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Pradip Kharya: Delhi’s chikungunya outbreak

27 Sep, 16 | by BMJ Group

photo-1-1In 2006 India experienced one of its worse chikungunya outbreaks, when more than 1.5m cases were reported. The current outbreak in Delhi has claimed at least 15 lives so far, and the city’s hospitals are overloaded because of demand from neighbouring states such as Rajsthan, Uttar Pradesh, and Haryana. more…

David Shaw: Delaying surgery for obese and smoking patients is illogical and unethical

23 Sep, 16 | by BMJ

david_shawIt was recently reported that Vale of York clinical commissioning group (CCG) plans to delay all elective surgery for obese patients for a year until they lose 10% of their weight, and to smokers for six months unless they stop smoking for eight weeks. [1] Both the overall rationale for this policy and the clinical rationale for targeting these particular groups are unclear.

The most obvious objection to the proposed policy is that it is unfair to target specific patient groups in this way. Why should the obese and smokers be singled out? The rationale cannot be clinical risk: while surgery is riskier for morbidly obese patients, and smoking is bad for your health in the long term, mildly obese patients and smokers are just as likely to recover well from surgery as slim non-smokers. The CCG seems to think that it is logical to target both smokers and obese patients simply because patients who are very obese and smoke are at greater clinical risk. more…

Arthy Santhakumar: The verdict is out on superbugs

22 Sep, 16 | by BMJ

arthy-santhakumarA global health peril that demands global action. 

For only the fourth time in history, a health issue has reached the great political heights of the United Nations General Assembly. Following HIV, non-communicable diseases, and Ebola—antimicrobial resistance (AMR) has taken the grand stage, receiving a standing ovation in the form of a united political declaration which promises to combat AMR and has been signed by 193 member states.

The high-level meeting, held on 21 September concluded with world leaders making a pledge of more than £600 million, to mobilise the human and financial resources needed for innovation and preservation of this public common good. more…

Peter White et al: Releasing patient data from the PACE trial for chronic fatigue syndrome

22 Sep, 16 | by BMJ

The PACE trial was the largest clinical trial to date into Chronic Fatigue Syndrome (CFS), also sometimes referred to as Myalgic Encephalomyelitis (ME). This randomised controlled trial involved 641 UK patients suffering from CFS and compared the effectiveness of four treatments. It found that when added to specialist medical care (SMC), cognitive behaviour therapy, and graded exercise therapy were more effective than both adaptive pacing therapy, and SMC alone.

We have received many requests over the last five years to release the patient data collected in the PACE trial, and former editor of The BMJ Richard Smith suggests we have made “a serious mistake” in not always releasing data. The data requests often cite the importance of transparency, giving other scientists the opportunity to investigate our data, and changing customs in science where data sharing is increasingly encouraged. more…

Simon McGrath: PACE trial shows why medicine needs patients to scrutinise studies about their health

22 Sep, 16 | by BMJ

simon-mcgrathLike all patients, what I want most from clinical research is treatments that work, not ones that merely look good on paper. As The BMJ has pointed out, patients are often faced with over-hyped treatments and an incomplete research base biased towards positive results.

These biases arise partly because of “publish or perish” pressure on researchers. By contrast, patients’ only concern is to establish what really works: their interests are directly aligned with those of good science and sound medicine. more…

Ian R Barker: Compassion fatigue—the neglected problem

20 Sep, 16 | by BMJ

ian_barkerCompassion fatigue—also known as vicarious traumatisation results in a gradual reduction in compassion over time. It is more common in those dealing with trauma or caring for close relatives (1). If often presents as hopelessness, decrease in experience of pleasure, constant stress and anxiety, and a pervasive negative attitude (2). Interestingly, it has been claimed that as a result of the media portraying constant tragedy the general public has been somewhat more cynical and resistant to suffering, a form of compassion fatigue. more…

Clara Hellner Gumpert: The Karolinska Institute after the Macchiarini scandal

19 Sep, 16 | by BMJ

clara_gumpertIn 2010, Paolo Macchiarini, an Italian doctor and researcher, was recruited as a guest professor to the Karolinska Institute, and as a surgeon to the Karolinska University Hospital. In 2008, Macchiarini performed the first transplant of a trachea from a dead donor. Prior to the transplant, the trachea was prepared with stem cells. Between 2011 and 2013, Macchiarini carried out three transplants at the Karolinska University Hospital, using artificial tracheas coated with stem cells. Two patients died and one is still in intensive care. Between 2010 and 2015, six reports of suspected research misconduct have been filed against Macchiarini. more…

Marta Balinska: Psychological distress versus mental illness

19 Sep, 16 | by BMJ Group

marta“You will know very few happy moments in life, so make the most of them.” Those are words I often heard from my late mother, leading me to believe that life was going to be a painful affair. In retrospect, I wonder whether she was dealing with chronic depression or whether she was “merely” dogged by unhappiness. In fact, is unhappiness so different from depression? The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease” from which it is logical to deduce that if you are unhappy, then you are ill. more…

Steve Ruffenach on accepting technology in medicine

15 Sep, 16 | by BMJ

steve_ruffenachLike every other profession, medicine has been radically changed by our friend Tech. You of course know Tech; he is that associate that is always around, always snooping where he doesn’t belong. He’s the one who won’t leave you alone no matter where you are or what you are doing.

His virtues and failings have been discussed countless times for centuries. And our love-hate relationship with him has been present ever since he first showed up. Every time Tech comes out with a new ability, we seem to immediately embrace it and then condemn it. The classical Greek philosopher Socrates condemned one of Tech’s earliest tricks, the act of writing, (“It will produce forgetfulness in the minds of those who learn to use it”), although his student Plato wrote the Socratic dialogues to preserve his work. The Luddites hated and smashed the new-fangled factory machines that threatened their work (“We wish to live peaceably and honestly by our labour” 1), but used various appliances to make their point and meet their goals. And while many people love their horses more than their automobiles, (“One can get in a car and see what man has made. One must get on a horse to see what God has made” 2), those very cars and trailers are irreplaceable in the lives of nearly every horse lover. more…

Suzanne Gordon: Why introductions matter

13 Sep, 16 | by BMJ

suzanne_gordonThe other day, I was invited to give a seminar on interprofessional teamwork to a group of residents and attendees at a prestigious university medical center in Europe. The first thing people did when they trooped into the room was introduce themselves to me. Since there were about 25 people in the room, no one really expected me to remember their names. But each and every one of them went through the drill. more…

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