Medicine and Science from The BMJ

You’ve been ICE’d

We’re taught that patients' ideas, concerns, and expectations are central to a successful consultation, but has ICEing gone too far?
A “What your patient is thinking” article published this week talks about the pressure that asking questions in the wrong way can put on a patient.
Sophie Cook, education editor for The BMJ, is joined by the author of that article - The BMJ’s patient editor, Rosamund Snow, and by Roger Neighbour, former president of the royal college of general practice, and author of "The Inner Consultation".
http://www.bmj.com/content/354/bmj.i3729

Should we scrap the internal market in England’s NHS

The "internal market" was created after the 1987 UK general election focused attention on inadequate funding in the NHS, long waiting lists for elective surgery, and large unwarranted variations in clinical care.
Economists attributed these problems to a lack of incentives for efficiency, and the remedies offered included increasing competition in the NHS.
Twenty nine years later, this interesting experiment is not likely to have been worth it, says Alan Maynard, professor emeritus of health economics at the University of York. But Michael Dixon, a GP and commissioner in Devon, says that if properly funded and liberated from some of the administrative burdens of "red tape," the internal market could increase accountability.
Read their full debate:
http://www.bmj.com/content/354/bmj.i3825

Treating hip osteoarthritis

2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.
Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Aresti, a specialist registrar in trauma and orthopaedic surgery and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com
In a linked podcast, Nick Nicholas, a patient who has hip OA gives us his perspective.
Read the full article:
http://www.bmj.com/content/354/bmj.i3405
Listen to the linked podcast:
https://soundcloud.com/bmjpodcasts/having-hip-osteoarthritis

Having hip osteoarthritis

2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.
Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Nicholas, an obstetrician who has had OA and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com
In a linked podcast, Nick Aresti, a specialist registrar in trauma and orthopaedic surgery to talks about management of the condition.
Read the full article:
http://www.bmj.com/content/354/bmj.i3405
Listen to the linked podcast:
https://soundcloud.com/bmjpodcasts/treating-hip-osteoarthritis

PreP And public health

The drug Truvada, licenced for HIV PrEP, costs £350 a month but is shown to be cost effective in preventing infection. However, in the English NHS, a row has broken out about which body should fund the treatment - NHS England claims local authorities have responsibility, local authorities believe NHS England does.
In this podcast Jim McManus, director of public health at Hertfordshire County Council, explains why he believes local authorities cannot afford the treatment, and describes the pressure that public health budgets are under.
Read the full editorial:
http://www.bmj.com/content/354/bmj.i3515

Can guidelines be reformulated to account for how doctors actually use information?

Guidelines usually assume a rational comprehensive decision model in which all values, means, and ends are known and considered. In clinical encounters, however, patients and doctors most often follow “the science of muddling through.
Given that clinical knowledge does not follow the narrow rationality of “if-then” algorithms contained in guidelines, alternatives are desperately needed.
Glyn Elwyn, professor at the Dartmouth Institute for Health Policy and Clinical Practice, joins us to discuss what we know about how doctors and patients use evidence, and what the alternative to guidelines could look like.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i3200

Evidence live - Emily Sena on closing the gap between clinical and basic science

When we think about medical evidence, we think of RCTs, registries and meta-analysis. But these EBM tools have yet to filter into the basic science that underpins clinical science.
One person changing that is Emily Sena, research fellow in clinical brain sciences at the University of Edinburgh - and one of the few people who’s trying to meta-analyse animal studies.

Julia Beluz And Victor Montori - Journalists And doctors; separated by a common evidence

The same piece of evidence may reach you via a journalist, or via your doctor - but the way in which that evidence is communicated is changed by your relationship between that person.
Julia Beluz from Vox and Victor Montori from the Mayo Clinic join us to discuss if it's possible to reconcile those competing points of view.

Epilepsy in pregnancy

In every 1000 pregnancies, between two and five infants are born to women with epilepsy. For such women, pregnancy can be a time of anxiety over maternal and fetal wellbeing.
In 96% of pregnancies they will deliver a healthy child. However, some women will experience an increase in seizure frequency, which can be harmful for the mother or fetus, and evidence comes from observational study and registry data suggests some antiepileptic drugs are associated with an increased risk of congenital and neurodevelopmental abnormalities.
Michael Kinney, specialist registrar in neurology, and James Morrow, principal investigator of the UK and Ireland Epilepsy and Pregnancy Register, both based at the Royal Group of Hospitals in Belfast, join us to discuss how to manage epilepsy in pregnancy.
Read the review:
http://www.bmj.com/content/353/bmj.i2880
For information on joining the UK epilepsy and pregnancy register, call 0800 389 1248 or visit http://www.epilepsyandpregnancy.co.uk/

Caring for patients with delirium at the end of their life

Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. A clinical update explains why successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the end of life.
Kate Adlington, clinical editor at The BMJ, is joined by the authors of the paper - Christian Hosker, consultant liaison psychiatrist at Leeds and York Partnership Foundation Trust, and Michael Bennett, professor of palliative medicine at the University of Leeds.
http://www.bmj.com/content/353/bmj.i3085