Medicine and Science from The BMJ

Dying patients in hospital, e-patients online

Patients are increasingly going online to find and discuss information about their condition. What are they getting on the web that they’re not getting from clinicians, and how is this changing healthcare?Also, how to care for a dying patient in hospital.

Suspected heart failure

Mabel Chew, practice editor at the BMJ, talks to Tushar Kotecha, a cardiology specialist registrar at Charing Cross Hospital in London, about when to suspect heart failure, and how to diagnose the condition.

The BMJ Awards: Medical Team of the Year

The BMJ Awards were held last Thursday. Fiona Godlee, the BMJ's editor in chief, announced that the Britain Nepal Otology Service (BRINOS) was named Medical Team of the Year.BRINOS (brinos.org.uk) started out in 1988 by setting up joint British and Nepalese surgical camps to treat ear disease among patients living outside the reach of hospitals in the capital of Kathmandu. A national survey in 1991 found that among the 19m people in Nepal, 2.7m were deaf and 1.5m had abnormal ear drums indicative of ear disease. BRINOS has performed more than 4000 major ear operations at 49 surgical day camps since its first expedition in 1989. Furthermore, there have been many anecdotal stories of improved education and employment opportunities in social isolation after surgery. The organisation expanded in 2000 to introduce community ear assistants, who are specially trained in the diagnosis and treatment of ear disease and dispense hearing aids passed on from the NHS.

Vulnerable adults, and the road to cycle safety

In a drive to improve safety, many cyclists now wear helmets. But how useful is legislation that mandates their use when compared with all the other safety initiatives available? Jessica Dennis, a PhD candidate from the Dalla Lana School of Public Health at the University of Toronto, tells us about her research into accident trends.Also this week, doctors play a key role in spotting when a vulnerable person is experiencing abuse, but it can be difficult to know how to tackle the issue. A clinical review sets out some advice. We're joined by the authors, Billy Boland, consultant psychiatrist and lead doctor for safeguarding adults, and Jemima Burnage, head of social work and safeguarding, at Hertfordshire Partnership NHS Foundation Trust in the UK.

Think then scan, don’t scan then think

Until now, the increased risk of cancer from CT scans has been modelled from the data gathered from survivors of the Hiroshima and Nagasaki bombings. However, new BMJ research, based on a large Australian cohort, offers new evidence to support the modelling. John Matthews, from the university of Melbourne, joins us to explain what they found.Also this week, social media is relatively new – but did you realise that doctors had been using social networks to improve health for centuries? Enrico Coiera, director of the Centre for Health Informatics at the University of New South Wales, explains more, and how in the digital age we might try and use virtual networks to do the same job on a larger scale.

Corporations as vectors of disease

This month the UK parliament has been looking at the big accountancy firms' involvement in drafting tax laws. Conversely, the Department of Health has hidden the involvement of tobacco lobbyists in proposed plain packaging legislation.Jeff Collin, professor of global health policy at the University of Edinburgh, argues that this culture of industry participation is worrying, but the lack of transparency by government is even worse.Also this week, what day of the week is safest for surgery? Paul Aylin, a clinical reader in epidemiology and public health at Imperial College London, explains his research.

Bias in clinical guidelines, and giving birth at home

Despite repeated calls to prohibit or limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists. Jeanne Lenzer explains what's going wrong.And is giving birth at home as safe for the mother as giving birth in hospital? New research from the Netherlands suggests that it is, and that risk assessment is key.

Tackling violence against women

This week, the World Health Organisation called for healthcare providers to be more aware of intimate partner and sexual violence against women, calling it a "global health problem of epidemic proportions." We look into what doctors need to know.And we discuss advice on diagnosing and treating first trimester miscarriage.

NSAIDs update

Recent research shows that some non-steroidal anti-inflammatory drugs increase cardiovascular risk in some patients. Given their widespread use, and breadth of indications for prescription, should clinicians be more circumspect about their practice?In this podcast, Mabel Chew BMJ's practice editor, talks to Richard O'Day, professor of clinical pharmacology at the University of New South Wales and author of a recent therapeutics article, about the latest research on NSAIDs

Surgical outcome data

Last week saw the start of a campaign to publish patient death rates for individual surgeons. Bruce Keogh, medical director of the NHS in England, talks to BMJ editor in chief Fiona Godlee about the initiative and the background to it.Also, the WHO has launched its Guidelines and Global Progress in HIV/AIDs report. Anne Gulland interviews Gottfried Hirnschall, a Director of the WHO’s HIV/AIDS Department, and his his scientist colleague, Philippa Easterbrook.