This week in the BMJ
Volume 324, Number 7336, Issue of 2 Mar 2002Asian patients have lower levels of cardiac revascularisation than white
Asian patients have lower levels of cardiac revascularisation than white
Rates of coronary revascularisation among comparable patients
with coronary heart disease are lower among south
Asians living in England than white patients. In their cohort study
based at a tertiary cardiac centre in London, Feder and colleagues (p
511) found that coronary angioplasty and coronary artery bypass
grafting were significantly lower in south Asian patients. These
differences were smaller after adjusting for socioeconomic status and
could not be explained by physician bias. However, the differences in treatment did not result in large differences in clinical outcome as
mortality and non-fatal myocardial infarction rates were similar for
the two groups.
![[To top]](/icons/back.gif){kind=icon}
Focus groups are effective in eliciting views in those with head and neck cancer
Focus groups are an effective and efficient way of assessing the
views of cancer patients and their carers on professionally derived
standards of care in oncology, and these views are powerful motivators
for the change in delivery of cancer care. Birchall and colleagues
(p 516) used focus groups with 40 patients who had head and neck
cancer and 18 carers and found that this approach was acceptable to
those patients who had an altered appearance and ability to
communicate, and also to recently bereaved carers. Some participants
also found the sessions therapeutic. In her commentary, Morton, who has
been treated for metastatic breast cancer (p 519), says that focus
groups for people with cancer should be led by a sympathetic person and
not too much should be demanded of patients.
(Credit: DR P MAZZARI/SPL)
Homoeopathy does not reduce allergy to dust mite in people with asthma
Homoeopathic remedies are no better than placebo in the treatment
of asthmatic patients who are allergic to house dust mite. In their
double blind randomised controlled trial of 242 people with asthma
(positive for skin prick test for house dust mite) in primary
care, Lewith and colleagues (p 520) also found different patterns of
change between the two groups. At three weeks there was a
significant deterioration in mood and the visual analogue scale
for asthma in the homoeopathic immunotherapy group compared with
the placebo group, which the authors cannot explain.
(Credit: K H KJELDSEN/SPL)
Different models of informaticist services serve different functions
Clinical informaticist services with an academic dimension (the
technical quality of evidence based answers) are best achieved within
an academic environment, whereas those with a service dimension (the
facilitation of questioning behaviour and implementation) require a
developmental approach in which pragmatic service considerations are
addressed. Greenhalgh and colleagues (p 524) used two
informaticist projects in two different settings to describe and
evaluate the two different models. The academic group provided general
information and detailed guidance intended for those hoping to set up a
similar service. The general practice group achieved a credible,
acceptable, and sustainable service that engaged local practitioners.
One year survival after renal transplantation is steadily improving
One year survival after renal transplantation is more than 88% for
cadaveric grafts and 95% from grafts from living donors, which are
currently being used much more. In addition, laparoscopic nephrectomy
minimises morbidity in living renal donors. In his clinical review,
Andrews (p 530) states that renal transplantation improves survival in
all age groups and for all underlying renal pathologies. Interleukin 2 receptor antibodies reduce early rejection rates and mycophenolate
mofetil may reduce chronic allograft nephropathy. Such "tailored
immunosuppression" aims to minimise transplant related morbidity.
(Credit: ANTONIA REEVE)
Diagnostic specificity and sensitivity changes in different settings
Both specificity and sensitivity may change as the same
diagnostic test is applied in primary, secondary, and tertiary care. In
the second article in the series on evidence based clinical diagnosis,
Sackett and Haynes (p 530) emphasise that diagnostic studies should
match methods to diagnostic questions, such as looking at whether test
results in affected individuals differ from those in normal patients.
They suggest that the keys to validity in studies of diagnostic tests
are: independent, blind comparison of test results with a reference
standard among a consecutive series of patients suspected of having the
disorder; inclusion of missing and indeterminable results; and
replication of studies in other settings.
One stop breast clinics are costly and reduce only short term anxiety
One stop breast clinics are less cost effective than dedicated breast
clinics and reduce women's anxiety only in the short term. In a
randomised controlled trial of 670 women, Dey and colleagues (p 507)
found that the additional cost to the NHS was £32 per woman because of
the greater cytopathological and radiological staff costs. Compared
with the women attending the dedicated clinic, those attending the one
stop clinic were less anxious 24 hours after the visit but not at three
weeks or three months after diagnosis. However, in his commentary,
Dixon (p 510) recommends not that one stop breast clinics should
be abandoned but that a more selective policy on ultrasonography should
be used.
(Credit: CHRIS BJORNBERG/SPL)
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
