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BMJ No 7120 Volume 315 This week in brief Saturday 29 November 1997 Several strategies can help patients adhere to TB treatment Directly observed treatment for TB is cheaper than conventional treatment Review of trials confirms toxicity of mefloquine prophylaxis Weapons injuries remain high after conflict has ended Health care in prisons needs more integration with NHS GPs' self assessment of knowledge is inaccurate Several strategies can help patients adhere to TB treatment Many patients with tuberculosis do not complete their treatment, and this leads to needless suffering and death. On p 1403 Volmink and Garner determine which strategies to promote adherence are effective by means of a systematic review of randomised controlled trials. Reminder cards sent to patients who defaulted on clinic visits, help for patients from lay health workers, a monetary incentive offered to patients, health education, a combination of a patient incentive and health education, and increased supervision of staff in tuberculosis clinics all seemed to improve adherence. The authors could not find any completed trials of directly observed treatment, although this intervention is widely advocated. The review also highlights the need for rigorous evaluations of other innovations, especially those that are feasible in developing countries. Directly observed treatment for TB is cheaper than conventional treatment Delivering care for the growing number of patients with tuberculosis is difficult when budgets are severely constrained. On p 1407 Floyd et al show that community based directly observed treatment recently implemented in a rural district of South Africa is cheaper, more cost effective, and less demanding of hospital infrastructure than a more conventional approach. Review of trials confirms toxicity of mefloquine prophylaxis Mefloquine is now widely recommended for antimalarial chemoprophylaxis, but recent anecdotal reports have suggested that its toxicity is higher than was previously thought. Croft and Garner (p 1412) conducted a systematic review of the effectiveness of mefloquine in malaria chemoprophylaxis, pooling the results of 10 randomised controlled trials of the drug carried out in non-immune adults. While the review confirmed the theoretical efficacy of mefloquine in preventing malaria infection, it corroborated the high toxicity of prophylactic mefloquine and found that study participants were significantly more likely to withdraw from taking mefloquine than from taking placebo. Weapons injuries remain high after conflict has ended Data on the extent of weapons injuries in post-conflict societies have rarely been published. On p 1417 Meddings reports the experience of two hospitals that provided care to injured people coming from a region which moved from conflict to a post-conflict period. Mean monthly admission rates between the two periods declined by 8% for injuries from fragmentation munitions, while rates for mine and gunshot injuries declined by 23% and 32% respectively. Overall, weapons related injuries declined by 23% between the two periods. In hospital mortality from weapons-related injuries increased from 2.5% to 6.1%. The continued availability of weapons is associated with an increased death rate and a burden of morbidity that is only slightly lower than during the conflict. Health care in prisons needs more integration with NHS The Health Care Service for Prisoners aims to provide care equivalent to NHS care: does it achieve this? On p 1420 Reed and Lyne describe the results of inspecting the healthcare facilities in 19 British prisons. Care in some prisons, mainly those where a primary care service is contracted in from the NHS, is broadly equivalent to NHS care, but in many prisons services are poor. Commissioning of health care lacks a sound base, and its delivery is poorly monitored. Some doctors are inadequately trained for the work they do, and arrangements for continuing professional development are weak. In a few prisons, health care is clearly unethical. The authors conclude that the NHS should be much more closely involved. GPs' self assessment of knowledge is inaccurate Much professional development in medicine relies on practitioners' ability to diagnose their own weaknesses. Tracey et al found virtually no correlation between practitioners' perceptions of their depth and range of knowledge in common areas of practice and their actual knowledge (p 1426). This indicates that much of what is being done in continuing medical education is misdirected. To meet individuals' real needs a more objective assessment is required. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline