Top ten most read in April: Atypical pathogens in patients with severe pneumonia; menu calorie counts; and need to clamp indwelling urinary catheters before removal

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Pexels. Mathias Reding.

Welcome to our ‘Most Read’ blog where we highlight the articles that have resonated the most with our readers. This month we have several new entries spanning a diverse array of topics, from mental health to respiratory health to health economics. 

Atypical pathogens in patients with severe pneumonia

In order to understand the prevalence of severe pneumonia caused by atypical pathogens, Wang et al. conducted a systematic review and meta-analysis, searching various medical databases for relevant studies published until November 2022. Unlike previous global reports, data in this study were not limited to studies conducted in developed countries and data from developing countries were also included. Meta-regression analysis was also used to explore potential sources of heterogeneity. After analysing the data from 75 eligible studies with a total of 18,379 cases of severe pneumonia, the researchers found that the overall prevalence of atypical pneumonia was 8.1%. The pooled estimated prevalence of Chlamydia was 1.8%, Mycoplasma was 2.8% and Legionella was 4.0%. However, the authors note that the substantial heterogeneity observed was not fully explained by the variables examined.

Menu calorie counts and obesity-related cancer rates

This study aimed to assess the impact of menu calorie labelling on reducing obesity-related cancer burdens in the United States. Using a cost–effectiveness analysis, Du et al. estimated the impact of the policy on reducing obesity-related cancer rates and associated costs among 235 million US adults aged at least 20, over a simulated lifetime starting from 2015. On the basis of consumer behaviour alone, the policy was associated with the prevention of 28,000 new cancer cases and 16,700 cancer deaths. From both healthcare and societal perspectives, the policy was associated with net cost savings of US$1,460 million and US$1,350 million, respectively. However, the authors acknowledge that given the nature of modelling research, this study does not provide a real-world evaluation of the impact of policy implementation on health and economic outcomes.

Need to clamp indwelling urinary catheters before removal

This meta-analysis aimed to assess the effect of bladder training through clamping on bladder and urethral function in patients with indwelling urinary catheters of different durations. The researchers searched multiple databases for relevant studies published between January 2000 and February 2022. In total, 17 papers, including 15 randomised controlled trials (RCTs) and 2 quasi-RCTs, involving a total of 3,908 participants, were included in the meta-analysis. They found that the clamping group had a significantly higher risk of urinary tract infections and a longer time to the first void compared with the free drainage group. Subgroup analysis focusing on indwelling catheter durations of seven days or less indicated that clamping significantly increased the risk of urinary tract infections and lengthened the time to the first void compared with free drainage. Sensitivity analysis was conducted and partially accounted for statistical heterogeneity; however, several factors associated with heterogeneity remained unclear.

Below are the top ten most-read papers in BMJ Open during April 2023:

*Most read figures are based on pdf downloads and full text views. Abstract views are excluded.
Rank* Author(s) Title
1 Szigethy et al. Efficacy of a digital mental health intervention embedded in routine care compared with treatment as usual in adolescents and young adults with moderate depressive symptoms: protocol for randomised controlled trial
2 Culvenor et al. SUpervised exercise-therapy and Patient Education Rehabilitation (SUPER) versus minimal intervention for young adults at risk of knee osteoarthritis after ACL reconstruction: SUPER-Knee randomised controlled trial protocol
3 Wang et al. Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
4 Du et al. What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA
5 Buis et al. Safe shortening of antibiotic treatment duration for complicated Staphylococcus aureus bacteraemia (SAFE trial): protocol for a randomised, controlled, open-label, non-inferiority trial comparing 4 and 6 weeks of antibiotic treatment
6 Uchai et al. Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016
7 Mengistu et al. Early initiation of breast feeding and associated factors among mother-baby dyads with immediate skin-to-skin contact: cross-sectional study based on the 2016 Ethiopian Demographic and Health Survey data
8 Ma et al. Need to clamp indwelling urinary catheters before removal after different durations: a systematic review and meta-analysis
9 Yu et al. White rice, brown rice and the risk of type 2 diabetes: a systematic review and meta-analysis
10 Keuppens et al. Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial


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