{"title":"David Oliver: If assisted dying is legalised, can we safeguard against misuse?","authors":"David Oliver","doi":"10.1136/bmj.q2348","DOIUrl":"https://doi.org/10.1136/bmj.q2348","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2348"},"PeriodicalIF":105.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"UK patients face imaging cancellations amid shortage of radioactive isotope.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.q2404","DOIUrl":"https://doi.org/10.1136/bmj.q2404","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2404"},"PeriodicalIF":105.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie McCormick, Chio Yokose, Na Lu, Deborah J Wexler, J Antonio Aviña-Zubieta, Mary A De Vera, Saiajay Chigurupati, Kiara Tan, Chixiang Chen, Rozalina McCoy, Gary C Curhan, Hyon K Choi
<p><strong>Objective: </strong>To emulate target trials comparing recurrence of nephrolithiasis among patients with pre-existing nephrolithiasis (overall and stratified by concomitant gout) initiating sodium-glucose cotransporter-2 (SGLT-2) inhibitors versus an active comparator.</p><p><strong>Design: </strong>Target trial emulation studies.</p><p><strong>Setting: </strong>Canadian population database, January 2014 to June 2022.</p><p><strong>Participants: </strong>20 146 patients with nephrolithiasis and type 2 diabetes, including those with concomitant gout at baseline, a high risk group.</p><p><strong>Interventions: </strong>Initiation of an SGLT-2 inhibitor or glucagon-like peptide-1 (GLP-1) receptor agonist, with a dipeptidyl peptidase-4 (DPP-4) inhibitor as alternative comparator.</p><p><strong>Main outcome measures: </strong>The primary outcome was recurrent nephrolithiasis events ascertained from diagnoses during emergency department visits, hospital admissions, or outpatient visits. Secondary outcomes included nephrolithiasis resulting in hospital admission or emergency department visits and flare-up of gout, as well as a positive control outcome (genital infection) and negative control outcomes (osteoarthritis encounter and appendicitis). Poisson and Cox proportional hazards regression models were used (primary analyses), as well as overlap weighting.</p><p><strong>Results: </strong>After inverse probability of treatment weighting, 1924 recurrent nephrolithiasis events occurred among the 14 456 weighted patients who used an SGLT-2 inhibitor (105.3 per 1000 person years), compared with 853 events among the 5877 weighted patients who used a GLP-1 receptor agonist (156.4 per 1000 person years). The adjusted rate ratio was 0.67 (95% confidence interval (CI) 0.57 to 0.79) and rate difference was -51 (95% CI -63 to -40) per 1000 person years, with a number needed to treat (NNT) of 20. Among those with recently active nephrolithiasis, the absolute rate difference was 219 per 1000 person years (NNT of 5). Protective associations persisted for nephrolithiasis events that required emergency department visits, hospital admissions, or procedures, and when an SGLT-2 inhibitor was compared with a DPP-4 inhibitor (rate ratio 0.73 (0.68 to 0.78), rate difference -38 (-46 to -29) per 1000 person years (NNT of 26)). Protective associations also persisted among patients with nephrolithiasis and concomitant gout, with a rate ratio of 0.67 (0.57 to 0.79) and rate difference of -53 (95% CI -78 to -27) per 1000 person years versus a GLP-1 receptor agonist (NNT of 19), and 0.63 (0.55 to 0.72) and-62 (-81 to -42) per 1000 person years, respectively, versus a DPP-4 inhibitor (NNT of 16). Furthermore, SGLT-2 inhibitor use was associated with a lower rate of gout flare-ups (rate ratio 0.72, 0.54 to 0.95, rate difference -16, -31 to -1 per 1000 person years) compared with GLP-1 receptor agonists (0.65, 0.52 to 0.82, and -21, -33 to -9 per 1000 person years) compare
{"title":"Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for recurrent nephrolithiasis among patients with pre-existing nephrolithiasis or gout: target trial emulation studies.","authors":"Natalie McCormick, Chio Yokose, Na Lu, Deborah J Wexler, J Antonio Aviña-Zubieta, Mary A De Vera, Saiajay Chigurupati, Kiara Tan, Chixiang Chen, Rozalina McCoy, Gary C Curhan, Hyon K Choi","doi":"10.1136/bmj-2024-080035","DOIUrl":"10.1136/bmj-2024-080035","url":null,"abstract":"<p><strong>Objective: </strong>To emulate target trials comparing recurrence of nephrolithiasis among patients with pre-existing nephrolithiasis (overall and stratified by concomitant gout) initiating sodium-glucose cotransporter-2 (SGLT-2) inhibitors versus an active comparator.</p><p><strong>Design: </strong>Target trial emulation studies.</p><p><strong>Setting: </strong>Canadian population database, January 2014 to June 2022.</p><p><strong>Participants: </strong>20 146 patients with nephrolithiasis and type 2 diabetes, including those with concomitant gout at baseline, a high risk group.</p><p><strong>Interventions: </strong>Initiation of an SGLT-2 inhibitor or glucagon-like peptide-1 (GLP-1) receptor agonist, with a dipeptidyl peptidase-4 (DPP-4) inhibitor as alternative comparator.</p><p><strong>Main outcome measures: </strong>The primary outcome was recurrent nephrolithiasis events ascertained from diagnoses during emergency department visits, hospital admissions, or outpatient visits. Secondary outcomes included nephrolithiasis resulting in hospital admission or emergency department visits and flare-up of gout, as well as a positive control outcome (genital infection) and negative control outcomes (osteoarthritis encounter and appendicitis). Poisson and Cox proportional hazards regression models were used (primary analyses), as well as overlap weighting.</p><p><strong>Results: </strong>After inverse probability of treatment weighting, 1924 recurrent nephrolithiasis events occurred among the 14 456 weighted patients who used an SGLT-2 inhibitor (105.3 per 1000 person years), compared with 853 events among the 5877 weighted patients who used a GLP-1 receptor agonist (156.4 per 1000 person years). The adjusted rate ratio was 0.67 (95% confidence interval (CI) 0.57 to 0.79) and rate difference was -51 (95% CI -63 to -40) per 1000 person years, with a number needed to treat (NNT) of 20. Among those with recently active nephrolithiasis, the absolute rate difference was 219 per 1000 person years (NNT of 5). Protective associations persisted for nephrolithiasis events that required emergency department visits, hospital admissions, or procedures, and when an SGLT-2 inhibitor was compared with a DPP-4 inhibitor (rate ratio 0.73 (0.68 to 0.78), rate difference -38 (-46 to -29) per 1000 person years (NNT of 26)). Protective associations also persisted among patients with nephrolithiasis and concomitant gout, with a rate ratio of 0.67 (0.57 to 0.79) and rate difference of -53 (95% CI -78 to -27) per 1000 person years versus a GLP-1 receptor agonist (NNT of 19), and 0.63 (0.55 to 0.72) and-62 (-81 to -42) per 1000 person years, respectively, versus a DPP-4 inhibitor (NNT of 16). Furthermore, SGLT-2 inhibitor use was associated with a lower rate of gout flare-ups (rate ratio 0.72, 0.54 to 0.95, rate difference -16, -31 to -1 per 1000 person years) compared with GLP-1 receptor agonists (0.65, 0.52 to 0.82, and -21, -33 to -9 per 1000 person years) compare","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"e080035"},"PeriodicalIF":105.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assisted dying laws around the world.","authors":"Mun-Keat Looi","doi":"10.1136/bmj.q2385","DOIUrl":"https://doi.org/10.1136/bmj.q2385","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2385"},"PeriodicalIF":105.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Digital avatars help to relieve distress in patients who hear voices, finds study.","authors":"Brian Kennedy","doi":"10.1136/bmj.q2396","DOIUrl":"https://doi.org/10.1136/bmj.q2396","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2396"},"PeriodicalIF":105.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fertility rate in England and Wales fell to a record low in 2023.","authors":"Matthew Limb","doi":"10.1136/bmj.q2397","DOIUrl":"https://doi.org/10.1136/bmj.q2397","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2397"},"PeriodicalIF":105.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"NHS will get £1.57bn funding boost to cut waiting times, chancellor announces.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.q2394","DOIUrl":"https://doi.org/10.1136/bmj.q2394","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2394"},"PeriodicalIF":105.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Machine learning and artificial intelligence research for patient benefit: 20 critical questions on transparency, replicability, ethics, and effectiveness.","authors":"","doi":"10.1136/bmj.q2390","DOIUrl":"10.1136/bmj.q2390","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2390"},"PeriodicalIF":105.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trends in cardiovascular disease incidence among 22 million people in the UK over 20 years: population based study.","authors":"","doi":"10.1136/bmj.q2381","DOIUrl":"10.1136/bmj.q2381","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2381"},"PeriodicalIF":105.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Weight loss drugs: Regulator reprimands Novo Nordisk over promotion.","authors":"Elisabeth Mahase","doi":"10.1136/bmj.q2377","DOIUrl":"https://doi.org/10.1136/bmj.q2377","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2377"},"PeriodicalIF":105.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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