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The BMJ Today: The landmark announcement that wasn’t

27 Jul, 15 | by BMJ

nutrition_info

Farewell to dietary cholesterol
The US Dietary Guidelines Advisory Committee has released its recommendations for the next edition of Dietary Guidelines for Americans. In an editorial on thebmj.com, Daan Kromhout writes that the committee’s recommendation that dietary cholesterol should no longer be a “nutrient of concern”, has been cause for much discussion. As has the omission of a recommendation on total fat consumption.

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Richard Lehman’s journal review – 27 July 2015

27 Jul, 15 | by BMJ Group

richard_lehmanNEJM  23 Jul 2015  Vol 373

307   Four summers ago I found myself dabbling in the early history of outcomes research. I was astonished to find that surgeons over a century ago were reflecting on much the same issues as they do today. In cancer, for example, there was lively debate about the place and timing of radiotherapy in relation to surgical procedures. Here’s a study of regional node irradiation in early-stage breast cancer, which recruited between the years 2000 and 2007. Ionizing radiation was first used to treat cancer in 1896 and this trial shows that we are still learning how to use it. The median follow-up here is 9.5 years, and irradiating the regional lymph nodes as well as the breast made no difference to the primary outcome, which was overall survival. It did, however, reduce the recurrence rate of breast cancer by an absolute margin of 5%, at the cost of a small difference in the occurrence of lymphoedema (absolute increase 3.9%) and pneumonitis (1%). more…

The earthquake in Nepal: Surgeons’ dispatch from Barhabise

24 Jul, 15 | by BMJ

Surgeons' dispatch from BarhabiseThe massive 7.8 magnitude earthquake that occurred 77 km northwest of Kathmandu, the capital of Nepal, on 25 April 2015 left more than 8000 people dead and 16 000 injured. The district of Sindhupalchok, where more than 3000 people were lost, was struck particularly hard.

At the request of the Japanese government, disaster relief medical teams from the Japan International Cooperation Agency (JICA) were sent to Nepal on 28 April. The primary medical team consisted of 48 people, including eight doctors: two trauma surgeons, two orthopaedists, two emergency physicians, one paediatrician and one anaesthesiologist. We arrived in Kathmandu on 29 April via Bangkok. Less than one percent of the buildings in the city were damaged and the infrastructure was preserved, so for many inhabitants life went on as usual for the most part. People living in tents in parks were gradually returning to their homes. However, there were frequent aftershocks. more…

Kallur Suresh: Psychiatry at the forefront of science

24 Jul, 15 | by BMJ

Generation Q 12 June 2012I recently attended the 2015 International Congress of the Royal College of Psychiatrists in Birmingham. It was one of the largest gatherings of psychiatrists from the UK and many other countries. It attracted around 2500 delegates who came to learn from its scientific programme, present their work, and network with other professionals. I was genuinely impressed by the quality of its academic content and its slick organisation. The theme of the congress was “Psychiatry at the Forefront of Science.”

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Neel Sharma: Medical certification—too many tests?

24 Jul, 15 | by BMJ

In May this year, Paul Teirstein and Eric Topol authored a viewpoint on the role of maintenance of certification (MOC) in the States. Their article highlighted the shift from a ten yearly to two yearly MOC approach pointing towards concerns of the value of such frequent retesting. These included the lack of evidence for such a shift, the fact that a written test can never truly translate to what is done in actual practice (“clinical decisions are often not black and white, yet test questions must have one best answer”), the limitation of the test itself in an environment of super specialisation (“adult anesthesiologists who never treat children must take a test that includes questions about pediatric anesthesiology. General surgeons must review trauma surgery for the recertification examination even though they do not treat patients who sustain trauma. A cardiologist who spends four days per week in a basic science laboratory and one day caring for patients in a clinic is tested on reading cardiac echocardiograms and exercise stress tests, yet never performs these services”) as well as the significant costs involved. In keeping with the first point, they detailed that evidence supporting physician certification and MOC was written by ABIM employees. more…

The BMJ Today: Are you closer to pharma than you think?

24 Jul, 15 | by BMJ

BMJ_pharma_cover• Are you closer to pharma than you think?
36 English clinical commissioning groups (CCGs) have been involved in medicines management programmes either directly or indirectly paid for by pharma. In a BMJ feature, Margaret McCartney examines the different types of relationships in practice, the potential benefits and harms that can arise from these and what patients know about these relationships. more…

Emma Ladds: Keeping a sense of perspective

24 Jul, 15 | by BMJ

photo (5)Getting through the key safe is often a major accomplishment on home visits. Once you’ve achieved that, you can be pretty sure you can manage what lies beyond. Today I was going to see a lady with a palliative brain tumour*. I’d been part of her admitting hospital team and had remarkably come across her again during my primary care placement almost 10 months later. She remained overwhelmingly positive and visits were always full of a joke or two. A new carer had started today, and had called to say that she thought Mrs B had slurred speech and could do with a medical review. I had sighed. Mrs B’s speech had been slurred for days now, thanks to her cortical invader. She was hemiplegic too. Not long now. I had agreed to go and visit though. I wanted to say goodbye. more…

Neville Goodman: Literally a metaphor

24 Jul, 15 | by BMJ

neville_goodman

We use metaphor, a figure of speech, to explain or enliven: in doing so we write metaphorically, or figuratively. The opposite of metaphorically is literally. We don’t need to add metaphorically to a metaphorical statement; we rely on readers to recognise the metaphor: “Doctors’ morale has hit rock bottom,” not, “Metaphorically, doctors’ morale has hit rock bottom.” But oddly, we sometimes feel the need to add literally to bolster metaphorical statements: “Doctors’ morale has literally hit rock bottom.” This use of literally has long been discouraged in style guides—for good reason. Long before Michael Gove MP issued his advice to civil servants, the Treasury invited Sir Ernest Gowers to help them to improve official English. The result was The Complete Plain Words (which combined two of Gowers’ earlier works), published in 1954 and recently revised and updated by his great-granddaughter. Parts of Gowers’ original works are on the internet, where you can read his examples of this “foolish use” of literally: “Miss X literally wiped the floor with her opponent,” and, “M. Clemenceau literally exploded during the argument.” Bill Bryson advises that literally be used only when something expected to be metaphorical is actually true: his example is, “He literally died laughing.” If he really did. more…

Jeffrey Aronson: When I use a word . . . Back breaking

24 Jul, 15 | by BMJ

jeffrey_aronsonWords typically develop from a root of some sort, and derivatives are formed from a primary word by changing or adding something. You can do this in many ways. You can form adjectives, for example, from other words by adding prefixes or suffixes, such as un– and dis–, or –ed, –ful, –ive, –less,–y, –ic, –al, and –ical, adverbs by adding –ly, and nouns by adding –ness and other endings. So, take a breath. The Indo-European root BHRE, which implied warmth and stirring, gives us words such as broth, bread, and braise. A breath is a warm exhalation, originally from anything cooking or burning. Derivatives include breathful, breathless, breathlessly, breathlessness, breathily, and breathalyser.

Back-formations, in contrast, are words that are formed by shortening other words, which can be done by aphaeresis (fore-clipping) or apocope (back-clipping). In using a breathalyser you breathalyse, a back formation. more…

William Cayley: Ethics and professional wisdom

23 Jul, 15 | by BMJ

bill_cayley_2The recently publicized news that the American Psychological Association (APA) “colluded” with US governmental agencies to create ethical guidelines permitting psychologists to participate in “harsh interrogations” of military detainees is appalling. According to the APA’s own press release, the guidelines were “based at least as much on the desires of the US Department of Defense as on the needs of the psychology profession and the APA’s commitment to human rights.” While appropriate kudos are due to the APA for having the courage to both commission the recent investigation of its ethical practices, and to publicize the results, the sad circumstances that led to those ethical lapses point to a clear need for robust understandings of professionalism and ethics. more…

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