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cover of episode The plan for NHS league tables is bad, and will lead to unintended consequences

The plan for NHS league tables is bad, and will lead to unintended consequences

2025/6/16
logo of podcast Medicine and Science from The BMJ

Medicine and Science from The BMJ
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I
Ian Leistikow
I
Irene Guerrini
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Nikki Kolk
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Richard Lilford
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Tim Hofer
Topics
Irene Guerrini: 作为一名顾问和成瘾精神科医生，我注意到非处方氯胺酮的使用日益增长。氯胺酮易于获得且价格低廉，这主要是因为它在医学、工业和兽医领域都有用途，难以控制其流动。一克氯胺酮的价格几乎与一杯咖啡相当，而且质量通常可靠。许多年轻人告诉我，氯胺酮可以麻痹情绪，减轻焦虑，并带来欣快感。对一些女性来说，它不会像大麻那样导致体重增加，因此更受欢迎。然而，长期使用会导致耐受性，需要增加剂量才能达到相同的效果，这增加了身体健康风险。突然停止使用会导致剧烈的腹部绞痛，难以用常规止痛药控制，这使得患者更频繁地出现在急诊室。我们必须关注这个问题，并为患者提供适当的治疗。 Nikki Kolk: 作为一名成瘾精神科顾问，我完全同意Irene的观点。氯胺酮使用障碍有明确的诊断标准，包括耐受性、戒断症状和失控。成瘾者会过度关注获取、使用和从氯胺酮中恢复，这会严重影响他们的生活，导致他们无法正常工作和学习。我们还观察到，许多成瘾者停止进食，导致体重过低。急诊医生在接诊年轻患者时，应询问他们的药物史，特别是氯胺酮的使用频率。如果患者出现泌尿系统症状，应转诊至泌尿科。重要的是，要告知患者如何获得药物滥用治疗，并强调除非解决氯胺酮依赖问题，否则症状不会好转。同时，由于氯胺酮会影响肝脏，应检查肝功能，并在必要时转诊至肝病诊所。我们需要共同努力，解决这个问题，为患者提供全面的支持和治疗。

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In this episode, we hear about ketamine addiction. It's in the news, but the rise in addiction amongst young people in the UK has caused concern for some time.  Irene Guerrini and Nicola Kalk, both addiction psychiatrists from the National Addiction Centre, join us to explain why its become a problem.

In November 2024 Wes Streeting, the UK’s health and social care minister, announced that he was planning to introduce league tables for hospitals - and would be linking managers' pay and continued employment to those outcomes. 

Richard Lilford, from the University of Birmingham, Timothy Hofer, from the University of Michigan, and Ian Leistikow, an inspector at the Dutch Health and Youth Care Inspectorate, join us to explain why this is a bad idea.

Non-prescribed ketamine use is rising in the UK)

Hospital league tables, targets, and performance incentives should be used with care)