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| This Month |
Impact of second reminder invitation on uptake of screening and cancer detection in BreastCheck: Fleming et al report on and demonstrate the invaluable contribution made by reminder invitations in breast cancer screening. During the period 2000-2010 a total of 819,182 women were offered a breast screen. The initial response was 448,974 (54.8%). Reminder letters were sent to 370,208 women and 245,157 (66.2%) responded to the second letter. Among the reminder group there were 1,550 cancers. The breast cancer rates among the initial responder and reminder groups was similar at approximately 6 per 1000.
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Childhood obesity: Parents fail to recognise. General Practitioners fail to act: White et al report on a study of childhood obesity in general practice. Among child-parent pairs, 15% of the children and 51% of the parents were obese. Only 18% of the parents had recognised that their child was obese. The background picture was one of children travelling to school by vehicle and watching 2 hours TV daily. There was frequent recourse to pre-prepared foods. Parents need to be more aware of the possibility of obesity as the majority of children who are overweight will be overweight as adults.
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Review of acute cancer beds: Evans et al have audited the bed use for cancer patients. The authors point out that there are 20,000 new cancer cases annually and resources need to be used optimally. The average length of hospital stay was 29.3 days. This was high compared with other Irish centres at 19 days. In the US stays are 6 days. The study found that one of the deficits in the current arrangement is the lack of discharge planning.
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Diagnosing the doctors’ departure: Survey on sources of dissatisfaction among Irish junior doctors: The paper by Bruce-Brand et al is worrying. It conveys a message of unhappiness among Irish NCHDs. Half of the doctors are dissatisfied and a further third are extremely dissatisfied with practicing medicine in Ireland. Their main concerns were the lack of training and the doubtful long-term prospects. Forty per cent felt that the training was poor. Almost half considered that their chances of getting a consultant post were unlikely. There needs to be renewed efforts to place NCHD training on a better footing. Currently they carry an excess burden of service duties and insufficient time and access to training.
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The incidence of injury presentations to emergency departments: What we don’t know can hurt us: Meaney et al report on the rates injury presentations to emergency medicine departments. The total, male and female age-adjusted rate of injury presentations was 11,322, 13,933 and 8550 per 100,000. Forty five per cent of all presentations to emergency departments are due to injuries.
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A critical evaluation of HIPE data: O’Callaghan et al report on the discrepancy between HIPE data and that collected by the authors on their vascular data base. The HIPE system under reports for some procedures while over reporting for others. The solution is for coders to receive more training and instruction in specific areas such as vascular surgery. Also senior clinicians need to be more involved in the process. HIPE is important because it influences the planning and funding of services.
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Fracture liaison service in a non-regional orthopaedic clinic- a cost effective service: Ahmed et al address the issue of secondary fracture prevention. They demonstrate the role of fracture liaison services (FLS). Using a combination of bone biochemistry and DXA scanning they found that two thirds of patients had reduced bone mineral density. The mean age of the patients was 69 years. The treatments included diet, calcium, vitamin D and biphosphonates.
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Obstetric outcome with low molecular weight heparin therapy during pregnancy: Donnelly et al describe the use of LMWH in the treatment and prevention of thromboembolism in an obstetric population. A total of 105 women were included in the study. Two thirds were in the prophylactic group and one third were in the treatment group. The findings are encouraging. There was no difference in the caesarean section rates compared with the hospital population. The prematurity rate was higher 11.3%. It is postulated that LMWH may stimulate myometrial contractility and cervical remodelling.
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