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Samir Dawlatly: How general do we want general practice to be?

26 Mar, 15 | by BMJ

As a medical student I got a parking ticket and three points on my driving license. The mistake I had made was parking in the wrong place on an unmarked road in the Peak District. When I sent in my fine I wrote a short note along the lines of, “I realise that being ignorant of this law is not a valid defence.”

For what it is worth, there has been a stir in social media this week over the publication of a survey carried out by ResilientGP, a fledgling organisation that purports to “stand up for general practitioners.” The organisation argues that one of the stressors in primary care, and there are many, is the unnecessary use of the NHS by patients with problems that seem unconnected to any health problem. more…

Tiago Villanueva: Returning to medical school 10 years later

26 Mar, 15 | by BMJ

tiago_villanuevaA few weeks ago, I returned to the Faculty of Medicine at the University of Lisbon—the medical school from where I graduated ten years ago. The reason was to participate at the AIMS meeting, an international conference for medical students as both a member of the jury of the oral presentations and as a speaker.  more…

Suzanne Cahill: What are the next steps on global action against dementia?

26 Mar, 15 | by BMJ

suzanne_cahillThe first World Health Organization ministerial conference on global action against dementia which took place in Geneva was organized to encourage governments worldwide to take action to prevent dementia and improve health and social care services, based on current scientific knowledge, evidence, and global experience. It was attended by some 400 invited delegates, representing 80 countries including those from low to middle income countries where dementia prevalence is greatest. A very sizeable UK representation was in evidence over the two days, with over 25 invited delegates participating and several excellent UK presentations delivered.

more…

Clare Wenham and John Edmunds: How effective is this year’s flu vaccine?

26 Mar, 15 | by BMJ

This flu season, Influenza A (H3N2) has been the dominant circulating strain, with transmission occurring unusually early (November and December). By December 2014, influenza rates were higher than they had been in the previous three years. However, recent research by Public Health England (PHE) suggested that there was a mismatch between the H3N2 strain selected for this year’s vaccine and the H3N2 that is circulating in the UK this winter. [1] This was based on an assessment of the vaccine effectiveness (VE) which was estimated to be only 3.4% (95%CI -44.8 to 35.5) against laboratory confirmed influenza (all types) and -2.3% (95%CI of -56.1 to 33.0) for Influenza A (H3N2). This is in comparison to the estimated average VE of influenza vaccines of 59%. [2] Furthermore, the VE for the same vaccine in Canada this season is also effectively zero, being estimated as -8% (95% CI:-50 to 23) but in the United States it appears to have a moderate effect, being estimated at 22% (95% CI 5 to 35). [3] more…

The BMJ Today: Alcohol pledges, fake antibiotic fixes, and NFL payouts

26 Mar, 15 | by BMJ

Analysis-low alcoholThe UK government’s responsibility deal with the alcohol industry promises to remove a billion units of alcohol (about 2% of consumption) from the market, through reducing the strength of alcoholic drinks such as beer and wine.

The interim report from the government has been published, and claims that the deal has already worked better than promised. However, researchers from the Sheffield Alcohol Research Group at the University of Sheffield have analysed that report and believe that it is so flawed it should be withdrawn. more…

William Cayley: About what are we being precise?

25 Mar, 15 | by BMJ

bill_cayley_2I’ve been too swamped with the day to day realities of teaching, patient care, and just plain real life lately to be very reflective, but Zackary Berger and Dave deBronkart finally spurred me on to put fingers to keyboard, and put words to my thoughts on the nascent move towards “precision medicine.”

From the first, when I heard of Mr Obama’s precision medicine initiative, I was underwhelmed (at best) and fearful of more misdirected use of resources at worst. more…

Chris Naylor: Integrated care—the end of the hospital as we know it?

25 Mar, 15 | by BMJ

Hospitals are often seen as an impediment to integrated care. The concern frequently voiced is that their dominant role in the health system makes it harder for commissioners to shift resources into the community, and to develop more coordinated services that cross organisational boundaries.

It is certainly true that an over-reliance on hospital based care—and the political reluctance to challenge this—has long been a barrier to necessary change in health systems across the world. Jean Rebert, one of the principal architects of the PRISMA integrated care system in Quebec, Canada, has made this case forcefully. Speaking at the World Congress on Integrated Care in Sydney last year, he said that in his experience, the greatest obstacle to integrated care is the political attractiveness of prioritising investment in hospitals over other forms of care. more…

Juliet Dobson: Understanding Ebola in Africa

25 Mar, 15 | by BMJ

juliet_dobsonWhat has the recent Ebola outbreak shown us about West Africa’s development? Did it reveal Africa’s weaknesses or its strengths? On 23 March, Hans Rosling, from the Karolinska Institute, and Margaret Lamunu, the World Health Organization’s Ebola expert, discussed how West African health systems tackled the Ebola outbreak, and what we can learn from the response as part of a live radio broadcast for the BBC’s A Richer World season. more…

The BMJ Today: History lessons

25 Mar, 15 | by BMJ

ThinkstockPhotos-465117786• In 1938 New Zealand created a national health system, coining the term “from cradle to grave,” and showing the British government what was possible.

More recently, the country repealed its unsuccessful, competition based health legislation.

As it is now hard to find anyone in England who believes that the 2012 Health and Social Care Act was a good idea: Can New Zealand again offer lessons for England? more…

Tony Kelly: Is being confident to speak up enough?

24 Mar, 15 | by BMJ

Tony KellyLast month we saw two key messages come through regarding patient safety. The first was the publication of Sir Robert Francis’s “Freedom to Speak Up report.” The second was a report by the Parliamentary and Health Service Ombudsman (PHSO), which found significant variation in the quality of NHS investigations into complaints of avoidable death and avoidable harm. Both reports have generated significant coverage and debate. more…

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