{"title":"Using patient data for patients' benefit.","authors":"Amitava Banerjee, David Mathew, Katherine Rouane","doi":"10.1136/bmj.j4413","DOIUrl":"10.1136/bmj.j4413","url":null,"abstract":"","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4413"},"PeriodicalIF":0.0,"publicationDate":"2017-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35455609","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}
General practices in England owe more than £90m (€103m; $120m) to NHS Property Services in outstanding premises fees, official figures have shown. The figures were disclosed in parliament by the health minister Philip Dunne in response to a request from Labour’s shadow health minister Justin Madders.1 They show that the total costs charged to GP tenants of NHS Property Services that remain outstanding were £9m in 2014-15, £28m in 2015-16, and £55m in 2016-17. The disclosure came as talks continued between the BMA and the NHS Property Services in a bid to resolve the ongoing dispute over substantial increases that the agency had applied to GPs’ rent and service charges. NHS Property Services is a limited company owned by the Department of …
{"title":"Figures show big increase in outstanding general practice premises fees.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.j4529","DOIUrl":"https://doi.org/10.1136/bmj.j4529","url":null,"abstract":"General practices in England owe more than £90m (€103m; $120m) to NHS Property Services in outstanding premises fees, official figures have shown.\u0000\u0000The figures were disclosed in parliament by the health minister Philip Dunne in response to a request from Labour’s shadow health minister Justin Madders.1 They show that the total costs charged to GP tenants of NHS Property Services that remain outstanding were £9m in 2014-15, £28m in 2015-16, and £55m in 2016-17.\u0000\u0000The disclosure came as talks continued between the BMA and the NHS Property Services in a bid to resolve the ongoing dispute over substantial increases that the agency had applied to GPs’ rent and service charges.\u0000\u0000NHS Property Services is a limited company owned by the Department of …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4529"},"PeriodicalIF":105.7,"publicationDate":"2017-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35456036","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 ongoing crisis is evidence of systematic discrimination against children
{"title":"Mental health services for children fail to meet soaring demand.","authors":"Bernadka Dubicka, Tori Bullock","doi":"10.1136/bmj.j4254","DOIUrl":"https://doi.org/10.1136/bmj.j4254","url":null,"abstract":"The ongoing crisis is evidence of systematic discrimination against children","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4254"},"PeriodicalIF":105.7,"publicationDate":"2017-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35559604","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 you need to know A 32 year old mother of two presents to her general practitioner after the sudden death of her previously healthy 29 year old brother. Postmortem examination identified an underlying inherited cardiomyopathy, and subsequent genetic analysis of postmortem DNA found the Arg502Trp variant in the MYBPC3 gene, a common cause of hypertrophic cardiomyopathy.1 Given the familial risk, relatives were advised to seek medical attention. The woman raises questions, including what the disease risk is for herself, her two children, siblings, and parents, what the gene result means, and whether the family should pursue genetic testing. She is concerned about preventing any further sudden deaths in her family. Here we provide an overview of the basic principles of genetic testing and how these can be applied in a general clinical setting. Inheritance of traits hails from Mendel’s pea experiments in the 1800s, where he showed that parents contribute an allele each to their offspring, with one “dominating” the other. This principle is the basis of modern medical genetics, where Mendelian diseases are inherited in families as autosomal dominant, recessive, or X linked traits (box 1). Adding to the complexity in humans, we also see incomplete penetrance—ie, the non-expression of a trait, and clinical heterogeneity, where variability in clinical characteristics due to environmental and other genetic factors occurs. While Mendelian inheritance refers to the inheritance of …
{"title":"A clinical approach to genetic testing for non-specialists.","authors":"Christopher Semsarian, Jodie Ingles","doi":"10.1136/bmj.j4101","DOIUrl":"https://doi.org/10.1136/bmj.j4101","url":null,"abstract":"#### What you need to know\u0000\u0000A 32 year old mother of two presents to her general practitioner after the sudden death of her previously healthy 29 year old brother. Postmortem examination identified an underlying inherited cardiomyopathy, and subsequent genetic analysis of postmortem DNA found the Arg502Trp variant in the MYBPC3 gene, a common cause of hypertrophic cardiomyopathy.1 Given the familial risk, relatives were advised to seek medical attention. The woman raises questions, including what the disease risk is for herself, her two children, siblings, and parents, what the gene result means, and whether the family should pursue genetic testing. She is concerned about preventing any further sudden deaths in her family. Here we provide an overview of the basic principles of genetic testing and how these can be applied in a general clinical setting.\u0000\u0000Inheritance of traits hails from Mendel’s pea experiments in the 1800s, where he showed that parents contribute an allele each to their offspring, with one “dominating” the other. This principle is the basis of modern medical genetics, where Mendelian diseases are inherited in families as autosomal dominant, recessive, or X linked traits (box 1). Adding to the complexity in humans, we also see incomplete penetrance—ie, the non-expression of a trait, and clinical heterogeneity, where variability in clinical characteristics due to environmental and other genetic factors occurs. While Mendelian inheritance refers to the inheritance of …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4101"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35456492","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":"Ben Maruthappu: Caring about technology.","authors":"","doi":"10.1136/bmj.j4153","DOIUrl":"https://doi.org/10.1136/bmj.j4153","url":null,"abstract":"","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4153"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35402129","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 50 year old man presented to a clinic with a two year history of multiple hypopigmented patches spread over the trunk and all four limbs (fig 1⇓). The patches were variable in size with central clearing; some margins were well defined and some poorly. Hair growth over the lesions was sparse, and he had loss of sensation over some of the patches. The peripheral nerves—ulnar, lateral popliteal, and posterior tibial—were thickened, with mild weakness in the muscles they supplied, but there was no loss of sensation in the hands and feet. A slit-skin smear …
{"title":"A forgotten and hidden disease.","authors":"Pugazhenthan Thangaraju, M K Showkath Ali","doi":"10.1136/bmj.j4234","DOIUrl":"https://doi.org/10.1136/bmj.j4234","url":null,"abstract":"A 50 year old man presented to a clinic with a two year history of multiple hypopigmented patches spread over the trunk and all four limbs (fig 1⇓). The patches were variable in size with central clearing; some margins were well defined and some poorly. Hair growth over the lesions was sparse, and he had loss of sensation over some of the patches. The peripheral nerves—ulnar, lateral popliteal, and posterior tibial—were thickened, with mild weakness in the muscles they supplied, but there was no loss of sensation in the hands and feet. A slit-skin smear …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4234"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35459235","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}
NHS England has made £10m (€11.4m; $13.4m) available for indemnity costs to help GPs working out-of-hours shifts over the winter. The scheme will run from 1 October 2017 until after the Easter weekend, 2 April 2018. NHS England said that it would allow doctors to commit to more out-of-hours sessions without needing to negotiate changes to their indemnity cover. GPs who want to work additional sessions will agree a likely number of sessions they will work over the period with their out-of-hours …
{"title":"£10m scheme will cover GPs' indemnity fees over winter.","authors":"Zosia Kmietowicz","doi":"10.1136/bmj.j4521","DOIUrl":"https://doi.org/10.1136/bmj.j4521","url":null,"abstract":"NHS England has made £10m (€11.4m; $13.4m) available for indemnity costs to help GPs working out-of-hours shifts over the winter.\u0000\u0000The scheme will run from 1 October 2017 until after the Easter weekend, 2 April 2018. NHS England said that it would allow doctors to commit to more out-of-hours sessions without needing to negotiate changes to their indemnity cover.\u0000\u0000GPs who want to work additional sessions will agree a likely number of sessions they will work over the period with their out-of-hours …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4521"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35559566","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}
Eva Gonzalez-Viana, Katharina Dworzynski, M Stephen Murphy, Russell Peek
#### What you need to know Growth in infants and preschool children is a common cause for parental and professional concern. Some weight loss is common in the early days of life, while establishing feeding, and is usually a physiological phenomenon associated with fluid shifts.1 The term “faltering growth” is used to describe a pattern of slower weight gain than expected for age and sex in infants and preschool children after these early days and is most often due to inadequate nutritional intake. Concerns about faltering growth arise in up to 5% of infants and preschool children, depending on the definition used.23 Concerns are usually raised in primary care, by parents, health visitors, or general practitioners (GPs). Current practice in assessment and management varies across the UK.4 This article summarises the recent National Institute for Health and Care Excellence (NICE) guidance on the recognition and management of infants and preschool children with faltering growth,5 focusing …
{"title":"Faltering growth in children: summary of NICE guidance.","authors":"Eva Gonzalez-Viana, Katharina Dworzynski, M Stephen Murphy, Russell Peek","doi":"10.1136/bmj.j4219","DOIUrl":"https://doi.org/10.1136/bmj.j4219","url":null,"abstract":"#### What you need to know\u0000\u0000Growth in infants and preschool children is a common cause for parental and professional concern. Some weight loss is common in the early days of life, while establishing feeding, and is usually a physiological phenomenon associated with fluid shifts.1 The term “faltering growth” is used to describe a pattern of slower weight gain than expected for age and sex in infants and preschool children after these early days and is most often due to inadequate nutritional intake. \u0000\u0000Concerns about faltering growth arise in up to 5% of infants and preschool children, depending on the definition used.23 Concerns are usually raised in primary care, by parents, health visitors, or general practitioners (GPs). Current practice in assessment and management varies across the UK.4 This article summarises the recent National Institute for Health and Care Excellence (NICE) guidance on the recognition and management of infants and preschool children with faltering growth,5 focusing …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4219"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35456475","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":"Epidemic of deaths from fentanyl overdose.","authors":"M Eugenia Socías, Evan Wood","doi":"10.1136/bmj.j4355","DOIUrl":"https://doi.org/10.1136/bmj.j4355","url":null,"abstract":"Another serious side effect of the war on drugs","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4355"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35456471","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 UK’s health research agency has pledged to get more non-academic doctors involved in research. To mark its 10 year anniversary, the National Institute for Health Research (NIHR) has announced an overhaul of its activities, streamlining all its research activities into a single academy. The academy will see the integration of all current academic training and higher career personal awards, and will host all …
{"title":"NHS doctors should be more involved in research, says research institute.","authors":"Anne Gulland","doi":"10.1136/bmj.j4523","DOIUrl":"https://doi.org/10.1136/bmj.j4523","url":null,"abstract":"The UK’s health research agency has pledged to get more non-academic doctors involved in research.\u0000\u0000To mark its 10 year anniversary, the National Institute for Health Research (NIHR) has announced an overhaul of its activities, streamlining all its research activities into a single academy. The academy will see the integration of all current academic training and higher career personal awards, and will host all …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4523"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j4523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35559565","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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