90 years for the Postgraduate Medical Journal

A Symposium is being organised by the Fellowship of Postgraduate Medicine to mark the 90th Anniversary of its first official journal, the Postgraduate Medical Journal. The Symposium will be held at the Medical Society of London on on 1st October 2015.
Speakers on the day will comment on what medicine was like in the 1920s, current progress in their field, and what is in prospect over the next 90 years.
Other speakers will include FPM Fellow Professor Peter Barnes FRS, London, who will speak on advances in respiratory medicine, Professor Dame Carol Black, Principal of Newnham College, Cambridge and Past-President of the Royal College of Physicians who will discuss opportunities to improve public health through a focus on health in the workplace, Professor Melanie Davies (Leicester) on progress in managing diabetes, vascular surgeon Professor Alison Halliday (Oxford) on carotid surgery to prevent stroke, FPM Fellow chemical biologist Andrew Marsh (Warwick) who will discuss advances in drug discovery, FPM Fellow cardiac surgeon Wade Dimitri (Coventry) who will discuss early development of heart surgery  Dr Paul Nunn (London), former Director of the WHO Tuberculosis Programme, on advances in managing tuberculosis, FPM Fellow Professor Munir Pirmohamed (Liverpool) who will discuss Progress in Personalised Medicine, Emeritus Professor Terence Ryan (Oxford) on Sir William Osler and Professor Karol Sikora (London) on cancer - a disease of our time.

The Postgraduate Medical Journal publishes topical reviews, commentaries and original papers on themes across the medical spectrum. It provides continuing professional development for all doctors, from those in training, to their teachers, and active clinicians, by publishing papers on a wide range of topics relevant to clinical practice.
Papers published in the PMJ describe current practice and new developments in all branches of medicine; describe relevance and impact of translational research on clinical practice; provide background relevant to examinations; and papers on medical education and medical education research.  The FPM is a British non-profit organisation founded in the autumn of 1919 as a merger of the Fellowship of Medicine and the Postgraduate Medical Association, with Sir William Osler as its first president. Its initial aims were the development of educational programmes in all branches of postgraduate medicine. 
The FPM organises clinical and research meetings and publishes two journals. The FPM has since 1925 published the international journal, the Postgraduate Medical Journal. In 2012 the Fellowship launched a new international journal, Health Policy and Technology, published on the Fellowship's behalf by Elsevier.

Microcirculation and the 2012 UK-US international Conference

@HealthMed The MicroCirc2012 conference at Keble College Oxford, 4-6 July, was co-organized by the British Microcirculation Society and the US Microcirculatory Society. 

Why study the microcirculation? The microvessels - small arteries, capillaries and small venules - play a vital role in providing nutrition to and removing waste products from vital organs. Microvessels are also critical for healthy maintenance of blood pressure. 

D Singer and PhD student H Saedon at MicroCirc2012

And in a wide range of diseases, a spectrum of inflammatory factors, acting on and/or derived from the microcirculation, contribute to disease causation and severity, and provide both biomarkers and targets for prevention and treatment of serious diseases from cardiovascular syndromes to diabetes, inflammatory disease and cancer, and from early abnormalities in the fetal circulation to diseases of ageing. 

A series of delegates posts are now appearing from the MicroCirc2012 conference, from a wide range of specialists, from molecular biologists to imagers, and from 1st year PhD students to senior academics. 

See more about the microcirculation and the 2012 Conference in reflections of principal organizer Professor Chris Garland, posts from delegates and in video interviews with Professor Giovanni Mann from King's College London, and Professor Steven Segal from Columbus, Missouri, USA.

Opium and mortality

@HealthMed Opium is widely used internationally. A study from Iran just published in the British Medical Journal now reports almost doubling of mortality rates in regular users of opium.

Here are my comments to the Science Media Centre on this study:

"The key message in this prospective study on opiates is of interest to pharmacologists, health professionals and members of the public: use of recreational opium, whether raw or modified, smoked or swallowed, appears associated with increased risk of death from a wide range of diseases, including circulatory and respiratory disorders, and cancer.

"However the results need to be interpreted with caution. This work is from north-east Iran and may not be typical for other ethnically or genetically different individuals. The authors note that they cannot be sure whether the relationship is causative. And oddly, risks from opiates did not appear to be amplified in people with high blood pressure, smokers or diabetics, raising some questions about the accuracy of clinical data collection."

Although some commentators have linked findings of this study to use of medically prescribed or over the counter opiates, there are too many confounders for that to be a reasonable extrapolation from the BMJ study. Nonetheless the general principle remains that medicines should only be used when clinically indicated.

See more about the study and related comments on the New Zealand Science Media Centre site.

Why have a National Blood Pressure Week?

 In the UK, over 1,500 venues are offering free blood pressure checks during National Blood Pressure Week (12-18 September 2011). Why all that effort?   High blood pressure is a major preventable and treatable risk factor for serious heart diseases and stroke syndromes throughout the world. And even at the age of 20 around one in 20 people may already have high blood pressure, increasing to around 1 in 2 people by the age of 70.

An annual blood pressure week provides an important focus to remind the public and health professionals about risks of high blood pressure, how to prevent it, measure it accurately and use lifestyle and drugs in people in whom blood pressure is too high.

Blood pressure should be as low as possible, with, for adults, the upper level, when the heart has contracted, below 140mmHg and the lower level below 90mmHg, when the heart is relaxed between heartbeats. These thresholds should be much lower in people at increased risk of blood pressure complications, such as diabetics and people with kidney disease.

Provided people are otherwise healthy, the ideal blood pressure is now considered by international experts for the upper value to below 120, the lower below 80, recorded as ‘below 120/80mmHg’.

It is very important that patients help by following a healthy lifestyle. This is both helpful to prevent high blood pressure, and for patients with hypertension, to reduce its severity. People should aim for a healthy weight, using fresh foods as far as possible, keep salt intake low, and alcohol intake within healthy limits, be active and have regular good sleep.

This year it is timely the UK’s National Blood Pressure Week comes just after the launch of important new blood pressure guidelines prepared by the National Institute for Health and Clinical Excellence (NICE) advised by experts from the British Hypertension Society (BHS).

The NICE guidelines contain new advice on blood pressure measurement, including involvement of patients in their own management, supported by home blood pressure readings.

It is of course very important that any blood pressure monitor, whether for clinical or home use, should be accurate. A helpful list of accurate devices is on the British Hypertension Society's website.’

If you have high blood pressure, you should make sure that your doctor knows about any over the counter tablets or herbal remedies you are taking, as these can interfere with the actions of blood pressure tablets.

There are now seven major types of blood pressure treatments. For best blood pressure control, prescribers need to the right drug options for the right kind of patient, taking into account, for example, age, ethnicity and potential risks in pregnancy. If single drugs are not sufficient to control blood pressure, the NICE guidelines provide advice on which drug combinations are best to use.

Useful websites:
British Hypertension Society – includes information on which blood pressure monitors are accurate  http://www.bhsoc.org
Blood Pressure Association – includes a list of venues for free blood pressure checks http://www.bpassoc.org.uk/
NICE guidance on hypertension for patients and carers: http://guidance.nice.org.uk/CG127/PublicInfo/pdf/English

Ideas for maintaining variety in providing for multiple special diets

What to do about special diets? It is possible with a little research to prepare an individual meal to cater for a cluster of guests each with different special dietary needs and preferences, for example allergy to gluten, diabetes mellitus and preference for vegetarian food. There are also now many recipe sources for individual special diets, for example in the UK the BBC website (separate listings for gluten-free, nut allergy, egg-free, dairy-free, 'healthy', pregnancy-friendly, shellfish-free, vegan and vegetarian), the Coeliac Society for gluten allergy and Diabetes UK and other international equivalent organisations for diabetic recipes. But when more than one allergy is present in the same family, maintaining daily variety is much more difficult.
Xavier Ternisien in today's Le Monde [Sunday 14th August] has highlighted a blogger for francophones who has risen to this challenge. Bordeaux 'blogueur' Anne Lataillade worked in financial services after graduating from business school. Struggling for inspiration for meals for separate gluten and egg allergy in her 2 children, she has been blogging on practical recipes since 2005. Her aim is to provide simple to make recipes that work, with ideas for savoury foods and desserts compatible with both these allergies. She accompanies her blogged recipes with photographs of the dishes and information on the sources and properties of the suggested ingredients. Her website also provides information on archived recipes and on publications arising.
A further website worth checking is 'Cooking Allergy Free'. This site, after free registration, allows access to a large menu of potential allergies and then to a limited range of suitable recipes compatible with a a very complex range of needs and preferences.
Attractive varied suggestions are a good approach to complement other measures to encourage adherence to special diets for medical allergies.
US actress Zooey Deschanel highlighted the challenges of catering for multiple food intolerances and preferences by appearing on a 2009 US television programme in which chefs were asked to provide food suitable for vegans intolerant to dairy, eggs, soya and gluten.