Seven days in medicine: 4-10 October 2017BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4670 (Published 12 October 2017) Cite this as: BMJ 2017;359:j4670
BMA calls for urgent meeting with health secretary
Richard Vautrey, chair of the BMA’s general practitioners committee, wrote to England’s health secretary, Jeremy Hunt, calling for an urgent meeting to discuss the pressures on general practice and warning that practices could be forced to close to new patients. The move follows Hunt’s speech at the Conservative conference, which the BMA criticised for offering no immediate, practical solutions to problems such as patient demand and staff shortages. Vautrey wrote, “With unprecedented patient demand, a recruitment and retention crisis, huge workforce shortfalls and major premises problems, it is no wonder that GPs are having to consider action such as suspending their patient lists.” (Full story doi:10.1136/bmj.j4590)
Campaign calls for rethink on job titles
Doctors and academics who are members of the Oxford Health Alliance called for a “rethink” on the use of the terms “junior” and “trainee” in reference to doctors in training, which they say are “discriminatory and belittling, untruthful in [their] application and harmful to morale.” Both terms should be abandoned in favour of terms that reflect the seniority and skills of this group of doctors, the alliance argues. Health Education England said that it cannot change these terms but is willing to discuss the issue, while the Department of Health said that it would review the use of the terms.
Man with advanced MND loses challenge
Noel Conway, 67, who has advanced motor neurone disease, lost his challenge to the legal ban on assisted suicide in England and Wales. He argued that the law condemned him to “unimaginable suffering.” Conway had asked three senior judges at the High Court in London for a declaration that the ban was incompatible with his human rights. But they ruled that, although the ban did interfere with his right to respect for his private life, this interference was necessary and proportionate to protect vulnerable people who might believe that they were a burden and better off dead. Conway said that he plans to appeal. (Full story doi:10.1136/bmj.j4631)
Trust pays £600 000 to 15 boys abused by consultant
Cambridge University Hospitals NHS Trust has so far paid £611 750 (€683 000; $807 000) to victims of sexual abuse by a former consultant paediatric haematologist, a freedom of information request by the BBC found. Myles Bradbury was jailed in December 2014 after admitting to 25 offences against 18 boys in his care at Addenbrooke’s Hospital in Cambridge, UK. The boys had blood cancers, and his offences, committed while examining them, involved touching naked genitalia. The BBC said that the payments related to 15 of the 31 claims the trust had received.
Views are sought on newly qualified doctors’ skills
The General Medical Council launched a consultation on the knowledge, skills, and professional behaviours needed by newly qualified UK doctors, which runs until 10 January 2018 (www.gmc-uk.org/education/31336.asp). The updated Outcomes for Graduates say that doctors will be expected to understand areas such as population health; managing patients with multiple diseases; consent, confidentiality, and safeguarding; and the needs of patients from diverse backgrounds. The document will help develop the medical licensing assessment, which is expected to be implemented in 2022 to ensure that UK doctors meet a common threshold.
US agency warns against using sleep positioners for babies
UK shops removed infant sleep positioners—also called “nests” or “anti-roll” products—from their shelves after a warning from the US Food and Drug Administration that the products should not be used for babies because of a suffocation risk. In the past 13 years 12 deaths from suffocation associated with sleep positioners have been reported in the US. And dozens of reports say that babies placed on their back or side in a positioner were found later in a hazardous position in or next to the product.
Dutch geriatrician faces charges over patient’s death
Dutch public prosecutors launched a criminal investigation into a specialist in elderly care who ended the life of a 74 year old woman with dementia at a nursing home, claiming “serious suspicion” that a criminal offence was committed. This is the Netherlands’ first such investigation of its 2002 euthanasia law. The woman was considered no longer competent to consent but had previously signed a living will requesting euthanasia. But a committee that reviews euthanasia cases dismissed the living will as “ambiguous and contradictory” and said that euthanasia had gone ahead without due care. (Full story doi:10.1136/bmj.j4639)
MPs relaunch inquiry into government strategy
Four parliamentary committees relaunched an inquiry into improving air pollution to examine whether the UK government’s plan on air quality goes far enough to meet legal limits and improve health. The government released its plan in July after the courts twice ruled it inadequate.1 Sarah Wollaston, health committee chair, said, “There is an increasing amount of evidence showing the impact of nitrogen dioxide and invisible particulates on human health. Many people are aware of their impact on our lungs and hearts, but new evidence suggests that they could also contribute to diseases as disparate as dementia and diabetes.” Written evidence should be submitted by 5 pm on 9 November (http://bit.ly/2g4dLj9).
Prevalence rises 10-fold since 1975
The proportion of girls worldwide who are obese increased from 0.7% (five million) in 1975 to 5.6% (50 million) in 2016, and the proportion of boys who are obese rose from 0.9% (six million) to 7.8% (74 million), an analysis in 200 countries found.2 Rates were highest (above 30%) in some islands in Polynesia and were around 20% or higher in the US and some countries in the Middle East and north Africa (eg Egypt, Kuwait, Qatar, and Saudi Arabia) and the Caribbean (eg Bermuda and Puerto Rico). Despite this increase more children worldwide are moderately or severely underweight (75 million girls and 117 million boys) than obese, the Lancet’s study found.
Insulin pumps reduce complications in young people
Children with type 1 diabetes (average age 14) from Europe who used an insulin pump had considerably lower rates of severe hypoglycaemia (9.55 v 13.97 per 100 patient years), hypoglycaemic coma (2.30 v 2.96 per 100 patient years), and ketoacidosis (3.64 v 4.26 per 100 patient years) than those who had insulin injections, as well as lower glycated haemoglobin levels (9.04% v 8.22%), a JAMA study of nearly 20 000 children found.3 Figures from NHS Digital showed that 15.3% of people with type 1 diabetes were treated with an insulin pump in England in 2015-16.4 (Full story doi:10.1136/bmj.j4665)
Mental healthcare for children needs “seismic” shift
The children’s health commissioner for England called for “a wholesale shift in the scale of ambition across government and the NHS on children’s mental healthcare.” In a report to MPs,5 Anne Longfield criticised the government for “shockingly poor” provision of services for under 18s and a lack of targets, monitoring, and accountability. The report criticised the fact that 40% of spending goes on acute care when early intervention is cheaper. Longfield called for the forthcoming green paper on mental health to bring about a “seismic” change in provision of children’s mental health services.
GPs in emergency department cut admissions
Having a GP in the emergency department of a UK paediatric hospital reduced waiting times and admissions but led to more antibiotic prescribing, a study in BMJ Quality and Safety found.6 Many hospitals now have GPs co-located in emergency departments, but evidence of their benefits is scant. At Alder Hey Children’s Hospital, children seen by the GP service were less likely than children seen in the emergency department to be admitted to hospital (2.2% v 6.5%) and less likely to wait longer than four hours to be seen (2.3% v 5.1%), but they were more likely to be given antibiotics (26.1% v 20.5%).