This week in the BMJ

Volume 333, Number 7574, Issue of 28 Oct 2006

[Down]Self care knowledge reduces anxiety in patients with arthritis
[Down]Telephone therapy works for obsessive compulsive disorder
[Down]Advance care planning instils hope in patients with end stage renal failure
[Down]Reappearance of measles in the UK raises questions
[Down]Monitor renal function and electrolytes in hypertension

Self care knowledge reduces anxiety in patients with arthritis

A self management programme for patients with osteoarthritis in primary care reduced anxiety and improved participants' perceived ability to manage symptoms say Buszewicz and colleagues (p 879). In this randomised controlled trial of 854 patients aged over 50 from 74 general practices in the United Kingdom, participants received an educational booklet or received the booklet and underwent six sessions of self management. No differences were seen in number of general practitioner visits between the groups, but patients' perceptions of their condition differed.


Figure 1
 Credit: GARRY WATSON/SPL

 



[To top]

Telephone therapy works for obsessive compulsive disorder

Cognitive behaviour therapy delivered over the telephone for obsessive compulsive disorder showed a similarly positive outcome to that for face to face treatment (effect size of treatment 2.5). In a randomised controlled non-inferiority trial of 72 patients, Lovell and colleagues (p 883) found high client satisfaction for both modes of treatment delivery. Cognitive behaviour therapy is effective in treating this disorder but the time involved leads to long waiting lists. Telephone intervention could reduce time to treatment and have economic advantages.


Figure 1
 Credit: PHOTOS.COM

 



[To top]

Advance care planning instils hope in patients with end stage renal failure

Informative advance care planning can facilitate rather than destroy hope in patients with end stage renal disease say Davison and Simpson (p 886). In this qualitative in-depth interview study of 19 patients recruited from dialysis and renal insufficiency clinics, the authors found that patients' hopes become the cornerstone of end of life discussions by providing patient derived focus in planning care. Patients viewed having information about individual prognosis as vital to maintaining their ability to hope and make realistic decisions about their future care.


Figure 1
 Credit: BSIP/SPL

 



[To top]

Reappearance of measles in the UK raises questions

More than 400 cases of measles have been confirmed in the United Kingdom this year, compared with 77 in 2005, while the World Health Organization calls for elimination of measles in Europe by 2010. In this clinical review (p 890), Asaria and MacMahon point out that measles remains the leading cause of vaccine preventable death worldwide, yet it could be eradicated if 90-95% of children were vaccinated. The authors outline the features and complications of this illness, thought to be on the rise owing to gaps in herd immunity.


Figure 1
 Credit: NIBSC/SPL

 



[To top]

Monitor renal function and electrolytes in hypertension

Patients' renal function and electrolyte concentrations should be monitored as part of treatment evaluation in hypertension because several classes of antihypertensives can lead to poor renal perfusion and abnormal electrolyte concentrations. In this guide to good practice, Martin and Coleman (p 896) examine two cases where drug treatment of hypertension precipitated serious problems detected by blood electrolyte analysis. The authors highlight the high incidence of underlying renovascular disease in patients with hypertension and issue caution about using potassium sparing agents.


Figure 1
 Credit: PAUL RAPSON/SPL

 



[To top]

Access jobs at BMJ Careers
Whats new online at Student BMJ