Print issue
This week
How should alopecia areata be managed? Should we screen for breast cancer? How delirium be treated and diagnosed? To find out more about this week's BMJ print issue, read Fiona Godlee's editor's choice, "Breast screening and other fights," and the print issue's table of contents. All articles have already appeared on bmj.com as part of our continuous publication policy.
News
Government drops plans to extend smoking ban in England
The UK government has dropped a planned review of England's smoking legislation that might have extended the ban on smoking in public places. Specialists in the subject have expressed their disappointment at the decision, saying they had hoped that the government would go further and extend smoke-free legislation to include public places frequented by children and to prohibit all smoking in cars and other vehicles.
Other news published on 30 July:
Effect of calcium supplements on risk of myocardial infarction and cardiovascular events
Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted. In a linked editorial, John Cleland and colleagues write that patients with osteoporosis should generally not be treated with calcium supplements, either alone or combined with vitamin D, unless they are also receiving an effective treatment for osteoporosis for a recognised indication.
Comment
More brickbats than bouquets?
We asked a range of commentators from clinicians to academics to comment on the white paper on health Equity and excellence: liberating the NHS. Has the NHS become "a huge laboratory for some dodgy experiments," in the words of one commentator; will the white paper divide the medical profession, as another claims; or will it simply empower doctors? To see all BMJ Group articles about the white paper, including blogs, podcasts, and doc2doc discussions, visit doc2doc.bmj.com/whitepaper
More comment published on 29 July:
- Dabigatran etexilate in people with atrial fibrillation
- Analysis: Shifting views on lipid lowering therapy
- Theodore Dalrymple: Loveless oblivion
- Review of the week: And the beats go on
- Des Spence: Doc holiday
- Personal view: The perils of being a doctor in Baghdad
- James Owen Drife: Doctors of mirth
- Medical classic: Memento Mori
Research
The clinical importance of white matter hyperintensities on brain MRI
White matter lesions, appearing as hyperintensities on T2 weighted magnetic resonance imaging, predict an increased risk of stroke, dementia, and death, according to this systematic review and meta-analysis. They may indicate an increased risk of cerebrovascular events when identified incidentally as part of diagnostic investigations, and might be used as an intermediate marker in research. The accompanying editorial agrees that their discovery should prompt detailed screening for risk factors of stroke and dementia.
Other recently published research:
Comment
Improving productivity in the NHS
The economic crisis with its projected effect on the NHS may be what is needed to motivate effective solutions to the inefficiency of practice variation, writes Albert Mulley. But with the stakes so high, it would be best if policy makers, health professionals, patients, and the public united to confront practice variation, he says.
Endgames
This week's instalment of our weekly educational clinical quiz is now live. Compiled from peer reviewed contributions from readers, it covers clinical medicine and statistics. There's also a prize quiz, pulled from the BMJ's sister product OnExamination.
This week's Endgames articles:
Education
Diagnosis, prevention, and management of delirium
Although delirium is common in general hospitals and care homes, it is often poorly recognised. John Young and colleagues summarise the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) guideline on how to recognise, prevent, and treat delirium.
Education
Management of alopecia areata
In this clinical review, M J Harries and colleagues look at the evidence for the management of alopecia areata and discuss which treatments may help patients. They also highlight potentially interesting new treatments that require further investigation. They conclude that researchers now need to focus on long term outcomes and clinically meaningful end points (such as quality of life measures) to identify the best strategies for treating alopecia.
More education published 27 July:
Community
Discuss the NHS white paper on doc2doc
The NHS white paper for England was published recently, signalling a revolution in GP commissioning and an end to strategic health authorities and primary care trusts. Discuss the white paper on doc2doc, BMJ Group's clinical community for doctors worldwide. Log in or register to read and join in the latest discussions, including clinical topics posted in forums that can only be accessed by verified doctors. doc2doc clinical editor Sabreena Malik's favourite posts today include:
- Physician assisted suicide and Tony Nicklinson
- Evidence and the art
- Condoms and the Catholic church
- Hype curves in medicine: can we escape them?
Read these and other forums on doc2doc, BMJ Group's global clinical community
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