Abstract:
OBJECTIVES:To evaluate the long term effects of perioperative beta blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. DESIGN:Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. SETTING:University anaesthesia and surgical centres and one coordinating centre. PARTICIPANTS:921 patients aged > 39 scheduled for major non-cardiac surgery. INTERVENTIONS:100 mg metoprolol controlled and extended release or placebo administered from the day before surgery to a maximum of eight perioperative days. MAIN OUTCOME MEASURES:The composite primary outcome measure was time to all cause mortality, acute myocardial infarction, unstable angina, or congestive heart failure. Secondary outcome measures were time to all cause mortality, cardiac mortality, and non-fatal cardiac morbidity. RESULTS:Mean duration of intervention was 4.6 days in the metoprolol group and 4.9 days in the placebo group. Metoprolol significantly reduced the mean heart rate by 11% (95% confidence interval 9% to 13%) and mean blood pressure by 3% (1% to 5%). The primary outcome occurred in 99 of 462 patients in the metoprolol group (21%) and 93 of 459 patients in the placebo group (20%) (hazard ratio 1.06, 0.80 to 1.41) during a median follow-up of 18 months (range 6-30). All cause mortality was 16% (74/462) in the metoprolol group and 16% (72/459) in the placebo group (1.03, 0.74 to 1.42). The difference in risk for the proportion of patients with serious adverse events was 2.4% (- 0.8% to 5.6%). CONCLUSIONS:Perioperative metoprolol did not significantly affect mortality and cardiac morbidity in these patients with diabetes. Confidence intervals, however, were wide, and the issue needs reassessment. TRIAL REGISTRATION:Current Controlled Trials ISRCTN58485613.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Juul AB,Wetterslev J,Gluud C,Kofoed-Enevoldsen A,Jensen G,Callesen T,Nørgaard P,Fruergaard K,Bestle M,Vedelsdal R,Miran A,Jacobsen J,Roed J,Mortensen MB,Jørgensen L,Jørgensen J,Rovsing ML,Petersen PL,Pott F,Haas M,doi
10.1136/bmj.332.7556.1482subject
Has Abstractpub_date
2006-06-24 00:00:00pages
1482issue
7556eissn
0959-8138issn
1756-1833pii
332/7556/1482journal_volume
332pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To evaluate risk of late life coronary heart disease associated with being overweight in late middle or old age and to assess whether weight change modifies this risk. DESIGN:Longitudinal study of subjects in the epidemiological follow up study of the national health and nutrition examination survey I. SETT...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7097.1791
更新日期:1997-06-21 00:00:00
abstract:OBJECTIVE:To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation. DESIGN:Randomised controlled trial. SETTING:Five in vitro fertilisation clinics in the Netherlands. PARTICIPANTS:308 couples (women aged <40) on the waiting list for a fi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c2501
更新日期:2010-09-30 00:00:00
abstract::Cancer control encompasses the whole spectrum from prevention and early diagnosis to treatment and palliation. The key to the future of cancer control will be to establish multidisciplinary approaches to each type of cancer across this spectrum. For primary prevention this requires some understanding of the causes of ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.309.6952.449
更新日期:1994-08-13 00:00:00
abstract:OBJECTIVE:To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. DESIGN:Systematic review. ELIGIBILITY CRITERIA:Studies that compared the association between conflicts of interest and favour...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m4234
更新日期:2020-12-09 00:00:00
abstract:OBJECTIVES:To determine the strength of evidence for the effectiveness of mental health interventions for patients with three common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain). To assess whether results obtained in secondary care can be extrapolated to primary care an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.325.7372.1082
更新日期:2002-11-09 00:00:00
abstract:OBJECTIVE:To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN:Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING:Six practice settings across the United States and two additional focus group sessi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.328.7449.1162
更新日期:2004-05-15 00:00:00
abstract:OBJECTIVE:To encourage active participation of Leicestershire general practitioners and their staff in audit; to examine the use of vitamin B-12 injections and to achieve a more appropriate use. DESIGN:Implementation of an agreed audit protocol, with central analysis and feedback of anonymous and aggregated data by a ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.6996.28
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVE:To investigate the risk of glioma in adults in relation to mobile phone use. DESIGN:Population based case-control study with collection of personal interview data. SETTING:Five areas of the United Kingdom. PARTICIPANTS:966 people aged 18 to 69 years diagnosed with a glioma from 1 December 2000 to 29 Februa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38720.687975.55
更新日期:2006-04-15 00:00:00
abstract:OBJECTIVE:To determine whether genetic factors associated with established rheumatoid arthritis could, in combination with rheumatoid factor, predict the development of radiological erosions in patients with early symmetrical (rheumatoid-like) arthritis. DESIGN:Prospective study. SETTING:Teaching hospital, early arth...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6866.1387
更新日期:1992-12-05 00:00:00
abstract:OBJECTIVE:To compare the prevalence of antibody to and proviral DNA of the retrovirus HTLV-I in relatives of 11 British patients with tropical spastic paraparesis who had migrated from Jamaica before they developed symptoms, and to examine factors possibly related to transmission of HTLV-I. DESIGN:Migrant, family stud...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6720.300
更新日期:1990-02-03 00:00:00
abstract:OBJECTIVE:To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS. DESIGN:Follow-up of cluster randomised trial 4.5 years after intervention. SETTING:NHS records of women who...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.39014.503692.55
更新日期:2007-01-20 00:00:00
abstract:OBJECTIVES:To evaluate the cost effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia (CIN). DESIGN:Economic analysis using a Markov modelling approach to combine cost and epidemiological data from the NHS Sentinel Sites Study with data from previous studies of post-treat...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7086
更新日期:2012-10-31 00:00:00
abstract:OBJECTIVES:To provide a contemporary account of the treatment and outcomes of acute coronary attacks in England and Wales and to identify strategies that might improve the outcome. DESIGN:Two year community and hospital based study in three British health districts. SETTING:Health districts of Brighton (population 28...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:
更新日期:1998-04-04 00:00:00
abstract:OBJECTIVE:To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN:Nine year retrospective study. SETTING:Cambridge and King's College Hospital liver transplant programme. SUBJECTS:...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6742.15
更新日期:1990-07-07 00:00:00
abstract::The aim of the study was to determine the outcome in 181 diabetic patients with advanced, previously untreated renal impairment who had been identified in a survey conducted in six health regions in the United Kingdom in 1985. Late in 1987 questionnaires were sent to the consultant physicians, geriatricians, and nephr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6708.1135
更新日期:1989-11-04 00:00:00
abstract::A sample of 106 senior house officers who had graduated from Nottingham University in 1987 was surveyed about their experience of and need for careers guidance, performance appraisal, and stress counselling. Of the 80 who replied, a quarter had received no careers guidance and a quarter no feedback about their work pe...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6722.445
更新日期:1990-02-17 00:00:00
abstract:OBJECTIVES:To evaluate the cardiac safety of central nervous system stimulants in children and adolescents. DESIGN:Population based retrospective cohort study. SETTING:Automated healthcare claims data from 1,219,847 children and young people eligible for 28 state Medicaid programmes from 1999 to 2006 linked to the So...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e4627
更新日期:2012-07-18 00:00:00
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更新日期:1991-07-20 00:00:00
abstract:OBJECTIVE:To determine the effect of withdrawing diuretic drugs on oedema in patients prescribed them for only ankle oedema, excluding patients with cardiac, hepatic, or renal failure. DESIGN:Randomised controlled trial. SETTING:15 general practices in the Netherlands. PATIENTS:1202 patients aged 65 years or older a...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1994-02-19 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.299.6697.487
更新日期:1989-08-19 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2010-10-06 00:00:00
abstract:OBJECTIVES:To determine the relation between the HIV/AIDS epidemic and support for dependent elderly people in Africa. DESIGN:Retrospective analysis using data from Demographic and Health Surveys. SETTING:22 African countries between 1991 and 2006. PARTICIPANTS:123,176 individuals over the age of 60. MAIN OUTCOME M...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2010-06-16 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
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更新日期:2015-07-28 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2016-04-06 00:00:00
abstract:OBJECTIVE:To determine the risk of chronic kidney disease in patients with psoriasis. DESIGN:Population based cohort study and nested cross sectional study. SETTING:Electronic medical records database based in United Kingdom. PARTICIPANTS:Cohort study: patients with psoriasis aged 18-90 each matched to up to five pa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2013-10-15 00:00:00
abstract:OBJECTIVE:To appraise a new method of prenatal screening for Down's syndrome based on maternal serum concentrations of alpha fetoprotein, unconjugated oestriol, and human chorionic gonadotrophin combined with maternal age--the "triple test." DESIGN:Examination of the cost effectiveness of the triple test relative to s...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1991-05-11 00:00:00
abstract:OBJECTIVE: To compare the effectiveness of flexible sigmoidoscopy in screening for colorectal cancer by patient sex and age. DESIGN: Pooled analysis of randomised trials (the US Prostate, Lung, Colorectal and Ovarian cancer screening trial (PLCO), the Italian Screening for Colon and Rectum trial (SCORE), and the Norwe...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
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更新日期:2017-01-13 00:00:00
abstract::Physicians need to evaluate clinical research critically, and determining the power of a study is an essential component of research evaluation. This report presents a graphical aid that permits rapid power determination for clinical trials with two groups. Power curves were developed for dichotomous outcomes by setti...
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pub_type: 杂志文章
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更新日期:1988-09-10 00:00:00
abstract:OBJECTIVE:Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN:Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland i...
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pub_type: 杂志文章
doi:10.1136/bmj.304.6829.746
更新日期:1992-03-21 00:00:00
abstract:OBJECTIVE:To assess the feasibility and acceptability of screening young children for iron deficiency in a deprived inner city practice and to assess the effects of a programme of dietary education. DESIGN:Prospective study of children in general practice, comparison with historical controls. SETTING:A deprived inner...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6703.838
更新日期:1989-09-30 00:00:00