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(2) NEEDS
OF PEOPLE DYING OF HEART FAILURE
NOT BEING MET
(3) PATIENTS
WITH CHRONIC ILLNESS NOT
BENEFITING
FROM ADVANCES IN CARE
(4) COMPUTERISED
GUIDELINES ARE NO "MAGIC
BULLET"
(1) EATING FISH CUTS RISK OF DEMENTIA
(Fish, meat, and risk of dementia:
cohort study)
http://bmj.com/cgi/content/full/325/7370/932
Elderly people who eat fish or seafood
at least once a
week are at lower risk of developing dementia,
including
Alzheimer's disease, finds a study in
this week's BMJ.
Using data from a large ageing study, a
team of French
researchers set out to test whether there
was a relation
between consumption of fish (rich in polyunsaturated
fatty
acids) or meat (rich in saturated fatty
acids) and risk of
dementia.
The study involved 1,674 people aged 68
and over
without dementia and living at home in
southwestern
France. Their frequency of consumption
of meat and fish
or seafood was recorded as daily, at least
once a week
(but not every day), from time to time
(but not every
week), or never. Participants were followed
up two, five,
and seven years afterwards.
Participants who ate fish or seafood at
least once a week
had a significantly lower risk of being
diagnosed as having
dementia in the seven subsequent years.
When education
was taken into account, the strength of
the association was
slightly reduced, suggesting that this
"protective" effect was
partly explained by higher education of
regular consumers,
say the authors. They found no significant
association
between meat consumption and risk of dementia.
As well as providing vascular protection,
the fatty acids
contained in fish oils could reduce inflammation
in the brain
and may have a specific role in brain
development and
regeneration of nerve cells, suggest the
authors.
Healthy dietary habits acquired in infancy
could be
associated with achievement of higher
education. Highly
educated people might also adhere more
closely to dietary
recommendations on fish consumption, they
conclude.
Contact:
Pascale Barberger-Gateau, Senior Lecturer,
Universite
Victor Segalen Bordeaux, France
Email: Pascale.Barberger-Gateau@isped.u-bordeaux2.fr
(2) NEEDS OF PEOPLE
DYING OF HEART FAILURE
NOT BEING MET
(Dying of lung cancer or cardiac
failure: prospective
qualitative interview study of patients
and their carers in the
community)
http://bmj.com/cgi/content/full/325/7370/929
(Editorial: Palliative care for heart
failure)
http://bmj.com/cgi/content/full/325/7370/915
The needs of people dying of heart failure
are not being
met, finds a study in this week's BMJ.
Researchers at the University of Edinburgh
compared the
experiences of 20 people with lung cancer
with those of
20 people with advanced heart failure,
using interviews
every three months for up to one year
with patients, their
carers, and key professional carers.
They found that patients with lung cancer
had access to
good quality written information and most
understood their
illness and its causes. In contrast, patients
with heart failure
rarely recalled being given any written
information, had a
poor understanding of their condition,
and had less
opportunity to address end of life issues.
More health and social services, including
financial benefits
were available to those with lung cancer,
although they
were not always used effectively. Cardiac
patients
received less health, social, and palliative
care, and care
was often poorly coordinated.
Many patients with end stage chronic illnesses
do not
receive appropriate services because their
multi-dimensional needs are not understood,
and their
prognosis is uncertain, say the authors.
They argue that all
patients with advanced serious illness
should be afforded
the same priority for palliative care
as patients with cancer.
Care should be prioritised according to
the degree of need
the patient has, not simply according
to the diagnosis.
Care for patients with advanced heart failure
should be
proactive and designed to meet their specific
needs, they
conclude.
Contact:
Scott Murray, Senior Lecturer in General
Practice,
Department of Community Health Sciences,
University of
Edinburgh, Scotland
Email: Scott.Murray@ed.ac.uk
(3) PATIENTS WITH
CHRONIC ILLNESS NOT
BENEFITING FROM ADVANCES IN CARE
(As good as it gets? Chronic care
management in nine
leading US physician organisations)
http://bmj.com/cgi/content/full/325/7370/958
Many patients with chronic diseases are
not benefiting
from advances in care because of a lack
of financial and
staff resources, inadequate information
systems, and
doctors' heavy workload, argue US researchers
in this
week's BMJ.
They assessed the extent to which evidence-based
chronic
care management processes and computer
based clinical
information systems were used to care
for patients with
asthma, congestive heart failure, depression,
and diabetes
in nine leading physician practices in
the United States.
The care management processes studied were
the use of
practice guidelines, population disease
management, case
management, and health promotion or disease
prevention
activities.
Although they found several examples of
high quality care,
some of the medical groups used few, if
any, care
management processes. In some cases care
management
processes were discontinued because of
financial and
staffing problems.
Nearly all study groups used clinical practice
guidelines for
all four chronic conditions. However,
the use of other care
management processes varied greatly across
conditions,
with fewer than half of the nine groups
using all four
processes. The use of computer based information
system
functions also varied greatly among the
groups.
They identified several barriers to the
use of care
management processes including lack of
financial and staff
resources, inadequate clinical information
systems,
doctors' heavy workload and doctors' resistance
to
change. One medical director said, "We
have a major
problem with overwork in primary care,
and it's getting
worse. It is impossible to launch any
programme that gives
physicians more work."
The future agenda for restructuring practices
should
include addressing workload issues, promoting
a culture
that supports quality improvement, expanding
clinical
information systems, and financial incentives
to reward
practices that improve the care and outcomes
of patients
with chronic disease, they conclude.
Contact:
Professor Thomas Rundall, University of
California at
Berkeley, School of Public Health, Division
of Health
Policy and Management, Berkeley, California,
USA
Email: trundall@uclink.berkeley.edu
(4) COMPUTERISED
GUIDELINES ARE NO "MAGIC
BULLET"
(Effect of computerised evidence
based guidelines on
management of asthma and angina
in adults in primary
care: cluster randomised controlled
trial)
http://bmj.com/cgi/content/full/325/7370/941
Computerised guidelines do not improve
care for patients
with chronic diseases, and are unlikely
ever to be the
"magic bullet" that answers all questions,
finds a study in
this week's BMJ.
Martin Eccles and colleagues set out to
evaluate the use of
a computerised decision support system
delivering
evidence based guidelines for asthma and
angina in 60
general practices in north east England.
The computerised guidelines had no significant
effect on
consultation rates, any aspect of the
process of care, or
prescription of any category of drugs
in patients with
asthma or angina. This was probably due
to low levels of
use of the software, despite the system
being optimised as
far as was technically possible, say the
authors.
Certainly in terms of implementing evidence
based care,
computerisation seems unlikely to be the
"magic bullet" that
answers all questions, and the current
system could not be
recommended. Even if the technical problems
of producing
a system that fully supports the management
of chronic
disease were solved, there remains the
challenge of
integrating the systems into primary care,
where busy
practitioners manage patients with complex,
multiple
conditions, they conclude.
Contact:
Martin Eccles, Professor of Clinical Effectiveness,
Centre
for Health Services Research, University
of Newcastle,
Newcastle upon Tyne, UK
Email: martin.eccles@ncl.ac.uk
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