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The BMJ Today: Questions over data underpinning beta blocker use in surgery and stroke management

1 Sep, 14 | by BMJ

debsIn a highly critical analysis article on, two cardiologists call on the European Society of Cardiology (ESC) to revise its recent guidance about the use of beta blockers in patients undergoing noncardiac surgery; to make processes more transparent; and to act more swiftly upon fraudulent research—particularly when patient lives are at risk.

Since 2009, the ESC guidelines have recommended giving a short course of oral β blockers from shortly before surgery until a few days or weeks after surgery to patients with ischaemic heart disease or positive preoperative stress test results who are having high risk surgery. The aim is to reduce perioperative mortality by preventing myocardial infarction. more…

The BMJ Today: In with the new

29 Aug, 14 | by BMJ

Online publishing is evolving all the time, providing opportunities to display information in new and different ways. Our two latest State of the Art clinical reviews—still a relatively new type of article in The BMJ—(entitled “Lower urinary tract symptoms in men” and “Bariatric surgery for obesity and metabolic conditions in adults” both include interactive graphics (showing the evolution of bariatric procedures and the international prostate symptoms score, which was also reviewed in a recent blog).  Both these “infographics” illustrate the subjects in a user-friendly, easy-to-understand, dynamic manner that static illustrations cannot provide. more…

The BMJ Today: When money and medicine mix

28 Aug, 14 | by BMJ

Anne_GullandEarlier this year, The BMJ published an editorial urging doctors in India to fight back against corruption in medicine. Kickbacks and bribes are a global problem but India, “with rampant corruption at all levels, is prominent in this international field,” the authors wrote.

Since the publication of the editorial in June, the article has been accessed more than 5000 times, but a new feature on by Vidya Krishnan shows how the anticorruption movement is gaining momentum. more…

The BMJ Today: If wishes were sustainable development goals

27 Aug, 14 | by BMJ

kellyFourteen years ago, leaders from across the world came together at the United Nations headquarters in New York to pledge their efforts towards achieving eight targets for global development. Together, these targets became known as the millennium development goals or MDGs (with three of them directly devoted to a health objective).

Since then, The BMJ, along with other publications and organisations, has scrutinised these goals. We’ve analysed the likelihood of achieving these goals—ruminating on the great challenges they present, and the actions that could advance their attainment. Equally, we’ve flagged up the MDGs’ success stories, such as when the goal for access to safe water was achieved five years early.

More recently, we’ve begun thinking about life after 2015, when the time allotted for the MDGs to do their thing runs out. Last year, Charles Kenny from the Center for Global Development examined the lessons we’ve learnt from the MDGs, and suggestions for the post 2015 development agenda. more…

The BMJ Today: Ebola, Edinburgh, edifices

26 Aug, 14 | by BMJ

deputy chair of MJA on stage (1)Ebola and the forthcoming referendum on Scottish independence have, among other things, spared UK national newspaper editors the anxiety of how to fill column inches in the “silly season” month of August. The BMJ can at least drop a print and iPad issue, as it is doing this week, but we and other general medical journals are devoting online space to showcase resources about the Ebola outbreak. Visit to find out more. more…

The BMJ Today: Medicine’s vast horizons

22 Aug, 14 | by BMJ

jose_merinoAt first glance, three articles published this week in The BMJ appear to have limited relevance to medicine. One, written by an economist, discusses the challenges faced by demographers when making predictions about population changes; a second deals with international drug control treaties and the need for policy experiments to evaluate the benefits and risks of drug legalization; and a third discusses whether it is ethical to hire sherpas when climbing Mount Everest. more…

The BMJ Today: Working as a GP is often a tall order

21 Aug, 14 | by BMJ

tiago_villanuevaAny GP around the world who’s been in the game long enough is aware that one of the big challenges of the job is to manage patients’ daunting and often unrealistic expectations. In time slots that range from five to 20 minutes—depending on the geographical jurisdiction one is practicing in—GPs do their best to adhere to best clinical practice and to provide quality healthcare under conditions of often great uncertainty and clinical complexity, while at the same time trying to stick to time and avoid litigation. It is often a tall order, and in many countries, GPs are poorly paid and not sufficiently recognised by their peers, society, and politicians for the extremely important work we do.

Recently, two parallel surveys of 1000 GPs and a similar number of patients found that 55% of GPs felt under pressure, particularly from patients, to prescribe antibiotics, even if they were not sure that they were necessary. In the surveys, commissioned by Nesta—the organisation behind the Longitude Prize, which rewards those developing smarter ways of using antibiotics—44% of GPs also admitted that they had prescribed antibiotics to get a patient to leave the practice. What could be seen as even more striking is that about 45% of GPs had prescribed antibiotics for a viral infection, knowing that they would not be effective. more…

The BMJ Today: In search of goodness

20 Aug, 14 | by BMJ

kristina_fisterMark Clarfield, an Israeli doctor, writes to his imagined Palestinian colleague. Izzeldin Abuelaish, a real Palestinian doctor living in Canada, writes back. As both yearn for peace, and attempt to show much professional and human compassion, the views expressed about the conflict that is ruling both their children’s lives seem somewhat elusive. Still, a recurring theme in these letters, as well as in the rapid responses, is hatred.

Having lived through the bloodshed that followed the break up of Yugoslavia, I wholeheartedly support the examination of hatred as a prerequisite of armed conflict. Right now, there is nothing more to want for Israel and Gaza than for the shelling to stop, and remain stopped. In my country, Croatia, the shelling stopped nearly 20 years ago. The war, it seems, still hasn’t ended though, as the battle continues in international courts. more…

The BMJ Today: Tranexamic acid and inferring significance of treatment effects

19 Aug, 14 | by BMJ

georg_roegglaTranexamic acid is a synthetic analog of the amino acid lysine. It is used to treat or prevent excessive blood loss during surgery and in various other medical conditions. An older analogue, epsilon aminocaproic acid, was temporarily withdrawn worldwide in 2007 after studies suggested that its use increased the risk of complications or death. Tranexamic acid, on the contrary, is considered to be a very promising drug. It is inexpensive and has been included in the WHO list of essential medicines.

Jashvant Poeran and colleagues have evaluated the effectiveness and safety of perioperative tranexamic acid use in patients undergoing total hip or knee arthroplasty in the United States in a large retrospective cohort study, which includes 872 416 patients. They report that tranexamic acid was effective in reducing the need for blood transfusions, while not increasing the risk of complications, including thromboembolic events and renal failure. more…

The BMJ Today: Computed tomography—to scan or not to scan?

18 Aug, 14 | by BMJ

wim_weberAs reported in the News section today, a group of experts has called attention to the dramatic rise in the use of computed tomography (CT) scanning.

The Committee on Medical Aspects of Radiation in the Environment said that English hospitals carried out almost five million CT scans in 2012-13, a fivefold rise of the numbers in 1996-97. This year saw an additional rise of 13%.

Quite spectacular numbers, as they suggest that almost 1 in ten of all people will have undergone a CT scan in 2014. These figures are by no means unique to England. I looked up the numbers for the Netherlands, and they are similar. more…

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