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Medical engagement

Our report is based on case studies of four NHS trusts with acknowledged high levels of medical engagement. It aims to help other organisations that are seeking to create cultures in which doctors want to engage more in the management, leadership and improvement of services. What is good medical engagement? In those organisations where it exists, how has good medical engagement been created and sustained? These questions are at the heart of this report, which builds on earlier work from The King’s Fund on medical leadership.  
The King's Fund
over 7 years ago
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60

How is the NHS performing? July 2014

Our twelfth Quarterly Monitoring Report features survey results from finance directors and interactive charts on selected NHS performance data.  
The King's Fund
over 7 years ago
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Financial failure in the NHS

We explore the current financial state of the NHS, the approaches used to avert financial failure and how to deal with it once it occurs. This report describes the current financial state of the NHS and the reasons for the deterioration in financial performance and ultimately financial failure. These include weak leadership, legacy costs, PbR, and the impact of the wider health economy.  
The King's Fund
over 7 years ago
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10

Shift work dulls your brain - report - BBC News

Working antisocial hours can prematurely age the brain and dull intellectual ability, scientists warn.  
BBC News
about 7 years ago
Specialists in out of hospital settings front cover
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Specialists in out-of-hospital settings

We visited six services where consultants are delivering or facilitating care outside hospital. This report presents the findings from those visits as case studies and identifies some of the key characteristics and challenges to this way of working.Demographic changes, technological advances and the changing pattern of disease are pushing up the numbers of patients with complex needs who require treatment in the community. But outside hospital, the resources and expertise are often not available to treat them, and patient care can be disjointed as different parts of the system fail to understand each other. In response, consultants in some areas of England are developing services that link secondary, primary, community and social care professionals.  
The King's Fund
about 7 years ago
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India’s ambition to eliminate visceral leishmaniasis

With the introduction of a new drug, can the new government keep its promise to rid India of kala azar? Talha Burki reports  
bmj.com
about 7 years ago
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So is cancer mostly 'bad luck' or not? - BBC News

News reports that most cases of cancer are the result of bad luck dominated headlines at the start of the year - but they now appear to have been incorrect.  
BBC News
about 7 years ago
Www.bmj
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NHS is not (yet) in crisis, but what about school rugby?

If a crisis is the point of judgment, the nadir, the turning point, the NHS in England can’t yet be judged to be in crisis, said John Appleby of the health think tank the King’s Fund in a BBC interview this week, because things may well get worse (doi:10.1136/bmj.h50). This is hardly reassuring but probably realistic. Hospitals around the country are declaring “major incidents” because of a lack of beds or staff or both, emergency departments report that they are at breaking point, and general practice is under unprecedented pressure (doi:10.1136/bmj.h66, doi:10.1136/bmj.g7266, doi:10.1136/bmj.g6069, doi:10.1136/bmj.g6040). And there is little sign yet of things improving. Less realistic but more palatable is the belief of NHS England’s chief executive, Simon Stevens, that the £30bn (funding gap expected for 2020-21 can be narrowed to £8bn. This is magical thinking, says Nigel Hawkes (doi:10.1136/bmj.g7842).  
bmj.com
about 7 years ago
Static.www.bmj
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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
about 7 years ago