This week in the BMJ
Volume 326, Number 7390, Issue of 22 Mar 2003Low dose inhaled glucocorticoid is superior to anti-leukotrienes
Low dose inhaled glucocorticoid is superior to anti-leukotrienes
Using leukotriene receptor antagonists instead of inhaled
glucocorticoids to treat patients with mild to moderate asthma
increases the risk of an exacerbation. In a systematic review of 13 trials comparing the treatments, Ducharme (p 621) determined that the risk of exacerbations of asthma requiring systemic glucocorticoids was
60% higher with anti-leukotrienes than inhaled glucocorticoids. Until
further evidence is available on the safety and efficacy of
anti-leukotrienes as single agent therapy, inhaled glucocorticoids should remain the standard treatment for asthma.
![[To top]](/icons/back.gif){kind=icon}
NHS doctors and managers hold different views on their relationship
Only 37% of clinical directors are positive about the
doctor-manager relationship, compared with 76% of chief executives. Davies and colleagues (p 626) surveyed groups of chief executives, clinical and medical directors, and directorate managers to explore their perceptions of different aspects of the doctor-manager
relationship. They found that staff at board level are more optimistic
than staff at directorate level. Medical managers are less optimistic than other managers. Clinical directors were the least satisfied with
the balance of power and influence between doctors and managers and
with the quality of managerial staff.
(Credit: KRISTAN GEYR/PHOTONICA)
Doctor-manager relationships can be improved
To bridge the gap between doctors and managers and start a debate
on the topic, this week the BMJ publishes a series of
potential solutions for problematic doctor-manager relationships. Nash
(p 652) proposes a seven point plan, which includes interdisciplinary education for both doctors and managers and development of a management research agenda to coordinate care better. He also encourages medical
schools to seek multisector philanthropic support. Malcolm and
colleagues (p 653) share the New Zealand experience of health system
reform, which has attempted to foster a new model of clinical leadership and autonomy. Using the case study of Kaiser Permanente, Crosson (p 654) illustrates a successful partnership between medicine and management through joint leadership and the alignment of mission and strategy. Atun (p 655) emphasises the need for management training
within medical schools and outlines 10 roles of the manager that can
help doctors and managers speak the same language. Multidisciplinary decision making is at the basis of Thomas's proposal to strengthen clinical networks, which she argues would result in better patient outcomes and improved doctor-manager relationships (p 655).
(Credit: EPA/PA)
Obesity is on the increase in British youth, especially in girls
Obesity and overweight are increasing among young people in
Britain. McCarthy and colleagues (p 624) compared data from two large
cross sectional surveys of British youth (aged 11 to 16) spanning a
total of 20 years. They found that waist circumference, a measure of
central fatness, has increased sharply, particularly in girls, and that
it has increased at a greater rate than body mass index. Accumulation
of excess central fat may increase future morbidity in British youth.
Levels of physical activity may have decreased faster in girls than in
boys, and central fatness may be related more to activity than energy
intake.
(Credit: DARREL J GEORGIO/PHOTONICA)
Pain needs a multidisciplinary, mechanism based approach
Recent developments support the idea of an individualised, holistic,
and mechanism based approach to pain management. Holdcroft and Power
(p 635) searched medical websites, systematic reviews, and leading
scientific papers on the topic of pain management. Successful pain
control should be multidisciplinary since it involves all the mechanisms that initiate and maintain pain. The authors report
on a new classification that divides the type of neuropathic pain into
spontaneous pain and stimulus evoked pain, requiring different research
paths. In terms of drug development, the need to mitigate the side
effects of opioids has encouraged various approaches, including
alternative opioids and combination
therapies.
(Credit: CHARLES ESHELMAN/PHOTONICA)
Student BMJ
Intimate examinations
Israeli students are refusing to perform intimate examinations on anaesthetised women without their informed consent.
