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David Wrigley: Like another bad penny?

31 Oct, 14 | by BMJ

david_wrigleyWe have just seen another report from a London based “think tank,” suggesting profound changes to the way the NHS works. These reports seem to turn up with annoying regularity and are often not written with any evidence base to support them, but they do seem to promote the views of organisations that donate vast sums of money to them. A few months ago we had Reform suggesting that we should introduce a regular payment for all patients to use the NHSan organisation that receives around a million pounds of funding from the very same insurance firms and private companies who would benefit from a “cash for treatment” healthcare system…

The latest idea can be found in a report from the Centre for Policy Studies (CPS)—a think tank founded by Margaret Thatcher in 1974, now chaired by Lord Saatchi, with CPS council members including David Willets MP, Brooks Newmark MP, John Redwood MP, Oliver Letwin MP, and Tim Montgomerie.

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William C Cayley: Social history on the back roads

31 Oct, 14 | by BMJ

bill_cayley_2Social context and relationships may shape what drives our patients, but sometimes the best way to ponder these is on a drive!

En route to a home visit today, I was met at the edge of town by a road crew doing last-minute sealing work before the onset of winter (despite what you may have heard, Wisconsin only has two seasons—winter and road construction!). As I sat mildly frustrated at the wait until they let us pass, I found myself wondering how many of the road crew, might actually be my patients. (In the end, no faces were familiar, but still it left me thinking).

The home visit was actually relatively straightforward, nothing new going on, no new needs requiring attention. On departing, I decided to both avoid another road construction delay, and take some back roads into town that I seldom explore.

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Mary E Black: Inside the mind of a Member of Parliament

31 Oct, 14 | by BMJ

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I had the opportunity to listen to a number of MPs explain how they think during the excellent Westminster experience  organized by Cumberlege Eden & Partners as part of my NHS Executive Fast Track Programme. I took notes from the MPs—current and recent—whom we met. The session was targeted at senior people in the NHS, but it could be generally applicable to other organizations.

Here are 10 examples of what might be running through their minds as you approach them for a long-awaited meeting.

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The BMJ Today: Clinical challenges

31 Oct, 14 | by BMJ

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When my patients with acute stroke develop a urinary tract infection, I often prescribe a course of co-trimoxazole (trimethoprim/sulfamethoxazole).  Many of these patients have hypertension and are also taking an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). Prior studies show that trimethoprim and renin-angiotensin system blockers  can lead to hyperkalemia, particularly when used in combination, and a study by Michael Fralick and colleagues at the University of Toronto published in The BMJ today finds that in elderly patients taking an ACEI or an ARB, the use of co-trimoxazole is associated with an increased risk of sudden death. Should I avoid the co-trimoxazole and renin-angiotensin blockers in my patients? Should I routinely measure potassium levels in these patients? At what point should I worry?

In an associated editorial, Mahyar Ethminan and James Brophy remind us that we should be careful about making clinical decisions based on data from observational studies, particularly case-control studies) as these can identify associations but not causal links. These studies are prone to several biases owing to unmeasured and residual confounders, imbalances between patients and controls and misclassification of exposures and outcomes. They acknowledge the quality of Fralick’s study and the fact that it brings attention to an important issue but remind us that a plausible course of action for clinicians is to be careful when using the drug combination but await confirmation of the findings before giving up using these essential antibiotics. more…

Cordelia Galgut: Emotional support through breast cancer

30 Oct, 14 | by BMJ

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Before being diagnosed with primary breast cancer myself, aged 49 in 2004, I would offer emotional support to women with this diagnosis, and arrogantly assume I understood pretty well what they were going through, at all stages—and my then clients were too polite to tell me to the contrary. Little did I know! Life on the other side of the breast cancer divide, as a patient, not a psychologist, differed hugely from how I understood it to be. For a start, it was a much more harrowing, long drawn out process, both physically and psychologically, than I could ever have imagined. It challenged my sense of myself as a woman much more than I could ever have foreseen, to say nothing of my theoretical beliefs as a psychologist. Indeed, I still suffer breast cancer’s fallout 10 years on. more…

Suzie Bailey: Strategy development – starring role or chorus line?

30 Oct, 14 | by BMJ

Suzie-BaileyIs “transformation” one of the most overused words in relation to the NHS and the issues it faces? Just last week, I heard a NHS deputy CEO joke that the word should be banned, and thought I’d happily join him! On the other-hand, “strategic development” is rarely mentioned. This is strange, as isn’t the NHS going to need to do more of both to overcome its quality, demand, and financial challenges?

The Five Year Forward View echoes this sentiment, that strategy is a vital part of the NHS. So, if strategic development has a starring role in helping the NHS’s clinically and financial sustainability—whose job is it?

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The BMJ Today: Leapfrogging—the new buzzword in healthcare

30 Oct, 14 | by BMJ

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It is easy to take universal health coverage for granted if you were born and raised in a European country, for example. But in low and middle income countries, people often have to somehow find the means to pay out of pocket for their healthcare, regardless of the availability of quality healthcare. Costs can quickly escalate to astronomical figures in case of serious health problems, and if people don’t have the financial means or relatives overseas who can help, they may end up not receiving any care at all or incurring unmanageable debt. more…

Sarah Knowles et al: Hacking into health research

29 Oct, 14 | by BMJ

Patients get called a lot of things these days. Simon Stevens, for example, referred to them as the “renewable energy” of health services. The NHS White Paper called them “the heart” of the NHS. We at PRIMER (the Primary care Research in Manchester Engagement Resource), however, decided to call them hackers.

More specifically, we invited patients to “be” hackers—to hack into health research by pitching their own ideas for new research projects. The format was borrowed from the existing NHS Hack Days (wonderfully subtitled as “geeks who love the NHS”), which bring together tech experts, such as programmers and developers, with medical experts, doctors, and nurses to work together on new tech ideas that would improve some aspect of healthcare. more…

William Cayley: Overdiagnosis, uncertainty, and epistemology

29 Oct, 14 | by BMJ

bill_cayley_2Many thanks to Anita Jain for reporting on the “Overdiagnosis” session at the Cochrane Colloquium—I wish I could have been there.

The suspicion that overdiagnosis (or at least over testing) is driven in part by the quest for certainty, is corroborated by an implementation study of the Vancouver chest pain rule. When the Vancouver chest pain rule was implemented as a triage protocol, the number of patients presenting for emergency care of acute chest pain who could subsequently be discharged early for outpatient follow-up was almost doubled. more…

The BMJ Today: Is milk good for you?

29 Oct, 14 | by BMJ

America’s iconic “Got Milk?” campaign was pulled this year after a successful run of over 20 years. Graced by the likes of Bill Clinton, Naomi Campbell, Elton John, David Beckham, and Angelina Jolie sporting a milk moustache, the campaign garnered wide recognition. Yet milk was losing favour against a growing variety of breakfast and drink options. The dairy industry therefore opted for a different positioning. Under the tagline “Milk Life,” the ads now tout the richness of milk’s protein content.

The evidence, though, on the health benefits of milk consumption is scant and divided. more…

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