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(2) (TREATING
MS IS EXPENSIVE, BUT COST
FALLS OVER
TIME
(3) MORE
EVIDENCE NEEDED ON TRUE IMPACT
OF NHS WALK-IN
CENTRES
(4) EMERGENCY
CARE SCHEME DOES NOT
TACKLE REAL
PROBLEMS
(1) WOMEN WITH
COSMETIC BREAST IMPLANTS
MORE LIKELY TO COMMIT SUICIDE
(Total and cause specific mortality
among Swedish
women with cosmetic breast implants:
prospective study)
http://bmj.com/cgi/content/full/326/7388/527
Women who undergo cosmetic surgery for
breast
augmentation are more likely to commit
suicide than
women from the general population, finds
a study in this
week's BMJ.
Researchers identified 3,521 Swedish women
aged
15-69 years who had had breast implants
between 1965
and 1993. They compared the observed number
of
deaths with the expected number of deaths
from suicide,
unintentional injury, cardiovascular diseases,
malignancies, and other causes over an
average of 11
years.
Although 59 deaths were expected, 85 women
died.
Fifteen women committed suicide, compared
with 5.2
expected deaths from suicide. Excess deaths
were also
due to malignant disease, mainly lung
cancer due to
smoking. The number of deaths for all
other causes was
close to expected.
Given the well documented link between
psychiatric
disorders and a desire for cosmetic surgery,
the
increased risk for death from suicide
may reflect a
greater prevalence of psychopathology
rather than a
causal association between implant surgery
and suicide,
say the authors.
Surgeons evaluating candidates for breast
implant
surgery need to be vigilant for subtle
signs of psychiatric
problems, they conclude.
Contact:
Veronica Koot, Clinician and Epidemiologist,
Julius
Centre for Health Sciences and Primary
Care, University
Medical Centre, Utrecht, Netherlands
Email: kuckkoot@ikmn.nl
(2) (TREATING
MS IS EXPENSIVE, BUT COST
FALLS OVER TIME
(Modelling the cost effectiveness
of interferon beta and
glatiramer acetate in the management
of multiple
sclerosis)
http://bmj.com/cgi/content/full/326/7388/522
The cost of drug treatment multiple sclerosis
is high, but
decreases with prolonged treatment up
to 20 years,
concludes a study in this week's BMJ.
Researchers evaluated the cost effectiveness
of four
drugs currently licensed for the treatment
of multiple
sclerosis in the United Kingdom (three
interferon betas
and glatiramer acetate). They assessed
the effect of each
drug against conventional management over
20 years
using the best available evidence.
They calculated that the cost of each year
of life saved or
prolonged by using any of the four treatments
ranged
from £42,000 to £98,000. Price
had a considerable
effect on the cost effectiveness for each
drug.
The authors stress, however, that uncertainty
surrounding
these estimates is substantial, largely
due to the
unpredictability of the disease and the
difficulty in
capturing all aspects of its impact on
patients. Further
research to establish the true impact
of these treatments
would be of considerable value, they conclude.
In the face of such uncertainties, the
Department of
Health has introduced a risk-sharing scheme
for
providing these treatments in the NHS,
writes Professor
David Miller in an accompanying commentary.
Although
the scheme will need substantial investment,
it is a
constructive approach in addressing a
difficult problem,
and it is hard to see a realistic alternative.
Further research is needed to identify
those who will
benefit most from disease modifying treatments.
Meanwhile, work must go on to develop
more effective
treatments, he concludes.
Contacts:
Paper: Chris McCabe, Senior Lecturer in
Health
Economics, School of Health and Related
Research,
University of Sheffield, UK
Email: c.mccabe@sheffield.ac.uk
Commentary: David Miller, Professor of
Clinical
Neurology, Institute of Neurology and
National Hospital
for Neurology and Neurosurgery, London,
UK
Email: d.miller@ion.ucl.ac.uk
(3) MORE EVIDENCE
NEEDED ON TRUE IMPACT
OF NHS WALK-IN CENTRES
(Effect of NHS walk-in centre on
local primary
healthcare services: before and
after observational study)
http://bmj.com/cgi/content/full/326/7388/530
(Impact of NHS walk-in centres on the workload
of
other local healthcare providers: time
series analysis)
BMJ Volume 326, pp 532-4
Introduction of NHS walk-in centres may
not affect the
workload of local general practitioners,
but more
evidence is needed to determine their
true impact on
other local healthcare services, according
to two studies
in this week's BMJ.
In the first study, researchers compared
the activity of
primary and emergency healthcare services
for two
towns in Leicestershire, before and after
a walk-in centre
opened in one of the towns.
They found no significant effect on general
practice
emergency consultations, the availability
of routine
appointments, use of out of hours services,
or the
number of calls to NHS Direct. However,
the workload
of the local minor injuries unit increased
significantly,
probably because it was in the same building
as the
walk-in centre.
In the second study, researchers assessed
the impact of
NHS walk-in centres on the workload of
20 accident
and emergency departments, 40 general
practices, and
14 out of hours services in England.
They found a reduction in consultations
at emergency
departments and general practices close
to walk-in
centres, although these reductions were
not statistically
significant. Walk-in centres did not have
any impact on
out of hours services.
To determine whether walk-in centres reduce
the
demand on other local NHS providers will
require study
of a large number of sites over a prolonged
period, they
conclude.
Contacts:
Paper 1: Ronald Hsu, Clinical Lecturer
in Epidemiology
and Public Health, Department of Epidemiology
and
Public Health, University of Leicester,
UK
Email: rth4@leicester.ac.uk
Paper 2: Melanie Chalder, Senior Research
Associate,
Cardiff University School of Social Sciences,
Cardiff,
UK
Email: chalderm@cardiff.ac.uk
(4) EMERGENCY
CARE SCHEME DOES NOT
TACKLE REAL PROBLEMS
(Letters: Inversion of emergency
pyramid)
http://bmj.com/cgi/content/full/326/7388/553
A new scheme designed to reduce waits in
emergency
departments is simply massaging the figures
to meet
government targets, warn senior doctors
in this week's
BMJ.
The "see and treat" concept involves having
senior staff
as the first clinical contact rather than
a triage and wait
approach. However, there are serious concerns
that
diverting senior clinicians from treating
ill patients will be
detrimental.
Adrian Fogarty, a consultant in accident
and emergency
medicine at the Royal Free Hospital, argues
that there
simply aren't yet sufficient numbers of
trained emergency
doctors to take on this workload.
Those senior emergency doctors currently
in post find
their time occupied with critically ill
patients, together
with complex medical and surgical cases.
They simply do
not have the time to deal with "minor"
cases as they walk
through the door, he says.
The NHS Modernisation Agency needs to realise
that
there will not be a quick fix solution
to emergency care
access in this country, at least not without
substantial and
sustained investment in appropriately
trained staff, he
concludes.
In another letter, Bruce Finlayson, a consultant
in
accident and emergency medicine at the
Norfolk and
Norwich University Hospital, writes: "Such
schemes as
see and treat, while laudable in the big
picture, are
methods of massaging the figures towards
the
government's four hour emergency targets
without
adequately addressing the real problems."
Contact:
Adrian Fogarty, Consultant in Accident
and Emergency
Medicine, Royal Free Hospital, London,
UK
Email: afogarty@btinternet.com
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