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Triage reduces general practitioners' workload but not costs
Nurse telephone triage of requests for same day appointments in
primary care resulted in 40% of patients being managed by a nurse
alone. Richards and colleagues (p 1214) compared triage with standard
management in routine primary care and found that although the same day
workload of general practitioners was reduced, triage increased nursing
and overall time per patient. Demand for out of hours and accident and
emergency care also increased. Costs did not differ between the two
groups. Practices need to be aware that new roles for nurses may reduce
the burden of traditional practice but may not significantly shrink
overall costs.
(Credit: SPL)
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Wald and colleagues (p 1202) provide evidence of a causal association
between homocysteine and cardiovascular disease. Their meta-analyses
show that a mutation in the MTHFR gene, which reduces folate
metabolism, significantly increases cardiovascular risk. The authors
report that consuming 0.8 mg of folic acid could decrease serum
homocysteine, reducing the risk of ischaemic heart disease by 16%,
deep vein thrombosis by 25%, and stroke by 24%.
Deliberate self harm and thoughts of suicide occur more often in
adolescents than is suggested by hospital statistics, especially among
girls. Hawton and colleagues (p 1207) studied 6020 school pupils aged
15 and 16 years. Only a minority of those reporting self harm in the
previous year had presented to hospital. Factors associated with
deliberate self harm were recent exposure to self harm by peers or
family members, drug misuse, depression, anxiety, impulsivity, and low
self esteem.
Depression and anxiety increase with greater frequency of
cannabis use in young people, especially women. Patton and colleagues (p 1195) followed a cohort of 1600 Australian adolescents for seven
years and show that, especially in girls, smoking cannabis weekly or
more often significantly increased later risks. This persisted after
adjustment for concurrent use of alcohol, tobacco, and other illicit
substances, as well as family disadvantage. In contrast, depression in
teenagers did not predict higher cannabis use. The study supports the
link between frequent cannabis use and mental health problems and
points to a need for strategies to reduce frequent recreational use in
young people.
Cannabis use in adolescence, as measured by self report
questionnaire, is associated with an increased risk of developing schizophrenia. In a historical cohort study of 50 087 Swedish conscripts, Zammit and colleagues (p 1199) report that cannabis use in
adolescence is a risk factor for schizophrenia, independent of the
effects of other drugs or social personality traits. Consideration of
these risks is important in light of debates about legalising cannabis
use. In a New Zealand cohort, Arseneault and colleagues (p 1212) found that adolescent cannabis use is a risk factor for schizophrenia, even after adjustment for pre-existing childhood psychoses. Their longitudinal study shows that early cannabis use (by
age 15) is of greater risk than later use (by age 18). Risk was
specific to cannabis, rather than other drugs. The study supports
efforts to discourage cannabis use among psychologically vulnerable
adolescents.
(Credit: SIPA PRESS/REX)
Doctors who feel overworked are likely to take a superficial approach
to learning, be motivated by external forces, and perceive many
barriers to continuing medical education. Delva and colleagues (p 1218) examined attitudes to learning among doctors in Ontario. They
report that doctors who felt they had choice and were well supported
were more likely to learn effectively and to be self motivated.
Younger, rural, and family physicians were most likely to report heavy
workloads and be vulnerable to ineffective learning. Regulatory bodies,
medical educators, and doctors themselves need to understand the
factors that affect lifelong
learning.
(Credit: SPL)
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