Fergie lost it with the referee. The Manchester United manager’s public criticism of the referee’s fitness in their recent match against Sunderland made headlines. Although subsequently making a personal apology he did raise the more general issue of referee’s fitness. Perhaps it was because he knew about the long established referee fitness programme in Scotland pioneered by Stewart Hillis, the recently retired professor of cardiology in Glasgow and doctor to the Scottish Football Association. Dr John McLean continues this cardiovascular screening initiative at the outstanding sports medicine facilities at Hampden Park, and hosted last Friday’s meeting on the benefits of exercise. It is good to be fit- not a new message, even for referees- but there are still many questions for patients and doctors. more…

A management consultant friend confessed last week that despite advising many media company clients about their digital strategy, he had little interest in Web 2:0 and social networking, shunned the TV when he got home, and ate dinner with his wife while BBC Radio 3 played in the background. more…

BMJ bloggers are in the habit of going to exotic places to listen to exciting lectures. In my time I’ve done my share of all that but a few weeks ago my medical education leapt ahead in an unlikely place – the Malvern Giant Flea Market.  In a subsidiary role as my antique dealer wife’s second opinion and general purposes porter, I rarely get to buy anything but, on this occasion, my eye was caught by a pair of medals on which serpents and staffs figured. A closer look disclosed one to be a medal commemorating the 1961 Hunterian Professor of the Royal College of Surgeons of England, Frank Groves Ellis (1925-2003). The other was awarded to Ellis when he was Lettsomian lecturer of the Medical Society of London in 1975. more…

That articulated lorry hurtling towards you may be driven by one of your fat beer drinking patients- who just has fallen asleep at the wheel. Sleep apnoea used to be a rather esoteric research field in the backroads of respiratory medicine but is now mainstream or, more alarmingly, main road.  Respiratory physicians may joke that if you make your patients wait 45 mins for their appointment, you need only investigate those who doze off in the waiting area. But, if the prevalence is 4% and rising in our increasingly obese population, with links to hypertension and diabetes, perhaps we should take a more active approach. Should we be doing routine pulse oximetry in all our obese patients? more…

‘The H1N1 pandemic-are we prepared?’ was the first hot topic at the 22nd congress of the European society of intensive care medicine (ESICM) in Vienna from 11th to 14th October 2009. The question of whether there will there be enough intensive care facilities for critically ill patients in a second wave of the pandemic was discussed extensively. Steve Webb from Canberra, Australia reported that, in the influenza A/H1N1 pandemic that affected Australia and New Zealand during the 2009 southern hemisphere winter, 133 patients with influenza had to have mechanical ventilation and 68 patients with severe influenza-associated acute respiratory distress syndrome (ARDS) were treated with extracorporeal membrane oxygenation ECMO. more…

Anticoagulation in patients with microbleeds and TPA for stroke beyond 3 hours

The 3rd World Congress on Controversies in Neurology, held in Prague October 8-11, used an all-debate format to highlight areas of uncertainty and disagreement in current neurological practice. With three concurrent sessions to choose from, I wasn’t able to attend everything of interest, but here are some highlights from two of the sessions: more…

I had the good fortune to attend the Don and Dusted debate at the British Library on Wednesday (9 October). Up for debate was whether traditional scholarly work, where dons have wide academic freedom to do more or less as they please, is being replaced with impact measured and outcome driven research, and whether this is a good thing. more…

The 45th annual meeting of the European Association for the Study of Diabetes (EASD) took place in Vienna, Austria, from September 30th to October 2nd  The town centre and all places of interest were flooded with the bright red congress-rucksacks. more…

As UK participants returned from last week’s European Health Forum in Gastein (read more), Austria, newspaper headlines calling for “Cuts in wasteful NHS bureaucracy” and “Pay freezes for high earners” will have reinforced the messages they heard. Debate focused on the impact of the financial crisis on health and what governments should do about it. While saving money by reducing waste in Europe’s” inefficient health systems” was one message, the central one was that health is largely determined by factors outside the health system, and that the rallying cry’s should be “social justice” and “jobs for health.” more…

If every media report of a cure for cancer were true, we should live forever. But, the media like a headline health story, and we cannot really blame the journalists. It is largely the fault of epidemiologists, according to Joe McLaughlin (International Epidemiology Institute, Maryland USA), who laments the change in culture. He feels that epidemiology has lost its way; experts talk up their findings, shamelessly court the media and, have lost the objectivity of their science. This was how he set the scene at a meeting of epidemiologists and editors at the Royal College of Physicians on Sept 24 and 25, convened by Gerard Swaen, of the Dow Chemical Company, under the aegis of ECETOC (European Centre for Ecotoxicology and Toxicology of Chemicals, Brussels) to discuss the potential for a register of observational epidemiology studies. more…