{"title":"Matt Morgan: Doctors should be taught by doctors.","authors":"Matt Morgan","doi":"10.1136/bmj.r2267","DOIUrl":"https://doi.org/10.1136/bmj.r2267","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"2 1","pages":"r2267"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656870","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}
Kari Kanto,Mathias Bäck,Thomas Ibounig,Robert Björkenheim,Antti Malmivaara,Tomasz Czuba,Jari Inkinen,Juha Kalske,Vesa Savolainen,Ilkka Sinisaari,Pirjo Toivonen,Simo Taimela,Teppo L N Järvinen,Mika Paavola,
OBJECTIVETo assess the long term efficacy of arthroscopic subacromial decompression (ASD) versus placebo surgery (diagnostic arthroscopy) and exercise therapy in patients with subacromial pain syndrome.DESIGNRandomised, placebo surgery controlled trial.SETTINGOrthopaedic department of three public hospitals in Finland.PARTICIPANTS210 adults aged 35 to 65 years with symptoms consistent with subacromial pain syndrome for more than three months, enrolled from 1 February 2005 with 10 year follow-up to 20 September 2023. Participants and outcome assessors were blinded to group allocation in the primary (ASD versus placebo surgery) comparison.INTERVENTIONSASD, placebo surgery, and exercise therapy (1:1:1). Exercise therapy was used as a pragmatic comparator.MAIN OUTCOME MEASURESThe primary outcomes were shoulder pain at rest and on arm activity, both assessed at 10 years using a visual analogue scale (VAS, ranging from 0 to 100, with 0 denoting no pain). The minimally important difference was defined as 15. A mixed model repeated measures analysis of variance was used, treating participants as random factors, incorporating baseline values as covariates.RESULTSParticipants were randomly assigned to ASD (n=59), placebo surgery (n=63), and exercise therapy (n=71). Of these, a total of 168 participants (87%) completed the 10 year follow-up. In the primary intention-to-treat analysis (ASD versus placebo surgery), no between group differences were observed for the two primary outcomes at 10 years: the mean difference between groups (ASD minus placebo surgery) was -1.5 points (95% confidence interval (CI) -8.6 to 5.6) in VAS pain score at rest and -3.2 points (-13.0 to 6.5) in VAS pain score on arm activity. No significant between group differences were found for any of the secondary outcomes or adverse events. In the pragmatic comparison, the mean difference between groups (ASD minus exercise therapy) was -4.0 points (-11.0 to 3.0) in VAS pain score at rest and -9.4 points (-19.0 to 0.3) in VAS pain score on arm activity. No significant between group differences were observed for the secondary outcomes or adverse events.CONCLUSIONIn patients with subacromial pain syndrome, ASD offered no benefit over placebo surgery or exercise therapy during 10 year follow-up.TRIAL REGISTRATIONClinicalTrials.gov NCT00428870.
{"title":"Arthroscopic subacromial decompression versus placebo surgery for subacromial pain syndrome: 10 year follow-up of the FIMPACT randomised, placebo surgery controlled trial.","authors":"Kari Kanto,Mathias Bäck,Thomas Ibounig,Robert Björkenheim,Antti Malmivaara,Tomasz Czuba,Jari Inkinen,Juha Kalske,Vesa Savolainen,Ilkka Sinisaari,Pirjo Toivonen,Simo Taimela,Teppo L N Järvinen,Mika Paavola, ","doi":"10.1136/bmj-2025-086201","DOIUrl":"https://doi.org/10.1136/bmj-2025-086201","url":null,"abstract":"OBJECTIVETo assess the long term efficacy of arthroscopic subacromial decompression (ASD) versus placebo surgery (diagnostic arthroscopy) and exercise therapy in patients with subacromial pain syndrome.DESIGNRandomised, placebo surgery controlled trial.SETTINGOrthopaedic department of three public hospitals in Finland.PARTICIPANTS210 adults aged 35 to 65 years with symptoms consistent with subacromial pain syndrome for more than three months, enrolled from 1 February 2005 with 10 year follow-up to 20 September 2023. Participants and outcome assessors were blinded to group allocation in the primary (ASD versus placebo surgery) comparison.INTERVENTIONSASD, placebo surgery, and exercise therapy (1:1:1). Exercise therapy was used as a pragmatic comparator.MAIN OUTCOME MEASURESThe primary outcomes were shoulder pain at rest and on arm activity, both assessed at 10 years using a visual analogue scale (VAS, ranging from 0 to 100, with 0 denoting no pain). The minimally important difference was defined as 15. A mixed model repeated measures analysis of variance was used, treating participants as random factors, incorporating baseline values as covariates.RESULTSParticipants were randomly assigned to ASD (n=59), placebo surgery (n=63), and exercise therapy (n=71). Of these, a total of 168 participants (87%) completed the 10 year follow-up. In the primary intention-to-treat analysis (ASD versus placebo surgery), no between group differences were observed for the two primary outcomes at 10 years: the mean difference between groups (ASD minus placebo surgery) was -1.5 points (95% confidence interval (CI) -8.6 to 5.6) in VAS pain score at rest and -3.2 points (-13.0 to 6.5) in VAS pain score on arm activity. No significant between group differences were found for any of the secondary outcomes or adverse events. In the pragmatic comparison, the mean difference between groups (ASD minus exercise therapy) was -4.0 points (-11.0 to 3.0) in VAS pain score at rest and -9.4 points (-19.0 to 0.3) in VAS pain score on arm activity. No significant between group differences were observed for the secondary outcomes or adverse events.CONCLUSIONIn patients with subacromial pain syndrome, ASD offered no benefit over placebo surgery or exercise therapy during 10 year follow-up.TRIAL REGISTRATIONClinicalTrials.gov NCT00428870.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":"e086201"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656877","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 BMJ appeal 2025-26: \"There is no ceasefire\"-Gazan doctors brace for winter as Israeli attacks and aid restrictions continue.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.r2492","DOIUrl":"https://doi.org/10.1136/bmj.r2492","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"19 1","pages":"r2492"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656867","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":"Rammya Mathew: Fighting health inequalities, one clinical encounter at a time.","authors":"Rammya Mathew","doi":"10.1136/bmj.r2494","DOIUrl":"https://doi.org/10.1136/bmj.r2494","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"153 1","pages":"r2494"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656878","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}
Marcus Lewis,David Fraile Navarro,Charlotte Blease,Rupal Shah,Sara Riggare,Sylvie Delacroix,Richard Lehman
{"title":"Clinical competencies for using generative AI in patient care.","authors":"Marcus Lewis,David Fraile Navarro,Charlotte Blease,Rupal Shah,Sara Riggare,Sylvie Delacroix,Richard Lehman","doi":"10.1136/bmj-2025-085324","DOIUrl":"https://doi.org/10.1136/bmj-2025-085324","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"198200 1","pages":"e085324"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656880","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":"Obesity: WHO calls for increased production of Ozempic and other weight loss drugs.","authors":"Luke Taylor","doi":"10.1136/bmj.r2540","DOIUrl":"https://doi.org/10.1136/bmj.r2540","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"21 1","pages":"r2540"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656868","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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