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(2) PARENTS
RECOGNISE BENEFITS OF
POSTMORTEMS
(3) WHY ARE DOCTORS SO UNHAPPY?
(4) MENINGITIS C VACCINE IS COST EFFECTIVE
(5) ACTION
NEEDED TO TACKLE FAKE DRUGS
TRADE
(1) PATIENTS PREFER
CARE FROM A NURSE
PRACTITIONER THAN FROM A DOCTOR
(Systematic review of whether nurse
practitioners working in
primary care can provide equivalent
care to doctors)
http://bmj.com/cgi/content/full/324/7341/819
Patients are more satisfied with care from
a nurse practitioner
than from a doctor, finds a study in this
week's BMJ.
Researchers in Bristol reviewed 34 studies
to determine
whether nurse practitioners working in
primary care can
provide equivalent care to doctors.
They found that patients were more satisfied
with care by a
nurse practitioner. Nurse practitioners
had longer
consultations and carried out more investigations
than
doctors. Nurse practitioners made more
complete records
and scored better on communication than
doctors. They also
offered more advice on self care and management.
"Our review lends support to an increased
involvement of
nurse practitioners in primary care,"
say the authors. Nurse
practitioners seem to provide a quality
of care that is at least
as good, and in some ways better, than
doctors, although
further research is needed to confirm
that nurse practitioner
care is safe in terms of detecting rare
but important health
problems.
Contacts:
Chris Salisbury, Consultant Senior Lecturer,
Division of
Primary Health Care, University of Bristol,
UK
Sue Horrocks, Research Associate
Elizabeth Anderson, Senior Lecturer
(2) PARENTS RECOGNISE
BENEFITS OF
POSTMORTEMS
(Cross-sectional survey of parents'
experience and views of
the postmortem examination)
http://bmj.com/cgi/content/full/324/7341/816
Parents who have lost a baby view the postmortem
examination as a useful and necessary
tool in helping to
discover the reasons why their baby died,
finds a study in this
week's BMJ.
Researchers at Newcastle University surveyed
258 women
who had attended a bereavement counselling
service after
losing a baby during pregnancy or infancy
about their
experience and views of the postmortem
examination.
Of the 166 women who completed the questionnaire,
81%
agreed to a postmortem examination on
their baby. The most
common reasons given for agreeing to an
examination were
wanting more information about what had
happened and
helping to improve medical knowledge and
research.
Twenty-eight women did not agree to a postmortem
examination. The most common reason given
was that they
felt their baby had suffered enough.
Eighty-six per cent believed the findings
of the examination
had been explained appropriately, although
nine women
regretted their decision. Of those who
refused an
examination, four had regrets about their
decision. One said:
"Now, two years later, I would like to
know why they died,"
and another: "an answer may have alleviated
the burden of
guilt."
Parents view the postmortem examination
as a useful and
necessary tool in helping to discover
the reasons why their
baby died, say the authors. All medical
staff involved in
consent for postmortem examinations should
be fully trained
in how to ask for parental consent, the
postmortem
examination procedure, and how to explain
the findings.
Contact:
Judith Rankin, Senior Research Associate,
School of Health
Sciences, University of Newcastle, Newcastle
upon Tyne,
UK
Email:
j.m.rankin@ncl.ac.uk
(3) WHY ARE DOCTORS SO UNHAPPY?
(Unhappy doctors: what are the causes
and what can be
done?)
http://bmj.com/cgi/content/full/324/7341/835
(The medical profession, the public,
and the government)
http://bmj.com/cgi/content/full/324/7341/838
Unhappy doctors are a worldwide phenomenon.
Two
articles this week's BMJ suggest that
the cause is a
breakdown in the implicit compact between
doctors,
patients, and society, and outline what
a new compact might
look like.
In the first article, based on workshops
with doctors in the
US and UK, Nigel Edwards and colleagues
argue that
workload and pay, though important, do
not fully explain the
problem. A key factor seems to be a change
in the
psychological compact between the profession,
employers,
patients, and society so that the job
is now different from
what doctors expected.
A new compact is needed, spelling out the
rights and
responsibilities of the government, the
medical profession,
and the public, say the authors. Clinical
leaders have a crucial
role in developing a new compact that
improves care for
patients, improves the effectiveness of
the healthcare
organisation, and helps create a happier
workforce, they
conclude.
The old implicit compact between the government,
the
medical profession, and the public has
been undermined over
the years and needs to be updated, say
Chris Ham and
George Alberti in the second article.
This will not be easy to agree but is essential
to enable the
different partners to make an effective
contribution to the
reform of the NHS. It is time to stop
grieving for the past and
to meet the challenges of the new world
and the future, they
conclude.
Contacts:
Nigel Edwards, Policy Director, NHS Confederation,
London, UK
Email: nigel.edwards@nhsconfed.org
George Alberti President, Royal College
of Physicians,
London, UK (via Linda Cuthbertson, Press
and PR
Manager)
Email: Linda.Cuthbertson@rcplondon.ac.uk
(4) MENINGITIS C VACCINE IS COST EFFECTIVE
(Modelling cost effectiveness of
meningococcal serogroup C
conjugate vaccination campaign in
England and Wales)
http://bmj.com/cgi/content/full/324/7341/809
The introduction of meningococcal C vaccine
in the UK in
1999 has rapidly and substantially reduced
the incidence of
meningitis in young people and is cost
effective, finds a study
in this week's BMJ.
Researchers at the Public Health Laboratory
Service in
London assessed the cost effectiveness
of the vaccination
campaign in people aged 0-17 years.
Immediately before the introduction of
the vaccine, the
burden of meningitis C was considerable,
with an estimated
1,137 cases in people aged 0-17 years
and at least 72
deaths annually. The vaccination campaign
is estimated to
have cost between £126m ($180m)
and £241m ($343m)
and the cost per life year saved is estimated
to be £6,259
($8919).
School based vaccination was more cost
effective than
routine vaccination of infants because
delivery costs are
lower and fewer doses are required, conclude
the authors.
Contact:
John Edmunds, Research Fellow, Immunisation
Division,
PHLS Communicable Disease Surveillance
Centre, London,
UK
Email: jedmunds@phls.org.uk
(5) ACTION NEEDED
TO TACKLE FAKE DRUGS
TRADE
(Editorial: Murder by fake drugs
)
http://bmj.com/cgi/content/full/324/7341/800
The World Health Organisation estimates
that fake drugs
account for 10% of global pharmaceutical
commerce.
Researchers in this week's BMJ call for
urgent international
action to tackle this murderous trade.
Recent examples of fake drugs include neomycin
eye drops
and meningococcal vaccine made of tap
water; paracetamol
syrup made of industrial solvent; and
contraceptive pills made
of wheat flour. Some counterfeit drugs
even contain actively
harmful ingredients, not just bogus placebos.
Death and illness arising from this murderous
trade are
considerable, especially in developing
countries, say the
authors. Guidelines have been produced,
but most
developing countries do not have the infrastructure
and
financial resources to implement them.
In the past, drug
companies have tended to avoid publicising
the problem for
fear of "damaging public confidence in
medicines". Some
countries, well aware of the scale of
their problem, have
preferred to ignore it, they add.
Much of the counterfeit drug trade is probably
linked to
organised crime, corruption, the narcotics
trade, unregulated
pharmaceutical companies, and the business
interests of
unscrupulous politicians, say the authors.
Much greater
international political will to eliminate
the problem is required,
they conclude.
Contact:
Paul Newton, Clinical Lecturer, Nuffield
Department of
Clinical Medicine, Oxford University,
Oxford, UK
Email: newtonpaul100@hotmail.com
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