bmj.com:

Education

A woman with acute myelopathy in pregnancy: take part in the debate

This case progression is the second of a three part case report where we invite readers to take part in considering the diagnosis and management of a real patient using rapid responses on bmj.com. In three weeks' time we will report the outcome and summarise the responses.

Read part 1, case presentation, and submit rapid response.

News

Doctors call for greater transparency over limits of genetic tests

Scientists at the meeting "Does genetics matter?" in London have called for much more openness around direct to consumer genetic testing. The availability of direct to consumer genetic tests has increased rapidly in the past 10 years. Many of these tests are provided through the internet or over the counter in shops and pharmacies. The UK's genetic watchdog, the Human Genetics Commission, is consulting on a code of practice for genetic testing.

More news published on 23 November:

Comment

Health research in developing countries

Despite sustained growth in spending on science and technology worldwide, financial resources for research are insufficient in many countries. However, Latin America has taken initiatives to pave the way forward, says Mauricio L Barreto in this editorial.

Education

Acute lower gastrointestinal haemorrhage

In most patients, acute lower gastrointestinal bleeding resolves with conservative management, but when bleeding is especially severe, more invasive investigations and treatment may be needed, say Andrew J Edwards and Giles F Maskell in this rational imaging article. (Image shows computed tomography angiograms (axial, top; coronal, bottom) of the abdomen showing pooling of contrast material (arrows) in the proximal transverse colon, indicating the site of haemorrhage.)

Research

School closures and work absence will affect UK economy most during flu pandemic

School closures and absence from work are likely to have more impact on the UK economy during a flu pandemic than the disease itself, regardless of its severity according to this study. In the accompanying editorial, Alan Maynard and Karen Bloor say that the current outbreak of swine flu has already been costly, in terms of substantial advance purchases of costly treatments and vaccines, and payments to GPs to provide them. But if these investments are effective, and the spread of the disease is restricted, significant financial benefits may result.

Comment

Head to head: Should the NHS strive to eradicate all unexplained variation?

Variation exists in all aspects of health care. But should the NHS strive to eradicate all unexplained variation? Yes, says Stephen Richards, it is damaging to both quality of care and finances. No, says Richard Lilford, imposing uniformity risks stifling medical progress.

Podcast

End of life

In the UK, death is a subject we steer clear of. Talking with a patient about the end of their life is uncomfortable, but necessary. A recent report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) entitled Caring to the End has highlighted why this conversation needs to improve. We hear from David Mason, one of the clinical coordinators for the report, about its findings. Also this week, when end of life care hits the headlines it is almost inevitably about assisted dying. We hear about times when doctors in Switzerland or the Netherlands help a patient to die, but what about when they refuse? Roeline Pasman and Dick Williems join us to discuss their study into the ways in which patients' ideas of unbearable suffering may differ from their doctors' ideas.

Video

Remembering John Crofton

John Crofton has died at the age of 97. He pioneered the randomised controlled trial in a 1948 BMJ paper that looked at the antibiotic streptomycin to treat tuberculosis. Earlier this year he participated in a BMJ film to promote its online archive now being searchable back to 1840. In this short film, he talks to Colin Blakemore about the importance of randomisation and blinding, and how it has helped to make medicine more evidence based.

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