bmj.com:

Print issue

This week

Is slow walking speed in elderly people associated with vascular mortality? The health department and the NHS: time to break free? Are the Conservatives serious? To find out more about this week's BMJ print issue, read Trish Groves's editor's choice, The power of stories, and the print issue's table of contents. All articles have already appeared on bmj.com as part of our continuous publication policy.

Podcast

End of life

In the UK, death is a subject we steer clear of. Talking with a patient about the end of their life is uncomfortable, but necessary. A recent report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) entitled Caring to the End has highlighted why this conversation needs to improve. We hear from David Mason, one of the clinical coordinators for the report, about its findings. Also this week, when end of life care hits the headlines it is almost inevitably about assisted dying. We hear about times when doctors in Switzerland or the Netherlands help a patient to die, but what about when they refuse? Roeline Pasman and Dick Williems join us to discuss their study into the ways in which patients' ideas of unbearable suffering may differ from their doctors' ideas.

Video

Remembering John Crofton

John Crofton has died at the age of 97. He pioneered the randomised controlled trial in a 1948 BMJ paper that looked at the antibiotic streptomycin to treat tuberculosis. Earlier this year he participated in a BMJ film to promote its online archive now being searchable back to 1840. In this short film, he talks to Colin Blakemore about the importance of randomisation and blinding, and how it has helped to make medicine more evidence based.

Comment

Head to head: Should the NHS strive to eradicate all unexplained variation?

Variation exists in all aspects of health care. But should the NHS strive to eradicate all unexplained variation? Yes, says Stephen Richards, it is damaging to both quality of care and finances. No, says Richard Lilford, imposing uniformity risks stifling medical progress.

Education

A woman with acute myelopathy in pregnancy: take part in the debate

This case progression is the second of a three part case report where we invite readers to take part in considering the diagnosis and management of a real patient using rapid responses on bmj.com. In three weeks' time we will report the outcome and summarise the responses.

Read part 1, case presentation, and submit rapid response.

News

Private company suspended from providing out of hours services while concerns investigated

An out of hospital service run by an independent private provider has been suspended after concerns over several serious incidents, including the death of an elderly patient. NHS London, the strategic health authority for the capital, has suspended until further notice the service run by Clinicenta in north London and is carrying out a full investigation into the services, which were suspended on 11 November.

More news published on 20 November:

Trust faces prosecution over death of patient who was given the wrong drug after birth of son

Education

Safety alerts from the National Patient Safety Agency

In the opening article of a new BMJ series, Tara Lamont and colleagues from the National Patient Safety Agency (NPSA) explain how the agency attempts to combine the "power of stories" in the individual incident with evidence from the NPSA's error reporting system: "Without numbers, stories are just anecdotes, but without stories, numbers are just dry statistics." But how many doctors see the many rapid response reports sent out by the NPSA to NHS organisations or visit its website and database of nearly four million incidents? Too few, we suspect. Hence this series. The first actual safety alert in the new series is about midazolam, an intravenous drug widely used for conscious sedation of patients for endoscopy, minor surgery, and dentistry.

Research

School closures and work absence will affect UK economy most during flu pandemic

School closures and absence from work are likely to have more impact on the UK economy during a flu pandemic than the disease itself, regardless of its severity according to this study. In the accompanying editorial, Alan Maynard and Karen Bloor say that the current outbreak of swine flu has already been costly, in terms of substantial advance purchases of costly treatments and vaccines, and payments to GPs to provide them. But if these investments are effective, and the spread of the disease is restricted, significant financial benefits may result.

Research

Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores

These new algorithms can predict risk of fracture in primary care populations in the UK without laboratory measurements and are therefore suitable for use in both clinical settings and for self assessment . QFractureScores could be used to identify patients at high risk of fracture who might benefit from interventions to reduce their risk.

Endgames

Endgames is the BMJ's free interactive quiz to help doctors prepare for their postgraduate examinations. Questions are made up of case reports and picture quizzes, providing you with a practical and quick revision tool on common topics rather than clinical rarities.

This week's Endgames articles:

Picture quiz: An unusual cause of acute renal failure

Statistical question: Random allocation I

OnExamination quiz: Acute abdomen

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