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Billy Boland: Final thoughts on the NHS Leadership Academy

19 Nov, 14 | by BMJ

billy_bolandHaving made my final submission for the NHS Leadership Academy, and after being told I’ve passed the course by my learning set, the programme should be in the bag. That is unless there are any last minute surprises from the validating board coming up.

I’ve always enjoyed the space between handing in coursework and getting my results. Given that I don’t yet officially know my fate, I thought now would be the right time to give my reflections on the programme as a whole. Here are some things to think about (Dos and Don’ts) if you’re considering applying yourself: more…

The BMJ Today: Safe self monitoring and patient treatments

19 Nov, 14 | by BMJ

Hypertensive disorders in pregnancy are a leading cause of maternal mortality worldwide, with associated problems of poor foetal growth, low birth weight, and preterm delivery. While there is a trend towards pregnant women monitoring their own blood pressure, a recent analysis article asks if this is safe and effective? Guidelines encourage it and research suggests that women prefer it, however, Hodgkinson and colleagues advise caution.

They list some of the disadvantages of self monitoring, including the lack of validation of some monitors, as well as no diagnostic thresholds from home monitoring to identify pre-eclampsia or gestational hypertension. The authors call for a strengthening of the evidence base before this is recommended as a formally accepted part of antenatal care. more…

Colin Brown: In the field in Sierra Leone—part two

18 Nov, 14 | by BMJ

colin brownIn the second instalment of this blog series, I will share some ongoing challenges faced by Sierra Leone in treating Ebola Virus Disease (EVD). I will also share some success stories and how both will help shape the future of healthcare in the region.

Challenges

This week I watched several people die in front of me, helpless to do anything. As health professionals, this is not what we are trained for. We assess. We diagnose. We treat. One young man was being cared for in an isolation unit, waiting for his test result to come back. It had been two days since it was sent and a result was expected later that day. It would be too late. A fit, young, muscular man, he was propped upright by his younger brother—also suspected of having EVD. His breathing was laboured, his eyes vacant, his body limp. He died in his brother’s arms a minute later. more…

Lawrence Haddad: Think we can’t end global malnutrition by 2030? Think again

18 Nov, 14 | by BMJ Group

L_Haddad_twitter_400x400There is a public health crisis that is threatening the health and lives of men, women, and children across our planet at an alarming rate, and the richest nations are affected as well as the poorest. And the sad truth is that many nations in the world have not made addressing the crisis a high enough priority to successfully combat it. We are not talking about Ebola, which has claimed the lives of some 5000 people worldwide. Malnutrition—in the form of stunting, obesity, heart disease, and early death—affects at least 2 billion people worldwide. more…

Desmond O’Neill: A gerontological fear of missing out

18 Nov, 14 | by BMJ Group

desmond_oneillFaced with a gerontology conference with 30 parallel sessions over five days, the texting argot of teenagers comes in handy. To LOL and YOLO has been added FOMO: Fear of Missing Out! Effective FOMO management strategies involve several ingredients. The first is not change between sessions as invariably the timetable has changed in the other room, undermining the experience of both sessions.

The second is reassurance that repeated scrutiny of the programme book to choose sessions bestows a flavour of the hot issues in gerontology. Mixing during coffee breaks and receptions to hear what other delegates found interesting is equally important.

Finally, the poster sessions offer the best opportunity to pick and mix, as well as for serious discussion. Platform presenters are as moved by fear of looking foolish as by science, so dialogue at oral sessions tends to be correspondingly less free-ranging. more…

The BMJ Today: Gender and health—are men and women so different?

18 Nov, 14 | by BMJ

navjoyt_ladherThere are differences in the way men and women experience healthcare. Sometimes this is because the sex of a person confers a particular risk for a disease. Sometimes societal norms and cultural values lead to inequalities between men and women, which in turn affect health. Several articles published on thebmj.com in the past couple of days illustrate these differences.

In India, 13 women have died after having laparascopic sterilisation as part of a government run mass sterilisation programme in the Indian state of Chhattisgarh. A further 14 women are described as “seriously ill.” As part of India’s attempts to control population growth, people are offered financial incentives to undergo sterilisation. These payments are offered for both vasectomy and female sterilisation; however, of the four million sterilisations that were carried out last year in India, 97% were in women. Given that vasectomy is considered a safer and less complex operation than tubal ligation, one wonders what is behind this particular difference? more…

Samir Dawlatly: Open letter to the Department of Health and NHS England

17 Nov, 14 | by BMJ

Dear Department of Health and NHS England

It seems clear that you, the medical fraternity, as well as the mass media agree that there is a recruitment and retention crisis in general practice in England. What is also clear is that we have differing opinions on the reasons this crisis has arisen.

While doctors and some of the organisations that represent us are open about working conditions in the hope that they can be improved, it appears that you are intent on sticking to the same, seemingly rehearsed, lines. Whether the audience is a room full of GPs, medical students, or a national newspaper, the message seems to be: “The reason for the GP recruitment crisis is that GPs complain so loudly about their conditions, putting off medical students and junior doctors—if they didn’t complain so much we could recruit more GPs.” I paraphrase, of course. more…

Neal Maskrey: Treating the patient and not the disease

17 Nov, 14 | by BMJ

neal_maskreyIt was the biggest turnout for many a year. In our small coastal town in the north west of England, 5000 of us stood together bare headed for an hour on a magnificently clear but cold November morning. The Salvation Army brass band was muted but played beautifully, and there was pomp and circumstance aplenty. But at the 11th hour on the second Sunday of the 11th month, even small children and dogs fell silent, somehow recognising the importance of the two minutes of silence. more…

Christopher Burns-Cox: The Assisted Dying Bill

17 Nov, 14 | by BMJ

It does look as if most people now at last want to enable suffering persons of a sound mind and with less than six months to live to be helped to achieve their wish—death, to relieve suffering. And, after the House of Lords voted recently to accept amendments to the Assisted Dying Bill, a change in the law is one step closer.

Many antagonists of the bill do not seem to understand that a person has to be mentally competent, and this means that the new law will not apply to patients with dementia. Many also are not aware that very similar laws are in place in Switzerland; Holland; Belgium; and the states of Oregon, Washington, and Vermont in the United States. The number of assisted deaths in those jurisdictions is very small indeed, and very careful monitoring shows no sign of the “slippery slope” that some prophesy will happen in UK. more…

Richard Lehman’s journal review—17 November 2014

17 Nov, 14 | by BMJ

richard_lehmanNEJM 13 November 2014 Vol 371
1867 “Metastatic melanoma remains just over the border of curability. As we wait and hope for some breakthrough in an agonizingly incremental process, there will be more trials like this one,” I wrote last week about a paper in JAMA. They haven’t been long coming. The two in this week’s printed New England Journal represent the highest standards in the field, which I find less than encouraging. In this first one, funded by F. Hoffmann–La Roche/Genentech, the primary outcome measure was progression free survival, but oddly this was assessed first by the investigators themselves and only afterwards by an independent review panel. I could not find any reference to investigator blinding. Anyway, the conclusion of this trial, in which 495 patients were recruited at 135 sites around the world, is that “the addition of cobimetinib to vemurafenib was associated with a significant improvement in progression free survival among patients with BRAF V600–mutated metastatic melanoma, at the cost of some increase in toxicity.” There was no significant effect on mortality at nine months. Now at present, metastatic melanoma is a certain death sentence, and the median age of the patients was 55, ranging from 23-88. So these patients were mostly facing a severe curtailment of their lifespan, and they volunteered to receive a treatment that might significantly worsen the quality of the short life remaining to them. Our response to their courage and altruism should be to ensure that trials of this kind are interpreted from the viewpoint of the patient, rather than the pharmaceutical company trying to obtain a licence for a new drug. Individuals themselves should be able to judge how a “significant improvement” in disease progression might be weighed against “some increase in toxicity.” The best way to achieve this would be for F. Hoffmann–La Roche/Genentech to release their full datasets and meta-data to independent analysts, including an advisory group of patients with metastatic melanoma. more…

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