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Mara Evans blogs from a maternity ward in South Sudan

21 Jul, 16 | by BMJ

MaraProfile picThe day was hot and quiet. Ward rounds had finished and the local midwife and I were waiting on a woman’s seventh baby. The other midwife had just examined our labouring patient and told me she was dilating well at seven centimetres. Generally, when a person is giving birth to their seventh baby things can happen quite fast, so we were prepared for the woman to tell us when she needed to push.

Women labour next to each other in the maternity department, and mostly prefer to lay down while they do. I attempt to encourage women to walk about, as this can help with labour, but my pantomime actions are apparently hilarious, and usually not considered seriously. more…

Chris​ Simms: The Iraq war, Chilcot, and cherry picking data: How to find a way forward?

20 Jul, 16 | by BMJ

Chris_simsThe first week of July 2016 was a week to remember. A cluster of war related stories dominated the media, including the 100th anniversary of the Battle of the Somme (1 July), the death of Elie Weisel on 2 July, on 3 July there was the deadliest bombing in Bagdad since 2003, three days later we had the release of the Chilcot report and the 45 minute response it drew from former Prime Minister Tony Blair, and on 8 July the deployment of NATO troops into Eastern Europe (for the first time since the end of the Cold War).

These events tend to underscore the importance of careful assessment of past mistakes and taking measures to prevent their reoccurrence. more…

Clare Marx: Making the best of Brexit for the NHS

20 Jul, 16 | by BMJ

Change, challenges, setbacks, and advances are the hallmarks of modern medical careers. We can either let “Brexit” type moments consume us, whispering from the sidelines, or show the leadership necessary to deal with the uncertainty which now confronts us.

It is in this latter spirit that I believe the NHS must respond to leaving the European Union.

Maintaining and enticing staff to work here has to be a top priority. Over 40% of surgeons trained outside of the UK. Attracting and training more UK graduates is clearly important but losing our non-UK colleagues would be cataclysmic. Within surgical teams are the thousands of technicians, porters, and cleaners who have moved to the UK to serve our NHS. Toughened migration rules often particularly affect such groups of workers and we must send a clear message to the Government that the NHS also needs to retain these vital staff.  more…

Deborah Kirkham: Mind the technology gap—how can the NHS bridge it?

20 Jul, 16 | by BMJ

deborah_kirkhamI find the exhibition halls at conferences fascinating. They provide an interface between private and public sector which many clinicians are not exposed to in their day to day work. There’s the private companies with their baristas and artisan coffee beans; a stand that’s bigger than the square footage of an average UK home, and so many lights, screens, and colours, that one can only stand and gaze in wonder. At others, more modest organisations, or perhaps more modest public sector budgets, stretch to a branded tablecloth, a pop-up banner, and a free pen. more…

Richard Smith: What are the causes of health?

19 Jul, 16 | by BMJ

richard_smith_2014Ask doctors for the causes of heart failure or any disease, and answers will pour from them. Ask them about the causes of health or wellbeing, and they will go blank. Doctors are trained to think about disease not health.

Sir Harry Burns, formerly chief medical officer for Scotland, asks doctors about the causes of health or wellbeing to get them thinking. He shows a slide, compiled by others, of the many theories of salutogenesis, the opposite of the familiar pathogenesis. They boil down, he believes, to just six things. They are: more…

Adrian James: Why mental health treatment should only ever be “patient-first”

19 Jul, 16 | by BMJ

adrian_james2Earlier this month I spoke at a conference on Psychological Therapies for Severe and Prolonged Mental Illness in London. I was one of only two psychiatrists on the bill, among many psychologists putting forward a “therapies first” approach to the treatment of severe mental health problems.

As I said at the conference, I have a problem with this insistence on indicating a preference. And that’s not a matter of me protecting my own ground; it’s a matter of protecting patients. I’ve argued the need for more psychological therapies on many occasions. I have no interest in turf-wars. I have an interest in providing patients with the most appropriate treatment, in the most appropriate way. more…

Rosamund Snow: What makes a real patient?

19 Jul, 16 | by BMJ

rosamund_snowA few years ago I applied for a grant to study my own long term condition. I started out as Ms Snow, ashamed of saying the name of my disease, and ended up Dr Snow, the type 1 diabetic, knowing a lot more about research and academia than I ever thought I would. I realised that patients can see things in research that clinicians can’t because we think to look in new places, and we spot discrepancies that doctors take for granted. I became particularly interested in power relations, and then in the things that stop patients having a say in what gets researched in the first place. more…

Madhukar Pai: How drug resistant TB can show the path to tackling antimicrobial resistance

18 Jul, 16 | by BMJ

Madhukar PaiAntimicrobial resistance (AMR) is a global health threat, and it is estimated that if we do not find solutions to tackle the rise of drug resistant pathogens, by 2050 10 million lives a year and a cumulative 100 trillion USD of economic output will be at risk.

Since the introduction of antibiotics, microbes have evolved a variety of methods to resist antibiotics. We are now dealing with “superbugs” that are virtually untreatable, including colistin resistant E coli, drug resistant gonorrhoea, carbapenem resistant enterobacteriaceae, methicillin resistant Staphylococcus aureus, extensively drug resistant tuberculosis, and extended-spectrum beta-lactamase producing strains. The antibiotic pipeline is running dry, and AMR is threatening to undo major gains made in the control of infectious diseases. more…

Mary E Black: Stik—My NHS Homerton hero

18 Jul, 16 | by BMJ

maryeblack copyWhat inspires me? People who think differently, public spaces that are beautiful, art in unexpected moments. So when an enormous blue painting of a sleeping baby appeared on an outside wall by the cafe of the Homerton University Hospital NHS Foundation Trust in 2015, I took notice. This video tells the story. The work was specially created for the hospital by Stik, a local artist. The iconic image of a sleeping baby, painted in Stik’s usual style of block colour and thick-black lines, has since been adopted by NHS workers across the country. According to Stik “It represents the vulnerability of the NHS and the feeling of fondness we have for it. The NHS is our baby and we have to protect it,” Stik also donated a limited edition of 100 prints of The Sleeping Baby, which were sold out in a couple of hours after people queued round the corner overnight—this raised 50,000 GBP for the Trust’s charity, Homerton Hope and the original prints have just raised a further 38,000 GBP at auction. more…

Richard Lehman’s journal review—18 July 2016

18 Jul, 16 | by BMJ

richard_lehmanNEJM 14 July 2016 Vol 375
Olanzapine stops chemo vomiting
134 For about five thousand years, doctors sought out plants that would make their patients vomit, believing that this would expel noxious humours. In this week’s NEJM there’s a good example of this in an interesting short piece about early clinical trials featuring Adrien Helvétius (1662–1727) who introduced ground ipecacuanha root (ipecac) from Brazil. It was still given to children who had taken accidental overdoses when I was a junior doctor. But the true benefactors of mankind today are those who discover powerful anti-emetics to help people taking cancer chemotherapy. Many anti-emetics have been discovered by chance, and the latest of them is olanzapine. We’re used to seeing it used as an antipsychotic which causes somnolence, weight gain, and type 2 diabetes. But over the last two or three years it’s been increasingly used short-term as an anti-emetic for cancer patients. This trial shows that it is highly effective even at the extreme end of the vomiting spectrum. It was compared with placebo in combination with dexamethasone, aprepitant, or fosaprepitant, and a 5-hydroxytryptamine type 3–receptor antagonist, in patients with no previous chemotherapy who were receiving cisplatin (≥70 mg per square meter of body-surface area) or cyclophosphamide–doxorubicin. I think I shall start taking olanzapine half an hour before switching on the news. It might prevent that strange feeling of nausea and being about to go mad.
more…

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