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Hemal Kanzaria et al: How can we reduce medical waste in US hospitals?

4 Apr, 14 | by BMJ

hemal_kanzariaUS hospitals annually discard millions of dollars of clean, unused medical equipment due to procedural excess or federal regulations. [1,2] Many health professional students do not recognise the magnitude of this waste or the extent of worldwide inequities in access to such supplies. In an era of value driven care, it is critical to engage students in cost conscious care and waste reduction efforts.

Remedy at University of California San Francisco (R@UCSF) is a student implemented, service learning initiative for the responsible redistribution of medical supplies to underserved communities. [3] Through an experiential curriculum, the program objectives are a) to reduce disparities in access to healthcare supplies by providing clean and needed equipment to under resourced communities and b) to expose students to the magnitude of medical waste in US hospitals. more…

The BMJ Today: Is medicine marching towards an era of greater openness?

4 Apr, 14 | by BMJ

Tiago_VillanuevaIn the latest Endgames picture quiz, a 41 year old man presents to the emergency department with a two week history of worsening shortness of breath, productive cough, intermittent fever, night sweats, and non-pleuritic pain in the right side of the chest wall. He was diagnosed with a pulmonary abcess secondary to community acquired pneumonia. There are no published guidelines regarding the management of pulmonary abscess, which includes antibiotics that are in part chosen according to clinical judgment rather than a sound evidence base. more…

Jonathon Tomlinson: Moral luck, agent regret and the doctor as drug

3 Apr, 14 | by BMJ

jonathon_tomlinson“You saved my life, doctor. I can’t thank you enough.” Letter from Tom 2011

“Our mother is dead … because of you.” Bereaved daughter. Poplar coroner’s court 2010

“What is the drug you use with patients all the time?” “The doctor is the drug.” M Balint 1952 [1]

Professional identity is particularly strong in doctors and medical students, and perhaps more than our non-medical peers we assimilate this into our personal identity. [2,3] With this, comes a sense of moral responsibility; we cannot avoid thinking that what happens to our patients is not just down to what we do, but the kind of people we are. How much we internalise our identity and feel morally responsible varies considerably, at one, perhaps narcissistic, extreme it’s all about us and at another, perhaps psychopathic, extreme, it’s anyone or anything other than us. more…

The BMJ Today: Paying people to live healthier lives and tackling climate change

3 Apr, 14 | by BMJ

This week, the Intergovernmental Panel on Climate Change (IPCC) released its Fifth Assessment Report. The scientists who wrote it warn of the serious impact that climate change—unequivocally influenced by human activity—will have on humans and other species in the planet. The IPCC calls for world leaders and policy makers to promote adaptation strategies to mitigate the implications of climate change for future generations. Climate change may be the greatest challenge we face as a species yet many people have difficulty grasping its implications. The changes are abstract, will occur in the future, and mitigation strategies have economic costs and limited short term benefits. In addition, several institutions, corporations, and individuals with vested interests refute the claims of mainstream scientists and promote the fallacious view that there is great uncertainty around the predictions of the IPCC and that many in the scientific community are skeptical about the impact of human activity on climate change. more…

Nathan Sivagananathan and Tehani Renganathan: Trail—improving cancer care in Sri Lanka

2 Apr, 14 | by BMJ

nathan_sivagananathanIn 2011 Nathan Sivagananathan and Sarinda Unamboowe set out to transform the lives of patients with cancer in the northern region of Sri Lanka. For over three decades the northern territory has been in the throes of terrorism, with little room for economic or social development. The ongoing war made the 400 km journey to the country’s only cancer hospital, which was located in Colombo, even more challenging as patients had to travel by both sea and land because of land blocks and danger zones. Many people preferred to remain untreated, unwilling to make the challenging journey across the country to receive the treatment they required. more…

The BMJ Today: Vitamin D, probiotics, and polio

2 Apr, 14 | by BMJ

We have been longing for a final word on whether vitamin D supplements improve health. An umbrella review published today included 107 systematic literature reviews and 74 meta-analyses of observational studies looking at serum levels of vitamin D, as well as 87 meta-analyses of randomised trials testing vitamin D supplements. A total of 137 outcomes were included, spanning a wide array of diseases.

We’ve also published a systematic review and meta-analysis of 73 cohort studies with over 800 000 participants and 22 randomised trials with 30 000 participants that examined the link between vitamin D and deaths due to cardiovascular disease, cancer, and other causes. more…

Gavin Yamey: Soldiers, academics, and an unusual health initiative

1 Apr, 14 | by BMJ

gavin_yameyIt’s not every day that you find yourself at a work meeting chatting to a soldier who led the Counterinsurgency Advisory and Assistance Team in Afghanistan and the doctor who directed the largest global health initiative in human history.

Retired US Army Colonel Joseph Felter is now a Stanford University academic with expertise in studying the root causes of political violence. Eric Goosby, an HIV physician at the University of California, San Francisco (UCSF), who was among the first clinicians in San Francisco to treat the disease at the start of the pandemic, led the $US45 billion global AIDS initiative PEPFAR—the US President’s Emergency Plan for AIDS Relief. more…

The BMJ Today: Selective decontamination revisited and healthcare reform in Massachusetts

1 Apr, 14 | by BMJ

georg_rogglaRichard Price and co-workers published a network meta analysis evaluating the effect on mortality of selective digestive decontamination (SDD), selective oropharyngeal decontamination (SOD), and topical oropharyngeal chlorhexidine in patients in general intensive care units. They found that both SDD and SOD confer a mortality benefit when compared with chlorhexidine. more…

Ryan Irwin: What healthcare can learn from football—10 key lessons

31 Mar, 14 | by BMJ

ryan_irwinFootball, the world’s most played sport, provides an excellent laboratory for understanding the nature of organisations and has some useful lessons for members of the healthcare economy. Here, 10 lessons are explored.

1. Culture is king
Culture is the product of values, beliefs, and behaviours. Football clubs are synonymous with their own cultures, which when expressed positively, bring a sense of shared pride, celebrate ethnonationality, and encourage positive personal expression. However, when expressed negatively, it can lead to hooliganism and extremism. [1] Healthcare leaders and organisations should understand and influence their own organisational culture, to ensure a culture of quality, safety, and learning, or fall victim to cultures which create harm. more…

Sarah Gregory: What can we learn from how other countries fund health and social care?

31 Mar, 14 | by BMJ

England is not alone in facing the implications of an ageing population with changing patterns of illness. To inform the work of the independent commission on the future of health and social care in England, I have spent the past few months looking at how other countries are responding to these challenges.

By comparison with other OECD countries, two features of the English system stand out. First, we have an unusually defined split between our health and social care systems. By comparison, many countries have developed a funding system for social care that complements their funding for health. For example, Germany, France, Korea, and Japan have all introduced insurance for social care to complement their systems of health insurance. Second, we are at the lower end of the range for public spending on social care, although it is difficult to establish direct comparisons as we do not report on social care funding to the OECD. The UK spent 1.2 per cent of GDP on long term care in 2012/13, while the highest figure reported to the OECD was 3.7 per cent (in the Netherlands). more…

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