This week in the BMJ
Volume 332, Number 7538, Issue of 18 Feb 2006Larger clinical teams deliver higher quality primary care
Larger clinical teams deliver higher quality primary care
Under the new UK general medical services contract, the size and the composition of the clinical team are the most important determinants of the quality of primary medical care. Sutton and McLean carried out a cross sectional study of 60 general practices in Scotland to identify factors associated with quality under the new UK contract for 2004-5 (p 389). They found higher quality scores in deprived areas, in practices with larger clinical teams, and in practices more likely to respond to financial incentives. Further initiatives to improve primary care quality should focus on structure and resourcing of providers, they say.
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Authors value free access to research articles
Free access to research articles on bmj.com is an important factor in authors' decision on whether to submit their papers to the BMJ. In a cross sectional electronic survey by Schroter (p 394), over half of responding authors said that ending free access to research articles would make them slightly less likely to submit to the BMJ in the future, and two thirds said their view of the journal would change if it closed access to research articles. Authors' comments focused on disappointment with what they saw as a regressive step in the era of open access publishing and the loss of a distinctive feature of the BMJ.
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How to best manage Dupuytren's contracture
Treatment for Dupuytren's contracture is often unnecessary, but regular follow-up is needed to detect early joint contracture, say Townley and colleagues on page 397. This clinical review of Dupuytren's disease looks at presentation, epidemiology, associations, and pathophysiology of the disabling condition and discusses referral and surgical correction when contracture develops. Although timely surgery can prevent permanent loss of function, it cannot prevent recurrence. Some hopes might be pinned on recent research on medical treatment options—for instance, injection of collagenase, which has shown early clinical promise for mild disease.
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Treating secondary sleep disorders with melatonin is not effective
Exogenous melatonin is not effective in the management of secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag or shiftwork disorder. In a meta-analysis by Buscemi and colleagues (p 385), six randomised controlled trials showed no evidence that melatonin had an effect on sleep onset latency in people with secondary sleep disorders and nine trials showed no effect on onset in people who had sleep disorders accompanying sleep restriction. There is evidence, however, that melatonin is safe with short term use.
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Sham devices may have a greater placebo effect than inert pills
In patients with persistent arm pain, a sham acupuncture needle may enhance the placebo effect in comparison with an inert pill. In a randomised controlled trial of 270 adults, Kaptchuk and colleagues (p 391) compared the two placebo treatments and found that a 10 point arm pain scale showed greater downward slopes in the sham device group than in the placebo pill group (-0.33 v -0.15; P = 0.0001). They found no differences for arm function and grip strength.
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