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Sarah Walpole: Health through peace—mixing stories and science, and grabbing rays of hope

19 Nov, 15 | by BMJ

health through peace“We were deployed to attack civilians in their homes.” He stood in front of our 700 strong audience, bared the horrors of his experiences, and shared the pain of his realisation, all with brutal honesty. He described a standard operation carried out by British soldiers in Iraq: waking a family from their sleep with an explosion of the front of their house, holding them at gun point, separating men from women and children, bagging their heads and tying their wrists, smashing their belongings, stealing their documents, and leaving. He estimated that 95% of those on the receiving end of this procedure had no links to terrorism or militarism.  more…

David Zigmond: Arguments about money are often about much else

18 Nov, 15 | by BMJ

david_zigmond2When partnerships break down, money is an expected battleground. One of the most public and fiercely destructive examples is in the disintegrated marriage. Charge and countercharge escalate; then these are translated into monetary forms.

Understanding this translation is crucial to any hope of understanding or containing the human agenda. For money is so often the exchange currency (literally) that expresses other—frequently unarticulated, even unconscious—forms of loss: those of being valued and in relationship. Anger becomes a frequent foil for sorrow: litigation is often obliquely obscured grief.

This process—the expression of degraded relationships in monetary or legal terms—is now commonplace in our NHS. more…

Alisha Patel and Emma Pearson: Volunteering in rural South Africa

18 Nov, 15 | by BMJ

Alisha-Patel_picemma_pearsonAfter two years of medical school and miserable weather, we decided it was time to take our newly found skills to a warmer climate. In summer 2015, we spent three weeks volunteering in Underberg, a rural town in the KwaZulu-Natal province in South Africa. Our time there consisted of school outreach for children from the ages of 4-16 in the local school, community work, and research. It was a great opportunity to throw ourselves into the local culture and learn more about healthcare in South Africa. more…

Richard Smith: What causes cholera? A Victorian debate

18 Nov, 15 | by BMJ

richard_smith_2014Yesterday I was in The Cholera Hospital in Dhaka, Bangladesh; today I’m reading about a highly emotional debate about the causes and treatment of cholera that took place in India in the 1857, during the Indian Mutiny. Both experiences have taught me something, and you might learn something as well.

Cholera today

Cholera is endemic in Bangladesh, as it is in some 50 countries, with two peaks during the year, one just before the rainy season begins in April and one after it ends in October. During the peaks The Cholera Hospital may have a thousand admissions a day, most of the patients have cholera. The hospital is part of icddr,b [formerly the International Centre for Diarrhoeal Disease Research, Bangladesh], and it leads the world in the treatment of cholera. If patients arrive alive they leave alive. Nobody has to pay for treatment, and the hospital is well known to the poor of Dhaka, a city of 17 million people where a third live in slums. more…

Jane Feinmann: Consumers co-design consumer friendly healthcare

17 Nov, 15 | by BMJ

jane_feinmannI am one of 50 or so attendees on a one day course organised by the Point of Care Foundation learning how patients like myself can work as partners with doctors and nurses to co-design a better healthcare system.

It’s not a new idea. Don Berwick, author of the NHS Patient Safety Review, pointed out ten years ago that “healthcare workers and leaders can often best find the gaps that matter by listening very carefully to the people they serve, patients and families.” While the NHS has so far picked up on the idea of “listening” with initiatives such as the Friends and Family test becoming ubiquitous in GP practices and hospitals, it’s arguable how careful this listening is. more…

Patrick Cullen: Co-design for vulnerable patient groups—transforming patients’ experiences

16 Nov, 15 | by BMJ

patrick_cullen_picRecently I attended a conference at the King’s Fund that focussed on transforming patient experience, particularly the experience of vulnerable patient groups.

To me, the day felt as much like a call to action as a celebration of good practice. Hearing from Catherine Carter, a mother with learning disabilities and Asperger’s, about the distressing experiences of parents with learning disabilities offered a stark reminder of how much stigma there still is around certain conditions.

She described a project to engage people with learning disabilities using maternity services. more…

Richard Lehman’s journal review—16 November 2015

16 Nov, 15 | by BMJ

richard_lehmanNEJM 12 Nov 2015 Vol 373
SPRINTing to conclusions
OL There’s no denying that the research event of the week has been the online publication of the SPRINT hypertension trial. So here I am departing from the usual pattern of these reviews, because it would seem odd not to begin with it. I’m going to be very brief. The trial shows that in people of mean age 68 years with elevated cardiovascular risk, but not diabetes, aiming for a systolic blood pressure target of 120 rather than 140 mmHg produced a significant reduction in death and cardiovascular events over a median period of three years and three months. The patient characteristics, benefits, and harms in this trial are very well described. If you are consulted by an individual who fits its criteria, you could have an informed conversation about their risk lowering options, of which tighter BP control might be one.


Tom Jefferson: Happy birthday Ombudsman

13 Nov, 15 | by BMJ

Tom Jefferson with Emily O'ReillyThe institution of the European Ombudsman celebrated its first 20 years of activity with a party for staff and all those who have and still are contributing to its work. The shindig was held in the European Parliament.

In the words of the current Ombudsman, Emily O’Reilly, the Ombudsman’s function “was born out of the debate on the emerging European citizenship in the early 1990s, and its purpose precisely is to enable those European citizens to hold the ever more powerful EU institutions to account, as the direct effect of what they do impacts more and more on the daily lives of the people. It acts in a complementary way to the courts and to the parliament, as a check on EU institutional power.”

In the current climate, O’Reilly’s words may seem like a wish rather than reality. Except that the office’s record in the matter of access to secret clinical data is exemplary. more…

Mary E Black: How data science will change public health

13 Nov, 15 | by BMJ

maryeblack copyWe are living in a perfect storm: vast amounts of data and rapidly increasing, cheap computing power. The world is shifting towards basing decisions even more on data. I believe, to paraphrase Billy Bosworth, that “10 years from now when we look back at how this era of big data evolved . . . we will be stunned at how uninformed we used to be when we made (public health) decisions.” (Billy Bosworth, DataStax CEO, 2015)

This is groundbreaking stuff. Bring on commercial partnership, academic links, local activist groups, and hackers, for we cannot do this alone, we do not have the firepower. Here are my top 10 change predictions. All of them are already happening . . . somewhere . . . more…

Jeffrey Aronson: When I use a word . . . Let’s twist again

13 Nov, 15 | by BMJ

jeffrey_aronsonThe Indo-European root UER was not the only one that connoted twisting and turning. Others were PLEK, STREB, TERQ or TORQ, TERK, and UEI. Let’s start with PLEK, which in Greek gave πλεκ- and πλο(κ)-, in Latin plec- and plic-. It implied not only to twist, but other twisty actions as well—to braid or weave, to bend or fold. Folding also implied repetition.

DNA is plectonemic (Greek πλεκτός, twisted). Ploce (Greek πλοκή) is a rhetorical device in which the same word is repeated in the same sentence, often in a different sense or grammatical form. Here’s an example from Richard III (II:iv:61): “Make war upon themselves, brother to brother, Blood to blood, self against self.” more…

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