BMJ blogs

Those interested in the hospital volume/quality debate may like to take a look at this study from the USA which shows that admission to the highest-volume centres there is strongly influenced by social class, race and insurance status. Once upon a time, our National Health Service would have been the ideal place to carry out a contrasting study, showing how it is possible to allocate specialist services on the basis of need, optimal volume and accessibility. But I’m sure the Government are right in thinking we are better served with a haphazard network of competing bankrupt hospital trusts and overpaid, underused private treatment centres. (more…)

This is a classic example of a certain kind of screening study—the sort that tells you how marvellous it is that we can now spot (in this case) lung cancerat a stage early enough to cure it by surgery in 80% of cases. (more…)

This study randomised primary care patients with osteoarthritis to six sessions of self-management instruction plus a booklet or just the booklet. At one year, there was no difference in scores of pain, physical functioning or contact with primary care. A third of the patients randomised to the training sessions dropped out. Maybe they reasoned that if their joints hurt, they would like them to stop hurting. (more…)

Here is an important case-control study which goes a long way towards proving that conjugate pneumococcal vaccine could save a great many children’s lives, especially in the developing world (see editorial, p.1469). The investigators looked at the serotypes of pneumococcus involved in 782 cases and 2512 controls. (more…)

A new treatment for irritable bowel syndromewhich improves symptoms for 10 weeks after a 10-day course—let’s all start prescribing rifamixin, a non-absorbed antibiotic! But hang on. Read the editorial first. With meticulous politeness it points out all the defects of this drug-company sponsored trial, not least the fact that only one symptom—bloating—showed any significant improvement. (more…)

Coronary artery bypass grafting has become the commonest major surgical procedure in the developed world. But since it tends to be needed most in people who are old, have smoked, got fat, and/or become diabetic, there is a sizeable risk of post-operative pulmonary complications. A team from Utrecht sensibly wondered if these might be reduced by training the least fit to breathe properly by the use of preoperative intensive inspiratory muscle training. (more…)

I first became aware of dehydroepiandrosterone some years ago when a patient with Addison’s disease asked if I could prescribe it to help her general well-being and libido. Not wishing to deny her these benefits, I read up about it and discovered that it is the most abundant hormone produced by the adrenal cortex but nobody is sure what it is for. And no, it is not prescribable in the UK, though you can buy it from innumerable websites (5 million Google hits) selling the stuff as the elixir of youth. (more…)

This week’s BMJ is devoted to “Health in the Middle East

“Health is now the most important foreign policy issue of our time

The tabloids love a dirty hospital story. Epidemiologists too can relish using the words “nosocomial