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Desmond O’Neill: Ageing, astronauts, and organists in Rotterdam

23 Sep, 14 | by BMJ

desmond_oneill“Le frime” is an almost untranslatable French word for doing something that seems superfluous for the fun of it. It is as good a term as any for the opening ceremonies of our European Union Geriatric Medicine Society conferences. These reflect how individual nations put their best foot forward for guests. While the content may at first sight seem to be tangential to the core business of geriatric medicine, linkages appear with reflection.

And so it was in Rotterdam last week, with a line up including an astronaut/physician, the city organist, a retired Dutch prime minister, and silent movies (old and new). The setting was the magnificent De Doelen concert hall, in a futuristic city centre with an iconic and dramatic train station that opened this year.

The presentation from Dr André Kuipers was witty, entertaining, and informative. Space medicine offers insights into accelerated forms of ageing syndromes, particularly osteoporosis and sarcopaenia; the responses, particularly through exercise, were very relevant to the science of geriatric medicine. more…

Jocalyn Clark: Why has Bangladesh had such success in improving sanitation, but not neighboring India?

23 Sep, 14 | by BMJ

Jocalyn_Clark1Much has been made recently about the appalling rates of open defecation in India, a country that has on other development indicators shown stunning successes. Almost 600 million people in India defecate in fields, forests, bodies of water, or other open spaces rather than in closed latrines or toilets—that’s more than 10 times the number of any other single country, and 60% of the world’s total.

Why, in contrast, does neighboring Bangladesh—a country not only sharing a border but many religious, social, and cultural norms of South Asia—show such sanitation success? more…

The BMJ Today: Management of COPD

23 Sep, 14 | by BMJ

georg_roegglaChronic obstructive pulmonary disease (COPD) is one of the most common diseases a GP has to manage in their daily routine. The BMJ has recently set a focus on COPD management.

Shawn D Aaron draws attention to the fact that patients with COPD are prone to acute respiratory exacerbations, with a possible detrimental effect on patients’ health status, in a state of the art review. Initial treatment is unsuccessful in about a quarter off all patients. The author addresses the benefits and many limitations of established COPD therapies. more…

Dan Bloomfield: Sometimes patients could use a dose of nature, but how could it be prescribed?

22 Sep, 14 | by BMJ

CSH_and_MFETG_logos
This blog is part of a series on sustainable healthcare, which looks at health, sustainability, and the interplay between the two. The blog is coordinated by the Centre for Sustainable Healthcare and shares ideas from experts across the healthcare field.

Doctors generally understand that exercise is good for you. They also realise that isolation is harmful. The more surgeries I visit, the more I find that there is also a common acceptance within general practice that being outdoors in a wild or natural setting is “a good thing.” When they are stressed, need a break or a stretch of the legs, or want to wind down at the weekends, doctors are as likely as anyone else to head outdoors. Add a social element, and/or some aerobic physical activity, and—with suitable patients in mind—GPs become quite keen to suggest that a “dose of nature” is needed. more…

Richard Lehman’s journal review—22 September 2014

22 Sep, 14 | by BMJ

richard_lehmanNEJM 18 September 2014 Vol 371
1100  The way I have ureteric colic is so classical that just watching me sweat and groan is enough for anyone to make the diagnosis, even without the haematuria on the dipstick. I see the same thing all the time in out of hours primary care patients, and generally get the diclofenac injection drawn up after about two sentences of history taking while I dip the urine. I can’t remember ever having to refer anyone for acute imaging. But somehow acute nephrolithiasis manages to cost the US healthcare system $2bn a year, and it seems that most patients are investigated with an immediate abdominal CT. This is a dangerous procedure, partly because of the radiation load, but even more because of all the incidental findings that are bound to turn up. A large American trial compared CT with point of care ultrasound or full formal ultrasound. “Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations.” I suspect that if they had had a no-investigation arm, the results would have been the same. more…

The BMJ Today: The complexity of medical jargon

22 Sep, 14 | by BMJ

tiago_villanuevaUp to this day, I’m still often asked by friends when I am going to become a specialist, considering I am “just” a GP. It remains difficult for lay people to understand and acknowledge that GPs master a trade of their own, just like hospital specialists, and are not just doctors who didn’t pursue any specialist training beyond their primary medical qualification. In fact, general practice is considered a specialty in most (but not all) European countries.

But I worry when I read testimonials such as a recent blog written by Samir Dawlatly, a UK based GP, who argues that the term “general practitioner” is vague in itself. He calls for GPs to be renamed “general medical practitioners”—to reflect the fact that GPs usually provide general medical services. more…

Hugh Alderwick: The ups and downs on the road to health service improvement

19 Sep, 14 | by BMJ

hugh_alderwickParallels between the successful transformation of the Veterans Health Administration (VA) in the United States and the changes needed in the NHS in England have been made for a number of years. But recent troubles at the VA offer some important lessons for the NHS in the future, as explored in a roundtable discussion held at the King’s Fund last week.

The story of the transformation of the VA is familiar to many. Once a fragmented and hospital centred public healthcare system, changes made in the late 1990s helped the VA to become an organisation renowned for providing high quality, affordable care. more…

Richard Smith: Is it time to stop using the word poverty in Britain?

19 Sep, 14 | by BMJ

richard_smith_2014Is poverty yet another word that is so misunderstood we should stop using it—at least in Britain? John Lanchester, a friend of mine, argued so in the Observer. Can he possibly be right?

Lanchester doesn’t seem to be arguing that we should stop using the word poverty when we mean “absolute poverty.” When the Millennium Development Goals were set absolute poverty was defined as having to live on an income of less than $1 a day, but subsequently it was raised to $1.25. In 1980 half the world’s population lived below that line, now it’s a fifth—1.2 billion people. Few people, if anybody, would dispute that having to live on such an income is to live in poverty. Using this measure, Asia might be expected to eradicate poverty by 2030, but the Asian Development Bank has just argued that the rate should be $1.51, meaning that nearly 60% of the population of Bangladesh—a country I visit regularly—is living in poverty. more…

Samir Dawlatly: A case of semantics

19 Sep, 14 | by BMJ

The problem lies in semantics. GP. General practitioner. Could one be more vague than that? There’s an argument that since, on the whole, we provide general medical services (in medical centres) we should be called general medical practitioners. After all, my undergraduate training was in medicine and surgery, not simply everything in general.

Around the time I completed my training to become a G(M)P, I became very downhearted by what I expected to be the likely outcomes of the Health and Social Care Act. I hadn’t been particularly politically aware in the lead-up to the passing of the bill, as I was too busy trying to cram consultations into 10 minutes and learn all the red flags that I was supposed to know. more…

The BMJ Today: What do walnut whip, the Carpenters, and Candy Crush have in common?

19 Sep, 14 | by BMJ

Walnut whip, the Carpenters, and Candy Crush are just some of the guilty pleasures to which doctors have admitted when filling in our questionnaire for BMJ Confidential. This week it is the turn of Louis Appleby, who was national director for mental health from 2000 to 2010, and for offender health from 2010 to 2014. His particular interest is suicide and he still harbours the ambition of reducing the suicide rate again, which was at an all time low in 2007.

Appleby does not reveal whether he thinks the rate reached such a low because of the then government’s effective mental health policies, or the booming economy before the 2008 crash, but he thinks there is hope for a reduction now because doctors no longer see suicide as inevitable and the health service as powerless to prevent it. more…

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