This week in the BMJ
Volume 325, Number 7375, Issue of 30 Nov 2002Effects of involving patients are unknown
Effects of involving patients are unknown
Of 42 reports describing changes in health services, none contained
evidence that the use of services, quality of care, satisfaction, or
health outcomes were affected by involving patients. Crawford and
colleagues (p 1263) conducted a systematic review of published reports
and grey literature to examine the effects of involving patients in the
planning and development of health care. This involvement, it has been
argued, can improve the provision of services across a range of
settings.
(Credit: CC STUDIO/SPL)
![[To top]](/icons/back.gif){kind=icon}
Involving users in delivering mental health services is effective
Involving users in the delivery and evaluation of mental health
services is feasible. Simpson and House (p 1265) systematically reviewed the literature and found that users, even those with a history
of severe mental illness, could take part in delivering and researching
mental health services, with no negative effects. With the drive
towards evidence based practice, more data relating to users'
involvement are expected. Planners and providers of health care would
benefit from more formal evaluation of users' involvement.
Off-pump heart surgery causes less neurocognitive impairment
Off-pump coronary artery bypass graft surgery results in
less neurocognitive impairment than the on-pump technique. Zamvar and
colleagues (p 1268) conducted a randomised controlled trial of 60 patients undergoing coronary artery bypass graft surgery for triple
vessel disease. They found that those assigned to the off-pump
technique were less likely to show major deterioration in scores for
neuropsychometric tests one week and 10 weeks after surgery.
(Credit: ANTONIA REEVE/SPL)
Use lower CHD risk thresholds for ethnic minorities
People of South Asian and African origin with uncomplicated mild
hypertension risk being undertreated. Their risk of combined cardiovascular disease is greater than for white people, Cappuccio and
colleagues (p 1271) found when they conducted a cross sectional survey
in 1386 men and women aged 40-59 years. People of South Asian origin
and those of African origin with mild uncomplicated hypertension should
be treated when their 10 year risk of coronary heart disease is 12%
and 10% respectively. Current guidelines state that the threshold for
treatment is 
15%, but this figure has been calculated from data on
white people. Reducing the risk threshold for these ethnic minorities
may reduce inequalities in the prevention of cardiovascular
disease.
Report cards are fine in principle
The government hopes that report cards will drive improvements
in quality and facilitate greater accountability in the NHS. Marshall
and colleagues (p 1278) used focus groups to examine the implications
of the UK government's policy for publishing comparative information
on the performance of general practice. Members of the public, general
practitioners, and those in charge of clinical governance support the
proposed disclosure of information on the quality of care in general
practice in principle, but they are concerned about the practical
implications and political motivations behind the initiative.
WHO may be passé
In the fourth of his five part series, Yamey (p 1294) examines the
relevance and role of WHO in the global health enterprise. The
increasing prominence of the World Bank, Gates Foundation, and
Global Fund as international health financiers threatens
WHO's centrality to international health. But with globalisation
fragmenting the international health landscape, the need for an
overarching health agency is strong. WHO faces ongoing debate and major
challenges to realising its new role.
(Credit: P VIROT/WHO)
Global resurgence of tuberculosis is troubling
One third of the world's population has latent tuberculosis, and
nine million new cases of active tuberculosis emerge annually, which
results in up to three million deaths. In a clinical review, Chan and
Iseman (p 1282) discuss the challenges associated with treating
tuberculosis. Patients' non-adherence is the most common cause of
treatment failure and acquired drug resistance, but predicting non-compliance is difficult. The immediate challenges for the control
of tuberculosis are developing treatment regimens that are shorter or
less frequent for patients. Long term prospects include improved vaccines.
Buildings dominate discussions on reconfiguring health care
Many health professionals are engaged in efforts to
reconfigure health services, but these are dominated by discussions
about building hospitals. Black (p 1290) argues that in the UK
discussions about reconfiguring specialist health services are focused
on centralising services in big hospitals. The public, however, values local services. Labour supply problems and information technology may also influence changes in health systems. The NHS
ought to encourage different ways of investment for health gain.
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
