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Ian Barker: Why we should all move to an opt-out system for organ donation

22 May, 15 | by BMJ

ian_barkerOn 1 December 2015, Wales will be the first country in the UK to introduce an opt-out system for organ donation. This means that patients will need to actively opt out of organ and tissue donation—otherwise consent will be assumed. This change is significant and one to be welcomed. As an advocate of organ donation, I hope the rest of the UK soon follows suit, having witnessed the benefit of transplantation and the solace it can bring to families involved. more…

David Wrigley: A seven day NHS? My seven point plan for Mr Cameron & Mr Hunt

22 May, 15 | by BMJ

david_wrigleyThe media have called this the “first major speech” in this brand new Conservative majority government. Prime Minister David Cameron, with five years of power ahead of him, decided to focus on the NHS, and, in particular, he focused on one particular aspect—seven day working. Trailed in the Tory manifesto and now offered to the nation it sounds appealing, but as is usually the case with many things Mr Cameron does, most of it doesn’t stand up to proper scrutiny.

Here is my seven point plan for Mr Cameron’s seven day NHS: more…

Jeffrey Aronson: When I use a word . . . The X factor

22 May, 15 | by BMJ

jeffrey_aronsonThere are symbols in the International Phonetic Alphabet (IPA) that do not represent the sounds of letters they look like. Among these is the grapheme /x/, which does not represent any of the sounds of the letter ex, but instead represents the sound of a voiceless velar fricative, as in an obsolete English word for sherry, Xeres (hheres), properly Xeres sack (sherris sack), from the original spelling of the Andalusian town of Jerez (hhereth). more…

The BMJ Today: Crisis and corruption

22 May, 15 | by BMJ

nagpaul_chaand• Chaand Nagpaul, chair of the BMA’s general practitioners committee, urges UK health ministers to halt a “surreal obsession” with seven day working at a time when the GP workforce is facing a workforce catastrophe, with more than a third set to retire in the next five years.

Addressing the association’s annual local medical committee conference in London, he warned the new UK government that “unless it turns this around we won’t have a comprehensive general practice service in parts of the UK.” more…

Neel Sharma: Reforms in medical education—are we missing something?

22 May, 15 | by BMJ

Medical education has seen significant change over the past decade and more. Advances in teaching, learning, and assessment strategies are vast. The didactic lecture form of teaching is no longer the flavour of the month it seems with more and more emphasis on problem and team based learning. Classrooms are seeing the use of mobile devices to allow for rapid learner access to information and instructors are now tasked with the need not to simply disseminate information but to ensure understanding and provide appropriate feedback. Classes are being “flipped” and the MOOC movement has meant that attending face to face teaching is slowly becoming a non-existing entity. more…

A gap in the evidence—what is the role of surgery in the patient with severe (secondary) Raynaud’s phenomenon?

21 May, 15 | by BMJ

herrick_arianelindsay

This blog is part of a series of blogs linked with BMJ Clinical Evidence, a database of systematic overviews of the best available evidence on the effectiveness of commonly used interventions.

By Ariane Herrick and Lindsay Muir

People with Raynaud’s phenomenon secondary to an underlying disease or condition (the best researched one being systemic sclerosis) can progress to irreversible tissue injury with ulceration and/or critical ischaemia and gangrene. Although there has been increasing interest in recent years in identifying new drug therapies for severe Raynaud’s phenomenon with randomised controlled trials (RCTs) of, for example, phosphodiesterase inhibitors and endothelin receptor antagonists, the recent new BMJ Clinical Evidence overview identified no RCTs of any of the surgical procedures that have been advocated for advanced peripheral vascular disease. Specifically, there have been no RCTs of any of the following interventions: botulinum toxin injections, surgical debridement, peripheral (digital, digital plus ulnar and/or radial artery) sympathectomy, cervical/thoracic sympathectomy, arterial reconstruction, or amputation. more…

Tessa Richards: Fewer tablets, more self management support

21 May, 15 | by BMJ

Tessa_richardsIt’s easy to lose confidence and withdraw from life when you become ill and lose your job. “Anne” struggled for 20 years with multiple long term conditions and a drug regimen of 28 tablets a day before going on a six week self management course which “turned [her] life around.” She and other patients spoke eloquently at a recent meeting organised by The Health Foundation on how such courses gave them the motivation, knowledge, and skill to question what best management meant for them, change their behaviour, and reach self defined goals. Doctors should routinely “prescribe” self management courses for patients with long term conditions—and do so soon after diagnosis, not 20 years later, the meeting concluded. more…

The BMJ Today: Tobacco, tennis, and “unmitigated quackery”

21 May, 15 | by BMJ

cigarettes_darkAn investigation by The BMJ into attempts by big tobacco to prevent the introduction of plain packaging of cigarettes has revealed that MPs and peers accepted gifts from the tobacco industry, including tickets to the men’s final at Wimbledon and the opera at Glyndebourne. Jonathan Gornall’s article showed that 38 MPs received a total of £60,000 of industry hospitality between the time when changes were first mooted in 2010 and the vote this year. more…

Sue Hogston: “We only have one chance to get it right, so why are some still getting end of life care so wrong?”

20 May, 15 | by BMJ

Sue Hogston_Today’s report by the parliamentary and health service ombudsman demonstrates that end of life care could be improved for up to 355 000 people a year; highlighting tragic cases where people’s suffering could have been avoided or lessened with the right care and treatment.

Issues identified in the report as the most common within end of life care were: more…

David Oliver: Do bring me problems

20 May, 15 | by BMJ

david_oliver_2015In her book Smile or Die: How Positive Thinking Fooled America and the World, Barbara Ehrenreich brilliantly deconstructed this cult. Her starting point was her own diagnosis of breast cancer and the bullying attitude that if you don’t “fight” the cancer and stay “positive” in the face of distress and worry, then your demise is your own doing. She showed how these exhortations to think positively had permeated thinking in many aspects of policy, business, careers, and “self-actualisation.” Jenni Murray referred to this as seeing “the glass as half full even when it lies shattered on the floor.” On a recent day on call, I bonded with another physician over her irritation at this US business phenomenon entering UK healthcare, while also agreeing that some NHS staff have embraced the equally unhelpful cult of “negative thinking.” more…

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