Drug regulation
Rosiglitazone: what went wrong?
Over 10 years after the diabetes drug rosiglitazone was approved by regulators, and despite studies on tens of thousands of people, questions remain about its cardiovascular safety. An investigation by the BMJ looks at why this happened. Nick Freemantle, professor of clinical epidemiology and biostatistics, asks what we can learn from the continuing regulatory focus on the thiazolidinediones (read accompanying commentary). And editorialists Richard Lehman and colleagues say that in licensing drugs for diabetes, surrogate end points are not enough and conclude: "If the regulatory bodies do not insist on definite evidence of greater benefit than harm to patients ... they are failing in their basic purpose."
bmj.com
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Comment
Maintaining the competence of Europe's workforce
With increased professional and patient mobility across EU borders, T Horsley and colleagues argue that we need a common set of principles for continuing professional development and a more harmonised approach to accreditation.
News
G20 pathologist is suspended and has limits put on his future practice
Freddie Patel (pictured), the forensic pathologist who carried out the first postmortem examination on Ian Tomlinson, the newspaper seller who died during the G20 protest in London last year, has been suspended from practice for three months by the General Medical Council. He was found guilty of misconduct in conducting two unrelated postmortem examinations and of deficient professional performance in a third. All three examinations were carried out between 2002 and 2005.
More news published on 6 September:
Research
Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum
In this case-control analysis within a UK primary care cohort, the risk of oesophageal cancer increased with 10 or more prescriptions for oral bisphosphonates and with prescriptions over about a five year period. In Europe and North America, where the incidence of oesophageal cancer at age 60-79 is typically 1 per 1000 population over five years, this is estimated to roughly double, to 2 per 1000. The accompanying editorial says that evidence is inconclusive, but advises cautious prescribing and active follow-up.
Research
Choice of fluids for resuscitation in children with severe infection and shock
The current evidence on choice of fluids for resuscitation in children with infections is weak, say the authors of this systematic review. Samuel Akech and colleagues say that while existing trials have provided important evidence in malaria and dengue, resuscitation in children with paediatric sepsis, for which colloids could be of benefit, has not been studied. The evidence from existing studies is not robust enough to make any definitive recommendations over the choice of resuscitation fluid and a definitive trial is required to address this. In a linked editorial Joseph Carcillo says that isotonic crystalloids are advised in early resuscitation, and colloids in late resuscitation.
Education
Transient loss of consciousness - initial assessment, diagnosis, and specialist referral
Maggie Westby and colleagues summarise the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of transient loss of consciousness in people aged 16 and over.
Research
Electronic health records in secondary care in England
Interim results from the first prospective, longitudinal evaluation of implementing and adopting nationwide electronic health records in secondary care in England indicate that a top-down, centrally driven policy to deliver standardised records systems to diverse local NHS organisations has contributed to deployment delays and frustrations. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations' perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems.
Education
Endgames
This week's instalment of our new weekly educational clinical quiz is now live. Compiled from peer reviewed contributions from readers, it covers clinical medicine and statistics. There's also a prize quiz, pulled from the BMJ's sister product OnExamination.
Endgames:
Community
Today on doc2doc
BMJ Group's clinical community for doctors worldwide now has more than 30 000 members. Meet them by logging in or registering to read and join in the latest discussions, including clinical topics posted in forums that can only be accessed by verified doctors. doc2doc clinical editor Sabreena Malik's favourite posts today include:
- Diagnosis: Facebook syndrome
- Question about cortisol circadian rhythm
- Pakistan floods blog: The AJW book project
- Journal club: Do we need to exclude exocrine pancreatic insufficiency in IBS? (J Gastroenterol Hepatol)
Read these and other forums on doc2doc, BMJ Group's global clinical community
