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Physician associates in the UK: some fundamental questions that need answers now

British Medical Journal - Mar, 19/03/2024 - 17:16
Healthcare in the UK is facing a crisis. At issue is the creation of new groups of health workers called physician associates (PAs) and anaesthetic associates (AAs).1 Originally PAs and AAs were envisaged as assistants to doctors to increase their productivity by relieving them of some routine tasks. However, in many hospitals and general practices they are being deployed to replace doctors, taking on increasingly complex roles, including the assessment and management of patients with undiagnosed problems.2 This is despite them having completed only a two year training programme. While most will also have a science degree, this need not be in a subject related to medicine. Concerns have been exacerbated by the simultaneous reduction in medical specialty training posts,3 the fact that many PAs and AAs are paid substantially more than foundation doctors despite much less training than the doctors they work with,4 evidence that they are illegally prescribing...

Little change in ethnic diversity in top roles at NHS trusts in England

British Medical Journal - Mar, 19/03/2024 - 17:06
There were more people from ethnic minority backgrounds in executive and senior managerial roles in NHS trusts in England in 2023, but because of a rise in the proportion of ethnic minorities in the workforce there has been minimal progress in diversity at the top of trusts, show latest data.Staff from ethnic minorities held 180 (11%) executive roles in English NHS trusts in 2023, up from 161 (10%) in 2022, shows the latest NHS Workforce Race Equality Standard (WRES), which aims to capture how NHS trusts are tackling race inequalities.1The gap between ethnic minority representation in the workforce and among executive directors increased from 13.5% in 2021 to 15.7% in 2023 because more people from ethnic minority backgrounds have joined the NHS in the past year (from 22.4% to 26.4%).Overall, 26.4% (380 108) of people who worked for trusts in England in 2023 were from minority ethnic backgrounds, up 13%...

We need medical leadership built on trust

British Medical Journal - Mar, 19/03/2024 - 16:36
Trust is central to the practice of medicine, but recent events have shown it to be fragile, even within our professional communities.In 2022, the Ipsos Global Trustworthiness Monitor asked people from 29 countries what attributes were most important when deciding whether to trust an organisation or institution.1 The top three responses were: “If it is reliable/keeps its promises,” “If it is open and transparent about what it does,” and “If it behaves responsibly.” Recent events have shown that our medical community has lessons to learn.The announcement by the UK Foundation Programme Office (UK FPO) that the appointment process for the Specialised Foundation Programme will change in 2025 to preference-informed allocation, a system that does not take account of previous academic attainment, has left many medical students feeling distressed.2 The change in the recruitment process impacts many students who made decisions based on the current system, only now to find the...

The BMJ Editorial Scholar 2024/2025

British Medical Journal - Mar, 19/03/2024 - 15:31
Are you a medical student interested in learning how a medical journal is run? Do you have a passion for creating engaging content for medical students? If so, apply to be The BMJ’s next editorial scholar.The editorial scholar takes one year out of medical school to work with The BMJ’s international team of editors and lead BMJ Student, the student section of The BMJ.In this role you will:Be trained in journalism and editingCommission, peer review, select, and edit articlesPlan, produce, and host episodes of The BMJ’s student podcast Sharp ScratchBe involved with publishing the journal for print and onlineHave the opportunity to write your own articles for BMJ Student as well as other sections within The BMJRun BMJ Student’s social media channelsMaximise the potential of The BMJ’s student offering.We are particularly interested in candidates who have clinical experience and can communicate ideas effectively. You will be motivated, creative, and preferably...

Correction

British Medical Journal - Mar, 19/03/2024 - 15:26
Since it was published, this Opinion article by Sarah Clarke (BMJ 2024;384:q61810; doi:10.1136/bmj.q618) has been updated to include a revised competing interests statement.

Medical associates: the introduction of PAs, ANPs, and ACPs is creating new challenges for doctors on rotational training

British Medical Journal - Mar, 19/03/2024 - 13:16
The addition of new clinical staff on hospital wards is welcome. The steady introduction of physician associates (PAs), advanced nurse practitioners (ANPs), and advanced clinical practitioners (ACPs) has undoubtedly helped to manage the ever increasing demand in UK hospitals. However, this new blend of different clinical ward roles is disrupting the training, skill development, and professional autonomy of rotating doctors. Given that these non-traditional clinical roles are likely to stay and expand,1 attention needs to turn to navigating the new dynamics these roles bring and to ensuring that clinical work remains collaborative and safe.Rotational training brings several challenges.2 Doctors arriving on hospital wards need to navigate new systems and adapt to new processes of working every three to six months. It takes time to develop professional relationships with colleagues, nursing staff, and ward consultants. The presence of permanent ward clinicians can be valuable in easing this transition, helping disoriented doctors...

Antibiotic costs rise 1100% as big pharma exits Nigeria

British Medical Journal - Vie, 01/03/2024 - 12:16
In Nigeria, the rapidly escalating drug prices are indicative of a deeper issue: fundamentally, it’s about the economy. The situation shows no signs of abating, especially as recent reports in January 2024 indicated inflation has surged to a 27 year high of 28.92%.1GlaxoSmithKline (GSK) announced its withdrawal in August 2023, citing various operational challenges and marking the end of its more than 50 year presence since its establishment in Lagos in 1972.2 Similarly, three months after GSK’s announcement, Sanofi, known for producing the polio vaccine, began planning its exit.3 Both companies have shifted to a third party distribution model to maintain their supply of products in Nigeria.In numerous developing countries, notably within Africa and Asia, a striking paradox exists in which essential drugs can cost up to 30 times more than in developed nations.4 This stems from various factors, including procurement inefficiencies, opaque pricing models, and limited market competition, often...

Illness trajectories in the age of big data

British Medical Journal - Vie, 01/03/2024 - 12:11
For decades, healthcare providers have understood that patients follow typical trajectories of health decline as they approach the end of life, and they have used this understanding to help patients and families anticipate the dying process. Traditional trajectories focus on function or overall health status and include sudden death, terminal illness (rapid and accelerating deterioration), organ failure (slower decline marked by periods of acute exacerbation and recovery), and frailty (slow decline with fewer acute changes).1Two Education articles in the BMJ add novel dimensions to our understanding of health decline. Murray et al explain how declines in function do not always mirror declines in social, psychological, and spiritual dimensions. They also add a new trajectory, multimorbidity, to describe a person with conditions from multiple trajectories (such as heart disease from organ failure and cognitive impairment from frailty).2 Geijteman et al describe how people with cancer are increasingly defying the traditional trajectory...

Using illness trajectories to inform person centred, advance care planning

British Medical Journal - Vie, 01/03/2024 - 12:01
What you need to knowMost patients with progressive illness follow characteristic trajectories of decline, previously identified as rapid, intermittent, or a gradual decline from a low baselineMultimorbidity is increasingly common and follows a distinct fourth trajectoryAn understanding of the dynamic multidimensional trajectories of patients with progressive illnesses helps clinicians consider individual holistic needs and have meaningful conversations with patients and families about advance care planningIn patients with an acute deterioration in health (such as from an infection), considering the main underlying illness trajectory helps guide shared decision making about realistic current and future treatment and care optionsPatients diagnosed with a serious illness often ask doctors about prognosis as a way into talking about what life might be like in the future.12 Illness trajectories can offer conceptual maps of archetypical patient journeys in the final years and months of life. Trajectories have been used clinically for nearly 20 years to aid...

Illness trajectories of incurable solid cancers

British Medical Journal - Vie, 01/03/2024 - 11:56
What you need to knowNew systemic anticancer treatments, such as targeted therapy and immunotherapy, have made treating incurable solid cancer more successful but also more challenging and unpredictableUpdated treatment illness trajectories for patients with incurable solid cancer include major temporary improvement, long term ongoing response, and rapid declineDiscuss with the patients and caregivers their goals and preferences, ideally at the time of diagnosis, particularly because of the prognostic uncertainty associated with systemic anticancer treatmentSupportive and palliative care should be provided in conjunction with newer anticancer therapies to address patients’ physical, psychological, social, and spiritual challengesCancer remains one of the leading causes of death worldwide,1 and the number of cancer related deaths is expected to be over 16 million by 2040.2 Over 90% of all new cases of cancer are solid cancer types, including breast, lung, colorectal, and prostate cancer.3 When solid cancer is incurable, patients often have a life expectancy...

UK workers during the pandemic: inadequate protection and, consequently, increased risk

British Medical Journal - Vie, 01/03/2024 - 11:41
There are striking similarities, as well as differences, between the shortcomings in protection and consequent increased risk to UK and US workers during the covid-19 pandemic.1Extant UK law should have served well during this time. Instead of striving to fulfil their legal duty, however, many UK employers opted merely for “public health guidance,” which explicitly did not commit to fulfilling health and safety statute.2Public health authorities both in the US1 and the UK were mistaken in clinging to “droplet dogma” rather than recommending respirators as personal protective equipment (PPE) for exposed workers.3 While the US Occupational Safety and Health Administration “held different views … to protect frontline workers, particularly those in healthcare facilities,”1 the UK Health and Safety Executive (HSE) merely endorsed Public Health England guidance as “effective control measures.”4 Since HSE held back from publishing specific guidance on the protection of healthcare workers, trade unions had to produce their...

Doctors report big rise in patients with illness because of socioeconomic factors

British Medical Journal - Vie, 01/03/2024 - 11:00
Over half (55%) of consultants surveyed say that they have seen a rise in the past three months of patients with ill health from social and economic factors, according to a census of 3689 doctors carried out by the Federation of the Royal Colleges of Physicians.In its annual census, the federation found that nearly one in four doctors (24%) said that most of their workload is now because of illnesses or conditions related to the wider determinants of health, such as living in mouldy or damp homes, poor air quality, and lack of access to healthy food. The census was sent to 22 213 consultants, giving a response rate of 17%.Altogether, 85% of consultants said that they were now concerned about the impact health inequalities are having on their patients.In response, the federation, which represents the Royal Colleges of Physicians (RCP), the Royal College of Physicians of Edinburgh (RCPE), and...

Impact of the “Zero Resistance” program on acquisition of multidrug-resistant bacteria in patients admitted to Intensive Care Units in Spain. A prospective, intervention, multimodal, multicenter study

Último número Revista Medicina Intensiva - Vie, 07/04/2023 - 22:15
Francisco Álvarez-Lerma, Mercedes Catalán-González, Joaquín Álvarez, Miguel Sánchez-García, Mercedes Palomar-Martínez, Inmaculada Fernández-Moreno, José Garnacho-Montero, Fernando Barcenilla-Gaite, Rosa García, Jesús Aranaz-Andrés, Francisco J. Lozano-García, Paula Ramírez-Galleymore, Montserrat Martínez-Alonso
Med Intensiva. 2023;47:193-202

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Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system

Último número Revista Medicina Intensiva - Vie, 07/04/2023 - 22:15
P. Perelló, J. Gómez, J. Mariné, M.T. Cabas, A. Arasa, Z. Ramos, D. Moya, I. Reynals, M. Bodí, M. Magret
Med Intensiva. 2023;47:203-11

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Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study

Último número Revista Medicina Intensiva - Vie, 07/04/2023 - 22:15
E.P. Gomes, M.M. Reboredo, G.B. Costa, F.S. Barros, E.V. Carvalho, B.V. Pinheiro
Med Intensiva. 2023;47:212-20

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Clinical presentation and outcomes of acute heart failure in the critically ill patient: A prospective, observational, multicentre study

Último número Revista Medicina Intensiva - Vie, 07/04/2023 - 22:15
L. Zapata, C. Guía, R. Gómez, T. García-Paredes, L. Colinas, E. Portugal-Rodriguez, I. Rodado, I. Leache, A. Fernández-Ferreira, I.A. Hermosilla-Semikina, F. Roche-Campo
Med Intensiva. 2023;47:221-31

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Resultados del uso de plasma de pacientes convalecientes de COVID-19 en pacientes críticos

Último número Revista Medicina Intensiva - Vie, 07/04/2023 - 22:15
I. Astola Hidalgo, A. Fernández Rodríguez, E. Martínez Revuelta, M. Martínez Revuelta, A.M. Ojea, P. Herrero Puente, D. Escudero Augusto
Med Intensiva. 2023;47:232-4

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Efecto Macklin como predictor radiológico precoz de barotrauma en pacientes COVID-19 con SDRA en ventilación mecánica invasiva

Último número Revista Medicina Intensiva - Vie, 07/04/2023 - 22:15
F.J. Casadiego Monachello, M.C. de la Torre Terron, J.A. Mendez Barraza, S. Casals Vila
Med Intensiva. 2023;47:235-7

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