{"id":27134,"date":"2013-06-17T10:51:43","date_gmt":"2013-06-17T09:51:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=27134"},"modified":"2013-06-17T10:51:43","modified_gmt":"2013-06-17T09:51:43","slug":"richard-lehmans-journal-review-17-june-2013","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/","title":{"rendered":"Richard Lehman’s journal review\u201417 June 2013"},"content":{"rendered":"

\"RichardJAMA\u00a0 12 June 2013\u00a0 Vol 309<\/strong>
\n2345\u00a0\u00a0 \u201cMoral panic\u201d is a term which dates back to the 1830s and describes \u201can intense feeling expressed in a population about an issue that appears to threaten the social order.\u201d Just now the Chief Medical Officer for England is putting her weight behind a campaign of moral panic about antibiotic overuse by doctors, and if I dissent I shall be considered a threat to the social order. We are supposed to confess that as GPs we greatly overuse antibiotics, and as a result they are losing their effectiveness and we are about to return to the pre-antimicrobial era. The study reported<\/a> here from the USA shows that primary care paediatricians can be persuaded to use fewer broad spectrum antibiotics for respiratory infections in favour of amoxicillin and penicillin V. The fact is that after 60+ years of \u201coveruse,\u201d these remain highly effective first-line treatments in primary care, and you don\u2019t need most of the rest. We may differ on the likelihood of their usefulness in particular clinical contexts, but there is no room for moral panic. Dame Sally should save that for the use of antibiotics in animal feed.
\n<\/p>\n

2353\u00a0\u00a0 If you measure C-reactive protein, leucocytes, and fibrinogen in people, what will you find? That those who are ill have higher levels, and that everyone\u2019s levels bob up and down all the time. In this study<\/a>, these \u201cbiomarkers\u201d were found to be raised prior to exacerbations of chronic obstructive pulmonary disease. I\u2019d have been very surprised if it were otherwise, and this isn\u2019t going to persuade me to do weekly blood tests on COPD patients.<\/p>\n

2335\u00a0 A trial of ventilated patients on ICU<\/a> found that music selected from a\u00a0 range of six CDs helped to reduce sedative use in these patients, but noise-cancelling headphones worked just as well. I can\u2019t help thinking that\u2019s not enough CDs to choose from. If I end up ventilated on ICU, please rummage through my CDs and find the Bach violin sonatas played by Yehudi Menuhin with Malcolm and Gauntlett. Then if I died and went to heaven, I wouldn\u2019t be able to tell.<\/p>\n

(NB: This recording from 1961 has never been reissued on CD by EMI but is available on the little-known French label, Forgotten Records.)<\/p>\n

NEJM\u00a0 13 June 2013\u00a0 Vol 368<\/strong>
\n2255\u00a0\u00a0 Staphylococcus aureus remains the commonest cause of healthcare associated infection; and for a time, meticillin-resistant staph aureus (MRSA) caused widespread moral panic. Fortunately it also led to an outstanding cluster-randomized trial in ICUs within the Hospital Corporation of America. In the first group of ICUs, patients with positive nasal swabs for MRSA were isolated; in the second, swab positive patients were isolated and treated with nasal mupirocin and daily whole-body cleansing with chlorhexidine impregnated cloths; in the third group there was no testing and everybody got the nasal ointment and the chlorhexidine bathing. \u201cIn routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen.\u201d A classic study<\/a>, which at one stroke has solved an important clinical question, and will save lives.<\/p>\n

2277\u00a0\u00a0 But alas it\u2019s back to panic stations again. I am having to abandon my policy of not commenting on H7N9 influenza because there is so much about it in the journals. Here is a report of the clinical findings<\/a> in 111 cases from Chinese hospitals. It\u2019s bang up to date: the cut-off is May 10th 2013. This type of influenza A can be very nasty, and 27% of these patients who came into hospital, mostly with viral pneumonia, were dead by May 10th. But until we know more about the typical presentation of this virus in the community, and about human-to-human transmission, panic should be put on hold. For now. We may be doomed. But not for another week or two.<\/p>\n

2286\u00a0\u00a0 Adrenaline? In the title of a NEJM<\/em> paper? Surely in America it should be epinephrine. But it doesn\u2019t matter in the end, because this Norwegian trial<\/a> shows that for the hospital treatment of acute bronchiolitis in infants, inhaled racemic adrenaline (epinephrine) is not more effective than inhaled saline. And if you prescribe the saline inhalations as necessary instead of per regular schedule, the babes leave hospital sooner.<\/p>\n

2294\u00a0\u00a0 A clinical review<\/a> discusses acute high altitude illnesses. I shall spend the next few days in Peru, at sea level. Here is my clinical summary of acute high altitude illnesses. 1. Do not go to high altitudes 2. If you must, get acclimatized. 3. This does not apply to commercial flights.<\/p>\n

Lancet\u00a0 15 June 2013\u00a0 Vol 381<\/strong>
\nLast week it was China, this week it\u2019s the latest antivirals for HIV and HCV. You can\u2019t argue with the intrinsic importance of these topics but you can argue that they don\u2019t make riveting reading for the generalist doctor. For that you have increasingly to go to the BMJ<\/em>\u2014and I\u2019m not just writing out of brand loyalty. Once again I can\u2019t point to anything of interest in the Lancet<\/em>, except perhaps a speculative paper on how a true cure for HIV might one day emerge<\/a>, and a very broad-brush look at the factors<\/a> which can lead to improvement in poor-world health systems.<\/p>\n

BMJ\u00a0 15 June 2013\u00a0 Vol 346<\/strong>
\nLaudable pus\u2014thick and primrose-yellow, with hints of green and streaks of red\u2014is the good old fashioned stuff that we all enjoy releasing from abscesses whenever we get a chance. But staphylococcal pus comes in for little lauding these days. Meticillin-resistant S aureus<\/em> gets all the headlines, but all staphylococci tend to cause wound infections and are worth taking measures against pre-operatively. A systematic review<\/a> here shows that nasal swabbing and the use of intranasal mupirocin are useful for preventing post-operative infections and in those with MRSA, and glycopeptide antibiotics (vancomycin, teicoplanin) can be \u201cbundled\u201d in too.<\/p>\n

Stroke care improvement programmes in the UK seem to work, just as stroke centres did when they were first set up. A prospective cohort study<\/a> examines the figures and looks for the contribution made by each element of improved care. Once again we get this wretched word bundle, and Bundle 4 is defined as: \u201cpatient given antiplatelet therapy where appropriate and had adequate fluid and nutrition for first 72 hours.\u201d Why on earth bundle together adequate food and fluid with antiplatelet therapy? Anyway, this bundle makes the most difference: it is perhaps a marker for units where the nurses have enough time to make sure the patients are fed and watered.<\/p>\n

Canadian legislation to enforce the wearing of helmets by bicycle riders has made very little difference to rates of injury<\/a>. This provokes a lovely editorial<\/a> from Ben Goldacre and David Spiegelhalter on the perils of population evidence versus personal benefit and political correctness. I really don\u2019t know how Ben gets time to write editorials. In fact I don\u2019t know how he gets time to sit down, let alone eat or sleep. But I do seem to remember he wears a cycle helmet, one specially designed to contain his hair.<\/p>\n

The main buzz in this week\u2019s BMJ<\/em> though comes from Deb Cohen\u2019s great piece of investigative reporting<\/a> on the concealed signals of pancreatic hypertrophy and damage caused by incretin mimetics. This is the glitazone story all over again, and once again reveals the lunacy of releasing drugs for long-term use on millions of high-risk individuals without the faintest idea of their long term harms or benefits. Points made in excellent editorials by Edwin Gale<\/a> and Victor Montori<\/a>.<\/p>\n

JAMA Intern Med\u00a0 10 June 2013 Vol 173<\/strong>
\n956\u00a0\u00a0 It\u2019s great to see Iona Heath feature<\/a> in a viewpoint on waste and harm in the treatment of mild hypertension in a leading US journal. It is taking so long for the entrenched models of thinking about cardiovascular risk factors to give way to a patient centred view of risk and benefit.<\/p>\n

972\u00a0\u00a0 If only everything in medicine wasn\u2019t such a mess! But we should take comfort that no generation before on earth has witnessed the advances in treatment that we have: the toll of premature death from cardiovascular disease and from cancer is coming down all the time. The trouble is that it could come down so much faster if there wasn\u2019t such a welter of poorly conducted research and profiteering, as this study of the characteristics of oncology research reveals<\/a>.<\/p>\n

981\u00a0\u00a0 And the price of all this prolongation of life is that more people get old. I like Andrew Dilnot\u2019s view that this is something we should rejoice about, but health systems just see it as a resource problem. Everybody is in the business of devising care pathways which will keep the elderly out of hospital, myself included. By which I mean I am trying to devise one before I need one. But I wonder if it is really possible to generalise across health systems. Here is panacea no 1, as trialled from a tertiary centre in Birmingham<\/a>, Alabama: it is\u2014wait for it\u2014an interdisciplinary team which goes out into the community! Gosh, we have these in Birmingham England too!<\/p>\n

990\u00a0\u00a0 And here is panacea no 2. It is called MACE<\/a> and it is\u2014wait for it\u2014a multidisciplinary team which goes out into the community from Mount Sinai Hospital in New York! Gosh, I don\u2019t know if we have these in New York England too. This is a little village in the bogs of Lincolnshire, which might have to rely on the good offices of the GP, district nurse, and a few kind neighbours.<\/p>\n

Plant of the Week: Geum chiloense<\/em><\/a><\/strong><\/p>\n

This is the nearest thing to a Peruvian plant flowering in our garden at present\u2014the alstroemerias (Peruvian lilies) come later. It\u2019s strange to have reached the middle of June and still be waiting for an abundance of other flowers. Meanwhile, some of our geums have been in sporadic flower since March, and are covered now; better still, they will carry on into autumn. These imperturbable plants really do merit a place in every garden, filling spaces at the edge of each border.<\/p>\n

The characteristic colours of geums are yellow, orange, and red in all shades, and there are numerous good varieties. The flowers usually nod charmingly but there are many upright ones too. Just go along to the nursery and choose. Better still, go to a friend\u2019s garden and ask for any you like: they divide easily at any time of the year, and indeed should be divided and replanted every third year or so, to keep at their best.<\/p>\n","protected":false},"excerpt":{"rendered":"

JAMA\u00a0 12 June 2013\u00a0 Vol 309 2345\u00a0\u00a0 \u201cMoral panic\u201d is a term which dates back to the 1830s and describes \u201can intense feeling expressed in a population about an issue […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-27134","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"\nRichard Lehman's journal review\u201417 June 2013 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Lehman's journal review\u201417 June 2013 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"JAMA\u00a0 12 June 2013\u00a0 Vol 309 2345\u00a0\u00a0 \u201cMoral panic\u201d is a term which dates back to the 1830s and describes \u201can intense feeling expressed in a population about an issue [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2013-06-17T09:51:43+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Richard Lehman’s journal review\u201417 June 2013\",\"datePublished\":\"2013-06-17T09:51:43+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/\"},\"wordCount\":1756,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"articleSection\":[\"Richard Lehman's weekly review of medical journals\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/\",\"name\":\"Richard Lehman's journal review\u201417 June 2013 - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"datePublished\":\"2013-06-17T09:51:43+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"width\":540,\"height\":350},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/06\\\/17\\\/richard-lehmans-journal-review-17-june-2013\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Richard Lehman’s journal review\u201417 June 2013\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Richard Lehman's journal review\u201417 June 2013 - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/","og_locale":"en_US","og_type":"article","og_title":"Richard Lehman's journal review\u201417 June 2013 - The BMJ","og_description":"JAMA\u00a0 12 June 2013\u00a0 Vol 309 2345\u00a0\u00a0 \u201cMoral panic\u201d is a term which dates back to the 1830s and describes \u201can intense feeling expressed in a population about an issue [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2013-06-17T09:51:43+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Richard Lehman’s journal review\u201417 June 2013","datePublished":"2013-06-17T09:51:43+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/"},"wordCount":1756,"commentCount":1,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","articleSection":["Richard Lehman's weekly review of medical journals"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/","url":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/","name":"Richard Lehman's journal review\u201417 June 2013 - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","datePublished":"2013-06-17T09:51:43+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","width":540,"height":350},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/17\/richard-lehmans-journal-review-17-june-2013\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Richard Lehman’s journal review\u201417 June 2013"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/27134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=27134"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/27134\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38363"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=27134"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=27134"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=27134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}