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Naveed Ahmed Khan: The increase in cases of brain eating amoeba

23 Sep, 16 | by BMJ

naveed_khanThere has been an alarming increase in the number of reported deaths due to brain-eating amoeba, Naegleria fowleri, a parasite that invades the brain through the nose via water. [1] The parasite feeds on the brain and causes severe haemorrhage and inflammation resulting in widespread brain tissue destruction. Even with treatments, the fatality rate is almost 100%. [2] The reported number of deaths is likely to represent only the tip of the iceberg and the actual number of deaths is most likely far higher.  more…

Jeffrey Aronson: When I use a word . . . Sanguine—hopeful, not bloody minded

23 Sep, 16 | by BMJ

jeffrey_aronsonThe first of Galen’s four fluid humours of the body, αἷμα, blood, was associated with the temperament that came to be known as sanguine, from the equivalent Latin word, sanguis. Sanguis meant the fluid that flows from wounds, the blood that colours the face red, bloodshed, as in battle or sacrifice, life blood or the vital fluid, vigour, vitality, the source of one’s instincts, and kindred or consanguinity.

Latin words that invoked sanguis included sanguiculus and sangunculus, both meaning black pudding, and sanguisuga, a leech. Sanguinalis or herba sanguinarius was a plant that stopped haemorrhage more…

Paul Buchanan: No decision about me without me

23 Sep, 16 | by BMJ

peb-photo-jpgMany are the conversations, opinions, statements, and arguments within the patient world about the meaning of that phrase “No decision about me without me”—but what does it actually mean, and to whom? Many of us have emotionally connected it to the phrase “Do No Harm” and think of it in the same terms, believing that as a patient it must be obvious to those with power and decision making ability over us that they will do their best for us. more…

David Shaw: Delaying surgery for obese and smoking patients is illogical and unethical

23 Sep, 16 | by BMJ

david_shawIt was recently reported that Vale of York clinical commissioning group (CCG) plans to delay all elective surgery for obese patients for a year until they lose 10% of their weight, and to smokers for six months unless they stop smoking for eight weeks. [1] Both the overall rationale for this policy and the clinical rationale for targeting these particular groups are unclear.

The most obvious objection to the proposed policy is that it is unfair to target specific patient groups in this way. Why should the obese and smokers be singled out? The rationale cannot be clinical risk: while surgery is riskier for morbidly obese patients, and smoking is bad for your health in the long term, mildly obese patients and smokers are just as likely to recover well from surgery as slim non-smokers. The CCG seems to think that it is logical to target both smokers and obese patients simply because patients who are very obese and smoke are at greater clinical risk. more…

Arthy Santhakumar: The verdict is out on superbugs

22 Sep, 16 | by BMJ

arthy-santhakumarA global health peril that demands global action. 

For only the fourth time in history, a health issue has reached the great political heights of the United Nations General Assembly. Following HIV, non-communicable diseases, and Ebola—antimicrobial resistance (AMR) has taken the grand stage, receiving a standing ovation in the form of a united political declaration which promises to combat AMR and has been signed by 193 member states.

The high-level meeting, held on 21 September concluded with world leaders making a pledge of more than £600 million, to mobilise the human and financial resources needed for innovation and preservation of this public common good. more…

Peter White et al: Releasing patient data from the PACE trial for chronic fatigue syndrome

22 Sep, 16 | by BMJ

The PACE trial was the largest clinical trial to date into Chronic Fatigue Syndrome (CFS), also sometimes referred to as Myalgic Encephalomyelitis (ME). This randomised controlled trial involved 641 UK patients suffering from CFS and compared the effectiveness of four treatments. It found that when added to specialist medical care (SMC), cognitive behaviour therapy, and graded exercise therapy were more effective than both adaptive pacing therapy, and SMC alone.

We have received many requests over the last five years to release the patient data collected in the PACE trial, and former editor of The BMJ Richard Smith suggests we have made “a serious mistake” in not always releasing data. The data requests often cite the importance of transparency, giving other scientists the opportunity to investigate our data, and changing customs in science where data sharing is increasingly encouraged. more…

Simon McGrath: PACE trial shows why medicine needs patients to scrutinise studies about their health

22 Sep, 16 | by BMJ

simon-mcgrathLike all patients, what I want most from clinical research is treatments that work, not ones that merely look good on paper. As The BMJ has pointed out, patients are often faced with over-hyped treatments and an incomplete research base biased towards positive results.

These biases arise partly because of “publish or perish” pressure on researchers. By contrast, patients’ only concern is to establish what really works: their interests are directly aligned with those of good science and sound medicine. more…

William Cayley: What is your story?

21 Sep, 16 | by BMJ

bill_cayley_2Much has been written in recent years about “narrative medicine” or “narrative based medicine,” and there has even been discussion of how to integrate “narrative” and “evidence based” medicine in both journal articles and books.

Most of this work (very helpfully) focuses on the narratives of patients: who they are as people, how their sufferings affect them, how they create or find meaning, etc. These are all important considerations, but what about our narratives of our work as physicians or healthcare professionals? In what story context do we see our work? more…

Matthias Wienold: Patient safety—when patients take centre stage

21 Sep, 16 | by BMJ

Matthias_WienoldIt is a rare moment for most physicians to engage with patients beyond the professional encounter. Some friends may become our patients, and sometimes patients can become friends—few physicians, however, take active roles in patient organisations or interact with patient representatives on an ongoing basis. Even fewer physicians take on a patient’s role when they interact on social media (for example, as in Kate Granger’s campaigning work). more…

Richard Smith: Teaching children to make better health decisions

21 Sep, 16 | by BMJ

richard_smith_2014After 30 years of trying to teach clinicians, policymakers,  journalists, and patients the basic concepts of deciding if claims about health interventions are valid, Andy Oxman, one of the originators of evidence based medicine, decided that it’s tough to teach adults new ways of thinking because of all the baggage in our heads. So he and his colleagues in Norway and East Africa have turned their attention to children. A group of 20 health and education researchers, teachers, clinicians, publishers, designers, and creators of games from eight countries met last week in Bellagio, Italy, to discuss progress with the work and future plans. more…

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