This week in the BMJ
Volume 326, Number 7388, Issue of 8 Mar 2003MS drugs are pricey, and more research on patients' is needed
MS drugs are pricey, and more research on patients' is needed
The cost of drug treatment in multiple sclerosis is high but decreases
with prolonged treatment. Evaluating the cost effectiveness of
interferon beta and glatiramer acetate, Chilcott and colleagues (p 522) estimated that cost effectiveness with a 20 year time horizon
ranges from £42 000 to £98 000 per quality adjusted life year
gained. Uncertainty about estimates was substantial because of the
unpredictability of the disease and the difficulty in capturing all
aspects of its impact on patients. As Miller discusses in a commentary
(p 525), more primary and secondary research is needed on who will
most benefit from these disease modifying treatments.
(Credit: JAMES KING-HOLMES/SPL)
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NHS walk-in centres may not reduce workloads
Two studies show that the effect of NHS walk-in centres is unclear. Hsu
and colleagues (p 530) measured the workload of general practices,
minor injuries units, and emergency departments in one town before and
after a walk-in centre was introduced and compared the results with
those of a town with no centre. Although they found no significant
change in the workload of general practices, the use of the minor
injuries unit and emergency departments increased compared with the
control town. Chalder and colleagues (p 532) used a time trend
analysis in a region of England to assess the impact of walk-in centres
on the workload of other local healthcare providers. Consultations at
emergency departments and general practices geographically close to
walk-in centres were slightly reduced, but out of hours consultations
were not.
Students don't appraise studies, they just interpret results
When assessing the validity of their clinical decisions according
to newly acquired evidence, medical students can correctly apply study
results but often fail to take account of how well designed the study
was. Evidence based medicine is increasingly emphasised in medical
schools, but few studies assess the ability of students to apply
research evidence to clinical decisions. In a randomised study Schwartz
and Hupert (p 536) presented literature with varying validity of
methods and varying levels of importance of results to students who had
examined a standardised patient. They then measured changes in
students' beliefs about their decisions in managing the patient.
Evidence of low importance led to more incorrect shifts in decisions,
but neither the validity of methods nor the interaction between
validity and importance influenced students' certainty about the
correctness of their treatment decisions.
(Credit: JOSE GOITIA/AP)
Teachers are important role models
The role of the teacher is often undervalued, but teaching can be
rewarding and enjoyable and have lasting impacts on students. In this
week's ABC, Gordon (p 543) shows how you can customise your teaching
to help students realise their potential. She discusses five features
of one to one teaching: providing an orientation, agreeing on the
ground rules, asking helpful questions, giving feedback, and
encouraging reflection.
Evidence for lowering LDL cholesterol in diabetes is lacking
Recommendations to reduce low density lipoprotein cholesterol
concentrations to reduce cardiovascular risk in diabetic patients without coronary heart disease do not reflect the uncertainty in the
evidence. A systematic review by Gami and colleagues (p 528) found
that diabetic patients were excluded from many trials of primary
prevention of cardiovascular disease, or relevant outcomes were not
reported separately. The authors conclude that there is
insufficient evidence to determine the safest way to reduce LDL
cholesterol
or whether this is the correct goal in diabetic patients
without coronary heart disease.
(Credit: JOHN BAVOSI/SPL)
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