At high concentrations, free radicals and radical-derived, nonradical reactive species are hazardous for living organisms and damage all major cellular constituents. At moderate concentrations, how...

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Free Radicals in the Physiological Control of Cell Function

The CONSORT (Consolidated Standards of Reporting Trials) Statement, including a checklist and a flow diagram, was developed to help authors improve their reporting of randomized controlled trials. Its primary focus was on individually randomized trials with 2 parallel groups that assess the possible superiority of one treatment compared with another but is now being extended to other trial designs. Noninferiority and equivalence trials have methodological features that differ from superiority trials and present particular difficulties in design, conduct, analysis, and interpretation. Although the rationale for such trials occurs frequently, those designed and described specifically as noninferiority or equivalence trials appear less commonly in the medical literature. The quality of reporting of those that are published is often inadequate. In this article, we present an adapted CONSORT checklist for reporting noninferiority and equivalence trials and provide illustrative examples and explanations for those items amended from the original CONSORT checklist. The intent is to improve reporting of noninferiority and equivalence trials, enabling readers to assess the validity of their results and conclusions.

/pdf/reporting-of-noninferiority-and-equivalence-randomized-v12srq216e.pdf

Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement.

Obesity relationships with community design, physical activity, and time spent in cars

Psychological beliefs such as optimism, personal control, and a sense of meaning are known to be protective of mental health. Are they protective of physical health as well? The authors present a program of research that has tested the implications of cognitive adaptation theory and research on positive illusions for the relation of positive beliefs to disease progression among men infected with HIV. The investigations have revealed that even unrealistically optimistic beliefs about the future may be health protective. The ability to find meaning in the experience is also associated with a less rapid course of illness. Taken together, the research suggests that psychological beliefs such as meaning, control, and optimism act as resources, which may not only preserve mental health in the context of traumatic or life-threatening events but be protective of physical health as well.

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Psychological resources, positive illusions, and health.

OBJECTIVE
To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings.


RESEARCH DESIGN AND METHODS
A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used.


RESULTS
A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care.


CONCLUSIONS
Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care.

Interventions to improve the management of diabetes in primary care, outpatients, and community settings : a systemic review

Death is the new sex, last great taboo in Western society and Western medicine, as Richard Smith discusses in his editorial (p 129). In the trinity of births, marriages, and deaths, only death does not have glossy magazines devoted to stylish consumption at the attendant ceremonies. On the web, of course, …

Death and dying

This week, a series of four articles considers the place of the randomised controlled trial as we approach the second century of experience with the concept. Its basic principle is genuine uncertainty as to which treatment arm of the trial it would be in a patient's best interests to enter. This is not necessarily an easy concept to transmit, …

Randomised controlled trials

In the future there will be more old people than there are now. How do we know? Because the Government Statistical Service tells us so ( www.statistics.gov.uk/misc/sitemap.htm ). Government statistical reports were notoriously dusty paper publications, but being able to download the actual data in electronic form from a website does make them more interesting. So if …

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The ageing population.

The consensus that regular physical exercise is a vital part of maintaining health and wellbeing has existed for at least a decade.1 The human body is made to exercise, yet our increasingly motorised existence means that we now walk an average of eight miles less each day than our forebears 50 years ago.2 Cycling has shown a similar decline: in 1949 34% of miles travelled using a mechanical mode were by bicycle; today only 1-2% are.2

The car, weighing the best part of a ton and often conveying only one person and a briefcase, is a highly inefficient mode of transport. The fumes cars expel cause appreciable mortality3 and are a major contributor to …

https://www.bmj.com/content/bmj/320/7239/888.full.pdf

Cycling and health promotion. A safer, slower urban road environment is the key.

Although unemployment among doctors is rare, many doctors express dissatisfaction with their work. This mismatch between expectation and reality may in part be due to doctors not receiving adequate advice on their careers. This week we launch a new section in the BMJ designed to respond to this lack. Career Focus, as the new section is known, will be published each week in the classified advertising supplements and will help keep doctors abreast of the many possible avenues that their working lives may follow.

The one thing we know for sure about the NHS of the future is that it will be different from now. Last month the British Association of Medical Managers (BAMM) gathered together a team of hospital doctors and managers to play …

/pdf/careers-advice-for-doctors-4parq9107y.pdf

Douglas Carnall

Papers

Death and dying

Randomised controlled trials

The ageing population.

Cycling and health promotion. A safer, slower urban road environment is the key.

Careers advice for doctors