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38

What is the most effective operation for adults with severe and complex obesity?

Accessing, undergoing, and achieving a successful outcome from surgery for “severe and complex obesity” is difficult and requires determination and effort. Here, we consider “severe and complex obesity” to mean that an individual’s health is compromised by his or her weight to the extent that surgery can be considered to be an appropriate option.1 Surgery may be offered to adults with a body mass index (BMI) of ≥40, or a BMI of ≥35 with an obesity related disease, and it can be very successful. An average 50% of excess weight may be lost in the first few years after surgery, and if this is sustained it is associated with long term reduction in overall mortality and decreased incidences of diabetes, myocardial infarction, stroke and cancer.1 2 This treatment, however, requires careful consideration and serious commitment, with the need to demonstrate full engagement in a structured weight loss programme, to have tried all appropriate non-invasive measures of weight loss, and persevered for referral to a specialist surgical team.1 Once surgery is approved it is necessary to choose which operation to undergo.  
bmj.com
over 7 years ago
Www.bmj
1
25

Chronic hypertension during pregnancy

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths.1 2  
bmj.com
over 7 years ago
Www.bmj
1
22

Inducing hypothermia after out of hospital cardiac arrest

Out of hospital cardiac arrest is common and is associated with a high rate of mortality.1 With early ambulance treatment, about 30% of these patients have a return of spontaneous circulation and are transported to hospital. However, many patients remain comatose owing to hypoxic brain injury, and this is the leading cause of death after hospital admission.  
bmj.com
over 7 years ago
Www.bmj
1
23

Time to take periodontitis seriously

Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the United Kingdom and 60% of those over 65 years.1 It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status.2 Periodontitis also compromises speech, reduces quality of life,3 and is an escalating burden to the healthcare economy. In the UK alone it was estimated to cost £2.8bn (€3.4bn; $4.6bn) in 2008,4 not including raised all cause mortality, an association that has been noted in several populations.5 Worryingly, the disease is often silent, being present for decades before diagnosis and treatment. It can leave a substantial pathological footprint on multiple organ systems, as well as the oral cavity.  
bmj.com
over 7 years ago
Www.bmj
1
23

Chronic hypertension during pregnancy | The BMJ

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths. - currently located behind a paywall. Your institution may have access through Athens/Elservier or similar.  
bmj.com
over 7 years ago
Www.bmj
1
18

Time to take periodontitis seriously | The BMJ

Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the United Kingdom and 60% of those over 65 years.1 It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status.2 Periodontitis also compromises speech, reduces quality of life,3 and is an escalating burden to the healthcare economy. In the UK alone it was estimated to cost £2.8bn (€3.4bn; $4.6bn) in 2008,4 not including raised all cause mortality, an association that has been noted in several populations.5 Worryingly, the disease is often silent, being present for decades before diagnosis and treatment. It can leave a substantial pathological footprint on multiple organ systems, as well as the oral cavity. - currently located behind a paywall. Your institution may have access through Athens/Elservier or similar.  
bmj.com
over 7 years ago
Www.bmj
1
18

Higher sugar intake linked to raised risk of cardiovascular mortality, study finds

Higher consumption of added sugar is associated with an increased risk of cardiovascular mortality, a new US study has shown.1  
bmj.com
over 7 years ago
Www.bmj
1
18

Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies

Objectives To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths.  
bmj.com
over 7 years ago
Www.bmj
1
31

What is the most effective operation for adults with severe and complex obesity?

Accessing, undergoing, and achieving a successful outcome from surgery for “severe and complex obesity” is difficult and requires determination and effort. Here, we consider “severe and complex obesity” to mean that an individual’s health is compromised by his or her weight to the extent that surgery can be considered to be an appropriate option.1 Surgery may be offered to adults with a body mass index (BMI) of ≥40, or a BMI of ≥35 with an obesity related disease, and it can be very successful. An average 50% of excess weight may be lost in the first few years after surgery, and if this is sustained it is associated with long term reduction in overall mortality and decreased incidences of diabetes, myocardial infarction, stroke and cancer.1 2 This treatment, however, requires careful consideration and serious commitment, with the need to demonstrate full engagement in a structured weight loss programme, to have tried all appropriate non-invasive measures of weight loss, and persevered for referral to a specialist surgical team.1 Once surgery is approved it is necessary to choose which operation to undergo.  
bmj.com
over 7 years ago
Www.bmj
1
21

Chronic hypertension during pregnancy

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths.1 2  
bmj.com
over 7 years ago
Www.bmj
1
24

Antibiotics to promote growth in children?

Overt infections are a leading cause of death worldwide in children under 5,1 and strategies to prevent and treat infections are a cornerstone of child survival programmes. Recent assessments suggest that despite a net increase in the size of birth cohorts, the number of children dying before their fifth birthday has fallen to 6.6 million (uncertainty range 6.3-7.0 million) per year, a 45% reduction from almost 12 million deaths in 1990.2 In contrast, the fall in undernutrition has been modest at best. An estimated 165 million children under 5 were stunted in 2011 and an estimated 52 million severely wasted; almost 45% of the current burden from child mortality in under 5s can be attributed to malnutrition.3 Although many risk factors for early child mortality are well recognised, the mechanisms underlying chronic enteropathy and growth failure among children in low and middle income countries remain uncertain.4  
bmj.com
over 7 years ago
Www.bmj
1
15

Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies

Objectives To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths.  
bmj.com
over 7 years ago
Static.www.bmj
1
20

Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study

Objective To determine the relative risks of prostate cancer incidence, metastasis, and mortality associated with screening by serum prostate specific antigen (PSA) levels at age 60.  
bmj.com
over 7 years ago
Www.bmj
1
9

Androgen deprivation therapy is ineffective for early prostate cancer, US study shows

Men with early prostate cancer who are treated with androgen deprivation therapy instead of surgery or radiation therapy show no reduction in mortality compared with those who receive no treatment, a retrospective analysis of US cancer registries has shown.1  
bmj.com
over 7 years ago
Www.bmj
1
24

Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance

Pressure ulcers are serious and distressing, and they can affect people of any age. Not only do they increase mortality, result in extended hospital stays, and consume substantial healthcare resources, they are often an example of avoidable harm. Reported prevalence rates range from 4.7% to 32.1% in hospital populations and as much as 22% in nursing home populations.1 Prevention of this devastating condition must be a priority for the NHS. Stage 1 pressure ulcers (see box for definition of stages) can be reversible if identified promptly, and most stage 2 and 3 ulcers can be healed with appropriate care, but all require a multidisciplinary approach for effective management. It is hoped that this guideline will help reduce pressure ulcers nationally and improve care when pressure ulcers do occur.  
bmj.com
over 7 years ago
Www.bmj
1
16

Time to take periodontitis seriously

Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the United Kingdom and 60% of those over 65 years.1 It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status.2 Periodontitis also compromises speech, reduces quality of life,3 and is an escalating burden to the healthcare economy. In the UK alone it was estimated to cost £2.8bn (€3.4bn; $4.6bn) in 2008,4 not including raised all cause mortality, an association that has been noted in several populations.5 Worryingly, the disease is often silent, being present for decades before diagnosis and treatment. It can leave a substantial pathological footprint on multiple organ systems, as well as the oral cavity.  
bmj.com
over 7 years ago
Www.bmj
1
36

Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance

Pressure ulcers are serious and distressing, and they can affect people of any age. Not only do they increase mortality, result in extended hospital stays, and consume substantial healthcare resources, they are often an example of avoidable harm. Reported prevalence rates range from 4.7% to 32.1% in hospital populations and as much as 22% in nursing home populations.1 Prevention of this devastating condition must be a priority for the NHS. Stage 1 pressure ulcers (see box for definition of stages) can be reversible if identified promptly, and most stage 2 and 3 ulcers can be healed with appropriate care, but all require a multidisciplinary approach for effective management. It is hoped that this guideline will help reduce pressure ulcers nationally and improve care when pressure ulcers do occur.  
bmj.com
over 7 years ago
Www.bmj
1
23

Chronic hypertension during pregnancy

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths.1 2  
www.bmj.com
over 7 years ago
Www.bmj
1
16

Time to take periodontitis seriously

Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the United Kingdom and 60% of those over 65 years.1 It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status.2 Periodontitis also compromises speech, reduces quality of life,3 and is an escalating burden to the healthcare economy. In the UK alone it was estimated to cost £2.8bn (€3.4bn; $4.6bn) in 2008,4 not including raised all cause mortality, an association that has been noted in several populations.5 Worryingly, the disease is often silent, being present for decades before diagnosis and treatment. It can leave a substantial pathological footprint on multiple organ systems, as well as the oral cavity.  
www.bmj.com
over 7 years ago