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Marika Davies: Doctors and death row—should doctors ever take part in executions?

11 Feb, 15 | by BMJ

marika_daviesThe US Supreme court has put three executions in Oklahoma on hold while it considers a legal challenge to the state’s use of midazolam in its lethal injection protocol. This is likely to reignite the debate about the involvement of doctors in capital punishment, a practice that is prohibited by the American Medical Association, but permitted and often even required by state law. more…

Pallavi Bradshaw: Are medics increasingly at risk of being criminalised?

10 Feb, 15 | by BMJ

pallavi_bradshawHowever clichéd it may sound, like most medics I wanted to be a doctor to help people. While we strive to do the best for our patients, there will be times when things go wrong. Mistakes happen—no one is infallible. We would all like to think that in the aftermath of an error, we would be the ones to log it officially, invite scrutiny, and be willing to reflect and learn. This is certainly how the General Medical Council (GMC) would like us to behave and how I would advise my members to react. But how realistic is such behaviour in the current environment in which doctors work? more…

Karl Swedberg and Inger Ekman on person centred care in Europe

10 Feb, 15 | by BMJ

The health systems of the European Union make up a central part of Europe’s social protection. They contribute to social cohesion and social justice as well as to sustainable development. Important values that should underpin all European healthcare have been agreed upon. The overarching values of universality, access to good quality care, equity, and solidarity have been widely accepted to guide the work of the different EU institutions. However, based on present cost development and structural changes in health systems, these values are being challenged. more…

Penny Pereira: What does it really take to improve patient safety?

6 Feb, 15 | by BMJ

HF: Staff & Board PortraitsHow confident are you that the risk management processes in your organisation enable you to predict and manage all the risks your patients are likely to face? If you have doubts, you’re probably not alone, as the findings from our Safer Clinical Systems programme suggest.

Looking back at my time on the board of a hospital, risk management was generally based on records of past incidents rather than a proactive assessment of risks that could occur in the future. Approaches ranged from a dashboard tallying up data on mortality and individual causes of harm, to overwhelming 100-line tables detailing incidents, risks, and action plans. more…

Paul Roblin on Dobson et al’s Lancet Tamiflu re-analysis: an independent review group. Really?

5 Feb, 15 | by BMJ

On 30 January 2015 the Lancet published a re-analysis of oseltamivir effects in symptomatic influenza like illness “Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials.” This was authored by Joanna Dobson, Richard J Whitley, Stuart Pocock, and Arnold S Monto.

The Lancet supplemented this re-analysis with an article by Heath Kelly and Benjamin Cowling, entitled “Influenza: the rational use of oseltamivir.” The Kelly and Cowling article claims that the re-analysis was done by an independent research group. I am concerned that not all the relevant links of the authors of the Dobson Lancet paper have been declared in the competing interests section. more…

Neville Goodman: Stemming the rising tide of epidemic proportions

3 Feb, 15 | by BMJ

neville_goodmanMetaphor is useful. When Malcolm Gladwell wrote about an epidemic of Hush Puppies, no one thought that Hush Puppies were transmissible in anything more than the metaphorical sense. But as doctors we need to be more careful before we muddy the meanings of our technical words. An epidemic is a widespread occurrence of an infectious disease in a community at a particular time. Yes, its second dictionary meaning is a sudden, widespread occurrence of an undesirable phenomenon (perhaps Malcolm Gladwell disliked Hush Puppies), but we are doctors. Transmissible diseases demand aspects of prevention and treatment and population response not relevant when considering diseases that are not transmissible. That is one reason for guarding its meaning, but the other is the last phrase of the definition: at a particular time. The world has recently seen a perfect and unpleasant example: the epidemic of Ebola in West Africa. As I write, the number of new cases is falling: it was a widespread occurrence of an infectious disease, and it occurred at a particular time. We are lucky that it did not become pandemic: prevalent over a whole country or large part of the world; or endemic: regularly found in a particular people or in a certain area. These words need to be protected because they have particular meanings that are important to communicate. more…

Vincent Iacopino: Health professionals have no role in Saudi blogger’s flogging case

2 Feb, 15 | by BMJ

CGIThe disturbing case of a Saudi blogger sentenced to flogging should serve as a reminder that health professionals should never participate in torture or cruel, inhuman, or degrading treatment.

Raif Badawi, 31, was sentenced last year to 1000 lashes and 10 years in prison for insulting Islam after he criticized Saudi clerics on his blog. Following his first round of flogging on 9 January, his second round of punishment was postponed for the third time on Friday. Earlier delays reportedly occurred because doctors found he was not physically fit for further lashing. While it may appear that the doctors are assisting Badawi by delaying punishment, their participation is actually enabling the infliction of physical and mental pain. more…

Stuart Buck: Sharing data from past clinical trials

30 Jan, 15 | by BMJ

Stuart_BuckThere was a time when academic and government researchers performed experiments that were clearly unethical—such as letting syphilis go untreated, or asking people to administer severe electric shocks to each other. Ethics review boards sprang up in an important effort to make sure that research on human subjects remained within the bounds of legality and ethics. But for all the good that ethics review boards do, today they often block undeniably valuable research from going forward. The re-analysis of clinical trial data is a recent case where specious ethics objections are used to stymie good research into the effectiveness of drugs given to patients. more…

Ohad Oren and Michal Oren on the “Cordon Sanitaire Hospital:” A vision being fulfilled

27 Jan, 15 | by BMJ

Credit: Herbert Bishko

Credit: Herbert Bishko

michal_oren3

Seven years ago, we outlined our vision of a humanitarian hospital. As Israelis who had witnessed the suffering of the citizens of Gaza, we felt compelled to develop a model that would improve their overwhelming deficiencies in medical care. We envisioned a medical facility that would be dedicated to the care of wounded Palestinians at times of war. According to our model, deployable medical teams of all nationalities, would provide high quality emergency care in the framework of this hospital. We described our vision in a blog and published it in The BMJ. The responses were instantaneous. A pulmonologist, a surgeon, and a paediatrician were among the many who shared their enthusiasm and motivated us to “cross dividing lines and serve humanity.” One sensed a “glimmer of hope” in a relentlessly bloody conflict. Another believed that our dream was possible if “enough people take up the call.” One even wrote that our blog should be “circulated to Israeli and Palestinian leaders and to many more.” more…

Ferelith Gaze: Clarity and stability for the NHS in a time of political uncertainty

26 Jan, 15 | by BMJ

Ferelith_gazeWe are all prey to systemic amnesia, and in the final 100 days before the 2015 general election, we need to be mindful of the particular vulnerability of the NHS to political soul searching. After all, the NHS has, as the Institute for Government notes, been reorganised 20 times in 41 years.

Clearly, change is not new to the NHS, even while its foundations have remained strong. Throughout its extraordinary history the NHS has adapted to patient needs and medical advances, evolved and innovated. It is internationally renowned for its “world-leading … commitment to health and healthcare as a human right,” and ranks first among comparable countries for quality, access, and efficiency. more…

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