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Mashup Score: 4Recommendations on recording harms in randomised controlled trials of behaviour change interventions - 2 hour(s) ago
Harms are possible from behaviour change interventions, such as the worsening of a health behaviour intended for change (rebound effect), improving a health behaviour but with subsequent worsening of another behaviour (risk compensation), and participants feeling targeted or stigmatised by an intervention. The processes and definitions originally designed to record harms within drug trials are typically followed to record harms in trials of behaviour change interventions owing to the lack of alternative guidance. Therefore, important harms could be missed in the evaluations of behaviour change interventions or irrelevant harms data may be recorded, leading to inefficiency. This paper presents evidence informed recommendations on how to record harms in randomised controlled trials of behaviour change interventions. Randomised controlled trials evaluate the risks and harms, as well as the benefits, of interventions. However, in randomised controlled trials of behaviour change interventio
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet
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Mashup Score: 9Lucy Letby case: what happens now? - 9 hour(s) ago
A court judged nurse Lucy Letby guilty of seven murders and seven attempted murders in August 2023. But in the year since then questions have been raised about the evidence used to convict her. With a new statutory inquiry now sitting, Chris Stokel-Walker recaps what has happened with the case and what its wider implications are It was the most heinous of crimes. Nurse Lucy Letby was found guilty of seven murders and seven attempted murders of babies under her care in a neonatal ward at the Countess of Chester Hospital, where she worked from January 2012 until July 2016.1 Letby was removed from the unit after the death of triplets capped off a torrid year for the ward, during which several babies were harmed, many of them dying in unexplained circumstances. Police began investigating the deaths in May 2017 at the behest of hospital authorities,2 and Letby was arrested at her home in July 2018 in connection with the deaths. The nurse was charged with 22 offences in total and was convict
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet-
In the year since Lucy Letby was found guilty of seven murders and seven attempted murders questions have been raised about the evidence used to convict her. With a new statutory inquiry now sitting, @stokel recaps the case and its wider implications https://t.co/GWRCphFnap
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Mashup Score: 5Cli-Fi—helping us manage a crisis - 22 hour(s) ago
> The great Indian heat wave broke all records. It scorched a vast swath of the country, from Gujarat and Rajasthan in the west, eastward across Uttar Pradesh and Bihar to West Bengal. In rural areas and in the megacities of Delhi and Lucknow, the temperature climbed above 40°C and the humidity above 60%; they hovered there for days, with little relief at night. Power plants and water systems stopped functioning. The combination of heat and dehydration killed hundreds of thousands in just a few days. In one city in Uttar Pradesh, thousands of people had sought refuge in the water of a shallow local lake. But the water was hotter than their body temperature. When the heat wave finally subsided, one of the most grisly tasks was removing thousands of corpses from the lake. This scenario unfolds in the opening chapters of Kim Stanley Robinson’s The Ministry for the Future (2020). It is fictional. And it is unforgettable. Reading fiction is one of the sublime ways to experience art. Stories
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet-
In recent years, the genre known as climate fiction—or “cli-fi”—has blossomed. It can help us understand the #climate crisis, including its health dimensions, writes Howard Frumkin https://t.co/2isIXAhrIn
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Mashup Score: 124Medicine is difficult—there are no shortcuts - 1 day(s) ago
Delivering high quality, patient centred care requires medical training that is long enough, broad enough, and deep enough, writes Andrew Elder A senior medical leader recently gave me a piece of advice. “Even when you are bored stiff saying the same thing again and again, say it again. Even when you think everybody will be fed up hearing it, say it again. Because the politicians may not yet have heard you.” So, I will say it again. Medicine is difficult. Yes, we have fabulous imaging and more laboratory investigations than any of us can name. And yes, we can interrogate our patients’ genomes, and the genomes of the organisms and cancers that infect and affect them. But, despite all this wonderful technology, diagnosis remains difficult. Every patient is a unique individual in a unique context, a product of both their biology and their biography. Making accurate and timely diagnoses requires more than just technology—it requires listening, observation, careful thought, judgment, and ti
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"The visions of future healthcare that have produced the mission to generate more doctors in shorter timeframes do not come from those who see medicine on its front lines." @AndrewElder on the suggestion we “make” our doctors in shorter timeframes https://t.co/IiJFUpcx3d
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Mashup Score: 27Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline - 1 day(s) ago
Clinical question What is the impact of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on survival and on cardiovascular and kidneyoutcomes for adults living with chronic kidney disease (CKD)? Current practice Few therapies slow kidney disease progression and improve long term prognosis for adults living with CKD. SGLT-2 inhibitors have demonstrated cardiovascular and kidney benefits in adults with CKD with and without type 2 diabetes. Existing guidance for SGLT-2 inhibitors does not account for the totality of current best evidence for adults with CKD and does not provide fully stratified treatment effects and recommendations across all risk groups based on risk of CKD progression and complications. Recommendations The guideline panel considered evidence regarding benefits and harms of SGLT-2 inhibitor therapy for adults with CKD over a five year period, along with contextual factors, and provided the following recommendations: 1. For adults at low risk of CKD progression and comp
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A guideline panel considered evidence on the benefits and harms of SGLT-2 inhibitor therapy for adults with chronic kidney disease over a five year period and provided new recommendations. Read them ⬇️ https://t.co/PJnqxc694A
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Mashup Score: 8Treating the symptoms of climate anxiety - 1 day(s) ago
When I started writing Perilous Times —a novel in which Arthurian knights return from the dead to save Britain from peril in an exaggerated post-Brexit dystopia—I was suffering from an acute case of climate anxiety, the symptoms of which are no doubt familiar to many of us who are concerned about climate breakdown. In its early stages it manifests as a certain creeping dread, a difficulty imagining the future without a sense of foreboding, a growing fury that so little action is being taken to soften the impact and ameliorate the cause of climate breakdown. As the condition develops, patients often exhibit the desire to cause traffic obstructions and throw soup at famous paintings. (And with good reason: when planning non-violent protest over a Zoom call can lead to a five-year prison sentence, you might as well engage in more disruptive forms of protest.) In particularly hopeless cases, the patient sometimes writes …
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet-
"I don’t know how the bards behaved during the fall of Babylon, but, during long winters, our ancestors would gather around the fire and listen to tales of heroes and monsters . . . Perhaps we need to take a similar view of climate fiction." @Thomas_D_Lee https://t.co/Xupaxjht7A
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Mashup Score: 14
When Laura Benjamin arrived in Malawi, she was the only neurologist in the country. As the stroke unit she helped establish—the country’s first and only—approaches its second anniversary, she and others tell The BMJ about the wins and challenges Laura Benjamin recalls talking to the Ministry of Health in Malawi in 2017. “They had put together a health sector strategic plan for the next four years, and this document highlighted the diseases of focus for the country, prioritised by those with the greatest burden. They talked about hypertension, diabetes, and heart disease, but they didn’t talk about stroke, which goes hand in hand with these diseases. They said they didn’t have the data to show its importance.” Benjamin, a British neurologist, arrived in the southern African country expecting to study the links between stroke and HIV for her PhD. But she found herself immediately on the frontlines at Queen Elizabeth Hospital in Blantyre. “When I arrived in 2010, I had completed five year
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet-
"People would come from across the whole country, sometimes travelling 300 miles, to see me." When Laura Benjamin arrived in Malawi, she was the only neurologist in the country. She tells The BMJ about helping to establish the country's only stroke unit https://t.co/QBIMt5O0om
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Mashup Score: 13Helen Salisbury: Funding GPs through the additional roles scheme won’t solve GP unemployment - 1 day(s) ago
Funding for general practice has been falling since 2018,1 and the only new money available has been through the primary care networks—groups of practices covering 30 000-50 000 patients. Money has been provided in the form of the Additional Roles Reimbursement Scheme (ARRS) to pay the wages of pharmacists, physiotherapists, paramedics, physician associates, and a list of other allied healthcare staff—but, until last week, doctors weren’t included. This omission has had several unfortunate consequences. The main one is that, although there are fully qualified GPs who need jobs—and patients crying out for GP appointments—practices can’t afford to hire those doctors. Instead, they settle for other workers (provided at no …
Source: www.bmj.comCategories: General Medicine News, General Journals & SocietTweet-
"If the money currently spent on the Additional Roles Reimbursement Scheme budget was restored to core GP funding—trusting practices to use it wisely—we could then invest in more doctors, which is what patients want . . ." @HelenRSalisbury's latest column https://t.co/vKQWDaQKjG
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Mashup Score: 100More GPs needed in deprived areas to reduce widening gap in provision, says RCGP chair - 2 day(s) ago
The chair of the Royal College of General Practitioners has condemned “devastating” new figures showing that GPs in deprived areas of England are responsible for at least 300 more patients per doctor than those in wealthier areas, a gap that has widened over the past six years. The RCGP analysis,1 published on 3 October ahead of its annual conference in Liverpool, showed that the number of patients per fully qualified, full time GP working in areas with the highest level of income deprivation has risen by an average of 260 in the past six years, from 2190 …
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet-
The chair of @rcgp has condemned “devastating” new figures showing that GPs in deprived areas of England are responsible for at least 300 more patients per doctor than those in wealthier areas, a gap that has widened over the past six years https://t.co/s6RRN9P7sb
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Mashup Score: 303Child protection medicals must be carried out only by doctors, not PAs, say safeguarding experts - 2 day(s) ago
Physician associates (PAs) should not be carrying out medical examinations of children who have reported abuse or who are at risk of abuse and should not produce evidence for courts, forensic doctors have said in guidance. The advice from the Faculty of Forensic and Legal Medicine of the Royal College of Physicians was issued shortly after it came to light that an NHS trust had for four years employed a PA to do safeguarding work, instead of a paediatrician.1 Alder Hey Children’s NHS Foundation Trust said that it employed a PA within its safeguarding team between May 2019 and March 2024. The PA undertook child sexual abuse medicals up until October 2023, under the supervision of a safeguarding consultant. An audit carried out by the Royal College of Paediatrics and Child Health between March and July 2023 found that the PA was a member of the specialist safeguarding team and shared the on-call rota.2 But the arrangement could have prevented successful future prosecutions because PAs ar
Source: www.bmj.comCategories: General Medicine News, General HCPsTweet-
Physician associates should not be carrying out medical examinations of children who have reported abuse or who are at risk of abuse and should not produce evidence for courts, forensic doctors have said in guidance https://t.co/kPDXHnvIzR
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Harms are possible from behaviour change interventions. This article presents evidence informed recommendations on how to record harms in randomised controlled trials of behaviour change interventions @CTRU_Sheffield https://t.co/mvCLSkuaEm