04 (1.49 to 2.86)), and zolmitriptan (1.47 (1.04 to 2.08) to 1.96 (1.39 to 2.86)). For sustained pain freedom, the most efficacious interventions were eletriptan and ibuprofen (odds ratios from 1.41 (1.02 to 1.93) to 4.82 (1.31 to 17.67)). Confidence in accordance with CINeMA ranged from high to very low. Sensitivity analyses on Food and Drug Administration licensed doses only, high versus low doses, risk of bias, and moderate to severe headache at baseline confirmed the main findings for both primary and secondary outcomes. Conclusions Overall, eletriptan, rizatriptan, sumatriptan, and zolmitriptan had the best profiles and they were more efficacious than the recently marketed drugs lasmiditan, rimegepant, and ubrogepant. Although cost effectiveness analyses are warranted and ","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245320","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":"US women must be told breast density after mammogram, says FDA.","authors":"Janice Hopkins Tanne","doi":"10.1136/bmj.q2045","DOIUrl":"https://doi.org/10.1136/bmj.q2045","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246894","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":"Former GP is struck off for spreading conspiracy theories about covid pandemic.","authors":"Clare Dyer","doi":"10.1136/bmj.q2046","DOIUrl":"https://doi.org/10.1136/bmj.q2046","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246898","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":"\"Health creation system\" could save NHS £18bn a year, says commission.","authors":"Matthew Limb","doi":"10.1136/bmj.q2043","DOIUrl":"https://doi.org/10.1136/bmj.q2043","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246896","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}
Findings may buy time but highlight government policy tensions Ara Darzi’s independent review into the performance of the NHS in England, commissioned soon after Labour’s election victory in July 2024, was published on 12 September.1 The idea was to provide a rapid assessment of the state of the health system—focusing on problems, not solutions. Darzi’s findings are intended to inform the government’s 10 year plan for reforming the English NHS—expected in spring next year.2 The report comes around 16 years after Darzi’s last review into the English NHS.3 Darzi paints a bleak picture of a health system in crisis.1 People are waiting too long for care in hospitals, primary care, mental health services—everywhere. Long waits in major hospital emergency departments are pulling at the social contract underpinning the NHS and likely to be contributing to thousands of additional deaths. Quality of care is mixed. And care in some areas, such as for people with cardiovascular disease, seems to be going in the wrong direction. The share of NHS resources going to hospitals is increasing, despite repeated political promises to do the opposite, and NHS productivity has stalled. The NHS’s problems …
{"title":"Darzi’s NHS review shows depth of problems for Labour","authors":"Hugh Alderwick, Phoebe Dunn","doi":"10.1136/bmj.q2032","DOIUrl":"https://doi.org/10.1136/bmj.q2032","url":null,"abstract":"Findings may buy time but highlight government policy tensions Ara Darzi’s independent review into the performance of the NHS in England, commissioned soon after Labour’s election victory in July 2024, was published on 12 September.1 The idea was to provide a rapid assessment of the state of the health system—focusing on problems, not solutions. Darzi’s findings are intended to inform the government’s 10 year plan for reforming the English NHS—expected in spring next year.2 The report comes around 16 years after Darzi’s last review into the English NHS.3 Darzi paints a bleak picture of a health system in crisis.1 People are waiting too long for care in hospitals, primary care, mental health services—everywhere. Long waits in major hospital emergency departments are pulling at the social contract underpinning the NHS and likely to be contributing to thousands of additional deaths. Quality of care is mixed. And care in some areas, such as for people with cardiovascular disease, seems to be going in the wrong direction. The share of NHS resources going to hospitals is increasing, despite repeated political promises to do the opposite, and NHS productivity has stalled. The NHS’s problems …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236873","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":"New treatments for migraine … and other research","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.q2048","DOIUrl":"https://doi.org/10.1136/bmj.q2048","url":null,"abstract":"In this research review by Tom Nolan ( BMJ 2024;386:q1967, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236636","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}
I love the new academic year. It’s full of possibilities and new routines. I experienced 20 consecutive years of my children’s new priorities and schedules beginning in September, and it still seems a much bigger deal to me than the new year in January. I went back to the school gates for this new term to see Eastbourne’s first “School Street”1—a scheme where motorised traffic is banned from the adjacent streets around participating schools at drop-off and pick-up time. It was a pleasant change to see children and adults walking and chatting in the road. The restriction of motor traffic makes walking, cycling, and scooting much easier and …
{"title":"Scarlett McNally: Building healthy habits for the new academic year","authors":"Scarlett McNally","doi":"10.1136/bmj.q2013","DOIUrl":"https://doi.org/10.1136/bmj.q2013","url":null,"abstract":"I love the new academic year. It’s full of possibilities and new routines. I experienced 20 consecutive years of my children’s new priorities and schedules beginning in September, and it still seems a much bigger deal to me than the new year in January. I went back to the school gates for this new term to see Eastbourne’s first “School Street”1—a scheme where motorised traffic is banned from the adjacent streets around participating schools at drop-off and pick-up time. It was a pleasant change to see children and adults walking and chatting in the road. The restriction of motor traffic makes walking, cycling, and scooting much easier and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236638","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":"Physician associates: Parliament was \"misadvised\" on RCP's support for regulation, fellows say.","authors":"Jacqui Wise","doi":"10.1136/bmj.q2047","DOIUrl":"https://doi.org/10.1136/bmj.q2047","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246895","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}
When Guy Ah-Moye returned to his native Seychelles in 1970 after medical studies in London, he sailed on the British India ship with his trusty bicycle. On embarking, wearing nothing but shorts, he rode straight to the home of his friend Marcel Fayon, the local tennis champion, with both legs in the air and shouting with joy: “Sove ma kraz zote (Save yourself, I’ll crash into you)!” Delight at returning home turned to dismay when he discovered the conditions of the British colony’s medical services, including the use of blood pressure drugs that had long been obsolete in the UK. “It was rather primitive. There were lots of people dying from tetanus and leptospirosis,” he told the Today in Seychelles newspaper. As one of only a few doctors in the country Ah-Moye quickly established himself as a leading figure. He recognised that reform and modernisation were needed and he introduced specialist psychiatric care, family planning services, measles vaccines, and modern treatments for diabetes. He was appointed acting chief medical officer in 1977—he took a business studies course, devised a five year plan to shape the country’s primary healthcare …
1970 年，盖伊-阿-莫耶结束了在伦敦的医学学习，回到故乡塞舌尔。上船后，他只穿了一条短裤，骑着自行车直奔他的朋友、当地网球冠军马塞尔-法永的家："Sove ma kraz zote（省省吧，我会撞到你的）！"当他发现英国殖民地的医疗服务条件，包括使用在英国早已过时的降压药时，回国的喜悦变成了沮丧。"那是相当原始的。有很多人死于破伤风和钩端螺旋体病，"他告诉《今日塞舌尔》报。作为塞舌尔仅有的几位医生之一，阿-莫耶很快成为了领导人物。他认识到改革和现代化的必要性，并引进了精神病专科护理、计划生育服务、麻疹疫苗和糖尿病的现代治疗方法。1977 年，他被任命为代理首席医疗官--他学习了商业研究课程，制定了一项五年计划，以塑造该国的初级医疗保健......
{"title":"Guy Ah-Moye: London GP who led reform of health services in his native Seychelles","authors":"Tim Bullamore","doi":"10.1136/bmj.q2023","DOIUrl":"https://doi.org/10.1136/bmj.q2023","url":null,"abstract":"When Guy Ah-Moye returned to his native Seychelles in 1970 after medical studies in London, he sailed on the British India ship with his trusty bicycle. On embarking, wearing nothing but shorts, he rode straight to the home of his friend Marcel Fayon, the local tennis champion, with both legs in the air and shouting with joy: “Sove ma kraz zote (Save yourself, I’ll crash into you)!” Delight at returning home turned to dismay when he discovered the conditions of the British colony’s medical services, including the use of blood pressure drugs that had long been obsolete in the UK. “It was rather primitive. There were lots of people dying from tetanus and leptospirosis,” he told the Today in Seychelles newspaper. As one of only a few doctors in the country Ah-Moye quickly established himself as a leading figure. He recognised that reform and modernisation were needed and he introduced specialist psychiatric care, family planning services, measles vaccines, and modern treatments for diabetes. He was appointed acting chief medical officer in 1977—he took a business studies course, devised a five year plan to shape the country’s primary healthcare …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235018","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：