This week in the BMJ
Volume 327, Number 7426, Issue of 29 Nov 2003Children with mild ambylopia may not need treatment
Children with mild ambylopia may not need treatment
Delaying screening for unilateral visual impairment until the age of five may not affect outcome, and only children with moderately impaired acuity (6/18 or worse) need treatment. Clarke and colleagues (p 1251) randomised 177 preschool children with impaired vision to no treatment, glasses, or full treatment (glasses plus patch). Waiting a year, until the start of school, to begin treatment halved the likelihood of needing a patch and did not alter the potential for improvement. At 18 months' follow up, acuity did not differ in the groups. Children with minimally reduced vision (6/9) in only one eye may not need treatment at all, the authors say.
![[To top]](/icons/back.gif){kind=icon}
Cardiac nurses can help with smoking cessation
Coronary heart disease patients who had individual contact with nurses on smoking cessation were more likely to have stopped smoking after one year. Quist-Paulsen and Gallefoss (p 1254) randomised 240 patients admitted to hospital for coronary heart disease to a nurse led programme or usual care. The programme was focused on fear arousal and prevention of relapses and consisted of group sessions, one outpatient clinic, and telephone contact. The nursing time commitment for each patient was 2.4 hours.
|
Balancing aspirin and statins for heart disease prevention
Aspirin and low cost antihypertensives are more cost effective than statins for preventing coronary heart disease. From his incremental cost effectiveness analysis of preventing ischaemic heart disease Marshall (p 1264) found that treating moderate risk patients with aspirin is more cost effective than treating high risk patients with statins. Cost effectiveness rankings obtained from incremental cost effectiveness analyses can be used when preparing clinical guidelines.
|
Access to kidney transplants in Scotland is uneven
Scottish patients face inequities in getting on to the renal transplant waiting list and to receiving a new kidney. Oniscu and colleagues (p 1261) identified 4523 adults starting renal replacement therapy in Scotland in 1999 from the database of the Scottish Renal Registry and UK Transplant. The authors identified the factors that influence access to the renal transplant waiting list or transplantation—female sex, older age, hospitals where assessed and treated, primary renal disease, and socioeconomic status. They call for national guidelines for evaluating candidates for transplantation.
NHS makes bad use of acute beds
The NHS is using its beds much less effectively than Kaiser Permanente, a Californian health maintenance organisation. Ham and collaborators (p 1257) analysed 11 leading causes of use of acute beds in the NHS, Kaiser Permanente, and the US Medicare programme. They found that lengths of stay, bed days, and total bed day use are up to three times higher in the NHS than in Kaiser and the Medicare programme. Kaiser Permanente achieves lower bed use through integration of care, active management of patients, use of intermediate care, self care, and medical leadership.
Lassa fever poses international challenge
Lassa fever, a viral haemorrhagic fever transmitted by rats, is endemic in West Africa and has the potential to cause tens of thousands of deaths each year. In a review Richmond and Baglole (p 1271) describe the epidemiology, morbidity, mortality, and clinical course of the disease. Current knowledge is incomplete, and understanding the epidemiology, prevention, diagnosis, treatment, and social consequences of the disease poses substantial challenges to the international community.
|
Current assessment methods overestimate coronary risk
Current scoring methods for coronary heart disease may overestimate risk. Brindle and colleagues (p 1267) prospectively studied 6643 men participating in the British regional heart study and found that scoring methods derived from the Framingham study overpredicted risk by about 50%. The scores could be adjusted by dividing the calculated score by the amount of overprediction observed. This would improve predictive accuracy in the British population, but further refinements are required if treatment decisions are to be optimal.
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
