This week in the BMJ
Volume 325, Number 7373, Issue of 16 Nov 2002Screening for aneurysms in men is cost effective
Screening for aneurysms in men is cost effective
Screening for abdominal aortic aneurysms in older men is close to the
current NHS threshold for cost effectiveness. The multicentre aneurysm
screening study (p 1135) randomised nearly 68 000 men aged 65-74 to
undergo ultrasonography or to a control group. The trial provided firm
estimates of the effects and costs of a screening programme. Though at
four years the cost effectiveness was close to threshold of
acceptability, an extrapolation to 10 years indicated that screening
would be an attractively cost effective national programme.
(Credit: JAMES KING-HOLMES)
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Patients with psychotic illness want to discuss their symptoms
Patients with psychotic illness actively attempt to focus a
consultation on their psychotic symptoms. Using conversation analyses of 32 consultations, McCabe and colleagues (p 1148) found that psychiatrists were reluctant to engage when patients with schizophrenic conditions asked direct questions and repeated utterances about their
symptoms. In response to these attempts doctors hesitated, asked
questions rather than providing answers, and smiled or laughed. This
was associated with noticeable tension in the patient. Addressing patients' concerns about their psychotic symptoms and their ideas about their illness might lead to more satisfactory consultations and
better outcomes.
Bezafibrate has limited effects on heart attacks and strokes
Bezafibrate does not reduce the combined incidence of heart attacks and
strokes among men with lower extremity arterial disease, though it may
have some beneficial effect on heart attacks in men under 65. Bezafibrate modifies lipid profiles and lower fibrinogen concentrations, so it should reduce the incidence of cardiovascular events. However, in a double blind placebo controlled trial of bezafibrate in primary and secondary care, Meade and colleagues (p 1139) found no reduction in the combined incidence of heart attacks
and strokes. There may have been a reduction in non-fatal heart
attacks, especially in men under 65 years at entry, but this needs
confirmation in other trials. Bezafibrate leads to an increase in
homocysteine concentrations, which may partly explain the trial's results.
Parents and screening tests miss children's language problems
Neither a method using parental concern plus professional guidance nor
a structured screening test accurately identifies children with serious
speech and language problems. Both methods also lead to referral of
unaffected children. These were the findings of Laing and colleagues
(p 1152) when they assessed both methods in inner London in 582 children and with the help of 37 health visitors.
Nurse led follow up of cancer patients is safe and acceptable
Follow up of patients with lung cancer by specialist nurses leads
to positive outcomes and is acceptable to patients and general practitioners. A randomised controlled trial by Moore and colleagues (p 1145) compared nurse led follow up with conventional medical follow
up and found it to be safe, acceptable, and cost effective. Patients
who were followed up by nurses scored better on most satisfaction
subscales throughout the trial and were more likely to die at home than
in a hospital or hospice. The two groups did not differ in survival or
rates of objective progression.
(Credit: COLIN CUTHBERT/SPL)
Patients with IHD warrant screening for heart failure
Many patients with a history of ischaemic heart disease (IHD) or
diabetes have left ventricular systolic dysfunction and would be
candidates for a targeted echocardiographic screening programme for
heart failure. Davis and colleagues (p 1156) investigated the
prevalence of systolic dysfunction and heart failure in patients in the
community with general practice records of one or more risk factors.
Systolic dysfunction was common in patients with a history of
myocardial infarction, moderately so in those with angina or diabetes,
but uncommon in those with uncomplicated hypertension. Formal trials of
systematic echocardiographic screening of patients with ischaemic heart
disease and diabetes should be considered.
Iron supplements don't affect incidence of infections in children
Iron supplementation has no apparent harmful effect on the overall
incidence of infectious illnesses in children. Concerns have been
expressed that people who receive iron supplementation acquire more infections. In view of the
widespread prevalence of iron deficiency in children and its
adverse health consequences Gera and Sachdev (p 1142) carried out a
systematic review of 28 international randomised controlled trials to
examine this question. On average, iron supplementation did not
significantly increase the incidence of overall infectious illnesses,
but the risk of acquiring diarrhoea was 11% higher. Iron fortification
of foods merits further evaluation as the safest method of
supplementation among children.
