{"id":36326,"date":"2016-03-14T16:45:56","date_gmt":"2016-03-14T15:45:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=36326"},"modified":"2016-03-14T16:45:56","modified_gmt":"2016-03-14T15:45:56","slug":"jane-feinmann-addressing-malnutrition","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/","title":{"rendered":"Jane Feinmann: Addressing malnutrition"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-31668\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg\" alt=\"jane_feinmann\" width=\"128\" height=\"128\" \/><\/a>Doctors have faced up to the challenge of treating obesity. Is it now time to address that other major weight disorder\u2014malnutrition? Less common in the general population than obesity, malnutrition is an ever-present health risk for older people\u2014with one in ten over 65s either already suffering or at risk of becoming under-nourished, <a href=\"http:\/\/www.bapen.org.uk\/information-and-resources\/publications-and-resources\/bapen-reports\/cost-of-malnutrition-in-england\">according to a new report by BAPEN<\/a>\u00a0(the British Association of Parenteral and Enteral Nutrition). <!--more--><\/p>\n<p>Malnutrition affects around one million older people in the UK\u2014typically the result of a loss of appetite alongside an increase in mobility problems, mental or physical disability, and isolation. Essentially a process of slow starvation, malnutrition leads to low energy and mood, increased susceptibility to infections, loss of muscle mass increasing the risk of falls, and reduced mobility as well as loss of subcutaneous fat leading to pressure sores and delayed wound healing, thereby significantly extending hospital stays. It\u2019s also linked to mild cognitive impairment. As such malnutrition, &#8220;accounts for 30 per cent of hospital admissions, 35 per cent of care home admissions, 15 per cent of outpatient clinic attendances, and 10 per cent of those presenting at their GP&#8221;, BAPEN reports. The costs are huge: \u00a319 billion in health and social care every year.<\/p>\n<p>Yet it remains &#8220;under-detected and under-treated,&#8221; according to the report\u2019s author, Professor Marinos Elia of the Malnutrition Action Group of BAPEN and Professor of Clinical Nutrition &amp; Metabolism at the National Institute for Health Research Southampton Biomedical Research Centre. &#8220;We spend extremely large amounts on this problem, which could be readily helped by doing simple things well,&#8221; he said at the launch of the report in London in December 2015.<\/p>\n<p>A key step forward is greater awareness and increased diagnosis of the problem\u2014<a href=\"http:\/\/www.bapen.org.uk\/pdfs\/must\/must_full.pdf\">with professionals<\/a>, and <a href=\"http:\/\/www.malnutritionselfscreening.org\/\">more recently the general public<\/a>, able to access a\u00a0screening tool called MUST (Malnutrition Universal Screening Tool). The Malnutrition Task Force\u2019s pilot scheme at Salford Royal NHS Foundation has also developed a <a href=\"http:\/\/www.malnutritiontaskforce.org.uk\/salfords-armband-tackling-malnutrition-with-paper\/\">Paperweight Armband<\/a>, claimed to be &#8220;a non-intrusive, non-medical intervention solution that health care providers and the voluntary sector would be able to implement quickly and easily into their practice.&#8221; But what then? Research by the Malnutrition Task Force in February 2016 [1] showed that only 51 per cent of health professionals thought malnutrition was a priority in their organisations and 47 per cent &#8220;felt confident that their knowledge and skills were sufficient to help people most at risk.&#8221;<\/p>\n<p>Yet clinicians shouldn\u2019t assume that tackling malnutrition in older people is beyond their scope. For a start, screening for under-nutrition on admission to hospital should be universal, according to Andy Jones, immediate past chair of the Hospital Caterers Association and <a href=\"http:\/\/nutritionandhydrationweek.co.uk\">a co-organiser of Nutrition and Hydration Week<\/a>.\u00a0And once identified, the disorder should be documented in discharge summaries and referral letters. It\u2019s not good enough, Elia points out that when spotted in hospital, for instance, \u2018patients are not then given a care plan that will carry over from hospital to GP surgery.\u2019<\/p>\n<p>Once identified, &#8220;food and drink must become an integral part of the recovery plan,&#8221; argues Andy Jones. He says hospitals should have a &#8220;mealtimes matters&#8221; policy, with no wards rounds to be done when patients are eating\u2014and &#8220;doctors encouraged to be on the wards and get involved if they can in assisting people to eat.&#8221; This focus on mealtimes is an essential part of the evidence-based &#8220;Namaste&#8221; programme [2] for people with dementia, developed by St Christopher\u2019s Hospice and the South London and Maudsley Foundation Hospital and already implemented in care homes in South London.<\/p>\n<p>As to the best source of nutrients for frail older people, prescription fortified shakes and other foods have a part\u00a0to play particularly in providing protein. But, says Andy Jones, doctors could also encourage consumption of real food. &#8220;Currently it\u2019s too easy for a doctor to prescribe a fortified shake when a scone with cream would be eaten and probably better received,&#8221; he says. What is also working in a number of trusts, he says, are &#8220;24\/48 discharge packs&#8221; handed to patients who are deemed at risk and &#8220;which contain essentials like \u00bd pt milk, small loaf. Coffee\/tea, soup, dinners, cheese, jam all of which gives the person food to eat when they get home and allows social care processes to \u2018kick in\u2019 again.&#8221; And once GPs are able and willing to identify frail older people at risk of, or already suffering from malnutrition, they can then be helped by voluntary schemes led by dietitians\u2014such as Age UK\u2019s Staffordshire Make Every Mouthful Matter Care Pathway, developed and introduced by the <a href=\"http:\/\/www.ageuk.org.uk\/southstaffs\/our-services\/eat-well-staffordshire\/\">Stoke on Trent and Staffordshire Partnership<\/a>.<\/p>\n<p>Such schemes don\u2019t rely on doctors feeding malnourished patients. But it makes a huge difference when doctors identify frail older people at risk of malnutrition and make systems work to support those who can help them. &#8220;The key for doctors is to recognise that malnutrition co-exists with obesity\u2014and it\u2019s just as important to treat it,&#8221; says Dr Simon Gabe, chair of BAPEN. &#8220;That will make a huge difference.&#8221;<\/p>\n<p><em><strong>Jane Feinmann<\/strong> is a freelance medical journalist \u00a0with a particular interest in patient safety based in London. She belongs to\u00a0<a href=\"http:\/\/imperialcollegehealthpartners.com\/working-with-patients-and-the-public\/\">Imperial College Health Partners\u2019 Patient Safety Champion Network<\/a>.<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: The author has no competing interests to declare.<\/em><\/p>\n<p><strong>References:\u00a0<\/strong><\/p>\n<p>[1] Online survey of health and care professionals conducted by Dods Research, sample size 1518, fieldwork conducted between 9th and 18th December 2015<\/p>\n<p>[2] Stacpoole M, Hockley J, Thompsell A, Simard J, Volicer L. (2014) The Namaste Care programme can reduce behavioural symptoms in care home residents with advanced dementia. Int J Geriatr Psychiatry.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Doctors have faced up to the challenge of treating obesity. Is it now time to address that other major weight disorder\u2014malnutrition? Less common in the general population than obesity, malnutrition [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-36326","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jane Feinmann: Addressing malnutrition - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jane Feinmann: Addressing malnutrition - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Doctors have faced up to the challenge of treating obesity. Is it now time to address that other major weight disorder\u2014malnutrition? Less common in the general population than obesity, malnutrition [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-03-14T15:45:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Jane Feinmann: Addressing malnutrition\",\"datePublished\":\"2016-03-14T15:45:56+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/\"},\"wordCount\":925,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/05\\\/jane_feinmann.jpg\",\"articleSection\":[\"Guest writers\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/\",\"name\":\"Jane Feinmann: Addressing malnutrition - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/05\\\/jane_feinmann.jpg\",\"datePublished\":\"2016-03-14T15:45:56+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/05\\\/jane_feinmann.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/05\\\/jane_feinmann.jpg\",\"width\":100,\"height\":100},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/03\\\/14\\\/jane-feinmann-addressing-malnutrition\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Jane Feinmann: Addressing malnutrition\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Jane Feinmann: Addressing malnutrition - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/","og_locale":"en_US","og_type":"article","og_title":"Jane Feinmann: Addressing malnutrition - The BMJ","og_description":"Doctors have faced up to the challenge of treating obesity. Is it now time to address that other major weight disorder\u2014malnutrition? Less common in the general population than obesity, malnutrition [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2016-03-14T15:45:56+00:00","og_image":[{"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg","type":"","width":"","height":""}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Jane Feinmann: Addressing malnutrition","datePublished":"2016-03-14T15:45:56+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/"},"wordCount":925,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg","articleSection":["Guest writers"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/","url":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/","name":"Jane Feinmann: Addressing malnutrition - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg","datePublished":"2016-03-14T15:45:56+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/05\/jane_feinmann.jpg","width":100,"height":100},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/14\/jane-feinmann-addressing-malnutrition\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Jane Feinmann: Addressing malnutrition"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/36326","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=36326"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/36326\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=36326"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=36326"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=36326"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}