Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7133 Volume 316 This week in brief Saturday 7 March 1998 Ultrasound treatment relieves pain in carpal tunnel syndrome EuroQoL EQ-5D is a practical measure of population health Calcium channel blockers may increase risk of suicide Formulas for general practice prescribing budgets need to be piloted Neither asthma nor its treatment adversely affects growth Communication behaviour of hospital workers is inefficient Ultrasound treatment relieves pain in carpal tunnel syndrome No effective conservative treatment exists for carpal tunnel syndrome, and surgical decompression is often performed. In a randomised, "sham" controlled study of an intensive schedule of 20 sessions of ultrasound treatment, Ebenbichler et al (p 731) found that treatment led to short and medium term relief of pain and neurological symptoms in patients with mild to moderate forms of the syndrome. Optimal schedules of ultrasound treatment used alone or in combination with other medical treatments await elucidation. Long term efficacy is yet to be determined. EuroQoL EQ-5D is a practical measure of population health The measurement of states of health is crucial in determining the outcomes of health care. The EuroQoL EQ-5D questionnaire was developed as a generic state of health measure and describes states of health in five dimensions: mobility, self care, usual activities, pain or discomfort, and anxiety or depression. A survey of a representative sample of the general population which incorporated the EQ-5D questionnaire, reported by Kind et al (p 736), found important differences between subgroups of the population. Factors associated with poorer health status included age, social class, economic status, education, housing tenure, and smoking behaviour. Women had consistently higher rates of anxiety or depression than men. The EQ-5D questionnaire is now well established in clinical studies in the UK and elsewhere. Calcium channel blockers may increase risk of suicide A recent study suggested an excess risk of depression with calcium channel blockers. Lindberg et al (p 741) therefore investigated the risk of suicide associated with cardiovascular drugs, with special reference to calcium channel blockers. In a cross sectional ecological study of 152 Swedish municipalities they found a significant correlation between the use of calcium channel blockers and the incidence of suicide. In a population based cohort study of subjects who purchased various antihypertensive drugs in 1988-9 they then found a fivefold increase in the incidence of suicide in users of calcium channel blockers compared with non-users during follow up until the end of 1994. Formulas for general practice prescribing budgets need to be piloted British health authorities are introducing capitation based prescribing budgets for general practices - in an attempt to contain costs and allocate funds fairly. On p 748 Majeed and Head argue that finding a fair allocation formula is impossible because the cause of 60-70% of variation in prescribing is unknown, no direct measure of chronic illness exists, and a formula fails to distinguish between cost and quality in prescribing. Greenhalgh, however, argues that there is enough data on markers of good prescribing for authorities to identify a band within which a practice's prescribing costs should remain (p 750). Better data should be available when drugs are introduced into practice Donepezil was recently launched with favourable publicity as a new treatment for Alzheimer's disease, but debate over its effectiveness has been hampered by delays in publishing the clinical trials: these seem to suggest that the clinical benefit in a highly selected group of patients was small. On p 762 Melzer uses this example to question the clinical usefulness of the trials required for licensing, delays in publishing the evidence, and the way benefits are communicated. He suggests that trials should be conducted on more representative patients, should be published before the drugs are launched, and that advertisements should not refer to data outside the public domain. Patients who had surgery for their peptic ulcers may still have H pylori infection Most peptic ulcers are due to infection with Helicobacter pylori, and antibiotics generally cure both infection and ulceration. In past years ulceration was often treated surgically. On p 746 Danesh et al present data from 36 studies that showed that H pylori persisted in 83% of patients who had undergone vagotomy and 50% of those with a partial gastrectomy. They recommend that such patients should be reviewed and considered for antibiotic treatment. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline