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[Editorial] Medical professionalism and physician wellbeing

Sab, 04/09/2021 - 00:00
Integrity, compassion, altruism, continuous improvement, excellence, working in partnership—these are the values of medical professionalism, according to a working group formed by the Royal College of Physicians in 2005. More recently, ideas about professionalism have focused on the attributes required for a modern doctor to fulfil their roles as healer, innovator, researcher, and patient partner. But much of the thinking around medical professionalism remains rooted in an idealised, traditional, and paternalistic foundation of self-sacrifice and service to humanity, in which the perceived good doctor prioritises the care of their patient over all else.

[World Report] The long road ahead for COVID-19 vaccination in Africa

Sab, 04/09/2021 - 00:00
Only 2·5% of Africans are vaccinated against COVID-19. Millions more doses will be needed to meet even modest targets and experts are sceptical of success. Sara Jerving reports.

[World Report] Health under cyberattack

Sab, 04/09/2021 - 00:00
Cyberattacks are becoming a major issue of health security, but are they getting the attention they need? John Zarocostas reports.

[Perspectives] Alika Lafontaine: Indigenous and Canadian change maker

Sab, 04/09/2021 - 00:00
Alika Lafontaine was running late for our Zoom call because he was seeing patients. An anaesthesiologist at Queen Elizabeth II Hospital in Grande Prairie, Alberta, Canada, he had already intubated two patients with COVID-19 that morning—both were young, unvaccinated adults. In a world of divided opinion about vaccines, health-care reform, and how to achieve equity, diversity, and inclusion in the medical professions, Lafontaine's ability to humanise and challenge health-care narratives and systems is fuelling change in Canada.

[Perspectives] The race to make a COVID-19 vaccine

Sab, 04/09/2021 - 00:00
Sarah Gilbert, Catherine Green, and their scientific colleagues at the University of Oxford who made a vaccine against the novel coronavirus, SARS-CoV-2, that has brought the world to a standstill, are heroes of our time, already decorated in the UK by the Queen and, in Gilbert's case, lauded by Mattel, which has made a Barbie doll in her image. Fired by a mission to save the world, these researchers are dedicated, altruistic, and determined that their vaccine would not only be safe and effective, but also cheap and easy to use in the poorest corners of the globe.

[Perspectives] The return

Sab, 04/09/2021 - 00:00
Since its origin, Greek tragedy has offered a space for audiences to reflect on current moral and ethical dilemmas. For example, Sophocles’ Antigone puts at its centre the clash between behaving according to one's personal values and complying with unjust societal laws, while Electra focuses on the conflict between filial love and the need for justice. In the first months of the COVID-19 pandemic, readings of Greek tragedy were also used to help health-care workers to address moral injury through the programme Theater of War for Frontline Medical Providers, previously described in this journal.

[Correspondence] The remoteness of pain in Canada's Indigenous peoples' collective memory

Sab, 04/09/2021 - 00:00
To continue the thread of the Editorial about Canada's indigenous people,1 the pain of Canada's indigenous peoples’ collective memory is neither buried nor unearthed from the living stories, silencing truths, understanding, mourning or reconciliation, deepening living pain, and trauma in some of the world's most remote regions.

[Correspondence] Responding to responsive behaviour in Alzheimer's disease

Sab, 04/09/2021 - 00:00
The Seminar on Alzheimer's disease by Philip Scheltens and colleagues1 contains a wealth of valuable information on biological and epidemiological aspects of the condition. However, an area of concern was the relegation of what were termed neuropsychiatric syndromes to drug treatment alone.

[Correspondence] Responding to responsive behaviour in Alzheimer's disease – Author's reply

Sab, 04/09/2021 - 00:00
I thank Desmond O'Neill and Sean Kennelly for pointing out the import­ance of behaviour as being responsive to external factors, rather than being an intrinsic deficit of Alzheimer's disease. We acknowledge the use of non-pharmacological measures here, but did not include it in our Seminar1 because of our focus on the earliest stages of the disease, in which behavioural aspects, such as described by O'Neill and Kennelly, are less obvious and less prevalent than in the later stages.

[Clinical Picture] Diagnosing pneumomediastinum in a neonate using a lung ultrasound

Sab, 04/09/2021 - 00:00
A preterm baby—delivered by caesarean section at 36 weeks and 5 days due to pathological trace on cardiotocography—presented immediately after birth with tachypnoea, and sternal, intercostal, and subcostal recessions.

[Seminar] Community-acquired pneumonia

Sab, 04/09/2021 - 00:00
Community-acquired pneumonia is not usually considered a high-priority problem by the public, although it is responsible for substantial mortality, with a third of patients dying within 1 year after being discharged from hospital for pneumoniae. Although up to 18% of patients with community-acquired pneumonia who were hospitalised (admitted to hospital and treated there) have at least one risk factor for immunosuppression worldwide, strong evidence on community-acquired pneumonia management in this population is scarce.

[Review] Mental illness and suicide among physicians

Sab, 04/09/2021 - 00:00
The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide.

[Editorial] Understanding long COVID: a modern medical challenge

Sab, 28/08/2021 - 00:00
As the COVID-19 pandemic continues, the need to understand and respond to long COVID is increasingly pressing. Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many millions of people globally. Yet very little is known about the condition. The term “long COVID” is commonly used to describe signs and symptoms that continue or develop after acute COVID-19. A NICE guideline, for example, includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (≥12 weeks), but there is no agreed upon definition.

[Comment] Pembrolizumab–chemotherapy for advanced oesophageal cancer

Sab, 28/08/2021 - 00:00
Oesophageal carcinoma includes two histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Each histological subtype has its own biological signature, with each having distinctive important molecular differences, and there are differences in cause and incidence between these two subtypes. Oesophageal squamous cell carcinomas share many genetic features with head and neck squamous cell carcinomas, whereas adenocarcinomas contain molecular changes similar to those in stomach cancer.

[Comment] Inadequate evidence on stillbirths: rethinking public health

Sab, 28/08/2021 - 00:00
Rates of stillbirths are an indicator of the quality of care around pregnancy and birth. They are increasingly a matter of global health concern, falling within the remit of the Sustainable Development Goal 3 (maternal health), which aims to end preventable deaths of newborn babies and children younger than 5 years by 2030. However, stillbirths continue to be a particular challenge in most low-income and middle-income countries (LMICs), especially in sub-Saharan Africa,1 where more than 0·8 million deaths have been estimated to occur annually.

[World Report] Aid agencies reassess needs after Afghanistan takeover

Sab, 28/08/2021 - 00:00
Health and humanitarian organisations face uncertainty following the Taliban's takeover of the country. Sharmila Devi reports.

[Perspectives] Ana Mocumbi: cardiologist tracking NCDs of poverty

Sab, 28/08/2021 - 00:00
When Ana Mocumbi graduated with an MD from Eduardo Mondlane University, in Maputo, Mozambique, in 1992, she could not train in cardiology, her specialty of choice. At the time, it was compulsory for medical graduates in the country to take up a rural post to address the scarcity of doctors and to pay back their years of initial training to the state. Mocumbi went to the Sofala province, which was badly affected by Mozambique's civil war, and worked as a general practitioner in its capital, Beira.

[Perspectives] Life as we know it

Sab, 28/08/2021 - 00:00
“Asking biologists about what it means for something to be alive makes for an awkward conversation”, says veteran science writer Carl Zimmer in Life's Edge: The Search for What It Means to Be Alive. “They’ll demur, stammer, or offer a flimsy notion that crumbles under even a little scrutiny. It's just not something that most biologists give much thought to in their day-to-day work.”

[Obituary] Michael Newton Marsh

Sab, 28/08/2021 - 00:00
Gastroenterologist and authority on coeliac disease. He was born in Bristol, UK, on May 15, 1937, and died of prostate cancer in Shilton, UK, on July 12, 2021, aged 84 years.

[Correspondence] HIV and overdoses: diversifying therapies for opioid use disorder

Sab, 28/08/2021 - 00:00
In the Series on HIV in the USA, Sally L Hodder and colleagues1 give appropriate attention to HIV prevention strategies that attend to the needs of people who inject drugs, including medications for opioid use disorder and harm-reduction programmes. Yet there is no mention that the USA has failed to expand options for medication therapies for opioid use disorder using an inclusive continuum of care framework, concordant with existing medical evidence and international practice.