The BMJ最新文献

{"title":"Valproate: Sanofi ordered to pay €285 000 to mother whose children had birth defects.","authors":"Barbara Casassus","doi":"10.1136/bmj.q2034","DOIUrl":"https://doi.org/10.1136/bmj.q2034","url":null,"abstract":"","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":"142245592","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":"A third of patients miss out on risk assessments before surgery.","authors":"Jacqui Wise","doi":"10.1136/bmj.q2035","DOIUrl":"https://doi.org/10.1136/bmj.q2035","url":null,"abstract":"","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":"142245593","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":"The importance of the day of embryo transfer during in vitro fertilisation","authors":"Simone Cornelisse, Liliana Ramos, Sebastiaan Mastenbroek","doi":"10.1136/bmj.q1703","DOIUrl":"https://doi.org/10.1136/bmj.q1703","url":null,"abstract":"The timing of embryo transfer, which aligns with different stages of embryo development, is an important element of in vitro fertilisation (IVF). This article briefly describes the main phases of IVF treatment, embryo development and transfer policies, cumulative live birth rates, and the key findings of the authors’ research. In vitro fertilisation (IVF) is a well established treatment for infertility and has been responsible for the birth of more than 10 million children worldwide since 1978.1 An IVF cycle includes ovarian hyperstimulation with hormones, oocyte retrieval, and then fertilisation and embryo culture in the laboratory.23 In most laboratories worldwide, embryos are cultured in vitro for three to six days, and the embryos with the highest chance of resulting in a live birth are selected for intrauterine transfer. Surplus embryos are cryopreserved for future use if a live birth is unsuccessful after an initial transfer or more children are planned. IVF, with or without intracytoplasmic sperm injection (ICSI), involves the handling of sperm cells and oocytes (gametes) and embryos outside the human body. In IVF, thousands of sperm cells are used to inseminate oocytes in the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235012","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":"Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial","authors":"Simone Cornelisse, Kathrin Fleischer, Lucette van der Westerlaken, Jan-Peter de Bruin, Carlijn Vergouw, Carolien Koks, Josien Derhaag, Jantien Visser, Jannie van Echten-Arends, Els Slappendel, Brigitte Arends, Moniek van der Zanden, Angelique van Dongen, Janneke Brink-van der Vlugt, Marcella de Hundt, Max Curfs, Harold Verhoeve, Maaike Traas-Hofmans, Yvonne Wurth, Petra Manger, Quirine Pieterse, Didi Braat, Madelon van Wely, Liliana Ramos, Sebastiaan Mastenbroek","doi":"10.1136/bmj-2024-080133","DOIUrl":"https://doi.org/10.1136/bmj-2024-080133","url":null,"abstract":"Objectives To evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and perinatal complications is increased compared with cleavage stage embryo transfers during in vitro fertilisation (IVF) treatment. Design Multicentre randomised controlled trial. Setting 21 hospitals and clinics in the Netherlands, 18 August 2018 to 17 December 2021. Participants 1202 women with at least four embryos available on day 2 after oocyte retrieval were randomly assigned to either blastocyst stage embryo transfer (n=603) or cleavage stage embryo transfer (n=599). Interventions In the blastocyst group and cleavage group, embryo transfers were performed on day 5 and day 3, respectively, after oocyte retrieval, followed by cryopreservation of surplus embryos. Analysis was on an intention-to-treat basis, with secondary analyses as per protocol. Main outcome measures The primary outcome was the cumulative live birth rate per oocyte retrieval, including results of all frozen-thawed embryo transfers within a year after randomisation. Secondary outcomes included cumulative rates of pregnancy, pregnancy loss, and live birth after fresh embryo transfer, number of embryo transfers needed, number of frozen embryos, and obstetric and perinatal outcomes. Results The cumulative live birth rate did not differ between the blastocyst group and cleavage group (58.9% (355 of 603) v 58.4% (350 of 599; risk ratio 1.01, 95% confidence interval (CI) 0.84 to 1.22). The blastocyst group showed a higher live birth rate after fresh embryo transfer (1.26, 1.00 to 1.58), lower cumulative pregnancy loss rate (0.68, 0.51 to 0.89), and lower mean number of embryo transfers needed to result in a live birth (1.55 v 1.82; P<0.001). The incidence of moderate preterm birth (32 to <37 weeks) in singletons was higher in the blastocyst group (1.87, 1.05 to 3.34). Conclusion Blastocyst stage embryo transfers resulted in a similar cumulative live birth rate to cleavage stage embryo transfers in women with at least four embryos available during IVF treatment. Trial registration International Clinical Trial Registry Platform NTR7034. Restricted access to the study data can be arranged on request to the corresponding author. Written proposals will be assessed by the ToF study group. A data sharing agreement including terms and conditions for authorship and publication will need to be signed before data are available.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235013","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":"Wellcome’s new head on the future of clinical research funding","authors":"Mun-Keat Looi","doi":"10.1136/bmj.q1257","DOIUrl":"https://doi.org/10.1136/bmj.q1257","url":null,"abstract":"After more than a decade under the stewardship of Jeremy Farrar, the Wellcome Trust has switched from having a director to a chief executive officer. So, what changes are afoot for the independent funder worth some £38bn? The BMJ asks the new man in charge, John-Arne Røttingen John-Arne Røttingen, like his predecessor, the infectious disease specialist Jeremy Farrar,1 is a doctor. He’s also a former global health ambassador for his home country of Norway and led its state funding body, the Research Council of Norway. “I’m a physician scientist. I’ve been really motivated by this sort of science—that’s why I started studying medicine,” he tells The BMJ . He studied medicine at the University of Oslo and, among other qualifications, holds an MSc from the University of Oxford. His research has covered basic science, epidemiology, clinical trials, health services research, and global health policy. Notably, he led the steering groups for the Ebola vaccine trial in Guinea and the Covid-19 WHO Solidarity trial. “Through the Ebola outbreak of West Africa [in 2014-16], I became really engaged with the need for a long term commitment on the issue of innovation and access to medicines—and how we find models for innovating where there are no commercial …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234443","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":"Kim Suvarna: histopathologist who carried out Salisbury Novichok autopsy","authors":"John Illman","doi":"10.1136/bmj.q1981","DOIUrl":"https://doi.org/10.1136/bmj.q1981","url":null,"abstract":"Kim Suvarna, a histopathologist at Sheffield Teaching Hospitals NHS Foundation Trust, was renowned for his 25 year old tweed jacket, bought from the local Oxfam shop, and his mantra, “Give me the short version.” Verbiage made his eyes roll. He did not suffer fools gladly, but he was as kind as he was fierce. His wife, Grace Horne, describes him as a shy man who wore his profession like a superhero’s cape. “As a doctor, he had the confidence to do anything. He had no problem standing up and lecturing 500 people. He loved imparting information.” A quirky man, he wore two wrist watches simultaneously and disregarded capital letters in emails. Kirsty Lloyd, one of his former trainees, now a consultant histopathologist in Sheffield, says, “He was all about efficiency, so perhaps the shift key was more effort than necessary.” Suvarna had a gift for and a love of teaching, an encyclopaedic memory, a fearsome intellect, and, above all else, passion and enthusiasm. He wrote more than 125 peer reviewed papers and edited several books, including Bancroft’s Theory and Practice of Histological Techniques (2018). He was the driving force behind the UK Cardiovascular Pathology Network and a contributing author to consensus statements from the Association for European Cardiovascular Pathology (AECP), of which he …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234438","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":"Timing embryo transfers during assisted reproduction","authors":"Demián Glujovsky","doi":"10.1136/bmj.q1910","DOIUrl":"https://doi.org/10.1136/bmj.q1910","url":null,"abstract":"New evidence will help women and clinicians navigate this difficult decision In assisted reproductive technology, the timing of embryo transfer after oocyte retrieval and in vitro fertilisation is crucial. Traditionally, embryos have been transferred at the cleavage stage (two or three days post-fertilisation). However, transferring embryos at the blastocyst stage (five or six days post-fertilisation) is increasingly common. Most studies focus on outcomes from fresh embryo transfers, often overlooking the potential of surplus frozen embryos. Additionally, the effect of transfer stage on obstetric and neonatal outcomes has been underexplored. The linked study by Cornelisse and colleagues (doi:10.1136/bmj-2024-080133) therefore represents an important advance in this area.1 Their multicentre, randomised controlled trial (n=1202) compared outcomes over 12 months after embryo transfers on day 3 or day 5, analysing all embryo transfers within that timeframe. The study’s thorough approach, which assessed cumulative live birth rates—including both fresh and frozen embryo transfers from a single oocyte retrieval—as well as obstetric complications, distinguishes it from previous research. The study found no difference in cumulative live birth rates (risk ratio 1.01, 95% confidence interval (CI) 0.84 to 1.22), whereas live birth …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235022","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":"Barriers to investigating and reporting research misconduct: prioritising publication integrity","authors":"Alison Avenell, Andrew A Klein, Jennifer A Byrne, Peter Wilmshurst, Mark J Bolland, Andrew Grey","doi":"10.1136/bmj.q2018","DOIUrl":"https://doi.org/10.1136/bmj.q2018","url":null,"abstract":"Bouter’s editorial1 on the UK Research Integrity Office (UKRIO) report Barriers to investigating and reporting research misconduct 2 highlights protecting patients from consequences of research misconduct. Waiting for publishers to correct publications affected by misconduct or errors can take years. In the meantime, these papers influence clinical guidelines and patient care. Delays have been so concerning that the 2023 House of Commons’ Science, Innovation, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235019","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":"One Health models are lacking an indigenous perspective","authors":"Arthur W Blume","doi":"10.1136/bmj.q2015","DOIUrl":"https://doi.org/10.1136/bmj.q2015","url":null,"abstract":"Indigenous peoples can help to build a more holistic approach to the health of humans and nature, writes Arthur Blume Indigenous world views have long appreciated and valued the interdependence of the natural world, and have contributed to a holistic and egalitarian frame of reference for understanding healthy relationships.1 The One Health movements emerged to integrate research and surveillance of human health with that of the natural world and have been proposed as holistic alternatives to the existing colonial model that may help to avoid zoonotic transmission of infectious diseases and health consequences from climate change.234 Some One Health oriented researchers have seen the value of including Indigenous peoples in the research,5 with many assuming that Indigenous peoples would gravitate toward One Health movements. However, none of the One …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234437","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":"A new system is needed to tackle research misconduct","authors":"Andrew D Weeks","doi":"10.1136/bmj.q2011","DOIUrl":"https://doi.org/10.1136/bmj.q2011","url":null,"abstract":"Modern evidence based medicine was built on trust: trust in researchers not to deliberately fabricate scientific research, as well as trust in peer reviewed journals to be gatekeepers of high quality research. Bouter rightly points out that trust in both has been lost.1 Not only is there increasing evidence of deliberate fabrication by researchers as the pressure to succeed grows, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234439","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}