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The BMJ Today: The glass ceiling, upcoming elections, and big tobacco

9 Apr, 14 | by BMJ

As I look around our open plan office, towards where our editor, Fiona Godlee, sits, it would seem that the glass ceiling has been shattered at The BMJ. But, in her personal view, Medicine still needs feminism, Helena Watson argues that there are “legions of feminist issues still left to fight.” more…

The BMJ Today: If you hear hoof beats in Texas think of horses, not zebras

8 Apr, 14 | by BMJ

As Saurabh Jha writes, “The likelihood that someone with cerebral aneurysm hit by a bat develops subarachnoid hemorrhage (near certainty) is not the same as the likelihood that someone who develops subarachnoid hemorrhage after high impact trauma has an aneurysm, hitherto undisclosed (very low).” But would you order tests so you could absolutely rule it out? Would you perhaps order further tests to rule out bleeding brain metastases from lung cancer? Jha asks us to stop “hunting for zebras in Texas” and put an end the “rule-out” culture that pervades medicine. more…

The BMJ Today: Is medicine marching towards an era of greater openness?

4 Apr, 14 | by BMJ

Tiago_VillanuevaIn the latest Endgames picture quiz, a 41 year old man presents to the emergency department with a two week history of worsening shortness of breath, productive cough, intermittent fever, night sweats, and non-pleuritic pain in the right side of the chest wall. He was diagnosed with a pulmonary abcess secondary to community acquired pneumonia. There are no published guidelines regarding the management of pulmonary abscess, which includes antibiotics that are in part chosen according to clinical judgment rather than a sound evidence base. more…

The BMJ Today: Paying people to live healthier lives and tackling climate change

3 Apr, 14 | by BMJ

This week, the Intergovernmental Panel on Climate Change (IPCC) released its Fifth Assessment Report. The scientists who wrote it warn of the serious impact that climate change—unequivocally influenced by human activity—will have on humans and other species in the planet. The IPCC calls for world leaders and policy makers to promote adaptation strategies to mitigate the implications of climate change for future generations. Climate change may be the greatest challenge we face as a species yet many people have difficulty grasping its implications. The changes are abstract, will occur in the future, and mitigation strategies have economic costs and limited short term benefits. In addition, several institutions, corporations, and individuals with vested interests refute the claims of mainstream scientists and promote the fallacious view that there is great uncertainty around the predictions of the IPCC and that many in the scientific community are skeptical about the impact of human activity on climate change. more…

Nathan Sivagananathan and Tehani Renganathan: Trail—improving cancer care in Sri Lanka

2 Apr, 14 | by BMJ

nathan_sivagananathanIn 2011 Nathan Sivagananathan and Sarinda Unamboowe set out to transform the lives of patients with cancer in the northern region of Sri Lanka. For over three decades the northern territory has been in the throes of terrorism, with little room for economic or social development. The ongoing war made the 400 km journey to the country’s only cancer hospital, which was located in Colombo, even more challenging as patients had to travel by both sea and land because of land blocks and danger zones. Many people preferred to remain untreated, unwilling to make the challenging journey across the country to receive the treatment they required. more…

The BMJ Today: Vitamin D, probiotics, and polio

2 Apr, 14 | by BMJ

We have been longing for a final word on whether vitamin D supplements improve health. An umbrella review published today included 107 systematic literature reviews and 74 meta-analyses of observational studies looking at serum levels of vitamin D, as well as 87 meta-analyses of randomised trials testing vitamin D supplements. A total of 137 outcomes were included, spanning a wide array of diseases.

We’ve also published a systematic review and meta-analysis of 73 cohort studies with over 800 000 participants and 22 randomised trials with 30 000 participants that examined the link between vitamin D and deaths due to cardiovascular disease, cancer, and other causes. more…

The BMJ Today: Selective decontamination revisited and healthcare reform in Massachusetts

1 Apr, 14 | by BMJ

georg_rogglaRichard Price and co-workers published a network meta analysis evaluating the effect on mortality of selective digestive decontamination (SDD), selective oropharyngeal decontamination (SOD), and topical oropharyngeal chlorhexidine in patients in general intensive care units. They found that both SDD and SOD confer a mortality benefit when compared with chlorhexidine. more…

The BMJ Today: Debates about alternative medicine and cancer screening

31 Mar, 14 | by BMJ

People love complementary and alternative therapies, and vote with their wallets to spend close to £5 billion a year in the UK alone on treatments such as massage, relaxation, evening primrose oil, and reflexology. Doctors may be more or less comfortable with these therapeutic choices, but we should all be trained to deal with them argues Graeme Catto in a new Head to Head that asks “Should medical students be taught alternative medicine?

Medical students should be given the full picture, not a cropped snap shot of the minority of practice that is evidence based, he writes. Some complementary therapies work. Others are positively harmful. But millions of people use them. To ignore their choices when training doctors would be a mistake, and a serious risk to fully informed doctor patient relations. more…

Richard Lehman’s journal review—31 March 2014

31 Mar, 14 | by BMJ

richard_lehmanNEJM  27 Mar 2014  Vol 370
1189   I sing the body mitotic: we are a mass of cells dividing, mutating, cannibalizing, spreading. The wonder is not that we ever die of cancer, but that we often don’t. Cells which become aggressive are extraordinarily versatile at remaining aggressive, as shown by the relatively rare ALK-Rearranged Non–Small-Cell Lung Cancer. This accounts for about 5% of non small cell lung cancers, and its invasiveness seems to be caused by mutations of the anaplastic lymphoma kinase gene (ALK). So the majority of these tumours show an initial response to crizotinib, a drug which inhibits ALK. But the nasty fact is that within a year, the cells no longer respond. A new ALK-targeting drug is ceritinib, the subject of a phase 1 trial reported here. It is promising: “Ceritinib was highly active in patients with advanced, ALK-rearranged NSCLC, including those who had had disease progression during crizotinib treatment, regardless of the presence of resistance mutations in ALK.” But having learnt habits of aggression, those cells may yet prove deadly. Ceritinib is described as “20 times as potent as crizotinib against ALK” in this Novartis-sponsored trial, but that figure means nothing in itself. The proof will be in the phase 3 trial.

The BMJ Today: Einstein’s theory of data, climate change and the “threat to human survival,” and New York facing legal challenge over e-cigs ban

28 Mar, 14 | by BMJ

“Information is not knowledge,” was Einstein’s cautionary take on the power (and limitation) of data. In healthcare, the collection of patient feedback and other data is regularly hailed as the panacea for all ills, physical or otherwise. In an analysis published on today, Angela Coulter and colleagues argue that in the UK, the NHS has been good at collecting data on patients’ experience of care, but has not yet used this information to systematically improve services. The authors suggest this could be remedied by establishing a national institute of “user” experience—to draw data together, determine how to interpret results, and put them into practice. The BMJ’s editor in chief Fiona Godlee reflects on how doctors can apply this work to their own practice in this week’s editor’s choice. more…

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