Ara Darzi’s Independent Investigation of the NHS in England does two main things.1 Firstly, it tells attentive health experts nothing they didn’t already know about the dreadful present state of the English NHS. It contains no surprises. Secondly, it’s very much about allocating blame for how the English NHS got into that state. Both of these were needed. Since the end of the covid pandemic, NHS England’s leadership has shown an unfortunate tendency to downplay and understate how bad things really are. A speech by Amanda Pritchard, NHS England’s chief executive, at the NHS ConfedExpo in June demonstrated this.2 Furthermore, NHS England attempted to suggest that the service had adequate resources. This worked about as well as you’d expect: the NHS in England is currently in deficit of at least £2bn, which is expected to worsen as the current financial year continues.3 The statistics are grim, if familiar. Productivity has cratered, as last year’s Institute for Government report The NHS Productivity …
{"title":"The Darzi review distributes blame effectively","authors":"Andy Cowper","doi":"10.1136/bmj.q2040","DOIUrl":"https://doi.org/10.1136/bmj.q2040","url":null,"abstract":"Ara Darzi’s Independent Investigation of the NHS in England does two main things.1 Firstly, it tells attentive health experts nothing they didn’t already know about the dreadful present state of the English NHS. It contains no surprises. Secondly, it’s very much about allocating blame for how the English NHS got into that state. Both of these were needed. Since the end of the covid pandemic, NHS England’s leadership has shown an unfortunate tendency to downplay and understate how bad things really are. A speech by Amanda Pritchard, NHS England’s chief executive, at the NHS ConfedExpo in June demonstrated this.2 Furthermore, NHS England attempted to suggest that the service had adequate resources. This worked about as well as you’d expect: the NHS in England is currently in deficit of at least £2bn, which is expected to worsen as the current financial year continues.3 The statistics are grim, if familiar. Productivity has cratered, as last year’s Institute for Government report The NHS Productivity …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Junior doctors in England accept pay deal worth 22% over two years.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.q2038","DOIUrl":"https://doi.org/10.1136/bmj.q2038","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Camacho and colleagues’ study highlights the economic and health impacts of high risk non-steroidal anti-inflammatory drug (NSAID) use.1 I would like to draw attention to the effects of NSAIDs on muscle and connective tissue repair, which is pertinent to the study. NSAIDs are widely used to manage pain …
{"title":"Non-steroidal anti-inflammatory drugs may disrupt muscle and tissue repair","authors":"Edoardo Cervoni","doi":"10.1136/bmj.q2030","DOIUrl":"https://doi.org/10.1136/bmj.q2030","url":null,"abstract":"Camacho and colleagues’ study highlights the economic and health impacts of high risk non-steroidal anti-inflammatory drug (NSAID) use.1 I would like to draw attention to the effects of NSAIDs on muscle and connective tissue repair, which is pertinent to the study. NSAIDs are widely used to manage pain …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steve Goodacre, Valerie Lechene, Graham Cooper, Sarah Wilson, Jim Zhong
### What you need to know A healthy woman in her mid 50s experiences sudden, tearing pain, like a lightning bolt from her neck to her chest, radiating to her back, coming in waves, with severity fluctuating over subsequent hours. At times she is able to talk and even walk, but she feels that her consciousness level is mostly reduced, and she has difficulty breathing. She feels dizzy and nauseous. Her mother survived a type A aortic dissection, three years previously, at the age of 77. An ambulance is called and arrives 90 minutes later. A paramedic makes a tentative diagnosis of aortic dissection based on the presenting features. The woman is given oral morphine and transported to hospital, arriving 45 minutes later. In the emergency department she receives an initial diagnosis of panic attack and is managed conservatively, until reassessment some hours later triggers computed tomography angiography, which shows an aortic dissection. Acute aortic syndrome (AAS) is a life threatening condition where a tear in the thoracic aorta can lead to rupture of the aorta and death. It encompasses three conditions: acute aortic dissection; intra-mural haematoma; and penetrating ulcer,1 and is commonly classified into Stanford type A (involving the ascending aorta) and type B (sparing the …
{"title":"Acute aortic syndrome","authors":"Steve Goodacre, Valerie Lechene, Graham Cooper, Sarah Wilson, Jim Zhong","doi":"10.1136/bmj-2024-080870","DOIUrl":"https://doi.org/10.1136/bmj-2024-080870","url":null,"abstract":"### What you need to know A healthy woman in her mid 50s experiences sudden, tearing pain, like a lightning bolt from her neck to her chest, radiating to her back, coming in waves, with severity fluctuating over subsequent hours. At times she is able to talk and even walk, but she feels that her consciousness level is mostly reduced, and she has difficulty breathing. She feels dizzy and nauseous. Her mother survived a type A aortic dissection, three years previously, at the age of 77. An ambulance is called and arrives 90 minutes later. A paramedic makes a tentative diagnosis of aortic dissection based on the presenting features. The woman is given oral morphine and transported to hospital, arriving 45 minutes later. In the emergency department she receives an initial diagnosis of panic attack and is managed conservatively, until reassessment some hours later triggers computed tomography angiography, which shows an aortic dissection. Acute aortic syndrome (AAS) is a life threatening condition where a tear in the thoracic aorta can lead to rupture of the aorta and death. It encompasses three conditions: acute aortic dissection; intra-mural haematoma; and penetrating ulcer,1 and is commonly classified into Stanford type A (involving the ascending aorta) and type B (sparing the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some readers may remember Kathy. She filled my childhood Sunday afternoons as the main character in my favourite television show. She wasn’t a doctor; she wasn’t even a human. Kathy was an intelligent dolphin who helped solve local crimes like an underwater version of Lassie , in the 1960s series Flipper . But Kathy’s story had a difficult end because of the isolated, captive environment she lived and worked in. Dolphins, particularly bottlenose dolphins like Kathy, live in “fusion-fission” societies. These social structures have fluid group membership, with individuals frequently changing affiliation. Dolphins swim with one pod for a while before switching to a very different group, forming new alliances and relationships. This dynamic social structure allows them to adapt to changing environments, learn new skills, find mentors, and …
{"title":"Matt Morgan: Pods and wards—flipping through rotations","authors":"Matt Morgan","doi":"10.1136/bmj.q2022","DOIUrl":"https://doi.org/10.1136/bmj.q2022","url":null,"abstract":"Some readers may remember Kathy. She filled my childhood Sunday afternoons as the main character in my favourite television show. She wasn’t a doctor; she wasn’t even a human. Kathy was an intelligent dolphin who helped solve local crimes like an underwater version of Lassie , in the 1960s series Flipper . But Kathy’s story had a difficult end because of the isolated, captive environment she lived and worked in. Dolphins, particularly bottlenose dolphins like Kathy, live in “fusion-fission” societies. These social structures have fluid group membership, with individuals frequently changing affiliation. Dolphins swim with one pod for a while before switching to a very different group, forming new alliances and relationships. This dynamic social structure allows them to adapt to changing environments, learn new skills, find mentors, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Peer review practices are \"delaying science,\" academic claims in lawsuit against six publishers.","authors":"Clare Dyer","doi":"10.1136/bmj.q2037","DOIUrl":"https://doi.org/10.1136/bmj.q2037","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna L Parks, David S Frankel, Dae H Kim, Darae Ko, Daniel B Kramer, Melis Lydston, Margaret C Fang, Sachin J Shah
Most people with atrial fibrillation are older adults, in whom atrial fibrillation co-occurs with other chronic conditions, polypharmacy, and geriatric syndromes such as frailty. Yet most randomized controlled trials and expert guidelines use an age agnostic approach. Given the heterogeneity of aging, these data may not be universally applicable across the spectrum of older adults. This review synthesizes the available evidence and applies rigorous principles of aging science. After contextualizing the burden of comorbidities and geriatric syndromes in people with atrial fibrillation, it applies an aging focused approach to the pillars of atrial fibrillation management, describing screening for atrial fibrillation, lifestyle interventions, symptoms and complications, rate and rhythm control, coexisting heart failure, anticoagulation therapy, and left atrial appendage occlusion devices. Throughout, a framework is suggested that prioritizes patients’ goals and applies existing evidence to all older adults, whether atrial fibrillation is their sole condition, one among many, or a bystander at the end of life.
{"title":"Management of atrial fibrillation in older adults","authors":"Anna L Parks, David S Frankel, Dae H Kim, Darae Ko, Daniel B Kramer, Melis Lydston, Margaret C Fang, Sachin J Shah","doi":"10.1136/bmj-2023-076246","DOIUrl":"https://doi.org/10.1136/bmj-2023-076246","url":null,"abstract":"Most people with atrial fibrillation are older adults, in whom atrial fibrillation co-occurs with other chronic conditions, polypharmacy, and geriatric syndromes such as frailty. Yet most randomized controlled trials and expert guidelines use an age agnostic approach. Given the heterogeneity of aging, these data may not be universally applicable across the spectrum of older adults. This review synthesizes the available evidence and applies rigorous principles of aging science. After contextualizing the burden of comorbidities and geriatric syndromes in people with atrial fibrillation, it applies an aging focused approach to the pillars of atrial fibrillation management, describing screening for atrial fibrillation, lifestyle interventions, symptoms and complications, rate and rhythm control, coexisting heart failure, anticoagulation therapy, and left atrial appendage occlusion devices. Throughout, a framework is suggested that prioritizes patients’ goals and applies existing evidence to all older adults, whether atrial fibrillation is their sole condition, one among many, or a bystander at the end of life.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A recent report has set out recommendations that could prevent doctors from taking their own lives. Adele Waters speaks to doctors and families touched by suicide Sarah Jacques remembers the day she came close to killing herself. The 46 year old former GP from Battle, East Sussex, says she “just snapped” one day at work, drove to the seafront, parked her car, and got out to watch the sea. She stayed there for six hours, thinking about drowning. “I just kept wanting to walk into the sea. I wouldn’t have tried to swim,” Jacques says. “Looking back, I don’t think I was conscious in that moment of how bad I was, how strong those feelings were. I just felt completely overwhelmed.” That morning—1 August 2022—began like any other, with a 7 30 am drive to her workplace, a surgery in Heathfield where she worked as a full time partner. “I suddenly found myself crying. I’d never done that before—cried as I drove to work,” she recalls. “I got to work and had to drag myself out of the car—I didn’t want to go in. And then it got to 11 am and even though I hadn’t stopped since 8 my screen was still full. It seemed like I hadn’t made any inroads into the workload. All I could see were tasks, instant messages, more appointments being booked, and people constantly knocking on my door for other things to be done. “I managed to type ‘help’ by instant message to one of the managers. She came to the room and found me in a distressed state. One of the partners came in and suggested I work from home, so I left. But I drove past my house and to Bexhill beach instead. “It’s hard to remember what stopped me from walking …
{"title":"Doctor suicide: “All I could see were tasks mounting, appointments being booked, and people constantly knocking on my door”","authors":"Adele Waters","doi":"10.1136/bmj.q1879","DOIUrl":"https://doi.org/10.1136/bmj.q1879","url":null,"abstract":"A recent report has set out recommendations that could prevent doctors from taking their own lives. Adele Waters speaks to doctors and families touched by suicide Sarah Jacques remembers the day she came close to killing herself. The 46 year old former GP from Battle, East Sussex, says she “just snapped” one day at work, drove to the seafront, parked her car, and got out to watch the sea. She stayed there for six hours, thinking about drowning. “I just kept wanting to walk into the sea. I wouldn’t have tried to swim,” Jacques says. “Looking back, I don’t think I was conscious in that moment of how bad I was, how strong those feelings were. I just felt completely overwhelmed.” That morning—1 August 2022—began like any other, with a 7 30 am drive to her workplace, a surgery in Heathfield where she worked as a full time partner. “I suddenly found myself crying. I’d never done that before—cried as I drove to work,” she recalls. “I got to work and had to drag myself out of the car—I didn’t want to go in. And then it got to 11 am and even though I hadn’t stopped since 8 my screen was still full. It seemed like I hadn’t made any inroads into the workload. All I could see were tasks, instant messages, more appointments being booked, and people constantly knocking on my door for other things to be done. “I managed to type ‘help’ by instant message to one of the managers. She came to the room and found me in a distressed state. One of the partners came in and suggested I work from home, so I left. But I drove past my house and to Bexhill beach instead. “It’s hard to remember what stopped me from walking …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What would a more productive general practice look like? Of course, it’s hard to measure productivity when your job is mostly about preventing things from happening. If you’re a surgeon, you can count the number of operations completed (although variations in complexity will mean that a simple number isn’t an accurate reflection of the work done)—but if most of your role is to keep people well and out of hospital, it’s harder to show that you’re doing a good job. The stroke that didn’t happen because blood pressure was successfully controlled, or the mental health crisis averted by timely intervention, remains invisible and …
{"title":"Helen Salisbury: Getting the best out of general practice","authors":"Helen Salisbury","doi":"10.1136/bmj.q2020","DOIUrl":"https://doi.org/10.1136/bmj.q2020","url":null,"abstract":"What would a more productive general practice look like? Of course, it’s hard to measure productivity when your job is mostly about preventing things from happening. If you’re a surgeon, you can count the number of operations completed (although variations in complexity will mean that a simple number isn’t an accurate reflection of the work done)—but if most of your role is to keep people well and out of hospital, it’s harder to show that you’re doing a good job. The stroke that didn’t happen because blood pressure was successfully controlled, or the mental health crisis averted by timely intervention, remains invisible and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The celebration of extreme study habits encourages an unhealthy attitude to learning and success, writes Diana Dovgy The term “academic weapon” went viral around two years ago, when a video on TikTok showed a university student sitting in the front row of a 700 person lecture.1 He shared that the key to acing the semester was to become an “absolute academic weapon,” which in his eyes meant approaching university with an extremely self-assured attitude and dominating the front row in lectures. Many viewers found the student’s attitude and advice humorous, which led to other users sampling the audio to create their own study hacks—both helpful and unserious. The term academic weapon originally emerged in the 2010s2 to mean a student who acquires traits seen by many as scholarly.3 Some students use TikTok to cast an ironic lens on this idea, but other “academic weapons” have garnered attention for their extreme depictions of scholarly dedication. …
{"title":"Medical students face enough pressures—the “academic weapon” trend doesn’t help","authors":"Diana Dovgy","doi":"10.1136/bmj.q2027","DOIUrl":"https://doi.org/10.1136/bmj.q2027","url":null,"abstract":"The celebration of extreme study habits encourages an unhealthy attitude to learning and success, writes Diana Dovgy The term “academic weapon” went viral around two years ago, when a video on TikTok showed a university student sitting in the front row of a 700 person lecture.1 He shared that the key to acing the semester was to become an “absolute academic weapon,” which in his eyes meant approaching university with an extremely self-assured attitude and dominating the front row in lectures. Many viewers found the student’s attitude and advice humorous, which led to other users sampling the audio to create their own study hacks—both helpful and unserious. The term academic weapon originally emerged in the 2010s2 to mean a student who acquires traits seen by many as scholarly.3 Some students use TikTok to cast an ironic lens on this idea, but other “academic weapons” have garnered attention for their extreme depictions of scholarly dedication. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：