Medicine and Science from The BMJ

This house believes that medicine is the best career in the world.

Medicine has long been a rewarding career, but doctors say the profession needs to overcome the frustrations of working in the NHS to ensure it remains so.
During the Big Debate at BMJ Live in London last week six speakers argued for and against the motion, “This house believes that medicine is the best career in the world.” After presentations from the six speakers and questions from the floor, the audience voted in favour of the motion.
Arguing the motions are:
Jennie Watson, medical student, Imperial College (for)
Janis Burns, junior clinical fellow, Royal Brompton and Harefield NHS Foundation Trust (against)
Helgi Johannsson, anaesthetic consultant, Imperial College Healthcare NHS Trust(for)
Pete Deveson, GP, Epsom, Surrey(against)
Clare Gerada, medical director, Practitioner Health Programme(for)
Partha Kar, diabetes and endocrinology consultant, Portsmouth Hospitals NHS Trust(against)
edit: To see Pete Devesons slides - check out https://www.youtube.com/watch?v=cfRezS1dZJY

Diagnosis and treatment of diabetic ketoacidosis in adults

Shivani Misra, clinical research fellow and specialist trainee in metabolic medicine from Imperial College London, joins us to discuss diagnosis and management of diabetic ketoacidosis in adults. She talks us through UK and US guidelines, and explains what the latest evidence tells us about prescribing fluid and insulin.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h5660

Europe’s impending syrup tsunami

Europe's common agricultural policy (CAP) on sugar is due to change, and Emilie Aguirre, from the UKCRC Centre for Diet and Activity Research at the University of Cambridge, argues that an influx of cheap high fructose corn syrup (HFCS, isoglucose) into the European market will have a negative effect on on the health of the continent.
Read the full analysis here:
http://www.bmj.com/content/351/bmj.h5085

Mark Britnell - You have to value your workforce

“The people of the UK are right to treasure their NHS,” writes Mark Britnell in his new book In Search of the Perfect Health System (Palgrave Macmillan). Currently chairman of KPMG Global Health, Britnell has worked in healthcare systems in over 60 countries. For his book he analysed 25 healthcare systems in search of what was working and what wasn’t in times of challenging demographic and economic change. He doesn’t find perfection, but against the others the NHS measures up pretty well.
Buy the book:
http://www.amazon.co.uk/In-Search-Perfect-Health-System/dp/1137496614

The junior doctor protest

Thousands of NHS staff have demonstrated against the government’s threatened “imposition” of an “unsafe and unfair” contract for junior doctors.
At a London rally on Saturday 17 October junior doctors and supporters noisily defended their trade union, as speakers accused England’s health secretary, Jeremy Hunt, of misleading the public about research evidence on weekend mortality rates in hospitals and the nature of contract negotiations.
Matt Limb was there for the BMJ, finding out why junior doctors are so angry.
Read more:
http://www.bmj.com/content/351/bmj.h5572

Are new diabetes drugs approved too easily?

Given the number of effective treatments for type II diabetes, which have good evidence about safety and efficacy, should any new drugs for the condition be subject to a higher regulatory bar?In this podcast, Huseyin Naci from the London School of Economics, John Yudkin from Univerity College London, and Ben Goldacre from the University of Oxford, explain why they believe the current process is inadequate, and suggest some ways in which it could be improved.Read the full analysis article:http://www.bmj.com/content/351/bmj.h5260

Is place of death important to patients?

The current orthodoxy is that home is the best and preferred place of death for most people, but in this podcast, Kristian Pollock a sociologist from Nottingham University questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere.
Read the full analysis:
http://www.bmj.com/content/351/bmj.h4855

Why do the Scottish do fewer knee arthroscopies?

The “correct” rates of discretional interventions are difficult to define. However, David Hamilton and Colin Howie point out that discrepancies in usage of knee arthroscopy within the UK suggest the organisation of the care pathway may be an important determinant
Read their full analysis:
http://www.bmj.com/content/351/bmj.h4720

Cardiac rehab

With improved survival and and ageing population, the number of people living with coronary heart disease in the UK has increased to an estimated 2.3 million. There is increasing evidence that cardiac rehabilitation benefits these patients, and as such it has been included in international clinical guidelines.
To discuss cardiac rehabilitation in this podcast, we're joined by Hasnain Dalal, a GP and honorary clinical associate professor at the University of Exeter Medical School, Rod Taylor, academic lead for Exeter Clinical Trials Support Network and NIHR senior investigator, and Jenny Wingham, a senior clinical researcher in cardiac rehabilitation.
Read the full clinical review online:
http://www.bmj.com/content/351/bmj.h5000
Listen to our podcast with a patient who's been through cardiac rehabilitation: https://soundcloud.com/bmjpodcasts/cardiac-rehab-patient

What it’s like to receive cardiac rehabilitation

With improved survival and and ageing population, the number of people living with coronary heart disease in the UK has increased to an estimated 2.3 million. There is increasing evidence that cardiac rehabilitation benefits these patients, and as such it has been included in international clinical guidelines.
​In this podcast, we're joined by Kevin Paul, who explains what it's like to receive cardiac rehabilitation, and what doctors should be aware of when they recommend it to patients.
Read the full clinical review online: http://www.bmj.com/content/351/bmj.h5000