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The BMJ Today: Clinical challenges

31 Oct, 14 | by BMJ

When my patients with acute stroke develop a urinary tract infection, I often prescribe a course of co-trimoxazole (trimethoprim/sulfamethoxazole).  Many of these patients have hypertension and are also taking an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). Prior studies show that trimethoprim and renin-angiotensin system blockers  can lead to hyperkalemia, particularly when used in combination, and a study by Michael Fralick and colleagues at the University of Toronto published in The BMJ today finds that in elderly patients taking an ACEI or an ARB, the use of co-trimoxazole is associated with an increased risk of sudden death. Should I avoid the co-trimoxazole and renin-angiotensin blockers in my patients? Should I routinely measure potassium levels in these patients? At what point should I worry?

In an associated editorial, Mahyar Ethminan and James Brophy remind us that we should be careful about making clinical decisions based on data from observational studies, particularly case-control studies) as these can identify associations but not causal links. These studies are prone to several biases owing to unmeasured and residual confounders, imbalances between patients and controls and misclassification of exposures and outcomes. They acknowledge the quality of Fralick’s study and the fact that it brings attention to an important issue but remind us that a plausible course of action for clinicians is to be careful when using the drug combination but await confirmation of the findings before giving up using these essential antibiotics. more…

The BMJ Today: Leapfrogging—the new buzzword in healthcare

30 Oct, 14 | by BMJ

It is easy to take universal health coverage for granted if you were born and raised in a European country, for example. But in low and middle income countries, people often have to somehow find the means to pay out of pocket for their healthcare, regardless of the availability of quality healthcare. Costs can quickly escalate to astronomical figures in case of serious health problems, and if people don’t have the financial means or relatives overseas who can help, they may end up not receiving any care at all or incurring unmanageable debt. more…

The BMJ Today: Is milk good for you?

29 Oct, 14 | by BMJ

America’s iconic “Got Milk?” campaign was pulled this year after a successful run of over 20 years. Graced by the likes of Bill Clinton, Naomi Campbell, Elton John, David Beckham, and Angelina Jolie sporting a milk moustache, the campaign garnered wide recognition. Yet milk was losing favour against a growing variety of breakfast and drink options. The dairy industry therefore opted for a different positioning. Under the tagline “Milk Life,” the ads now tout the richness of milk’s protein content.

The evidence, though, on the health benefits of milk consumption is scant and divided. more…

The BMJ Today: The joys and snags of being a GP

27 Oct, 14 | by BMJ

tiago_villanuevaAs a GP who didn’t train in the UK and who has never worked in the country as a GP, I follow the situation of general practice in the UK with great interest, but from a certain distance that characterises an outsider such as myself. I am well aware that general practice in the UK is going through difficult times, with a recruitment crisis, many GPs facing increasing workloads and on the verge of burnout, and some even leaving the country behind to work further afield.

The recruitment of GPs has always been a problem all around the world, for many different reasons. Despite everything, GPs in the UK remain among the best paid GPs in the world, which means we must look way beyond pay as an argument to attract more GPs to the trade. more…

The BMJ Today: Swingers, surrogacy, and three parent families

24 Oct, 14 | by BMJ

tom_m_sepSexual health and parenthood feature prominently in The BMJ today, in news stories that highlight the need to ensure policies are based on evidence and not prejudice.

Jacqui Wise describes a study that finds that heterosexual couples who swap partners or have group sex have high rates of sexually transmitted infections, a finding that may not surprise many readers.  more…

The BMJ Today: Get your sums right

23 Oct, 14 | by BMJ

The big news today is the publication of the chief executive of NHS England Simon Stevens’s five year plan for the NHS.

As Gareth Iacobucci reports in The BMJ today, the report has a strong focus on public health and the prevention of illness. Unsurprisingly, this includes Stevens’s pet topic of tackling obesity.

Stevens claims the report marks a “crossroads” for the NHS. It calls for the historical boundaries between primary and secondary care to be broken down and for new models of care to be developed, such as NHS hospitals taking control of general practice services or GPs heading up multispecialty provider groups. more…

The BMJ Today: Stop reviewing GP crisis and plan a solution

22 Oct, 14 | by BMJ

Two articles just posted on focus on general practice—the crisis that is engulfing it, how it suffers at the hand of political promises, and what action can preserve its future.

Veronica Wilkie, professor of primary care at the Institute of Health and Society at Worcester University, compares the current crisis to that in 1950 when JS Collings, an Australian researcher who had observed 55 practices, attacked general practice for being outdated, rarely satisfactory, and a potential danger to public health. more…

The BMJ Today: England’s ongoing battle with liver disease

21 Oct, 14 | by BMJ

Today, The BMJ reports the stark warnings from public health experts about the rate of mortality from liver disease in England, and the regional variation across the country.

As Jacqui Wise reports, new profiles from Public Health England show that male mortality rates from liver disease are four times higher in some local authority areas than in others. The profiles also show large variation in hospital admissions for liver disease in different parts of the country. more…

The BMJ Today: How “political” should The BMJ be?

20 Oct, 14 | by BMJ

At the Royal College of Physicians’ Harveian Oration last week, a doctor told me The BMJ had become a “political” rag. And it was not the first time that the accusation has been made. So when are medical and healthcare issues purely scientific matters and when are they “political?”

Dr Michael O’Donnell, former editor of World Medicine, and the subject of our BMJ Confidential column this week, believes that the organisation of healthcare has always been a political matter. His current day job is writing an eyewitness account of the rise and fall of the NHS. He calls Aneurin Bevan “a shrewd political operator,” not least because of the time it has taken “for those who wished to destroy the NHS to make any progress.” more…

The BMJ Today: Aiming for a culture of safety not perfection

17 Oct, 14 | by BMJ

kate_adlington_picDo you believe in the “boundless capacity of medical science?”

In a philosophical podcast to accompany this week’s analysis article, Professor Jerome Hoffman and Dr Hemal Kanzaria, of the University of California, suggest that efforts to reduce overdiagnosis and overtreatment should focus on changing physician and public attitudes towards medical error and uncertainty. more…

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