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The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients’ values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved.

home. For participants in this 40th anniversary celebration of the founding of the American Board of Family Medicine (ABFM), this emphasis on the centrality of reformed primary care to meet the health care needs of Americans is a call to the “supper table of mom and apple pie.” The call resonates with family physicians’ hunger for acknowledgment and with the fullness of knowledge that systems based on primary care have higher quality, healthier people, less inequality in health care and health, and lower costs. 2

A doctor who tried to submit for publication two research papers written by others has been suspended for 12 months by a medical practitioners tribunal. Mohammed Shali, who qualified in Mysore (now Mysuru), India, in 1998, sent an email in February 2013 to the editor of the International Journal of Clinical Skills attaching two papers. He named himself as first author of “An Unusual Cause of Dyspnoea—Mural Thrombus” and as coauthor of “An Unusual Cause of Dyspnoea—Atrial Myxoma.” The first paper had already been published elsewhere under a different title, and Shali had no role in its authorship. He falsely …

This research is part of a multi-method research program that evaluated the impact of knowledge mobilization of evidence-based information for older adults, professionals and caregivers. This research reports the results from nine caregiving clinical trials with one group of older adults, one professional group and one of carers, exposed to three levels of the intervention in each trial (n=261). The null hypotheses were that caregiving knowledge would not differ across the three conditions of no tools, paper tools or digital tools. Respondents were randomly assigned to one of three conditions for each of the three groups. The computed sample size required 29 respondents assigned to each of the three conditions for each of the three groups Respondents were tested on knowledge of caregiving pre-post. F tests showed there were significant differences across each of the three conditions. Professionals achieved higher scores with digital tools and older adults, the paper tools.

The recent study by Taft and colleagues, which explores communication differences in paper versus electronic health records (EHRs), was both interesting and timely.1 EHRs are becoming a focal point for healthcare delivery in the US, yet the impact of EHRs on the patient-provider relationship remains poorly understood. Communication is at the heart of this relationship, and providers are concerned about the potential for EHRs to reduce the quality of their communications with patients.2,3 We would like to provide additional thoughts on Taft et al .’s reported findings and put them into a broader context. First, it is interesting to note that the authors found that EHRs fostered better communications with patients across nearly all measures. However, we wonder what might explain why a physician would greet a patient more warmly when walking into an exam room with a laptop computer vs. a paper chart. This …

The Royal College of General Practitioners Research Paper of the Year Award showcases the excellence of research in primary health care conducted in the UK or Republic of Ireland. This year, prizes for the best papers published in 2013 were awarded in six categories aligned to the NIHR Clinical Research Network divisions with one overall winner. The winning papers include large, hugely ambitious studies using a range of sophisticated research methods. Notably this includes three randomised-controlled trials of complex interventions that are challenging to both implement and evaluate. The 2013 Research Paper of the Year was awarded to Mark Ledwidge and colleagues for the STOP-HF trial of a screening programme using brain-type natriuretic peptide to identify asymptomatic patients at high risk of heart failure, followed by collaborative care to optimise their treatment.1 …

The white paper focuses to a large extent on dismantling the internal market and the development of primary care. The provision of specialist services—which investigate and treat the bulk of serious ill health—get scant mention, despite their accounting for about £1.4 billion of NHS expenditure annually.1 In an almost throw away line, the white paper insists that “everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they need to be seen urgently and requesting an appointment.” It is not difficult to understand why cancer has been singled out for this treatment. It is a common and greatly feared disease. Much work has been done around the country following the Calman-Hine report2 to set standards for cancer care, define protocols and guidelines, develop multidisciplinary teams, and identify …

Biologics are essential to oncology care. As patents for older biologics begin to expire, the United States is developing an abbreviated regulatory process for the approval of similar biologics (biosimilars), which raises important considerations for the safe and appropriate incorporation of biosimilars into clinical practice for patients with cancer. The potential for biosimilars to reduce the cost of biologics, which are often high-cost components of oncology care, was the impetus behind the Biologics Price Competition and Innovation Act of 2009, a part of the 2010 Affordable Care Act. In March 2011, NCCN assembled a work group consisting of thought leaders from NCCN Member Institutions and other organizations, to provide guidance regarding the challenges health care providers and other key stakeholders face in incorporating biosimilars in health care practice. The work group identified challenges surrounding biosimilars, including health care provider knowledge, substitution practices, pharmacovigilance, naming and product tracking, coverage and reimbursement, use in off-label settings, and data requirements for approval.

We are writing to commend Zannad et al. 1 on their excellent paper. In recent years, guidance from both the US Food and Drug Administration (FDA)2 and the European Medicines Agency (EMA)3 addressing evaluation of the cardiovascular risk of new antidiabetic drugs for type 2 diabetes has led to the conduct of an accumulating number of large cardiovascular safety outcome trials designed to prospectively exclude an unacceptable degree of cardiovascular risk. Given that diabetes is associated with an increased risk of cardiovascular disease, the intent behind the creation of FDA’s (2008) and EMA’s (2012) regulatory guidance addressing such prospective exclusion was laudable. However, the time, logistical, and financial demands of conducting such trials are enormous: these run to 5–7 years for trial completion, involvement of potentially hundreds of investigational sites and multiple thousands of participants, and costs of hundreds of millions of … [↵][1]*The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology Corresponding author. Cardiac Safety Services, Quintiles, 4820 Emperor Blvd, Durham, NC 27703, USA. Tel: + 919 960 2626, Fax: + 919 960 2626, Email: rick.turner{at}quintiles.com [1]: #xref-corresp-1-1

Despite the high proportion and growing number of people with comorbidity/multimorbidity, clinical trials often exclude this group, leading to a limited evidence base to guide policy and practice for these individuals [1–5]. This evidence gap can potentially be addressed by secondary analysis of studies that were not originally designed to specifically examine comorbidity/multimorbidity, but have collected information from participants on co-occurring conditions. For example, secondary data analysis from randomized controlled trials may shed light on whether there is a differential impact of interventions on people with comorbidity/multimorbidity. Furthermore, data regarding comorbidity/multimorbidity can often be obtained from registration networks or administrative data sets. Journal of Comorbidity 2015;5(1):120–121

Why should a journal of sports and exercise medicine include an extensive series of papers that deal exclusively with exercise physiology; indeed with a tiny subsection of that discipline? The reason is perhaps twofold. The first is that the published articles all address the novel aspects of exercise-induced fatigue and the regulation of human exercise performance. Fatigue remains a common complaint that brings patients to their primary care physicians. Surely there must be some common explanation for the types of fatigue that we feel, whether at rest or during exercise? Can the exercise sciences contribute something unique to our understanding of this important clinical phenomenon? In 1923, Nobel Laureate Archibald V Hill developed the currently popular model of exercise fatigue.1 According to his understanding, fatigue develops in the exercising skeletal muscles when the heart is no longer able to produce a cardiac output which is sufficient to cover the exercising muscles' increased demands for oxygen. This causes skeletal muscle anaerobiosis (lack of oxygen) leading to lactic acidosis. The lactic acid so produced then ‘poisons’ the muscles, impairing their function and causing all the symptoms we recognise as ‘fatigue’. The collection of articles in this issue provides several invigorating challenges to Hill's hallowed interpretation. Which brings us to the second reason why these articles are published here rather than elsewhere. For some of the articles included were reviewed unfavourably elsewhere; perhaps they were considered heretical. Clearly, some believe that ideas challenging a hallowed dogma are best left unpublished. Otherwise, we might need to update our thinking. Or worse, our teaching! The issue begins with the complementary studies of Lex Mauger et al 2 from the University of Bedfordshire and Fernando Beltrami and his associates3 from the University of Cape Town. Their studies disprove perhaps the most fundamental idea on …

The current prescription charging system could seriously undermine the aims of the government's new white paper to make healthcare services more accessible to people who need them most, MPs heard last week. The charges are likely to hinder attempts to make the health service better at helping groups of people who currently find it difficult to get the right health care, such as people in underserved deprived areas, witnesses told the health select committee as part of its continuing inquiry into NHS charges. Witnesses were asked how the present system of prescription charges affected the policy set out in the …

A prespecified objective of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) was to assess whether any synergistic effects were apparent between the lipid-lowering and blood-pressure-lowering regimens in preventing cardiovascular events.A total of 19 257 hypertensive subjects were randomized to an amlodipine-based regimen or an atenolol-based regimen. Of these, 10 305 subjects with total cholesterolor =6.5 mmol/L were further randomized to atorvastatin 10 mg daily or placebo. In this analysis, the effects of atorvastatin were compared with placebo on coronary heart disease (CHD), cardiovascular and stroke events in those assigned amlodipine-based and atenolol-based regimens. In the ASCOT lipid-lowering arm (LLA), overall, atorvastatin reduced the relative risk of the primary endpoint of non-fatal myocardial infarction and fatal CHD events by 36% (HR 0.64, CI 0.50-0.83, P=0.0005), total cardiovascular events by 21% (HR 0.79, CI 0.69-0.90, P=0.0005), and stroke by 27% (HR 0.73, CI 0.56-0.96, P=0.024). However, atorvastatin reduced the relative risk of CHD events by 53% (HR 0.47, CI 0.32-0.69, P0.0001) among those allocated the amlodipine-based regimen, and by 16% (HR 0.84, CI 0.60-1.17, p: n.s.) among those allocated the atenolol-based regimen (P=0.025 for heterogeneity). There were no significant differences between the effects of atorvastatin on total cardiovascular events or strokes among those assigned amlodipine (HR 0.73, CI 0.60-0.88, P0.005 and HR 0.69, CI 0.45-1.06, P: n.s., respectively) or atenolol (HR 0.85, CI 0.71-1.02, P: n.s and HR 0.76, CI 0.53-1.08, P: n.s, respectively). Differences in blood pressure and lipid parameters (placebo corrected) between the two antihypertensive treatment limbs could not account for the differences observed in CHD outcome.These findings of an apparent interaction between atorvastatin and an amlodipine-based regimen in the prevention of CHD events are of borderline significance, and hence generate an hypothesis that merits independent evaluation in other trials.

Clinicians are increasingly aware of the important role that opioids play in the management of a variety of paediatric conditions. Frequently, clinicians encounter challenges in initiating opioid therapy and, then, in weaning paediatric patients off opioids. In the present article, three different cases (an infant and two adolescents) are used to illustrate why and how opiates may be used in paediatrics and how they can be discontinued. The presentations include neonatal abstinence syndrome, chronic headache and cystic fibrosis. The cases are meant to emphasize the distinctions rather than the similarities among the cases, which is why this is called a case parallel, rather than a case series. The article downplays the use of rigid rules in managing patients on opioids, and emphasizes a flexible and patient-centred approach.

I fully support Rory Collins’s request that The BMJ retracts Abramson and colleagues’ and Malhotra’s papers.1 2 3 The authors totally misrepresent Zhang and colleagues’ claims that statins were causally related to side effects in 20% of statin users.4 The two papers also imply that these side effects were not reported in trials because trial sponsors could have influenced the results and downplayed the …

Electronic data collection for randomised trials is attractive as it can, in theory, provide great financial advantages by reducing fieldwork costs and data inputting time, as well as increasing the accuracy of responses over and above paper based methods. For trials involving young people, electronic methods provide other advantages such as the ability to adapt questions to meet the needs of young people of differing ages and abilities. Researchers have also suggested that young people prefer electronic methods over traditional ones and have found equal validity across both methods. This presentation will discuss issues relating to the collection of sensitive information from young people in Northern Ireland, using electronic and paper formats. We will draw on experience gained across several research studies that have collected data on sexual risks and behaviours, particularly in school-based research; including a recent trial on adolescent pregnancy. We will examine the feasibility, reliability and validity of data collected along with an evaluation of the cost implications and ease of using both methods (including the merging of the resulting datasets if both methods are offered). The views of the researchers and participants will also be reflected upon.

The size and rapidity of the recent increase in the prevalence of obesity is paralleled only by the massive media interest in the causes and implications of these changes and the myriad number of proposed solutions. The availability of information on obesity is overwhelming, but there seems to be common consensus on three points; that obesity is an important public health problem, that the problem is getting worse and that the solution is simple: eat less and exercise more. And yet, although the changing prevalence is a recent phenomenon, obesity itself is not a new public health issue. In the classic paper reprinted in this edition of the journal, Breslow 1 noted in 1952 that a substantial proportion of Americans were overweight and that weight control was a ‘major public health problem’. Despite recognition of the increasing levels of obesity, and the knowledge that it is caused by excess energy intake and decreasing levels of physical activity, obesity remains a poorly understood phenomenon. There are profound gaps in our knowledge about the pathophysiological pathways underlying weight gain and in the effectiveness of approaches to tackle the rising prevalence. Breslow’s 1 paper provides a platform for discussing some of these contemporary issues.

Critical care medicine is an important and inseparable part of modern medical provision. Intensive care units (ICUs), although costly, are an essential element in the delivery of critical care. ICUs are characterized by hi-tech monitoring capabilities as well as increased density of medical and nursing staff compared with general wards or intermediate-care units. However, not all patients for whom ICU admission is indicated are actually admitted to ICU. There are several reasons for this inadequate delivery of care, including [1] lack of sufficient resources to create enough ICU beds and [2] failure of the treatment team outside the ICU to recognize the severity of the disease or the risk of deterioration of a currently stable situation.

Objectives: Efforts to educate men about the controversy surrounding prostate cancer screening are well intended but rarely evaluated rigorously. We evaluated an evidence-based (EB) booklet for men designed to promote informed decision-making. We also determined whether men's preference for involvement in decision-making ("passive", "collaborative" or "active") modified its impact. Setting and methods: Men aged 40-70 years were recruited from the practices of 13 local general practitioners (GPs) in Sydney, Australia. They completed a self-administered questionnaire before seeing their GP, who, according to pre-randomised codes, distributed either our EB booklet or conventional information. Post-test questionnaires were mailed to men three days later. Of the 248 eligible men recruited, 214 (86% response rate) returned post-test questionnaires. Knowledge of evidence and of risk of developing and dying from prostate cancer, attitudes, interest in screening for prostate-specific antigen (PSA), worry and decisional conflict were the main outcome measures. Results: Compared with those receiving conventional information, men receiving the EB booklet had significantly improved knowledge (50% of items correct, 95% CI 46-53%; vs 45% correct, 95% CI 42-48%) (p=0.048) and lower levels of decisional conflict (mean 21.6, 95% CI 20.7-22.5; vs mean 24.3, 95% CI 23.4-25.2) (p Conclusions: Our findings show the benefits of providing evidence-based information to men about PSA screening. Our EB booklet facilitated informed choice, even among "passive" decision-makers.

Background: Recent technological developments in medicine, including modern radiology have promoted the impact of scientific researches on social life. The scientific outputs such as article and patents are products that show the scientists’ attempt to access these achievements. Objectives: In the current study, we evaluate the current situation of Iranian scientists in the field of radiology and compare it with the selected countries in terms of scientific papers. For this purpose, we used scientometric tools to quantitatively assess the scientific papers in the field of radiology. Materials and Methods: Radiology papers were evaluated in the context of medical field audit using retrospective model. We used the related databases of biomedical sciences for extraction of articles related to radiology. In the next step, the situation of radiology scientific products of the country were determined with respect to the under study regional countries. Results: Results of the current study showed a ratio of 0.19% for Iranian papers in PubMed database published in 2009. In addition, in 2009, Iranian papers constituted 0.29% of the Scopus scientific database. The proportion of Iranian papers in the understudy region was 7.6%. Conclusion: To diminish the gap between Iranian scientific radiology papers and other competitor countries in the region and achievement of document 2025 goals, multifold effort of the society of radiology is necessary.

The Royal College of General Practitioners Research Paper of the Year Awards celebrate the best research on general practice and primary care. The awards for papers published in 2012 have been announced and highlight outstanding research in seven categories, with one overall Research Paper of the Year chosen from these category winners. Eighty-six papers were submitted to the competition representing the wide range of topics and methods which are relevant to primary care research. In the Cancer category, the panel selected Fiona Walter’s well-conducted randomised controlled trial from Cambridge of the MoleMate diagnostic aid: Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lessons in primary care: randomised controlled trial .1 Interestingly, the research team found that the systematic application of best practice guidelines following a history and naked eye examination (the control group) led to an impressive 96% sensitivity and 91% specificity for detecting suspicious lesions, which was more accurate than the MoleMate system. In the Diabetes category the winner was Rebecca Simmons et al : Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. 2 This paper described the long-term follow-up of patients at high risk of type 2 diabetes who were included in a cluster randomised trial in which practices …

In the European Union, the Committee for Advanced Therapies of the European Medicines Agency takes the lead in the scientific assessment for marketing authorization applications for advanced therapy medicinal products, which include gene therapy medicinal products, somatic cell therapy medicinal products, and tissue-engineered products. The Committee for Advanced Therapies also takes the lead in defining the scientific framework for the quality, nonclinical and clinical development of such products. This reflection paper represents the Committee's current thinking on management of clinical risks deriving from insertional mutagenesis. A multidisciplinary approach to insertional mutagenesis is provided. This reflection paper has been adopted by the committee in its April 2013 meeting.

Twenty six papers were presented as posters in the Seventh International Symposium on Cough; 12 papers were presented in the Basic Science of Cough session, and 14 papers presented in the Clinical Science of Cough session. These papers explored a wide spectrum of cough-related areas including pathophysiological mechanisms, treatment and detection of cough, and symptom assessment and perception, and were grouped into several general themes for facilitate the discussion. Studies presented in these posters have provided new information that should improve our knowledge on the basic physiology and pharmacology of cough, and the peripheral and central neural mechanisms involved in the generation of the cough motor pattern. In addition, in the clinical science section, studies reporting potential new anti-tussive agents and further characterisation of cough symptoms and perception have provided a base for the fruitful strategies for the development of novel anti-tussive therapies and cough management.

Publishing research can be time consuming, as papers are often submitted and reviewed by multiple journals before final acceptance. We hypothesized that attaching previous peer-review reports to the next submission of the paper to a different journal (possibly with point-to-point responses and amendments) could decrease the workload for both reviewers and editors and could shorten the time from final draft to actual publication. We therefore performed an online survey to assess the views of the editors-in-chief of all 100 general medical journals from the citation impact factor report category "internal & general medicine" (ISI Web of Knowledge). Of contacted editors, 61% responded. One of 4 journals do currently receive peer-review reports on occasion. Editors recognized potential advantages but also concerns on using previous peer-review reports across 3 themes: scientific community, quality of papers, and the publication process. The use of previous peer-review reports has the potential to facilitate authors, reviewers, and editors in optimizing peer review in general medical science.

Drug information for every outpatient was made for clinical use. Referring to about 900 prescription drugs, the name, effect, precautions for use, and contraindications for concomitant use for each drug were stated within 250 characters on both pages of a sheet of paper measuring 5.0cm×10.5cm in size.After starting this system the number of requests for supply of the drug information was about 6200 per month on the average, 49% of the total prescription number. This is a system that can be taken up by every hospital, as this system it does not require either any special instruments, special pharmacists or any prolonged waiting time for the patients to receive their drugs. Questionnairing to the patients showed the informating to be sufficiently understandable, thus improving the patients' knowledge of the drugs. Furthermore, 45% of the patients answered that they began to take drugs in a proper way thanks to the additional information. This drug information system was thus found to successsfully improve the QOL of the patient.

NAPCRG’s Annual Meeting is a forum for primary care researchers from across the globe to gather and present their research, collaborate for new research, and foster growth for up-and-coming researchers. The 2016 Annual Meeting was held in Colorado Springs, Colorado, November 12–16, 2016. Three

PEER REVIEW: One peer reviewer contributed to the peer review report. Reviewers’ reports totaled 27 words, excluding any confidential comments to the academic editor. FUNDING: The author(s) received no financial support for the research, authorship, and/or publication of this article. DECLARATION OF CONFLICTING INTERESTS: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Author Contributions Both the authors contributed to all aspects of the manuscript.

Background: Undergraduate medical education aims at sculpting the future physicians. Knowledge gained during this period helps the physician to deal with human ailments and thus human life. It is necessary to ensure that students learn what is important and thus it is very important to ask the right questions in the examinations.Methods: This is a retrospective analytical study involving evaluation of university theory examination question papers of pharmacology of IInd MBBS at our institute. Question papers from the year 2000 to 2016 were analyzed for weightage to content areas as regards to the syllabus. Results: Autonomic nervous system (25.28%) and cardiovascular system (22.30%) in paper I and chemotherapy (33.50%) and central nervous system (23.76%) in paper II are the maximum weightage content areas. Some aspects which are of clinical importance remained uncovered in a few papers, example: autacoids, kidney, gastrointestinal tract, non-steroidal anti-inflammatory drugs, miscellaneous.Conclusions: For consistency of validity in the assessment, we suggest that it should be based on structured guidelines. Methods like test blueprinting and table of specifications may be used.

Hypersensitivity diseases are not adequately coded in the International Coding of Diseases (ICD)-10 resulting in misclassification, leading to low visibility of these conditions and general accuracy of official statistics. To call attention to the inadequacy of the ICD-10 in relation to allergic and hypersensitivity diseases and to contribute to improvements to be made in the forthcoming revision of ICD, a web-based global survey of healthcare professionals' attitudes toward allergic disorders classification was proposed to the members of European Academy of Allergy and Clinical Immunology (EAACI) (individuals) and World Allergy Organization (WAO) (representative responding on behalf of the national society), launched via internet and circulated for 6 week. As a result, we had 612 members of 144 countries from all six World Health Organization (WHO) global regions who answered the survey. ICD-10 is the most used classification worldwide, but it was not considered appropriate in clinical practice by the majority of participants. The majority indicated the EAACI–WAO classification as being easier and more accurate in the daily practice. They saw the need for a diagnostic system useful for nonallergists and endorsed the possibility of a global, cross-culturally applicable classification system of allergic disorders. This first and most broadly international survey ever conducted of health professionals' attitudes toward allergic disorders classification supports the need to update the current classifications of allergic diseases and can be useful to the WHO in improving the clinical utility of the classification and its global acceptability for the revised ICD-11.

Economic Evaluation It is now almost universally believed that the resources available to meet the demands for health care are limited (Weinstein et al 1977). This means that decisions must be made about how available resources are allocated. Ethical considerations, policy directives or technical constraints can all affect those decisions. To make a fully informed decision, information should be available about the costs associated with providing health interventions, programmes and services and the consequences or outcomes resulting from them. This forms the essence of economic evaluation, attempting to place a value on these costs and consequences in order to compare health interventions.

Eighty-one papers were nominated as potential papers of the year for 2011. This is more than double the 34 titles submitted in 2010 and part of a rising trend of excellent papers from UK general practice. The reasons for this rise are the continuing increase in excellent primary care research in the UK and the inception this year of awards for each of the seven NIHR topic-specific research networks. In the Cancer category the panel were particularly impressed by Hippisley-Cox and colleagues’ BJGP paper Identifying patients with suspected gastro-oesophageal cancer in primary care: derivation and validation of an algorithm .1 There were several papers this year exploiting the rich research potential of primary care records but this one stood out as one that has potential to change practice once further experience of the algorithm’s use is gained. In the Dementias …

Life (ISSN 2075-1729, http://www.mdpi.com/journal/life/) is a new journal that deals with new and sometime difficult interdisciplinary matters. Consequently, the journal will occasionally be presented with submitted articles that are controversial and/or outside conventional scientific views. Some papers recently accepted for publication in Life have attracted significant attention. Moreover, members of the Editorial Board have objected to these papers; some have resigned, and others have questioned the scientific validity of the contributions. In response I want to first state some basic facts regarding all publications in this journal. All papers are peer-reviewed, although it is often difficult to obtain expert reviewers for some of the interdisciplinary topics covered by this journal. I feel obliged to stress that although we will strive to guarantee the scientific standard of the papers published in this journal, all the responsibility for the ideas contained in the published articles rests entirely on their authors. Discussions on previously published articles are welcome and I hope that, by fostering discussion and by keeping an open-minded attitude towards new ideas, the journal will spur progress in this little explored, difficult and very exciting area of knowledge. [...].

Background problem alcohol use is common among problem drug users (PDU) and associated with adverse health outcomes. Primary care has an important role in the overall stepped approach to alcohol treatment, especially screening and brief intervention (SBI). Aim To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care. Methods material for this discussion paper was gathered from three biomedical databases (PubMed, PsycINFO and Cochrane library), conference proceedings and online resources of professional organisations or national health agencies. Themes discussed in this paper are: (a) the potential of primary care for delivery of alcohol SBIs to PDUs, (b) screening methods and (c) application of brief interventions to PDUs. Although SBI improves health outcomes associated with problem alcohol use in the general population, further research is needed among high-risk patient groups, especially PDUs. Health Research Board 12M embargo - release after 24/08/2012 - AV 21/10/2011 au, ke, ab - kpw10/11/11 Embargo update in line with published version - OR 22/02/2013

Background The CONSORT Statement is a reporting guideline for authors when reporting randomized controlled trials (RCTs). It offers a standard way for authors to prepare RCT reports. It has been endorsed by many high-impact medical journals and by international editorial groups. This study was conducted to assess the endorsement of the CONSORT Statement by high-impact medical journals in China by reviewing their instructions for authors. Methodology/Principal Findings A total of 200 medical journals were selected according to the Chinese Science and Technology Journal Citation Reports, 195 of which publish clinical research papers. Their instructions for authors were reviewed and all texts mentioning the CONSORT Statement or CONSORT extension papers were extracted. Any mention of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (URM) developed by the International Committee of Medical Journal Editors (ICMJE) or ‘clinical trial registration’ was also extracted. For journals endorsing the CONSORT Statement, their most recently published RCT reports were retrieved and evaluated to assess whether the journals have followed what the CONSORT Statement required. Out of the 195 medical journals publishing clinical research papers, only six (6/195, 3.08%) mentioned ‘CONSORT’ in their instructions for authors; out of the 200 medical journals surveyed, only 14 (14/200, 7.00%) mentioned ‘ICMJE’ or ‘URM’ in their instructions for authors, and another five journals stated in their instructions for authors that clinical trials should have trial registration numbers and that priority would be given to clinical trials which had been registered. Among the 62 RCT reports published in the six journals endorsing the CONSORT Statement, 20 (20/62, 32.26%) contained flow diagrams and only three (3/62, 4.84%) provided trial registration information. Conclusions/Significance Medical journals in China endorsing either the CONSORT Statement or the ICMJE's URM constituted a small percentage of the total; all of these journals used ambiguous language regarding what was expected of authors.

Surely the answer to this difference in interpretation of Freemantle and colleagues’ paper is to ask Freemantle and colleagues to respond to Jeremy Hunt in a letter to The BMJ .1 2 It is easy for lay people, such as the health secretary, to misinterpret data in scientific papers, but part of the blame lies with the authors for not making their findings clearer …

The 50-year run of the journal Occupational Medicine and its forbears demonstrates the ways in which UK occupational medical practice has developed and changed since 1950. This has been in response to changes in society, technology and medicine. The journal has played an important part in education and professional development. It has also been the voice for the aspirations and concerns of its readers. Two aspects stand out: the development of occupational medicine as a specialty, and the way in which a medical model for occupational health service provision has been championed. A distinguished line of journal editors has been central to the crystallization of ideas within occupational medicine and their editorials map out professional successes and challenges over the years.

Background One barrier to systematically assessing feedback about the content or format of teaching conferences in graduate medical education is the time needed to collect and analyze feedback data. Minute papers, brief surveys designed to obtain feedback in a concise format, have the potential to fill this gap. Objectives To assess whether minute papers were a feasible tool for obtaining immediate feedback on resident conferences and to use minute papers, with one added question, to assess the usefulness of changing the format of resident morning report. Methods Minute papers were administered at the end of internal medicine morning report conferences before and after changing the traditional combined format (all residents) to a separate format (postgraduate year [PGY] 1 met separately from PGY-2 and PGY-3 trainees). We collected information during 3 months during 2 traditional sessions and 8 sessions in the format that separated PGY-1s (3 for PGY-1 and 5 for PGY-2 and PGY-3). Participants responded to an item rating the usefulness of the session and 3 open-ended questions. Results Trainees completed the forms in 2 to 3 minutes. Trainee assessment of the usefulness of internal medicine morning report appeared to increase after the change (4.09 versus 4.45 for PGY-1; 3.75 versus 4.38 for PGY-2 and PGY-3 residents). Conclusions Minute papers are practical instruments that provide manageable amounts of immediate feedback. In addition, minute papers can be adjusted slightly to help assess the impact of change. In that way, faculty can create an iterative process of feedback that models small cycles of change, a key quality improvement concept.

Menopause symptoms are often debilitating, affecting personal, social and professional quality of life. The majority of women use hormone replacement therapy (HRT) for valid reasons having carefully weighed up the pros and cons. Young women with premature menopause also require HRT for the primary prevention of osteoporosis, cardiovascular disease and dementia. Following the findings of three studies, the Collaborative Reanalysis (CR),1 the Women's Health Initiative (WHI),2 and the Million Women Study (MWS),3 it has been claimed that HRT is an established cause of breast cancer. As a result of this, and despite the many accepted benefits of HRT, a significant proportion of women who could benefit from HRT are not using it. The WHI and MWS had a profound effect on the prescribing of HRT and therefore on the lives of millions of menopausal women. Prescribing declined by more than two-thirds in most countries, including the UK, particularly by primary health care professionals who qualified in the last decade. Women were left feeling confused and at times terrified by alarmist headlines. This was illustrated by a survey through the Menopause Matters website where 70% of women who came off their HRT were aged less than 50 years and given current knowledge, 45% would not have discontinued therapy.4 A series of critiques of these studies (Parts 1–4)5–8 have been published in previous issues of this Journal. The latest paper in this series (Part 5)9 examines the reported decline in the incidence of breast cancer and possible attribution to the fall in …