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Objective: There have been numerous national and international attempts to define the management of H. pylori infection, largely characterised by a consensus approach and a predominantly specialist perspective. Most patients with H. pylori infection are managed in primary care where the approach is patient centred and often symptom based. The aim of this project was to develop evidence-based guidelines that were relevant and valid for general practitioners (GPs) across all of Europe.Method: A consensus meeting of 48 GPs from nine European countries identified key issues through the structured consideration in small groups of a series of case scenarios. The process was supported by access to national prevalence data, key research literature and on-line databases. It featured an immediate and a later postal feedback round. Consensus scores were calculated for each decision point, together with a rating of the supporting evidence. The output was combined with a systematic review of the literature.Results: Th...

Objectives: It is well recognised that the results of research evidence are frequently not implemented in clinical practice. Intervention studies have shown that doctors' habits are relatively resistant to change. A qualitative approach may provide new insights to understand the barriers and facilitators to change, and the role that evidence plays in the decision-making of general practitioners. We sought to understand general practitioners' perspectives on facilitators and hindrances to the implementation of evidence-based change in general practice and their attitudes towards the concept of evidence-based medicine.Method: Thematic analysis of 44 in-depth interviews with general practitioners from four health authorities. The interviews were focused on change in general practitioners' prescribing decisions in response to evidence.Results: Most general practitioners were aware of advice about recommended, evidence-based changes, but fewer were acting upon it. The main obstacles to full implementation were...

Parity of authorship should be a priority for journals, universities, and funding agencies Women have been attending medical school in numbers equal to or greater than those of men since 1996 in the United Kingdom,1 and in nearly equal numbers in the United States since 2003.2 However, despite parity in medical school admissions, substantial gender differences in rank and leadership remain in academic medicine. The progress of women attaining first and senior authorship of original research publications, the currency of success for promotion in academic medicine, will directly translate into equity of academic advancement for women in the future. In a linked paper (doi:10.1136/bmj.i847),3 Filardo and colleagues examined the prevalence of female first authorship among original research articles published over the past two decades (1994-2014) in six high impact general medical journals. This study is notable for its rigor, examining six issues a year for all selected journals throughout the 20 year study period and using online searches of authors to identify gender in those with ambiguous names. The authors report some good news—an …

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have been published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research in the area of anticoagulation for cardiovascular disease.

Chronic itch affects millions of patients worldwide and has a significant impact on quality of life. The assessment of itch and its associated effects is a significant component of clinical practice in itch management. Despite itch being a common complaint, there are few studies describing the use of structured questionnaires for evaluation and measurement of itch and its sensory and affective dimensions. The International Society of the Study of Itch (IFSI) has recently provided invaluable data on the use of visual analogue scales as an assessment tool for itch. However, it is clear that additional tools are needed to better assess the different dimensions of chronic itch and better tailor management. With this goal in mind, a Special Interest Group was initiated by members of IFSI to determine which of the various psychometric properties of itch questionnaires offer the greatest utility in the evaluation of chronic itch. This first consensus paper addresses what domains and structure of itch questionnaires need to be implemented to better assess chronic itch and guide therapy.

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes and general cardiology audience. The studies included in this article represent the most significant research in the area of cardiovascular disease in the elderly.

Many countries, including the UK, find themselves with an increasingly aging population [World Health Organisation (WHO), 2011]. The number of people in the UK aged over 75 is set to double over the next 25 years (ONS, 2011). However there is particular concern regarding the impact on health care provision and demand with debate in the literature concerning the strategies designed to cope with the increased demand such as improved health service performance, redesign, and investment in new treatments (Saltman et al., 2006). Aging is associated with an increased incidence and risk of developing a wide variety of disease conditions, the most prevalent being the decline in musculoskeletal function. There is a debate around whether the musculoskeletal decline is an aging phenomenon per se, or whether it is a distinct pathological process increasing in risk as the individual ages (Lawrence et al., 1989; Dieppe, 1993). In addition, muscle mass and function are also reduced with age (Minaker, 2007). Together, the muscle and bone factors are important in the observed increase in frailty and falls risk in the elderly population. The elderly are generally encouraged to take more exercise to ensure, and maintain, musculoskeletal health, and many healthcare strategies build upon this principle. This paper aims to outline how chiropractic intervention and maintenance programs can play a pivotal role in the health promotion and continued musculoskeletal functioning of the elderly population.

A US study published in the Journal of Food Protection in 2006 shows that only 32% of food processing-industry workers wash their hands properly. Compliance with proper hand hygiene practices is less than 40% in the healthcare sector. After more than five years of research and development, Cascades entered the Intelligent paper™ market with a novel approach in the fight against the spread of bacteria by hand contact.

Little is known about the success rate of epidemiologic manuscripts, or the number of rejections they may go through before being published.In late 2004 we conducted a retrospective follow-up study of the cohort of manuscripts submitted to Epidemiology in 2002. Using an e-mailed invitation, we conducted an online survey of authors identified from journal records. Authors were asked about submission attempts before and after their submission to Epidemiology.Epidemiology received 371 original articles in 2002, of which it published 101 (27%). Survey response rates were 68% among the authors of accepted manuscripts, and 58% among authors of manuscripts rejected by Epidemiology. These responses provided a total sample of 223 manuscripts for analysis. Of the cohort, 83% (n = 184) were eventually accepted for publication (by Epidemiology or others). The acceptance rate by Epidemiology was the same whether or not the manuscripts had been previously rejected by another journal. Of the 155 manuscripts rejected by Epidemiology, 116 (75%) were eventually published or accepted for publication, 11 (7%) were being prepared for resubmission at the time of follow-up (19-34 months after rejection), 5 (3%) were under review by a journal, and 23 (15%) were inactive. Among the papers we could follow from first submission, 62% of those eventually published had been rejected at least once. In general, papers rejected by one journal were subsequently sent to a journal with lower impact factor.These data suggest most epidemiology manuscripts are eventually published, although some persistence on the part of the authors may be necessary.

To mark the 20th anniversary of The BMJ ’s website, the journal asked 20 UK and international readers, authors, friends, and former colleagues to name an outstanding article published since the mid-1990s. The result is an extraordinary mix of editorials, research papers, analysis, and comment, including an investigation, on topics as wide ranging as the MMR vaccine scare, death, evidence based medicine, and the use of stirrups for pelvic examinations. Some represent seminal moments in recent medical history, others are pieces of research that, for their sheer simplicity and focus on patient experience, have inspired our readers to think and work differently. So here is The BMJ ’s top 20 and why, according to our 20 chosen readers, they are the best. “The development of the EQUATOR Network (www.equator-network.org) to improve reports of research and the 2014 Lancet series of papers on ways of increasing value and reducing waste in research (www.researchwaste.net) are just two examples of testimony to the enduring influence of Doug’s 1994 call for “less research, better research, and research done for the right reasons.” Iain Chalmers, health services researcher and a founder of the Cochrane Collaboration “Over the past 30 years we have seen medicine transformed from being based on the opinions of ‘experts’ to being based on systematic collation of evidence from clinical studies. There is still a vast amount to do to improve the evidence base itself. But articles such as this have helped explain to doctors the key principles of evidence based medicine and have inspired a new generation of clinicians and researchers.” Fiona Godlee, editor in chief, The BMJ “This paper and a linked one ( BMJ 1996;313:987, doi:10.1136/bmj.313.7063.987) revealed the profound sense of responsibility that parents felt for their children and how deep seated their fears are of serious …

The UK Research Paper of the Year category recognises outstanding research by one or more UK authors that has potential to considerably improve health and healthcare. Nigel Hawkes describes the shortlisted papers Do stem cells taken from the bone marrow and injected into patients with heart disease improve heart function? Lots of people believe so, and meta-analyses by the Cochrane Collaboration show a significant positive effect. But individual trials produce conflicting results, for no very obvious reason. Darrel Francis, professor of cardiology at Imperial College in London, says: “Some things in the early trials didn’t add up and when we went to the journals that published them, we were fobbed off. So we decided to look at discrepancies in all the published trials.” Discrepancies were defined as two or more reported facts that cannot both be true because they are logically or mathematically impossible. The team’s paper, published in The BMJ, concluded that the more discrepancies a paper contained, the more positive its results. “This field of therapy appears to be most effective in the hands of researchers whose reports contain factual impossibilities,” say Francis and colleague Graham Cole. “Indeed, when the factual impossibilities disappeared, so did any effect of the therapy.” They expected a sharp reaction from researchers with many discrepancies. “We tried to soften the blow by not naming the hundreds of report authors directly,” Francis says. “But it was authors with few discrepancies, and small or zero effect sizes, who criticised the study most vocally.” This includes the Cardiovascular Cell Therapy Research Network, funded by the US National Institutes of Health with $30 million, whose data coordinator, Lem Moye of the University of Texas, told people to disregard the …

Earlier diagnosis of cancer is a compelling objective for GPs and this year’s RCGP Paper of the Year makes a significant contribution in the case of ovarian cancer.1 The Bristol team led by Willie Hamilton undertook a case-control study using GP records in 39 Devon practices as part of the prevention and early diagnosis programme of the School for Primary Care Research.2 Their project identified seven symptoms which could help clinicians to diagnose ovarian cancer at an earlier stage than …

Rare tumor research presents many challenges. Large, randomized clinical trials are often impractical in this field and access to biospecimens may be problematic. These difficulties can best be addressed through multidisciplinary, national and international collaborative efforts among researchers, clinicians, governmental bodies, and patients. Numerous governmental and private organizations now exist to facilitate cooperation between researchers and institutions. Patient advocacy organizations now play an increasingly important role in partnering with traditional research groups to promote rare tumor research. Rare Tumors is now beginning an editorial series focusing on the problems of rare tumor research. We wish to invite all researchers and clinicians who are involved in rare tumor research and treatment to contribute their observations on the problems of working in this field, either as a letter to the editor, an editorial on a select issue, or as a review paper.

Most doctors can identify key papers that have influenced their approach to the management of a particular clinical problem, although sometimes the gestation period of this effect can be very prolonged. In this short review I discuss the effects of a seminal paper by Sheila Mackenzie from the early 1990s on my current approach to the diagnosis and management of chronic cough in children.

The Lancet has retracted a 1992 study by the Canadian self proclaimed “father of nutritional immunology,” Ranjit Kumar Chandra, on the grounds that its reliability “can no longer be assured.”1 The study—a major trial that reported an improvement in older people’s immunity and infection risk after taking nutritional supplements2—was the second of Chandra’s studies to be retracted within the past six months. In October The BMJ retracted his 1989 study into the immune benefits of baby formula after receiving a suppressed report of an inquiry of his research, completed in 1995 by his former employer, Memorial University of Newfoundland, after allegations of data fabrication.3 Doubts about the plausibility of the Lancet study first …

In this paper, we present the first attempt at determining which authors of research and commentary of direct relevance to tobacco control have the most cited publications in this field. We examine this from 1980 to 2004 and also for the past decade (1994–2004) in an effort to distinguish the 100 overall most cited authors for these periods. We have also provided a list of the 50 highest citation classics in tobacco control. Citations are the most common way of measuring the impact in the scientific community of an article, and cumulatively, of a researcher.1–3 However, there can be important differences between evaluating impact and the quality of a paper. The quality of a paper is essentially characterised by the notion of possible value and this cannot be easily measured in an objective and quantitative way.4 Smith has suggested a range of ways in which scientific output might otherwise be evaluated, but all of these outcomes can be less easily measured than by calculating citations.5 While use of databases for citation analysis have been widely criticised,6 they do offer the easiest approach for assembling “ball park” data even when taking into consideration that the databases do not distinguish between positive and negative credits. Authors generally cite exemplary or important articles. While controversial badly flawed articles can also be highly cited in critical articles referring to them, it seldom happens that an author will repeatedly produce such highly cited flawed articles. The field of tobacco control is very broad and includes basic science on toxicology, pharmacology, and genetics; clinical research reporting on the impact of tobacco use on individuals’ health; epidemiological research on large populations; studies of tobacco use; and matters relevant to policies and programmes designed to reduce tobacco use and the harm it causes. …

This paper describes the clubs for patients with hypertension which have operated effectively in parts of Croatia and Slovenia (Yugoslavia) for more than 15 years, with many thousands of patients enrolling voluntarily. Based on the principle of self-help, yet involving the regular participation of members of a patient's own primary health team, they increase compliance with long-term treatment regimens and improve the quality of life. Such programmes are capable of reducing the amount of time devoted by a medical practitioner while increasing the effectiveness of treatments. If they are to succeed, it is essential to ensure regular club meetings, social activities and encouragement to each individual member to find a role and to continue attending for as long as possible. A new life style and consequent benefits to health are obtained only through long membership.

Little is known about African American women’s collection of family health history (FHH) information and use of FHH tools. Most FHH research has investigated tools that use a biomedical paradigm, but other kinds of tools, such as those that include information about family social context, have been developed for use in diverse populations. Using mixed methods, we interviewed 32 African American women about behavioral steps to collecting FHH, family communication about health, and reactions to a biomedical FHH tool. Participants chose one of two FHH tools to take home. A follow-up call three weeks later assessed tool use. Many participants expressed support for writing down FHH information, but at baseline few had done so; most participants who had collected FHH information had done so verbally. Participants reacted positively to the biomedical FHH tool used during the interview, with many saying it allowed them to see patterns in their FHH. At follow-up, 67 % reported using their FHH tool, primarily to promote discussion among family members; only 32 % used the tool to write down FHH information. Although participants thought collecting FHH information was important and had positive reactions to both tools, the majority did not use the tools to write down information and instead collected FHH informally. These findings underline the importance of separating the components of FHH collection behaviors to analyze the steps used in FHH creation. Practitioners should consider additional methods of encouraging patients to create written FHHs in order to share the information with health care providers.

Background Zinc is important in adolescence because of its role in growth and sexual maturation. Adolescents from developing countries such as India may be at high risk of zinc deficiency because of unwholesome food habits and poor bioavailability of zinc from plant-based diets. Objective (1) to study zinc status and its association with profile of other micronutrients, (2) to construct a simple tool in the form of Adolescent Micronutrient Quality Index (AMQI) to assess quality of diets of the girls and (3) to examine the effect of zinc supplement on health of adolescent girls. Methods Girls (10–16 years) from two secondary schools of Pune, Maharashtra state, in Western India were enrolled in a cross-sectional study (n = 630). Data were collected on dietary intake, cognitive performance, taste acuity, haemoglobin, erythrocyte zinc and plasma levels of zinc, vitamin C, β-carotene and retinol. AMQI was developed using age–sex-specific Indian dietary guidelines and healthy foods and habits described in the recent US dietary guidelines. Zinc-rich recipes were developed considering habitual diets of the girls and vegetarian sources of zinc. An intervention trial (n = 180) was conducted to assess the effect of zinc-rich dietary supplements and ayurvedic zinc (Jasad) supplementation. Results Prevalence of micronutrient deficiencies was high in these girls. Poor cognitive performance was seen in half of the girls, and salt taste perception was affected in 45%. AMQI was correlated with nutrient intakes and blood micronutrient levels (p < 0.01), indicating the potential of AMQI to measure micronutrient quality of diets of adolescent girls. Results of the intervention trial indicated that supplementation of zinc-rich recipes vis-a-vis ayurvedic Jasad zinc has the potential to improve plasma zinc status, cognitive performance and taste acuity in adolescent girls. Conclusions Review of the studies on Indian adolescent girls demonstrates the necessity of adopting zinc and micronutrient-rich diets for positive health building in adolescents.

We determined how the quality of trial design and its reporting in scientific papers published in Anaesthesia has changed in the last 25 years. All articles between the years 1983-87 and 2003-07 were reviewed and classified according to methodology. Reporting and trial design of all prospective, comparative clinical interventional trials were compared between the two time periods using 12 criteria. Fewer articles now originate from the United Kingdom and Ireland than 25 years ago. Although fewer human interventional trials are now published in Anaesthesia, the quality of these trials has improved in terms of study design, bias control and proper disclosure. Significant improvements were observed in all criteria of trial design except for the declaration of non-primary adverse outcomes and the minimisation of the risk of type I errors. Further improvements could still be made with respect to sample size calculation, description of the method of randomisation, and blinding.

According to the back cover of this booklet, The British Nutrition Foundation promotes the nutritional wellbeing of society by interpreting and disseminating scientifically based knowledge and advice. Here they tackle the science and practice of sports nutrition, acknowledging that although the information is underpinned by rigorous research in exercise physiology and metabolism, it must be …

In 2001 Eysenbach defined e-health as “an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related tech-nologies. In a broader sense, the term characterizes not only a technical devel-opment, but also a state-of-mind, a way of thinking, an attitude, and a commit-ment for networked, global thinking, to improve health care locally, regionally and worldwide by using information and communication technology.”

This report is the SOSORT Consensus Paper on School Screening for Scoliosis discussed at the 4th International Conference on Conservative Management of Spinal Deformities, presented by SOSORT, on May 2007. The objectives were numerous, 1) the inclusion of the existing information on the issue, 2) the analysis and discussion of the responses by the meeting attendees to the twenty six questions of the questionnaire, 3) the impact of screening on frequency of surgical treatment and of its discontinuation, 4) the reasons why these programs must be continued, 5) the evolving aim of School Screening for Scoliosis and 6) recommendations for improvement of the procedure.

We read the paper by Hankins et al in the recent BJGP with interest.1 We accept that published psychometric data concerning GPAQ is relatively limited, and are committed to further research and development of the questionnaire. However, the situation is as bleak as they make out. Forms of validity such as face and content validity are an important aspect of questionnaire development, and GPAQ more than …

Two papers that reported that the blood pressure drug ramipril was beneficial in patients with intermittent claudication due to peripheral artery disease have been retracted after an investigation found that data were fabricated by the studies’ lead author, Anna A Ahimastos, a researcher at the prestigious Baker IDI Heart and Diabetes Institute in Melbourne, Australia. The first paper,1 published in JAMA in …

The most appropriate primary outcome measure for reproductive medicine has been discussed frequently. In 2003 the European Society for Human Reproduction and Embryology recommended that the outcome measure of assisted reproductive technology (ART) and non-ART should be singleton live birth. Although live birth is indeed the aim of clinical practice, and there is no discussion that it should be reported in infertility trials, we hereby provide arguments that plead for using ongoing pregnancy as the primary outcome in such trials. We feel that ongoing pregnancy best serves the many purposes of a primary outcome and best reflects the effectiveness of a treatment.

ContextTo determine whether the views expressed in a research paper are accurate representations of contributors' opinions about the research being reported.MethodsPurposive sampling of 10 research articles published in The Lancet; qualitative analysis of answers to 6 questions about the meaning of the study put to contributors who were listed on the byline of these articles. Fifty-four contributors listed on the bylines of the 10 articles were evaluated, and answers to questions were compared between contributors within research groups and against the published research report.ResultsA total of 36 (67%) of 54 contributors replied to this survey. Important weaknesses were often admitted on direct questioning but were not included in the published article. Contributors frequently disagreed about the importance of their findings, implications, and directions for future research. I could find no effort to study systematically past evidence relating to the investigators' own findings in either survey responses or the published article. Overall, the diversity of contributor opinion was commonly excluded from the published report. I found that discussion sections were haphazardly organized and did not deal systematically with important questions about the study.ConclusionsA research paper rarely represents the opinions of those scientists whose work it reports. The findings described herein reveal evidence of (self-)censored criticism, obscured meanings, confused assessment of implications, and failures to indicate directions for future research. There is now empirical support for the introduction of structured discussion sections in research papers. Editors might also explore ways to recover the plurality of contributors' opinions.

The use of statistics in medical diagnoses and biomedical research may affect whether an individual may live or die, whether their health is protected or jeopardized. Because society depends on sound statistical practice, all practitioners of statistics, whatever their training or occupation, have social obligations to perform their work in a professional, competent, and ethical manner.

Since its inception, the Annals of Family Medicine has sought research on clinical topics: new knowledge that fills a gap in our understanding of how health and illness are gained and lost, how patients present and progress in primary care, and how diagnosis and treatment of patients in primary care

Studies with negative results rarely hit the headlines. But the results are often just as important as the positive ones. A number of 'negative headline' studies are looked at in this review: intensive insulin therapy regime, thrombolysis in cardiac arrest, the effects of nutritional guidelines and rapid response outreach teams.

Editorial World Journal of Emergency Surgery (WJES) was started to encompass all aspects of clinical and basic research studies related to emergency surgery and its allied subjects. Emergency surgery is a multidisciplinary super-specialty involving all surgical specialties and all emergency medicine specialties. Emergency surgery is divided into traumatic and non-traumatic emergency surgery. WJES accepts the following types of articles: research, case reports, reviews, book reviews, commentaries, letters to the editor, methodology articles, and study protocol.

To the Editor: The following views are my own, and are not necessarily the views of any university department. I am responding to the discussion paper handed out on Thoughts on the state of Family Medicine in South Africa at the 16th National Family Practitioners Conference recently held in Cape Town.

The Medicines and Healthcare products Regulatory Agency was established in April 2003 by the merger of the Medicines Control Agency (MCA) and the Medical Devices Agency (MDA). This paper describes the scientific and organizational basis for the merger and describes the various challenges facing this new Agency.