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George Gillett: NHS and immigration: the ethical issue nobody is talking about

1 Sep, 15 | by BMJ

george_gillettLast February, the UK Home Office announced changes to immigration rules that would mean non-EU nurses would not have their visa applications prioritised. The decision not to add nursing to the list of “shortage occupations” reflects the government’s belief that nursing posts can be filled without international recruitment, but has received criticism from the Royal College of Nursing and a number of NHS managers. Clinical directors went as far as branding the move a “complete disaster,” while NHS Employers wrote to the Home Office to protest their decision earlier this month. more…

Navjoyt Ladher: Preventing Overdiagnosis 2015—winding back the harms of too much medicine

1 Sep, 15 | by BMJ

navjoyt_ladher“Medical science has made such tremendous progress that there is hardly a healthy human left”—Aldous Huxley

Today sees the start of the third annual Preventing Overdiagnosis conference, this year hosted by the National Cancer Institute in Washington DC. The BMJ has been a partner in this event since its inception and it forms an important part of our Too Much Medicine campaign, highlighting the harms to health from medical excess and the waste of valuable resources on unnecessary care. more…

The BMJ Today: Searching for the seven day services plan

1 Sep, 15 | by BMJ

david_cameronA freedom of information (FOI) request from BMJ Careers has found that there was no formal correspondence between the Prime Minister and the medical director of NHS England on the definition of seven day services before Cameron announced his plan to create “a truly seven day NHS.” The BMA said it was astounding that no such correspondence took place.  more…

Richard Lehman’s journal review—1 September 2015

1 Sep, 15 | by BMJ

richard_lehmanNEJM  20-27 Aug 2015  Vol 373

726   We start with a basket trial. Say you are in a supermarket and put lots of brown things in your basket—bread, a joint of lamb, a tin of brown beans, some kiwi fruit, and a shirt. Now, out of scientific curiosity, you decide to dip the contents of your basket in anti-brown, a corrosive substance that binds to anything that’s brown. You find that the bread dissolves completely, the lamb turns blue, the kiwi fruit explodes, the shirt shrinks and the beans remain unaffected. The actual basket trial described here was only slightly more sophisticated. It gathered together 120 patients with various forms of non-melanoma cancers, all of which expressed the oncogene BRAF V600. They were all given a selective oral inhibitor of the BRAF V600 kinase, vemurafenib. The short-term responses were then observed. “Preliminary vemurafenib activity was observed in non–small-cell lung cancer and in Erdheim–Chester disease and Langerhans’-cell histiocytosis… There were anecdotal responses among patients with pleomorphic xanthoastrocytoma, anaplastic thyroid cancer, cholangiocarcinoma, salivary-duct cancer, ovarian cancer, and clear-cell sarcoma and among patients with colorectal cancer who received vemurafenib and cetuximab.” more…

Jeffrey Aronson: When I use a word . . . The first medical word

28 Aug, 15 | by BMJ

jeffrey_aronsonIn an earlier blog I noted the impossibility of knowing which words came first, language having evolved thousands of years before written records, although claims have been made for the longevity of words such as I, we, and thou; this and that; who and what. One can, however, discover the earliest known recorded words in English, by searching the Oxford Engish Dictionary, which itself draws on information given in earlier dictionaries, glossaries, and encyclopaedias, sometimes collectively known as lexionaries, as well as primary texts. more…

Neville Goodman’s metaphor watch: Powerhouses and workhorses

28 Aug, 15 | by BMJ

neville_goodmanThe mitochondrion was termed the “powerhouse of the cell” in a Scientific American article in 1957 by Philip Siekevitz, who died in 2009. I suspect that anyone with biological knowledge would recognise the phrase instantly, and it’s an appropriate metaphor, so it’s odd that I couldn’t find it in any of the obituaries and articles of appreciation I looked at on the internet. Without wanting to accuse the obituary writers of snobbery, is it because the phrase and the journal are not “proper science?” Put the phrase into an internet search engine, and there are pages and pages of mitochondria. more…

Khaled El Emam, Tom Jefferson, Peter Doshi: Maximizing the value of clinical study reports

27 Aug, 15 | by BMJ

In late 2010, the European Medicines Agency (EMA) became the first regulator in history to promulgate a freedom of information policy that covered the release of manufacturer submitted clinical trial data. Under a separate, new policy (policy 070), the EMA will take an additional step and create a web based platform for sharing manufacturers’ clinical study reports (CSRs) upon a decision being made on a marketing authorization application or its withdrawal.

CSRs contain significant details that are often missing in journal publications of the same trials—for example, details pertaining to patient relevant outcomes and adverse events—and are an important new tool for those engaged in research synthesis. While the policy anticipates that the agency will require individual participant data (IPD) to also be shared, the EMA has not yet committed to a final timeline for this. more…

Jonathon Hope: What happens when doctors don’t know best?

27 Aug, 15 | by BMJ

jonathon_hopeA recent story of how a teenage cancer patient’s online research of symptoms was dismissed by doctors before death raises the question of where patients go to get information when the system fails to deliver.

Modern medical treatments, especially for LTC’s (Long Term Conditions), can lead to a devastating, often unrecognised, or untreated symptom burden for many, yet sharing the true nature of our online symptom search preferences with our clinician, can lead to criticism and stigmatisation. more…

Richard Lehman’s journal review—27 August 2015

27 Aug, 15 | by BMJ

richard_lehmanNEJM 6-13 Aug 2015 Vol 373

503 Outcomes in early breast cancer surgery just keep on getting better. But between 20-40% of patients who have a partial mastectomy need to undergo further surgery soon afterwards because the excision margin shows possible tumour involvement. A team at Yale decided to see if this could be averted by routinely performing a further shave of the cavity margins after all grossly visible tumour had been completely removed. Randomization—either to close the wound or to perform extra shaves—occurred at the moment of decision during the operation. And sure enough, those who had the extra shave were half as likely to need re-excision surgery, and had no increase in complications.

more…

Anant Bhan: The Call to Action Summit 2015—thoughts on some key areas for discussion and action

26 Aug, 15 | by BMJ

AnantBhan_BMJblogs_Jul2015

India is hosting the Call to Action Summit on the 27-28 August in New Delhi. The summit is focused on ending preventable child and maternal deaths, and will be co-hosted by the Ministry of Health and Family Welfare, the Government of India, the Ministry of Health Government of Ethiopia, USAID, UNICEF, the Bill & Melinda Gates Foundation, and Tata Trusts. The summit will bring together health ministers from 24 priority countries (contributing 70% of the world’s child and maternal deaths) which signed on to a global call for action for child survival in June 2012 along with researchers, policy makers, funders, experts, and representatives from industry, civil society, and media. The meeting has an interesting and packed agenda. It would be good to see a discussion on the following areas during the summit: more…

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