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(2) HRT
MAY PREVENT ENDOMETRIAL
CANCER
(3) 'WHITE
COAT EFFECT' HAS ADVERSE
EFFECT ON BLOOD
PRESSURE READINGS
(4) FUNDING
SOURCE HAS IMPACT ON
CONCLUSIONS
OF CLINICAL TRIALS
(1) TRUST MERGERS
HAVE NEGATIVE EFFECT
ON NHS SERVICES
(Process and impact of mergers of
NHS trusts:
multicentre case study and management
cost analysis)
http://bmj.com/cgi/content/full/325/7358/246
The merger of NHS trusts has a negative
effect on the
delivery of NHS services, causes delays
to service
improvements and fails to deliver promised
cash
savings or improve staff recruitment and
retention, says
a study in this week's BMJ.
Researchers based at the London School
of Hygiene &
Tropical Medicine studied the process
of merger in
nine trusts in the capital, which took
place between
April 1998 and April 1999. They examined
the main
reasons given for merging trusts and using
interviews
with staff, local health representatives
and by document
and cost savings analysis considered,
in four case
studies, whether or not these objectives
had been
achieved by the merger.
One of the main reasons given for merging
trusts was to
save money. However, against projected
savings of
£500,000 a year, the researchers
estimated that
average savings resulting from the mergers
were as little
as £179,000 in the first year and
£347,000 in the
second year.
Despite citing improved staff recruitment
and retention
as a reason to merge trusts, the process
did not
improve recruitment and retention levels.
In the
majority of cases the merger actually
had a negative
effect on staff morale. The process was
found to cause
tension between staff and management,
and staff stress
levels were increased by the uncertainty
and added
workload associated with merger. After
the merger it
was common for staff to feel ignored by
senior
management and for the management and
staff of one
trust to feel dominated by the staff and
management
from the trust with which they had merged.
Senior management often underestimated
the timescale
and amount of effort involved in the process
of a
merger and planned service improvements
were often
delayed by up to 18 months after the merger
had taken
place.
However the researchers found that trust
mergers do
have some benefits including the creation
of a larger
pool of professional staff, improvements
in staff
training, the unification of previously
fragmented
services and the cross-fertilisation of
ideas.
Contact:
Naomi Fulop, Senior Lecturer in health
service delivery
and organisational research, Health Services
Research
Unit, London School of Hygiene & Tropical
Medicine,
London, UK
Email: naomi.fulop@lshtm.ac.uk
or
Press Office, London School of Hygiene
& Tropical
Medicine, London, UK
(2) HRT MAY PREVENT
ENDOMETRIAL
CANCER
(Effect on endometrium of long term
treatment with
continuous combined oestrogen-progestogen
replacement therapy: follow up study)
http://bmj.com/cgi/content/full/325/7358/239
(Editorial: Continuous combined hormone
replacement
therapy and endometrial hyperplasia)
http://bmj.com/cgi/content/full/325/7358/231
The long-term use of hormone replacement
therapy
(HRT) does not increase the risk of endometrial
cancer
and may even protect the endometrium (the
lining of the
uterus) from the disease, concludes a
study in this
week's BMJ.
In one of the largest long-term studies
of its kind
researchers from across the UK collected
data from
534 postmenopausal women. Before the study
began,
364 of the women had taken oestrogen and
progestogen hormone replacement therapy
in which the
two hormones were given sequentially,
164 had not
used hormone replacement therapy and 10
had taken
oestrogen only hormone replacement therapy.
The women were placed on a course of continuous
combined HRT. Biopsy samples were then
taken from
the women before they started to take
the combined
HRT, after nine months, and between 24-36
months
and at the end of the five year study.
Before the research began, 21 women were
noted as
having abnormal endometrium, which when
associated
with other cellular changes can be an
early sign of
cancer, but following nine months of continuous
combined HRT, the endometrium had reverted
to
normal. No cases of endometrial cancer
developed
during the study.
Women who take daily combined HRT may actually
be better protected against endometrial
cancer than
women who do not use any form of hormone
replacement therapy, they conclude.
Contact:
Professor Michael Wells, Academic Unit
of Pathology,
University of Sheffield Medical School,
Sheffield, UK
Email: m.wells@sheffield.ac.uk
(3) 'WHITE COAT
EFFECT' HAS ADVERSE
EFFECT ON BLOOD PRESSURE READINGS
(Comparison of agreement between
different measures
of blood pressure in primary care
and daytime
ambulatory blood pressure)
http://bmj.com/cgi/content/full/325/7358/254
GPs should not make decisions about treating
patients
with hypertension based on high readings
of blood
pressure they have taken, finds a study
in this week's
BMJ. Instead, researchers recommend the
use of home
measurements by the patient or repeated
measurements
by a nurse, to counter the 'white coat'
effect.
The aim of the research was to assess various
methods
of measuring blood pressure. Eight doctors
and three
practice nurses participated in the research
involving
200 patients.
The patients had either been newly diagnosed
with high
blood pressure or were already receiving
treatment for
their high blood pressure. They were all
being
considered for treatment changes based
on clinical
readings.
Blood pressure readings were repeatedly
made by
either a nurse, home measurement, ambulatory
monitoring or by a doctor. The researchers
found
readings made by the doctors were high
in comparison
to those visited by the nurse or measured
by the
patients at home.
The authors conclude: "The 'white coat'
effect is
important in diagnosing and assessing
control of
hypertension in primary care and is not
a research
artefact. If ambulatory or home measurements
are not
available, repeated measurements by a
nurse or the
patient should result in considerable
less unnecessary
monitoring, initiation and changing of
treatment. It is
time to stop using high blood pressure
readings by
general practitioners to make decisions
about
treatment."
Overall the home measurement system performed
significantly better than all other methods
and was also
preferred best by patients, they conclude.
Contact:
Paul Little, clinician scientist, Clinical
Sciences Division,
Southampton University, Southampton, UK
Email: psl3@soton.ac.uk
(4) FUNDING SOURCE
HAS IMPACT ON
CONCLUSIONS OF CLINICAL TRIALS
(Association between competing interests
and authors'
conclusions: epidemiological study
of randomised
clinical trials published in the
BMJ)
http://bmj.com/cgi/content/full/325/7358/249
Author conclusions in clinical trials funded
by for profit
organisations are more likely to favour
experimental
intervention than trials funded by not
for profit
organisations reveals a study in this
week's BMJ.
As the BMJ is one of a few journals which
requires
authors to declare funding and competing
interests, the
researchers used 159 trials published
in the journal
between 1997 and 2001 as the basis for
their study.
Each study was examined for a link between
any
competing interests and the author's conclusions.
For the purpose of the trial the author's
conclusion was
defined as 'the interpretation of extent
to which overall
results favoured experimental intervention'.
Competing interests were defined as anything
which
could influence professional judgement.
Funding from
profit organisations was considered to
be a financial
competing interest and was analysed separately
from
the other competing interests, which included
personal,
academic, and political influences.
Authors' conclusions were not significantly
different in
trials without competing interests, trials
with other
competing interests or trials funded jointly
by profit and
non-profit organisations.
However in both pharmacological and
non-pharmocological trials funded by profit
organisations, the author's conclusions
were positively
associated with financial competing interests
- a
significant proportion of author conclusions
in these
trials favoured experimental intervention.
Due to the BMJ's policy of requiring authors
to report
competing interests, it is possible that
some authors
choose not to publish in the journal.
If this is the case
the researchers conclude that the study
may actually
underestimate the extent of association
between
competing interests and author's conclusions.
Contact:
Lise Kjaergard, research fellow, Centre
for
Intervention Research, Copenhagen University
Hospital, Copenhagen, Denmark
Email: Kjaergard@ctu.rh.dk
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