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Print issue

This week

Is the conflict of interest unacceptable when drug companies conduct trials on their own drugs? What is the economic impact of pandemic influenza? Are there socioeconomic inequalities in the survival and provision of neonatal care among very preterm infants? To find out more about this week's BMJ print issue, read Fiona Godlee's editor's choice, We need to put the evidence to work, and the print issue's table of contents. All articles have already appeared on bmj.com as part of our continuous publication policy.

Podcast

Médecins Sans Frontières

This week the BMJ launches its Christmas appeal. For the second year running, we chose M�decins Sans Fronti�res as the charity whose work we want to highlight and support. In this week's podcast Fiona Bass, a nurse with MSF, talks about her field work and how we can all help MSF continue their work (to make a donation, follow this link).

Education

Amenorrhoea, menopause, and endocrine therapy for breast cancer

Prolonged amenorrhoea is not necessarily indicative of menopause, say oncologists Eitan Amir and colleagues in this lesson of the week. They discuss the case of a 47 year old woman with a diagnosis of lymph node positive, invasive ductal carcinoma.

Comment

The NHS in the simulator

NHS funding is set to fall in real terms but it is unclear how the system will cope. Martin McShane and Richard Smith describe their experience of a simulation exercise designed to find out

More comment published on 3 December:

Medical classics: Human Guinea Pigs

Research

Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women

According to this study, the increased risk of venous thromboembolism reached a peak in the third postoperative week and remained substantially increased up to 12 weeks after surgery. During the 12 weeks after surgery 1 in 140 middle aged UK women were admitted to hospital with venous thromboembolism after an inpatient operation, and 1 in 815 after day case surgery; this compares with only 1 in 6200 admitted with venous thromboembolism during a 12 week period without surgery. Thromboprophylaxis should cover a wider group of patients, and possibly for longer than currently recommended, says an accompanying editorial. Image: SPL.

Research

Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs

Compared with metformin (pictured), monotherapy with first or second generation sulphonylureas was associated with a significant excess risk of all cause mortality, and second generation sulphonylureas with an excess risk of congestive heart failure, says this retrospective cohort study using the UK general practice research database. The thiazolidinediones were not associated with a risk of myocardial infarction; pioglitazone was associated with a significantly lower risk of all cause mortality compared with metformin, it adds. Image: SPL.

Research

Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men

After nine weeks, the study showed a 67% reduction in apnoea hypopnoea index (AHI) in the group allocated to very low energy diet, with the greatest effect seen in patients with severe disease, whereas no change occurred in the weight stable control group, according to this randomised controlled trial. Well designed clinical trials are needed to convince policy makers, patients, and practising clinicians of the long term usefulness of tailored approaches, says an accompanying editorial. Image: SPL.

Video

Maisie & George and the future of their planet

In the UK, up to 25% of public sector emissions come from the NHS. To mark the Copenhagen climate change summit, the BMJ has commissioned a short video about how the health service can reduce its carbon footprint. If we carry on as we are, what will the world be like for babies born today when they reach adulthood?

Comment

On the origin of variation

Are differences in practice an indication of wasted resources or the key to innovation? Many voters at the recent King's Fund debate, were persuaded that the answer depends on the underlying evidence, as Nigel Hawkes reports.

More comment published on 2 December:

Debate

Unexplained variations

Practice variation is widespread in the NHS. With a tightening of budgets, and a continuing programme of quality improvement, is eliminating this variation the way to kill two birds with one stone? At this year's King's Fund annual conference, the BMJ hosted a debate entitled "This House believes the NHS should strive to eradicate all unexplained variation". You can find out more about the debate, chaired by BMJ editor-in-chief Fiona Godlee (pictured), and listen to the speakers, at this link.

Education

Endgames

Endgames is the BMJ's free interactive quiz to help doctors prepare for their postgraduate examinations. Questions are made up of case reports and picture quizzes, providing you with a practical and quick revision tool on common topics rather than clinical rarities.

This week's Endgames articles:

Picture quiz: An 80 year old woman who fell in her home

Statistical question: Random allocation III

OnExamination quiz: Tuberculosis

Education

Safety alerts: Insertion of chest drains

Chest drains are often used in the medical management of pleural effusions and pneumothorax. However, the real risks of chest drains, such as poor selection of site for drain insertion and inadequate supervision of trainee doctors, are not fully recognised. This summary is based on a safety report (known as a "rapid response report" or "RRR") from the National Patient Safety Agency.

News

Doubling investment in maternal health would "transform the future of developing nations"

Maternal deaths in developing countries could be reduced by 70% and newborn deaths halved if the world doubled investment in family planning and pregnancy related care, reports research published by the Guttmacher Institute and the United Nations Population Fund. Over half a million maternal deaths and 3.5 million newborn deaths occur each year in developing countries and many of these are preventable, says the new report.

Safety data

The mysterious Dr Foster

Consultancy Dr Foster's dire warnings about safety in many of the UK's hospitals dominated the weekend headlines. But who or what exactly is Dr Foster? And were their warnings right? Nigel Hawkes reports. See also the discussion on doc2doc, BMJ Group's clinical community site for doctors worldwide.

doc2doc

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