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Research

Befriending the carers of people with dementia

Access to voluntary befriending made no difference to carers' mood or health related quality of life after 15 months, according to a randomised controlled trial of 236 family carers of people with primary progressive dementia in the UK. Consultant psychiatrist Rob Butler says in an accompanying editorial that existing supports and the quality of services may influence the effects of befriending. The case for offering everyone with dementia and their carer a single health or social care professional contact point is compelling, he adds.

Research

Fetal scalp sampling in labour

Is scalp pH analysis more effective at diagnosing hypoxia in the fetus during labour than scalp lactate analysis? According to this randomised controlled multicentre trial of the two methods, acidaemia at birth, operative interventions, low Apgar scores at five minutes, or admissions to neonatal intensive care units did not differ significantly. James P Neilson, professor of obstetrics and gynaecology, asks in an accompanying editorial if less invasive alternatives exist?

Blogs and podcasts

Rationing, Eurovision and learning from others

Joe Collier (pictured) fears there is something sinister about the UK government's failure to clarify the rationing role of the National Institute for Health and Clinical Excellence. Fiona Godlee discovers how tragedies such as 9/11 can help medicine to understand its imperfections. Listen to the accompanying podcasts. And the Eurovision Song Contest gets Domhnall MacAuley wondering if the UK's health care system is envied around the world. Finally Trish Groves blogs from the Council of Science Editors meeting about new online resources to enhance the quality and transparency of research. Have your say on BMJ blogs.

Fast Track Research

Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation

Early surgery relieved sciatica more effectively, but only in the first six months, and at two years 20% of all patients reported an unsatisfactory outcome, according to the two year results of a randomised controlled trial. A cost utility analysis of this RCT finds that early surgery provides better quality adjusted life years, and the greater healthcare costs are compensated for by earlier return to work. An accompanying editorial says this trial adds to the body of evidence supporting surgery eight weeks after onset of sciatica if symptoms persist. This research underwent fast track publication.

Research

Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women

Women with prothrombotic mutations or a high body mass index should avoid oral oestrogens, but transdermal preparations seem to be safer, says this systematic review and meta-analysis. The accompanying editorial says that observational evidence suggests that transdermal oestrogen may be safer than oral oestrogen, but the side effect profile of transdermal oestrogens is insufficiently well known owing to a lack of trials and incomplete and non-standardised reporting. HRT patches also cost more.

Careers

Is the Working Time Directive going to work?

August 2009 may seem a long way off, but the impact of the 48 hour restriction on junior doctors' working week, to be imposed on all European Union countries by that date, is already hitting home.

Research

Doctors' versus patients' global assessments of treatment effectiveness

In 240 trials included in Cochrane systematic reviews, doctors' and patients' global assessments of treatment effects - increasingly used as study end points - mostly agreed. The accompanying editorial is in favour of allowing patients to document serial changes in their health status, which would avoid relying on global assessments from doctors' or patients' perspectives.

Comment

Food additives and hyperactivity

An increasing number of children are taking drugs for hyperactivity. Removing colours and preservatives is a relatively harmless activity, so a properly supervised and evaluated trial period of eliminating them should be part of standard treatment, says an editorial by Andrew Kemp, professor of paediatric allergy and clinical immunology at the University of Sydney.

Comment

Will polyclinics deliver real benefits for patients?

Yes, says Michael Dixon, chair of the NHS Alliance, in this Head to Head article. They will deliver more patient centred care. No, says Stewart Kay, chair of the governance board of Londonwide LMCs and a member of the BMA's General Practitioners Committee. He argues that they are an unnecessary change.

News

One in three want to see radical change in US health care

The proportion of US citizens who want "radical change" in their healthcare system reached 36%, a Republican pollster told a briefing in Washington, DC, last week.

News

Law bans sale of products with false health claims

UK consumers are to receive stronger legal safeguards against products that claim, without any identifiable scientific evidence, to provide health benefits.

News

Walk-in clinics at US retail outlets run into problems because of slow return on investment

A boom in walk-in health clinics in US shops, supermarkets, and pharmacies is slowing.

Students

Tricky exam questions

Medical students are experts in examinations. But what should they do if they're tipped off about the answer to a question in a forthcoming exam? Report the source of the leak? Keep quiet? Share it with their fellow students? Have your say on the Student BMJ poll.