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Richard Lehman’s journal review—14 April 2014

14 Apr, 14 | by BMJ

richard_lehmanNEJM  10 Apr 2014  Vol 370
OL   A deadly virus has been conquered. Hepatitis C genotype 1 can be cleared with a simple oral combination treatment, and compared to that, the rest of this week’s medical news seems minor. So I will start by running through the hepatitis C papers which have just appeared on the NEJM website. It you want to read them all, they are free, but as most of you are not virologists or hepatologists, you may just want the bottom line. The names to conjure with are: ledipasvir and sofosbuvir on the one hand, and ABT-450, ritonavir, and ombitasvir on the other hand. Now that you have memorized these, I shall continue. The first of these combinations underwent three trials funded by Gilead Sciences, all of them outstandingly successful. Cure rates of 94-99% were achieved within 12-24 weeks with or without the addition of ribavirin, whether or not patients had received previous treatment or had hepatic cirrhosis. more…

Birte Twisselmann: European Union—live

11 Apr, 14 | by BMJ

BirteAs a three-times member of the national judging panel for the UK winner, I was invited to attend the awards ceremony for the EU Health Prize for Journalists 2013, at the European Commission in Brussels on 7-8 April 2014. And in the same way as last year, this meant an intense couple of days with some 60 journalists and jury members from all over Europe, well attended by EU officials, and hosted by the EC’s Directorate-General Health and Consumers (DG SANCO), in its stunning Berlaymont building. The prize is in its fifth year and is given for journalism covering “Europe for patients” themes ranging from cancer and rare diseases to prudent use of antibiotics, mental health, pharmaceuticals, and vaccine scares, to name a few. more…

The BMJ Today: Staying ahead of getting behind

11 Apr, 14 | by BMJ

tinukeI live in London, a city where most things are fast paced. Coffees are made to go, walking is more of an Olympic sprint, and our time is valued with the precision and importance usually reserved for world leaders. It seems that this isn’t a phenomenon exclusive to city dwellers. David Loxterkamp describes how GPs are burdened with a scarcity of time meaning they are constantly having to prioritise needs in order to stay ahead of getting behind. He feels that “patients deserve a doctor who has time to listen, care about them, and offer hope for the problems they believe are worthy.” more…

Billy Boland: Why criticism can be helpful

10 Apr, 14 | by BMJ

billy_bolandWhen we formed our Self Managed Learning (SML) group at the NHS Leadership Academy, I made it clear to the others that I wanted them to push me and be critical friends. A year can fly by and we’re scheduled to meet only six times. Groups can take a while to settle down, and I didn’t want to miss out on any learning by being polite. I hoped to hear the things that others who know me better wouldn’t say. I wanted to be orientated to my blind spots. The safety and confidentiality of the group were what would make it OK. Or so I thought. more…

The BMJ Today: The Tamiflu trials

10 Apr, 14 | by BMJ

BirteToday The BMJ is all about neuraminidase inhibitors and open data. Ten articles on the subject of anti-influenza drugs try to establish what we know. In sum: perhaps not enough to justify the huge expense governments worldwide have incurred in stockpiling these drugs, but perhaps enough in terms of improving transparency and providing researchers with all available data for independent scrutiny. more…

Neal Maskrey: Medical maths

9 Apr, 14 | by BMJ

neil_maskreyMost of us end up with a handful of people who remember us. Teachers have thousands of people who remember them for the rest of their lives. I’ve been lucky to have had dozens of memorable teachers, and one of the first was Miss Molineux. Miss Molineux was young, enthusiastic, and kind. We were not just the seven year olds she taught, but her devoted fan club. She drilled us in multiplication, encouraged our developing reading, and stayed late to play cricket with us after school. To this day if I have to multiply 8 by 7, a whiff of Miss Molineux’s perfume and 56 are simultaneous events.   more…

The BMJ Today: The glass ceiling, upcoming elections, and big tobacco

9 Apr, 14 | by BMJ

As I look around our open plan office, towards where our editor, Fiona Godlee, sits, it would seem that the glass ceiling has been shattered at The BMJ. But, in her personal view, Medicine still needs feminism, Helena Watson argues that there are “legions of feminist issues still left to fight.” more…

The BMJ Today: If you hear hoof beats in Texas think of horses, not zebras

8 Apr, 14 | by BMJ

As Saurabh Jha writes, “The likelihood that someone with cerebral aneurysm hit by a bat develops subarachnoid hemorrhage (near certainty) is not the same as the likelihood that someone who develops subarachnoid hemorrhage after high impact trauma has an aneurysm, hitherto undisclosed (very low).” But would you order tests so you could absolutely rule it out? Would you perhaps order further tests to rule out bleeding brain metastases from lung cancer? Jha asks us to stop “hunting for zebras in Texas” and put an end the “rule-out” culture that pervades medicine. more…

Desmond O’Neill: Combatting rigidity in medicine

8 Apr, 14 | by BMJ

desmond_oneillHigh quality films for children have a special place in our cultural landscape, an appeal which even embraces the medical humanities. To reach beyond children to the adults in their entourage requires a sure touch for tapping into the universal across the lifespan. In addition, many of the underlying fables are vehicles for deep and complex messages.

As teased out in Bruno Bettelheim’s remarkable Uses of Enchantment, the brooding themes of abandonment, death, witches, and injuries may allow children to come to terms with their fears and conflicts, particularly with parents and authority, in remote symbolic terms. more…

Richard Lehman’s journal review—7 April 2014

7 Apr, 14 | by BMJ

richard_lehmanNEJM  3 Apr 2014  Vol 370
1287   Multitarget stool testing, you will be pleased to hear, is not the most important topic in the NEJM this week. There is in fact so much else on the NEJM website that I could take up the whole review dealing with nothing but online papers. So let us quickly dispose of these crap tests. There is a new one which includes quantitative molecular assays for KRAS mutations, aberrant NDRG4 and BMP3 methylation, and β-actin, plus a hemoglobin immunoassay. This was compared with a standard immunochemical stool test (FIT). Both were used on nearly 10,000 people at average risk of bowel cancer, who all underwent full colonoscopy too. “Multitarget stool DNA testing detected significantly more cancers than FIT did, but had more false positive results.” The old screening dilemma revisited: progress does not lie this way.

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