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Print issue

This week

How long does it take to train a surgeon? Does lying still after intrauterine insemination increase pregnancy rates? How can the burden of malnutrition in Bangladesh be reduced? To find out more about this week's BMJ print issue, read Fiona Godlee's editor's choice, Crunch time for doctor's hours, and the print issue's table of contents. All articles have already appeared on bmj.com as part of our continuous publication policy.

Research

Evaluating the causal relevance of diverse risk markers

This horizontal systematic review pinpoints deficiencies and strengths in the evidence for depression, exercise, C reactive protein, and diabetes as unconfounded and unbiased causes of coronary heart disease. This new method could be used to develop a field synopsis and prioritise future development of guidelines and research.

Comment

Smoking cessation agents and suicide

Both varenicline and bupropion have been associated with "changes in behaviour, agitation, depressed mood, suicidal ideation, and attempted and completed suicide" in patients who had no psychiatric history and were not taking psychotropics. They cannot make a treatment preference if doctors do not fully inform them about the risks, uncertain though they may be, says this editorial by Jill E Lavigne, associate professor at Wegmans School of Pharmacy, St John Fisher College, Rochester, New York. A retrospective cohort study last month examined suicidal thoughts and behaviours after exposure to smoking cessation products.

Podcast

Analysing aspirin

BMJ deputy editor Trish Groves interviews Ike Iheanacho, editor of Drug and Therapeutics Bulletin, about its report on the use of aspirin as a primary preventative. Kirsten Patrick, an associate editor at the BMJ, talks to Charis Eng from the Cleveland Clinic about the growth in commercially available genomic screening tests. And Sabreena Malik, clinical community editor of doc2doc, BMJ Group's clinical community site, takes us through this week's news.

See also:

Aspirin for primary prevention of cardiovascular disease?

A practical guide to interpretation and clinical application of personal genomic screening

Comment

How long does it take to train a surgeon?

The time required to train a competent surgeon is a hotly debated topic as working hours for medical trainees are increasingly restricted worldwide. Surgical disciplines are unique in that surgeons must not only acquire medical knowledge but also develop the manual dexterity and, sometimes, the strength and endurance to perform procedures. Gretchen Purcell Jackson and John Tarpley examine the evidence from the United States on the effects of duty hour legislation on surgeons' training. In a linked editorial Roy Pounder writes that creating more flexibility around current working is the solution.

Comment

Dangers of listening to the fetal heart at home

An over the counter fetal heart monitor can be a fun purchase for expectant parents eager to hear their unborn child. But Abhijoy Chakladar and Hazel Adams warn that parents shouldn't rely on the devices to indicate fetal health. In an accompanying commentary, Rebecca Coombes warns that there are some monitors on the market that do not comply with UK and EU regulations.

Comment

Commercial solutions to malnutrition

Big business in Bangladesh is at the centre of a drive to reduce rates of malnutrition, but is this an appropriate public health measure, and will it make any more than a dent in the problem? Ben Bland asks. In a linked feature Tahmeed Ahmed and A M Shamsir Ahmed write about the interventions needed to reduce the burden of malnutrition in Bangladesh.

Also published on 5 November:

International Aid: Innovative financing of health care

Tessa Richards: Brave new world

Theodore Dalrymple: Sound sleep advice

Mary E Black: An interest in teeth

Des Spence: It's better to give

Medical Classic: De Rerum Natura (The Nature of Things)

The highs and lows of policy based evidence

Review of the week: On the concept of trauma

News

US lags behind 10 other countries in primary care

A large international survey of primary care doctors in 11 industrialised nations has found that the United States is often the outlier in medical practice, contributing to the higher cost of care in the US and its relatively poor health outcomes. The survey findings point to policy changes that might improve care in the US.

Also published on 5 November:

Half of people dying within four days of hospital admission lack input from senior doctors, inquiry finds

Cost of NHS and education grows faster than general economy

X ray machine tops poll of most important scientific invention

Former head of NHS watchdog attacks MPs' inquiry into patient safety

Student BMJ

How old is too old?

The Student BMJ considers the taboo of older mums. Recent articles also look at religion and drugs: doctors must consider the faith of their patients when prescribing. Plus bullying and sexism in medical school--has anything changed? Let us know what you think by sending a message on student.bmj.com.

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 for common topics rather than clinical rarities.
This week's Endgames articles:

Picture Quiz: An occult breast mass

Statistical Question: Study design

OnExamination Quiz: Adverse drug reactions

BMJ Group Awards 2010

Nominations open for next year's BMJ Group awards

The BMJ Group Awards are back - bigger, better, and with a stronger international flavour. Nominations are sought for 11 awards, to be presented at a gala evening in London next spring. Each category in the awards will have an internal champion within the BMJ, and judging will take place early next year. Nominations close on 15 November, and award winners will be announced on 10 March. Visit the awards website to find out more.

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