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Richard Smith: Why does prevention always come behind treatment of disease?

15 Jul, 16 | by BMJ

richard_smith_2014Why does prevention always come behind treatment of disease? Derek Yach, the chief health officer of Vitality, put this question to many people, and these are the answers he got from Don Berwick, formerly head of the Centers for Medicare and Medicaid Services and president of the Institute for Healthcare Improvement and a familiar figure around the NHS: prevention, answered Berwick, in contrast to healthcare lacks “a corporate voice”; and the science behind prevention is undeveloped.

The “corporate voice” of healthcare comes from hospitals, pharmaceutical and medical device companies, health insurers, health worker unions, and doctors and more…

Fiona Godlee: My biggest career failure

15 Jul, 16 | by BMJ

fi_blogLike most of us, I have known failure. I tried to get into Cambridge to do preclinical medicine from sixth form—twice: once in my fourth term and again in my seventh. Both attempts were unsuccessful. Instead I went to University College London and got to know London (my favourite city), and had the added benefit of studying history of medicine at the Wellcome Institute. But I did subsequently get to Cambridge for the fourth and fifth years of medical school and I live there now. more…

Neville Goodman’s Metaphor Watch: No, we aren’t nearly there

15 Jul, 16 | by BMJ

neville_goodman

It must be one of the most annoying and predictable child behaviours. Perhaps even more predictable than asking if orange juice has got bits in. Any journey of any length will be punctuated by the repeated question, “Are we nearly there?” Put “children car journeys nearly there” into Google and you’ll get lots of advice. It’s a really tedious question, to which the answer is always, “Be patient!”, so why (as a former colleague complained to me) do editorialists feel so keen to ask it? Children are asking a literal question, the “there” being grandma’s, the zoo, or the seaside. In medicine the question is metaphorical; the destination is not a place but a result: a better diagnosis or a better treatment. more…

Jeffrey Aronson: When I use a word . . . Re: “-er” or “-re”

15 Jul, 16 | by BMJ

jeffrey_aronsonAnglo-Saxon spelling was consistent, but when Old English and French collided after the Norman conquest of England in 1066, inconsistencies in English spelling arose that lasted until the printing press and dictionaries gradually forced greater regularity, if not always rationality. Samuel Johnson, in his influential dictionary of 1755, preferred the etymologically incorrect variant -our for many words that ended -or in the original Latin. Both forms (and others, such as -oure, -eur, -ore, and -owre) had been used in English before. In some cases his spelling has survived (colour, honour), in others it hasn’t (errour, inferiour).

But when the American lexicographer Noah Webster—whose first dictionary, A Compendious Dictionary of the English Language, appeared in 1806—embarked on a mission to remove superfluous letters from words, he removed the u from words ending in -our (color, honor), restoring the etymologically correct Latin forms. more…

Oliver Minton: Cancer survivorship—where to next

14 Jul, 16 | by BMJ

ollie_mintonI was invited to attend the inaugural cancer survivorship conference in Brussels—at the time our interests aligned (and indeed still do). The conference felt different with patient groups, bankers, actuaries and even royalty alongside all the usual suspects. I left feeling hugely positive about what could be achieved with governmental and organisational backing. However this was in 2014 and as we all realise the world is now a different place.

The cancer strategic direction has turned more to personalised medicine and potentially a focus on immuno-oncology. Blockbuster drugs and science will always make good headlines, but for many patients are diagnosed, treated, and cured of their disease and have to live with the sequelae of treatment. This goes beyond follow up appointments and blood tests, fear of recurrence, and into resuming normal life with work, family etc. more…

Lara Fairall: Serendipity and scaling up towards universal primary care

14 Jul, 16 | by BMJ

lara_fairallA Brazilian adaptation of our PACK training programme for primary care doctors and nurses went live last week in the Southern city of Florianὸpolis, or Floripa as it is known to locals, amid great excitement including a clip on local television. We’ve spent 15 years in South Africa developing, researching, and fine tuning our programme. PACK, or the Practical Approach to Care Kit, combines a clinical decision support guide with onsite, interactive, team-based training sessions to familiarise health workers with its content and support scalable implementation. It covers an approach to the most commonly seen symptoms and conditions amongst adults attending primary care services, integrating content on communicable diseases, NCDs, mental disorders and women’s health. We’ve demonstrated positive impacts on quality of care in a series of pragmatic trials mainly in the area of communicable diseases. The programme has been scaled up in South Africa reaching more than 20 000 nurses and doctors across more than 2000 clinics. Last year we partnered with the BMJ’s Evidence Centre to keep the guide up to date with the latest evidence, and to respond to the many requests we’ve had to adapt and implement the programme in other countries. You can read more about our journey over the past 15 years in an article published last year. more…

Suzanne Gordon: Encouraging all members of a medical team to speak up

12 Jul, 16 | by BMJ

suzanne_gordon

The oval, mahogany table dominates the center of the large conference room. A number of chairs circle the table and dot the perimeter of the room. Every week, a group of high level hospital administrators, physician leaders, and leaders of other professional and occupational disciplines—physical therapy, social work, clinical directors of nursing, housekeeping, etc—gather in this room to discuss hospital function. They call themselves a “team” and the gathering a “team meeting.” more…

Richard Smith: Another step towards the post-journal world

12 Jul, 16 | by BMJ

richard_smith_2014Recently I asked a leader of a major research funder what proportion of its grants led to a publication. “I’ve no idea,” he answered, “but it’s probably 20-30%. What bothers me the most is that it’s the positive stuff that gets published. You do an experiment day after day until it ‘works.’ You then publish what ‘works’ and not what doesn’t ‘work.’”

I was surprised that he wouldn’t know what proportion of grants led to a publication, that the proportion he guessed was so low, and that he knew there was a clear bias in what was published. Do research funders, especially those spending public money, not have an obligation to insist that all their grants result in some sort of publication (even if it’s simply an explanation of complete failure) and to avoid bias in what is published? more…

Tessa Richards: N-of-1 research

12 Jul, 16 | by BMJ

Tessa_richardsWimbledon is over (well done Andy Murray), but London still has a wealth of other treats to offer. A trip to the Science Museum, for example, where the Beyond the Lab exhibition is well worth a visit. It showcases nine “citizen science innovators,” selected to illustrate how people working alone in their own homes, can devise new technologies, crowdsource data, and add to the global health research enterprise. The EU funded exhibition, co-ordinated by the European Network of Science Centres and Museums (Ecsite), has opened simultaneously in Bonn, Warsaw, and Slovenia, and will tour Europe’s science centres. Two of the innovators whose work is described are members of the BMJ‘s patient advisory panel. more…

Andy Haines: Why health partnerships are good for global health

11 Jul, 16 | by BMJ

andy_hainesGlobal health is in a state of constant flux. Trends are perpetually changing and evolving, and new challenges arise on an almost weekly basis. The great gains seen in the fight against many infectious diseases are accompanied by increases in mental ill health, and non-communicable diseases such as diabetes, heart disease, stroke and cancer in many low and middle income countries. These trends are the result of several factors including increasingly obesogenic environments and diets based largely on processed foods high in sugar and saturated fat. These evolving challenges require integrated solutions that address both the underlying determinants of health as well as the need for universal health coverage with affordable and effective healthcare. more…

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