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Ahmed Rashid: Should junior doctors accept pharma support for clinical research training?

27 Mar, 15 | by BMJ

ahmed_rashidJunior clinical researchers know that there’s really only one way for them to comprehensively get on the academic ladder and prove their credibility. Those three letters that contain years of effort and soul searching that make all the difference. The essential and the impossible. The mountain. The PhD.

But, of course, once you’ve made the brave decision to take on this beast, you must then find the support to do so. And the particular support needed to tackle this beast is money. Unless you’re able to support yourself by other means, and dramatically reduce your income by enrolling as an independent postgraduate student, a clinical research fellowship may be the only option. more…

Paul Glasziou: Six proposals for evidence based medicine’s future

27 Mar, 15 | by BMJ

Gordon Guyatt coined the term “Evidence based medicine” (EBM) over 20 years ago, and it has had a remarkable global influence. But EBM is not a static set of concepts, set in stone tablets in the 1990s; it is a young and evolving discipline. The fundamental concept of EBM—using the best available research evidence to aid clinical care—may have changed little, but what is best and how to apply the concepts in practice continue to develop. The 3rd ISEHC conference in Taiwan, November 2014, marked another step in the evolution of evidence based healthcare. On the opening plenary, I suggested six areas where EBM’s future attention was needed. more…

Katherine Brown: The UK government’s relationship with the alcohol industry

27 Mar, 15 | by BMJ

Digital Printing SystemConcerns have been raised about this government’s relationship with the alcohol industry and the conflict of interest this presents in delivering better public health outcomes. At a time when alcohol related hospital admissions top one million, and the cost of alcohol misuse to the economy exceeds £21bn each year, there is a sense of urgency about getting to grips with the nation’s drinking problem by looking to policies with strong evidence of effectiveness. Minimum unit pricing appeared to be a powerful solution in the pipeline, promising to save thousands of lives and prevent thousands of crimes each year when it was announced with great fanfare in March 2012.

However, following what has been termed an aggressive lobbying campaign from the global alcohol producers, plans for minimum unit pricing were put on hold. Instead, attention has been focused on the Public Health Responsibility Deal as the cornerstone policy for reducing alcohol harm in England and Wales. This partnership agreement between drinks industry bodies and the government has very little public health representation, after the majority of NGO and health partners walked out when the announcement to delay plans for minimum pricing was made. more…

Kallur Suresh: The aviation industry needs to address human factors in aviation safety

27 Mar, 15 | by BMJ

Generation Q 12 June 2012The unspeakable tragedy of the death of 150 people in what is thought to be a deliberate act of pilot suicide over the French Alps has brought into sharp focus the question of mental health of airline pilots. French investigators say that the Germanwings plane was brought down by the co-pilot who locked the pilot out of the cockpit and refused to let him back in despite his desperate attempts to force entry.

Airline safety has been an exemplar for other safety-critical industries. Healthcare has learnt a lot about patient safety by looking at and emulating many of the safety features adopted by airlines, including a highly professional attitude, a step-by-step approach to tasks, standardised operating procedures, and checking and cross-checking by independent members of staff. Such an approach has made flying a very safe undertaking. more…

The BMJ Today: Fatal cardiovascular risk in LMICs, indefensible care, and Mission Indradhanush

27 Mar, 15 | by BMJ

china_obese• A new risk scoring system, as reported in the Lancet Diabetes & Endocrinology, has estimated that a higher percentage of people are at a greater risk of fatal cardiovascular disease in low and middle income countries than in high income countries.

The Globorisk system, led by researchers Kaveh Hajifathalian and Peter Ueda of the Harvard School of Public Health, Boston, will help “to overcome the technical barriers of global application of risk stratification” for the disease. more…

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…

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