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Neville Goodman’s Metaphor Watch: Once it was just oil, now it’s investigators

18 May, 16 | by BMJ

neville_goodmanA curious thing has happened to pipeline. The word—although originally, as happens with many words, as two separate words—is first recorded by the OED in the early days of the oil industry in the last quarter of the 19th century. Its first metaphorical use was recorded in Aldous Huxley’s first novel Crome Yellow (1921). Not long after that it became hyphenated, and then one word in the late 1940s. Turning nouns into verbs is nothing new: pipe-lining—in the literal sense of moving oil—appeared in the Pall Mall Gazette in 1886. The OED also records the adjective pipelined, the noun pipeliner, and the verbal noun pipelining. more…

Ian Roberts: Misleading meta-analyses of small trials?

17 May, 16 | by BMJ

roberts_ianIn September 2015, under the banner “Trusted evidence, Informed decisions, Better Health,” a Cochrane Collaboration press release proclaimed to the public that “preoperative statin therapy reduces the odds of postoperative atrial fibrillation and shortens the patient’s stay on the ICU and in hospital.” No adverse effects, no caveats, no calls for bigger and better trials, just a strong recommendation for practice. The relevant systematic review included 17 trials with a total of 2138 participants and reported a halving of the odds of post-operative atrial fibrillation with statin treatment (OR=0.54 95%CI 0.43 to 0.67; p<0.01). [1] A little over six months later, this claim was refuted by a randomized trial (the STICS trial) that included more outcome events (cases of atrial fibrillation) than all the previous trials combined. [2] It found no reduction in atrial fibrillation (OR=1.04; 95%CI 0.84 to 1.30; p=0.72) and no reductions in hospital stay. However, acute kidney injury was more common in statin treated patients. Although the new trial cannot rule out a smaller treatment effect, it does rule out reductions in atrial fibrillation considerably smaller (15%-20%) than those found in the Cochrane review. more…

William Cayley: Evidence based medicine—are we really there yet?

17 May, 16 | by BMJ

bill_cayley_2People almost invariably arrive at their beliefs not on the basis of proof, but on the basis of what they find attractive.” Blaise Pascal

Can we make evidence based medicine work if we don’t understand the evidence?

I appreciated this week’s BMJ analysis piece by Margaret McCartney et al, which gave recommendations for ways to make “evidence based medicine work for individual patients” more…

Tara Lamont and Tom Quinn: Driving better care—research and ambulance services

17 May, 16 | by BMJ

Tara_Lamont_3tom_quinnWhat do you get with twenty pigs and ten humans? Not a giant hog roast or a bad joke about xenotransplantation. No, this appeared to be the full extent of testing of one type of emergency equipment before it was widely used in ambulances. The “can do” attitude in emergency services means that new technologies have often been introduced ahead of good evidence. But that all changed when this kit became the focus of a major trial funded by the National Institute for Health Research (NIHR), the research arm of the NHS. more…

Georg Röggla: Health and migration

17 May, 16 | by BMJ

georg_rogglaI attended a remarkable reception with a focus on health and migration at the UK embassy in Vienna last week.

The ambassador Susan le Jeune d’Allegeershecque shared her personal experiences of when the wave of refugees reached the eastern Austrian border in 2015. She had seen completely exhausted and traumatised children and a pregnant woman whose waters had broken hours ago. more…

Heidi Larson et al: Vaccine crisis in China—act now to rebuild confidence

16 May, 16 | by BMJ

The recent unfolding of a five year old story of two million doses of vaccines illegally procured and sold across China is a confidence breaker. Worse, it is not a new episode of abusing a public health good for personal financial gain, but the latest of a series of public health incidents in China.

Twenty nine companies have been implicated in the current saga, 202 individuals arrested, and 357 civil servants “dismissed or demoted” according to the official government report. [1] The value of the improperly stored and distributed vaccines (some about to expire), has been estimated at over $40 million. The former pharmacist who choreographed the scandal, along with her daughter, were arrested nearly a year before the story became public. However, little was done about the crisis then. more…

Richard Lehman’s journal review—16 May 2016

16 May, 16 | by BMJ

richard_lehmanNEJM 12 May 2016 Vol 374
Smoake is dangerous to ye Lungs
1811 A new study of smokers with preserved pulmonary function finds that a lot of them have lung symptoms. And even if they don’t fulfil the criteria for chronic obstructive pulmonary disease (COPD), they still experience the familiar pattern of exacerbations and limitation of activity and end up using the same medications as people with COPD. Nothing has changed in the 412 years since King James I of England declared smoking to be “A custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse.” more…

The BMJ research editors: Why The BMJ rejected a “weekend effect” paper

16 May, 16 | by BMJ

Recently, perceived shortcomings of The BMJ peer review system have been extensively discussed on Twitter and elsewhere because we rejected a research paper by Rachel Meacock and colleagues examining the “weekend effect.” The paper was ultimately published in The Journal of Health Services Research and Policy. An author of the paper took the unusual step of publicly identifying Professor Nicholas Freemantle as one of The BMJ peer reviewers and implied that he had inappropriately declared no conflict of interest related to the paper under review. Professor Freemantle’s identity was known to her because of The BMJ’s open peer review process. more…

Anna Sutherland: Hospital at home increases the chances of dying at home

13 May, 16 | by BMJ

It’s Dying Matters Awareness Week, an opportunity to place the importance of talking about dying, death and bereavement on the national agenda and to share Cochrane evidence that may help inform choices for those at the end of life and those caring for them. Here, Palliative Medicine doctor Anna Sutherland shares her thoughts on a Cochrane review on hospital at home.

Increasing significance has been placed on achieving a person’s preferred place of death in recent years. In 2013 there were 473,552 deaths in England, of which 22% of people died at home, 22% in a care home, 6% in a hospice and 48% in hospital. What is not known is how many of these people died in their preferred place of death. (NEoLCIN) more…

Jeffrey Aronson: Mandates and manifestos

13 May, 16 | by BMJ

jeffrey_aronsonI recently heard Jeremy Hunt, UK health secretary, on the Today programme claiming that the Government has a mandate for the controversial contract that it wants junior hospital doctors to sign. I can’t find that mentioned in the Conservative Party’s 2015 manifesto.

The Indo-European root MAN meant a hand. The Latin word was manus, from which we get words directly and by adding suffixes: maintain, manacle, manage, manège, manicure, manipulate, manner, manoeuvre, mansuetude, manual, manufacture, [manu]factory, manumit, manuscript. Manqué is from the Latin mancus, having a useless hand. To emancipate is to take someone by the hand (Latin capere, to take). An amanuensis (short for servus a manu plus the suffix -ensis, belonging to) writes things out by hand at another’s dictation, as Tolstoy’s wife, Sofya Andreevna, did for him and Eric Fenby for Frederick Delius. The manubrium sterni is like a handle, comparing the body of the sternum (Greek στέρνον the chest) to the blade of a sword, and the xiphoid process (ξίϕος a sword) to its tip. more…

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