You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Desmond O’Neill: Stethophones and barriers to effective care of older people

1 Sep, 14 | by BMJ

desmond_oneillThere is a long tradition in medicine of accepting a degree of mismatch between labels and the functions that they address. A classic example is the stethoscope, through which few of us peer, but which only a terminal pedant would now agitate to be renamed a stethophone.

Recent debate over the redesignation of dementia as “major neurocognitive disorder” in the new DSM-V criteria highlights how the widespread acceptance of a somewhat less accurate descriptor may be more beneficial in terms of engagement with the public and among disciplines.

So, during the Berzelius symposium last month, I was surprised to come across a troubling barrier to developing better care for older people—the key adult users of health services—arising from resistance to an internationally accepted term. more…

Richard Lehman’s journal review—1 September 2014

1 Sep, 14 | by BMJ

richard_lehmanNEJM 21-28 August 2014 Vol 371
711  I have a new little grandson called Timothy. He is lucky being born in August because respiratory syncytial virus generally lies low at this time of the year. Most babies get RSV at some stage of their first year, and the earlier they get it the worse it tends to be, with recurring bronchiolitis every time they get any kind of upper respiratory virus. So I’m hoping Tim won’t get RSV this side of Christmas, and that when he does he will shake it off as a mere cold. There is no effective treatment, although the NEJM seems to believe there may be one in the offing, as they have chosen to give space to a British phase 1 study of GS-5806, a novel oral small molecule that inhibits RSV entry at low nanomolar concentrations by blocking viral-envelope fusion with the host-cell membrane. That sounds like a pretty cunning trick, and in a challenge study in 54 healthy adults, it reduced the viral load and the severity of clinical disease. It also tended to reduce their neutrophil counts and raise their alanine aminotransferase. So not much use for my tiny Tim until it has undergone phase 2 and 3 trials in lots of adults and babies in the community. more…

The BMJ Today: Questions over data underpinning beta blocker use in surgery and stroke management

1 Sep, 14 | by BMJ

debsIn a highly critical analysis article on thebmj.com, two cardiologists call on the European Society of Cardiology (ESC) to revise its recent guidance about the use of beta blockers in patients undergoing noncardiac surgery; to make processes more transparent; and to act more swiftly upon fraudulent research—particularly when patient lives are at risk.

Since 2009, the ESC guidelines have recommended giving a short course of oral β blockers from shortly before surgery until a few days or weeks after surgery to patients with ischaemic heart disease or positive preoperative stress test results who are having high risk surgery. The aim is to reduce perioperative mortality by preventing myocardial infarction. more…

The BMJ Today: In with the new

29 Aug, 14 | by BMJ

Birte
Online publishing is evolving all the time, providing opportunities to display information in new and different ways. Our two latest State of the Art clinical reviews—still a relatively new type of article in The BMJ—(entitled “Lower urinary tract symptoms in men” and “Bariatric surgery for obesity and metabolic conditions in adults” both include interactive graphics (showing the evolution of bariatric procedures and the international prostate symptoms score, which was also reviewed in a recent blog).  Both these “infographics” illustrate the subjects in a user-friendly, easy-to-understand, dynamic manner that static illustrations cannot provide. more…

Ohad Oren: Why soldiers are like patients

29 Aug, 14 | by BMJ

 

Credit: Herbert Bishko

Credit: Herbert Bishko

Each war revives the clash between the safety of a country’s own citizens and that of its soldiers. The recent Operation Protective Edge, taken by Israel with the objective of restoring calm to its citizens, should be examined by the same standard. Was the presumed political gain worth the soldiers’ loss of lives? Was the blow to Hamas’s infrastructure a reasonable compensation for the death of sixty four young combatants? And, more broadly, are we willing to sacrifice the innocent lives of soldiers in order to temporarily decrease the number of rockets targeting our neighborhoods? more…

James Raftery: NICE: “inconsistent,” “in large part arbitrary and opaque,” according to friends

29 Aug, 14 | by BMJ

A strong critique just published points to logical inconsistencies in NICE’s consideration of social values, specifically in how it handles quality adjusted life years (QALYs). Since these are key to many of the most controversial decisions made by NICE’s appraisal committees, this matters. It matters all the more that the authors include Tony Culyer, who was “the founding vice chair of the National Institute for Health and Clinical Excellence and is a member of the NICE Citizens Council Committee and the NICE International Advisory Committee.” Besides being a leading health economist, he pioneered NICE’s approach to economic evaluation. Chris McCabe, another prominent health economist, has long advised NICE, notably through its decision support unit, which specialises in difficult cases. more…

Jo Bibby: The healthcare decisions we make should be personal

28 Aug, 14 | by BMJ

jo_bibbyAs the summer holidays draw to a close, thousands of people up and down the country will have found out whether the hours and months spent meticulously researching the best places to visit and to stay ultimately came to fruition.

There are lots of decisions to make in life. Holidays are a perfect example of how much time people are willing to commit to an activity that they hope will improve their happiness and wellbeing. We notice similar patterns with the time we invest in buying new furniture or a new car too. But it’s often been asked why people don’t tend to put the same effort into making decisions about their healthcare. more…

The BMJ Today: When money and medicine mix

28 Aug, 14 | by BMJ

Anne_GullandEarlier this year, The BMJ published an editorial urging doctors in India to fight back against corruption in medicine. Kickbacks and bribes are a global problem but India, “with rampant corruption at all levels, is prominent in this international field,” the authors wrote.

Since the publication of the editorial in June, the article has been accessed more than 5000 times, but a new feature on thebmj.com by Vidya Krishnan shows how the anticorruption movement is gaining momentum. more…

Lavanya Malhotra: The ice bucket challenge—trivialising trend or canny awareness campaign?

28 Aug, 14 | by BMJ

Lavanya MalhotraLately, social media sites have been invaded by videos of people upending buckets of icy water over their heads. The goal behind this watery exercise is to raise funds, as well as awareness, for amyotrophic lateral sclerosis (ALS) research. The ALS ice bucket challenge is simple: douse yourself in icy water, record it, post it online—on Facebook or Twitter, for instance—including a message about doing it for ALS research, and donate money to the ALS Association (ALSA) through its donation webpage. In the UK, people can donate to the Motor Neurone Disease Association.

The final step is to nominate several friends to do the same. This chain reaction strategy has generated publicity and money for ALSA. So far, 1.7 million people have donated, raising $79.7m (€60.4m; £48m). more…

Paul Teed: Is medical opinion shifting towards support for an assisted dying law?

27 Aug, 14 | by BMJ

Paul TeedOver the weekend, the Times published findings from a new survey conducted by Medix, which asked 600 doctors various questions on assisted dying, assisted suicide, and euthanasia. The coverage contrasted the findings with those from a similar Medix survey a decade ago, reported then in The BMJ. But reading the complete data in the new survey highlights what some would consider surprising, if not shocking, views from doctors, especially when we consider how the medical establishment is often cited as unanimously opposed to any proposals on this issue.

While the majority of doctors were against a UK change in law to allow physician assisted suicide and/or euthanasia when asked the question in broad terms, a majority of respondents also believed that there would be grounds for physician assisted euthanasia if a patient had a terminal illness. more…

BMJ blogs homepage

The BMJ

Helping doctors make better decisions. Visit site



Creative Comms logo

Latest from The BMJ

Latest from The BMJ

Latest from BMJ podcasts

Latest from BMJ podcasts

Blogs linking here

Blogs linking here