Releases Saturday 20 April 2002
No 7343 Volume 324
Please remember to credit the BMJ as source when publicising
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(1) GPS NEED MORE TRAINING TO HELP
PATIENTS WITH DEPRESSION
(2) RISK
OF HEART PROBLEMS AMONG DIABETIC
PATIENTS LESS
THAN PREVIOUSLY THOUGHT
(3) SURGERY
LEAGUE TABLES COULD THREATEN
ACCESS TO CARE
(4) URGENT
ACTION NEEDED TO IMPROVE
MATERNAL CARE
IN LATIN AMERICA
(1) GPS NEED MORE
TRAINING TO HELP
PATIENTS WITH DEPRESSION
(Effectiveness of teaching general
practitioners skills in
brief cognitive behaviour therapy
to treat patientwith
depression: randomised controlled
trial)
http://bmj.com/cgi/content/full/324/7343/947
General practitioners may require more
extensive training
and support to acquire skills to help
patients with
depression, finds a study in this week's
BMJ.
Researchers recruited 84 general practitioners
and 272
of their patients with anxiety or depression.
Half the
doctors received basic training in brief
cognitive (mental)
behaviour therapy and half provided their
usual care.
After six months, doctors' knowledge of
depression and
attitudes towards its treatment showed
no major
difference between trained and untrained
doctors. The
training also had no discernible impact
on patients'
outcomes.
Basic training in brief cognitive behaviour
therapy has
little effect on general practitioners'
attitudes to the
identification and treatment of depression
or the outcome
of their patients with emotional problems,
say the
authors. Either they did not learn sufficient
skills or had
little time to put them into effect.
They suggest that general practitioners
may require more
extensive training and support if they
are to acquire skills
that will have a positive impact on their
patients.
Contact:
Oliver Davidson, Honorary Senior Lecturer,
Department
of Psychiatry and Behavioural Sciences,
Royal Free and
University College Medical School, Royal
Free Campus,
London, UK
Email: ODavidson{at}gum.ucl.ac.uk
(2) RISK OF HEART
PROBLEMS AMONG DIABETIC
PATIENTS LESS THAN PREVIOUSLY THOUGHT
(Comparison of cardiovascular risk
between patients
with type 2 diabetes and those who
had had a
myocardial infarction: cross sectional
and cohort studies)
http://bmj.com/cgi/content/full/324/7343/939
Patients with type 2 diabetes are at lower
risk of death
and hospital admission for heart attack
than patients with
established coronary heart disease, finds
a study in this
week's BMJ.
These results challenge the widely held
view that patients
with diabetes have as high a risk of cardiovascular
events
and death as non-diabetic patients who
have had a heart
attack, and therefore have important implications
for
clinical practice.
Researchers in Dundee carried out two studies
involving
over 4,600 patients with type 2 diabetes
and over 8,700
patients with established coronary heart
disease. In both
studies, the risk of death and hospital
admission was
higher in patients who had suffered a
heart attack
compared with the diabetic patients.
"Our results have important implications
for clinical
practice, in that we should be cautious
about basing
treatment decisions on individual risk
factors for
cardiovascular disease in isolation,"
conclude the
authors.
Contact:
Josie Evans, Lecturer, Department of Epidemiology
and
Public Health, Ninewells Hospital, Dundee,
Scotland
Email: j.m.m.stansfield{at}dundee.ac.uk
(3) SURGERY LEAGUE
TABLES COULD THREATEN
ACCESS TO CARE
(Letter: Surgeons should beware of
plans to print
individual performance)
http://bmj.com/cgi/content/full/324/7343/979/a
Plans to publish details of the performance
of individual
surgeons could lead to a reluctance to
treat riskier
patients, according to a letter in this
week's BMJ.
Nicholas Pace, Consultant Anaesthetist
at the Western
Infirmary in Glasgow argues that before
the NHS
proceeds much further, note ought to be
taken of
experience in the United States, the country
with most
experience in the public release of such
data.
For example, in Pennsylvania, where death
rates for all
surgeons providing coronary artery bypass
surgery are
published, 59% of cardiologists reported
increased
difficulty in finding surgeons willing
to perform such
surgery in severely ill patients who required
it.
Furthermore, 63% of the cardiac surgeons
reported that
they were less willing to operate on such
patients.
Another study suggested that the movement
of severely
ill patients to an adjacent state had
been a measurable
effect of New York State's public reporting
of data on
coronary artery bypass surgery.
It is unclear where these patients would
move to if faced
with similar problems in the United Kingdom,
says the
author. Access to health care for seriously
ill patients
would probably be decreased, ultimately
leading to a
decrease in NHS costs ? a byproduct that
would be
welcomed by the government.
A further complication factor is that operative
death is
always attributed to the surgeon, but
important influences
such as anaesthetic care and intensive
care resources are
ignored, adds the author. "In other words,
surgeons may
be criticised for their postoperative
morbidity when
compared with their colleagues, but it
may all be the fault
of the anaesthetist," he concludes.
Contact:
Nicholas Pace, Consultant Anaesthetist,
Western
Infirmary, Glasgow, Scotland
Email: np{at}blanefield.com
(4) URGENT ACTION
NEEDED TO IMPROVE
MATERNAL CARE IN LATIN AMERICA
(Consumer demand for caesarean sections
in Brazil:
population based cohort study linking
ethnographic and
epidemiological methods)
http://bmj.com/cgi/content/full/324/7343/942
(Episiotomy rates in primiparous
women in Latn
America: hospital based descriptive
study)
http://bmj.com/cgi/content/full/324/7343/945
(Editorial: Promoting evidence based
practice in maternal
care)
http://bmj.com/cgi/content/full/324/7343/928
Unnecessary caesarean section is known
to increase
health risks for both mother and infant,
while routine
episiotomy has no benefit. Two studies
in this week's
BMJ illustrate the gap between evidence
and practice in
maternal care.
The first study shows that many poor women
in Brazil
actively seek a caesarean section because
of fear of
substandard labour care, including lack
of pain control.
Rich women were more likely to have caesarean
sections, and a vaginal birth was considered
a risky and
negative experience. Many lower to middle
class women
sought caesarean sections to avoid what
they considered
poorer quality labour care.
The unequal distribution of medical technology
has
altered concepts of good and normal birthing,
say the
authors. Arguments supporting interventionist
birthing
"for all" on the basis of equal access
to health care must
be reviewed, they conclude.
The second study found that nine in every
10 women
who gave birth spontaneously in hospitals
in Latin
America between 1995 and 1998 had an episiotomy,
despite evidence that the procedure is
not justified.
This situation is inadmissible in the light
of the current
evidence, and the challenge now is to
change the use of
episiotomy in Latin American hospitals,
say the authors.
Making substantial progress towards improving
the
quality of maternal health care is urgent,
writes Ana
Langer, in an accompanying editorial.
While we continue
to discuss unnecessary surgical interventions,
millions of
women that require these procedures do
not have access
to them and risk their own and their children's
lives.
Contacts:
Caesarean paper: Dominique Behague, Department
of
Anthropology, McGill University, Montreal,
Quebec,
Canada
Email: dbehague{at}aol.com
Episiotomy paper: Fernando Althabe, Latin
American
Center for Perinatology, Pan American
Health
Organisation, World Health Organisation,
Montevideo,
Uruguay
Email: althabef{at}clap.ops-oms.org
or
José M Belizán:
Email: belizanj{at}clap.ops-oms.org
or
Eduardo Bergel:
Email: bergeled{at}clap.ops-oms.org
Editorial: Ana Langer, Regional Director,
Population
Council, Latin America and Caribbean Office,
Mexico
City, Mexico
Email: alanger{at}popcouncil.org.mx
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(http://www.eurekalert.org)
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