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p p p p NEWS & VIEWS EDITORIALS RESEARCH EDUCATION 1 News and research news 7 COVER Supporting clinicians 11 Massachusetts health reform CLINICAL REVIEW after medical error and disparities in joint 4 COVER Party manifestos: 27 COVER Relapse in multiple The needs of these “second replacement use: diff erence in what they pledge for the NHS sclerosis victims” are often ignored diff erences study 6 BMJ Confi dential: Ian Galea et al Amresh D Hanchate et al Bee Wee Hanan Edrees and Frank thebmj.com Federico EDITORIAL p CPD/CME hour RESEARCH p FEATURES 8 Advancing equity in healthcare Lessons from Massachusetts 12 Eff ect of Massachusetts PRACTICE 15 Election watch Gareth Iacobucci and beyond healthcare reform on racial and WHAT YOUR PATIENT IS ethnic disparities in admissions THINKING HEAD TO HEAD Marshall H Chin RESEARCH pp to hospital for ambulatory 31 Car parking is a clinical quality 16 COVER Can healthy people care sensitive conditions: issue 9 Patients need safer hospitals, benefi t from health apps? retrospective analysis of David Gilbert every day of the week Iltifat Husain and Des Spence hospital episode statistics thebmj.com Hospital acquired conditions Frank J Attenello et al CPD/CME hour must be reduced throughout the EDITORIAL p ANALYSIS week, not just at weekends UNCERTAINTIES RESEARCH p 32 Is early induction or expectant 18 COVER From “special Kumar Dharmarajan et al measures” to “good” in less 13 Incidence of “never events” management more benefi cial RESEARCH p than a year among weekend admissions in women with late preterm Matthew Limb 10 Realising the promise of non- versus weekday admissions to pre-eclampsia? invasive prenatal testing US hospitals: national analysis Lucy C Chappell et al It should transform the quality of Danny McCormick et al VIEWS 41 Endgames antenatal care EDITORIAL p 20 Letters Lyn S Chitty and Mark Kroese 42 Minerva 22 Observations 14 Methotrexate use and risk of lung disease in psoriasis, 23 Margaret McCartney psoriatic arthritis, and If I ruled the NHS infl ammatory bowel disease 36 Palliative care team of the year 24 Personal View Richard Conway et al fi nalists 2015 25 Obituaries 38 Mental health team of the year fi nalists 2015
18 April 2015 350:1-42 No 8004 | ISSN 1759-2151 THE BMJ AWARDS FINALISTS Health Apps Supporting From “special The BMA grants editorial freedom to the Editor of The BMJ. The views be liable for any loss, injury, or damage resulting from the clinicians after measures” to medical error “good” in a year HEAD TO HEAD, Party manifestos: Multiple sclerosis: expressed in the journal are those of the authors and may not necessarily use of The BMJ or any information in it whether based on what they pledge managing relapse for the NHS CPD/CME hours p 16 comply with BMA policy. The BMJ follows guidelines on editorial contract, tort, or otherwise. Readers are advised to verify any independence produced by the World Association of Medical Editors information they choose to rely on. (www.wame.org/wamestmt.htm#independence) and the code on good ©BMJ Publishing Group Ltd All Rights Reserved. No publication practice produced by the Committee on Publication Ethics part of this publication may be reproduced, stored in a retrieval system, (www.publicationethics.org.uk/guidelines/). or transmitted in any form or by any other means, electronic, mechanical, The BMJ is intended for medical professionals and is provided without photocopying, recording, or otherwise, without prior permission, in writing, warranty, express or implied. Statements in the journal are the responsibility of The BMJ. of their authors and advertisers and not authors’ institutions, the BMJ Published weekly. US periodicals class postage paid at Rahway, NJ. MOBILE APPS Can healthy Publishing Group, or the BMA unless otherwise specified or determined by Postmaster: send address changes to BMJ, c/o Mercury Airfreight people benefit? law. Acceptance of advertising does not imply endorsement International Ltd Inc, Blair Road, Avenel, NJ , USA. . Weekly. To the fullest extent permitted by law, the BMJ Publishing Group shall not Printed by Polestar Limited
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18 April 2015 Vol 350 The Editor, The BMJ BMA House, Tavistock Square, London WC H JR Email: [email protected] Tel: + ( ) Fax: + ( ) BMA MEMBERS’ ENQUIRIES Email: [email protected] Tel: + ( ) BMJ CAREERS ADVERTISING Email: [email protected] Tel: + ( ) DISPLAY ADVERTISING Email: [email protected] Tel: + ( ) REPRINTS UK/Rest of world Email: [email protected] Tel: + ( ) USA Email: [email protected] Tel: + () SUBSCRIPTIONS BMA Members Email: [email protected] Tel: + ( ) Non-BMA Members MARIO ANZUONI/REUTERS MARIO Email: [email protected] Tel: + ( ) PICTURE OF THE WEEK OTHER RESOURCES For all other contacts: Street artist Lydia Emily Archibald touches up her mural in Los Angeles, California, last week, aimed at raising resources.bmj.com/bmj/contact-us For advice to authors: awareness about multiple sclerosis. The artist, who is well known for large scale murals in cities such as New York, San resources.bmj.com/bmj/authors Francisco, and Berlin, was diagnosed as having multiple sclerosis in . To submit an article: submit.bmj.com CLINICAL REVIEW, p The BMJ is published by BMJ Publishing Group Ltd, a wholly owned subsidiary of the British Medical Association. THEBMJ COM POLL This week's poll: INDEXING THE BMJ Last week’s poll asked: Does hospital car The BMJ is an online journal and we therefore recommend that you index Should doctors be allowed to prescribe cheaper parking affect content from thebmj.com rather than drugs such as Avastin 'off-label' when there is this print edition. We suggest you use the patient care? Digital Object Identifier (doi) available evidence of sufficient quality, efficacy, and safety? online at the top of every article. BMJ h YES NO The BMJ is printed Total votes cast: VOTE NOW ON on % recycled paper BMJ h THEBMJ COM (except the cover)
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the bmj | 18 April 2015 FOUND IN TRANSLATION THIS WEEK
Online highlights from thebmj.com LATEST BLOGS THIS WEEK IN 1915 Sex in secure inpatient forensic settings Frank Shufflebotham writes about the 14 cases of lead poisoning he came across in young men training for the Most forensic psychiatric hospitals in the UK army. Of the 14 men, 10 were pottery workers, three house either prohibit or actively discourage the sexual painters, and one a plumber. Symptoms started to show activity of inpatients. Michelle Rydon-Grange from three to seven weeks after mobilisation or enlistment, explores what is it about sex in psychiatric and Shufflebotham suggests that the “altered conditions of hospitals that causes such unease, and asks life, especially the muscular exercises associated with route whether a new approach is needed. marches and physical drill, cause increased metabolism, ̻̻http://bmj.co/psychiatrysex with the result that lead compounds previously locked up in the organs and muscles of the body become released and From Harry Potter to Hippocrates reach the blood stream.”
WELLCOME WELLCOME Birte Twisselmann takes a tour of the Royal ̻̻BMJ 1915;1:672 College of Physicians’ garden, which includes Your chance to quiz a potential future UK health secretary about 1000 plants with “medicinal” uses and some 200 that are named after doctors. ̻̻Watch the debate live from 11 am on 21 April at www.healthdebate.net ̻̻http://bmj.co/rcpgarden The BMJ is co-hosting a UK spokesman Andy Burnham, presenter Sarah Montague. general election hustings with and UKIP health spokeswoman You can submit questions for representatives from the main Louise Bours. consideration in advance of the political parties and is asking This debate will provide a event in one of two ways: readers to join the debate by platform for the parties to explain By responding to this article; submitting questions. their policies on health and care By emailing [email protected] Participants in the event, to an audience of professionals, which will be streamed live practitioners, patients, and The debate is being organised from the British Library at 11 policy makers. After opening by the Health Foundation, am on 21 April, include Tory statements from the parties’ Nuffield Trust, King’s Fund, health secretary Jeremy Hunt, spokespeople, it will follow a NHS Confederation, the BMA, Liberal Democrat health minister Question Time format, chaired by National Voices, and The BMJ. Norman Lamb, Labour health BBC Radio 4 Today programme Cite this as: BMJ 2015;350:h1932
Measuring the performance of health systems Bernard Merkel looks at efforts over the past 15 years to measure the performance of different health systems. He finds a troubled history, from a World Health Organization report that became a national insult to Brazil, to more recent attempts to increase efficiency in the face of austerity. ̻̻http://bmj.co/measuringhealth MOST READ RESPONSE OF THE WEEK When I use a word . . . Zzzzzzzzzzzz ARTICLES ONLINE There seems to be a worrying development in the actions of pharmaceutical companies to use the legal and patent In the latest of his weekly “When I use a word” Efficacy and safety blogs, Jeffrey Aronson looks at the so called “z of paracetamol for systems to continue to profit from the NHS. This [the warning not to prescribe generic pregabalin for pain control] reminds us drugs”—zaleplon, zolpidem, and zopiclone— spinal pain and of the ongoing saga of Avastin and Lucentis, but it is even more and tracks how z came to be associated with osteoarthritis bizarre in that it is about who supplies the same drug—and, sleeping. ̻ http://bmj.co/zdrugs ̻̻BMJ 2015;350:h1225 let’s be clear, that is all that this is about. ̻ Why have UK doctors Such activity by pharmaceutical companies puts the patent been deterred from system on trial, and the concept of “off-label” prescribing—an prescribing Avastin? essential feature of modern healthcare that has led to many advances, not the least of which was the interest in the use of ̻BMJ 2015;350:h1654 ̻ gabapentinoids in pain medicine in the first place. Austerity, sanctions, Barry Miller, consultant in pain medicine and anaesthesia, and the rise of food Royal Bolton Hospital, Bolton, UK, in response to, “Doctors are banks in the UK warned not to prescribe generic pregabalin for pain control” ̻̻BMJ 2015;350:h1388 BMJ 2015;350:h1629 GETTY
18 April 2015 | the bmj THIS WEEK
EDITOR'S CHOICE How to transform care? McCartney fears that With just a few weeks to go to the UK general election, discussed and considered thousands of times every the target culture the two main political parties have been slugging it day,” he writes. “Care would become everyone’s means that doctors out over who will pay more for the NHS. In his weekly concern.” are stuck working Election Watch column (p 15) The BMJ’s news reporter, Holcombe believes that this strategy might help for the government Gareth Iacobucci, unpicks the financial pledges made prevent a climate in which so many of the stories in the rather than patients, by Labour and the Conservatives. And in a one-off news are about failure, and particularly failure in care. and she, too, wants Observations column the chief executive of the NHS Editorialists Hanan Edrees and Frank Federico focus to be emancipated Confederation, Rob Webster, seeks to cut through the on the “second victims” of medical error or adverse political row and conflicting messages to spell out the events in healthcare: the clinicians involved, who things that are needed from the government financially may be “suffering in silence” (p 7). “These healthcare thebmj.com to support the NHS in the next parliament (p 22). providers are often told to take care of the next patient ЖЖFor more from The BMJ on “It’s time to bring clarity on what is needed in the without an opportunity to discuss the details of the the UK general election go to NHS,” writes Webster. “The money is one challenge, event or share how this has affected them personally bmj.co/election. transforming care is an even greater one.” and professionally,” they write. Edrees and Federico For a possible model of how to transform care call for the development of more structured support we could look to Basildon and Thurrock University programmes to help the “second victims.” Hospitals. As Matthew Limb reports (p 18), in July In her weekly column the general practitioner The BMJ is co-hosting a UK 2013 it was one of 11 NHS foundation trusts put into Margaret McCartney admits that every day she fails to general election hustings with the special measures because of high death rates. Within do things as well as she should (p 23). “I don’t spend health spokespeople from the a year, and after many new initiatives, including a enough time discussing this preventive strategy or main political parties at 11 am on 21 April. Watch the debate live at boost to the trust’s clinical leadership, it was rated that treatment.” Reflecting on the “true” meaning of www.healthdebate.net. “good” overall by the Care Quality Commission. Its partnership with patients, McCartney fears that the associate medical director, Charlotte Hopkins, says target culture means that doctors are stuck working that now the focus is “very much on how you go from for the government rather than patients, and she, good to outstanding.” too, wants to be emancipated. “We need a revolution This week’s contributor to our If I Ruled the NHS where patients truly come first, not politicians.” series has clear ideas about how to transform care For a clearer picture of what the priorities are for (p 23). Chris Holcombe, a consultant breast surgeon politicians, turn to page 4 for a summary of the NHS from Liverpool, would ensure that every candidate for related proposals from the party manifestos. Tell us Twitter every interview for every NHS post—whether clinical what you think of the proposals in a rapid response. ЖЖFollow the editor, Fiona or managerial and administrative—was asked how Trevor Jackson, deputy editor, The BMJ Godlee @fgodlee, and The BMJ much they care. “Care, what it is, how it is practically [email protected] at twitter.com/bmj_latest applied, and how it could be improved would be Cite this as: BMJ 2015;350:h2027
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