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Doctors’ Day in India: Time for critical reflection for the medical profession

30 Jun, 15 | by BMJ

AnantBhanBhavnaDhingraIndia celebrates Doctors’ Day every year on 1 July, in memory of Bidhan Chandra Roy (1 July 1882-1 July 1962), a well respected physician who was also the second chief minister of the state of West Bengal. The day sees a fair bit of fanfare, with events held across the country, especially by bodies such as the Indian Medical Association. While the day serves to highlight the importance of medicine in society, it should also be an opportunity for medical professionals to reflect on their profession and the challenges facing it. more…

The BMJ Today: Sex workers in Bangladesh, welfare advice, and incentives for behavioural change

30 Jun, 15 | by BMJ

bangladesh_sexworkers• Female sex workers in Bangladesh
In a feature published on thebmj.com today, Jocalyn Clark provides a moving account of the plight of female sex workers in Bangladesh. With effectively no voice to demand basic rights and entitlements, these women suffer severe social stigma, poor health, and violence. Several non-governmental organisations have stepped in to offer health services, advocate on their behalf, and empower them to pursue alternative options for a living. Progress remains slow however, given the lack of political will to recognise this group and directly tackle factors such as poverty and social estrangement, which drive women and children into the sex trade. more…

Michael Soljak: Data access for research—Kafka writes again

29 Jun, 15 | by BMJ

Data are the lifeblood of health research, and the UK government is claiming that data collected in the course of NHS clinical care are available to reputable researchers for the purposes of improving health and healthcare. However, the reality is rather different, and it is becoming increasingly difficult to obtain research data.

Anonymised patient level Hospital Episode Statistics (HES) data on inpatient admissions have been available for research and other secondary uses for many years, and their use has led to major improvements in quality, from identifying higher mortality at weekends to sounding the alarm about institutional failures such as those at Mid Staffordshire Foundation Trust. This was achieved with reasonable information security standards and a proportionate approach to the risks and benefits by the Information Centre for Health and Social Care, as it was called then. more…

Martin Marshall: The travesty of the 10 minute consultation

29 Jun, 15 | by BMJ

martin_marshall“Perfunctory work by perfunctory men.” That’s how an eminent physician once described general practice. “A ridiculous claim” cried GPs, rising to the defence of their discipline, “specialists just don’t understand the nature of general practice. They don’t value our ability to make quick decisions based on a deep understanding of our patients and their context, our exceptional skill at managing risk and uncertainty, of using serial consultations to optimise the effectiveness of our diagnostic and therapeutic interventions.” more…

Richard Lehman’s journal review—29 June 2015

29 Jun, 15 | by BMJ

richard_lehmanNEJM 25 June 2015  Vol 372

2533  The research articles in this week’s print NEJM are all about arcane stuff I’ve covered previously. The Clinical Practice article takes us back to the real world—the one we’d rather not think about, where there is a smell of urine and random cries from rooms down the corridor. How would you like to be cared for if you get advanced dementia? I would like to be in institutional care, and not be a burden to those I love. I would not want to be given antibiotics and I certainly wouldn’t want to be fed artificially. I wouldn’t like to think that my family would have to argue about such things, time and again. But alas, the real world is appallingly bad at caring for people who are dying of dementia. Looking back, I shudder at my complicity in this. “Mrs Bannister’s got a UTI with two plusses of protein and nitrates (sic). Can we have a prescription faxed to Boots?” The printer started whirring before the second sentence was finished. And it’s the same the world over. “In SPREAD, 75% of suspected infections were treated with antimicrobials, but less than half of all treated infections and only 19% of treated urinary tract infections met minimal clinical criteria for the initiation of antimicrobials.” I wish this article was open access, because it would be a fine addition to any Choosing Wisely library. more…

The BMJ Today: Spot Diagnosis—a new type of education article in The BMJ

29 Jun, 15 | by BMJ

endgames_spotdiagnosis• The BMJ has just published the first of a new breed of articles in the education section, namely in endgames. This new type of article is called Spot Diagnosis, and it consists of a single image that is characteristic of a specific condition, and which is accompanied by a short vignette. The first one is on compressive cervical goitre and the authors are based in Kettering General Hospital, in the UK.

If you are potentially interested in writing a Spot Diagnosis for endgames, we’d be delighted to hear from you. The guidelines on how to write a Spot Diagnosis can be found in our instructions for authors. more…

Jeffrey Aronson: When I use a word . . . An indefinite article

26 Jun, 15 | by BMJ

jeffrey_aronsonThe grapheme <a> is used as a symbol for the phoneme /a/ when it is pronounced as the low front unrounded form of the vowel, as in the Scottish pronunciation of “back.” In the International Phonetic Alphabet (IPA) it is called Cardinal vowel number 4. The grapheme that looks like a handwritten version <ɑ>, Cardinal vowel number 5, represents the low back unrounded version; it has a slight hint of an o in it, but probably only phoneticists can reliably distinguish the two sounds.

But the letter a is also a word in its own right, the so called indefinite article. Originally it was “an,” a form of the Old English word for one, án, but by 1150 it was reduced to “a” before consonants (for example a word) and before vowels that are pronounced as consonants (for example a eucalyptus, a one, a urinal); “an” was retained before words beginning with a vowel (an operation) or an h (an hour), even if aspirated (an historian), although not nowadays. more…

Barbara Harpham: CCGs are not adopting new technologies quickly enough

26 Jun, 15 | by BMJ

barbara_harphamIn December 2011, the NHS identified six ways technology could help patients and, ultimately, save money. A freedom of information request was sent to 211 clinical commissioning groups (CCGs) across England in October 2014 looking for a progress update; 189 (90%) responded.

How did they do? Well, it’s a mixed bag, with CCGs naturally opting to cherry-pick where to focus their efforts. But overall the picture is not healthy. more…

Richard Graham: Is it time to unplug?

26 Jun, 15 | by BMJ

Richard_Graham_Portrait

As we approach the first UK National Unplugging Day, one might well ask why there is a need to have a day promoting gadget free time for families. After all, we can switch off our smartphones and tablets any day or at any time, and thus feel reassuringly conscious of and in command of our use of them. Or can we?

Our use of digital devices is now extensive, with Ofcom’s recent “Adults’ media use and attitudes report” indicating that online time for most adults has doubled over the last decade. For young adults, communication and accessing media (predominantly videos now) will take up more than nine hours of each day. For medical practitioners, is this just an issue of lifestyle and choice, or are there consequences of using devices, if only through the disruption of sleep, that we should attend to? Should we consider this use high, problematic, or even a sign of “addiction?” more…

The BMJ Today: The ongoing debate over e-cigarettes, increase in syphilis and gonorrhoea in England, and doctors’ burnout

26 Jun, 15 | by BMJ

electronic_cig• Jonathan Gornall’s feature, “Why e-cigarettes are dividing the public health community,” is continuing to generate interest this week. Gornall’s piece examining how the tobacco industry’s move into e-cigarettes and harm reduction has seen some experts shift their views has already attracted responses online. Join the debate here.

• Today, Susan Mayor reports on some concerning figures from Public Health England, which show a major increase in the number of people with syphilis and gonorrhoea—particularly in men who have sex with men (MSM). The figures show that the number of syphilis diagnoses increased by nearly half and gonorrhoea cases increased by one third in 2013-14. more…

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