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Full versions with references and competing interests are on thebmj.com 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 EDITORIALp CPD/CMEhour RESEARCHp 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 RESEARCHpp 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/CMEhour must be reduced throughout the EDITORIALp ANALYSIS week, not just at weekends UNCERTAINTIES RESEARCHp 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 RESEARCHp 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 EDITORIALp 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. 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To the fullest extent permitted by law, the BMJ Publishing Group shall not Printed by Polestar Limited the bmj | 18 April 2015 THIS WEEK 18 April 2015 Vol 350 The Editor, The BMJ BMA House, Tavistock Square, London WCH 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. THEBMJCOMPOLL 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. BMJh YESNO The BMJ is printed Total votes cast: VOTENOWON on % recycled paper BMJh THEBMJCOM (except the cover) podcasts Talk medicine Listen to what you want, when you want, and how you want thebmj.com/podcasts Download any QR code reader on your smartphone and scan this code to start listening 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 ̻̻BMJ̻1915;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. ̻̻Watch̻the̻debate̻live̻from̻11̻am̻on̻21̻April̻at̻www.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 Cite̻this̻as:̻BMJ̻2015;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 ̻̻BMJ̻2015;350:h1225 let’s be clear, that is all that this is about.