BMJ – 20/5/17

It’s been a difficult week here in the UK and with the fast pace of current events, it seems the entire news media, let alone the BMJ, are eternally playing catch-up. As expected this week’s BMJ has a focus on the recent NHS cyber-attack and next week’s will no doubt concentrate on major incident planning after the awful events in Manchester. With a more sober breath than normal, here we go.

Cover story: Disturbed Grief – When I read the term “disturbed grief,” in this week’s article, I first thought the BMJ was alluding to some kind of Rihanna/Marilyn Manson mash-up, but no, disturbed grief is actually a DSM classified condition that covers variations on persistent or (for want of a better word) “extreme” grief reactions.

For anyone who has grieved, some of the lines in this article seem at odds with the experience. Grief is an extreme sensation, and to see it described in this article as “uncomplicated” seems antithetical. Apparently when severe “reactions” and “symptoms” are experienced on most days six months after a bereavement, then you’re heading into pathological territory. Those more likely to have “disturbed grief reactions” include women, those from lower socioeconomic groups and people who have been bereaved through violence.

There is a dearth of research in to what treatments are effective in grief disorders. Psychological interventions have been recommended and whilst antidepressants may be useful in treating associated symptoms of depression, in cases of “sole grief disorder” there is less evidence for efficacy.

The BMJ does acknowledge the problems behind medicalising grief. In an experience that is so emotive, subjective and yet universal, it is often difficult to extricate feelings from the science, but then that is the art of medicine.

Hands up or I’ll take your computer hostage: Most of us working that day, would have preferred it if the hackers had just stolen our bank details instead. The faff of having the majority of the NHS computer service go down! Don’t the hackers know that the NHS is broke? Ransom? Hah! The hackers would have gotten a better deal taking NHS printer paper and selling it on Ebay.

There are quite a few articles in the BMJ about how the NHS fell prey to this attack because of chronic underfunding in cyber-security and lack of accountability for when things go wrong. I’d recommend you read these articles, however, you could save yourself the bother and just extrapolate the arguments used to explain why the NHS is failing in general (see my back catalogue of BMJ reviews for further details).

A quick rundown of the rest: Now that the only week of British summertime is here, it seems criminal to spend a single minute in the library, but we here at medicine.co.uk are dedicated souls. However, we are more unconscientious when it’s a tossup between the BMJ or ice cream. Here’s a quick summary of some articles that caught our distracted eye…

The case of the yummy dodgy sushi: Is nothing sacred to the BMJ? Last week it was steak and now it’s sushi. Eating undercooked fish may lead to infection by the funky sounding anisakiasis (larva – gross), which presents like an acute abdomen.

The Nursing Take on the Junior Doctors’ Strike: Our nursing colleagues have voted impressively (91% of 52,000) for planned protest activity over the government’s nursing pay restraint.

Confounding or correlative?: Applications for Paeds ST1 training posts have fallen by 27.5% in the last two years and there is an average vacancy rate of 14%. Meanwhile the RCPCH reports a slowing down in improvements in child health measures including the scary statement that there was a rise in infant mortality in 2015. Particularly worrying is the fact that there was a discrepant rise in infant mortality for lower socioeconomic groups.

Chuckle of the Week – Happy Birthday to NHS scanners! Apparently one source of entry for cyber-infection includes NHS MRI and CT scanners, which are on average ten years old and still use  dated software (ahem, the dastardly Windows XP). According to the chief exec of NHS Providers, the reason why scanners continue to run on decades old operating systems is “to get the full life out of them,” which, to be fair, seems a fitting sentiment in the healthcare system. Incidentally the first iPhone came out in 2007 as well. Why on earth Apple ignored the NHS’s model and kept on innovating their software, I’ll never know.

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