NDLI: Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports

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Year: 2017 Volume: 356

Year: 2017 Volume: 353

Year: 2017 Volume: 346

Year: 2016 Volume: 534

Year: 2016 Volume: 532

Year: 2016 Volume: 356

Year: 2016 Volume: 355

Year: 2016 Volume: 354

Year: 2016 Volume: 353

Year: 2016 Volume: 352

Management of lumbar spinal stenosis

Junior doctors are set to take industrial action, says BMA.

Nurses' leader warns government not to pick fight with profession over seven day working.

Midlands hospital appoints humanist 'pastoral carer' to join its chaplaincy team.

Mental healthcare is biggest NHS worry for the public.

GPs to discuss possible industrial action in crisis summit.

Use hand cleaning to prompt mindfulness in clinic.

Margaret McCartney: Dishonourable New Year honours.

Wider group of health professionals should be located in emergency departments, college says.

Most US patients continue to be prescribed opioids after overdose.

Adult survivors of childhood cancer are at high risk of cardiac abnormalities, study finds.

Children born from infertility treatment are not at risk of developmental delays, study finds.

Act requires officials to review how US dietary guidelines are formulated. (Journal: BMJ (British Medical Journal) Volume: 352)

NHS choir's number one hit puts health service in media spotlight over Christmas.

Chronic traumatic encephalopathy is reported in 25 year old former American football player

Give patients direct access to physiotherapy.

Cautionary tales about DNACPR.

Sixty seconds on . . . mindfulness.

Self referral to physiotherapy and other services would empower patients and doctors.

WHO calls for efforts to prevent newborn deaths in South East Asia.

Maternal use of oral contraceptives and risk of birth defects in Denmark: prospective, nationwide cohort study

Telling patients of incidental genetic findings is questionable, researchers warn.

Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study

Co-trimoxazole in addition to antiretroviral therapy may reduce malaria risk in HIV positive adults

Concussion: doctor who took on the might of American football hits the big screen.

Anne Mackie: Optimistic, direct, and pragmatic.

Voluntary euthanasia is now legal in Quebec, says appeal court. (Journal: BMJ (British Medical Journal) Volume: 352)

Not a typical case of bilateral knee osteoarthritis.

A modest proposal on gun control—and a real one

Assessment of palpitations.

Junior doctors' contract talks will resume on Friday.

Obama issues executive orders to curtail gun violence.

WHO analgesic ladder: a good concept gone astray.

Full disclosure about cancer screening.

Defining antibiotic effectiveness and resistance: how a private party may soon rule judgments over susceptibility testing.

Potential head of Food Standards Agency would treat antimicrobial resistance as priority.

Should patients pay to see the GP?

Why cancer screening has never been shown to “save lives”—and what we can do about it

Newer antiplatelet agents in acute coronary syndrome.

Teens’ e-cigarette use rises as spending on advertising soars, says CDC

Former ministers call for commission to review NHS and social care funding.

Parkinson's disease: fetal cell or stem cell derived treatments.

Downsizing: policy options to reduce portion sizes to help tackle obesity. (Journal: BMJ (British Medical Journal) Volume: 352)

Disabled children risk further abuse after unsubstantiated referral for neglect, research finds.

Oral antifungal is associated with increased risk of miscarriage.

Seven days in medicine: 2-8 January

Junior doctors' contract: the sticking points in negotiations.

Health department beefed up Keogh strike letter, says Independent.

Abortion numbers halve in Northern Ireland as doctors fear prison.

Margaret McCartney: Bruce Keogh's letter to junior doctors: the importance of independence.

Targeted exercise for muscles that support the spine reduces low back pain, Cochrane review shows.

High rate of symptoms is seen five years after gastric bypass surgery for obesity.

Metformin as firstline treatment for type 2 diabetes: are we sure? (Journal: BMJ (British Medical Journal) Volume: 352)

Cut drinking to reduce risk of cancer, says new guidance.

Retinoblastoma survivors face raised risk of serious health problems, study finds.

Organ transplantation may link to deaths from cancer, study finds.

US dietary guidelines make no recommendation on sugar tax.

India to track progress of 75 cities to improve sanitation

Strong support for strike sends clear message to government, says BMA.

Women aged 50 to 74 should have mammogram every two years, say US guidelines

Proton pump inhibitors are associated with risk of chronic kidney disease, study finds.

Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: prospective cohort study

Opioids in pregnancy.

GP who orchestrated cigarette scam is struck off.

Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial (Journal: BMJ (British Medical Journal) Volume: 352)

Stop smoking services are under threat owing to budget cuts.

Frozen faecal matter works as well as fresh for transplantation in C difficile patients.

US president endorses 'moonshot' effort to cure cancer.

Metformin as firstline treatment for type 2 diabetes: are we sure? (Journal: BMJ (British Medical Journal) Volume: 352)

Five minutes with . . . Norman Lamb.

Sixty seconds on . . . alcohol guidelines.

The problem of accessing psychotherapies for depression in the UK.

Approach to diagnosing Lyme disease misses a large proportion of cases.

Could campaigns like Dry January do more harm than good?

Calm down everyone: Keogh's action is not explosive stuff.

Junior doctors' contract talks will resume on Thursday.

Panel's questions will delay large cigarette packet warnings, says expert.

Amyloid plaques are still main target for Alzheimer's drugs.

How Jeremy Hunt derailed clinician led progress towards a seven day NHS.

BMA disagrees that 15 of 16 junior contract issues are resolved

Exercise induced bronchoconstriction in adults: evidence based diagnosis and management.

Poor vision in a patient with white hair and pale skin.

Tuberculosis—diagnosis, management, prevention, and control: summary of updated NICE guidance

Jonty Heaversedge: Conscientious and a little narcissistic.

First US case of Zika virus infection is identified in Texas.

Coils implanted into lungs show promise for emphysema.

World invests too little and is underprepared for disease outbreaks, report warns.

Manufacturers failed to report infections from duodenoscopes, US investigation finds. (Journal: BMJ (British Medical Journal) Volume: 352)

Doctors are prejudiced against transgender patients, MPs say.

Seven day opening of GP surgeries may not work everywhere, minister tells MPs.

Doctors and patients express concern over prospect of physician assisted death.

NHS trust first to face trial for corporate manslaughter after 'wholly avoidable' death of patient.

'Publish or perish' is good for African research.

Three Italian hospitals where women died in labour are criticised in report.

Ebola outbreak in west Africa is officially over.

Cardiovascular outcomes associated with use of clarithromycin: population based study

Pay in the NHS: did the consultants' salaries include waiting list initiatives?

Charts on NHS pay did not provide a fair comparison.

Author's reply to St Leger and Kay.

Problems with treating snake bite in India.

Seven days in medicine: 9-15 January

From the picket line: junior doctors speak out.

Long term opioid analgesic use is linked to increased risk of depression, study shows.

Low cost mesh for hernia repair is as good as commercial mesh, trial finds.

Cardiovascular risks associated with clarithromycin.

Vandals force volunteer doctors to close clinic in Calais's refugee camp.

Low blood levels of bicarbonate are linked to premature death in healthy older people, study shows.

India is at high risk from surge in cases of melioidosis, warn researchers.

NHS organ registry considers new way to stop families over-ruling relatives’ wish to donate

Doctors condemn closures at Sudanese teaching hospital.

Manufacturers failed to report infections from duodenoscopes, US investigation finds. (Journal: BMJ (British Medical Journal) Volume: 352)

Bahraini doctor detained for Tweets needs legal and medical support, says BMA.

WHO confirms new case of Ebola in Sierra Leone.

Speeding up access to new drugs threatens evidence based medicine, says health economist.

Inverse probability weighting.

Second test for Down's syndrome is recommended for NHS.

Patients offered choices about psychological treatment have better outcomes, study shows.

Chronic kidney disease in elderly people: disease or disease label?

Female doctors hit back at claim they avoid antisocial hours.

New bowel cancer screening test is recommended for England.

Only patients with BP below 160/100 should be referred for surgery to avoid cancellations, guidelines say

Bivalirudin in the treatment of acute coronary syndrome.

Details of French trial must be released urgently, say UK experts.

First death by voluntary euthanasia in Quebec is confirmed.

US military prepares to punish soldiers who attacked MSF hospital.

NHS plans sugar tax on food and drink sold in hospitals by 2020

I chose reconstruction, but not to 'look good'.

Zika virus outbreak prompts US to issue travel alert to pregnant women.

Half million US women at risk of genital mutilation, study finds.

NICE guidelines on the menopause.

Margaret McCartney: Regulation doesn't guarantee safety.

Indian editors urge medical council to rethink publication guidelines for academic promotions.

Betahistine for Meniere's disease.

Doctors need to adopt 'realistic' medicine, says Scotland's chief medical officer.

Physiotherapy and occupational therapy do not improve early Parkinson's disease, study finds.

Computer algorithm could help GPs predict dementia risk.

Jamaica advises women to avoid pregnancy as Zika virus approaches.

Government blocked guidance that urged minimum staff ratios in emergency departments.

Failure of care in mental health trust: Déjà vu in terms of treatment of people with learning disabilities?

Retention crisis in general practice must be tackled, says think tank.

Attacking the devil: the thalidomide story.

Are India's quacks the answer to its shortage of doctors?

'Exorbitant' regulator fee rises will damage patient care, warns BMA.

Efficacy and safety of betahistine treatment in patients with Meniere’s disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial)

One in seven colorectal cancer patients is under 50, US study shows

Two thirds of rheumatology patients wait too long for assessment, audit finds.

French drug trial protocol fails to answer key questions.

India has world's highest number of stillbirths.

Home Office fights to conceal details of detainee's death.

WHO calls for tax on sugary drinks to tackle child obesity.

Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests.

Ebola outbreak exposed major weakness in UK handling of health emergencies.

Margaret McCartney: Who gains from the media's misrepresentation of science?

Punjab's minister of medical education moves to oust medical council president.

Political interference derails Punjab Medical Council's investigation into 'ghost faculty'.

Sixty seconds on . . . Zika virus.

Decompensated alcohol related liver disease: acute management.

Headaches and hormones: a potentially lethal combination.

6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

Zika virus outbreaks prompt warnings to pregnant women.

Recovery position cuts hospital admissions in unconscious children, study shows.

David Oliver: Keeping care home residents out of hospital.

WHO urged to define responsibility during emergencies.

Rise in deaths of mental health patients needs investigating, says MP.

Planned Parenthood 'sting' film makers are indicted in Texas.

Indian diabetes lifestyle interventions work at many ages and weights.

Mailing free nicotine patches to smokers reduces smoking rates, study shows.

Similar quit rates are found with three smoking cessation options.

Should we ban boxing?

Robin Ferner: A weakness for bad jokes.

Bringing healthcare to the UK's abused domestic workers.

Netherlands tops European healthcare index.

Psychiatrist is charged after 12 patient deaths

Ignorance about sepsis was a factor in child's death, says report.

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports

Prescriptions for hydrocodone plummet after US tightens prescribing rules.

Diagnosis and management of diabetes in children and young people: summary of updated NICE guidance.

World Health Organization and emergency health: if not now, when?

Australian doctor challenges government over child detention 'torture'.

General practice being 'eroded' in Scotland, says RCGP.

Antidepressants may double risk of suicide and aggression in children, study finds.

Reducing emergency admissions through community based interventions.

Rheumatoid arthritis, TNF inhibitors, and non-melanoma skin cancer

French parliament passes law to allow sedation at end of life.

More reasons why Dutch GPs are happier.

Diagnosis of airways obstruction should be based on symptoms and an $FEV_{1}/FVC$ ratio below the lower limit of normal

Authors' reply to Brusasco and colleagues and Quanjer and colleagues.

Arbitrary thresholds of natural variability and severity should not be used to diagnose chronic obstructive pulmonary disease.

Electronic cigarettes: the renormalisation of nicotine use.

Fosfomycin should not be first line treatment for uncomplicated urinary tract infection.

Dietary flavonoid intake and weight maintenance: three prospective cohorts of 124 086 US men and women followed for up to 24 years

Authors’ reply to Al-Wali and Hughes

NHS leader defends expansion of personal health budgets to 100 000 people by 2020

Rheumatoid arthritis, anti-tumour necrosis factor treatment, and risk of squamous cell and basal cell skin cancer: cohort study based on nationwide prospectively recorded data from Sweden

Misrepresenting harms in antidepressant trials.

European Parliament rejects high sugar content in baby foods.

Coordinate older age care around people, not services, says report.

Top US cancer centers push for more use of HPV vaccine.

NHS hits target on reducing carbon emissions.

Accelerating achievement of the sustainable development goals.

First case of corporate manslaughter against NHS trust collapses.

GP inspections are damaging patient care, shows practice survey.

WHO urges countries in dengue belt to look out for Zika.

Women with sleeping problems may be more likely to develop diabetes.

Depression in teenagers can be identified with three questions, study shows.

Double vision. (Journal: BMJ (British Medical Journal) Volume: 352)

Zika vaccine could be in production by year's end, says maker.

The neglected refugee crisis.

John Delwyn Thomas.

New approaches to evaluating complex health and care systems.

PRISMA harms checklist: improving harms reporting in systematic reviews

GP leaders vow to secure more money for general practice.

India sees progress in child health but rising obesity, shows health survey.

Hospitals are 'gaming' data on common operations, leading surgeon says.

Margaret McCartney: Technology isn't enough.

White middle class death rate rise is linked to common diseases.

GPs in UK follow lung cancer guidelines less closely than in other countries, study finds.

Proton beam therapy is as effective as radiotherapy in childhood brain cancer but less toxic, study shows.

US panel recommends depression screening for all adults.

Detection of ductal carcinoma in situ and subsequent interval cancers.

Abortion in Northern Ireland: is change on the cards?

Five minutes with . . . Chaand Nagpaul.

Sixty second on . . . greening the NHS.

Lancet retracts paper by disgraced Canadian researcher.

Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial

Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study

'Schizophrenia' does not exist.

One in 10 patients on antidepressants may have unrecognised bipolar disorder

Poor governance in the award of honours and degrees in British medicine: an extreme example of a systemic problem.

Long term marijuana use is linked to impaired verbal memory.

NHS figures indicate variation in readmission rate among patients discharged at weekends.

Junior doctors will take industrial action next week.

GPs call for an end to CQC inspections.

Abdominal pain in a 31 year old woman

BMA defends decision to end GPs' responsibility for care home residents.

GPs will consider 'mass resignation' if government ignores crisis.

MPs pass innovative medicines bill.

Questions your patients may have about Zika virus.

Zika virus is a global public health emergency, declares WHO.

Saved from the skip: doctor's action sees hospital art get national recognition.

Statutory regulation needed to expose and stop medical fraud.

Government and national bodies take charge of decision making as NHS crisis grows.

Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study)

UK is safe from Zika virus and is helping towards a vaccine, MPs hear.

Private tuberculosis testing is cheaper in India.

App helps to improve contraception uptake in rural India.

Extra hour of sitting each day is linked to 22% higher odds of type 2 diabetes

Higher levels of mercury in brain are not linked to increased risk of Alzheimer's, study finds.

Rivaroxaban: can we trust the evidence?

Mark Porter: A covert petrolhead.

What doctors think would make NHS 111 safer

A baby with low Apgar scores at birth.

Achieving universal testing for malaria.

Over half of English general practices report unmanageable workload.

'No small talk please, my baby's just died'.

Study shows that Dry January does more good than harm.

Alcohol consumption—the importance of context

Parents' depression is linked to worse school performance in children.

National smoking bans improve health outcomes, Cochrane review shows.

WHO analgesic ladder gone astray: wider implications.

Evidence that Dry January changes behaviour for good.

WHO analgesic ladder and chronic pain: the need to search for treatable causes.

Ophthalmologist who filed 99 claims against NHS trusts acted vexatiously and wasted resources, GMC says

Zika virus was transmitted by sexual contact in Texas, health officials report.

New GPs are offered £20 000 to work in underserved areas

Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

Pacemaker battery scandal.

Parkinson's disease diagnosis is preceded by increased risk of falls, study finds.

WHO warns European countries to be on alert for Zika.

Longer shifts don't increase harm to patients, finds controversial study.

MPs find no evidence that Cancer Drugs Fund was spent wisely.

What is the role of coronary angioplasty and stenting in stable angina?

Former banker who hiked price of drug refuses to speak at congressional hearing.

CCGs told to delay signing £1.2bn deal on cancer and end of life services

Ridding NHS of “unwarranted variation” could save £5bn a year, says report

David Oliver: Doctors need intergenerational solidarity.

US needs \$1.1bn to treat opioid addiction

Walking the tightrope: communicating overdiagnosis in modern healthcare.

Alabama pays town's residents to undergo TB testing.

Better training is needed on fetal alcohol disorders, says BMA.

Margaret McCartney: Why GPs are stressed.

French drug trial had three major failings, says initial report.

Trust pays cardiologist £1.22m for unfair dismissal

Time for global action on Zika virus epidemic.

NICE recommends pulmonary rehabilitation programmes for patients with COPD.

Corticosteroids in women at risk of late preterm delivery may reduce respiratory complications in newborns.

Antibiotic resistance in Enterobacteriaceae: mechanisms and clinical implications

CDC updates Zika virus guidance to protect pregnant women.

Judge might reopen GSK paroxetine case.

David Oliver: Jeremy Hunt was wrong to blame the 'irresponsible BMA' for his own mistakes.

Agreement of treatment effects for mortality from routinely collected data and subsequent randomized trials: meta-epidemiological survey

Current exposure to pollution has greater health impact than former exposure, study shows.

Four hour waiting time for acute psychiatric care urged.

Flipping the model for access to patient records. (Journal: BMJ (British Medical Journal) Volume: 352)

Post-exposure prophylaxis against rabies is still needed after a bite from a vaccinated animal

Taking the patient's body surface area into account when estimating GFR.

Need for a forum where young doctors can express feelings about patients.

Need for increased investment in public health.

Sixty seconds on . . . the Cancer Drugs Fund.

Replacing the term chronic kidney disease.

Extending migrant charging into emergency services.

Anticipating missing reference standard data when planning diagnostic accuracy studies.

A limping child.

Indian Medical Association backs lifting ban on sex testing.

Deadlock persists over junior doctor contract.

Five minutes with . . . Nigel Crisp.

Sun exposure guidance should be tailored to individuals, says NICE.

Futile CPR is tantamount to assault.

Painless, gradually enlarging, subcutaneous lesion of the eyelid.

DNACPR: Venn's perverse view.

Resuscitation is futile in terminally ill patients.

Severe eye damage in infants with microcephaly is presumed to be due to Zika virus.

Using established forums to improve difficult doctor-patient relationships

Will the UK’s new alcohol guidelines change hearts, minds—and livers?

Higher nurse to patient ratio is linked to reduced risk of inpatient death.

Research to Publication e-learning

Permanent mesh has 'limited utility' for vaginal prolapse repair, review finds.

Antidepressants are addictive and increase the risk of relapse.

Authors’ reply to Gøtzsche and Hamilton

Qualitative research and The BMJ.

Patients in trials of antidepressants are not typical of those in everyday practice.

Better approach needed to detect and treat military personnel with adverse effects from mefloquine.

California doctor convicted of murder in overdose deaths is sentenced to 30 years

Two GPs face charges of manslaughter over death of boy in 2012

Unsafe and understudied: the US gun problem.

An open letter to The BMJ editors on qualitative research. (Journal: BMJ (British Medical Journal) Volume: 352)

Policy layers delay funding of innovative care deal for elderly people, conference hears.

Antihypertensive treatments for adults with type 2 diabetes

Voices unite to demand free healthcare for refugees in Germany.

Welfare changes could put an extra 1.5 million children into poverty

Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials (Journal: BMJ (British Medical Journal) Volume: 352)

Lesley Fallowfield: Psycho-oncology supremo

Research bodies vow to share data on Zika.

Autosomal dominant polycystic kidney disease. (Journal: BMJ (British Medical Journal) Volume: 352)

UK records four cases of Zika virus in past six weeks.

Higher oxygen saturation targets are safer for preterm infants, trials show.

Fall in 1:1 nursing ratios in neonatal ICUs is linked to higher death rate

Junior contract will be imposed, Hunt announces.

Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study

Treasury bails out England's health department.

Atypical glandular cells on cervical cytology.

NHS 'winter' pressure could become norm in summer, experts warn.

Uber for healthcare.

Nobel official resigns in wake of storm over Italian surgeon.

Referrals for pulmonary hypertension rise by 21% in five years, audit finds

Paracetamol exposure prenatally and in infancy is linked to asthma, study shows.

Chancellor's psychiatrist brother is struck off medical register.

India sets out plan to eliminate malaria by 2030 (Journal: BMJ (British Medical Journal) Volume: 352)

GSK is fined £38m for delaying generic paroxetine

MSF accuses Pfizer of misleading advertising.

Margaret McCartney: Pity the NHS—Jeremy Hunt has chosen the nuclear option

Vow to impose contract means further action is 'inevitable,' says junior doctors' leader.

The private, online GP will see you now.

Incidence of dementia declined in past 30 years in US, study shows

High cholesterol diet is not linked to increased heart risk, study shows.

GP is suspended after prescribing zopiclone for patient to give to neighbours.

Government promises £1bn a year more to “transform” mental health in England

Senator questions pain panel's ties to industry.

Australian doctors refuse to discharge refugee girl into government detention.

India sets out plan to eliminate malaria by 2030 (Journal: BMJ (British Medical Journal) Volume: 352)

Suicidality and aggression during antidepressant treatment: authors misinterpreted earlier paper from the FDA.

Authors' reply to Smith and colleagues.

Folic acid to prevent neural tube defects: another solution.

Benefits of training India's quacks.

A ban on smoking in psychiatric hospitals would reduce self burn injuries.

Decision on folic acid fortification in Europe must consider both risks and benefits.

Authors' reply to Makiyama and colleagues.

Paper on suicidality and aggression during antidepressant treatment was flawed and the press release was misleading.

David Oliver: Senior nurses should stand up for nursing.

Loss of potential reward is best motivator in workers' wellness programme, study finds.

Erythropoietin stimulating agents do not significantly improve quality of life in chronic kidney disease, study finds.

Treating hypertension in patients with medical comorbidities.

An open letter to The BMJ editors on qualitative research. (Journal: BMJ (British Medical Journal) Volume: 352)

(Journal: BMJ (British Medical Journal) Volume: 352) : Correction.

Hypopigmentation of newborn skin.

Concerns about study on maternal H1N1 influenza vaccination and offspring mortality

Authors' reply to Amitai and Koren.

Author's reply to Dubicka and colleagues and Stone.

Seven day services will need 4000 extra doctors, says leaked report

Ian Forgacs: Loves skinny dipping.

Egyptian doctors vote for free hospital care in police assault protest.

Alcohol and serious harms of antidepressant treatment.

Tackling the crisis in general practice.

Author's reply to Goldacre.

The safety of incretin based drug treatments for type 2 diabetes

Margaret McCartney: Mindful of mindfulness.

Publication and reporting of clinical trial results: cross sectional analysis across academic medical centers

Treasury will take “incredibly dim view” of £2.3bn NHS overspend

Time to abandon three-phase trials?

Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study

Sixty seconds on . . . bed blockers.

Proton pump inhibitors may be linked to dementia risk.

Facial surgeons call for review of two week cancer referral system.

Interstitial lung abnormalities are linked to increased risk of death.

Health Education England threatens to cut trusts' funding for training if they don't impose junior doctor contract.

Voting for change in Myanmar.

Junior doctors' contract: the key questions.

Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies

Tackling the public health needs of refugees.

How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?

Involve clinicians to avert a digital disaster.

Sharp spike in deaths in England and Wales needs investigating, says public health expert.

Visa changes could lead to hundreds of doctors leaving the NHS, warns BMA.

Stopping antidepressants following depression.

Acute otalgia and otorrhoea in primary care.

Greater adverse effects of alcohol consumption in deprived communities are explained in study.

Megaphone diplomacy fails in junior doctor contract dispute.

All BMJ research papers should share their analytic code.

NICE calls for more research on ELISA tests for Crohn's disease.

Testosterone may improve sexual function and mood in older men with low levels.

Five minutes with . . . John Appleby.

Patient participation groups in general practice: what are they for, where are they going?

Patient feedback for quality improvement in general practice.

WHO sets out \$56m Zika virus response plan

Major changes proposed for NHS in Scotland.

Groups call for 'dangerous' trial of doctors' working hours to stop.

Sugar tax could stop 3.7 million UK people becoming obese, claims report

What next for the junior doctor contract? (Journal: BMJ (British Medical Journal) Volume: 352)

When doctors start civil disobedience it's time to take notice.

Pioglitazone may reduce cardiovascular events in high risk patients with prediabetes. (Journal: BMJ (British Medical Journal) Volume: 352)

Feedback to GPs reduces antibiotic prescribing, study finds.

Abnormality on a plain film chest radiograph.

Carotid artery stenting is as effective as carotid endarterectomy, study shows.

NHS in England embraces collaboration in tackling biggest crisis in its history.

Finalists are announced for The BMJ Awards 2016

NHS overspend reaches £2.3bn

What next for the junior doctor contract? (Journal: BMJ (British Medical Journal) Volume: 352)

Pioglitazone may reduce cardiovascular events in high risk patients with prediabetes. (Journal: BMJ (British Medical Journal) Volume: 352)

Funding uplift agreed under GP contract deal.

Genetically modified mosquitos may be used in fight against Zika.

Risk of vitamin D deficiency rises with breast feeding after age 1, study shows

Ditching our simplistic systems for categorising mental health problems.

Rebranding schizophrenia is unlikely to reduce stigma.

Government slow to improve services for people with learning disabilities, report finds.

No link between macrolide antibiotics and ventricular arrhythmias, study finds.

Sweet potato as an alternative to potato in gestational diabetes mellitus.

Australian paediatric perspective on DNACPR.

'Vaginal seeding' of infants born by caesarean section.

Government should apologise to junior doctors, says health policy expert.

Urgent action on UK air pollution is needed, say experts.

Junior doctors announce three more 48 hour strikes

Is the timing of recommended childhood vaccines evidence based?

Drugs for smoking cessation.

Junior doctor is suspended for citing colleagues on falsified research without their knowledge.

Proliferation of private online healthcare companies.

Cardiac abnormalities may help identify women at risk of recurrent pre-eclampsia

Counselling women with congenital cardiac disease.

Disadvantaged families are at greatest risk from austerity cuts to children's centres.

Investment in Sure Start children's centres is needed more than ever.

Promoting organisational justice in medicine and health science research and practice.

UK exit from EU would be serious threat to science and healthcare, experts warn.

Questions about the reliability of ROCKET-AF anticoagulation data

Doctors in danger.

Five minutes with . . . Andrew Pollard, chair of JCVI.

'Schizophrenia' is a useful concept.

Schizophrenia: changing the name and broadening the concept is problematic.

Soft tissue sarcoma.

Doctors fail to recognise acute respiratory distress syndrome, study finds.

Guidelines help doctors to identify sepsis earlier.

Women should be given maternity care budget of £3000

Management of interstitial lung disease associated with connective tissue disease

UK nurse who contracted Ebola is readmitted to hospital.

US governors seek to limit opioid prescribing.

Partha Kar: Still hoping to be Batman.

Survey ranks Indian cities on cleanliness.

The NHS: national religion or national football?

Sixty seconds on . . . vaginal seeding.

Analysis of matched case-control studies

NHS deficits will persist for years, experts warn.

Laser treatment opens temporary window in blood-brain barrier

Less than a third of NHS employees think their organisation has enough staff.

Zika highlights need for ethical framework for developing vaccines for pregnant women.

What would a 'responsible health secretary' do?

Australian hospital discharges asylum seeker infant, into more controversy.

Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (Prevention After Stroke—Blood Pressure) randomised controlled trial

Physician whistleblower is awarded \$59m in Pfizer settlement

Zika virus: management of infection and risk.

Blood pressure targets in primary care.

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses

Prognostic uncertainty drives GP antibiotic prescribing in children, study shows.

Oral fluoroquinolone use and serious arrhythmia: bi-national cohort study

Complications of rhinosinusitis.

Falling demand for mefloquine threatens future of this important antimalarial, experts warn.

US health officials investigate sexually transmitted Zika virus infections.

Staying in EU is 'no brainer' for UK science, says institute director.

Safety standards for invasive procedures.

Dogs died in studies of drug that killed man in French trial.

Rules on lobbying threaten to gag tax funded researchers.

Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the $INTERGROWTH-21^{st}$ Project: a prospective longitudinal cohort study

Margaret McCartney: Passing the patient.

India draws a red line under antibiotic misuse.

New 'managed access' process for Cancer Drugs Fund to go ahead, NHS England confirms.

Zika cases climb to 147 in US and Puerto Rico

Indian medical colleges to get single entrance exam.

Fraud is going unchecked, says US agency.

A quarter of patients with rarer cancers see GPs several times before referral.

Aflibercept is better drug for diabetic macular oedema, study finds.

Taking aspirin before coronary artery surgery does not increase deaths or bleeding, study shows.

Neurological services need urgent attention, say MPs.

Seven day NHS services: what trusts are doing.

Brazil struggles to cope with Zika epidemic.

Seven day services: how are trusts doing against Keogh's clinical standards?

Type 1 diabetes is associated with increased risk of several cancers

Benefits of female 'libido' drug flibanserin are marginal, systematic review finds.

Bottled water for all, all the time?

Overspending driven by oversized single dose vials of cancer drugs.

Ten towns that promote health to be built in England.

E-cigarettes help up to 22 000 smokers in England quit each year

Study links Zika virus to Guillain-Barré syndrome

Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study

Fever in an intravenous drug user.

Complex lifestyle differences make study on potato consumption and risk of gestational diabetes difficult to interpret.

Trends and comparison of female first authorship in high impact medical journals: observational study (1994-2014)

A (relatively) risky business: the link between prostatic radiotherapy and second malignancies

Thanks for sharing: the bumpy road towards truly open data.

Sixty seconds on . . . the consultant contract.

The gender gap in first authorship of research papers.

Flipping the model for access to patient records. (Journal: BMJ (British Medical Journal) Volume: 352)

Funding cuts could kill local authorities' enthusiasm for improving public health, experts say.

History 'will not thank' NHS leaders who ignore collaborative opportunities.

A seven day NHS.

Graeme Catto: Resilient, realistic, interested.

One in four COPD patients gets no treatment at first diagnosis, study shows.

Data too important to share: do those who control the data control the message?

Reduced oxygen saturation is not linked to repeat hospital visits in infant bronchiolitis.

Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis

Many Americans have problems with cost and access to healthcare, poll finds.

Non-antibiotic effects of ibuprofen in uncomplicated urinary tract infection in women

Study on potato consumption will increase confusion regarding food and the risk of gestational diabetes.

Authors' reply to Kristiansen.

News coverage of clinical research.

Authors' reply to Gachi, Mullie and colleagues, and Weatherburn.

Skilled use of the media by vested interests to promote drugs and other health products.

Advice is needed on the benefits of sweet potato in diabetes.

Drunk on risk: how the chief medical officers' alcohol guidelines are demonising drink. (Journal: BMJ (British Medical Journal) Volume: 352)

The BMJ paper and seven day services.

Cardiologist shortage prompts NHS trust to ask GPs to cut referrals.

Inducing labour in older women does not increase complications, study finds.

Most melanoma patients have few moles, study finds.

Health challenges of war and peace.

Canadian Medical Association dismisses second journal editor in 10 years

Evidence of benefit of personal budgets is outdated, says spending watchdog.

Experts seek ban on tackling in school rugby to prevent child injuries.

Zika virus may be linked to several birth defects, expert warns.

Interesting case of lymphocytosis and splenomegaly.

US to require safety warnings for Essure sterilization device.

One in 10 practices in England faces financial collapse, survey shows

Government could fire and rehire consultants to introduce new contract, says BMA.

Back pain after trauma.

Olympus to pay \$646m to settle charges over device sales

US hospitals make progress against healthcare associated infections.

Cardiac surgeons at Birmingham hospital must submit weekly mortality data after higher than expected deaths.

Rise in India's health budget is 'disappointing,' say experts.

Long term aspirin may reduce overall cancer risk.

Cannabis use in psychotic patients is linked to worse outcomes.

David Oliver: The real world for NHS doctors.

Healthcare leaders urge Hunt to resume talks on juniors' contract.

Margaret McCartney: Glasgow's lost hospital beds.

Hypoglycemia as an indicator of good diabetes care.

A painful foot: Lisfranc fracture-dislocations

China to train 22 000 more paediatricians in next four years

No increase in serious asthma events occurs with fluticasone plus salmeterol, study shows.

Eating peanuts in early years reduces allergy risk even with later abstinence.

Zika infection in pregnancy is linked to range of fetal abnormalities, data indicate.

Paediatrician shortage is putting child services at risk, warns college.

At last, NICE to take over the Cancer Drugs Fund.

Can anyone stop the illegal sale of medicines online?

Do hydrolysed infant formulas reduce the risk of allergic disease?

All doctors would benefit from a forum to reflect on practice.

Study provides insufficient evidence of a link between clarithromycin and myocardial infarction.

Can genetic evidence help us understand why height and weight relate to social position?

Crisis in general practice: the problem of 'independent' contractor status.

Public supports commercial access to patient records when public benefit is clear.

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis

Interlinked mental and physical health problems cost NHS more than £11bn a year

Body fat rather than weight should be considered when assessing a patient's health, study finds.

Annular, scaly, erythematous rash on the buttocks and thighs.

Dementia plan for England is unveiled.

Height, body mass index, and socioeconomic status: mendelian randomisation study in UK Biobank

European scheme to develop drugs for diseases with no treatment launched.

The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. (Journal: BMJ (British Medical Journal) Volume: 352)

Need for evidence on telehealth providers.

Abolishing unnecessary bureaucracy in general practice.

Editorialists' reply to Blake.

Clinical academics' postdoctoral career development: what about gender inequality?

Prioritising prevention and health promotion.

Author's reply to Blake.

Government's lack of knowledge of how medical hierarchy is structured.

Authors' reply to House.

Unilateral facial flushing precipitated by eating.

AAP urges pediatricians to act against child poverty.

Crossing the line: NICE's value for money threshold.

Culture of bullying at Birmingham hospital prevented staff from reporting high cardiac death rates.

Trusts have been set 'impossible task' to balance books, say NHS leaders.

MPs criticise government for complacency over GP crisis.

Sixty seconds on . . . meldonium.

I’m over 65, but I don’t need a discounted bus fare

Stephen Bolsin: Whistleblower on the Bristol scandal.

Smoking ban does not apply to prisons, Court of Appeal rules.

Company is blamed for early halt of trial into obesity treatment.

Pre-eclampsia is linked to small increase in risk of cardiomyopathy in longer term

Darzi calls for overhaul of safety incident reporting.

Primary care management of patients after weight loss surgery.

Analysing indicators of performance, satisfaction, or safety using empirical logit transformation.

WHO strengthens Zika travel advice to pregnant women.

US workers without paid sick leave are more likely to forgo care, study finds.

Type 1 diabetes in adults: supporting self management

Social prescribing could help alleviate pressure on GPs.

Number of children given antidepressants is rising, study shows.

Partial breast radiotherapy is as effective as standard whole breast radiotherapy, study finds.

Focus on harm reduction in fight against HIV, says report.

Five minutes with . . . Candace Imison.

Clinicians will get legal protection for owning up to mistakes.

The global push for institutional childbirths—in unhygienic facilities

Survival after kidney transplant from non-matching live donor is good

Teenage pregnancy rate falls to record low.

Propaganda or the cost of innovation? Challenging the high price of new drugs.

US drug costs are rising faster than overall health spending, officials report.

Poor leadership is blamed for failure to reshape Scotland's health service.

Pension funds: tobacco investment up in smoke. (Journal: BMJ (British Medical Journal) Volume: 352)

Pension funds: tobacco investment up in smoke. (Journal: BMJ (British Medical Journal) Volume: 352)

New recruitment contract for health and care services regulator dismays lay experts.

Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials (Journal: BMJ (British Medical Journal) Volume: 352)

Food industry body admits that voluntary agreements lack punch.

Doctors cite lack of time as greatest barrier to research.

Hospitals and GPs are offered incentives to reduce antibiotic prescribing.

Rates of prophylactic mastectomy triple in decade, study shows.

Regression discontinuity designs in healthcare research.

Medical management of renal stones

Cancer care team.

Studies drawing on qualitative research are funded by the most prestigious research funders in the UK.

Shaken baby witness was dishonest about her expertise, finds tribunal.

Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden (Journal: BMJ (British Medical Journal) Volume: 352)

Two in five consultant posts were unfilled last year.

Taking up the proposal of allocating one slot a month for a year to qualitative research.

Government has no credible plan to plug NHS funding 'black hole,' MPs warn.

The BMJ editors respond.

Hunt rejects claim that no plan exists to tackle NHS funding 'black hole'.

The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis

Reinventing qualitative research.

The BMJ should not narrowly confine publication to positivist quantitative studies.

Ongoing effects of burns.

The pursuit of ignorance.

US health officials press Congress for Zika funds.

By not publishing good qualitative research The BMJ is not fulfilling its values.

BMA calls for changes to end of life care.

Dermatology team. (Journal: BMJ (British Medical Journal) Volume: 352)

Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

The chronic disease explosion: artificial bang or empirical whimper?

David Oliver: Resuscitation orders and reality.

Qualitative research can inform clinical practice.

GP accused of fraudulently conducting a clinical trial.

Non-affective psychosis in refugees

Antibiotic resistance in children with E coli urinary tract infection.

Abrupt quitting is more likely to work than gradual reduction of cigarettes, study finds.

The BMJ should be adventurous and lead the way on qualitative research.

Qualitative research, observational research, and The BMJ.

Tribunal was 'unduly lenient' over psychiatrist's deception, says High Court.

Almost three million hospital bed days have been lost through social care cuts, charity warns.

Austerity is linked to rising mortality among older pensioners.

Obesity may increase risk of rare type of stroke in women taking oral contraceptives.

Growing up in care.

Ara Darzi: Pet hate—procrastinators

Drunk on risk: how the chief medical officers' alcohol guidelines are demonising drink. (Journal: BMJ (British Medical Journal) Volume: 352)

Bisphosphonates beyond five years.

Should we treat subclinical hypothyroidism in obese children?

Sixty seconds on . . . the NHS Bill.

The rewards of switching to digital.

It's the workforce, stupid.

Sugar tax will double funding for sport in primary schools, says chancellor.

Coronary artery disease: screen or treat?

True patient participation is difficult and takes dialogue.

Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist

Sit-stand desks offer little evidence of health benefits, review finds

Cervical pessary does not prevent preterm births, study shows.

This mismanagement of the NHS amounts to neglect.

South Africa's sex workers will receive HIV prevention and treatment.

People with autism die 16 years earlier on average, says charity

Men gain more disability-free years in older age than women, US study finds

Texas anesthesiologist who billed when off work is convicted of defrauding insurers.

Reducing prognostic errors: a new imperative in quality healthcare.

Doctors are urged to limit opioid prescribing.

Paracetamol does not reduce pain or improve function in osteoarthritis, study shows.

Indian medical council should be scrapped, says parliamentary committee.

How Cuba eliminated mother-to-child transmission of HIV and syphilis

My mum's decision changed my view of assisted dying.

Margaret McCartney: Looking for dementia—in the name of “awareness”

Headline writers find sweet spot with sugar tax.

Doctors who take company cash are more likely to prescribe brand name drugs, analysis finds.

Dermatology team. (Journal: BMJ (British Medical Journal) Volume: 352)

Soft drink makers consider legal challenge against sugar tax.

Junior doctors vote to escalate industrial action.

Update: New England Journal of Medicine publishes correction to 2012 CHEST trial of hydroxyethyl starch versus colloids

Peak in deaths in 2015 is not a complete mystery

Conditions for making trial data available to other investigators.

US researchers blocked from testing Cuban drug.

Seven day services: how relevant is the junior doctors' contract?

The drug industry can help reduce cancer drug costs.

Nearly half of general practices are failing to investigate complaints properly.

Environment may play significant role in multiple sclerosis.

Purpuric and petechial rashes in adults and children: initial assessment.

A beacon for free healthcare in Pakistan.

The Greater Manchester experiment. (Journal: BMJ (British Medical Journal) Volume: 352)

GMC can continue to strike off doctors who miss hearings, appeal court rules.

Down with food waste.

Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database

A woman with abdominal distension and pain.

Quality of diet and mortality among Japanese men and women: Japan Public Health Center based prospective study

US pledges better protection for babies born to addicts.

US areas with highest heart death rates have shifted from north east to south.

NHS England rolls out world's first national diabetes prevention programme.

High rates of psychiatric diagnoses are found in young transgender women.

Health and social care devolution: the Greater Manchester experiment.

Should doctors boycott working in Australia's immigration detention centres?

Doctor who gave expert advice in 'shaken baby' cases is struck off.

Recent guidance on antenatal corticosteroids in prematurity.

Maternity care varies widely across England, report shows.

Female survivors of childhood cancer have good chance of motherhood, study finds.

Jeremy Hunt interview: Still a safe pair of hands?

Rheumatoid arthritis. (Journal: BMJ (British Medical Journal) Volume: 352)

NHS England blames possible legal action for decision not to fund HIV prevention pill.

Sixty seconds on . . . scarlet fever.

Gastroenterology team.

Clinical leadership team.

Trainee who used escort while on call is suspended for 10 months

Innovation into practice.

David Oliver: Acutely ill patients on trolleys and beds—why not chairs?

WHO's Chan warns over spread of Zika virus beyond Latin America.

Prevention team.

Medical agency builds migrant camp in the heart of Europe.

The need to 'carer proof' healthcare decisions.

Junior doctors escalate action to full withdrawal of labour.

Review of decision to restrict meningitis B vaccine to babies will report in summer.

Children's fruit drinks are laden with sugar, study finds.

Jane Maher: Late-onset rock chick

Crackdown on illegal vaccine sales in China leads to 37 arrests

Depression in pregnancy.

New England Journal of Medicine essay on morcellation prompts a call for retraction.

NICE recommends exercise and not acupuncture for low back pain.

Rosacea is linked to Parkinson's disease in Danish study.

Increased mortality associated with weekend hospital admission: a case for expanded seven day services? (Journal: BMJ (British Medical Journal) Volume: 352)

'War on drugs' has harmed public health and human rights, finds new analysis.

Government changes are jeopardising public health.

Pain at the back of the heel.

Screen all for depression.

Striking junior doctors will return to work in emergency, says BMA.

Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis

Undercounting of football concussions skewed NFL research, US investigation alleges.

Margaret McCartney: Privacy is not secrecy.

Sixty seconds on . . . the war on drugs.

Pioglitazone use and risk of bladder cancer: population based cohort study

How to translate clinical trial results into gain in healthy life expectancy for individual patients.

A patient with muscle weakness.

Selecting the right drug treatment for adults with type 2 diabetes

Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care

New abortion guidance in Northern Ireland places greater emphasis on women's health.

It's time to regulate the use of whole body electrical stimulation.

Couples at risk from exposure to Zika virus should consider delaying pregnancy, says CDC.

Ebola is no longer a public health emergency, says WHO.

David Southall: Determined, honest, and anxious.

Indian doctor is arrested for not attending court hearing 24 years ago

Reasons for UK doctor's erasure are withheld on grounds of 'confidentiality'.

Doctors are failing to help people with gender dysphoria.

Experts call for younger men to be offered PSA test for prostate cancer. (Journal: BMJ (British Medical Journal) Volume: 352)

NHS is unprepared for risks posed by climate change, warn leading UK health bodies.

Reminder letters for bowel screening tests improve uptake.

Five minutes with . . . Ian Green.

The Greater Manchester experiment. (Journal: BMJ (British Medical Journal) Volume: 352)

Diabetes prevention counseling is cost effective, US study finds.

New and emerging targeted therapies for cystic fibrosis

The law is not equipped to consider scientific dispute.

Junior doctors' dispute: a pollster's view.

Facial cutaneous squamous cell carcinoma.

We need 'healthy towns' across all of England.

'Shaken baby' expert with unconventional views struck off.

Bus fare discounts for senior citizens should be taken and used.

Fines for breaching NHS performance targets are 'counterproductive'.

Consolidation of regulation in Europe is needed for the ICMJE's data sharing proposal to work.

US taskforce will push for parity in mental health and substance misuse treatment.

The question should be whether the timing of vaccination optimises the impact on child health.

Systematic review in The BMJ leads to changes to Australian guidelines on hydrolysed formula.

Safety of vaginal microbial transfer in infants delivered by caesarean, and expected health outcomes.

Johann Malawana: we must maintain doctors' goodwill.

Study provides evidence that 'vaginal seeding' of infants born by caesarean partially restores microbiota.

Patients having breast reconstruction should enter into surgery with as much information as possible.

Novartis wined and dined doctors at 80 000 “sham events” to increase prescribing, US alleges

Author's reply to Banda and Lokugamage.

Substantial slice of £4.2bn IT fund must go to general practice, say GP leaders

BMA launches judicial review against contract imposition.

Junior doctors' contract and equality analysis are published.

Early referral for foot ulcers is vital, finds audit of diabetes care.

Access to specialist palliative care is still inadequate, audit finds.

A radical prescription for the Medical Council of India.

Offering women safer options than 'vaginal seeding' for infants born by caesarean section.

US health officials press Congress for \$1.9bn to combat Zika

US panel recommends low dose aspirin to prevent cardiovascular disease and colorectal cancer.

Emergency departments in England report worst waiting times ever.

Sparse data bias: a problem hiding in plain sight.

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Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sharma, Tarang Gøtzsche, Peter C. Guski, Louise Schow Freund, Nanna
Description	Author Affiliation: Sharma T ( Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark ts@cochrane.dk.); Guski LS ( Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark.); Freund N ( Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark.); Gøtzsche PC ( Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Faculty of Health and Medical Sciences, Denmark.);
Abstract	Objective To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors. Design Systematic review and meta-analysis. Main outcome measures Mortality and suicidality. Secondary outcomes were aggressive behaviour and akathisia. Data sources Clinical study reports for duloxetine, fluoxetine, paroxetine, sertraline, and venlafaxine obtained from the European and UK drug regulators, and summary trial reports for duloxetine and fluoxetine from Eli Lilly’s website. Eligibility criteria for study selection Double blind placebo controlled trials that contained any patient narratives or individual patient listings of harms. Data extraction and analysis Two researchers extracted data independently; the outcomes were meta-analysed by Peto’s exact method (fixed effect model). Results We included 70 trials (64 381 pages of clinical study reports) with 18 526 patients. These trials had limitations in the study design and discrepancies in reporting, which may have led to serious under-reporting of harms. For example, some outcomes appeared only in individual patient listings in appendices, which we had for only 32 trials, and we did not have case report forms for any of the trials. Differences in mortality (all deaths were in adults, odds ratio 1.28, 95% confidence interval 0.40 to 4.06), suicidality (1.21, 0.84 to 1.74), and akathisia (2.04, 0.93 to 4.48) were not significant, whereas patients taking antidepressants displayed more aggressive behaviour (1.93, 1.26 to 2.95). For adults, the odds ratios were 0.81 (0.51 to 1.28) for suicidality, 1.09 (0.55 to 2.14) for aggression, and 2.00 (0.79 to 5.04) for akathisia. The corresponding values for children and adolescents were 2.39 (1.31 to 4.33), 2.79 (1.62 to 4.81), and 2.15 (0.48 to 9.65). In the summary trial reports on Eli Lilly’s website, almost all deaths were noted, but all suicidal ideation events were missing, and the information on the remaining outcomes was incomplete. Conclusions Because of the shortcomings identified and having only partial access to appendices with no access to case report forms, the harms could not be estimated accurately. In adults there was no significant increase in all four outcomes, but in children and adolescents the risk of suicidality and aggression doubled. To elucidate the harms reliably, access to anonymised individual patient data is needed.
ISSN	09598138
e-ISSN	17561833
Journal	BMJ (British Medical Journal)
Volume Number	352
Language	English
Publisher	British Medical Journal Publishing Group
Publisher Date	2016-01-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Antidepressive Agents Adverse Effects Depressive Disorder Drug Therapy Psychomotor Agitation Etiology Serotonin Uptake Inhibitors Suicide Prevention & Control Administration & Dosage Double-Blind Method Psychology Suicidal Ideation Meta-Analysis Research Support, Non-U.S. Gov't Medicine
Content Type	Text
Resource Type	Article

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