BMJ - British Medical Journal

Near-infrared spectroscopy (NIRS), originally described in 1977, entered clinical practice as a non-invasive method to assess regional tissue oxygenation.1 This monitoring technique was initially used in high risk surgeries to measure cerebral oxygenation in real time. After encouraging results that linked intraoperative NIRS guided, goal directed treatment to improved neurological outcomes in cardiac surgery, NIRS use quickly expanded.234 This increased use has sparked the development of multiple competing clinically approved NIRS monitoring systems, highlighting the substantial market interest in this technology.5Despite the widespread use of NIRS, negative findings from subsequent trials have raised concerns about whether NIRS monitoring truly improves outcomes.678 These concerns have prompted a debate regarding the surgical populations who might benefit from NIRS and the best practices for its use.9 In a linked research paper (doi:10.1136/bmj-2024-082104), Han and colleagues present noteworthy findings from the Bottomline-CS trial, which examined whether perioperative care guided by cerebral and peripheral tissue...

A love of people and their life stories inspired Raja Badrakalimuthu to specialise in old age psychiatry.“Working with older people, you get to have conversations about their lives,” says Badrakalimuthu, a consultant old age liaison psychiatrist at Royal Surrey County Hospital in Guildford. “Their generation built our society, and we’ve inherited the legacy of their hard work. I find it satisfying to be able to do something for them—to thank them, and show my gratitude.”Old age psychiatry is “the perfect blend of medicine and mental health,” he says. “Older people can have multiple physical conditions and you have to take this into account when diagnosing dementia.”With new dementia drugs becoming incorporated into clinical practice, and new cognitive assessments and scans becoming readily available, “it’s an exciting time to be doing old age psychiatry,” Badrakalimuthu says. Old age psychiatrists also have to be aware of what kind of support is available...

Buse and McKee discuss the potential changes to global health directions, funding, and structures under a second Trump administration.1 They note the risk to funding of organisations supporting sexual and reproductive health rights. These include the reinstatement of such policies as the “global gag rule,” in which the US government refuses to fund global non-government organisations who provide, refer, or promote access to abortion.2 This was very damaging under the first Trump administration.3 But changes in health policy direction and funding could also undermine progress in women’s health in other ways such as increased gender based violence, diminished reproductive autonomy, and shifts in societal norms. We would like to discuss this last aspect.An effect of Trump 2.0 will be the emboldening of men and others who share certain perspectives about the role of women in society. The far right slogan, “Your body, my choice,” tweeted by white nationalist Nick Fuentes...

Data on hospital beds are important1 but must not eclipse upstream priorities for tackling pressures in the NHS. Strengthening general practice is crucial. This calls for medical educators and NHS leaders who value and promote generalist skills—in particular, the art of “holding patient care in general practice.” “Holding” necessitates meeting patients’ health needs as far as possible entirely within the primary care setting and avoiding premature or unnecessary secondary care involvement or specialist investigations. Community presentations such as self-limiting illnesses, mental health issues, and medically unexplained symptoms infrequently follow a linear diagnostic algorithm. They require a “social-psycho-bio” (rather than a “bio-psycho-social”) perspective that tackles social circumstances, psychological wellbeing, and media driven expectations. Here, learners must be comfortable consulting “in the dark”: navigating patient care through history, examination, incremental management, and safety netting rather than defaulting to sequential clinical tests.2 In low risk populations, excessive investigation begets onward referral from ambiguous...

National PPE approach was focused on hospitalsDanny Mortimer, chief executive of NHS Employers and deputy chief executive of the NHS Confederation, told the inquiry that there was a lack of availability of personal protective equipment (PPE) in every part of the health service, but that it was particularly severe in general practices, community settings, and mental health services.1 He said members of the confederation believed that the national approach to PPE was focused on the acute sector. He cited a confederation survey of GPs in early 2020 in which 83% of respondents reported that they didn’t have proper access to masks with filters and 73% reported a lack of access to goggles and visors.Giving evidence on 18 March, Mortimer highlighted problems with the availability of specific equipment such as masks fitted with respirators. “There was particular concern about the availability of equipment that could fit different types of faces, whether...

In healthcare, prediction models or algorithms (hereafter referred to as prediction models) estimate the probability of a health outcome for individuals. In the diagnostic setting—including screening and monitoring—the model typically aims to predict or classify the presence of a particular outcome, such as a disease or disorder. In the prognostic setting the model aims to predict a future outcome—typically health related—in patients with a diagnosis of a particular disease or disorder, or in the general population. The primary use of a prediction model in healthcare is to support individual healthcare counselling and shared decision making on, for example, subsequent medical testing, referral to another healthcare professional or facility, treatment, discharge from hospital, or lifestyle changes. For example, the tool QR4 predicts the probability of developing a cardiovascular event within the next 10 years and informs whether individuals should undergo changes to their lifestyle or be prescribed drugs.1 Prediction models are...

bmj;388/mar21_10/r565/FAF1faAt the height of the Troubles in the early 1980s Ian Bownes, a young trainee psychiatrist in Northern Ireland, was sent into the notorious H blocks in Belfast’s Maze prison to assess if its paramilitary inmates were mentally fit to go on hunger strikes.It would have been an unsettling experience for anyone to go inside the Maze, which mainly housed republican prisoners. For a young Protestant like Bownes, however, it must have been even tougher. That Bownes did so for many years spoke to his “quiet heroism,” how much his professional opinion was valued, and how fully he was trusted to uphold the confidentiality on which his access depended, says friend and former colleague Harry Kennedy, a professor of forensic psychiatry at the University of Dublin.When Bownes first went into the Maze, republican prisoners were escalating a campaign of protest against the British government. This included demands to reinstate special...

Great British Energy, a new, publicly owned company created by the government, is to invest £200m to fit solar panels to the roofs of 200 NHS hospitals and 200 schools in England. The aim is to cut costs and carbon and make key areas of the public sector less dependent on the uncertain energy market. The programme is expected to save £400m over the lifetime of the panels (30 years), with savings reinvested in the NHS and education. The NHS spends an estimated £1.4bn a year on energy, a figure that has more than doubled since 2019.The programme is expected to last two years, and the first panels should be on NHS sites and schools by the end of summer 2025. The educational component of the programme will focus on schools in deprived areas, particularly in the north east, north west, and west Midlands.Mark Harber, special adviser on healthcare sustainability...

Weight management programmes for obese or overweight children may be effective, but their impact has been hampered by low uptake and completion rates, an evaluation of eight pilot projects across England has suggested.1A report from the Office for Health Improvement and Disparities evaluated eight projects funded through a £4.2m government grant in July 2021, which piloted extended brief interventions (EBIs) and expansion of behavioural weight management services for children aged 2 to 19 and their families.EBIs involve a practitioner discussing a child’s weight and growth with their parent or carer, and can include the use of behaviour change techniques, tailored support, and onward referral to services. Weight management services usually involve 12 week programmes and include diet and physical activity guidance. Their primary aim is weight maintenance and growing into a healthier weight, rather than weight loss.The pilots were funded for a year and took place across several areas in...

The World Health Organization (WHO) has called for an urgent international public health response as tuberculosis (TB) funding cuts threaten to reverse two decades of progress in containing the world’s deadliest infectious disease.The UN health agency said that it was particularly concerned about services in the world’s worst affected nations collapsing, allowing the respiratory disease to spread almost unabated.More than a million people died from TB last year, but that number is expected to rise sharply as public health systems, particularly in Africa, are no longer able to diagnose, treat, and monitor the disease. WHO warned that the situation could quickly deteriorate, as 27 countries faced “crippling breakdowns” in their TB response as funding cuts hit every stage of detection, treatment, and prevention.“The huge gains the world has made against TB over the past 20 years are now at risk as cuts to funding start to disrupt access to services...

A US judge has blocked drastic job cuts to the US Agency for International Development (USAID).On 18 March Judge Theodore Chuang of the US District Court for Maryland ruled that the moves—which effectively shut the agency—had probably violated the US constitution. The case was brought by more than 20 current and former USAID employees and contractors.The fired employees are not back at work but have been placed on paid administrative leave. The judge said the fast shutdown of the agency “deprived the public’s elected representatives in Congress of their constitutional authority to decide whether, when, and how to close down an agency” authorised by Congress.1The cuts were initiated by the Department of Government Efficiency (DOGE) which is headed by billionaire Elon Musk, adviser to President Donald Trump. Around 1600 of USAID’s US employees were fired and most of the rest were placed on administrative leave. USAID had about 13 000...

Liz Calhoun was halfway through her three year emergency physician training when she learnt from a text message that her hospital was closing in three months. She and the other 571 resident physicians at Hahnemann University Hospital in Philadelphia did not know how or where they would finish their training. In the end they didn’t have three months to figure it out: the training programme closed 30 days later.Hahnemann, located in the heart of the city, was a “safety net” hospital, meaning that its staff provided care to patients regardless of their insurance status or ability to pay. At the time of its closure in 2019, Hahnemann made headlines as the model for what can go wrong when a profit driven private equity firm takes over a hospital. In the years since, several other hospitals bought by private equity firms have abruptly closed, leaving their communities’ health, economies, and resident...