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The BMJ Today: The pitfalls of migration

15 Oct, 14 | by BMJ

I’ve been taking lots of travel histories lately. As a GP who sees lots of patients with fever, patients are even starting to pre-empt me (” . . . and I’ve never been to Africa”). This heightened awareness is unsurprising, given news that some countries are introducing airport screening for Ebola. But will this actually make much difference? Probably not, say editorialists Mabey et al. By their calculations, “an entrance screening policy will have no meaningful effect on the risk of importing Ebola into the UK.” more…

Sanna W Khawaja: What can we learn from the locum?

15 Oct, 14 | by BMJ

sanna_khawajaWhen recounting the tale of my first ever shift as a bona fide doctor, the line “I was on call with a locum SHO and a locum Reg” tends to get the perfect reaction: sympathy and kudos. I follow “The Locum Doctor” on Facebook and have made many a witty (some would disagree) joke with a “locum” punchline. The newspapers also love a bit of locum bashing. Yet here I am, taking a gap year for a number of reasons and I am “the emergency department (ED) locum.” more…

Richard Smith: The joy of a hernia repair

14 Oct, 14 | by BMJ

richard_smith_2014I had a hernia repair recently, but the day turned out to be one of the pleasantest I’ve had in a long time. Can that really be true?

Oddly, I looked forward to the day. It was partly the thought of being “made whole,” partly it being a different day from the normal, and partly a chance to experience the NHS doing what it does well. more…

The BMJ Today: The challenge of getting ready for autumn

14 Oct, 14 | by BMJ

Emma-ParishAs the seasons shift here in the UK to embrace autumn, more people will seek advice for coughs, sore throats, and hoarseness, but are you up to date on laryngitis? In their clinical review, an Australian ENT team present the diagnostic challenge of this condition, outlining the red flag symptoms to prompt investigation for malignancy—very timely for mouth cancer awareness month in November. more…

Mihail Călin: Romanian healthcare workers keep packing

13 Oct, 14 | by BMJ

Mihail_CălinAn oncologist from Tulcea, a city 280 kilometres east of Romanian capital Bucharest, returned to work one week into his retirement because there was no other specialist to care for his 4000 patients. In Maramureș, a Romanian county on the northern border with Ukraine, an anaesthesiologist has to commute between two towns so that emergency surgeries can be performed–other operations are being postponed for less crowded days. Călărași, a poor county in the south, only has one diabetologist.

All of these reports are partly owing to the massive migration of medical personnel, which began after Romania’s accession to the European Union in 2007. Between 14 000 and 20 000 doctors—and probably at least as many nurses—have left the country over the past seven years, leaving behind patients with even poorer access to care and overwhelmed colleagues. Many Romanians are pinning their hopes for solutions on the EU—the destination for most migrant health workers. more…

The BMJ Today: Ebola and the importance of taking a travel history

13 Oct, 14 | by BMJ

navjoyt_ladherThe new cases of Ebola virus disease reported in Spain and the United States in recent days have reminded healthcare workers around the world to be vigilant for the infection. Several weeks ago, we spoke to Nick Beeching, senior lecturer and consultant in infectious disease at the Liverpool School of Tropical Medicine, about the UK’s response to the outbreak.

In the video, he outlines when to suspect viral haemorrhagic fever and emphasises that cases in the UK are extremely rare in comparison to other imported diseases, such as malaria. more…

Richard Lehman’s journal review—13 October 2014

13 Oct, 14 | by BMJ

richard_lehmanNEJM 9 October 2014 Vol 371
1381  With blood transfusion, it seems that less is usually better. This has been shown in renal patients and palliative care, and is now reconfirmed in septic shock. Fifteen years ago, the Canadian Critical Care Trial Group study showed that transfusing critically ill patients at threshold of 10 G/dl of haemoglobin produced worse outcomes than using a threshold of 7. Now Scandinavian triallists have gathered and randomised 1000 patients with septic shock in 32 general ICUs in Denmark, Sweden, Norway, and Finland: a logistic feat to be wondered at. They have shown that a threshold of 7 is as good as a threshold of 9, saving gallons of blood. In fact, it halves the amount of blood used. more…

Sian Falder: Burns care overseas—the forgotten health crisis

10 Oct, 14 | by BMJ

sian_falderThe role of UK medical professionals overseas often captivates the public, especially when there are dramatic scenes and mass suffering. There is something about war zones and huge natural disasters which especially capture the imagination and interest. But why? Is it the indiscriminate destruction of innocent life, the number of casualties, or the danger to those who try and help, which makes these situations so compelling? more…

The price of joining the middle income country club: reduced access to medical innovation

10 Oct, 14 | by BMJ

When people think about medical humanitarian aid, the usual association is with war zones and natural disasters, and the assumption is that the most critical medical needs are concentrated in the world’s poorest countries. That’s mostly right, but not entirely.

While the needs of low income countries remain huge, there are large—and growing—populations excluded from access to healthcare who now live in countries classified as middle income countries (MIC). This shift presents enormous challenges, particularly in accessing new lifesaving drugs and vaccines for diseases that take a disproportionately high toll on poor, marginalized populations. more…

Vinitha Soundararajan and Alisha Patel: Sustainable Healthcare

10 Oct, 14 | by BMJ Group

Vinitha_SoundararajanClimate change, an ageing and growing global population, and depleting planetary resources are well established issues. There is a call for urgent action, especially in healthcare.

The NHS has been scrutinised for being a major contributor to the national carbon footprint. Health services globally need to act more sustainably to maintain the world we live in. Is it too late to act? What can we do about it? more…

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