The BMJPub Date : 2024-11-25DOI: 10.1136/bmj.q2614
Limon K Nahar, Rebecca Andrews, Sue Paterson
{"title":"Deadly nitazenes: a 2024 update","authors":"Limon K Nahar, Rebecca Andrews, Sue Paterson","doi":"10.1136/bmj.q2614","DOIUrl":"https://doi.org/10.1136/bmj.q2614","url":null,"abstract":"In September 2024, deaths from drug overdose in the US fell for the first time since the opioid epidemic.1 But in England and Wales, drug related deaths increased in 2023 to the highest level since 1993,2 with just under half involving an opioid.3 In England, we have seen a sharp rise in deaths involving nitazenes, a group of potent synthetic opioids. These compounds are being found in street heroin and cocaine, seized powders, counterfeit …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"119 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-25DOI: 10.1136/bmj-2022-072501
Alok Godse, Yincent Tse, Abosede Kokumo, Christian Harkensee
{"title":"Haematuria in children","authors":"Alok Godse, Yincent Tse, Abosede Kokumo, Christian Harkensee","doi":"10.1136/bmj-2022-072501","DOIUrl":"https://doi.org/10.1136/bmj-2022-072501","url":null,"abstract":"### What you need to know A 12 year old boy presented with a history of recurrent frank haematuria. He reported three or four episodes in the past three months, with each episode quickly fading after a couple of days. On detailed questioning, he revealed that, during each episode, he experienced transient mild dysuria, urinary frequency, urgency, and central abdominal discomfort. Abdominal examination revealed no tenderness, his foreskin was retractable, and no meatal inflammation or excoriation was visible. In clinic his urine looked clear yellow with no visible blood. Urine dipstick revealed 3+of blood. Visible haematuria (macroscopic) is visible bloody discoloration of urine. With easy availability of urine dipstick tests, the incidental discovery of persistent (defined as more than 6 months) non-visible haematuria (microscopic haematuria or NVH) may also occur. Visible haematuria is rare, and its incidence is unknown, whereas non-visible haematuria has been found in up to 5% of school children on mass screening in Asian schools,12 with up to 0.5% persisting three to six months later. Unlike in adults, underlying malignancy as a cause of haematuria in children is extremely rare (<0.1%).345 Although the underlying cause cannot be determined by whether the haematuria is visible or non-visible, isolated non-visible haematuria is most commonly idiopathic, whereas visible haematuria may stem from the kidney (such as IgA nephropathy or autoimmune disease) or the urinary tract (such as posterior urethritis, urinary tract stones, balanitis, or urinary tract infection46). It would, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-25DOI: 10.1136/bmj.q2573
Dermot Ryan
{"title":"Following guidelines: don’t ignore evidence based medicine","authors":"Dermot Ryan","doi":"10.1136/bmj.q2573","DOIUrl":"https://doi.org/10.1136/bmj.q2573","url":null,"abstract":"Guidelines are not only hard to swallow1 but impossible to use. Most guidelines are for single conditions, but most patients over 60 have a multiplicity of conditions. Were we to “follow the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-25DOI: 10.1136/bmj.q2630
Adele Waters
{"title":"Robert Geoffrey Twycross: palliative care physician, pioneer of the modern hospice movement, and staunch opponent of assisted dying","authors":"Adele Waters","doi":"10.1136/bmj.q2630","DOIUrl":"https://doi.org/10.1136/bmj.q2630","url":null,"abstract":"As befitting someone whose life’s work was to enable patients to have a good death, Robert Twycross had mapped out his own to the last detail. Every aspect of his funeral was planned. The day before he died he was dictating messages to publishers about a forthcoming textbook. He had even told one of his daughters the day he was most likely to die—and he was right. More importantly, says his eldest daughter Alison Twycross, who was with him as he died, his final hours were as he would have advocated. “Dad died very peacefully in a way that I wish everyone could achieve,” she said. “He was ready. He was at home, pain free, and his family were around him—it was a good death.” Apart from Cicely Saunders, founder of the modern hospice movement, “I don’t think there has been anyone else that has made such a sustained and major contribution to palliative care,” said Andew Wilcock, long term mentee, writing partner, and friend. “He leaves a profound legacy that continues to influence how end-of-life care is provided around the world. Countless numbers of patients and their families …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"256 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-25DOI: 10.1136/bmj.q2597
Erin Dean
{"title":"Training shouldn’t be purgatory: the consultant cardiologist","authors":"Erin Dean","doi":"10.1136/bmj.q2597","DOIUrl":"https://doi.org/10.1136/bmj.q2597","url":null,"abstract":"When choosing to specialise in cardiology, Rob Egdell worried that he was taking the easy route as he enjoyed it so much “I dabbled with lots of other complicated things, but always came back to cardiology,” says Rob Edgell. “I was worried that something I enjoyed and found straightforward might get boring. But if you enjoy it, you do it with vigour and energy, and you’re fulfilled by it.” That he made this choice is clearly a relief to the consultant cardiologist at East Cheshire NHS Trust in Macclesfield—he has loved caring for cardiac patients ever since. It also prompts him to recommend to resident doctors that they choose a specialty they enjoy. “Even when you’re focused on the end game of becoming a consultant or a GP, training is a long process and you can’t really go through it as a sort of period of purgatory,” he advises. “You have to enjoy what you’re doing or life feels miserable, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-25DOI: 10.1136/bmj.q2594
Kwaku W Baryeh
{"title":"Doctors need training to become good leaders","authors":"Kwaku W Baryeh","doi":"10.1136/bmj.q2594","DOIUrl":"https://doi.org/10.1136/bmj.q2594","url":null,"abstract":"Oliver emphasises the benefits of having clinicians in leadership and management positions.1 There is evidence that people with expertise in the core business of an organisation in leadership positions create better outcomes than non-experts.23 I agree with Oliver that attacking those who take up these roles is unhelpful, but we must explore why this happens. There is a perception of a “clinician versus manager” atmosphere in the NHS. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-22DOI: 10.1136/bmj.q2606
Nigel Edwards, Mark Dayan
{"title":"League tables for the NHS","authors":"Nigel Edwards, Mark Dayan","doi":"10.1136/bmj.q2606","DOIUrl":"https://doi.org/10.1136/bmj.q2606","url":null,"abstract":"Measures of performance need to be meaningful The secretary of state for health and social care, Wes Streeting, has announced NHS league tables to guarantee “no more rewards for failure” in UK healthcare.1 Under the plan, the worst performing hospitals would have turnaround teams installed and managers sacked, while the best would have more freedom to invest capital.2 This package of measures mirrors the policy approach of the early 2000s. A wealth of evidence from that period suggests this is no easy fix.3 Designing a ranking that is fair and accurate for organisations as huge and complicated as NHS trusts is difficult. Star ratings in the 2000s saw repeated cycles of a crisis of confidence before major revisions and improvements were made.4 Goodhart’s law states that once a measure becomes a target, it stops being a good measure, as managers find ways to hit the target without making anything better.5 Ambulance trusts under star ratings would delay starting the clock for waits and recategorise calls so that standards were …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"188 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-22DOI: 10.1136/bmj.q2617
Louise Holly
{"title":"Tackling digital harms: why simply banning children from social media won’t protect them","authors":"Louise Holly","doi":"10.1136/bmj.q2617","DOIUrl":"https://doi.org/10.1136/bmj.q2617","url":null,"abstract":"We need to redesign social media and other digital platforms so that these spaces are safer and healthier, writes Louise Holly Across the globe, countries are grabbling with how to shield children from the dangers of the digital world. One idea is to prevent children from accessing the most harmful digital spaces. Australian has just introduced a bill to parliament proposing to ban children under 16 from using social media.1 If passed, it would make Australia the first country in the world to have such strict legislation. Mitigating the physical and mental health risks posed by digital platforms is an urgent public health priority that governments need to engage with, but limiting children’s online participation will not tackle the root causes of these harms. Australia’s proposed law will make it illegal for anyone under 16 to have a social media account and wouldn’t have exemptions for parental consent. Companies such as Meta, ByteDance, and Google will be responsible for checking that users are not under 16 and could face penalties if they fail to comply.2 If the law is passed, it wouldn’t take effect for over a year, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-22DOI: 10.1136/bmj.q2627
Jeffrey K Aronson
{"title":"When I use a word . . . Academic fraud—plagiarism","authors":"Jeffrey K Aronson","doi":"10.1136/bmj.q2627","DOIUrl":"https://doi.org/10.1136/bmj.q2627","url":null,"abstract":"Of the various types of academic misdemeanours and felonies, perhaps plagiarism is the most difficult and complex to study and write about. Even defining it is difficult. The US Office of Research Integrity (ORI) defines plagiarism as “the appropriation of another person's ideas, processes, results, or words without giving appropriate credit,” but how do you define when it has occurred? What are the quantitative and qualitative thresholds? What are the different types of plagiarism? Why does plagiarism occur? How does one detect it? What is self-plagiarism and should we even call it that? There is an enormous literature on the subject and it needs to be tamed; an annotated bibliography would help, if anyone would create one. Perhaps they already have? The third member of the academic felonies trio, after fabrication and falsification, which I have previously discussed,12 is plagiarism. It may not seem obvious, but the origin of the word “plagiarism” is buried in the hypothetical IndoEuropean root PLĀK, meaning flat. The Greek word πλάξ meant a flat plate, from which we get “placoid” an adjective referring to the type of scale that covers certain cartilaginous fishes, of the order Placoidei, including sharks and rays, now known as Elasmobranchii, ἐλασμός being a beaten out metal plate. Another group of fishes, now extinct, with flat bony plates encasing the head and thorax, went under the name of placoderms. Other flat words that come from the same root include placenta, which in Latin meant a flat cake, and leukoplakia, the flat white precancerous patches that are sometimes seen covering mucous membranes, typically in parts of the mouth and on the vulva, where it is also called lichen sclerosus or kraurosis vulvae (Greek κραῦρος brittle, dry); in men it can affect the penis, when it is known as balanitis xerotica …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJPub Date : 2024-11-22DOI: 10.1136/bmj.q2621
Daniel Sokol
{"title":"Acts of dishonesty: why medical students should think twice before acting unethically","authors":"Daniel Sokol","doi":"10.1136/bmj.q2621","DOIUrl":"https://doi.org/10.1136/bmj.q2621","url":null,"abstract":"The temptations of doctors to act inappropriately are many and well documented. They include, among others, the temptation to put financial gain before patient wellbeing, to cut corners to reduce workload, to cover up errors for self-preservation, to speak ill of patients and colleagues in moments of frustration, and to engage in improper relationships with patients. Far less discussed are the temptations towards wrongdoing of medical students which, although usually less dramatic in nature, are nonetheless rife. Medical students are for the most part high achieving students, accustomed to success and in fear of failure. At medical school, they tend to have one overriding goal, which is to pass their exams and qualify as doctors. The desire to pass is so intense that it leaves them prone to the temptation of wrongdoing in order to secure a pass. As an example, solely from the domain of dishonesty, I have had medical students tell me of the following …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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