NDLI: Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up (Journal: BMJ (British Medical Journal) Volume: 354)

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Year: 2017 Volume: 353

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Year: 2016 Volume: 532

Year: 2016 Volume: 356

Year: 2016 Volume: 355

Year: 2016 Volume: 354

Screening for asymptomatic bacteriuria before total joint arthroplasty.

Patient focused registries can improve health, care, and science.

Parents of children having heart surgery at Bristol hospital 'were let down'.

Doctors getting biggest payments from drug companies don't declare them on new website.

Canada's new assisted dying law faces legal challenge.

Margaret McCartney: Optional disclosure of payments is pointless.

Drugs for treating alcohol dependence in England cost nearly £4m in 2014

Nearly half of people with infertility do not seek medical help, survey shows.

Disclosing drug companies payments should be compulsory, say top earners.

Better working environments could boost recruitment to anaesthesia, says study.

Government rejects BMA’s call to invest extra £350m a week in NHS

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

GPs in England and Scotland are reluctant to use email consultations, survey finds.

GPs should have direct access to wider range of tests for suspected cancer, says NICE.

GP is suspended for three months for smacking hand of patient with dementia.

Obama presses Congress to agree to Zika funding.

Uptake, outcomes, and costs of implementing non-invasive prenatal testing for Down’s syndrome into NHS maternity care: prospective cohort study in eight diverse maternity units

Lost in translation: evidence to improve outcomes of very preterm infants.

NHS funding at serious risk from Brexit, think tank warns.

Embracing the ethically complicated patient.

NHS leaders condemn racist abuse of staff.

Junior doctors reject proposed new contract.

Medical register could include voluntary conflicts of interest information.

Health groups demand closure of Europe's coal fired power stations.

Patient care will worsen, warn NHS finance chiefs.

Antibiotics for acute respiratory tract infections in primary care.

Risk of staphylococcal infection runs in families.

David Oliver: Celebrating the expert generalist.

Screening for health literacy is not the answer.

Robert Califf: controversial new head of the FDA.

Funding PrEP for HIV prevention.

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort

Adding to the transitional care evidence base for future national guidance.

Nursery policies on conjunctivitis may encourage GPs to prescribe antibiotics.

Switching older people to a pill organiser could increase adverse events, researchers warn.

Brexit: the decision of a divided country.

Disclosure UK: transparency should no longer be an optional extra.

The threat of poor quality antibiotics in increasing antimicrobial resistance.

Was there ever a golden age for junior doctors?

Advances in the management of chronic insomnia

Sheila Hollins: Looking beyond learning disabilities.

Goodbye to the European Working Time Directive?

Junior doctor contract will be imposed, says Hunt.

Assessment and management of cirrhosis in people older than 16 years: summary of NICE guidance

Hip osteoarthritis.

Disclosure UK website gives 'illusion of transparency,' says Goldacre.

Referendum anger with The BMJ is misdirected.

GMC review of fitness to practise procedures is complete.

Authors' reply to Gallagher and Winocour.

Calcium channel blockers are not associated with increased risk of breast cancer, study finds.

Corrado and colleagues reply to Van Brabandt and colleagues.

Don't dismiss pioglitazone on basis of uncertain risk.

US food subsidies fuel obesity, study finds.

Sixty seconds on . . . helium.

The BMJ should not tell us how to vote on Brexit.

Five minutes with . . . David Gilbert, patient director.

US has worst traffic accident death rate among high income countries.

Soldiers injured in Iraq War were let down by lack of dedicated health facilities, Chilcot report finds.

England's most senior doctor immortalised.

Seven days in medicine: 29 June to 5 July 2016

What Brexit means for the European Working Time Directive.

Controversial database of medical records is scrapped over security concerns.

Neonatal units in Wales are understaffed and under-resourced, says report

A fifth of acute pancreatitis cases are not diagnosed promptly, inquiry warns.

All government departments must tackle causes of ill health, say experts.

GMC says it can't force doctors to disclose payments from drug companies.

Barbara (Basia) Howells

Thomas Oswald Candler.

Nina Avis Mellon.

Peter Alan Trott.

Michael Stephen Arnold Townsend.

Congenital heart disease units will close in Manchester, Leicester, and the Royal Brompton.

Medical boards often shield doctors guilty of sexual misconduct, investigation finds.

Tobacco giant loses legal action over Uruguay's tobacco packaging rules.

Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis

NHS failed to commission mental health services properly at Yarl's Wood.

The BMJ appoints two new ethics committee members.

Five ways the UK clinical academic workforce is changing.

Slow response contributed to scale of west African Ebola epidemic, CDC concludes.

US officials ban Theranos CEO from running laboratories for two years.

US urges Puerto Rico to start aerial spraying to reduce risk of birth defects.

Cancer risk is higher in years before and shortly after type 2 diabetes diagnosis, study shows

E-cigarettes may be reversing fall in teenage smoking, study finds

Anthony Carl Kaeser.

Government should think again about prioritising seven day NHS services, King's Fund says.

Oscar Wendell Jordan.

George Alexander McDonald.

John Watt Robertson.

Johnson & Johnson is ordered to pay \$70m to boy who developed gynecomastia

Drug previously available only through Cancer Drugs Fund is approved for NHS use.

Maurice Simeon Albin.

National body is considering a single register for all health and care professionals.

Sixty seconds on . . . road traffic crashes.

The junior doctor contract: we now need strong leadership at all levels.

Five facts about the gender pay gap in UK medicine.

Small increase in alcohol duty may cut violence related emergency department visits.

Commonly used drugs and supplements can worsen heart failure, US doctors warn.

Multivitamin and mineral supplements in pregnancy are unnecessary expense, review finds.

More doctors are engaged in commissioning under CCGs.

Should the NHS abolish the purchaser-provider split?

Chilcot: physical and mental legacy of Iraq war on UK service personnel.

The Goldilocks problems in regulation.

University closes PTSD studies after complaints from drug regulator.

Authors' reply to Kole.

Australian researchers declare an end to AIDS as a public health issue.

Studies must show the value of regulatory schemes.

Light touch regulation may be most effective.

Public Health England advice on PSA testing.

Staff shortages are impeding efforts to improve cancer outcomes in England.

Digital pathology imaging offers more benefits than glass slides and microscopes.

'Bleak' future predicted for social care without urgent extra funding.

Health reforms achieved primary goals, says Obama.

No HIV transmission from condomless sex when partner is on ART, study shows.

Grosvenor Charles Thomas Burfitt-Williams

Treat signs of sepsis with same urgency as chest pain, says NICE.

'Unloading shoes' are no better than walking shoes for knee osteoarthritis, trial finds.

Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care

Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group: population based cohort study

Richard Lilford: Hates non sequiturs at dinner parties.

Senior doctors need to do more to boost juniors' morale.

Government looks into claims of discrimination against UK scientists since Brexit.

Using NHS data to improve health.

Five minutes with . . . Chris Harrison, cancer tsar.

David Oliver: End of life care in hospital is everyone's business.

Indian surgeon vows to continue stem cell research on brain dead patients.

Haiti's health system collapsing under weight of doctors' strike.

National Health Action Party gets interim leader after founder resigns.

Meningitis B vaccine should not be given to babies, committee says.

US states that allow medical marijuana see drop in prescriptions for other drugs, study finds.

Big health data: the need to earn public trust.

Hunt for new health secretary is over as Jeremy stays in post.

Seven days in medicine: 6-12 July 2016

Colorectal adenocarcinoma: risks, prevention and diagnosis.

Routine preoperative tests for elective surgery: summary of updated NICE guidance.

Factors that increase risk of persistent pain after breast cancer surgery are identified.

Streamlined genetic testing pathway is developed for women with ovarian cancer.

US regulator stops leukemia treatment trial after three patients die.

Children with suspected diabetes should be seen by a specialist immediately, says NICE.

New test could help 40 000 pregnant rhesus D negative women avoid treatment, says NICE

Yellow fever in Africa.

Sunil Inderraj Handa.

Peter Edward Baldry.

NHS must rein in spending on specialised services, MPs warn.

Frozen tissue service offers fertility hope to young people with cancer.

Health experts urge MPs to back decriminalisation of prostitution.

Challenges facing the health secretary in new Cabinet.

Embracing inherent uncertainty in advanced illness.

FDA lifts hold on cancer immunotherapy trial placed after patients died.

Workforce gaps are result of reorganisations and 'quick fixes,' Health Foundation says.

NHS needs culture shift regarding sleeping at work.

UK prime minister appoints new ministerial team.

Canada's scientists win overhaul of federal research grant system.

Stress is unlikely to increase breast cancer risk, study finds.

Evidence based medicine and bronchiolitis: don't ignore uncertainties.

Diverting tampon taxes will not solve the issue of violence against women.

Progress towards 2030 UN goal to end HIV epidemic falters

Five facts from the GMC's annual training survey.

NHS England unveils mental health plan.

Ministers have little choice but to keep boosting spending on NHS.

Severely obese teens who have bariatric surgery show improved mobility and less pain.

Sixty seconds on . . . medical marijuana.

Brexit will hamper introduction of seven day hospital services, expert warns.

Fracking is linked to asthma increase, study finds.

NHS plan is at risk from cuts to public health and social care, MPs warn.

US Congress fails to agree Zika virus funding before summer break.

Scaled up general practice organisations do not provide better quality of care, report says.

We should investigate social media's value properly.

More of the same from the Department of Health?

England must support its community hospitals.

Live tweeting: a tool for learning and reflection.

Twitter can enhance the medical conference experience.

Jenny Higham: Fearing Brexit damage.

Pelvic organ prolapse.

Revolutions in public health: 1848, and 1998? (Journal: BMJ (British Medical Journal) Volume: 354)

(Journal: BMJ (British Medical Journal) Volume: 354) : Correction.

Arthroscopic surgery for knee pain.

Variability in LDL cholesterol is linked to poorer cognitive performance in older people.

Diabetes drugs show no significant difference in risk of death.

Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up (Journal: BMJ (British Medical Journal) Volume: 354)

Margaret McCartney: The unacceptable cost of non-NHS screening

I never asked to be ICE'd.

Unilateral metamorphopsia in a 73 year old woman

Deaths at UK immigration detention centres are the result of avoidable systemic failures, report says. (Journal: BMJ (British Medical Journal) Volume: 354)

Use of imaging tests after primary treatment of thyroid cancer in the United States: population based retrospective cohort study evaluating death and recurrence

When and how to update systematic reviews: consensus and checklist. (Journal: BMJ (British Medical Journal) Volume: 354)

Wellbeing and being well.

Public Health England recommends vitamin D supplements in autumn and winter.

Eating more unsaturated fats and less carbohydrate reduces blood glucose, study finds.

NHS England plans to heal relations between government and junior doctors.

Surgeon specialization and operative mortality in United States: retrospective analysis

Surgeon is suspended for altering dead patient's notes retrospectively.

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation (Journal: BMJ (British Medical Journal) Volume: 354)

Now you see it, now you don't.

Poor adherence to antihypertensive drugs. (Journal: BMJ (British Medical Journal) Volume: 354)

Seven days in medicine: 13-20 July 2016

David Oliver: Hip fracture care shows the way.

Brenda Mary Slavin.

Deaths at UK immigration detention centres are the result of avoidable systemic failures, report says. (Journal: BMJ (British Medical Journal) Volume: 354)

Replenishing \$13bn Global Fund is “not a given”

Experimental procedures involving animals rise slightly, show British figures.

Variable discharge of older UK patients is 'unacceptable,' say MPs.

The management of chronic breathlessness in patients with advanced and terminal illness. (Journal: BMJ (British Medical Journal) Volume: 354)

Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response meta-analysis (Journal: BMJ (British Medical Journal) Volume: 354)

Dietary therapy for irritable bowel syndrome.

Vitamin K is important for epilepsy in pregnancy.

Ask patients 'What matters to you?' rather than 'What's the matter?'.

Authors' reply to Divers and Braillon.

Epilepsy in pregnancy: from ideal to real life?

Female smokers are at highest risk for brain bleeds, study shows.

Cancer research must focus on how cancer cells evolve, new UK strategy argues.

(Journal: BMJ (British Medical Journal) Volume: 354) : Correction.

England's health department avoids breaching budget on 'technicality'.

Laura Kris Squance.

Michael Leveaux.

Warren Durrant.

Elizabeth Forsythe.

Douglas Robertson.

American Cancer Society questions study claiming increase in metastatic prostate cancer.

Federal privacy rules offer scant protection for users of health apps and wearable devices.

Margaret McCartney: Clean eating and the cult of healthism.

Hunt is accused of 'underhand' cover up over health department finances.

US probes first apparent non-sexual person-to-person Zika transmission and first domestic outbreak

One in 10 adults has tinnitus and risk increases with noise exposure, study shows

Simpler psychological treatment is as effective as CBT for depression and is cheaper, study shows.

Open contracting for health services.

Three are charged in \$1bn US Medicare fraud case

India is urged to resist US pressure to rein in its affordable medicines policies.

Flu vaccination reduces hospital admissions for cardiovascular disease in people with diabetes, study shows.

Induced labour is not associated with risk of autism, say researchers.

Juniors' 'reduced' hours are more intense.

Range of generics will be withdrawn across Europe.

NHS trust stands by doctors who set up clinic for private work. (Journal: BMJ (British Medical Journal) Volume: 354)

When hospitals switch to electronic records.

Richard Selzer.

Sedentary people are advised to do at least one hour of moderate activity a day.

A pill too hard to swallow: how the NHS is limiting access to high priced drugs.

Long travel time to specialised stroke centre offsets potential benefits, study shows.

Olympus chose not to alert US doctors of infections linked to its duodenoscopes.

Former Johnson and Johnson executives are convicted over off label marketing.

US proposes to expand fixed payments to cardiac care.

Seven days in medicine: 20-26 July 2016

Global cost of physical inactivity is estimated at \$67.5bn a year

Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis

NHS 'haemorrhaging money' on clinical negligence claims, defence bodies warn.

Pregnancy outcomes after treatment for preinvasive cervical lesions.

Congenital heart disease in adults.

Adverse inpatient outcomes during the transition to a new electronic health record system: observational study

NHS trust stands by doctors who set up clinic for private work. (Journal: BMJ (British Medical Journal) Volume: 354)

Improved GP retainer scheme with increased funding is launched.

New Cancer Drugs Fund is flawed without NICE reform, says Roche.

Killed surgeon at Berlin hospital had treated patient who shot him.

Hospitals and birth centers remain safest setting for giving birth, US obstetricians say.

More than 50 UK Zika cases are reported in people returning from abroad so far this year

Kalipso Chalkidou: Internationally NICE.

NHS's financial woes undermine quality and safety drive.

Locking doors in mental health hospitals does not reduce suicide or absconding, shows study.

New Pakistani visa controls leave patients from Afghanistan without treatment.

£60m scheme will cover GPs’ rising indemnity costs

Young people in Asia carry high risk for non-communicable diseases, finds report

Four in Florida are infected with Zika from local mosquitoes.

British scientists seek guarantees for researchers bidding for EU funding.

Pressured general practices get £16m support fund

Margaret McCartney: Can junior doctors feel safe to blow the whistle?

NHS funding in England: money's too tight to mention.

UK's first maternity service for rape survivors opens in London.

Use of private sector for NHS hip surgery has reduced NHS provision, study finds.

Poor continuity of primary care may increase mortality in elderly people, study shows.

Minority ethnic people find home BP monitoring less acceptable than white British, study shows.

Eating more plant protein is associated with lower risk of death.

Fish oil omega 3 fatty acids improve heart muscle recovery after MI, trial shows

Streamlining ethical review of data intensive research.

Academics should leave research credentials behind when they move, Stern report says.

NHS England to appeal against ruling that it can fund PrEP to prevent HIV.

Dozens of Turkish doctors are among those detained after coup.

GSK and Google form partnership to develop bioelectronic medicines.

One in 10 young people experiences a distressing sexual problem

NEET: India's single exam for admission to medical school promises transparency and quality.

Thomas Boulton.

US officials issue travel alert for Miami area as Zika cases rise to 15

Ontario plans to stop funding high dose opioids.

Saving antibiotics for when they are really needed: the Dutch example.

Prescription drug misuse in Europe is higher than previously thought.

Thinner thread is better for cervical stitch procedure, say researchers.

Quality and Outcomes Framework: what have we learnt?

Diabetes drugs in England cost nearly £1bn last year

After 12 years, where next for QOF?

Can pay for performance improve the quality of primary care?

Ophthalmologist who had an affair with patient avoids sanctions because of 'unique' surgical skills.

Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study

QT interval and drug therapy (Clinical review from Drug and Therapeutics Bulletin)

Australian doctors condemn 'horrific' treatment of children in juvenile detention.

John McKessar Duncan.

Learn from the mistakes of care.data.

Neelika Karunaratne.

Smaller employers are less likely to provide occupational health support.

NICE calls for wider supply of condoms to reduce STIs.

Geoffrey James Roberts.

Warfarin with sulfonylureas and hypoglycemic events: consider dose, length of treatment, and all sulfonylureas.

Liquid biopsies will be routine NHS test for cancer 'in under five years'.

The Brexit broadcast that stoked fears over the NHS's future.

Author's reply to Mathioudakis and colleagues.

Serum procalcitonin can guide antibiotic administration for respiratory tract infections in primary care.

David Oliver: NHS continuing care is a mess.

Insurance claims related to opioid dependence have risen by 3200%, US study finds

Opt-in method is vital for data sharing

Smoking rates vary widely in US racial and ethnic groups.

Authors’ reply to Bosco-Lévy and Salvo

Council of Europe dismisses claim that abortion in Italy is harder because more doctors are objecting. (Journal: BMJ (British Medical Journal) Volume: 354)

Five minutes with . . . Jenny Higham, chair of the Medical Schools Council.

PHE guidance does warn about PSA testing.

Meta-analysis looks at effectiveness of MoodGYM programme in computerised cognitive behavioural therapy

James Riddick Heron.

Charles Desmond Ross Pengelly.

Oestrogen-containing contraceptive pills increase vitamin D levels, study finds

HIV charity criticises NHS England over 'homophobic' PrEP statement.

Leading pancreatic cancer researcher is struck off for fabricating data.

Nearly half of US pediatric trials are unfinished or unpublished, study finds.

Choice of non-medic to run radiology school was “ill conceived,” says royal college

Curative hepatitis C treatment is effective in drug users, trial shows.

Caution is urged over 'game changing' asthma drug.

Cash strapped CCG plans to halt non-urgent referrals

Trusts spend 25 times more on locum fees than on recruiting for permanent posts

Five boosts to GP funding.

Congenital Zika syndrome with arthrogryposis: retrospective case series study

NHS trust may shut emergency department at night because of staffing 'crisis'.

Margaret McCartney: Game on for Pokémon Go

Medicine's solemn moments.

Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013

Social networking for patients.

Most patients taking warfarin do not maintain stable INR values.

Michael Sharpe: Psychiatry was no 'waste of a career'.

Website aims to help people understand health research.

Meaningless METS: studying the link between physical activity and health.

Rita Redberg: an unwavering campaigner against the harms of too much medicine.

Stand up for the NHS: Margaret McCartney joins Phil Hammond on stage in Edinburgh.

Blood pressure variability and cardiovascular disease: systematic review and meta-analysis

Sixty seconds on . . . the NHS 'reset'.

Junior doctors will have whistleblowing protection added to contracts.

Blood pressure variability and cardiovascular risk.

Maternal mortality rates rise in US, study finds.

Avoiding unconscious bias.

Benign male genital dermatoses. (Journal: BMJ (British Medical Journal) Volume: 354)

GP recruits offered £20 000 to train in Scotland

Scotland prioritises action on child poverty.

Suspected sepsis: summary of NICE guidance.

General practice should be recognised as specialty in UK, leaders argue.

Brazil to investigate if other factors act with Zika to cause congenital defects.

Thymectomy improves outcomes in myasthenia gravis, trial shows.

Admission for infection is linked to increased suicide risk.

Seven days in medicine: 3-9 August 2016

(Journal: BMJ (British Medical Journal) Volume: 354) : Correction.

NHS misses key performance targets again in June.

Richard Shayle Bartholomew.

Samir Kumar Chatterjee.

Anne Marion Pearson.

CCG ditches plan to suspend non-urgent referrals

Australian medical leaders call for urgent action on reports of abuse of immigrant detainees.

NICE recommends ticagrelor with aspirin for three years post-MI

History of depression in grandparent and parent may raise risk of the condition.

David Oliver: Consultant contracts and seven day services.

Medicaid expansion is associated with improved access to care and self reported health, US study finds.

Syrian doctors appeal to President Obama for help.

The management of dry eye. (Journal: BMJ (British Medical Journal) Volume: 354)

Andrzej Maciejewski.

Bernard Nchewa Nwulu.

Robert Marshall Milne.

Arthroscopic surgery for knee pain: where is the shared decision making?

The FDA, Juno Therapeutics, and the ethical imperative of transparency.

Poor quality data from diet studies may dilute better quality evidence.

Authors' reply to Henderson.

Author's reply to Hanretty and Ford.

ICEs require skilled communication.

Brexit vote: absolute numbers are misleading.

Canadians authorised to use cannabis for medical purposes to be allowed to grow their own again.

Margaret McCartney: Racism, immigration, and the NHS.

The Stern review of the Research Excellence Framework.

Incidence of neonatal abstinence syndrome triples in US.

Obama turns his hand to health policy analysis.

UK drug appraisal process is restricting access to cancer drugs, say charities.

Authors' reply to Timms and Bird.

Informed choice involves many active skills.

Healthy diet could prevent gout flares, study finds.

Strict BP control in chronic kidney disease reduces long term risk of death, study shows.

Growing gaps in paediatric rotas threaten children's healthcare, says royal college.

Author's reply to Woodward.

On validation of cardiovascular risk scores.

Pioglitazone use and risk of bladder cancer in patients with type 2 diabetes: retrospective cohort study using datasets from four European countries

Vitamin D supplements poison dozens of Danish children.

German body calls for pause in European plan for fast track drug approval.

Timeline cluster: a graphical tool to identify risk of bias in cluster randomised trials.

Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial

What doctors say and what patients hear.

'Weekend effect' for emergency general surgery has almost disappeared, study shows.

Decriminalising sex work in the UK.

'Adaptive pathways' to drug authorisation: adapting to industry?

GP receptionists could do more to relieve 'burden' on patients, study finds.

Intranasal flu vaccine provides similar protection to injected flu vaccine, finds study.

No 'breakthrough' in Alzheimer's disease.

Sharp rise in patients waiting more than 18 weeks for elective surgery

Seven days in medicine: 10-16 August 2016

Cardiovascular and death risks are lower if parents live longer, show UK data.

Draft bill for new regulatory structure for medicine in India prompts criticism.

Sixty seconds on . . . the £20 000 golden hello

How junior doctors reached the brink of fresh strikes.

GPs test value of adding dementia item to midlife health check.

Idiopathic normal pressure hydrocephalus.

Negotiations have begun on new national GP funding formula.

Acute hepatitis in a teenager.

'It's just a bit of colic,' they said.

Intractable nausea and vomiting associated with poor glycaemic control in a patient with type 1 diabetes

NHS sustainability and transformation plans: proposals for savings lack scrutiny.

Paediatricians criticise college survey on links with formula milk firms. (Journal: BMJ (British Medical Journal) Volume: 354)

14 million people in central Africa to be vaccinated to try to halt yellow fever outbreak

Brazil sees sharp rise in chikungunya cases.

Nick Harding: Happiest working for health in Malawi.

Five minutes with . . . Frank Atherton, chief medical officer for Wales.

Lessons for consultants from the junior doctor dispute.

Use Brexit to strengthen language tests for EU doctors, royal college says.

Targeted case finding improves treatment of patients at high risk for CVD, study finds.

Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study

NICE recommends dropping two drugs from Cancer Drugs Fund.

Paracetamol is no more likely to exacerbate asthma in children than ibuprofen, shows study.

Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial

Five alternatives to 'junior' doctor.

Older people with anaemia have higher mortality after stroke, finds study.

Oily fish intake reduces risk of diabetic retinopathy, study shows.

Colour coded warnings on how medicines affect driving do not work, study shows.

NHS must do more to tackle white male dominance of leadership roles, Labour Party says.

Disease modifying therapies for relapsing multiple sclerosis

Tribunal orders university to release data from PACE chronic fatigue study.

Fewer people are quitting smoking, say NHS stop smoking services.

David Oliver: Wishful thinking won't save the NHS.

Clinicians underwhelmed by 'watered down' childhood obesity strategy.

Supermarkets criticise obesity strategy's lack of mandatory restrictions on sugar.

Regulatory agencies should engage in drug pricing.

Drug prices are kept high in US by protection and price negotiations, study finds.

CCGs vary widely in how well they deliver healthcare, new measure shows.

Ballot on industrial action by GPs averted as government accepts BMA's demands.

Joint research projects will focus on social impact of Zika in Brazil.

Marie Stopes abortion services suspended after safety concerns.

Cosmetic surgery will be regulated more closely in England.

Redesigning healthcare to fit with people.

Vitamin D advice seems at odds with new methods.

More 'how to lie with statistics' in the NHS.

Deaths from heart disease in UK fall, but prevalence is unchanged.

Combined HRT may raise breast cancer risk, study finds.

What is the most effective treatment for frozen shoulder?

Patents: problem or panacea?

Drug appraisal issues must be resolved at policy level.

Diagnosis, treatment, and monitoring of dry eye disease.

Analysis authors reply to Response by Corrado and colleagues.

Better research is needed on surgery for lumbar spinal stenosis.

Author's reply to Dean and Coakley.

Surgery is not always best for lumbar spinal stenosis.

Donor faecal transplantation is highly curative in recurrent C difficile infection, trial finds.

Head injuries in youth are often linked to psychiatric disorders and disability, study finds.

Anxiety in teenage girls rises sharply in past decade, finds study.

Government's own documents question 'seven day NHS' feasibility.

Suicide crisis among indigenous Australians tests rural services.

Being overweight may raise risk of eight more cancers, review finds.

Some breast cancer patients with low genetic risk may not need chemotherapy, trial shows.

Head of radiology school to be re-appointed after complaints from royal college

Brazilian attorneys demand abortion rights for women infected with Zika.

NHS trusts cut overall deficit but remain at 'breaking point,' leaders warn.

Only married heterosexual Indian couples will be allowed to use surrogate mothers under proposed new law.

Conflicts of interest common among US cancer guideline authors, study finds.

GPs report missing payments for trainees' pay.

The childhood obesity strategy.

Preparing for when things go wrong.

Two years of sunshine: has openness about payments reduced industry influence in healthcare?

Council of Europe dismisses claim that abortion in Italy is harder because more doctors are objecting. (Journal: BMJ (British Medical Journal) Volume: 354)

Losing a marble.

David Oliver: Don’t undervalue non-clinical work

Sixty seconds on . . . the childhood obesity strategy.

Children's emergency service is suspended at Stafford hospital on safety grounds.

Margaret McCartney: Staff hold the answer to our failing NHS.

Details emerge of plans to cut NHS services in England.

Baby doll simulation scheme does not reduce teen pregnancies, study finds.

Keeping Kate Granger's legacy alive.

NICE recommends 3D heart imaging for diagnosing heart disease

Cough and haemoptysis in an older woman.

Adult onset asthma may increase risk of heart disease and stroke.

Ghostwriting: the importance of definition and its place in contemporary drug marketing.

Five facts about diversity on NHS boards.

Why size matters at times of great change.

External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study

Disgraced Canadian researcher faces criminal charges for fraud.

GP appointments should be 15 minutes long, says BMA

Drugs that put older people at risk for fractures are rarely stopped, study finds.

Physician associates—what do they do?

India's NEET exam poses problems in its current form.

US Surgeon General writes to all US doctors about opioids.

Outbreak of Zika in Singapore sparks warnings in neighbouring countries.

Australia's torture of asylum seekers.

Physician assistants can lighten doctors' workload but are a challenge to professional boundaries.

The hidden dangers of a cancer diagnosis.

Benign male genital dermatoses. (Journal: BMJ (British Medical Journal) Volume: 354)

Alcohol consumption for women trying to conceive.

Epinephrine pen maker offers discounts after alleged price hiking.

Alcohol consumption and fecundability: prospective Danish cohort study

Tocolysis may optimise outcomes in very preterm infants.

Unethical skin bleaching with glutathione.

Exercise therapy is supplementary to arthroscopic surgery when surgery is indicated.

Injuries before and after diagnosis of cancer: nationwide register based study

Introducing a preterm care bundle: magnesium sulphate can be the fifth component.

Institutional ageism in global health policy.

Authors' reply to Joshi.

Acute MI is initially misdiagnosed in nearly a third of patients, study finds.

Authors' reply to Page and Rafi.

Unnecessary angiography could be reduced by using non-invasive imaging, study finds

Sexual problems are common in under 55s after acute MI, study finds

Junior doctors announce five days of full strike action.

One in 10 children becomes obese or overweight in primary school years

A new home for science.

Bill Noble: Enthusiastic, slothful, conflicted.

Margaret McCartney: Evidence based protest for the NHS.

Former faculty member is charged with attempted murder of medical school dean.

Italian surgeon should never have been hired by Karolinska, inquiry concludes.

Vigilance still needed to contain Africa's yellow fever outbreak, says WHO.

Long term cause specific mortality among 34 489 five year survivors of childhood cancer in Great Britain: population based cohort study

Five minutes with . . . Jon Goldin, consultant psychiatrist.

Doctor who worked as locum while on sick leave is struck off.

Seven days in medicine: 24-30 August 2016

Sexual harassment and bullying in UK surgery: no room for complacency.

Health must be embedded across all government policy, MPs say.

Operate with respect: how Australia is confronting sexual harassment of trainees.

New rule could help identify children with cough who need antibiotics.

NICE consults on child vaccination rates.

David Oliver: Groundhog days for doctors.

India's private sector needs to take greater role in tuberculosis care.

Gay, bisexual, and other men who have sex with men: time to end the fixation with HIV. (Journal: BMJ (British Medical Journal) Volume: 354)

US drug labels to warn of risks of combining opioids and benzodiazepines.

Real world COPD study may be better way to evaluate drug treatments.

Invasive coronary strategy improves survival after MI, shows UK study.

Junior doctors' strike next week is suspended, BMA announces.

A young man with recurrent limb shaking.

Strike cannot be justified and could harm patients, GMC warns.

Continued spread of Zika raises many research questions, WHO says.

How valuable is physical examination of the cardiovascular system?

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis

Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis

Reducing blood pressure too low has risks for patients with heart disease, registry finds.

Recessions are harmful to health.

Patients with private health insurance are asked to help out cash strapped NHS.

Patient safety concerns were chief reason for strike suspension, says BMA.

The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. (Journal: BMJ (British Medical Journal) Volume: 354)

High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study (Journal: BMJ (British Medical Journal) Volume: 354)

Short term exposure to air pollution and stroke: systematic review and meta-analysis (Journal: BMJ (British Medical Journal) Volume: 354)

When and how to update systematic reviews: consensus and checklist. (Journal: BMJ (British Medical Journal) Volume: 354)

An unhappy 10th birthday: Doctors of the World’s London clinic

Quality improvement is vital to NHS finances.

Surgical training must ensure continued production of specialist surgeons.

Oestrogen/progesterone should be clearly explained.

Outcomes for UK service personnel indicate high quality trauma care and rehabilitation.

No doctor should be above the law.

Health outcomes during the 2008 financial crisis in Europe: systematic literature review

Taking vitamin D in addition to drugs reduces severe asthma attacks, finds review.

It's time for serious dialogue, not playing politics.

Anticancer chemotherapy in teenagers and young adults: managing long term side effects.

US woman freed after court overturns 20 year sentence for causing death of her unborn baby

Psychiatrist struck off for repeated plagiarism.

Sixty seconds on . . . CBT apps.

The cricketer promoting shockwave therapy for erectile dysfunction.

Will new sepsis guidance prompt a surge in unnecessary use of antibiotics?

Adding tests to risk based guidelines: evaluating improvements in prediction for an intermediate risk group.

Commentary: How to encourage more diagnostics for infectious diseases.

Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance

David Spiegelhalter: Doesn't like Hunt's use of statistics.

NHS is unlikely to return to high levels of funding until 2049

Extending primary care hours cuts emergency department visits.

Placement of Pokémon characters may breach confidentiality

MenB vaccine programme cuts cases of meningitis and septicaemia in infants.

What 'girls' and 'queers' can teach patients.

Swedish government sacks entire Karolinska Institute board over Macchiarini.

Views from the frontline: reactions to the strike suspension.

Men and women should practise safe sex for six months to avoid Zika, says WHO.

PrEP, Truvada, and Gilead.

First outbreak of Crimean-Congo haemorrhagic fever in western Europe kills one man in Spain

Seven days in medicine: 31 August to 6 September 2016

Safe care can't be guaranteed if five day strikes go ahead, NHS boss warns.

Orthopaedic surgeons and geriatricians 'must collaborate' to improve hip fracture care.

Marked fall in ovarian cancer deaths is attributed to oral contraceptive use.

Health department's NHS accounts are 'rotten,' say MPs.

Junior doctors' dispute: where are we now?

Expert panel recommends that the US cancer “moonshot” focuses on 10 areas

US drug industry group launches campaign to defend pricing.

NHS winter pressures are becoming an all year reality, warn experts.

Health secretary promises 'world class' hospital IT.

Record demand on NHS is pushing services above safe thresholds, report warns.

Benefits of statins have been underestimated and harms overstated, review finds.

Margaret McCartney: General practice is going the way of NHS dentistry.

Three in four are unaware of obesity link to cancer, says charity.

Placebo controls in clinical trials: concerns about use in relapse prevention studies in schizophrenia.

NHS announces online symptom checker.

David Oliver: No more broken promises.

Problems with ethical approval and how to fix them: lessons from three trials in rheumatoid arthritis.

US Federal Trade Commission charges academic publisher over 'deceptive' practices.

Drug deaths hit record high in England and Wales, figures show.

Self controlled case series methods: an alternative to standard epidemiological study designs.

The people's NHS: time for a new hypothesis?

'Something has to give,' warns leader of NHS trusts over finances.

Margaret McCartney: The prurient interest in Trump and Clinton's health.

More patients with oesophageal and gastric cancers are getting curative treatment plans.

Tell women IUD is more effective than emergency contraceptive pill, says NICE.

Sugar industry paid for dietary research in 1960s, analysis shows

Simple blood test for heart failure should be more widely available, say MPs.

Prevalence of microcephaly in Europe: population based study

Electronic cigarettes and smoking cessation in England.

Population surveillance for microcephaly.

Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis

Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

A painless lump in the arm.

Junior doctors' High Court challenge to Jeremy Hunt.

Senior doctors must support junior colleagues, say medical royal colleges.

Mental illness and terrorism.

Urinary frequency and dysuria in an older woman.

Diagnosis and management of esophageal achalasia

Death: avoiding the unavoidable?

Current physical activity guidance is misinterpreted.

Data sharing: lessons from Copernicus and Kepler.

“Nothing about us without us”—patient partnership in medical conferences

Statins evidence: when answers also raise questions.

Metrics should be a complement in research, not a substitute for human judgment.

UK revalidation changes lacked evidence.

Evidence based practices are helping preterm birth outcomes in India.

The GMC is working to improve revalidation.

Management of prisoners with autism is not perfect but is improving.

Congenital Zika syndrome: time to move from case series to case-control studies and data sharing

E-cigarettes help smokers quit, Cochrane review confirms

Living kidney donation.

Risk factors for endocarditis after transcatheter aortic valve replacement are identified.

Misinformed debates on FGM can harm understanding.

BMA Council to consider options before proceeding with five day strikes.

Sri Lanka declared malaria free.

Sixty seconds on . . . Department of Health accounts.

Strike action will intensify winter pressures on A&E, say NHS leaders.

William Frankland: From Fleming to Saddam Hussein.

Five minutes with . . . Steve Rolles, drug policy analyst.

GPs earned £90 600 on average in 2014-15

Health effects of 9/11 terror attacks continue to grow

GPs need more support to help young people with mental health problems, review finds.

Risk of dying from early prostate cancer is low regardless of treatment, study finds.

Co-creating health: more than a dream

Vaccine skeptic pediatrician is charged with gross negligence.

UN urges broader access to drugs.

Positive language leads to positive wellbeing.

Mandatory publication in India: setting quotas for research output could encourage scientific fraud.

Recurrent otalgia in adults.

Patient threatens legal action over lack of compensation for hepatitis C contaminated blood.

British woman will be allowed to use dead daughter's eggs to conceive her own grandchild.

Seven days in medicine: 7-13 September 2016

Psychiatrist admits making sexual advances to medical students he tutored.

US hospitals mark up prices more than 20-fold to maximize revenue, study suggests

NHS is not in 'land of milk and honey' with tough choices ahead, warns head of NHS.

David Oliver: Treating NHS staff fairly when things go wrong.

Many older patients with high blood pressure are not taking medication as directed, US study finds.

Canada's ban on private healthcare faces legal challenge.

BMJ editor asks chief medical officer to set up inquiry into statin risks and benefits.

Repeated failure to report female genital mutilation should be a criminal offence, MPs say.

Preliminary results from case-control study confirm Zika virus causes microcephaly

Screening reduced cervical cancer deaths by more than two thirds, UK study finds.

Early menopause is linked to higher risk of cardiovascular disease and death, review finds.

UK troops to continue to receive mefloquine despite concern over adverse events.

Senior doctors urge public inquiry over Hunt's claims of excess weekend mortality.

Legalise medicinal cannabis, MPs urge.

Taliban militants kill doctor working to eradicate polio.

Approved drugs are to be studied for use in Alzheimer's disease.

Language lessons to help protect against dementia.

Cuts to social care funding represent urgent threat to the NHS, warn experts.

Small amounts of alcohol increase risk of atrial fibrillation, study finds.

Having a named accountable GP does not improve continuity of care, study finds.

US to impose tougher rules on reporting clinical trial data.

Margaret McCartney: The NHS can't afford more litigation.

Surgeon's comments about Asian colleagues were rude but not racist, tribunal says.

Self reported wellbeing: the role of neuroscience research.

Directors of public health are pivotal in tackling health inequalities.

Medical literature has seen a positive evolution of transparency.

Addison's forum helps to support and engage patients.

Vasectomy is not linked to raised risk of prostate cancer, study finds.

FTO genotype and weight loss: systematic review and meta-analysis of 9563 individual participant data from eight randomised controlled trials (Journal: BMJ (British Medical Journal) Volume: 354)

Obesity treatment—are personalised approaches missing the point?

NICE issues guidance on inappropriate sexual behaviour in children.

β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study (Journal: BMJ (British Medical Journal) Volume: 354)

Mental health issues need private space for discussion.

The importance of patient involvement in implementing electronic health record systems.

Designing healthcare to fit real people.

36 patients die from unknown causes after transfer from a private mental health facility in South Africa

GMC relaunches language test for overseas doctors, but concerns remain over equivalence.

University does not have to release copies of contract with Boehringer Ingelheim Foundation, German court rules.

Doctors could be asked to declare private income, NHS England says.

Freedom of information: can researchers still promise control of participants' data?

Junior doctors' strikes: BMA responds to your questions.

Five minutes with . . . Caroline Gannon.

New way to define disease is needed to reduce overdiagnosis, experts agree.

Sixty seconds on . . . sex education.

Doctors are working five unpaid extra weeks a year, claim leaders.

Eggs or peanuts in early infant diet may cut allergy risk.

Side effects are under-reported in peer reviewed journals

Increasing physicians in hospital staff does not improve quality of care, US study suggests.

Government must spell out how mental health will achieve parity with physical health, say MPs.

Timothy Evans: Keen to cut variations in practice.

A bilateral macular star and optic disc oedema.

Clinical assessment and management of multimorbidity: summary of NICE guidance.

Infliximab biosimilars are safe, effective, and cheap, UK audit shows.

Swine flu vaccine is unlikely to raise risk of overall birth defects, study finds.

Risk of erectile dysfunction associated with use of 5-α reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink

GP who supplied abortion drug in 'fake sheikh' sting is struck off.

Testosterone supplementation for 'low T' is not supported by evidence, review concludes.

Investment in general practice rises slightly after years of cuts.

Shortage of healthcare professionals in China.

Seven days in medicine: 14-20 September 2016

World will lack 18 million health workers by 2030 without adequate investment, warns UN

UK performs fifth in the world on sustainable development goals.

World leaders pledge action on antimicrobial resistance.

Rethinking primary care's gatekeeper role.

Neurologists win Ig Nobel prize for discovering that scratching the other side relieves itching.

Psychiatrist who was cleared by first tribunal is struck off.

Most mild chronic kidney disease is benign, GP study finds.

Dementia strategy has not cut antipsychotic prescribing in care homes, study finds.

David Oliver: Reducing delays in hospitals.

CCGs to get £6 a patient to extend general practice opening hours

Clarity is needed on plans for digital NHS, says think tank.

Burns from e-cigarettes and other electronic nicotine delivery systems

Nearly one in 10 premature babies did not have a temperature check in first hour after birth, UK audit finds

Wearable fitness device does not help maintain weight loss, study finds.

Faecal blood testing cuts unnecessary colonoscopies by a third, shows study.

BMA considers plans after suspending junior doctor strikes.

PCPNDT seems to benefit India's birth sex ratios.

GMC was wrong to release report on GP's competence to patient, rules judge.

We must go for gold in public health.

Students face deep conflict in reporting harassment.

SACN is committed to openness and engagement.

Bullying in surgery isn't just Australia's problem.

Recession may decrease mortality trends.

Every operation is a special event.

UK needs 'radical rethink' on public health, say medical scientists.

Margaret McCartney: Breaking down the silo walls.

Nine in 10 people are exposed to air pollution over WHO limits, warns report

Bivalirudin or unfractionated heparin in patients with acute coronary syndromes managed invasively with and without ST elevation (MATRIX): randomised controlled trial

Cancer Drugs Fund requires further reform.

Future jobs of FDA’s haematology-oncology reviewers

Doctors recommend continuous glucose monitoring for patients with type 1 diabetes

GMC closes inquiry into troubled Aberdeen hospital.

UK must stop arms sales to Saudi Arabia in light of bombings of Yemeni health facilities, says charity.

Growing up on a farm may cut risk of allergic conditions in adulthood.

Nausea in early pregnancy is linked to low risk of loss.

Should general practice be a specialty in its own right?

Trusts move to new contract as BMA vows to keep fighting imposition.

BMA invites health secretary to symposium on seven day services.

Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline.

Introduction to BMJ Rapid Recommendations.

Senior consultant warns against indiscriminate closures of emergency departments.

Manufacturer failed to disclose faulty device in rivaroxaban trial.

Commentary: Diagnostic devices in clinical trials have high stakes for patient care.

NSAIDs and the failing heart.

Sixty seconds on . . . medical philanthropists.

Novel oral anticoagulants for atrial fibrillation.

Dyspnoea in an older woman.

Junior doctors lose legal challenge over contract imposition.

Five minutes with . . . John Ioannidis.

Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study

Does tranexamic acid improve outcomes in traumatic brain injury? (Journal: BMJ (British Medical Journal) Volume: 354)

A persistent cough.

Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies

Workload pressures are leading to unsafe hospital discharges, say MPs.

Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis

One in five with bowel cancer diagnosed as emergency had previous 'red flag' symptoms.

Physical activity programme reduces major disability in elderly people, study shows.

Alan McGlennan: Happy despite appearances.

Alcohol consumption in Europe is still cause for alarm despite decrease, says WHO.

How the BMA lost control of the junior doctors' dispute.

The BMJ appoints its first China editor.

Women have higher rates of mental disorders than men, NHS survey finds.

David Oliver: Frailty in acute care.

Emerging treatments for severe obesity in children and adolescents

Reanalysis of PACE trial reignites row over chronic fatigue treatment.

CCGs must engage with public on potential service closures, says new guidance.

Seven days in medicine: 21-27 September 2016

Authors' reply to Ramachandran.

Link between prescribing and gifting of educational materials should be studied.

Junior doctors say what BMA should do now to stop the new contract.

Mediterranean diet in UK shows positive effects in study.

Hormonal contraception use among teenagers linked to depression.

Medical school 'banter' denigrating GPs and psychiatrists must stop, say college heads. (Journal: BMJ (British Medical Journal) Volume: 354)

MSF urges world leaders to act over bombing of hospitals in Aleppo.

Cannabis is associated with relapse of psychosis, study finds.

New gene editing technique CRISPR-Cas9 raises important ethical questions, says advisory body

Why do we shine lights in the eyes of conscious patients after head injury?

European drug agency to appeal ruling that it stop releasing trial data.

Widow wins right to use frozen embryos that were due to be destroyed.

Clinton promises to expand healthcare access and cut out-of-pocket costs

Ten years too long: strontium ranelate, cardiac events, and the European Medicines Agency.

Cancer patients have unrealistic expectations of taking part in trials, UK study finds.

Maternal mortality varies sevenfold across the US, report finds.

Risk of mortality with concomitant use of tamoxifen and selective serotonin reuptake inhibitors: multi-database cohort study

Revisiting the drug interaction between tamoxifen and SSRI antidepressants.

Reduce NHS's reliance on migrants, HEE is told.

Bariatric surgery and fractures.

Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

Sixty seconds on . . . Zika and the Olympics.

Betting on hepatitis C: how financial speculation in drug development influences access to medicines.

What is the best way to manage neurogenic bowel dysfunction?

Five minutes with . . . Ivan Oransky.

Robotic surgery for prostate cancer achieves similar outcomes to open surgery, study shows.

London 2012 relived

High cost of new drugs.

UK response to serial drug company misdemeanour—no action, no shame

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Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up (Journal: BMJ (British Medical Journal) Volume: 354)

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Risberg, May Arna Ranstam, Jonas Engebretsen, Lars Stensrud, Silje Kise, Nina Jullum Roos, Ewa M.
Description	Author Affiliation: Kise NJ ( Department of Orthopaedic Surgery, Martina Hansens Hospital, PO box 823, N-1306 Sandvika, Norway nina.kise@mhh.no.); Risberg MA ( Norwegian Research Centre for Active Rehabilitation, Oslo, Norway Division of Orthopaedic Surgery, Oslo University Hospital, Norway Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.); Stensrud S ( Norwegian Research Centre for Active Rehabilitation, Oslo, Norway.); Ranstam J ( Department of Orthopaedics, Clinical Sciences Lund, Lund University, Sweden.); Engebretsen L ( Division of Orthopaedic Surgery, Oslo University Hospital, Norway Faculty of Medicine, University in Oslo Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway.); Roos EM ( Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.);
Abstract	Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score $(KOOS_{4}),$ defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results No clinically relevant difference was found between the two groups in change in $KOOS_{4}$ at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial’s inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option. Trial registration www.clinicaltrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT01002794","term_id":"NCT01002794"}}NCT01002794).
ISSN	09598138
e-ISSN	17561833
Journal	BMJ (British Medical Journal)
Volume Number	354
Language	English
Publisher	British Medical Journal Publishing Group
Publisher Date	2016-07-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Medicine
Content Type	Text
Resource Type	Article

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