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Researchers whose rapid investigations into possible covid treatments that helped to save over a million lives worldwide have won a top prize in this year’s BMJ Awards. The Recovery collaborative group’s trial, which was the first to show that the inexpensive steroid dexamethasone improved survival among patients with covid-19 who had severe respiratory complications, was awarded The BMJ ’s research paper of the year.1 It found that dexamethasone reduced the risk of death by a third among patients on ventilators and by almost a fifth among those on oxygen. The award judges praised the “landmark” NHS study. They said, “The setup of …

Summary Background Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. Methods To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs). Findings Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82–0·89; p

Surgical patients are facing new territory. On the one hand they hear that elective surgery carries an increased risk of getting covid-19, on the other, that delaying surgery may cause problems, and that operations can be done safely when precautions are taken. In this article, Mary Venn, surgical research fellow, and Carrie Tierney Weir, a patient with inflammatory bowel disease, describe how their collaborative group, CovidSurg, has worked with patients to rapidly produce information resources about the risks of surgery during the pandemic.

> Building a place where all physiotherapists can freely unite, collaborate, learn and contribute to improving global health — Rachael Lowe, Physiopedia Director Physiopedia is a free online resource of physiotherapy knowledge, collaboratively written and edited by physiotherapists (http://www.physio-pedia.com). Essentially Wikipedia for physiotherapists, Physiopedia uses an innovative Wiki platform enabling any qualified physiotherapist from anywhere around the globe to contribute and edit content. It is built around collaborative group authoring, with the aim of gathering the sum of all physiotherapy knowledge and making it freely available to all (including the general public). For the busy sports physiotherapist, Physiopedia offers an abundance of tissue-specific (eg, tendons, muscles) and joint-specific (eg, knee, shoulder) resources in one place at a click of a button, as well as lots of other physiotherapy-related material. Physiopedia receives ~1 million visits per month from over 200 countries, and the more than 2000 knowledge-based pages are updated by physiotherapists on average of 200 times per day. Free online content is made up largely …

We read with great interest the extended report by Lilleker et al 1 on the EuroMyositis registry. Our attention was particularly addressed to antisynthetase syndrome (ASSD) because in the last years we and all members of the AENEAS (American and European Network of Antisynthetase Syndrome) collaborative group strongly contributed2–7 to increase the knowledge on this peculiar disease. We think that a comparison between our cohorts could be of interest and useful for clinicians, even if the lack of some data in the EuroMyositis paper does not allow us to perform statistical analysis. Both groups collected a very large number of patients (AENEAS collaborative group 813 cases, EuroMyositis 512 cases). The comparison of available …

Background/introduction Gonorrhoea (GC) cases appear to be rising as well as increasing problems with resistance to many antibiotic groups. With open boundaries and free movement of populations and doctors, a consistent standard of care is important across Europe. Regular evaluation is crucial in controlling the emergent spread of resistant GC. Aim(s)/objectives To evaluate current clinical practice amongst sexual health physicians across Europe against the current European guidelines. Also, key areas of controversy will be explored with to help inform further guideline development. Methods The ECCG is a network of 120 sexual health specialists across 38 countries, who conduct questionnaire-based research across the European region. An expert panel consisting of six ECCG members was established then interviewed to help identify areas of controversy. Subsequently, a clinical scenario based questionnaire was developed then disseminated to all ECCG members. Results Provisional results demonstrate variation in clinical practice across Europe. This is discernable from the choice of treatment for a patient with a history of anaphylaxis to penicillin and treatment for confirmed pharyngeal infection. In addition, data showed a lack of consensus to guidelines regarding choices of look back period for sexual contacts. Discussion/conclusion Management of GC varies across Europe and is not always in line with current European guidelines. Although there are minor variations between guidelines, there are vast discrepancies amongst European clinicians regarding clinical practice. There is a need for on-going Europe wide education to ensure that patients are receiving safe evidence based care.

Aromatase inhibitors and bisphosphonates can extend the lives of women with breast cancer, studies published in the Lancet have shown.\[1\]\[2\] Aromatase inhibitors were already known to reduce the risk of recurrence of breast cancer more effectively than tamoxifen, but the effect on survival was unknown. To investigate this researchers from the Early Breast Cancer Trialists’ Collaborative Group combined the results of nine clinical trials including 31 920 women who had used aromatase inhibitors and tamoxifen at various times during the course of treatment. All of the women were postmenopausal and had been treated for oestrogen positive breast cancer. Overall the results showed that women’s breast cancer was less likely to recur if they took an aromatase inhibitor (relative risk …

Introduction Rectal prolapse is a disabling condition which is under-reported and affects the quality of life of our ageing population. Despite this there is ‘no accepted standard procedure’1a given patient should receive. The perceived risk of surgery has meant that elderly patients often undergo a perineal operation with an abdominal operation being reserved for younger patients or those with recurrence. Randomised controlled trials have found it challenging to recruit patients making comparison between outcomes difficult for abdominal and perineal operations. Method The Surrey and South West London Pelvic floor group was founded in 2014 and includes the following hospitals – Ashford and St Peters Hospital, Croydon University Hospital, East Surrey Hospital, Epsom and St Heliers Hospital, Frimley Park Hospital, Kingston Hospital, Royal Berkshire Hospital, St Georges Hospital and Wexham Park Hospital. All patients who underwent surgery for full thickness rectal prolapse between April 2011 and March 2013 were included. Data was collected retrospectively from the notes using a standardised proforma. Results 244 patients underwent surgery for full thickness rectal prolapse in the study period. Seven patients were excluded due to incomplete data leaving 237 patients. All but four patients were female. Median age at time of operation was 78.4 years with an average ASA of 2.1. The recorded overall recurrence for all surgery was 17.7%. Median length of stay (LOS) was 2 days. Conclusion In this retrospective multicentre study abdominal operations for full thickness rectal prolapse had a significantly lower rate of recurrence than the perineal approach. This was despite there being a higher proportion of patients in the abdominal group who had had previous surgery for rectal prolapse. Although patients in the abdominal group were younger and fitter there was no difference in length of stay and complication rates. The rates of recurrence for perineal operations were similar1but the recurrence rate after abdominal operations was higher than previousy reported in the literature.1This may be a reflection of the individual learning curves for laparoscopic rectal prolapse surgery during the study period (2011–2013). Disclosure of interest None Declared. Reference Senapati A, Gray RG, Middleton LJ, et al.; PROSPER Collaborative Group. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68

Objective To evaluate the relative effectiveness of hysterectomy, endometrial destruction (both “first generation” hysteroscopic and “second generation” non-hysteroscopic techniques), and the levonorgestrel releasing intrauterine system (Mirena) in the treatment of heavy menstrual bleeding. Design Meta-analysis of data from individual patients, with direct and indirect comparisons made on the primary outcome measure of patients’ dissatisfaction. Data sources Data were sought from the 30 randomised controlled trials identified after a comprehensive search of the Cochrane Library, Medline, Embase, and CINAHL databases, reference lists, and contact with experts. Raw data were available from 2814 women randomised into 17 trials (seven trials including 1359 women for first v second generation endometrial destruction; six trials including 1042 women for hysterectomy v first generation endometrial destruction; one trial including 236 women for hysterectomy v Mirena; three trials including 177 women for second generation endometrial destruction v Mirena). Eligibility criteria for selecting studies Randomised controlled trials comparing hysterectomy, first and second generation endometrial destruction, and Mirena for women with heavy menstrual bleeding unresponsive to other medical treatment. Results At around 12 months, more women were dissatisfied with outcome with first generation hysteroscopic techniques than with hysterectomy (13% v 5%; odds ratio 2.46, 95% confidence interval 1.54 to 3.9, P

Source Citation The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-72. 18539916

Commentary on: BOOST II UK Collaborative Group; BOOST II Australia Collaborative Group; BOOST II New Zealand Collaborative Group, et al. Oxygen saturation and outcomes in preterm infants. N Engl J Med 2013;368:2094–104.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] The goal of oxygen therapy is to deliver sufficient oxygen to the tissues while minimising oxygen toxicity and oxidative stress. Although many extremely preterm infants receive supplemental oxygen for prolonged periods, the optimal oxygen saturation has not yet been defined. The Benefits Of Oxygen Saturation Targeting (BOOST) II randomised controlled trial (RCT) aimed to evaluate the effects of targeting an oxygen saturation of 85–89%, as compared with a range of 91–95%, on disability-free survival at 2 years in infants born before 28 weeks’ gestation. During the study period, two major changes were made to the original study protocol; first, in the midst of the UK and Australian trials, … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.issn%253D0028-4793%26rft.volume%253D368%26rft.spage%253D2094%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1302298%26rft_id%253Dinfo%253Apmid%252F23642047%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1302298&link_type=DOI [3]: /lookup/external-ref?access_num=23642047&link_type=MED&atom=%2Febmed%2F19%2F1%2F20.atom [4]: /lookup/external-ref?access_num=000319574200007&link_type=ISI

Commentary on: Roncaglioni MC, Tombesi M, et al. Risk and Prevention Study Collaborative Group. n-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013;368:1800–8[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Ecological, case–control and prospective studies consistently demonstrate reduced cardiovascular morbidity and mortality associated with higher intake of fish and their constituent omega-3 fatty acids and with higher omega-3 fatty acid status.1 This effect has been ascribed to improvement of the cardiovascular risk profile resulting in disease prevention.1 Trials in patients following myocardial infarction (MI) or with heart failure demonstrated significantly lowered mortality with pharmaceutical grade omega-3 ethyl esters at a dose of approximately 850 mg/day,2 ,3 suggesting a therapeutic effect in at-risk patients. This may be due to a reduction in cardiac arrhythmias, although this effect has not been demonstrated unequivocally, … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.issn%253D0028-4793%26rft.volume%253D368%26rft.spage%253D1800%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1205409%26rft_id%253Dinfo%253Apmid%252F23656645%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1205409&link_type=DOI [3]: /lookup/external-ref?access_num=23656645&link_type=MED&atom=%2Febmed%2F19%2F1%2F18.atom [4]: /lookup/external-ref?access_num=000318540000008&link_type=ISI

On the basis of the study by the Birthplace in England Collaborative Group,1 the Royal College of Obstetricians and Gynaecologists advocates advising first time mothers of the benefits of delivering in obstetric units or alongside midwifery units. Low risk multiparous women can deliver in any of the four locations. However, research is needed to explain the high …

Obesity levels continue to climb worldwide, but high income countries have managed to mitigate some of the harmful effects by achieving impressive reductions in blood pressure and cholesterol concentrations over the past 30 years. These findings come from a vast amount of data gathered from every country in the world by the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborative Group and published in three reports in the Lancet (www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62037-5/abstract). The data show that in 2008 one in three adults in the world was overweight (BMI ≥25 kg/m2) and one in nine adults was obese (BMI ≥30 kg/m2). Since 1980 the average body mass index (BMI) has increased in all regions, but now middle income countries have caught up with high income countries. The highest levels of obesity in the world are found in Pacific Island nations. The research, supported by the Bill and Melinda Gates Foundation and the World Health Organization, shows that systolic blood pressure is currently highest in low income and middle income countries. Between 1980 and 2008 mean systolic blood pressure declined markedly in high income countries by 7.3 mm Hg, whereas it increased in …

Source Citation Heart Protection Study Collaborative Group. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20, 536 people. BM...

▴ Poustie VJ, Russell JE, Watling RM, et al and the CALICO Trial Collaborative Group. Oral protein energy supplements for children with cystic fibrosis: CALICO multicentre randomised control trial. BMJ2006;332:632–5 [OpenUrl][1][Abstract/FREE Full Text][2] Due to a multitude of causes, cystic fibrosis (CF) is characterised by poor nutrition which is an important predictor of decline in lung function. Oral protein energy supplements are used widely to improve energy intake and nutritional status in patients suffering from CF. These supplements are costly and a … [1]: {openurl}?query=rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.38737.600880.AE%26rft_id%253Dinfo%253Apmid%252F16467348%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=332/7542/632&atom=%2Fthoraxjnl%2F61%2F7%2F591.atom

Chemotherapy and hormonal therapy achieve long term improvements in survival in women with breast cancer, with even greater increases in 15 year survival than five year survival. These are the latest findings from a five yearly meta-analysis published last week ( Lancet 2005;365: 1687-717). The Early Breast Cancer Trialists' Collaborative Group coordinated the world's largest collaborative analysis of cancer trials, including data from 145 000 women with early breast cancer who had been studied in 194 randomised trials. The group assessed the effects after 10 …

TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ 2003;327:708–13. [OpenUrl][1][Abstract/FREE Full Text][2] Q Is midazolam or haloperidol plus promethazine more effective for rapid sedation of agitated or aggressive people with mental illness? ### ![Graphic][3] Design: Randomised controlled trial. ### ![Graphic][4] Allocation: Concealed. ### ![Graphic][5] Blinding: Treatment was open, but assessors were blinded to intervention. ### ![Graphic][6] Follow up period: Twenty minutes for primary outcome. ### ![Graphic][7] Setting: Three psychiatric emergency rooms, Rio de Janeiro, Brazil. ### ![Graphic][8] Patients: 301 people needing sedation for agitation or aggressive behaviour. ### ![Graphic][9] Intervention: Intramuscular injection of midazolam (15 mg or 7.5 mg) or haloperidol plus promethazine (5 mg or 10 mg haloperidol plus 50 mg promethazine). ### ![Graphic][10] Outcomes: Participant asleep or tranquillised at 20 minutes; adverse effects. ### ![Graphic][11] Patient follow up: 99%. Midazolam rendered significantly more participants asleep or tranquil in 20 minutes than haloperidol plus promethazine (AR … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.volume%253D327%26rft.issue%253D7417%26rft.spage%253D708%26rft.epage%253D713%26rft.atitle%253DRapid%2Btranquillisation%2Bfor%2Bagitated%2Bpatients%2Bin%2Bemergency%2Bpsychiatric%2Brooms%253A%2Ba%2Brandomised%2Btrial%2Bof%2Bmidazolam%2Bversus%2Bhaloperidol%2Bplus%2Bpromethazine%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.327.7417.708%26rft_id%253Dinfo%253Apmid%252F14512476%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=327/7417/708&atom=%2Febmental%2F7%2F2%2F42.atom [3]: /embed/inline-graphic-1.gif [4]: /embed/inline-graphic-2.gif [5]: /embed/inline-graphic-3.gif [6]: /embed/inline-graphic-4.gif [7]: /embed/inline-graphic-5.gif [8]: /embed/inline-graphic-6.gif [9]: /embed/inline-graphic-7.gif [10]: /embed/inline-graphic-8.gif [11]: /embed/inline-graphic-9.gif

Source Citation PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lanc...

EDITOR—The UK Collaborative Group on Monitoring the Transmission of HIV Drug Resistance reports an estimated prevalence of transmitted HIV drug resistance in 2000 of 27%.1 In an ongoing study of acute primary HIV infection at St Mary's Hospital, London, England, we have identified 28 seroconverters since January 2000. All patients sequenced to date (15/28) have no evidence of drug resistant mutations in either reverse transcriptase or protease before …

Source Citation Kenyon SL, Taylor DJ, Tarnow-Mordi W, for the ORACLE Collaborative Group. Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. Lancet. 2001 Mar...

A simple solution of glucose, insulin, and potassium seems to be effective in reducing deaths from heart attacks and is inexpensive enough to be widely used, according to a new study ( Circulation 1998;98:2227-34). The study resurrected a long abandoned treatment for myocardial infarction and was conducted at 29 hospitals in six Latin American countries by the Estudios Cardiolµgicos Latino-america Collaborative group. The group is led by Dr Rafael Diaz of Argentina's cardiovascular institute in Rosario. Glucose, insulin, and potassium infusions for heart attacks were initially introduced in 1962 but subsequently abandoned due …

Results from the largest ever collection of randomised data on a cancer drug suggest tamoxifen should be given to all patients with breast cancer who have had surgery for hormone dependent tumours, regardless of age. The new data decisively overturns accepted wisdom that tamoxifen has no benefit for younger women or those with breast only tumours. It also indicates that the drug has a substantial benefit on top of chemotherapy. Coordinators of the Early Breast Cancer Trialists' Collaborative Group based at Oxford University's Clinical Trial Service Unit say that acting on these results will prevent around 20000 more deaths from breast cancer a year worldwide, including …