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19

Global child health: Why kernicterus is still a major cause of death and disability

Stream Global child health: Why kernicterus is still a major cause of death and disability by BMJ talk medicine from desktop or your mobile device  
SoundCloud
almost 7 years ago
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2
38

Preterm birth and the role of neuroprotection

Preterm birth remains a common complication of pregnancy and causes substantial neonatal morbidity and mortality. As improvements in the care of preterm neonates have outpaced efforts to prevent preterm birth, the numbers of survivors with neurologic sequelae that affect quality of life have increased. The main strategies to reduce the impact of neurologic complications of prematurity include prevention of preterm birth and protection of the developing fetal brain through antenatal administration of drugs. These strategies rely on a basic understanding of the intertwined pathophysiology of spontaneous preterm labor and perinatal brain injury, which will be reviewed here. The review will outline current methods for the prevention of prematurity and neuroprotection. The use of magnesium sulfate as a neuroprotective compound will be discussed, including concerns over its association with increased pediatric mortality and abnormalities in bone density.  
bmj.com
almost 7 years ago
Static.www.bmj
1
24

Opioids for low back pain

Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.  
bmj.com
almost 7 years ago
Preview
2
8

Opium soaked tampons, voodoo elixirs and leeches: welcome to New Orleans' Pharmacy Museum

Located in the townhouse of the US’s first licensed pharmacist, this lively, macabre, cringe-inducing museum provides a refreshing re-contextualization of its many artifacts and an unflinching encounter with our mortality  
the Guardian
almost 7 years ago
Www.bmj
1
7

People with diabetes have one third higher mortality risk than general population, audit shows | The BMJ

The risk of death is one third higher among people with diabetes in England and Wales than in those without diabetes, the National Diabetes Audit has said, adding that this is due to complications resulting from poor diabetes control. - currently located behind a paywall. Your institution may have access through Athens/Elservier or similar.  
bmj.com
over 6 years ago
Www.bmj
1
14

Most common cause of death in England and Wales in 2013 was heart disease in men and dementia in women

The leading cause of death among men in England and Wales in 2013 was ischaemic heart disease, accounting for 15.4% of deaths, while among women it was dementia and Alzheimer’s disease, which caused 12.2% of deaths, show the latest statistics.1 Dementia and Alzheimer’s disease overtook heart disease as the leading cause of death among women in 2012.  
bmj.com
over 6 years ago
Www.bmj
1
11

Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study

Objectives To quantify the relationship between a national primary care pay-for-performance programme, the UK’s Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.  
bmj.com
over 6 years ago
Www.bmj
1
15

Surgical team in India calls for mandatory enforcement of WHO safety checklist

A team of gastrointestinal surgeons in India has called for mandatory enforcement of the World Health Organization’s surgical safety checklist across the country, after implementing it in their own department and observing lower postoperative complications and mortality.  
bmj.com
over 6 years ago
Www.bmj
1
9

Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study

Objectives To quantify the relationship between a national primary care pay-for-performance programme, the UK’s Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.  
bmj.com
over 6 years ago
Www.bmj
1
11

Under-reporting and case fatality estimates for emerging epidemics

Using the example of Ebola, this article highlights the problems of using population level data to estimate case fatality rates in epidemics  
bmj.com
over 6 years ago
Www.bmj
1
14

Outbreak of swine flu in India is no worse than seasonal flu, say specialists

The outbreak of H1N1 influenza in India this year, which has killed 875 people since 1 January, is not yet a major concern because the incidence and mortality are no different from those caused by seasonal flu in developed countries such as the United States, infectious disease specialists have told The BMJ.  
bmj.com
over 6 years ago
Static.www.bmj
1
44

Opioids for low back pain

Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.  
bmj.com
over 6 years ago
Www.bmj
1
13

Most common cause of death in England and Wales in 2013 was heart disease in men and dementia in women

The leading cause of death among men in England and Wales in 2013 was ischaemic heart disease, accounting for 15.4% of deaths, while among women it was dementia and Alzheimer’s disease, which caused 12.2% of deaths, show the latest statistics.1 Dementia and Alzheimer’s disease overtook heart disease as the leading cause of death among women in 2012.  
bmj.com
over 6 years ago
Www.bmj
1
15

Surgical team in India calls for mandatory enforcement of WHO safety checklist

A team of gastrointestinal surgeons in India has called for mandatory enforcement of the World Health Organization’s surgical safety checklist across the country, after implementing it in their own department and observing lower postoperative complications and mortality.  
bmj.com
over 6 years ago
Www.bmj
1
9

Authors’ reply to Foster and colleagues

We thank Foster and colleagues for their comments.1 2 Projections of disease progression that are based on natural history studies from tertiary referral centres may exaggerate hepatitis C virus (HCV) related morbidity and mortality. Inception cohort and epidemiological data suggest that only a minority of infected people will progress to end stage liver disease over their lifetime.1  
bmj.com
over 6 years ago
Static.www.bmj
1
30

Response from Hepatitis C Trust, BASL, BIA, BVHG, BSG, and BHIVA to article asking whether widespread screening for hepatitis C is justified

Koretz and colleagues argue that hepatitis C virus (HCV) screening should be delayed.1 We disagree. HCV transmission was common in the 1960s-80s, and because mortality occurs 30-40 years after infection deaths will rise exponentially over the next decade.2 Delaying effective intervention will have a massive impact. The authors argue that because a community study showed an increase in liver and non-liver mortality most infected people will not die from HCV. Infection can cause or exacerbate renal disease, diabetes, and dyslipidaemia and treatment reduces all cause mortality,3 indicating that both liver and non-liver related deaths are caused by …  
bmj.com
over 6 years ago
Www.bmj
1
25

Surgical team in India calls for mandatory enforcement of WHO safety checklist

A team of gastrointestinal surgeons in India has called for mandatory enforcement of the World Health Organization’s surgical safety checklist across the country, after implementing it in their own department and observing lower postoperative complications and mortality.  
bmj.com
over 6 years ago
Www.bmj
1
9

Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study

Objectives To quantify the relationship between a national primary care pay-for-performance programme, the UK’s Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.  
bmj.com
over 6 years ago