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(2) MANUAL
THERAPY IS EFFECTIVE TREATMENT
FOR NECK PAIN
(3) CERVICAL
SCREENING IS WORKING WELL,
BUT IS LABOUR
INTENSIVE
(4) DELAY
IN SPOTTING TB IS MORE COMMON IN
WHITE PEOPLE
AND WOMEN
(5) COMMON
SARS POLICY FOR SCHOOLS
URGENTLY NEEDED
(1) PRIVATE FINANCE
INITIATIVE IS ASSOCIATED
WITH NHS DOWNSIZING AND BED
REDUCTIONS
(Downsizing of acute inpatient beds
associated with
private finance initiative: Scotland's
case study)
http://bmj.com/cgi/content/full/326/7395/905
The private finance initiative (PFI) in
Lothian, Scotland
has not reached its targets for inpatient
admissions and
performance, show researchers in this
week's BMJ. The
effect has been a cut in services and
downsizing of
hospital and community facilities compared
with other
NHS hospitals in Scotland.
The high costs of using PFI in replacement
NHS
hospitals in the UK is associated with
bed reductions of
around 30% in first wave schemes. The
Scottish
Executive and Department of Health maintain
that these
plans will result in improvements in hospital
performance
and expanded community provision.
Matthew Dunnigan and Allyson Pollock analysed
projected and actual trends in bed capacity
and inpatient
and day case admissions in Lothian in
the first five years
(1995-6 to 2000-1) of the PFI plan for
the new Royal
Infirmary of Edinburgh.
They also set out to establish whether
there was a "PFI
effect" by comparing clinical activity
and performance in
Lothian with the rest of Scotland.
By 2000-1, 81% of the planned bed cuts
for Lothian
had been achieved. However, the projected
21%
increase in inpatient and day case admissions
to all acute
specialties only reached 0.3%. Inpatient
admissions to
surgical specialties were projected to
rise by 8% but
actual admissions fell by 13% due to severe
capacity
constraints.
Despite predictions that the length of
stay in hospital
would fall, the total reduction across
all acute specialties
was just 0.1 days, while length of stay
across surgical
admissions rose. Long stay geriatric beds
and private
nursing home beds continued to close,
and the
proportion of delayed discharges was higher
than the
Scottish average.
The analysis shows strong evidence of reduced
service
delivery across Lothian and its associated
PFI
development compared with other Scottish
NHS
hospitals, say the authors. Further hospital
and
community service downsizing may be required
to meet
the current financial deficit, principally
due to the high
costs of PFI, they conclude.
Contacts:
Allyson Pollock, Professor, School of Public
Policy,
University College London, UK
Email: allyson.pollock@ucl.ac.uk
or
Matthew Dunnigan, Senior Research Fellow,
Glasgow
Royal Infirmary, Scotland
(2) MANUAL THERAPY
IS EFFECTIVE TREATMENT
FOR NECK PAIN
(Cost effectiveness of physiotherapy,
manual therapy,
and general practitioner care for
neck pain: economic
evaluation alongside a randomised
controlled trial)
http://bmj.com/cgi/content/full/326/7395/911
Manual therapy is more effective and less
costly for
treating neck pain than physiotherapy
or care by a
general practitioner, claim researchers
in this week's
BMJ.
The study involved 183 patients recruited
by 42 general
practitioners in the Netherlands. All
patients were aged
18-70 years and had suffered neck pain
for at least two
weeks. Sixty patients received manual
therapy (spinal
mobilisation), 59 received physiotherapy
(mainly
exercise), and 64 received standard care
from a general
practitioner (counselling, education,
and drugs).
After 26 weeks, patients in the manual
therapy group
recovered more quickly than the physiotherapy
group
and the general practitioner care group,
but differences
were negligible by 52 weeks. The total
costs of manual
therapy were around one third of the costs
in the other
two groups.
"Our findings showed manual therapy to
be more cost
effective than physiotherapy and continued
care
provided by a general practitioner in
the treatment of
non-specific neck pain," conclude the
authors.
Contact:
Ingeborg Korthals-de Bos, Research Fellow,
Institute
for Research in Extramural Medicine, VU
University
Medical Centre, Amsterdam, Netherlands
Email: ibc.korthals-de_bos.emgo@med.vu.nl
(3) CERVICAL SCREENING
IS WORKING WELL,
BUT IS LABOUR INTENSIVE
(Outcomes of screening to prevent
cancer: analysis of
cumulative incidence of cervical
abnormality and
modelling of cases and deaths prevented)
http://bmj.com/cgi/content/full/326/7395/901
The NHS cervical screening programme is
working well
and preventing deaths, but is labour and
resource
intensive - around 1,000 women need to
be screened for
35 years to prevent one death, say researchers
in this
week's BMJ.
Dr Angela Raffle and colleagues analysed
the screening
records of 350,000 women over 20 years
and modelled
cases of cervical cancer and deaths with
and without
screening.
Their results suggest that 8 out of every
10 women with
"high grade" cell change will not go on
to develop
cancer, but all need to be treated.
For each death prevented at least 150 women
have
abnormal test results, over 80 women are
referred to
specialist clinics for investigation,
and over 50 have
treatment. At least one woman will die
of cervical cancer
despite participating in screening.
These findings have important implications,
say the
authors. For instance, even women who
receive results
of borderline changes can become anxious
about their
risk of cancer, so it is essential to
change people's
perception of the meaning of an abnormal
screening
result.
Furthermore, because of the resources involved
and the
potential to do harm, it is in the public's
interest to
control the introduction of cancer screening
programmes
that have not been adequately evaluated
or quality
assured, they conclude.
Contact:
Angela Raffle, Consultant in Public Health
Medicine,
Bristol North Primary Care Trust, Bristol,
UK Tel (via
Vicky O'Loughlin, Press Officer): +44
(0)117 900 2694
Email: angela.raffle@bristolnorth-pct.nhs.uk
(4) DELAY IN SPOTTING
TB IS MORE COMMON IN
WHITE PEOPLE AND WOMEN
(Delay in the diagnosis of pulmonary
tuberculosis,
London, 1998-2000: analysis of surveillance
data)
http://bmj.com/cgi/content/full/326/7395/909
Delays in diagnosing tuberculosis are more
common in
white people and women, finds a study
in this week's
BMJ.
Researchers analysed surveillance data
and a national
survey to estimate delays in tuberculosis
diagnosis in
London from 1998 to 2000.
They found a median delay of 49 days. Delays
between
onset of symptoms and diagnosis were more
likely for
white patients and women. This might be
because
tuberculosis may be suspected and investigated
more
readily among men or black or Asian people,
suggest the
authors.
Recent campaigns have appropriately tried
to raise
awareness of tuberculosis, particularly
among ethnic
minority groups, say the authors. "Our
data suggest that
campaigns also need to be targeted at
white people, who
comprise a third of cases, they conclude.
Contacts:
Shabbar Jaffar, Senior Lecturer, or Alison
Rodger,
Specialist Registrar, Infectious Disease
Epidemiology
Unit, London School of Hygiene and Tropical
Medicine,
London, UK
Email: shabbar.jaffar@lshtm.ac.uk
/ alison.rodger@lshtm.ac.uk
(5) COMMON SARS
POLICY FOR SCHOOLS
URGENTLY NEEDED
(Letter: Policies on SARS are confused
in UK boarding
schools)
http://bmj.com/cgi/content/full/326/7395/929
The Government should urgently develop
a common
SARS policy for UK boarding schools, according
to a
letter in this week's BMJ.
Current school policies on SARS are confusing,
writes
Ian Wong at the University of London School
of
Pharmacy. Some Chinese students are subjected
to
quarantine imposed by their schools, while
one school is
reported to be excluding students returning
from certain
parts of the Far East after Easter.
Yet the Health Protection Agency states
that there is no
need for students returning from areas
affected by SARS
to be excluded or quarantined unless they
are unwell.
The author identified SARS policies in
10 UK boarding
schools. Five schools followed the Health
Protection
Agency's recommendation, and four stated
that up to 10
day's quarantine was required. One school
advised
students "not to return for the summer
term until such a
time that the school is satisfied that
the virus is
understood, contained, and an appropriate
treatment is
available."
The author urges the Department for Education
and
Skills and the Department of Health to
work together in
this matter urgently and develop a common
policy for
schools. This will assist schools in making
rational
decisions and more importantly address
the fear of
parents and children.
Contact:
Ian Wong, Director, Centre for Paediatric
Pharmacy
Research, School of Pharmacy, University
of London
and the Institute of Child Health, University
College
London, UK
Email: ian.wong@ulsop.ac.uk
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