Your weekly BMJ digest – 22/4/17

It’s that time of the week again, folks. I know, I know, you’re all clamouring for the latest from the BMJ, so much so you’ve been having trouble sleeping because of the anticipation. Without further ado, here it is:

Cover Story – walk to work: The BMJ leads with a prospective cohort study (don’t worry, I had to look that one up too – it means following a recruited bunch of subjects, splitting them up into different groups and then observing how many in each group get a particular outcome). This UK Biobank study looks at a whopping 502549 adults and compares the incidence of death and disease between active commuters (travelling by bike, foot etc) vs non-active commuters (car, public transport). The overall analysis reveals that active commuters (especially cyclists) have less negative health outcomes ergo, the study concludes, we should encourage active commuting.

Maybe the people in charge of structuring training schemes should take note of Celis-Morales’ study, and minimise the frequent reallocation of trainees to different hospitals in a deanery? Whilst you may happily cycle to work for one year of your training program, next year’s/month’s rotation in a different hospital often necessitates a non-active commute. Unless the idea is to move every year/rotation? Who wants to stay in one place with their family anyway?

Everything you ever wanted to know about appendicitis but were afraid to ask: It’s a question that has plagued many of us and led to so many sleepless nights – what is the reason behind falling numbers of appendicectomies these days? This BMJ article satisfies the curiosity of even the most ardent GI surgeon. Apart from listing the facts we all learnt for med school finals, it also throws up some interesting points. Did you know, for instance, that although lifetime risk of appendicitis is greater in men, appendicectomy rates are higher in women? Or that “1% of appendicectomies reveal a neoplasm?” And for the history buffs amongst you, McBurney (of the famous point) described the standard open procedure in 1891 and it has “remained largely unchanged” since then. Talk about standing the test of time.

Speaking of time (a tenuous segue, I’ll admit): A BMC Geriatrics study has shown that elderly people who interact with children in intergenerational play groups, tend to feel better in the sense they have more self-esteem and feel more connected. Some organisations in the USA and Australia are capitalising on this idea by building nurseries and care homes on the same site. 

The State of the NHS:  In a quick blitz of the BMJ articles on policy and NHS developments we have:

1. We’ve all been there. We forgo our cappuccino at Costa when money becomes tight. Well, it seems Greenwich CCG is doing a similar thing and in order to save £500,000 they want to cut cataract surgery for anything less than “exceptional cases.” With such a draconian measure though, that’s less like saving on costly coffee and more like starving granny to reduce the food bill.
2. The Royal College of Physicians say there aren’t enough trained doctors to provide a service for mechanical thrombectomy for stroke as NHS England has proposed. Wonderful promise with a distinct lack of planning or infrastructure to deliver said promise? This had eau d’Jeremy all over it.
3. A new take on surgical training will be piloted from August 2018 with a proposed return to the “firm” structure of yesteryear. Watch this space (in a few years time).
4. GMC performance assessments (doesn’t sound good does it? It’s not) are more likely to be conducted for doctors who are trained overseas. A variety of reasons are proposed but the worry, of course, is discrimination and bias.
5. The results of one vanguard (50 pilot schemes established in 2015 to deliver some of the promises promised in the NHS Five Year Forward View) have shown some encouraging results. The Nottinghamshire vanguard put better support systems in place for a number of people living in care homes. Analysis now shows there has been 23% less emergency admissions from this cohort when compared of the rest of the country. Yay.
6. The House of Lords has suggested forming an independent “Office for Health and Care Sustainability” to ensure long term planning for the future and needs of the NHS. Again, I ask why does this not exist already?
7. The NHS financial “watchdog” NHS Improvement met with the Treasury on April 10^th to discuss borrowing billions of pounds from investment companies. Coming soon – Hedge Fund(ed) Healthcare “R” Us.
8. The charity “Doctors of the World” is recommending that GPs avoid becoming stooges for the government/immigration services and refuse to give up details or “rat” on patients, who may be undocumented. Changes have already been made in January to allow NHS information services to share patient address details with the Home Office without needing to involve the patient’s GP.

Keeping the continuity: Remember last week’s article about the need to reduce sugar, salt and other dietary “baddies” where possible? Well, the BMJ has backed it up this week with evidence from a study published in JAMA Cardiology, where 11 New York counties which restricted dietary transfats, showed less myocardial and stroke events compared to 23 counties that hadn’t restricted transfats.

And finally, spare a thought for: A poor Consultant Neurosurgeon, who whilst dictating his letters, realised he had operated on the wrong vertebra of his patient. There but for the grace of God, go us.