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(2) STRONG
SPIRITUAL BELIEFS MAY HELP PEOPLE
RECOVER FROM
BEREAVEMENT
(3) DIABETES
TARGETS WILL BE IMPRACTICAL IN
ROUTINE PRACTICE
(4) ORGANISED STUDENTS ARE MORE SUCCESSFUL
(1) WALK-IN CENTRES
PERFORM WELL COMPARED
WITH GENERAL PRACTICE
(An observational study comparing
quality of care in walk-in
centres with general practice and
NHS Direct using
standardised patients)
http://bmj.com/cgi/content/full/324/7353/1556
NHS walk-in centres provide adequate and
safe clinical
care to a range of patients compared with
general practice
and NHS Direct, concludes a study in this
week's BMJ.
The research team chose five clinical scenarios,
representing
problems likely to be presented by patients
to walk-in
centres. Professional role players then
carried out 297
consultations in 20 walk-in centres, 20
general practices,
and 11 NHS Direct sites in and around
three UK cities.
Considering all scenarios together, walk-in
centres achieved
a significantly greater mean score than
general practices and
NHS Direct, but there was considerable
variation between
scenarios.
In contrast to general practices, walk-in
centres and NHS
Direct referred a higher proportion of
patients.
Walk-in centres perform adequately and
safely compared to
general practice and NHS Direct for the
range of conditions
under study, say the authors. However,
the
cost-effectiveness of walk-in centres
and their impact on
workload of other healthcare providers
requires further
assessment, they conclude.
Contact:
Chris Salisbury, Senior Lecturer, Division
of Primary Health
Care, University of Bristol, Bristol,
UK
Email: c.salisbury@bristol.ac.uk
(2) STRONG SPIRITUAL
BELIEFS MAY HELP PEOPLE
RECOVER FROM BEREAVEMENT
(Spiritual beliefs may affect outcome
of bereavement:
prospective study )
http://bmj.com/cgi/content/full/324/7353/1551
People who profess stronger spiritual beliefs
seem to resolve
their grief more rapidly and completely
after the death of a
person close to them than those with no
spiritual beliefs,
finds a study in this week's BMJ.
Researchers in London monitored 135 relatives
and close
friends of patients admitted to a Marie
Curie centre with
terminal illness to examine whether the
presence and
strength of spiritual beliefs determined
how bereaved people
recover from their grief.
People reporting no spiritual belief had
not resolved their
grief after 14 months. People with strong
spiritual beliefs
resolved their grief progressively over
the same period.
People with low levels of belief showed
little change in the
first nine months but thereafter resolved
their grief.
Most palliative care units try to involve
family members and
friends who are important and close to
the person dying.
Attention to spiritual matters may be
an important
component to this work, say the authors.
Despite some limitations, this finding
might help in identifying
people who are having difficulty in readjusting
to life after
their loss, they conclude.
Contact:
Professor Michael King, Department of Psychiatry
and
Behavioural Science, Royal Free and University
College
Medical School, London, UK
Email: m.king@rfc.ucl.ac.uk
or sgibson@rfc.ucl.ac.uk
(3) DIABETES TARGETS
WILL BE IMPRACTICAL IN
ROUTINE PRACTICE
(Effective diabetes care: a need
for realistic targets )
http://bmj.com/cgi/content/full/324/7353/1577
Targets due to be set as part of the national
service
framework for diabetes in England and
Wales will be
impractical for use in routine clinical
care, according to an
article in this week's BMJ.
Aggressive treatment of high levels of
blood sugar,
cholesterol, and blood pressure and regular
use of
antiplatelet drugs has been advocated
in type 2 diabetes.
Yet current targets are attainable in
only 50-70% of
individuals in research studies, argues
Peter Winocour of
Queen Elizabeth II Hospital in Hertfordshire.
The targets are often impractical and involve
taking too
many drugs, with which patients often
will not comply, he
adds. Individually tailored targets would
be preferable,
taking account of factors such as estimated
duration of
diabetes, obesity, age and lifestyle.
Given the cardiovascular risk profile of
type 2 diabetes, up
to 10% of patients could require as many
as nine drugs. A
high proportion will also require treatment
for existing heart
disease and coincidental unrelated chronic
disease, says the
author. "It is difficult to see how we
can realistically expect
patients to comply for long with such
a draconian regimen
requiring so many separate drugs."
He concludes: "The development of combination
tablets by
the pharmaceutical industry seems of the
utmost priority for
effective prevention of complications
of type 2 diabetes.
Until then we must be pragmatic. We should
set targets that
are reasonable for our clinics and our
individual patients."
Contact:
Peter Winocour, Consultant Physician, Queen
Elizabeth II
Hospital, Welwyn Garden City, Hertfordshire,
UK
Email: peter.winocour@qeii.enherts-tr.nhs.uk
(4) ORGANISED STUDENTS ARE MORE SUCCESSFUL
(Medical students' compliance with
simple administrative
tasks and success in final examinations:
retrospective cohort
study )
http://bmj.com/cgi/content/full/324/7353/1554
Disorganised medical students are more
likely to struggle
and subsequently fail their end of year
examinations, find
researchers in this week's BMJ.
Medical students at Sheffield University
were asked to
provide a recent passport photograph at
the start of their
paediatric module. The pictures are distributed
to the wards,
teachers and hospitals involved in the
programme to make
identification and assessment easier.
Almost half the students who failed to
complete this simple
administrative task failed the end of
year examinations. This
highlights the importance of organisation
and attitude in
determining an individual's success, and
supports the view
that disorganised learning is one of the
most important
predictors of examination failure, say
the authors.
It is beneficial to identify students whose
learning style and
approach are inappropriate, before they
fail, add the
authors. Additional targeted help may
be provided for these
students.
Contact:
Neil Wright, Lecturer in Paediatrics, or
M S Tanner,
Professor of Paediatrics, Sheffield Children's
Hospital,
Sheffield, UK
Email: N.P.Wright@sheffield.ac.uk
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