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Joseph Borick: A Jogini’s story

9 Oct, 14 | by BMJ

Joseph BorickOur story begins on a warm humid day in a rural village in Andhra Pradesh, India. Our team of six doctors, nurses, and medical students arrived with a mobile health bus to run a community clinic. As the patients rolled in and out of the clinic at a remarkably quick pace, I remember one patient* that immediately struck me. Her complaints of fatigue and weight loss with increased susceptibility to infections alarmed me. A brief physical showed diffuse swelling of her lymph nodes. With the help of a healthcare worker from Operation Mercy India Foundation, I was able to sit with this patient for an extended interview. Her story immediately gripped me. more…

The BMJ Today: Guidelines—comfort in a sea of uncertainty?

9 Oct, 14 | by BMJ

rich_hurleyWe’ve just published two more summaries of recommendations from the National Institute for Health and Care Excellence. We hope that these help our busy clinician readers get to grips fast with current best practice, especially where uncertainty or controversy exists.

Both these summaries cover the latest you should know on diagnosis and management; one concerns acute heart failure in adults and the other multiple sclerosis.

In synthesising its guidance, NICE does systematic reviews of the best available evidence and considers cost effectiveness. “When minimal evidence is available,” the summaries warn, “recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice.” more…

Julie Browne: A delicate power balance—teachers and learners in medical education

9 Oct, 14 | by BMJ

Julie Browne By the time I taught my first medical students, I was already an experienced schoolteacher and well used to frank, and occasionally uninhibited, feedback on my performance from my young students. There was Elliot, who, if he wasn’t allowed to run about the classroom, could often be found fast asleep under a desk; Izzy, who once threw a chair at me; Alice, who loved storytime so much she invariably ended the session snuggled comfortably on my feet; and Danny, who spat in my handbag but later sent me a Christmas card. more…

Richard Smith: A tobacco company CEO writes to his marketing department

8 Oct, 14 | by BMJ Group

richard_smith_2014Dear all,

I see a great opportunity for us. You won’t believe this, but I’m at a public health conference in Sousse in Tunisia. I’ve come with my twin brother, a professor of public health. I am, of course, incognito. My brother asked me—yes, asked me—to come. Despite what you might think, we agree on most things—but differ radically on tobacco. We are twins, our connection goes deep. He hoped that by getting me to come to this conference he might get me to change my views. Unfortunately for him—and we’ve discussed this—the effect has been the opposite: I see a huge chance to grow our business. more…

The BMJ Today: Honey, I shrunk the health service

8 Oct, 14 | by BMJ Group

If the blistering analysis article posted today on thebmj.com is correct, then foundation trusts (FTs) need to prepare for a cut in the NHS funded services they are legally obliged to provide. This reduction in “mandatory” core services could come as soon as 2016 for some FTs. It matters, say the authors, because the fewer services NHS trusts are required to provide, the less comprehensive our health service becomes.  more…

William Cayley: Thinking about Ebola from the sidelines

7 Oct, 14 | by BMJ

bill_cayley_2Recently I was staring at two dramatically different bits of “news” on my computer screen. Yet another story on the spreading Ebola outbreak was in one window, and the latest update on our practice’s clinical performance metrics was in the next window. News of an out of control plague, juxtaposed with little red and green numbers telling me how well (or poorly?) I’m doing at “keeping” enough of my patients “in control” with their blood pressures, lipids, and the like. more…

Tom Jefferson: EMA’s release of regulatory data—trust but verify

7 Oct, 14 | by BMJ

The European Medicines Agency (EMA) has now released the final version of its policy on the prospective release of clinical reports of trials, which are submitted by sponsors to support marketing authorisation applications (MAAs). The agency has said that it will—at a future date—determine how to release individual participant data (IPD).

Scope
The policy—to become effective from 1 January 2015—explains what will be released and how. Full clinical study reports will not be released. Rather, selected parts of clinical study reports will be released, including the “core report” (although this is not labelled as such in the text), the statistical analysis plan, protocol and its amendments, and a blank case report form. (To those familiar with clinical study reports, these are sections 1-15, 16.1.1, 16.1.2, and 16.1.9 of the ICH E3 guidelines.) The policy document does not explain why full clinical study reports will not be released. more…

The BMJ Today: Climate change and conflicts of interest: the sound and the fury

7 Oct, 14 | by BMJ

debs“Fury as top medical journal joins the green bandwagon” fumed the Daily Mail last week, which took exception to The BMJ’s publication of an article that, in the words of editor in chief Fiona Godlee, was not medicine or health but “pure climate science.”

“In this unequal battle with big business and political inertia we have a crucial card to play: the knowledge that much of what we need to do to tackle climate change will bring substantial benefits to health,” Godlee charged, adding that the World Health Organization should call a public health emergency.

And how prescient that comment was. Said fury came from Dr Benny Peiser of the Global Warming Policy Forum (GWPF), a think tank founded by former Chancellor Lord Lawson.

“The World Health Organization would become a global laughing stock if they were to follow the ridiculously over-the-top demands of a green alarmist editor. There is a real disconnect between what they are saying and the reality,” he was quoted as saying. more…

Desmond O’Neill: Sky disc and the marvel of ageing

7 Oct, 14 | by BMJ

desmond_oneillOne of the great challenges of hospital medicine is retaining a sense of the marvel of ageing after a busy night on general take. The sheer complexity of the frail, multimorbid, and delirious nonagenarian can easily rattle junior trainees. Seeing beyond the losses to the accumulated richness of life experiences demands insight, but can be teased out by powerful metaphors.

When teaching students and trainees, I often lean on late life creativity in the face of disability: Matisse in his wheelchair, Renoir with the paintbrush strapped to his arthritic hands, Klee and his scleroderma.

A different parallel struck me recently at the combined German, Austrian, and Swiss congress of gerontology and geriatric medicine in Halle, a modest-seeming city in former East Germany. more…

Tony Waterston and Jean Bowyer: Teaching and learning about disability in the West Bank

6 Oct, 14 | by BMJ Group

tony_waterston“We want to improve the attitudes of nurses towards their patients.” This call from senior nurses at an Educating of Educators course in Ramallah (a Palestinian city in the central West Bank) could have been echoed in any country in the world, but these nurses are determined to bring about change and have the capacity to do so. more…

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