Editor's Choice

Education with an angle

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1548 (Published 16 April 2009) Cite this as: BMJ 2009;338:b1548
  1. Jane Smith, deputy editor, BMJ
  1. jsmith{at}bmj.com

    One of the things that readers tell us consistently is that they want more education in the BMJ. I hope you’ll be pleased this week: the education sections are particularly strong.

    Our cover highlights the clinical review on the early management of burns and scalds, from minor burns managed in primary care to those that need referral to specialist units (doi:10.1136/bmj.b1037). “Education with an angle” might be a subtitle for the Practice section, since all the articles have a particular perspective. Thus, the article on obstructive sleep apnoea appears in our “Easily missed” series of conditions that may be commoner than doctors think or missed on first presentation. The good news is that treatment with continuous positive airway pressure is effective for those with moderate and severe symptoms—and it allows patients to keep their driving licences (doi:10.1136/bmj.b1165). On the “Change Page” Steven Doherty argues not for a new change but for implementation of a well established one: though several systematic reviews have shown that systemic corticosteroids are effective in acute asthma, many patients still don’t get them and he discusses ways in which conformity with guidelines can be improved (doi:10.1136/bmj.b1234)

    One problem with implementing evidence based medicine is, of course, that the evidence keeps changing. An important recent example is the mounting evidence that ever tighter glucose control in people with type 2 diabetes may actually be harmful. As Richard Lehman and Harlan Krumholz point out in their editorial (doi:10.1136/bmj.b800), the evidence that tighter control might not be better was emerging just as the targets for the 2009 quality and outcomes framework (QOF) were being re-negotiated. The framework sets evidence based clinical targets for British general practices to reach (and pays them for doing so), and it has helped improve the implementation of evidence based interventions. But the 2009 version now includes a tighter target for glycated haemoglobin—just as that looks to be the wrong thing to be doing.

    The research pages this week happen to have an emphasis on men. The best news is that men who increase their exercise in middle age increase their longevity (after a lag of 10 years) over those who continue to be inactive (doi:10.1136/bmj.b688). Less good news, however, comes from two research papers from China: China has too many men (doi:10.1136/bmj.b1211) and those who live to become old and frail die uncomfortably (doi:10.1136/bmj.b1175). Matthew Dupre and colleagues, the authors of the second paper— and our editorialist, Zhanlian Feng (doi:10.1136/bmj.b601)—talk of the challenges: “an unbalanced population structure and a rapidly aging population is straining the traditional family orientated system of care.” But it is not only China that is facing those pressures.

    According to Nicholas Christakis, the whole world faces them too (doi:10.1136/bmj.b1534). In his Observations column he lists shifts in the sex ratio, age structure, and kinship systems as three of four important changes in world society (the other is income distribution). He warns that in focusing on environmental threats, we should not overlook that we need to pay as much attention to “who, and not just what, surrounds us.”

    Notes

    Cite this as: BMJ 2009;338:b1548

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