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(2) ARE
ONE STOP BREAST CLINICS
JUSTIFIED?
(3) HOMOEOPATHY
IS NOT AN EFFECTIVE
TREATMENT FOR
ASTHMA
(1) STUDY REVEALS
ETHNIC DIFFERENCES IN
TREATMENT FOR HEART DISEASE
(Ethnic differences in invasive management
of
coronary disease: prospective cohort
study of
patients undergoing angiography)
http://bmj.com/cgi/content/full/324/7336/511
South Asian patients are less likely to
receive
treatment for coronary artery disease
than white
patients, finds a study in this week's
BMJ.
Researchers in London compared rates of
coronary
revascularisation (a procedure to restore
adequate
blood supply to the heart) in 502 south
Asian and
2,974 white patients with heart disease.
Although the same proportion of south Asian
and
white patients were deemed appropriate
to undergo
revascularisation, south Asian patients
were less
likely to receive it than white patients.
This difference
cannot be explained by physician bias
or
socioeconomic status of patients, say
the authors,
but they suggest that south Asian and
white patients
may differ in their understanding of the
risks and
benefits of the procedure.
These findings provide the strongest evidence
to date
that coronary revascularisation among
comparable
patients with heart disease is less likely
to be carried
out in south Asian patients than in white
patients in
the United Kingdom, say the authors.
The national service framework for coronary
heart
disease in England and Wales explicitly
requires the
equitable provision of revascularisation
between
ethnic groups; this may not be happening,
they
conclude.
Contact:
Gene Feder, Professor of Primary Care Research
and Development, Barts and the London,
Queen
Mary's School of Medicine and Dentistry,
London,
UK
Email: g.s.feder@qmul.ac.uk
(2) ARE ONE STOP
BREAST CLINICS
JUSTIFIED?
(Costs and benefits of a one stop
clinic compared
with a dedicated breast clinic:
randomised controlled
trial)
http://bmj.com/cgi/content/full/324/7336/507
One stop clinics for assessing women with
suspected
breast cancer may not be as cost effective
as
previously thought, according to a study
in this
week's BMJ.
Women aged 35 or over who were referred
to
hospital with a breast lump were randomly
allocated
to attend either a dedicated breast clinic
or a one
stop clinic. The costs and benefits of
each clinic were
measured and compared.
Compared to women attending the dedicated
clinic,
those attending the one stop clinic were
less anxious
24 hours after their visit but not at
3 weeks or 3
months after diagnosis. A one stop policy
cost £32
more per patient. The costs saved by reducing
the
number of visits are more than offset
by the staff
costs of same day reporting of diagnostic
tests, say
the authors.
Benefits of one stop clinics are, in the
main, short
term, and may not justify the added costs,
they
conclude.
Before the one stop breast clinics that
already exist
are dismantled on the basis of these results,
several
issues need to be considered, writes Michael
Dixon
in an accompanying commentary. They should
not
yet be abandoned, but their supporters
do need to
show that if they see more patients per
clinic and use
a more selective testing policy than in
this study, the
benefits are not outweighed by the costs,
he
concludes.
Contacts:
Paola Dey, Lecturer, Centre for Cancer
Epidemiology, University of Manchester,
Manchester, UK
Email: paola.dey@cce.man.ac.uk
J Michael Dixon, Consultant Surgeon, Edinburgh
Breast Unit, Western General Hospital,
Edinburgh,
Scotland
Email: jmd@wght.demon.co.uk
(3) HOMOEOPATHY
IS NOT AN EFFECTIVE
TREATMENT FOR ASTHMA
(Use of ultramolecular potencies
of allergen to treat
asthmatic people allergic to house
dust mite: double
blind randomised controlled clinical
trial)
http://bmj.com/cgi/content/full/324/7336/520
(Editorial: Randomised controlled
trials for
homoeopathy)
http://bmj.com/cgi/content/full/324/7336/498
Homoeopathic remedies are no better than
placebo
for the treatment of asthmatic patients
who are
allergic to house dust mite, but there
is a difference in
response between homoeopathy and placebo,
concludes a study in this week's BMJ.
The research team identified 242 asthmatic
people
allergic to house dust mite. Participants
received
either homoeopathic therapy or placebo
and were
assessed over 16 weeks.
They found no improvement in lung function
or
quality of life between those treated
with placebo
and those who received homoeopathic therapy.
They conclude that a homoeopathic dose
of house
dust mite therapy is no better than placebo
for the
treatment of people with asthma who are
house dust
mite allergic.
Previous studies have suggested that this
type of
homoeopathy is effective in the treatment
of hay
fever and possibly asthma. However, this
study was
substantially larger than any of the earlier
studies and
included a wider range of outcome measures,
say the
authors.
Contact:
George Lewith, Senior Research Fellow and
Honorary Consultant Physician, Royal South
Hants
Hospital, Southampton, UK
Email: GL3@soton.ac.uk
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