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Matthew Honeyman: Reconfiguring NHS services: necessary but fraught with difficulties

20 Apr, 15 | by BMJ

matthew_honeymanWith the NHS facing growing pressures on all fronts, following the general election the next government is likely to begin a new round of NHS service reconfiguration planning. In addition, work will continue to implement the new care models—such as urgent and emergency care networks and modernised maternity services—set out in the NHS five year forward view. So what are the challenges around service reconfiguration? And what evidence is available to help guide this planning process? more…

Richard Lehman’s journal review—20 April 2015

20 Apr, 15 | by BMJ

richard_lehmanNEJM 16 April 2015 Vol 372
1489 Your learning task this week is to memorise “proprotein convertase subtilisin–kexin type 9 (PCSK9).” The next big lipid lowering debate will be all about inhibitors of PCSK9, and somebody should urgently invent a popular name for them. I suggest fatins (fat lowering injections), to rhyme with statins. There are two of them at the moment: alirocumab and evolocumab. In this trial, alirocumab was given as an injection every two weeks to two thirds of 2341 patients at high risk for cardiovascular events who had LDL cholesterol levels of 1.8 mmol per litre or more and were receiving treatment with statins at the maximum tolerated dose. The rest had a placebo injection. “At week 24, the difference between the alirocumab and placebo groups in the mean percentage change from baseline in calculated LDL cholesterol level was −62 percentage points (P<0.001); the treatment effect remained consistent over a period of 78 weeks.” The trial was not powered to detect a fall in actual cardiovascular events over this period, but as its name ODYSSEY LONG TERM implies, it means to go on:
To strive, to seek, to find, and not to yield. (Last line of Ulysses by Tennyson) more…

The BMJ Today: What is happening in US medicine?

20 Apr, 15 | by BMJ

9_11_emergency_workersEven though I was far away from New York City, I will always remember the 11 September 2001, as I was in medical school taking an exam that day. An article in research news reports that the emergency medical workers who arrived in the immediate aftermath of the World Trade Centre attacks were at greater risk for a number of chronic conditions compared with the workers who did not attend the aftermath of the attacks. For example, first responders were almost four times more likely to have reflux, seven times more likely to have post-traumatic stress disorder, and twice as likely to have depression. more…

Jeffrey Aronson: When I use a word . . . Conjugation

17 Apr, 15 | by BMJ

jeffrey_aronsonA case of Vernet’s syndrome, unilateral paralysis of the 9th, 10th, and 11th cranial nerves, caused me to read up about the jugular foramen and tumours therein.

The jugular foramen, a triangular structure at the base of the brain near the mastoid process, nearly long enough to be regarded as a canal, contains numerous important structures, including the internal jugular vein, the inferior petrosal sinus, and the posterior meningeal artery, the glossopharyngeal, vagus, and spinal accessory nerves, Arnold’s nerve, and Jacobsen’s nerve. more…

Gabriel Rada: How much health evidence is there in the world?

17 Apr, 15 | by BMJ

gabriel_rada

This blog is part of a series of blogs linked with BMJ Clinical Evidence, a database of systematic overviews of the best available evidence on the effectiveness of commonly used interventions.

Thirty five years ago, Archie Cochrane reproached the medical profession for not having managed to organise a “critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials.”

Systematic reviews were invented to deal with this problem, thus enabling what we call evidence based medicine, and their number has being steadily growing. more…

Tessa Richards: Is your conference “Patients Included?”

17 Apr, 15 | by BMJ

Tessa_richardsThe conference circuit is buzzing. If you are not physically caught up in the whirl there are plenty of colourful twitter feeds to follow—last week’s #EvidenceLive for example. Next week #Quality2015 will be a hot hashtag as around 3000 or so delegates will gather at this year’s International Forum on Quality and Safety in Healthcare at London ExCel. Among the throng will be a small but doughty team of patients and carers, for this year’s conference has taken the “Patients Included” call seriously and is holding a “Big Debate” on the motion “The patient knows best.” more…

The BMJ Today: Candy Crush as pain relief, and doctors as carers and scientists

17 Apr, 15 | by BMJ

CANDY_CRUSH A news story reports on the intriguing case of a man who lost the use of his left thumb after playing the smartphone game Candy Crush all day for more than six weeks. The authors of the case report suggest that the stimulation of playing the game may explain why the man did not feel pain from his injury. Video games might, they suggest, have a potential role in pain management, and any pain reduction effect may be a reason why “some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming.” more…

Clare Gerada: Can we trust pre-election promises on the NHS?

16 Apr, 15 | by BMJ

clare_geradaOnly a few weeks to go until the most unpredictable election in years and polls show that the NHS tops the list of voters concerns. Not surprisingly, politicians, of all persuasions are committing to promises about the service—details of extra funding and what they will offer patients in future. The Conservative manifesto, for example, pledges an extra £8 billion by 2020, same day appointments with GPs for those over 75, and an NHS leading the world in fighting the scourges of cancer and dementia—what’s not to like?

But those who have been paying attention may ask why should we trust politicians who have such a poor record on the NHS? more…

Marika Davies: Medical ethics and the criminal justice system

16 Apr, 15 | by BMJ

marika_daviesIf a patient produced a machete during a consultation, reminding you of your duty of confidentiality as he calmly placed it in the sharps bin, what would you do?

Professional dilemmas such as this and many others were explored at this year’s BMA forensic medicine conference on medical ethics and the criminal justice system. Aimed at medical professionals working in environments such as prisons, detention centres, police custody suites, forensic psychiatry units, and sexual assault referral centres, the conference provided a fascinating insight into the world of forensic medicine and the ethical challenges it presents. more…

The BMJ Today: Promises, promises

16 Apr, 15 | by BMJ

election• It’s political parties’ manifestoes week, and The BMJ‘s reporter Gareth Iacobucci has summarised the promises made on the NHS, health, and social care of those that have been published, and outlined the public pledges made by the parties yet to officially announce their plans. There is much to take in, and useful headings allow for easy comparisons across the political spectrum. more…

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