Comment
Can the NHS cut costs while improving care?
The recent financial crisis and subsequent economic recession have placed healthcare systems in most parts of the world under extreme pressure. In the NHS it's estimated that savings of over £20bn need to be made in the next few years. But can the NHS save money while maintaining and improving the quality of care? This cluster of articles discuss the issue.
Comment
Iona Heath: Do not sit on the bed
"I learnt recently from senior nursing colleagues that sitting on a patient's bed, by either visitors or clinicians, is now prohibited, apparently in the interests of infection control. My immediate reaction is to thank all my lucky stars that I have been able to spend my career in general practice, where flowers are still welcome and sitting on the patient's bed positively encouraged," writes Iona Heath.
More comment published on 16 March:
News
Universal access to HIV treatment will not be achieved by 2015 without radical action
Despite international commitment to achieving universal access to treatment for HIV, 10 million infected people still lack access to antiretrovirals, and the goal will not be achieved unless decisive measures are taken to revitalise the process, the United Kingdom's international development minister, Gareth Thomas, said last week.
News published on 17 March:
- National laws must be improved to protect children against violence, UN says
- Interventions aimed at helping indigenous people in Australia could worsen problems
- New deal would see 50% more elderly people in England helped with costs of social care
- NHS, not police, should be responsible for medical examination of rape victims
- Government has failed to improve dementia services as promised, report says
- European governments agree to tackle environmental threats to health
- More than a third of the world's population lacks basic sanitation
Research
Sutures versus staples for skin closure in orthopaedic surgery
After orthopaedic surgery, the risk of developing a wound infection is significantly higher when the wound is closed with staples rather than sutures, particularly in patients who have hip surgery. The use of staples for closing hip or knee surgery wounds after orthopaedic procedures can therefore not be recommended, though the evidence comes from studies with substantial methodological limitations, say the authors of this meta-analysis of controlled trials. The accompanying editorial says that, staples are quicker than sutures, but may increase complications.
More research published on 16 March:
Research
Epidemiology of rib fractures in older men
Rib fracture was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture in the Osteoporotic Fractures in Men (MrOS) prospective cohort study. A history of rib fracture predicted more than double the risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture, say the authors.
Research
Effect of revaccination with BCG in early childhood on mortality
This randomised controlled trial including 2871 children aged 19 months to 5 years in Guinea-Bissau found no overall beneficial effect of revaccinating participants with BCG. The effect of BCG revaccination on mortality might depend on other health interventions, say the authors. The accompanying commentary points out that the trial's lack of a data monitoring committee and formal stopping rules is scientifically and ethically problematic and that the multidimensional vulnerability of trial participants in developing countries renders the need for such oversight more pressing. And the accompanying editorial reminds us that attention needs to be paid to important interactions with other vaccines, vitamin A, and the organisms that cause fatal pneumonia.
Education
Prevention and medical management of Clostridium difficile infection
The incidence of Clostridium difficile infection in the United Kingdom has increased since the late 1990s. High profile outbreaks in the United States, Canada, and northern Europe have been associated with a previously uncommon but highly virulent strain. This clinical review focuses on the prevention and medical management of C difficile and concludes that many cases could be prevented by prudent antibiotic prescribing and vigorous infection control measures, which may also reduce other healthcare associated infections and limit the spread of multiresistant organisms. More data are urgently needed on the management of refractory, fulminant, and recurrent disease, say the authors.
Other recent education articles:
Careers
Revalidation
The General Medical Council (GMC) rolls out its consultation on revalidation this month, giving doctors a say on the "biggest change in regulation for 150 years", as the council puts it. Doctors know that revalidation will happen, they know it's happening soon, and they know it will examine their fitness to practice. But beyond that, the details are pretty sketchy for most. This week BMJ Careers publishes three articles on the theme: a GMC briefing on its consultation, an interview with the GMC's new chief executive, Niall Dickson, and an opinion piece from a locum GP.
Student BMJ
Wanted: student editor for Student BMJ
Would you - or a medical student you know - like to learn how to edit the Student BMJ? The job involves all aspects of publishing the award winning international magazine for medical students online and in print, including commissioning, peer reviewing, and editing articles. You should have some clinical experience, excellent written English, and some experience of writing or editing. The job is based at our London offices for a year starting this May and attracts the salary of a first year NHS house officer. Find out how to apply here.
doc2doc
Dealing with the worried well
The Times reported this week that: "The worried well are putting the NHS under unsustainable pressure by seeing their GPs for coughs, colds and other minor ailments that they should be treating themselves." Should these patients be treated by primary care doctors? Should there be better primary care triage? Or do all patients deserve to see doctors, despite their 'well' status? And what if something serious was dismissed as a worried well complaint? Would it lead to more clinical negligence claims?
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