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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…

Nick Hopkinson: Saving the NHS—a lesson from Carthage

20 Sep, 16 | by BMJ

nick_hopkinsonCato the Elder is said to have concluded every speech he made in the Roman Senate, regardless of the topic, with “Delenda est Carthago”—Carthage must be destroyed. In answering the Editor of The BMJ’s call for ideas on how the medical profession can protest against the destruction of the NHS, a similar clarity and consistency of message is essential.

The simple proposal is that in every discussion on every topic of medical interest, the management of long term conditions, novel therapies, the causes and the cures of cancer, avoidable deaths, whatever thing awareness is being raised about this week, good news or bad, doctors need to include a clear statement that it is government policy to underfund the NHS by £20 billion pounds by 2020. more…

Health apps and how to evaluate them: Review of the PHE 2016 conference, part two

20 Sep, 16 | by BMJ

suchita_shahEmbedded in the NHS Five Year Forward View is a sleek, bulled pointed ministerial promise: “an expanding set of NHS accredited health apps that patients will be able to use to organise and manage their own health and care.” Whatever your views might be on ministerial promises, it’s definitely true that digital technology is making its way into mainstream public health. In my previous blog, a roundup of several sessions at the Public Health England (PHE) annual conference, I wrote about how digital technology is partnering with behavioural science to influence the health choices we make. Here, I’ll share what I learned about health apps. more…

Using behavioural science and digital technology to “nudge”: Review of the PHE 2016 conference, part one

19 Sep, 16 | by BMJ

suchita_shahBeing a GP at a public health conference is, I imagine, like being a proctologist at a plumbers’ convention: familiar subject matter, different perspective. I spend a lot of my clinical time advising people about smoking, alcohol, healthy eating, weight loss, mental health, contraception—all sorts of things that have at their core the vagaries of human behaviour—but I’m not sure I do it very well. A tidal wave of long term conditions is flooding the NHS, and I’m always interested to know what new tricks the population health approach has to address these. 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…

Richard Lehman’s journal review—19 September 2016

19 Sep, 16 | by BMJ

richard_lehmanNEJM  15 Sep 2016  Vol 375

Preherpetic vaccines in the old
For most people who get shingles, the rash and discomfort last for a couple of weeks and then gradually remit. The point of a shingles vaccine is to prevent post-herpetic neuralgia, an uncommon, unremitting condition which can blight people’s lives. Age increases both your chances of getting shingles and the risk of it causing postherpetic neuralgia. The title of this paper is “Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older” and “Medical writing was provided by 4Clinics, France, with funding support from GlaxoSmithKline Biologicals.” So let’s see what effect this vaccine had on rates of postherpetic neuralgia. “In the pooled modified vaccinated cohort that included all participants 50 years of age or older, postherpetic neuralgia developed in 4 of 32 HZ/su recipients and in 46 of 477 placebo recipients with herpes zoster, during a mean follow-up period of 3.8 years.” By slipping in the word “pooled,” the writers from 4Clinics, France have merged two trials and are no longer reporting on ZOE-70 alone, as they did up to this point, but adding in the over-70 subset from ZOE-50. And in so doing they also reveal that in the over-50s trial, there were no cases at all of postherpetic neuralgia under the age of 70. By that token, I can’t see any point in giving the GSK vaccine to people under the age of 70, especially as it causes a local reaction and/or fatigue in the majority of recipients. But maybe that is not the message that we are meant to take away. **See note below** 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…

Tessa Richards: WHO and the politics of health

16 Sep, 16 | by BMJ

Tessa_richardsGaining cross country consensus on joint European strategies to tackle politically and culturally sensitive public health issues is not easy. So it was not surprising perhaps that a decision to adopt an action plan on sexual and reproductive health at the World Health Organization’s 66th Regional Committee meeting in Copenhagen went to the wire.

It started calmly enough, with a detailed account of the wide and protracted prior consultation with the 53 member states, and most delegations expressed high praise for the plan. Suddenly, Turkey and Russia threw last minute googlys more…

Jeanne Lenzer: Donald Trump on Dr Oz—the greatest non-evidence based show on earth

16 Sep, 16 | by BMJ

jeanne_lenzerLate night comics will love Donald Trump’s latest act of showmanship: the neatly choreographed moment when he pulled out his “medical record” from his jacket pocket on The Dr Oz Show last night.

The show and this big reveal garnered plenty of headlines: now everyone knows that Mr Trump is overweight, verging on obese; that he thinks that waving his hands during his speeches is exercise; and that he asks his aides not to tell fast food servers that they are purchasing for Trump lest they doctor the food. And he takes low dose aspirin and a statin. more…

William Cayley: Systems wisdom

16 Sep, 16 | by BMJ

bill_cayley_2In a recent BMJ blog Steve Ruffenach made some excellent points on the importance of balancing “accept” and “except” in approaching “Tech” in medicine.

However, as we continue to feel the pressure of realizing “meaningful use” of electronic medical records (often with attendant requirements for documentation, reporting, and ad-nauseam clicks of different buttons in each patient’s chart), I’ve been intrigued by growing evidence suggesting we need rather to focus on “wise use.”

Some seem to feel that the more systems (usually supported by “tech”) that we implement in medicine more…

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