Abstract: Jan P Vandenbroucke professor, Department of Clinical Epidemiology, Leiden University hospital, Leiden, Netherlands for the StroBe Initiative correspondence to: e von elm strobe@ispm.unibe.ch Many questions in medical research are investigated in observational studies.1 Much of the research into the cause of diseases relies on cohort, case-control, or cross sectional studies. Observational studies also have a role in research into the benefits and harms of medical interventions.2 Randomised trials cannot answer all important questions about a given intervention. For example, observational studies are more suitable to detect rare or late adverse effects of treatments, and are more likely to provide an indication of what is achieved in daily medical practice.3 Research should be reported transparently so that readers can follow what was planned, what was done, what was found, and what conclusions were drawn. The credibility of research depends on a critical assessment by others of the strengths and weaknesses in study design, conduct, and analysis. Transparent reporting is also needed to judge whether and how results can be included in systematic reviews.4 5 However, in published observational research important information is often missing or unclear. An analysis of epidemiological studies published in general medical and specialist journals found that the rationale behind the choice of potential confounding variables was often not reported.6 Only few reports of case-control studies in psychiatry explained the methods used to identify cases and controls.7 In a survey of longitudinal studies in stroke research, 17 of 49 articles (35%) did not specify the eligibility criteria.8 Others have argued that without sufficient clarity of reporting, the benefits of research might be achieved more slowly,9 and that there is a need for guidance on reporting observational studies.10 11 Recommendations on the reporting of research can improve reporting quality. The consolidated standards of reporting trials (CONSORT) statement was developed in 1996 and revised five years later.12 Many medical journals supported this initiative,13 which has helped to improve the quality of reports of randomised trials.14 15 Similar initiatives have followed for other research areas—for example, for the reporting of metaanalyses of randomised trials16 or diagnostic studies.17 We established a network of methodologists, researchers, and journal editors to develop recommendations for reporting observational research: the strengthening the reporting of observational studies in epidemiology (STROBE) statement. Aims and use of STROBE statement The STROBE statement is a checklist of items that should be addressed in articles reporting on the three main study designs of analytical epidemiology: cohort, case-control, and cross sectional studies. The intention is solely to provide guidance on how to report observational research well: these recommendations are not prescriptions for designing or conducting studies. Also, while clarity of reporting is a prerequisite to evaluation, the checklist is not an instrument to evaluate the quality of observational research. Here we present the STROBE statement and explain how it was developed. In a detailed companion article, the explanation and elaboration article,18-20 we justify the inclusion of the different checklist items and give methodological background and published examples of what we consider transparent reporting. We strongly recommend using the STROBE checklist in conjunction with the explanatory article, which is available freely on the websites of the publishing journals. 18-20

Abstract: #### Summary points Dementia is important in relation to driving. As the disease progresses the ability to drive safely is eventually lost and at that point current regulations demand that driving stops. Many patients continue to drive after dementia has been diagnosed,1 2 3 4 5w10 however, and withdrawal of their licence should not be undertaken lightly. A study highlighted the negative consequences of stopping people with dementia from driving.w11 Stopping driving can limit access to family, friends, and services and is an independent risk factor for entry to a nursing home.w12 Traffic medicine has evolved significantly since the 1990s, with more emphasis on preserving mobility. As populations age and increasing numbers of older people drivew1 general practitioners are key players in ensuring that older people are not constrained by an unfair attribution of risk. Health professionals, however, practise in a society where the perception of older drivers is negative.w2 This may stem from misconceptions about the impact of age related disease on driving: these misunderstandings also apply to medical journals, which commonly reproduce statements on the apparent increase …

Abstract: Further to the three research areas Fortin et al identify for investigation,1 four additional aspects of multimorbidity are also relevant. Firstly, acute conditions also contribute to comorbidity, and there is no reason for their exclusion. Secondly, comorbidity is of particular relevance to primary care, which is person focused and not disease focused.2 Thirdly, research on the …

Abstract: I am struck by the global absence of a debate about health literacy in achieving health equity for all.1 Patients (users) in all countries have a right to information about health. This is enshrined in the constitution of the World Health Organization of 1946. If we are to share our knowledge we need to …

Abstract: The long awaited revamp of the Wellcome Collection, which claims to be the world's first public venue devoted to looking at the human condition, impresses Colin Martin

Abstract: Joe Collier is impressed by a BBC documentary about the marketing of paroxetine

Abstract: Sadness is normal because life can be difficult.1 2 Sadness in bereavement, for example, is appropriate and healthy—I hope my children will be sad after I've gone. However, sadness is not depression: when it is combined with cognitive, emotional, somative, and behavioural features it becomes the syndrome of depression, with its multifactorial aetiology, so common in primary care. But diagnosis does not mean …

Abstract: I was delighted to read the editorial suggesting that we should move away from the primitive “one threshold fits all” mentality for starting antihypertensive treatment and take a view based on the overall cardiovascular risk.1 We already do this when treating cholesterol for the purposes of primary prevention, so it is inconsistent not to use this approach for blood pressure, which is another continuous variable. The recent Joint British Societies' guidelines recognise this as the predicted cardiovascular risk rises with systolic blood pressure to 160 mm Hg,2 yet they are not used as a tool for assessing whether to treat hypertension. This is part of the general problem that occurs when we assign arbitrary values to continuous and often fluctuating biological variables to create boundaries for disease labels. For example, bronchial hyper-reactivity can change quite notably over time, and it can be very difficult to decide whether the label of asthma is appropriate. Our target driven culture encourages the use of these labels, but I think that they are often not very helpful, and I often use asthma drugs in those whom I would not label as asthmatic. Glucose metabolism represents another such variable, and I look forward to the day when I read an editorial suggesting that we abandon the World Health Organization's criteria for diagnosing diabetes, in favour of a decision tool for the treatment of abnormal glucose metabolism based on risk.

Abstract: The BMA's annual public health conference is an opportunity for doctors to air public health issues and debate them, to challenge each other and establish what is known and what is not known.1 The specialty of public health takes evidence based medicine at least as seriously as other specialties, but from time to time …

Abstract: It was five years after the end of the second world war. A young lecturer in orthopaedics from Manchester published a book titled The Closed Treatment of Common Fractures—a slim volume with a modest aim: “to re-emphasise the non-operative method.” His target readership was primarily junior trainees in accident and emergency and orthopaedics. His years of service as a military surgeon in the war almost certainly provided him with ammunition for his work. He had an important message for the hapless doctor left unsupervised to treat common fractures concerning why and how fractures displace and how best to reduce and hold …

Abstract: Clinicians should stop patients doing this if it has no benefit