This week in the BMJ
Volume 324, Number 7353, Issue of 29 Jun 2002Early treatment for amblyopia improves outcome
Early treatment for amblyopia improves outcome
Children who received orthoptic screening for amblyopia between the
ages of 8 and 37 months have better outcomes from their treatment at
7.5 years than children who are screened only at 37 months. Williams
and colleagues (p 1549) randomised 3490 children to receive either
intensive or once only orthoptic screening. They found that those
children given intensive screening had a lower prevalence of amblyopia
and better visual acuity in the worse seeing eye, supporting the
hypothesis that early treatment leads to better outcomes.
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Anti-leukotrienes do not benefit asthma
Adding anti-leukotrienes to inhaled glucocorticoids produces a
non-significant reduction in the risk of an exacerbation of asthma and
cannot be recommended as a substitute for increasing the dose
of inhaled glucocorticoids. These finding are from a systematic review
of 13 trials by Francine Ducharme (p 1545) of the evidence on the
safety and efficacy of anti-leukotrienes as add-on therapy to inhaled
glucocorticoids. Until further evidence is available, the gold standard
treatment of asthma should remain the use of inhaled glucocorticoids.
Spiritual belief resolves grief
People who profess strong spiritual beliefs resolve their grief
more rapidly and completely after the death of a close person than
people with no spiritual beliefs, say Walsh and colleagues (p
1551). They followed up 135 relatives and close friends of patients
admitted to a Marie Curie centre with terminal illness. Fourteen months
after the death of the loved one, people who reported no spiritual
belief had not resolved their grief whereas those with strong beliefs
had.
Disorganised students fail exams
Disorganised medical students are more likely to fail
examinations. Wright and Tanner (p 1554) show that almost half the
students who failed to complete the basic administrative task of
providing a recent passport photograph at the start of their paediatric module failed the end of year examinations. This, they say,
highlights the importance of organisation and attitude in determining
an individual's success.
Walk-in centres outperform GPs
Walk-in centres perform better than general
practices and NHS Direct in certain clinical
scenarios. Grant and colleagues (p 1556) analysed 297 consultations of
five clinical scenarios performed by role players in these three
primary care settings. Walk-in centres achieved higher scores for all
scenarios and performed particularly well on postcoital contraception
and asthma scenarios. However, walk-in centres and NHS Direct referred
a higher proportion of patients than general practices, and the impact
of referrals on other healthcare providers, the authors say, requires
further research.
Scrutinising risk factor thresholds
Interventions to lower blood pressure, serum cholesterol,
and other risk factors reduce the risk of cardiovascular disease regardless of initial levels. The goal, therefore, write Malcolm Law
and Nicholas Wald (p 1570), should not be to "normalise" risk factors but simply to reduce them as much as possible. This means, they
say, targeting everyone at high risk, as determined by age or
known cardiovascular disease, rather than by the level of their risk
factors.
NSF targets for diabetes are impractical
Metabolic and blood pressure targets set by the national service
framework for diabetes are impractical for use in routine clinical
care, argues Peter Winocour (p 1577). "It is difficult," he says,
"to see how we can realistically expect patients to comply for long
with such a draconian regimen requiring so many separate drugs."
Until combination tablets become available, targets should be based on
our clinics and individual patients, rather than set from results
attained in research studies.
(Credit: SUE SHARPLES)
Researching medical education
Research in medical education began over three decades ago. On p 1560
Geoff Norman reflects on how this research has informed the
understanding of learning, teaching, and assessment in medicine. Areas
of major development, he says, include basic research on the nature of
medical expertise, problem based learning, performance assessment,
and continuing education and assessment of practising physicians.
Dengue is escalating
Dengue viruses cause an estimated 50-100 million illnesses a
year, including 250 000 to 500 000 cases of dengue haemorrhagic fever. The Aedes aegypti mosquito is the principal
vector; it prefers to feed on human blood and has a bite that is
almost imperceptible. Robert Gibbons and David Vaughn (p 1563) review
the five clinical presentations of dengue, their treatment, and
their prevention. Until the Aedes mosquito is controlled or
a vaccine is made available, the prevalence of dengue, they say, will
escalate.
(Credit: RENZO GOSTOLI/AP PHOTO)
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