Medics who are d/Deaf and hard of hearing are an essential part of the NHS workforce, yet more needs to be done to ensure that their needs are met, writes George Webster The year before I started my medical degree, I began wearing hearing aids. I’d never wanted to wear hearing aids, but was having continual communication challenges. Feeling excited to embark on my medical training, I wanted to make the most of all of the learning opportunities without barriers. I believed that wearing hearing aids would enable me to do this, while also acting as a visual cue to others that I am hard of hearing. Despite my initial reluctance, I found that hearing aids had a marked positive impact on my social and personal life. I gained confidence and felt like I was finally enjoying the things I had been excluded from in the past. Once I started medical school, however, I encountered some unexpected challenges, especially when I began my clinical placements. Hearing what doctors are saying when they’re delivering teaching on busy ward rounds can be impossible; lecturers rarely provide captions; and I have received comments such as “but you don’t look deaf.” One particularly disappointing …
{"title":"d/Deaf students: feeling heard in medical school","authors":"George Webster","doi":"10.1136/bmj.q2595","DOIUrl":"https://doi.org/10.1136/bmj.q2595","url":null,"abstract":"Medics who are d/Deaf and hard of hearing are an essential part of the NHS workforce, yet more needs to be done to ensure that their needs are met, writes George Webster The year before I started my medical degree, I began wearing hearing aids. I’d never wanted to wear hearing aids, but was having continual communication challenges. Feeling excited to embark on my medical training, I wanted to make the most of all of the learning opportunities without barriers. I believed that wearing hearing aids would enable me to do this, while also acting as a visual cue to others that I am hard of hearing. Despite my initial reluctance, I found that hearing aids had a marked positive impact on my social and personal life. I gained confidence and felt like I was finally enjoying the things I had been excluded from in the past. Once I started medical school, however, I encountered some unexpected challenges, especially when I began my clinical placements. Hearing what doctors are saying when they’re delivering teaching on busy ward rounds can be impossible; lecturers rarely provide captions; and I have received comments such as “but you don’t look deaf.” One particularly disappointing …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678265","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}
Psoriatic arthritis is an inflammatory arthritis that affects around 30% of patients with psoriasis. The disease spectrum includes peripheral arthritis, enthesitis, tenosynovitis, dactylitis, axial involvement, and skin and nail psoriasis in most patients. In addition to the cutaneous and musculoskeletal manifestations, several comorbidities can complicate the disease course, including cardiovascular disease, diabetes mellitus, metabolic syndrome, gout, anxiety, and depression. The management of patients with psoriatic arthritis begins with a careful assessment of the skin and joints and screening for comorbidities. This review describes the assessment tools and outcome measures used in the evaluation of patients with psoriatic arthritis. It summarizes the approach to therapy, including non-medicinal interventions such as education, lifestyle changes, physiotherapy, and occupational therapy. It discusses the evidence on pharmacologic treatments, including drugs used for symptomatic relief such as non-steroidal anti-inflammatory drugs, and those used to control the disease process; this last group comprises conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), including methotrexate, leflunomide, and sulfasalazine, and biologic and targeted DMARDs, including anti-tumor necrosis factor (TNFα), anti-interleukin-17 (IL-17), anti-IL-12/23, and anti-IL-23 agents, as well as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) antagonists. Although these drugs are usually tailored to the clinical profile of the patient, biomarkers predictive of response to therapy are needed so that a more personalized approach can be followed.
{"title":"Advances in the management of psoriatic arthritis in adults","authors":"Fadi Kharouf, Dafna D Gladman","doi":"10.1136/bmj-2024-081860","DOIUrl":"https://doi.org/10.1136/bmj-2024-081860","url":null,"abstract":"Psoriatic arthritis is an inflammatory arthritis that affects around 30% of patients with psoriasis. The disease spectrum includes peripheral arthritis, enthesitis, tenosynovitis, dactylitis, axial involvement, and skin and nail psoriasis in most patients. In addition to the cutaneous and musculoskeletal manifestations, several comorbidities can complicate the disease course, including cardiovascular disease, diabetes mellitus, metabolic syndrome, gout, anxiety, and depression. The management of patients with psoriatic arthritis begins with a careful assessment of the skin and joints and screening for comorbidities. This review describes the assessment tools and outcome measures used in the evaluation of patients with psoriatic arthritis. It summarizes the approach to therapy, including non-medicinal interventions such as education, lifestyle changes, physiotherapy, and occupational therapy. It discusses the evidence on pharmacologic treatments, including drugs used for symptomatic relief such as non-steroidal anti-inflammatory drugs, and those used to control the disease process; this last group comprises conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), including methotrexate, leflunomide, and sulfasalazine, and biologic and targeted DMARDs, including anti-tumor necrosis factor (TNFα), anti-interleukin-17 (IL-17), anti-IL-12/23, and anti-IL-23 agents, as well as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) antagonists. Although these drugs are usually tailored to the clinical profile of the patient, biomarkers predictive of response to therapy are needed so that a more personalized approach can be followed.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678329","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 large multinational study in the Nordic countries which compared pregnancy outcomes of women with epilepsy with those of women without epilepsy finds that the risk of a range of serious complications including pre-eclampsia, embolism, disseminated intravascular coagulation, cerebrovascular events, and mental health conditions is substantially raised ( JAMA Neurol doi:10.1001/jamaneurol.2024.2375). Women with epilepsy also had a higher risk of death in childbirth than women without epilepsy. Earlier this year, Minerva noted a study from the US showing that mortality in people with hearing loss was raised but mitigated by wearing hearing aids ( Lancet Healthy Longev doi:10.1016/S2666-7568(23)00232-5). Electronic health records of more than three million US veterans suggest …
{"title":"Types of curiosity . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.q2510","DOIUrl":"https://doi.org/10.1136/bmj.q2510","url":null,"abstract":"A large multinational study in the Nordic countries which compared pregnancy outcomes of women with epilepsy with those of women without epilepsy finds that the risk of a range of serious complications including pre-eclampsia, embolism, disseminated intravascular coagulation, cerebrovascular events, and mental health conditions is substantially raised ( JAMA Neurol doi:10.1001/jamaneurol.2024.2375). Women with epilepsy also had a higher risk of death in childbirth than women without epilepsy. Earlier this year, Minerva noted a study from the US showing that mortality in people with hearing loss was raised but mitigated by wearing hearing aids ( Lancet Healthy Longev doi:10.1016/S2666-7568(23)00232-5). Electronic health records of more than three million US veterans suggest …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678267","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}
Good communication skills are particularly important when dealing with doctors as patients, but I am a little concerned about the emphasis on not being “manipulated into doing something you wouldn’t …
{"title":"Doctors should be sensitive to the worries of colleague patients","authors":"Phil Taylor","doi":"10.1136/bmj.q2561","DOIUrl":"https://doi.org/10.1136/bmj.q2561","url":null,"abstract":"Good communication skills are particularly important when dealing with doctors as patients, but I am a little concerned about the emphasis on not being “manipulated into doing something you wouldn’t …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678270","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}
Lynn’s summary of medical apprenticeships1 made us reflect on our own experiences through medical school. As recently graduated medical students, now working as NHS foundation doctors, we would have loved the opportunity to be apprentices. We advocate for the continued expansion of this innovative route. Notwithstanding the advantageous financial circumstances of avoiding hundreds of thousands of pounds of debt, the medical apprenticeship programme offers apprentices the opportunity to become legitimate …
{"title":"Medical apprenticeships ensure undergraduates are legitimate participants in communities of practice","authors":"John Gillespie, Antony Fernando, Hozafa Ali","doi":"10.1136/bmj.q2571","DOIUrl":"https://doi.org/10.1136/bmj.q2571","url":null,"abstract":"Lynn’s summary of medical apprenticeships1 made us reflect on our own experiences through medical school. As recently graduated medical students, now working as NHS foundation doctors, we would have loved the opportunity to be apprentices. We advocate for the continued expansion of this innovative route. Notwithstanding the advantageous financial circumstances of avoiding hundreds of thousands of pounds of debt, the medical apprenticeship programme offers apprentices the opportunity to become legitimate …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678271","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":"Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.q2605","DOIUrl":"https://doi.org/10.1136/bmj.q2605","url":null,"abstract":"In this BMJ Rapid Recommendation by Agarwal and colleagues ( BMJ 2024;387:e080257, doi: …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678328","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}
Chris and Elaine Brooks in a 1904 Quadrant motorbike Chris Brooks was dangling from the hoist of a Sea King helicopter over a fishing trawler 60 miles off the coast of Louisbourg, Nova Scotia. As a flight surgeon with the Royal Canadian Navy he was preparing to rescue a fisherman with a knife wound whose guts were being held in by a sanitary towel. It occurred to him that, should the Sea King ditch, he would be the first to drown. This episode sparked an interest in marine survival. He undertook research into surviving helicopter ditchings, introduced new lifejackets and immersion suits for the Royal Canadian Air Force and Navy, and created emergency breathing apparatus for helicopter crew and passengers. As part of a team at Canada’s Defence and Civil Institute of Environmental Medicine (DCIEM) he helped devise a survival pack for helicopter pilots’ ejection seats. It contained a whistle, knife, chocolate, and a life raft—as well as shark repellent. The team also developed the first centrifuge in Canada to train pilots for high acceleration manoeuvres, cobbled together from the carcass of a second world war centrifuge and …
{"title":"Chris Brooks: flight surgeon and marine survival expert who designed lifesaving equipment for the Canadian navy and air force","authors":"Tim Bullamore","doi":"10.1136/bmj.q2569","DOIUrl":"https://doi.org/10.1136/bmj.q2569","url":null,"abstract":"Chris and Elaine Brooks in a 1904 Quadrant motorbike Chris Brooks was dangling from the hoist of a Sea King helicopter over a fishing trawler 60 miles off the coast of Louisbourg, Nova Scotia. As a flight surgeon with the Royal Canadian Navy he was preparing to rescue a fisherman with a knife wound whose guts were being held in by a sanitary towel. It occurred to him that, should the Sea King ditch, he would be the first to drown. This episode sparked an interest in marine survival. He undertook research into surviving helicopter ditchings, introduced new lifejackets and immersion suits for the Royal Canadian Air Force and Navy, and created emergency breathing apparatus for helicopter crew and passengers. As part of a team at Canada’s Defence and Civil Institute of Environmental Medicine (DCIEM) he helped devise a survival pack for helicopter pilots’ ejection seats. It contained a whistle, knife, chocolate, and a life raft—as well as shark repellent. The team also developed the first centrifuge in Canada to train pilots for high acceleration manoeuvres, cobbled together from the carcass of a second world war centrifuge and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678952","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}
This previously well teenager presented with a three week history of fever, headache, and a single episode of tonic-clonic seizure. On examination, he responded slowly to verbal commands and motor stimuli, and muscle strength in all four limbs was decreased (graded 4/5 on the Medical …
{"title":"Multiple contrast enhancing subdural lesions","authors":"Jinfang Liu, Zhongyi Sun","doi":"10.1136/bmj-2024-079362","DOIUrl":"https://doi.org/10.1136/bmj-2024-079362","url":null,"abstract":"This previously well teenager presented with a three week history of fever, headache, and a single episode of tonic-clonic seizure. On examination, he responded slowly to verbal commands and motor stimuli, and muscle strength in all four limbs was decreased (graded 4/5 on the Medical …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678268","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}
Best writes about doctors becoming patients.1 My inventory of ailments is well into double figures—I had thought that getting old would take longer. Everyone, patient and doctor, is unique. Doctors as patients can present somewhat different challenges to the general population, can find the …
{"title":"Experience from both ends of the stethoscope could inform research","authors":"Steven Ford","doi":"10.1136/bmj.q2555","DOIUrl":"https://doi.org/10.1136/bmj.q2555","url":null,"abstract":"Best writes about doctors becoming patients.1 My inventory of ailments is well into double figures—I had thought that getting old would take longer. Everyone, patient and doctor, is unique. Doctors as patients can present somewhat different challenges to the general population, can find the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678269","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}
Distrust in science underpins the new administration The second term of office of US president elect Donald Trump looks set to be characterised by loss of influence of scientific and medical expertise. Scepticism and hostility to expertise portend poorly for policies on vaccines, health insurance coverage, Medicaid, and female reproductive rights. Trump’s choices of staff for the new administration is a case in point. Robert F Kennedy Jr, nominated as health secretary,1 has displayed ignorance of how science and medicine work, hostility to vaccination, a penchant for spreading misinformation, ignorance of how Medicare and Medicaid—the government’s main health programmes— operate, and has no management experience or knowledge to lead a department with a $1.8tn (£1.4tn; €1.7tn) budget and 80 000 employees.23 These deficiencies are …
{"title":"Health policies under Trump","authors":"Ezekiel J Emanuel, Merjan Lijerón Ozisik","doi":"10.1136/bmj.q2587","DOIUrl":"https://doi.org/10.1136/bmj.q2587","url":null,"abstract":"Distrust in science underpins the new administration The second term of office of US president elect Donald Trump looks set to be characterised by loss of influence of scientific and medical expertise. Scepticism and hostility to expertise portend poorly for policies on vaccines, health insurance coverage, Medicaid, and female reproductive rights. Trump’s choices of staff for the new administration is a case in point. Robert F Kennedy Jr, nominated as health secretary,1 has displayed ignorance of how science and medicine work, hostility to vaccination, a penchant for spreading misinformation, ignorance of how Medicare and Medicaid—the government’s main health programmes— operate, and has no management experience or knowledge to lead a department with a $1.8tn (£1.4tn; €1.7tn) budget and 80 000 employees.23 These deficiencies are …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678326","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}
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