Medical Centre

Health systems throughout the world face many challenges, including the rising prevalence of chronic diseases such as diabetes; a rise in unhealthy behaviours and risk factors for poor health outcomes, such as physical inactivity, calorie-rich diets and obesity; increasing difficulty in maintaining expenditure on health services and funding new, high-cost treatments; maintaining the population’s access to healthcare while at the same time curtailing this growth in healthcare spending; and determining the most appropriate balance between primary care and specialist services. A new series of health policy reviews in the JRSM will report on these issues and how health systems are aiming to address key health policy challenges. Traditionally, research and debate in these areas has been very nation-specific, with relatively few attempts to carry out cross-national studies. However, if many of the challenges faced by healthcare systems are similar, then it is likely that countries can dr...

Immediate access to patients' complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR) system must be balanced against public concerns about data security and personal privacy. Successful development of EHRs requires better understanding of the views of the public and those most affected by EHRs: users of the National Health Service. In an article published recently in BMC Medical Informatics & Decision Making , Serena Luchenski and colleagues from Imperial College London describe a protocol for a study that aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions) and views relating to development of EHR for healthcare, health services planning and policy and health research. A multi-site cross-sectional self-complete questionnaire designed for use ...

The Joint Committee on Vaccination and Immunisation (JCVI) advises the Secretary of State for Health and Welsh Ministers on vaccination and immunisation policies. As an academic primary care physician , I am a strong supporter of evidence-based immunisation schemes and also believe - as far as is practical - in open policy-making in which evidence that government bodies use to make their decisions is made public. In a letter published in the British Medical Journal , I commented on the use by the JCVI of unpublished data and refusal of the JCVI to make public all the evidence it uses. The Chair of the  JCVI, Andy Hall, states that the Joint Committee on Vaccination and Immunisation (JCVI) does not make public all the evidence it uses for its decisions because this would lead to scientists refusing to send their work to the committee before it was published in a peer reviewed journal. However, he does not supply any evidence supply evidence that academics would refuse ...

Clinical guidelines recommend maintaining blood pressure levels to below 130/80 mm Hg in high risk patients, including people with diabetes. In a paper published in the British Medical Journal , Eszter Vamos and colleagues from Imperial College London examined the effect of systolic and diastolic blood pressure achieved in the first year of treatment on all cause mortality in patients newly diagnosed with type 2 diabetes, with and without established cardiovascular disease. They carried out a retrospective cohort study using data from the United Kingdom General Practice Research Database on 126 092 adults with a new diagnosis of type 2 diabetes, between 1990 and 2005. Before diagnosis, 12 379 (9.8%) patients had established cardiovascular disease (myocardial infarction or stroke). During a median follow-up of 3.5 years, they recorded 25 495 (20.2%) deaths. In people with cardiovascular disease, tight control of systolic (less than 130 mm Hg) and diastolic (less than 80 mm Hg) bloo...

The worldwide increase in the prevalence of Type 2 Diabetes Mellitus (T2DM) has been particularly marked in the states of the Cooperation Council for the Arab States of the Gulf (GCC). In a systematic review published in PLoS One , Layla Alhyas and colleagues from Imperial College London examined studies that had aimed to measure the prevalence of T2DM in this region. They identified 27 for review. Six studies were published in the 1980s, 13 in the 1990s, 8 in the 2000s. Eleven studies were of Saudi populations, 3 Kuwaiti, 2 Bahraini, 6 Emirati, 4 Omani and 1 Qatari. Sample sizes ranged from 336 to 600132. All were cross-sectional studies. Subgroup analysis by country indicated that the estimated prevalence of T2DM between GCC countries are comparable. The lowest estimated prevalence was found in KSA 4.01%; followed by Oman 4.5%. Bahrain had the highest estimated prevalence of T2DM among GCC countries at 5.17%. The estimated prevalence rates between Qatar, UAE and Kuwait were clo...