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Ottawa 2016 and ANZAHPE Conference

31 Mar, 16 | by Hemali Bedi

By Manasi Jiwrajka

The beautiful city of Perth on the Western Coast of Australia hosted the Ottawa 2016 and ANZAHPE conference this year. Delegates from the US, Canada, the UK, Netherlands, Indonesia, Hong Kong, China, South Africa, Australia and many other countries attended this conference. I downloaded the mobile app for this conference prior to my flight from Brisbane to Perth, and got a minute by minute update on the conferedited_IMG_20160322_144637ence.

There were several important medical education themes addressed during this conference from simulation in the context of medical education, OSCEs, peer tutoring, medical scientist, rural health program, global health, and empathy. My poster was titled ‘Why Should Students Write a Global Health Case Report?’, and I presented it to an eclectic audience that thanked me for my enthusiasm! Several educators approached me after the presentation for more information regarding their students writing case reports for the BMJ, and I reminded them of the elective competition that is due on April 30th.

Some of my favourite parts of the conference included (i) a talk on cultural competency, and including patients culture to provide individualised healthcare, (ii) the concept of ‘phenomics’, suggesting that a patient’s environment can affect their health prognosis, (iii) all the focus on feedback for students, (iv) how empathy levels can be altered following a reflection exercise, and is dependent on coping styles, (v) and acquiring loads of free pens!

I am looking forward to the next ANZAHPE conference in Adelaide next year.

Behaviour change: A bitter pill to swallow

29 Mar, 16 | by Hemali Bedi

By Kristian Dye

The case reported by Dunton et al comes from a very particular cultural context, and yet it demonstrates things that all practitioners see in almost all healthcare settings.

The patient reported is a 60 year old man with type 2 diabetes, who despite taking his medications, is unable to make the diabetes-592006_1920behaviour change that could impact the course of his disease.

The report looks at the complex nature of this phenomenon, that it is not as simplistic as ‘not wanting to change’, but that there are cultural and sociological issues at play.

The real question for clinicians across the globe for many long-term conditions is no longer how to treat them, but how to support patients to manage their own conditions.

What skills are most important for clinicians to facilitate the self-care that long-term conditions rely upon?

World Tuberculosis Day 2016

24 Mar, 16 | by Hemali Bedi

By Hemali Bedi

Tuberculosis (TB) is one of the world’s top global health challenges. [1] It is both ptb-poster-largereventable and curable, yet in 2014, 9.6 million people contracted TB and 1.5 million died from the disease. [1] Currently, over 95% of cases and deaths occur in developing countries. [2]

March 24th marks World TB Day, which aims to increase awareness of the global burden of TB and call for political and social support to tackle the disease. [3] Co-ordinated by the World Health Organization (WHO), this day commemorates Dr Robert Koch’s discovery of the TB bacillus bacteria in 1882. [3] This year, the campaigns focus is “Unite to End TB”. [4]

WHO recognise that tackling this complex disease requires a multifactorial approach – societal, social, economic and medical factors all need to be addressed. [1] This is outlined in WHO’s 2015 Global Tuberculosis Report, which takes an in depth look at the global strategy needed to combat the epidemic.

World TB Day calls for progress in these areas and highlights the need for collaboration across sectors and disciplines to address the medical and social causes of ill health. [4]

If you would like to know more about TB, visit BMJ Case Report’s collection of TB related cases or see our Global Health Collection.

References

[1] 2015 Global Tuberculosis Report. The World Health Organization. http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1 , published 2015

[2] Tuberculosis. The World Health Organization. http://www.who.int/mediacentre/factsheets/fs104/en/, published October 2015

[3] World TB Day. Stop TB Partnership. http://www.stoptb.org/events/world_tb_day/, accessed 21 March 2016

[4] World TB Day 2016: Unite to End TB. The World Health Organization. http://www.who.int/campaigns
/tb-day/2016/en/
, accessed 18 March 2016

An unfortunate injection

7 Mar, 16 | by Hemali Bedi

By Bhavik Shah

Foot drop” due to injured sciatic nerve because of a faulty technique of intramuscular injection is prevalent in developing countries. Some important Global Health issues related to this problem are discussed here.nurse-527622_1280

Indiscriminate use of injections

Oral medications are easier to administer and are equally effective in treating many conditions without causing pain or compromising skin barrier, yet the use of intramuscular injections has increased dramatically in the developing world. Some established facts leading to injection overuse include prescriber misconceptions regarding “strength” of injections, rapid onset of action and desire to meet patient expectations. [1] Such indiscriminate use of injections needs to stop.

Limited training in proper injection technique                 

The most common scenario for sciatic nerve injection injury occurs when the site of needle insertion is located more medial and/or inferior to the recommended site on the upper and outer quadrant of the buttock. [2] As such injuries are easily preventable, proper training to develop an anatomical understanding of the sciatic nerve is essential.

Inequality in access to quality healthcare    

Inadequate access to appropriate healthcare in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). [3] Access to quality healthcare requires improvement in physical infrastructure, appropriate training for rural providers, and assistance to patients accessing care.

References:

  1. Comparison of pharmacokinetics and efficacy of oral and injectable medicine. (2015). [online] Available at: http://www.who.int/occupational_health/activities/5injvsora.pdf [Accessed 3 Sep. 2015].
  2. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. J Neurosurg. 1998 Jul; 89(1):13–23.
  3. Haddad S, Narayana D, Mohindra K. Reducing inequalities in health and access to health care in a rural Indian community: An India-Canada collaborative action research project. BMC Int Health Hum Rights. 2011; 11 Suppl 2: S3.

Rare Disease Day

29 Feb, 16 | by Hemali Bedi

By Hemali Bedi

Rare diseases affect one in 2000 people or less; [1] but, rare diseases are more than just a rdd-logo-smallmedical challenge. Together, they present a public health problem that affects approximately 400 million people worldwide. [1]

February 29th marks the ninth annual Rare Disease Day, which is co-ordinated by EURORDIS. [2] With the aim of raising awareness for rare diseases, this day is celebrated by health care professionals, researchers, patients, carers and policy makers in over 80 countries across the world. [2]

People all over the world are affected by rare diseases, which make them an important global health issue. [1] The causes of most rare diseases remain unknown. [1] The challenges of living with a rare disease often include a lack of medical knowledge about the condition, delayed diagnosis and inequitable access to health care. [1] Some of these factors are listed in a recent Global Health case report by Sundram et al, which focuses on a rare congenital disorder known as Cloacal dysgenesis sequence.

At BMJ Case Reports, we are interested in Global Health case reports that focus on all the causes of ill health and access to healthcare services, whether economic, social or political – global health issues as they impact on individual patient’s lives.

With this in mind, what else can be done to raise awareness of rare diseases and promote them as an international public health priority?

References

[1] The World Health Organization. Priority Medicines for Europe and the World “A Public Health Approach to Innovation” Update on 2004 Background Paper. www.who.int/medicines/areas/priority_medicines/BP6_19Rare.pdf

[2] What is Rare Disease Day? Rare Disease UK. www.rarediseaseday.org/article/what-is-rare-disease-day, accessed 22 February 2016

Steps to success

3 Feb, 16 | by Hemali Bedi

By Kristian Dye

Frates and Crane report a case that is a little unusual among case reports. The patient had no weird or wonderful signs or symptoms. She had no particular pathology. She was not unwell. Her presentation was all about lifestyle, risk, and the case is all about modification of that risk. walking-711789_1920

The patient in this case is an archetype for many patients seen in primary care. She is overweight, has elevated lipids, has a sedentary lifestyle and has a family history of stroke.

For me, this only really poses two questions:

1. What was different in this case to those who we can convince of the value of risk modification, but who are unable to achieve it?
2. How can we achieve these kinds of results for more of our patients?

Answering these questions could reduce morbidity and premature mortality among our populations much more radically than more glamourous, cutting-edge interventions.

 

How to write a global health case report

22 Jan, 16 | by Hemali Bedi

By Hemali Bedi

Have you come across an interesting case in your medical training so far? Whether you have a patient in mind, are browsing through our online collection, or joining our blog, we’re here to help you submit your own global health case reports. Seema Biswas, Editor in Chief of BMJ Case Reports, guides you through the writing process in a new article featured in The Student BMJ.

Seema Biswas comments, “To make a difference in thstudent-849822_1280e lives of patients we must look at the causes of disease, which are often intrinsically related to the environment individual patients and the wider community live in. The field of global health considers the social, cultural, economic, and political determinants of health of patients with the aim of raising awareness of these causes to achieve equity in health for all people worldwide.”

Key messages in this guidance

  • Always get written consent from your patient before you put pen
    to paper. Not only is this good medical practice, it’s also mandatory if you want to submit to a journal such as BMJ Case Reports.
  • Structure your article logically. BMJ Case Reports has a global health template which you can follow.
  • Don’t forget to ask for the patient’s perspective – they may, or may not want to contribute to your article, but they should have the chance to do so.
  • Remember, global health case reports don’t have to come from abroad. Cases from your part of the world are just as worthy. We should be thinking about the social determinants of health of all our patients, wherever we happen to be working.
  • Visit the BMJ Case Reports website for examples of previously published global health case reports and look at the annotated example.

Read the full article here, join our global health blog and get writing! We look forward to receiving many interesting global health case reports!

The Student Elective Competition – have you entered yet?

31 Dec, 15 | by Hemali Bedi

By Hemali Bedi

Travelling far afield for your elective? If so, we want to hear all about it. Write up your experiences into a Global Health case report and not only could you be the lucky winner of a £500 travel bursary, your article could also be included in the 2016 special edition print journal.

We’ve put together a quick guide to tell you everything you need to person with suitcaseknow.

What is a Global Health case report?

Global Health case reports should focus on:

  • the causes of disease
  • the social determinants of health
  • access to healthcare services
  • how Global Health issues affect individual lives

Global Health case reports require a comprehensive review of the relevant literature. This includes related publications published by governments and global organisations, not simply the medical literature. For more information, see our website.

What could I win?

  • A £500 travel bursary to help you attend a medical conference or event related to Global Health.
  • Your article will be published in our 2016 special edition print journal along with three runners-up.

How do I get started?

Before you begin, why not have a browse of our existing Global Health case reports collection? Be sure to check out our Instructions for Authors for guidance on patient consent, the submission process, and formatting issues such as the use of images. If you’ve never written a Global Health case report before, you may find our template useful to help get you writing.

The deadline for entries is 30th April 2016. For more information, visit our competition website or get in touch!

Palliative care conundrums in an Ebola treatment centre

21 Dec, 15 | by Hemali Bedi

By Kristian Dye

Dhillon et al. present a case discussing the care of a patient with Ebola, which demonstrates in a micromedical-563427_1280cosm some of the biggest issues facing healthcare providers in patients with palliative or terminal care needs – albeit in a particular extreme care environment.

In the case, the patient is declared palliative and restarted on active management, before being considered palliative once again and passing away.

These are issues which perplex physicians in all care settings.

  1. When do we consider a patient for palliative
    care only?
  2. How can we reconcile differing beliefs and values within the team to deliver the best care for patients?

Deciding a patient is palliative

This is an issue that continues to vex physicians the world over. Cardona-Morrell and Hillman identify no less than 18 different scales and assessment tools available to attempt to guide these decisions, none of which are perfect.

Rightly, much of this effort is focused on identifying those within the population who are entering the end of life, and for whom discussions and decisions surrounding palliative care can help them to avoid invasive and unpleasant interventions – in the UK the Gold Standard Framework is the current tool used in community settings.

The difficulty with many of these tools is that they are not well-suited to the kind of case presented here. The ‘normally fit but acutely unwell’ patient presents a real problem for prognostication – where patients in similar situations receive the same care, some will still die, others stage recoveries that would make Lazarus jealous. In these situations, how can we make clinical judgement without losing the patient in the interest of treating clinical indicators?

Team-based approaches in palliative care

Palliative care is one of the areas of medical practice where personal values can have the biggest impact on the judgements physicians make. We all bring with us a multiple of baggage – emotional, cultural and religious – that colour our views.

A helpful summary of religious views on palliative care, by Steinberg, demonstrates the breadth of both agreement and disagreement between major religions on this topic.

Alongside this, our practice has to be informed by the ethical principles underpinning medical care. Respect for autonomy, the duty to act in the patient’s best interest and the duty not to harm our patients are all critical to decisions around palliation of the dying patient – and all are open to interpretation by the practitioner.

What approaches can we take to ensure that judgement are taken by consensus, objectively, and within the context of the individual patient?

Introducing BMJ Case Reports 10,000 cases special edition booklet

14 Dec, 15 | by Hemali Bedi

By Hemali Bedi

We are pleased to announce that BMJ Case Reports has published over 10,000 online cases. And what better way to celebrate this massive milestone than by sharing our second print edition – the 10,000 cases special edition booklet.

Seema Biswas, Editor in Chief of BMJ Case Reports, comments, “As we enter this new phase, we want to highlight Global Health: improvement in health and access to healthcare for all; and to make sure that all our case reports, clinical or Global Health, include the patient’s perspective.”

Our aim is to publish cases with valuable clinical lessons, with the advantage being that we learn from real cases. We hope that this special collection of case reports will serve as a useful educational resource that supports both learning and teaching. Why not have a look and let us know what you think? We’d love to hear your feedback.

We would like to thank all of our authors and contributors, and we look forward to welcoming many more cases in the days to come.

BMJ Case Reports: publishing, sharing and learning through experience

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