This week in the BMJ
Volume 331, Number 7508, Issue of 9 Jul 2005Routine funduscopy isn't justified in patients with hypertension
Routine funduscopy isn't justified in patients with hypertension
There is no evidence that routine funduscopy adds value in the management of patients with hypertension. In a systematic review, van den Born and colleagues (p 73) searched for studies examining the association between hypertensive retinopathy and blood pressure, hypertensive organ damage, and cardiovascular risk. Large interobserver variations in the assessment of retinal microvascular changes, low predictive values for the association between retinopathy and blood pressure, and inconsistent associations between retinal changes and cardiovascular risk all hamper finding evidence to support routine funduscopy in patients with high blood pressure.
|
![[To top]](/icons/back.gif){kind=icon}
Nuclear factory workers are at increased risk of cancer
Even low doses of ionising radiation that nuclear industry workers typically receive are associated with an increased risk of cancer. In a retrospective cohort study, Cardis and colleagues (p 77) monitored 407 391 nuclear industry workers in 15 countries for external radiation, with a total follow-up of 5.2 million person years. From these results they estimated that 1-2% of deaths from cancer among workers in this cohort are attributable to radiation. These estimates are higher than the risk estimates used for current radiation protection standards.
|
Psychosocial intervention doesn't improve lumbago
A Dutch study found that a minimal intervention aimed at assessment and modification of psychosocial factors was no more effective than usual care for (sub)acute low back pain. In a cluster randomised controlled trial that included 60 general practitioners and 314 patients, Jellema and colleagues (p 84) measured functional disability, perceived recovery, and sick leave at baseline and after 6, 13, 26, and 52 weeks. None of the outcomes showed improvement in the intervention group, but the authors say that not enough studies have been done on the effectiveness of such interventions.
|
Patients don't mind students in general practice consultations
Medical students' participation in general practice consultations doesn't seem to bother patients. Benson and colleagues (p 89) used validated instruments to survey 240 patients who had students present at consultations and 409 whose consultations were not for teaching (response rates 82% and 72%, respectively). The scores did not differ significantly between the two groups. Qualitative data obtained from 10 focus groups showed that patients generally supported the teaching of students in their practice, but would like to know how many students, and of which sex, would be present, and to have a choice about participation.
|
Living with locked-in syndrome
Nick Chisholm has been living with locked-in syndrome, also known as coma vigilante, since being injured on a rugby field in year 2000. Dissection of the vertebral arteries left him quadriplegic and without the ability to speak, but completely conscious. He shares his story on p 94. Interspersed with Nick's narrative, Grant Gillett provides information on this rare medical condition and discusses clinical and ethical issues that arise in locked-in syndrome.
|
Academic medicine, where are you headed?
Will academic medicine in 2025 be the pillar of medical advancement, a long forgotten historical scribble, or something in between? Who knows; as Clark says on p 101, it is impossible to predict the future. ICRAM, the international campaign to revitalise academic medicine, created a team to develop a vision for the future of academic medicine. The five resulting scenarios aim to enable richer conversations by stretching thinking on what the future might bring.
|
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
