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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…

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.


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…

James McCormack and Mike Allan: Simply making evidence simple

20 Mar, 15 | by BMJ

james_mccormackmike_allanIn an ideal world in which shared decision making is practised with impunity, healthcare providers need—at their fingertips—an appreciation and understanding of (as well as access to) the best available evidence for the main medical conditions they see on a day-to-day basis.

Unfortunately, for many clinicians, this lofty and worthwhile concept often becomes derailed early on in practice because one’s first experiences with evidence are: more…

Andrew McIntosh: How can we improve cricket helmet standards?

20 Mar, 15 | by BMJ

andrew_mcintoshThere has been renewed interest in cricket helmets for a few reasons: the Cricket World Cup, the death of Phillip Hughes, and a relatively new British Standard for cricket helmets. This interest comes after a relatively long pause in helmet development. I began watching cricket before helmets and remember the controversy around their introduction in the late 1970s. It took a while, but cricket helmet standards were published in the 1990s. In my opinion, standards for protective equipment are essential to ensure that the equipment meets a defined performance. However, as is still the case with a lot of “protective” equipment in sport, there has been little regulation governing the sale and/or use of the equipment. This has meant, for example, that someone can purchase and wear a cricket helmet that doesn’t comply with any standard. Sports federations can help a lot by mandating equipment that meets specific standards. Apart from improving the baseline level of protection for the athletes, this might provide the right signals to government agencies that protect consumer interests. more…

Pallavi Bradshaw: Innovation doesn’t need a new law

17 Mar, 15 | by BMJ

pallavi_bradshawAt the end of last week, common sense prevailed. The decision was made that the Medical Innovation Bill would not get a second reading in the House of Commons, and therefore, would not progress any further in this parliament. Rather, there appears to be growing recognition of the need to take a step back and properly understand what innovation in medicine currently looks like. This is something that we at MPS have been calling for since the bill’s inception—and most importantly will ensure there will be a responsible, evidence-based response to this issue. Before introducing legislation it’s important to understand to what extent innovation in medicine is held back, what factors might be a barrier to innovation, and based on this evidence, what the solutions might be. My view remains that ultimately a new law just isn’t necessary. more…

Neel Sharma: Those who can teach, those who can’t don’t

16 Mar, 15 | by BMJ

Recently I was left dumbfounded by a senior colleague who stated that the sign of a good medical educator is one who can do two things well: publish and deliver conference presentations. I questioned him on the aspect of teaching. Surely this is relevant in the field of medical education— a field designed to enhance the teaching and learning avenues of those in training and beyond. His response was curt: Those who can do, those who can’t teach. Of course, it goes without saying we don’t exactly see eye to eye. more…

Julia Pakpoor: Three artists with multiple sclerosis respond to “Good Out Of Bad”

12 Mar, 15 | by BMJ

goob_1I spent a recent evening at an art exhibition in the trendy Shoreditch area of East London, where three young artists were presenting their work. All three artists have the chronic disease multiple sclerosis (MS). They had been given a brief of “Good out of bad,” and been asked to respond.  more…

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