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2009-2010 Editorials

 

PSA at 60 may predict risk of death from prostate cancer

20 Oct 2010Paid-up subscribers

The debate on PSA screening to detect prostate cancer is ongoing. Two large studies published in 2009 gave an unclear message. The European ERSPC trial showed a significant reduction in prostate cancer mortality as a result of screening but with a significant risk of overtreatment in order to save lives (48 additional patients requiring treatment for each life saved). The American PLCO study showed no benefit from screening, but has been criticised for the large amount of PSA testing outside the study in the control arm, contaminating the results and potentially diluting any benefit.A meta-analysis incorporating these two studies and four other randomised controlled trials (a total of 387,286 men), published in the BMJ, has examined the overall evidence for PSA screening. [With external links to current evidence and summaries]

Changes to the notification system will improve reporting

20 Sep 2010Registered users

In the UK, reporting is now a professional duty, whereas previously failure to report was a crime. Potential sanctions include referral to the GMC, rather than prosecution, or a law suit from a patient whose illness could have been prevented if the clinician had notified appropriately. These revisions to the public health legislation are a positive step in assisting the Health Protection Agency, with the support of doctors, to carry out its role to protect the public more effectively.The reality is at present that few cases of notifiable diseases are notified. Often doctors are unaware of their duty to notify or of the process for doing so. Some doctors notify when they are aware of the need for public health action (e.g. meningococcal disease), or where confirmatory testing depends on the diagnosis being reported (e.g. measles, mumps); however, many are unaware of the urgency.

MI admissions fall following smoking ban in England

20 Jul 2010Paid-up subscribers

A study in the BMJ has found a significant reduction in the incidence of myocardial infarction (MI) since smoke-free legislation was introduced in England on 1 July 2007.There have been many studies including meta-analyses showing that passive smoking increases the risk of coronary heart disease and this risk could be increased by as much as 60%, similar to that seen in light smokers. The mechanism of such effects is thought to be through increases in platelet aggregation and alterations in endothelial function. These effects can occur very rapidly and as such the benefits of reducing smoke exposure could be seen quite early.

GMC guidance will help GPs improve end of life care

23 Jun 2010Paid-up subscribers

The GMC (UK) has published important guidance on the treatment and care of patients who are likely to die within the next 12 months. The guidance takes account of the Mental Capacity Act, case law, the Government's end of life care strategy and GMC guidance on consent. It provides a framework for making decisions which are often clinically complex and may present ethical dilemmas, and for the first time provides guidance on advance care planning.

Helping patients back to work

30 May 2010Registered users

 In April in the UK the old sick note, which had survived in its current form since 1922, was finally replaced with the new fit note. 'The aim is to encourage patients to return to work sooner, by focussing on capability rather than disability, while at the same time simplifying the system and reducing the number of forms that GPs need to complete.'

Group CBT is a cost-effective option for persistent back pain

15 Apr 2010Registered users

It is estimated that 2.6 million people seek advice about back pain from their GP each year. One year after an initial episode of back pain, approximately one third of patients report intermittent or continuing pain of at least moderate intensity and one in five report substantial limitation of activities.Group CBT is an effective, low-cost intervention for adults with persistent non-specific, low back pain, a randomised controlled trial from primary care has shown.