bmj.com:

Print issue

This week

How can we restart the antibiotic pipeline? What is BMJ CME? Was Florence Nightingale an early whistleblower? To find out more about this week's BMJ print issue, read Tony Delamothe's editor's choice, "CME, GMC, and Florence Nightingale," and the print issue's table of contents. All articles have already appeared on bmj.com as part of our continuous publication policy.

News

Major NHS survey finds care standards are improving but medication information is poor

The NHS is showing marked improvements in cleanliness and in reducing mixed sex accommodation, according to a survey of 69 000 adult inpatients in 162 hospital trusts in England. However, the Survey of adult inpatients 2009, published by the Care Quality Commission (the NHS regulator), also found that more action is needed to tackle the lack of information about medicines and their potential side effects.

News published on 21 May:

Local people to be elected to run primary care trusts, says new government

Research

The health and socioeconomic impacts of major multisport events

There is insufficient evidence to show that major multisport events like the Olympics benefit or harm the health and economy of the host population. The authors of this systematic review are now calling on decision makers to ensure that robust evaluations are in place for the London 2012 Olympics and Paralympics and the Glasgow 2014 Commonwealth Games so that it is clear that costs "can be justified in terms of benefits to the host population." Editorialist Mike Weed argues that "the risk for the UK population is not that we will not get the benefits for our £150 a head investment in London 2012, but that there will be no robust evidence of what we have paid for."

Research

Unintended effects of statins in men and women in England and Wales

The type and dosage of statin drugs given to patients to treat heart disease should be proactively monitored as they can have unintended adverse effects. Julia Hippisley-Cox and Carol Coupland found that some statins can lead to an increased risk of liver dysfunction, acute renal failure, myopathy, and cataracts in patients. Adverse effects were similar for all the statins except for liver dysfunction, where the highest risks were found for fluvastatin. The increased risks persisted during treatment but were highest in the first year. The accompanying editorial says that like any medical intervention, statins are not entirely free of adverse events, but that when used according to current guidelines, the benefits outweigh the risks.

Research

Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency

Patients treated over prolonged periods with metformin, a common drug for diabetes, are at risk of developing vitamin B-12 deficiency, which is likely to get progressively worse over time, according to this randomised placebo controlled trial. The researchers suggest that regular measurement of vitamin B-12 levels during long-term metformin treatment should be strongly considered. In an editorial, Josep Vidal-Alaball and Christopher C Butler say: "We first need to determine whether simple dietary counselling when metformin is started and at medication reviews will solve the problem. If it does not, a trial of screening for vitamin B-12 deficiency in patients taking metformin would be needed."

Education

Neonatal jaundice: summary of NICE guidance

About 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breast fed babies are still jaundiced at age 1 month. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence on how to diagnose and treat jaundice in newborns up to 28 days old.

Also published on 20 May:

Education

Endgames

This week's instalment of our new weekly educational clinical quiz is now live. Compiled from peer reviewed contributions from readers, it covers clinical medicine and statistics. There's also a prize quiz, pulled from the BMJ's sister product OnExamination.

This week's Endgames articles:

Comment

Lethal injections: no healthcare professionals should be involved

On 15 February the American Board of Anesthesiology, which certifies anaesthetists in the United States, stated that "anesthesiologists may not participate in capital punishment if they wish to be certified." To Mike Weever, a US anaesthetist practising in the United Kingdom but partly US trained, this statement would seem surreal if it were not so necessary. The death penalty is constitutional, and so is the use of a lethal injection to achieve it. In this personal view he explains why he thinks no healthcare professionals should be involved in participating in capital punishment.

More comment published on 20 May:

Research and comment

Effect of antibiotic prescribing in primary care on antimicrobial resistance

Patients prescribed antibiotics in primary care may develop drug resistance that lasts up to 12 months, according to this systematic review and meta-analysis. The authors found strong evidence that resistance to antibiotics prescribed for respiratory or urinary infection is greatest in the month immediately after treatment, but may last for up to a year. This residual effect may be a driver for high levels of resistance in the community. The authors of an accompanying analysis argue that new antibiotics to tackle multidrug resistant bacteria are much needed. An editorial calls for economic strategies to bring new drugs to market.

Comment

Whistle while you work: an analysis of NHS foundation trust policies

Despite laws to protect NHS workers who wish to raise concerns about patient care, a BMJ investigation reveals that some NHS trusts still make it hard for staff to speak out. The BMJ compared whistleblowing policy documents, valid up to November 2009 from 118 of the 122 NHS foundation trusts, against six standards set out in guidance produced by Public Concern at Work, an independent authority that also runs a helpline for NHS staff. The results show that some trusts do not have measures in place to protect whistleblowers.

Call for articles

BMJ practice section

This section aims to assist clinicians in their daily tasks. We are particularly interested in:

Change page - alerting clinicians on the immediate need for a change in practice, with compelling evidence that the change is beneficial and feasible;
Easily missed - highlighting important conditions that may be often missed at first presentation in primary care;
Rational testing - updating clinicians on the best use of diagnostic testing for common or important clinical presentations; and
Uncertainties page - highlighting areas of practice that lack convincing supporting evidence.

You can email proposals to practice.bmj{at}bmjgroup.com and find out more here.

Community

Today on doc2doc

BMJ Group's clinical community for doctors worldwide now has 26,600 members. Log in or register to read and join in the latest discussions, including clinical topics posted in forums that can only be accessed by verified doctors. doc2doc clinical editor Sabreena Malik's favourite posts today include:

Read these and other forums on doc2doc, BMJ Group's global clinical community