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Alice Munro: The National Emissions Ceilings Directive—a critical week for the health of Europeans

8 Jun, 16 | by BMJ

alice_munroToday EU leaders will attempt to come to an agreement on air pollution reduction targets that will determine the quality of our air for the next 15 years. The National Emissions Ceiling (NEC) Directive is a key piece of EU emissions legislation that is central to efforts to reduce air pollution. [1] The success of the agreement will, however, depend on the UK government and other member states abandoning efforts to weaken and delay the directive.

The new proposed targets cover six pollutants: sulphur dioxide, nitrogen oxides, ammonia, and volatile organic compounds PM2.5 and Methane. How the targets are achieved is up to member states, but all must be committed to intermediate and final targets for 2020, 2025, and 2030.  more…

Dan Kremer: Time limits on published sanctions are needed but we must tailor them to doctors’ circumstances

7 Jun, 16 | by BMJ

dan_kremerWe are pleased that the General Medical Council (GMC) has changed its policy on how long it publishes sanctions imposed on doctors, but do not believe it sufficiently considers individual doctors’ circumstances.

Currently all sanctions on a doctor’s registration, imposed by either a fitness to practise panel or an interim orders panel, remain on the medical register indefinitely, even after the sanction no longer applies. more…

Remembering Jean Martin Charcot: The “Napoleon of Neuroses”

1 Jun, 16 | by BMJ

Jeanhommedia Martin Charcot (pictured) (1825-1893) was one of the great pioneers of neurology—the so called Napoleon of the neuroses. He was the first to describe multiple sclerosis, named the “shaking palsy” Parkinson’s disease, and bestowed the eponym for Tourette’s syndrome in honour of his student Georges Gilles de la Tourette. (His other later famous students included Sigmund Freud.)

Less well known is Charcot: photographer, artist, actor, mimic, and showman—the Carl Sagan of his era. more…

Lawrence Loh: Public health and why terminology matters

26 May, 16 | by BMJ

Lawrence_Loh_picAs younger generations of physicians develop a newfound interest in the social determinants of health, public health has increasingly become a buzzword for providers to throw about. In the medical community, it is now more and more common to find someone who is “practising” public health. But are they?

Having worked as a public health physician for five years, I am slowly beginning to notice subtle distinctions between practising public health and incorporating a public health issue into one’s practice. Many conflate the two, but these are not the same thing. more…

Suzanne Gordon: What we call healthcare professionals matters

25 May, 16 | by BMJ

suzanne_gordonThe other day I attended a patient safety workshop at a major US hospital. The physicians and nurses, IT, and other quality and safety staff in the room were deeply concerned about the latest report in The BMJ documenting that 250,000 patients a year die from preventable errors, making this the third leading cause of death in the US. Almost all the attendees agreed that learning concrete teamwork skills and flattening hierarchies is critical to patient safety as well as job satisfaction, employee engagement, and staff retention. And yet, as the attendees shared their concerns and experiences, almost all of them used terms that are inherently anti-team and reinforce the steepest healthcare hierarchies. more…

Anne Marie Rafferty: Whose responsibility is the workforce anyway?

24 May, 16 | by BMJ

anne_marie_raffertyIt’s the workforce stupid! That is the key message of the Nuffield Report, “Reshaping the workforce to deliver the care patients need.” Workforce solutions are rarely quick fixes so policy makers often find it is more appealing to introduce new types of workers rather than grind away at trying to make what we already have work better. So it is gratifying that the Nuffield Trust report takes such a measured view of what might help to make the system work better and rightly focusses on the largest part of what we’ve got in the system, the so-called non-medical workforce (though no one likes to be referred to as a “non” anything). more…

Paul Hunter: Zika virus would be able to spread in Europe

23 May, 16 | by BMJ

paul_hunterZika virus is not new. Last year, when I was asked if I knew of an expert on the disease in the UK, I searched for papers written by an author giving a UK address. I found 11 papers, six of which were written before I had started primary school in 1961. Yet in the past six months the virus has risen to the top of the infectious disease news headlines with very good reason.

It is now widely accepted that the infection is responsible for the epidemic of microcephaly (a devastating disability) seen in South America in babies of mothers infected during pregnancy. Furthermore, other serious neurological sequelae have been described in both children and adults, including Guillain-Barré syndrome, acute myelitis, and meningo-encephalitis. more…

Ian Roberts: Misleading meta-analyses of small trials?

17 May, 16 | by BMJ

roberts_ianIn September 2015, under the banner “Trusted evidence, Informed decisions, Better Health,” a Cochrane Collaboration press release proclaimed to the public that “preoperative statin therapy reduces the odds of postoperative atrial fibrillation and shortens the patient’s stay on the ICU and in hospital.” No adverse effects, no caveats, no calls for bigger and better trials, just a strong recommendation for practice. The relevant systematic review included 17 trials with a total of 2138 participants and reported a halving of the odds of post-operative atrial fibrillation with statin treatment (OR=0.54 95%CI 0.43 to 0.67; p<0.01). [1] A little over six months later, this claim was refuted by a randomized trial (the STICS trial) that included more outcome events (cases of atrial fibrillation) than all the previous trials combined. [2] It found no reduction in atrial fibrillation (OR=1.04; 95%CI 0.84 to 1.30; p=0.72) and no reductions in hospital stay. However, acute kidney injury was more common in statin treated patients. Although the new trial cannot rule out a smaller treatment effect, it does rule out reductions in atrial fibrillation considerably smaller (15%-20%) than those found in the Cochrane review. more…

Anna Sutherland: Hospital at home increases the chances of dying at home

13 May, 16 | by BMJ

It’s Dying Matters Awareness Week, an opportunity to place the importance of talking about dying, death and bereavement on the national agenda and to share Cochrane evidence that may help inform choices for those at the end of life and those caring for them. Here, Palliative Medicine doctor Anna Sutherland shares her thoughts on a Cochrane review on hospital at home.

Increasing significance has been placed on achieving a person’s preferred place of death in recent years. In 2013 there were 473,552 deaths in England, of which 22% of people died at home, 22% in a care home, 6% in a hospice and 48% in hospital. What is not known is how many of these people died in their preferred place of death. (NEoLCIN) more…

Jo Waller: Could a leaflet help catch cancer earlier?

11 May, 16 | by BMJ

jo_wallerWe’ve written before about the difficulty of recognising symptoms that could be signs of cancer, and knowing when it’s appropriate to go to the doctor about them. There’s lots of evidence that cancer is more treatable if it’s found at an earlier stage, but we know less about effective ways of encouraging people to seek help appropriately.

Encouraging people to seek help

Our new study tried to do just this. We focused on gynaecological cancers—that is ovarian, cervical, endometrial (womb/uterine), vaginal and vulval cancers which together affect over 20,000 women a year in the UK. We know from previous research that some of the things that stop people going to the doctor with symptoms are: more…

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