Medicine and Science from The BMJ

BMJ roundtable: How to fix out of hours care

The BMJ recently held a discussion between experts in the fields of general practice, emergency medicine, and paediatrics about the state of out of hours care in the UK, and crucially offered their vision for a better service.
Are children a special case, can urgent care ‘hubs’ be a silver bullet, is NHS 111 up to the job of triaging patients, do there enough clinicians involved in out of hours care, and are other countries doing a better job?
The state of out of hours care can best be described as ‘patchy,’ with some, even most, people receiving good and timely care although from a confusing plethora of different bodies - walk-in centres, urgent care centres, out of hours centres, telephone consultation and - that most recognisable of all NHS brands - Accident and Emergency. But there are also very serious deficiencies attributed to core problems identified by our experts below.
Around the table were: Clifford Mann, president of The Royal College of Emergency Medicine and an emergency medicine consultant in Taunton in Somerset; Neena Modi, professor of Neonatal Medicine in the Imperial College, London and president of Royal College of Paediatrics and Child Health; and Professor Martin Roland, professor of Health Service Research at the University of Cambridge and who has 35 years experience as a GP.
Read the write up:

Bad with names

It's bad practice to prescribe a brand name drug when a cheaper, viable and approved generic is available. But, particularly in the US, this happens too much, at major cost to the health system.
The team behind Michigan State University's paediatric clinics set out to increase their prescribing of generics, and found that much of the problem was that whilst brand names lodged in staff and patient's minds, generic names were easily forgotten.
Sath Sudhanthar, paediatrician and assistant professor in paediatrics, and Kari Chandler, nurse manager, tell Harriet Vickers how they overcame this and tripled the team's generic medication prescription rate.
Read their full report: http://qir.bmj.com/content/4/1/u209517.w3931.full

”The harm and the benefit of treatment is about the same” - cardiac screening for athletes

Sudden cardiac death of young athletes needs to be avoided but does screening really help? Hans Van Braband, researcher at the Belgian Health Care Knowledge Centre, joins us to explain that the evidence for screening doesn't show benefit, and may lead to harm.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i1156

Doctors in spaaaaaace

Sheyna Gifford has an unusual claim to fame—she is the first doctor ever to work on Mars. Not the planet Mars, of course, but Mauna Loa, a volcano in Hawaii, whose dusty, rust coloured landscape is probably the closest on earth to the red planet. She is serving on the Hi-Seas programme, a mission run the University of Hawaii and funded by NASA, whose purpose is to simulate a three year voyage to Mars and back.
Since last August Gifford and six other scientists have been living in a 1000 square foot solar powered dome, which they rarely leave. The project is treated as a real mission to Mars so the crew have all the supplies for their year long stay and, because of the time delay between Mars and Earth, they cannot speak to the outside world. They can, however, communicate by email, so Sheyna sent The BMJ this voice file to answer 15 of our questions.
Questions: Anne Gulland
Copyright: Sheyna Gifford, MD, 2016.

The pattern of damage caused by Zika virus in the brains of 23 foetuses

In February World Health Organization (WHO) declared the microcephaly epidemic in South America an international public health emergency. Today, the US Centers for Disease Control and Prevention, the CDC, has confirmed that it’s is Zika virus which is causing that microcephaly. 
The outbreak was originally spotted in Recife, in Brazil, and it’s from there that the authors of this research paper have been carrying out imaging of the skulls of babies born with microcephaly and probable Zika virus infection - to establish patterns of damage in the brain.
We're joined by Maria de Fatima Vasco Aragao, professor of radiology and scientific director of Multimagem Radiology Clinic, Recife. Also, Vanessa Van Der Linden, paediatric neurologist and clinic director of Association for Assistance of Disabled Children Recife.
Read the full research:
http://www.bmj.com/content/353/bmj.i1901

”What’s the point in living, in a body I don’t want” - how the NHS treats trans people

James Barrett, president of the British Association of Gender Identity Specialists, and Nina, a trans woman, join us to discuss how difficult it can be for trans people to access gender clinics, and what barriers are faced by the community after their transition has been completed.
Read James Barrett's personal view:
http://www.bmj.com/content/352/bmj.i1694

Budget decisions can decrease alcohol deaths in less than 18 months

Alcohol consumption has been a perennial problem, but recently The economic downturn and rises in alcohol taxation seem to have stemmed the persistent rise in associated mortality.
Nick Sheron, head of clinical herpetology at Southampton university, and one of the authors of an analysis article, explains how government fiscal policy has the ability to immediately reduce alcohol related deaths.

Why the junior doctors are striking again

Abi Rimmer, BMJ Careers reporter, talks to junior doctors on the picket line at Northwick Park Hospital.
Read her report:
http://bmj.co/1qydmFq

Greenwing cast explain why they’re with the junior doctors

Abi Rimmer, BMJ careers reporter, talks to the cast of hospital comedy Greenwing, who explain why they're supporting junior doctors on the picket line.
Read her report:
http://bmj.co/1oJ2W41

Plan, do, study, act

Plan, do, study, act cycles, or PDSA cycles, are the basis of many quality improvement projects, they're a model to trial changes and feed the lessons from each test into the next.
Why are they a popular method, and how do you get the best out of them? And what on earth happens when they explode?
Harriet Vickers asks Julie Reed, National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for north west London.
Read all of Julie's paper (for free): http://qualitysafety.bmj.com/content/25/3/147
Check out BMJ Quality: http://quality.bmj.com