This week in the BMJ
Volume 329, Number 7466, Issue of 11 Sep 2004MAOBIs can benefit patients with Parkinson's disease
MAOBIs can benefit patients with Parkinson's disease
Monoamine oxidase type B inhibitors (MAOBIs), such as selegiline, may be beneficial in patients with early Parkinson's disease. In a meta-analysis including 17 trials and 3525 patients, Ives and colleagues (p 593) found that patients taking MAOBIs had better total scores, motor scores, and activities of daily living scores on the unified Parkinson's disease rating scale at three months than patients taking placebo; they were also less likely to need additional levodopa or to develop motor fluctuations, and they were not more likely to die or experience side effects.
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What is it like to have Parkinson's disease?
To receive a diagnosis of a chronic neurological illness is the beginning of a long journey into the unknown—a journey that may begin in hope, pass through periods of elation and frustration, and finally end in acceptance and resignation, say Baker and Graham (p 611). People begin the journey with different knowledge of and different ways of accepting Parkinson's disease. Every patient should see a doctor with a special interest in Parkinson's disease, receive an accurate diagnosis, have support, receive continuous care, and take part in managing the illness.
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Evidence based model improves care of depression
Evidence based management models can improve the care of patients with depression. Dietrich and colleagues (p 602) randomised 405 patients aged 
18 years to the intervention (which consisted of a systematic approach to the assessment and management of depression, with staff providing telephone support under supervision from a psychiatrist) or to standard care. Patients who had the intervention were more likely to show remission at six months (37% v 27%, P = 0.014) or to rate their depression care as good or excellent (90% v 75%, P = 0.0003). Each major disease may need its own care manager, comments Von Korff (p 605); whether and how care management will be integrated into routine practice remains an open and important issue.
Specialisms don't reflect ethnic origin
The ethnic origin of UK trained doctors has little influence on opportunity to enter particular specialties. Analysing official databases of NHS consultants and of students accepted to study medicine, Goldacre and colleagues (p 597) found that the percentage of consultants who had trained abroad and were non-white (but not UK trained doctors from ethnic minorities) was significantly high in geriatric medicine, genitourinary medicine, paediatrics, old age psychiatry, and learning disability. Ethnic minorities are well represented in medical schools in the United Kingdom, and they have the same career destinations as UK trained white doctors.
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Mortality among doctors in Uganda is high
A high proportion of doctors who graduated in 1984 in Uganda died within 20 years of graduation. Dambisya (p 600) obtained information about 74 of the 77 doctors who graduated in Makerere, Uganda, and found that 22 had died. The most common causes of death were AIDS (11 cases) and suicide (six cases, five related to knowledge or fear of being HIV positive). Two thirds of the surviving graduates work in Uganda, mainly in the public sector.
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Computers may facilitate assessment of medical students
Computer based testing can offer many advantages over traditional paper based methods of assessment, including automated marking and student feedback. Cantillon and colleagues (p 606) say that it is not just an alternative method for delivering examinations but represents an important qualitative shift away from traditional methods. It can now be delivered anywhere via a secure computer network. In some subject areas, computer-delivered adaptive tests, pitched at the level of expertise of each candidate, allow for shorter testing time and use of fewer questions.
Screening for herpes simplex may not be ethical
Universal serological screening for herpes simplex virus type 2 may be ethically unjustified, at least in countries with a low prevalence of infection. On page 618, Krantz and colleagues use an ethical model to consider the potential biotechnical, medical, epidemiological, and psychological advantages and disadvantages of screening at individual and public health level. Apart from the infection being mostly asymptomatic and the lack of a cure, universal screening would be inappropriate because adequate information for exercising the right of autonomy would not be met, testing would not benefit babies, and equity might be jeopardised if all patients did not have access to specialists in venereology, say the authors.
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