This week in the BMJ
Volume 332, Number 7543, Issue of 25 Mar 2006Treat low back pain with acupressure
Treat low back pain with acupressure
Acupressure is more effective than standard physical therapy in alleviating low back pain in terms of pain scores, functional status, and disability. Hsieh and colleagues (p 696) randomised 129 patients with chronic low back pain to one month's (six sessions) treatment with acupressure or routine physical therapy. Acupressure produced significantly greater improvement in outcome measures both immediately after treatment and at the six month follow-up.
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Education can improve GPs' detection of dementia
Decision support software and practice based workshops are effective educational approaches in improving rates of detecting dementia in primary care. Downs and colleagues (p 692) randomised 35 UK general practices to one of three educational interventions (an electronic tutorial on CD Rom, decision support software built into the electronic medical record, or practice based workshops) or control. The latter two interventions significantly improved rates of detection compared with control practices, but there were no significant differences by study arm in the management of dementia.
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Breast cancer screening yields 10% over-diagnosis
Mammographic screening of women aged 55 years or older leads to a 10% over-diagnosis of breast cancer (detection of cases that would otherwise never have come to clinical attention). Zackrisson and colleagues (p 689) undertook a follow-up study of the participants from a Swedish trial that had randomised more than 42 000 women aged 45-69 to mammographic screening or not (control). Fifteen years after the end of that trial, over-diagnosis was 10% in the women randomised to screening at age 55-69 compared with the unscreened controls.
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Should all children be immunised against hepatitis A?
Given the recent US recommendation for vaccination of all children against hepatitis A, Temte (p 715) examines the evidence on hepatitis A epidemiology, childhood vaccinations, and issues relating to vaccine policy. The new recommendation is based on strong epidemiological evidence of its effectiveness but is compromised by the reduced prevalence of the virus thanks to the success of targeted vaccination. Temte warns that adding two more injections to an already crowded vaccination schedule may reduce compliance and increase the already high costs but concludes that the recommendation is probably justified.
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Cost effectiveness studies show publication bias
Most published cost effectiveness analyses report favourable cost effectiveness ratios below the thresholds set for good value. Bell and colleagues (p 699) carried out a systematic review of 494 studies measuring health effects in quality adjusted life years (QALYs) and found that two thirds of published cost effectiveness ratios were below the threshold of $50 000/QALY and only 21% were above $100 000/QALY. Published cost effectiveness analyses are of limited use in identifying health interventions that do not meet popular standards of "cost effectiveness," say the authors.
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