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Place of qualification and outcomes of GMC "fitness to practise" process
General Medical Council decisions about doctors who qualified outside the UK are more likely to have far reaching consequences (high impact decisions), according to this cohort study. The authors say there is no clear reason why overseas doctors do worse in fitness to practise processes than their UK trained peers. Given the growing dependency on foreign trained doctors in countries like the UK and US, it is essential to determine "whether international medical graduates offer the same quality of care as doctors who train and practise in destination countries," says an accompanying editorial.
Understanding provision of chemotherapy to patients with end stage cancer
The trend to greater use of chemotherapy at the end of life could be explained by patients' and physicians' mutually reinforcing attitudes of "not giving up," and by physicians' broad interpretation of patients' quality of life, in which taking away patients' hope by withholding treatment is considered harmful. Input from other health professionals, notably nurses, to rebalance the ratio of quantity of life to quality of life, may be necessary.
Reporting of eligibility criteria of randomised trials
According to this cohort study comparing trial protocols with subsequent articles, many users of trial information rely on published journal articles, which generally do not reflect the exact definition of the study population as prespecified in the protocol. Incomplete or inadequate reporting of eligibility criteria hampers a proper assessment of the applicability of trial results.
Group therapy for adolescents who repeatedly self harm
Adding a targeted group therapy programme did not improve outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The authors of this randomised controlled trial with economic evaluation conclude that follow-up would add useful information about the natural history of repeated self harming behaviour in adolescence, and comparative studies in areas with different patterns of service use would illuminate the potential effect of routine care.
Randomised prostate cancer screening trial: 20 year follow-up
Screening does not significantly reduce prostate cancer deaths, and the risk of overdetection and overtreatment is considerable, concludes this 20 year study by Gabriel Sandblom and colleagues.
More research published on 30 March:
Prophylaxis with co-trimoxazole against malaria in HIV exposed children in rural Uganda
In this randomised clinical trial, co-trimoxazole prophylaxis was moderately protective against malaria in uninfected children born to HIV infected mothers when continued until 2 years of age. Notably, this was in an area of high rates of malaria transmission and high prevalence of resistance to antifolate antimalarial drugs. However, the authors caution that it is too early to decide whether to recommend co-trimoxazole sfor HIV exposed children testing HIV negative after cessation of breast feeding.
Transitions to palliative care in acute hospitals in England
In this qualitative study, 58 health professionals involved in the provision of palliative care in primary or secondary care in England identified important barriers to implementing a policy of structured transitions to palliative care in acute hospitals. These barriers need to be tackled if current UK policy on management of palliative care in acute hospitals is to be established, say authors Merryn Gott and colleagues.
Type of anaesthesia during cancer surgery and cancer recurrence
This randomised trial including 503 adult patients who had potentially curative surgery for cancer did not identify any reduction in recurrence of cancer or survival when epidural block was used for surgery for their cancer. The accompanying editorial says that regional anaesthesia has short term benefits over general anaesthesia, but the cancer related effects are unknown.
The influence of study characteristics on reporting of subgroup analyses in randomised controlled trials
Subgroup analyses are more likely to be reported in trials funded by industry than in non-industry funded trials, but only if the primary outcome is not statistically significant, say Xin Sun and colleagues in this systematic review.
