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Trish Groves: How bloggers responded to the updated Cochrane reviews on Tamiflu and Relenza

24 Apr, 14 | by BMJ Group

trish_grovesMy earlier blog outlined BMJ reader feedback to the two updated Cochrane reviews on the benefits and harms in influenza of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza). But the two research articles also attracted a great deal of attention in the blogosphere. more…

Sean Roche: Is excessive bureaucracy unethical?

24 Apr, 14 | by BMJ

sean_rocheIn subjecting the bureaucratic machine underpinning the NHS to ethical scrutiny, I suggest that we adhere to a basic premise: that it is ethically incumbent on a public health service to maximise the health and wellbeing of the population, within the constraints of the finite resources at its disposal.

In my view we currently fall far short of this imperative. A major obstacle is what I would describe as a “fetishization” of data, and the subsequent procedures for collecting it. In my specialty, psychiatry, there has been an alarming escalation in demands for various kinds of data to be collected and entered by clinicians who could be more profitably occupied by actually seeing patients in a therapeutic context. One driving force behind data-mania derives from an overly zealous Department of Health and local commissioners who need hard statistical evidence that they are getting value for money. “Payment by results” has brought a gamut of new scores and ratings of patients in order to render the market transaction between purchaser and provider smooth and transparent. Now, I am fully supportive of the intelligent use of data in the optimization of quality care, but I believe we have now exceeded a tipping point beyond which data-mania becomes wasteful, counterproductive, and violates our basic premise. In a word, unethical. more…

The BMJ Today: Reporting patient safety concerns and prescribing cannabinoids

24 Apr, 14 | by BMJ

How would you raise concerns if you felt that clinical practice was below standard in your hospital or surgery and patient safety was being compromised? Do you and your teams have clearly defined ways to report any concerns? The BMJ news reports on a whistleblower who has finally been acquitted of unfair dismissal in a complicated and lengthy case which included an original concern around overcrowding and a patient death on a ward.
more…

Trish Groves: Reader responses to updated Cochrane reviews on Tamiflu and Relenza

23 Apr, 14 | by BMJ Group

trish_grovesIt’s nearly two weeks since The BMJ published two updated Cochrane reviews on the benefits and harms in influenza of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza). These research articles were accompanied by The BMJ’s peer review comments and other supplementary files and appendices and several commissioned articles. more…

The BMJ Today: Consent, discrimination, and the liver

23 Apr, 14 | by BMJ Group

navjoyt_ladherWhat’s the matter with care.data? “It’s consent, stupid,” says Margaret McCartney in her latest No Holds Barred column. A leaflet is not sufficient to convey the complex issues around data extraction and potential re-identification. The same applies for screening, where leaflets are often posted to inform people about the benefits and harms of breast and aortic screening. But as Margaret points out: “This isn’t good enough—we all need two way communication with another human being” to offer a more nuanced discussion and check understanding.  more…

Desmond O’Neill: Expanding the imaginarium of ageing

23 Apr, 14 | by kellybrendel

desmond_oneillMy most formative experience in gerontology was a student gap year in Marseille. A volunteer with Les Petits Frères des Pauvres, a charmingly radical organisation dedicated to improving life for older people, I was fascinated by their motto—les fleurs avant le pain. At first sight, the focus on flowers ahead of bread seemed twee. more…

Richard Lehman’s journal review—22 April 2014

22 Apr, 14 | by BMJ

richard_lehmanNEJM  17 Apr 2014  Vol 370

1494    Back in the 1970s, people used to say that we had entered an era of safe surgery and dangerous medicine. I find it odd that people are now trying to make surgery safer by using a variety of moderately dangerous drugs on healthy people about to have operations. We now know from other trials that beta-blockers given before non-cardiac surgery may actually do harm. This large 2×2 factorial trial tests the effect of aspirin 200mg given before non-cardiac surgery and continued at 100mg daily for 30 days after. “Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding.” more…

The BMJ Today: Respect for international doctors

22 Apr, 14 | by BMJ

A cluster of recent articles on bmj.com concern the educational performance of international medical graduates compared with UK graduates. The subject has been hotly debated since the 1980s when it emerged that international medical graduates and doctors from ethnic minorities had disproportionately high failure rates in membership exams compared with UK graduates. more…

KM Venkat Narayan: Roads in India – a fast growing death trap

22 Apr, 14 | by BMJ

Today I received a sad email about a 24 year old family friend who died in a road traffic accident in Mumbai.  Rohan Sardar skid on the road while riding his bike, suffered a head injury and, after much delay at the ill equipped, civic run Shatabdhi Hospital, was moved to Kokilabai Dhirubai Ambani Hospital where he died. His family and friends are devastated. more…

William Cayley: Is primary care in the US really the future?

22 Apr, 14 | by BMJ

bill_cayleyIs primary care really the future? I’d like to say “Yes,” but I’m not so sure… (at least in the USA).

There has been much talk and writing about the growing need for primary care physicians to serve our population, and one “promise” of the Affordable Care Act is “its potential to make primary care more accessible.” At the same time, the major family medicine organizations in the USA have embarked on an ambitious project to “examine the challenges and opportunities facing family medicine today, and define a path forward in the context of a rapidly changing healthcare landscape.more…

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