This week in the BMJ
Volume 328, Number 7448, Issue of 8 May 2004Training improves care givers' and patients' wellbeing...
Training improves care givers' and patients' wellbeing...
Simple training for care givers improves the quality of life of the patients and their care givers. Kalra and colleagues (p 1099) randomised 300 care givers, who were looking after stroke patients, to an intervention consisting of training in basic nursing and helping with activities of daily living or to standard care. The trained care givers reported that care giving was less of a burden, and they were less anxious or depressed. Patients' mortality and admission to hospital were similar in both groups, but patients who were helped by trained care givers experienced less anxiety, less depression, and a better quality of life.
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... and saves money
Training care givers reduces the length of patients' hospital stay—and the cost of care—in the first year after a stroke. In the economic evaluation of the randomised trial by Kalra and colleagues, Patel and collaborators (p 1102) found that, when patients were looked after by care givers given additional simple training, total health and social care costs over one year were £4043 lower. The difference in costs was largely due to a shorter hospital stay, but patients looked after by trained care givers required less physiotherapy and occupational training than patients whose care givers had had no training.
A third of type 1 diabetics have renal damage within 20 years
About a third of patients diagnosed as having type 1 diabetes will develop persistent microalbuminuria within 20 years. Of the 277 patients with newly diagnosed type 1 diabetes followed up by Hovind and colleagues (p 1105) for a median of 18 years, 79 developed persistent microalbuminuria and 27 progressed further to persistent macroalbuminuria. Higher urinary albumin excretion rate, higher systolic and diastolic blood pressure, lower stature, higher glycated haemoglobin concentration, and male sex were all predictors of microalbuminuria. Poor glycaemic control at the onset of diabetes is an important predictor of microalbuminuria, say the authors, and spontaneous permanent regression to normoalbuminuria is uncommon.
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Management of self harm varies in England
The provision of services for patients with self harm varies widely in England. Analysing data from 32 hospitals across the health regions, Bennewith and colleagues (p 1108) found that 23 had a designated self harm or liaison service. Of the 21 service standards recommended for self harm, more than half were not in place at 11 hospitals. The proportion of assessments, admissions, psychiatric admissions, or arrangements for follow up was similar in hospitals with a designated service and those without; in those with designated services, however, assessments were more likely to be done by a senior psychiatrist. Most hospitals had a designated self harm or liaison service, but interdisciplinary working and service planning were less common.
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Poorer Scottish patients with heart failure see their GPs less
The risk of heart failure is higher among poorer people in Scotland, but poorer people are less likely to see their general practitioner than affluent patients. McAlister and colleagues (p 1110) identified 2186 patients with heart failure among 307 741 patients from 53 general practices participating in the Scottish continuous morbidity project between April 1999 and March 2000. They found that, compared with affluent patients, poorer patients were 44% more likely to develop heart failure but 23% less likely to have ongoing contact with their general practitioner. General practitioners' prescribing did not differ across different social classes. Socioeconomically deprived patient may have poorer outcomes because they have less contact with their general practitioners, conclude the authors.
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