The BMJ最新文献

{"title":"Helen Salisbury: Early warning scores and medicine by numbers","authors":"Helen Salisbury","doi":"10.1136/bmj.q2484","DOIUrl":"https://doi.org/10.1136/bmj.q2484","url":null,"abstract":"“Do you remember that child you saw two days ago?” All doctors dread what might come next: we fear that something bad has happened because we missed a clinical sign or made a poor judgment. This kind of worry keeps us all alert, even at the end of a busy day as the duty doctor. Hospitals have developed scoring systems to help medical and nursing staff gauge how sick a child is, and the Royal College of Paediatrics and Child Health has suggested that these should be rolled out in the community.12 There could be advantages not only in improving detection of children at risk of deterioration but also in shared understanding and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599445","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}

{"title":"We need to do more to keep antibiotics working","authors":"Ara Darzi","doi":"10.1136/bmj.q2491","DOIUrl":"https://doi.org/10.1136/bmj.q2491","url":null,"abstract":"Action to prevent antimicrobial resistance from escalating requires dedicated funding, accessible diagnostics, and public engagement, writes Ara Darzi Antimicrobial resistance (AMR) is one of the starkest public health challenges of our time. As bacteria evolve and develop resistance to treatment, antibiotics and other drugs become ineffective. This poses a threat that could reverse a century of medical progress. Without urgent action to keep antibiotics working, AMR could claim 39 million lives over the next 25 years.1 This threat looms over our clinical practice. Antibiotics are crucial to countless procedures, from cancer therapies to routine surgeries. But we are not adequately prepared to tackle this crisis, and the global response is not going far or fast enough. In September 2024, the United Nations issued a political declaration on AMR, securing a commitment from countries worldwide to confront the problem.2 This was an important step in the right direction. But to take meaningful strides, the international community must act urgently on three fronts: funding, diagnostics and public engagement. This month, global health leaders will …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599446","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}

{"title":"Rammya Mathew: GPs have to be able to request MRI scans for patients in primary care","authors":"Rammya Mathew","doi":"10.1136/bmj.q2472","DOIUrl":"https://doi.org/10.1136/bmj.q2472","url":null,"abstract":"At a recent clinical meeting, I heard that GPs local to me are about to lose the ability to request magnetic resonance imaging (MRI) scans for patients presenting with musculoskeletal symptoms. We’re instead advised to refer our patients to a musculoskeletal clinical assessment and triage service (CATS)—staffed largely by musculoskeletal advanced practitioners, who will assess our patients and determine whether imaging is warranted. The hope is that fewer patients will have unnecessary imaging and that this will reduce the potential harms of overdiagnosis. Radiologists rarely report musculoskeletal MRI scans as entirely normal, and it can …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600973","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}

{"title":"Child abuse, neglect, and exploitation of young people","authors":"Andrea G Asnes, Gunjan Tiyyagura","doi":"10.1136/bmj.q2364","DOIUrl":"https://doi.org/10.1136/bmj.q2364","url":null,"abstract":"Standardising practice can improve identification and reduce bias Even for the most experienced healthcare providers, recognising and evaluating suspected child maltreatment or exploitation is challenging. The pressure to make the correct diagnosis is extremely high. Failing to recognise maltreatment can result in the child experiencing severe harm or even death. Conversely, incorrect diagnoses of accidental injuries as abusive or misinterpretations of poverty as neglect may burden care givers and lead to subsequent mistrust in healthcare providers.1 Unwarranted investigations and subsequent referral to child welfare (social) services affect marginalised populations disproportionately, including children of black, Hispanic, and Aboriginal ethnicity, and visible minorities.23 Two education articles in The BMJ offer healthcare providers guidance to better identify child abuse and neglect and recognise young people experiencing criminal and sexual exploitation.45 They summarise the growing evidence base that should inform consistent, effective practice. Schwartz et al discuss screening using clinical decision rules such as the TEN-4-FACESp, which identifies region, age, and patterns of bruising that are more likely to be caused by abuse than accidental injury.46 Such tools have advanced the ability of busy frontline clinicians to identify injuries suggestive of child maltreatment, but they rely on providers’ ability to remember which bruises, and at what ages, are “high risk.” Also, a positive screening result does not mean that a child is certainly …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598110","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}

{"title":"Abortion dominant, but health sidelined: the road to Trump’s win","authors":"Joanne Silberner","doi":"10.1136/bmj.q2456","DOIUrl":"https://doi.org/10.1136/bmj.q2456","url":null,"abstract":"Donald Trump is the new US president after an ill tempered campaign that saw abortion dominate on the Democratic side but healthcare a minor part of the overall election discourse. Joanne Silberner reports on the medical issues that were debated—and what this may bode for the new president’s agenda The route to the US presidency this election season was a wild ride, marked by a relatively last minute change of candidates on the Democratic side, from incumbent president Joe Biden to his deputy Kamala Harris, and disinformation, misdirection, and odd statements by former president—now president elect—Donald Trump, the Republican candidate. Three weeks before voting day, Drew Altman, chief executive of the health policy research foundation KFF, wrote that this was not a “healthcare election.”1 Indeed, throughout the months long campaigning the only health topic that made it into the top tier for the presidential candidates was reproductive rights. Beyond that, the high price of prescription drugs and the limits of the health insurance system got occasional mentions. The candidates made some promises about reform of Medicare, the healthcare insurance scheme for over 65s and disabled people. And only the Democrats talked about Medicaid, the major scheme for people on low incomes. However, as Altman noted, healthcare costs formed a big part of the US public’s worries about the economy. And a Harvard Youth Poll of 18 to 29 year olds done in March found that healthcare was a key issue for them, rating higher than inflation, housing, gun violence, and jobs.2 Trump announced his plan to run again for the presidency in November 2022. His hour long speech mentioned healthcare once, in promising to “systematically” bring it back to “the American middle class and to America itself.” By July 2024, at the Republican National Convention, where Trump became …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598106","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}

{"title":"Why I . . . wrote my memoir","authors":"Kathy Oxtoby","doi":"10.1136/bmj.q2425","DOIUrl":"https://doi.org/10.1136/bmj.q2425","url":null,"abstract":"Ike Anya talks to Kathy Oxtoby about how he realised his dream of having a published memoir When Ike Anya was working his way through medical training in Nigeria his grandmother reassured him, “Everything worthwhile is achieved small by small.” Some 30 years later, Anya chose that saying as the title of his memoir. “You become a doctor ‘small by small.’ This Nigerian expression is also a lovely way of paying tribute to my grandmother,” says Anya, a consultant in public health medicine who works as a locum and is based in London. In his memoir, Anya recalls the achievements and failures of his student days and his first demanding year as a house officer while living in 1990s Nigeria during a time of political unrest, social change, and a worsening economy. Of the process of creating his memoir he says, “You have to be incredibly honest in your writing. I felt there would be no interest in a memoir that only paints a good picture.” You also have …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598107","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}

{"title":"Identification and management of child abuse and neglect","authors":"Sarah B Schwartz, Deborah Schonfeld, Payton Pederson, Frances Yeung","doi":"10.1136/bmj-2023-079054","DOIUrl":"https://doi.org/10.1136/bmj-2023-079054","url":null,"abstract":"### What you need to know Child abuse and neglect, collectively known as maltreatment, is common, and most healthcare providers who care for children will encounter some form of maltreatment in their practice.1 Common presentations include physical abuse, sexual abuse and commercial sexual exploitation of children, and neglect. In this article, we make recommendations for frontline healthcare providers on identifying child maltreatment and making evidence based assessments in primary care and emergency department settings. While presentations of maltreatment may be similar internationally, the subsequent investigation and management recommendations vary according to culture, legislation, income classification, and resources. We discuss broad principles with respect to recognition and subsequent escalation and reporting to child welfare authorities or social services, largely in keeping with North American and European settings. If raising concerns about a child’s welfare, we recommend all healthcare providers consult local laws and statutes in the first instance. Child maltreatment is the physical, sexual, and psychological/emotional abuse, and neglect of infants, children, and young people aged 0-17 years by parents, caregivers, and other authority figures, as defined by the World Health Organization (box 1).6 Emotional abuse and fabricated or induced illness in children are forms of child maltreatment, but beyond the scope of this article. Child maltreatment may present acutely or may be …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598165","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}

{"title":"Democratise and decolonise to decarbonise: how to reap health and climate benefits of transport infrastructure in Africa","authors":"Tolu Oni, Meelan Thondoo, Hastings Chikoko","doi":"10.1136/bmj.bmj-2023-076772","DOIUrl":"https://doi.org/10.1136/bmj.bmj-2023-076772","url":null,"abstract":"Tolu Oni and colleagues argue that building healthy low carbon transport infrastructure in Africa’s rapidly growing cities requires addressing historical contexts, confronting power imbalances, and claiming transport as a social good Africa is undergoing rapid urbanisation while facing growing climate vulnerabilities and a rising burden of non-communicable diseases. With global urban growth expected to be greatest in Africa and Asia,1 addressing the interlinked issues of health, climate, land use, and pollution is crucial for sustainable development. By 2030, the number of African cities with over half a million people is estimated to increase by 80%,2 putting pressure on housing, transport, and energy sectors. The transport sector is important for development and economic progress, influencing environmental (noise and air pollution, green and blue spaces), economic (employment, household income), and social (education, social network) factors. It can facilitate access to livelihoods, education, and social connectedness but has historically been associated with negative impacts on health and climate. Positive changes are emerging across the African region towards healthier and low carbon transport systems, with increasing emphasis on safe non-motorised travel such as walking and cycling, alongside robust mass transport systems. Although transport has a crucial role in facilitating mobility for human and economic development, conceptualisation of efficiency needs to move away from the extractive and exploitative movement of goods and people to prioritise health and climate resilience. This reframing should consider the historical context, power dynamics, and the unique characteristics of the continent’s mobility ecosystem. Despite having the lowest car ownership per capita, Africa has the highest traffic related deaths in the world.3 Motor vehicle emissions account for 90% of urban air pollution in sub-Saharan Africa, causing ill health and death.4 The transport sector in Africa is estimated to cause more deaths than AIDS, tuberculosis, and malaria combined.5 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598108","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}

{"title":"Identifying young people who are experiencing criminal and sexual exploitation","authors":"Rosemary Roberts, Zaynab Chatoo, Hannah Jacob","doi":"10.1136/bmj-2024-079497","DOIUrl":"https://doi.org/10.1136/bmj-2024-079497","url":null,"abstract":"### What you need to know James is a 16 year old boy who lives in a residential (children’s) home. Over the past two months, he has regularly gone missing, returning with new clothes and a new smartphone and laptop. He has been dropped off by different cars late at night. His reluctance to offer explanations for his absences and new possessions raised concerns among care workers. He presents to the emergency department with an arm injury and is found to have a fracture. He seems withdrawn and provides only limited details about how the injury occurred. He is in a rush to leave and hesitant to stay for review by the orthopaedic team, saying that his friend is waiting for him outside. Exploitation of young people is an important public health concern. In England and Wales, it occurs across all parts of the country, with more than 17 000 crimes related to child sexual exploitation reported yearly, and at least 27 000 young people at risk of exploitation by criminal organisations.12 The numbers affected increase each year; 10% more in 2022 than in 2021.2 As with other crimes, rates are likely underestimated, and this type of abuse is under-recognised and underreported.34 Because of this, and a lack of a gold standard definition, estimating global prevalence is difficult.5 Recent estimates suggest 300 million children are victims of online sexual exploitation and abuse, meaning the total number affected by any form of criminal and sexual exploitation will be even greater.6 There is …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598104","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}

{"title":"Quality care is needed for older people with diabetes in care homes—now and for the future","authors":"Martin Scivier","doi":"10.1136/bmj.q2471","DOIUrl":"https://doi.org/10.1136/bmj.q2471","url":null,"abstract":"We need to improve carers’ skills in diabetes management and technology, writes Martin Scivier As an older person living with diabetes, I am apprehensive about the current and future care of older people with diabetes in UK nursing and residential care homes. This is an area that has been neglected over the years.1 It worries me that I may have to rely on untrained carers who may not fully understand my personal diabetes management, especially use of diabetes technology. I fear my diabetes could be poorly managed and controlled because of staff members’ lack of knowledge. There is an urgent need to ensure safe, quality care for older people with diabetes in care homes and to improve carers’ skills in daily diabetes management and the use of diabetes technology. Over a third of the 5.6 million people with diabetes in the UK are over the age of 65.23It is likely that because of the complications of aging they may need to be cared …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599443","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}