Medicine and Science from The BMJ

Dying on the canal

Lady-Jacqueline Aster lives on a 72 foot canal boat. She's been diagnosed with adrenocortical cancer, and is receiving palliative care and is planning to die in the home she loves.
In this interview The BMJ's patient editor, Rosamund Snow, talks to Lady-Jacqueline about her cancer, her care and her funeral plans - and why planning one's own death can be fun.
Read more about healthcare on the water
http://www.bmj.com/content/356/bmj.j245
Since this recording, Rosamund died by suicide, making these discussions about planning for death more poignant. You can read more about Rosamund's life and work in her obituary.
http://www.bmj.com/content/346/bmj.j850

Education round up - HIV testing, legal highs and care for relatives of the dying

The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding.
In this week's round up we're discussing:
The offer of an HIV screen for an asymptomatic adult
http://www.bmj.com/content/356/bmj.i6656
Two articles on legal highs
Novel psychoactive substances: types, mechanisms of action, and effects
http://www.bmj.com/content/356/bmj.i6848
Novel psychoactive substances: identifying and managing acute and chronic harmful use
http://www.bmj.com/content/356/bmj.i6814
and how to become better at supporting relatives and carers at the end of a patient’s life
http://www.bmj.com/content/356/bmj.j367

Identifying a viral rash in pregnancy

Viral exanthema can cause rash in a pregnant woman and should be considered even in countries that have comprehensive vaccination programmes. Measles and rubella can cause intrauterine death. Intrauterine infection with rubella can lead to congenital rubella syndrome in the liveborn baby.
In this podcast, Jack Carruthers, honorary clinical research fellow at Imperial College London joins us to discuss spotting a viral rash, what steps to take to assess cause, and what advice to give a worried parent.
Read the full clinical review:
http://www.bmj.com/content/356/bmj.j512

Nuffield Summit 2017 - Reducing Demand

As the NHS strains under pressure from rising patient activity, an ageing population, and financial constraints, The BMJ hosted a discussion on how clinicians should be helping to manage demand at last week’s Nuffield Trust health policy summit.
Taking part are:
- Eileen Burns, president of the British Geriatrics Society
- Andrew Fernando, GP and medical director of North Hampshire Urgent Care
- Candace Imison, director of policy at the Nuffield Trust
- Martin Marshall, vice chair of the Royal College of General Practitioners
- Amanda Philpott, chief officer of two clinical commissioning groups
- Maxine Power, director of innovation and improvement science at Salford Royal NHS Foundation Trust
- Jeremy Taylor, chief executive of the charities’ coalition National Voices
- Judith Smith, director of the Health Services Management Centre
- Ashok Soni, chair of NHS England’s local professional network for pharmacy in London
Listen to all of our other Nuffield Summit Roundtables:
http://www.bmj.com/nuffieldsummit

Emergency care plans at the end of life

When a person’s heart or breathing stops and the cause is reversible, immediate cardiopulmonary resuscitation (CPR) offers a chance of life. However, when a person is dying—for example, from organ failure, frailty, or advanced cancer—and his or her heart stops as a final part of a dying process, CPR will not prevent death and may do harm. But conversations around that distinction are difficult.
In a this podcast, we explore the ways in which these conversations go wrong, and give some practical advice on carrying them out better. Joining Helen Macdonald are Zoe Fritz, consultant acute physician, and Wellcome Fellow, David Pitcher, former president of the Resuscitation Council, and Kate Masters, whose mothers death led to a change in the law around DNACPR orders.
Read the articles discussed in this podcast:
Emergency care and resuscitation plans http://www.bmj.com/content/356/bmj.j876
Resuscitation policy should focus on the patient, not the decision
http://www.bmj.com/content/356/bmj.j813
My mum’s care means that decisions not to resuscitate must now be discussed with patients
http://www.bmj.com/content/356/bmj.j1084

Should malaria be eradicated?

The World Health Organization, the Roll Back Malaria Partnership, and the United Nations, all have a vision of a malaria-free world. The world has already committed to malaria eradication, albeit without a target date.
Bruno Moonen, deputy director for malaria at the Bill and Melinda Gates Foundation, thinks that for malaria, eradication is the only equitable and sustainable solution.
Where as Clive Shiff, associate professor at the Johns Hopkins Bloomberg School of Public Health, thinks this is a top-down strategy, dependent on massive concentrated funding until finished - funding which could be more effectively spent elsewhere.
In this podcast they debate whether malaria should be eliminated, or eradicated, and how that might work.
Read the full debate:
http://www.bmj.com/content/356/bmj.j916

Palliative care is about life, not death

Scott Murray, professor of primary palliative care at the University of Edinburgh, has written, and talked in this podcast before, about the benefits of early palliative care - and today he’s back to explain how illness trajectory, and the pattern of decline at the end of life, affects 4 main areas of wellness - physical, social, psychological and spiritual or existential.
Read his full analysis article:
http://www.bmj.com/content/356/bmj.j878

Community acquired pneumonia in children

In 2015, community acquired pneumonia (CAP) accounted for 15% of deaths in children under 5 years old globally and 922 000 deaths globally in children of all ages.
In this podcast Iram Haq, a registrar and clinical research associate in paediatric respiratory medicine, joins us to discuss the definition of pneumonia, how to assess for the infection, and what treatments are effective.
Read the full clinical update:
http://www.bmj.com/content/356/bmj.j686

The inadequacy of the UK’s childhood obesity strategy

The UK government published its report Childhood Obesity: a Plan for Action, in August 2016. A new analysis article takes them to task for the inadequacy of that response to a growing problem.
Neena Modi is a professor of neonatal medicine, at Imperial College London, and president of the Royal College of Paediatrics and Child Health, and joins us to discuss what that report should have contained.
Read the full analysis:
http://www.bmj.com/content/356/bmj.j762

Low intensity pulsed ultrasound - no difference for bone healing

A new rapid recommendation had concluded that LIPUS makes no different to patients experience of bone healing, and therefore shouldn't be used.
In this podcast, we talk to three of those panel members - Rudolf Poolman, orthopaedic surgeon from The Netherlands, Stefan Schandelmaier, a methodologist from McMaster University, and Maureen Smith, a patient representative.
Read the full recommendation:
http://www.bmj.com/content/356/bmj.j576