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Evaluating policy and service interventions
The effect of many cost effective policy and service interventions cannot be detected at the level of the patient. Richard Lilford and colleagues introduce a new framework that could help improve the design (especially choice of primary end point) and interpretation of evaluative studies.
10-fold rise in obesity surgery in England since 2000
The use of bariatric or weight loss surgery has increased 10-fold in NHS hospitals in England since 2000, according to this study. One reason for this rapid rise is increased demand from obese patients as they become more aware of surgery as a viable treatment option, say the researchers.
Migraine with aura and risk of cardiovascular and all cause mortality in men and women
Individuals who suffer from migraines with aura are at a higher risk of dying from heart disease or stroke, according to research by Larus Gudmundsson and colleagues. In a linked editorial, Klaus Berger and Stefan Evers question whether doctors should inform patients about the risks associated with migraine with aura. They argue that "for many people the information will cause an unwarranted amount of anxiety, although others may use the opportunity to modify their lifestyle and risk factors accordingly." The researchers stress, however, that the individual risk for a migraine sufferer remains low. A second paper, finds that female sufferers of migraines with aura are also at a higher risk of haemorrhagic stroke.
Nurse led interventions to improve control of blood pressure in people with hypertension
Nurse led interventions for hypertension require an algorithm to structure care, say the authors of this systematic review and meta-analysis. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems, they conclude.
Education and self management for people with newly diagnosed type 2 diabetes
This cost effectiveness analysis of a 12 month, multicentre, cluster randomised controlled trial previously reported on bmj.com (read more) shows that the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.
Making decisions for people with dementia who lack capacity
According to this qualitative study of family carers in the UK, the following strategies helped with implementation of decisions: introducing change slowly; organising legal changes for the carer as well as the patient; involving a professional to persuade the patient to accept services; and emphasising that services optimised, not impeded, independence.
Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis
In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year, according to this randomised controlled trial. An accompanying editorial asks how long should treatments be continued.
