Baby P investigations - why did this child die in 2007 despite regular visits to professionals. Up until now social servies have largely taken the blame however now the focus has moved onto the doctors he had seen before he died. For example he was seen by a locum paediatrician 48 hours before he died who failed to see Baby P had a broken back. The development clinic he had attended was seriously understaffed and could not work effectively.
Health Stories of the Decade. Jeremy Laurence. BMJ 2009;339:b5281. December 2009
The story of the Noughties: Deadly Scares vs Miracle Cures. Pandemic flu according to one journalist is the story of the decade, starting with Avian flu, developing to SARS and Swine flu. Other stories in the top 10 were: MMR vaccine, Hospital Acquired Infections, the NHS, Obesity, Smoking, Cancer Drugs, IVF, Harold Shipman and Alcohol. Alot of it stems to public confidence in science and the mistrust that the public can have in politicians. The author says "The NHS has been transformed in the past decade" and that this is a credit to the labour government however the future of the NHS does look bleak due to the recession (cuts of billions over the next three years). How do we save money without compromising quality of care? Predictions are that alcohol and obesity will dominate the next decade. The BMA and Scottish parliament have backed minimum pricing for alcohol and it will be interesting to see if this comes into effect in the future.
The most internet hits was for a bizarre story in Canada where an obese patient was treated by brain stimulation and by chance scientists located and stimulated a memory center allowing the patient to recall memories he had long since forgotten - 'Scientists unlock the secrets of Memory'. There was also the story of the surgeon in the Democratic Republic of Congo who performed a successful arm amputation by texting his colleague in London.
Tuesday, 22 December 2009
BMJ Podcast 4th December 2009
This weeks news: Reaction to the Dr Foster review, an annual league table of performance of NHS trusts in the UK in terms of patient safety. Is this a productive and necessary task? Is this just for journalists? Many trusts are rated as excellent and the review does not take in improments. Also in the news a warning from the MDU about doctor's flirting on Facebook. Sounds like yet another attempt to reduce the freedom of speech and social lives of doctors.
Christmas Appeal: Medecins Sans Frontieres. In countries affected by war or recently recovering, MSF is often the main and only source of healthcare. The goal of the service is to provide medical care to those most in need. Often only the simplest of care can save lives and this highlights the real vulnerability people in these areas have to disease. A small health center can make huge improvements. People can help MSF by a) Volunteering (only 2 years experience are required plus experience of travel) and b) Lending support by spreading the word of what MSF does eg. campaigning for access to essential medicines and neglected diseases that may not be profitable to Western pharmaceutical countries and c) Financially (85% of funds are from the general public).
Link to the Christmas Appeal.
http://www.msf.org.uk/bmjappeal.aspx
I've just donated £6 today and I'd encourage anyone reading this to help the cause!
Christmas Appeal: Medecins Sans Frontieres. In countries affected by war or recently recovering, MSF is often the main and only source of healthcare. The goal of the service is to provide medical care to those most in need. Often only the simplest of care can save lives and this highlights the real vulnerability people in these areas have to disease. A small health center can make huge improvements. People can help MSF by a) Volunteering (only 2 years experience are required plus experience of travel) and b) Lending support by spreading the word of what MSF does eg. campaigning for access to essential medicines and neglected diseases that may not be profitable to Western pharmaceutical countries and c) Financially (85% of funds are from the general public).
Link to the Christmas Appeal.
http://www.msf.org.uk/bmjappeal.aspx
I've just donated £6 today and I'd encourage anyone reading this to help the cause!
BMJ Podcast 27th November 2009
BMJ Careers and Specialist training. This starts at the beginning of December each year but is widely considered a long and difficult application process. The BMJ and BMA offer info about choices. The BMJ offers careers advice for doctors entering the application process.
The King's Fund Annual Debate. In America privatised health has been present for many years and there have been lots of attempts to improve the way treatment and healthcare is provided. At the moment people pay for the services which they receive, however the new movement proposed is for patients to pay for the outcome of the treatment and management they receive eg. HBA1C levels in diabetics. More clinical outcomes need to be developed to offer a more appropriate level of improvement resulting from a treatment. In the UK, NICE could learn from this approach in its decision making on the funding of medicine provided by the NHS.
The King's Fund Annual Debate. In America privatised health has been present for many years and there have been lots of attempts to improve the way treatment and healthcare is provided. At the moment people pay for the services which they receive, however the new movement proposed is for patients to pay for the outcome of the treatment and management they receive eg. HBA1C levels in diabetics. More clinical outcomes need to be developed to offer a more appropriate level of improvement resulting from a treatment. In the UK, NICE could learn from this approach in its decision making on the funding of medicine provided by the NHS.
BMJ Podcast 20th November 2009
End of life care. The conversation between patients and the end of life decisions within the community is currently not as good as it could be. What happens when patient's ideas differ from those of their patients? Unbearable suffering may be interpreted differently. Euthanasia is legalised under strict conditions in the Netherlands. GPs are the most common to carry this out in patient's homes and the decision comes about after long discussion. Physicians who have objects are free to make these known and are able to refuse but should refer the patient to another doctor. The advantage in the Netherlands is more openness and discussion about the topic in the country. Still two thirds of requests are not accepted. Physicians may be more likely to focus on the physical perceptions of suffering whilst patients are more likely to focus on the psycho-social aspects. The law does not specify the definition. Society does find it difficult to approach this subject and equally doctors and nurses do not like to approach the topic. End of life care pathways are tools with stages of care to assist the process, having a role particularly in hospitals for doctos who may not have as much experience in end-of-life care. Audits of end-of-life care and research into the use of pathways will help to identify areas which are being dealt with effectively and places where care can be improved.
Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. Published 16 November 2009, doi:10.1136/bmj.b4362
In 2003 the chlamydia national screening programme was set-up. Only 1 in 6 people take part in the screening process and levels need to be higher in the region of about 25% for the screening process to be successful. The disease is a huge public health problem and is vastly underdiagnosed.
Climate change - are population dynamics and family planning the keys to reducing greenhouse gas emmissions to help future generations? Perhaps this is an area which was discussed at the recent summit in Copenhagen.
Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. Published 16 November 2009, doi:10.1136/bmj.b4362
Cite this as: BMJ 2009;339:b4362
In 2003 the chlamydia national screening programme was set-up. Only 1 in 6 people take part in the screening process and levels need to be higher in the region of about 25% for the screening process to be successful. The disease is a huge public health problem and is vastly underdiagnosed.
Climate change - are population dynamics and family planning the keys to reducing greenhouse gas emmissions to help future generations? Perhaps this is an area which was discussed at the recent summit in Copenhagen.
Thursday, 3 December 2009
Email to the Student BMJ
Dear Prizzi Zarsadias,
I was inspired by the article in the BMJ published on the 29th October 09, which was also discussed on the BMJ Podcast 'Analysing Aspirin', published on the 6th Novmeber 2009:
Edelman E, Eng C. A practical guide to interpretation and clinical application of personal genomic screening. BMJ 2009;339:b425
I am a fourth year medical student at Dundee university and have recently completed an intercalated BMSc in Human and Molecular Genetics. I was emailing to find out the interest in this area, and whether an article on this subject and looking at the exciting developments in genetics which the future holds would be of interest to the Student BMJ.
Historically, clinical geneticists have been involved in the treatment and management of single gene disorders (monogenic) with low frequency but high morbidity such as Duchenne's Muscular Dystrophy, and chromosomal abnormalities such as Trisomy 21 (Down's Syndrome). Most of the genes involved in monogenic disorders have now been identified and the research emphasis has shifted of late to the polygenic inheritance of complex, common conditions such as Diabetes Mellitus and Alzheimers Disease. Genome-wide association studies have become increasingly popular in the identification of inherited susceptibility markers which increase an individual's chance of inheriting common conditions, such as breast cancer.
Yours faithfully,
Gordon Hale
4th Year MBChB
I was inspired by the article in the BMJ published on the 29th October 09, which was also discussed on the BMJ Podcast 'Analysing Aspirin', published on the 6th Novmeber 2009:
Edelman E, Eng C. A practical guide to interpretation and clinical application of personal genomic screening. BMJ 2009;339:b425
I am a fourth year medical student at Dundee university and have recently completed an intercalated BMSc in Human and Molecular Genetics. I was emailing to find out the interest in this area, and whether an article on this subject and looking at the exciting developments in genetics which the future holds would be of interest to the Student BMJ.
Historically, clinical geneticists have been involved in the treatment and management of single gene disorders (monogenic) with low frequency but high morbidity such as Duchenne's Muscular Dystrophy, and chromosomal abnormalities such as Trisomy 21 (Down's Syndrome). Most of the genes involved in monogenic disorders have now been identified and the research emphasis has shifted of late to the polygenic inheritance of complex, common conditions such as Diabetes Mellitus and Alzheimers Disease. Genome-wide association studies have become increasingly popular in the identification of inherited susceptibility markers which increase an individual's chance of inheriting common conditions, such as breast cancer.
Thomas G, Jacobs KB et al. A multistage genome-wide association study in breast cancer identifies two new risk alleles at 1p11.2 and 14q24.1 (RAD51L1). Nat Genet. 2009 May;41(5):579-84.
Other topical issues which I would like to write about include the issue of personalised medicines, and the promises and pitfalls of 'gene therapy' medicines. During my intercalated degree I was personally involved in a research project which concerned the development of a gene-therapy for the rare inherited dermatological disorder, Pachyonychia Congenita (www.pachyonychia.org). The treatment has since been involved in clinical trials in the US and could potentially offer a cure patients affected by this debilitating disease.
Yours faithfully,
Gordon Hale
4th Year MBChB
Tuesday, 1 December 2009
1st December 2009
First day of December - not loing till christmas. It's icy cold outside at the moment and I've got (almost) the whole day off today until doing specialist nurse shadowing at 4pm this afternoon.
The first thing which caught my attention today was this article:
The first thing which caught my attention today was this article:
Interventions for muscular dystrophy: molecular medicines entering the clinic.
Bushby K, Lochmüller H, Lynn S, Straub V. Lancet. 2009 Nov 28;374(9704):1849-56
Muscular dystrophy can be caused by mutations in more than 30 different genes however this condition may be one of the first to benefit from 'personalised genetic medicines'. These could be either gene-based or cell-based therapies. Personalised medicines would be able to target specific medicines and this reminded me of the work I had done for my dissertation in treatments for PC.
Spent alot of time this morning thinking about future plans. I don't think it would be possible to stay in Dundee forever because I feel as if I would be missing out on the bigger picture if that was the case, it would be better to gain experience somewhere else. Both Glasgow and Edinburgh seem to have top-class medical genetics research institutions which offer the academic foundation programme and clinical PhDs. If Amy and I moved to Glasgow, particularly somewhere on the south-west part of Glasgow eg. Motherwell then I could always apply to Glasgow and have Edinburgh as a back-up (it would be possible to live there and commute to either). We would also be near Amy's family and hopefully Mum and Dad will re-locate towards the central belt in the future aswell. What would be perfect would be if Heather came down aswell to Edinburgh uni or Glasgow, then everyone would be close-by!
So in the meantime:
Amy applys to Glasgow foundation schools 1st choice. I'll finish in Dundee, then apply to Glasgow for academic training, failing that I can apply to foundation schools in Glasgow. After that I'll have plenty of options for the future, PhDs etc, be it in Glasgow or Edinburgh, depending also on what Amy gets up to with her training. Meanwhile we settle down somewhere in SE Glasgow (as long as there's somewhere nice to live!).
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