This week in the BMJ

Volume 326, Number 7395, Issue of 26 Apr 2003

[Down]Descent is mainstay of altitude illness treatment
[Down]Screening 1000 women for 35 years prevents one cervical cancer death
[Down]Delay in TB diagnosis is more common in white people and women
[Down]PFI is ineffective
[Down]Assessment of bed blocking lacks valid tools
[Down]Manual therapy is cost effective for treating neck pain

Descent is mainstay of altitude illness treatment

Altitude illness is best handled by stopping further ascent, but severe or persistent symptoms require descending, aided by oxygen and drug treatment. In a clinical review, Barry and Pollard (p 915) explain the symptoms and forms of the illness and the available treatments. In most cases, altitude illness is a self limiting and benign syndrome, but it can progress to life threatening forms, such as pulmonary or cerebral oedema. It is common in travellers to altitudes over 2500 m, and the mainstay of treatment is descending. The authors say that doctors should view oxygen and drug treatment as adjuncts to aid descent.
 
(Credit: DMTM CHAMONIX)




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Screening 1000 women for 35 years prevents one cervical cancer death

In the NHS cervical screening programme, 10 000 women need to be screened for 35 years to prevent 10 out of the 25 deaths estimated to occur without screening. Raffle and colleagues (p 901) analysed the screening records of 350 000 women in Bristol across 20 years and modelled cases of cervical cancer and deaths with and without screening. According to their model, for each death prevented, 152 women have abnormal test results, 79 are referred for investigation, and 53 have treatment. The authors draw attention to the fact that because screening is resource intensive and potentially harmful, good evidence on all its outcomes is required.



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Delay in TB diagnosis is more common in white people and women

Diagnoses of tuberculosis in London between 1998 and 2000 were made a median of seven weeks after onset of symptoms, and delay in diagnosis was more likely in white people and women. Rodger et al (p 909) analysed surveillance data and a national survey and found a median of 49 days from onset of symptoms of tuberculosis to diagnosis or treatment. Looking at the variables of ethnic group and sex, they found that diagnosis after the median time was more likely in white people and women. Time since entry into the United Kingdom was also positively associated with delay; age and birthplace were not.



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PFI is ineffective

The private finance initiative (PFI) implemented in Lothian, Scotland, led to capacity constraints across all acute specialties and downsizing of hospital and community provision. Dunnigan and Pollock (p 905) analysed projected and actual trends in bed capacity and inpatient and day case admissions for the Lothian healthcare plan, and compared the results with those from the rest of Scotland. Rates for inpatient admission in all specialties and for day case admissions in acute specialties were significantly lower in Lothian hospitals than in the rest of Scotland, while the proportion of delayed discharges in staffed beds was higher. The authors conclude that PFI did not reach its targets, and further downsizing may be required due to its high costs.
 
(Credit: STOCKBYTE/REX)




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Assessment of bed blocking lacks valid tools

The evaluation of inappropriately delayed discharge is beset by poor measurement tools, poor evidence, and problems of lack of definition. Vetter (p 927) examined the evidence from systematic reviews and other studies and found that the current tools for measuring bed blocking have poor validity and reproducibility, which increases when local availability of alternative care is ignored. The author found no strong evidence to show that in cases labelled as inappropriately delayed discharge the patients would have had better outcomes if they had been discharged earlier.



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Manual therapy is cost effective for treating neck pain

Manual therapy (spinal mobilisation) is more effective and less costly than physiotherapy or care by a general practitioner for treating neck pain. Korthals-de Bos and colleagues (p 911) conducted an economic evaluation comparing the cost effectiveness of three different treatments for patients with neck pain. After 26 weeks, patients having manual therapy had higher recovery rates than those having physiotherapy or being cared for by a general practitioner, but these rates were similar after 52 weeks. Total costs in the manual therapy group were around a third of the costs in the other two groups.
 
(Credit: STOCKBYTE/REX)




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