JRSM short reports最新文献

Objectives: To investigate the importance of incorporating secondary care input to aid commissioning following National Health Service reforms which will see the replacement of Primary Care Trusts with Clinical Commissioning Groups; to determine barriers that might arise given that this issue had been raised during public consultations and to explore ways to improve this input.

Design: Qualitative project with semistructured one-to-one interviews which were audio recorded, transcribed and analysed using thematic content analysis by two investigators. The findings were discussed and organized into a framework.

Setting: Bradford and Airedale, UK.

Participants: We interviewed 19 participants from primary care, the medical directorship and a range of specialties.

Main outcome measures: One-to-one semistructured interviews allowed a flexible dialogue to discuss planned questions and any other themes which participants brought up. This elicited a variety of experiences and ideas which provided the basis for in depth theoretical analysis required for our objectives.

Results: There was an almost universal agreement that the integration of secondary care advice is important in commissioning. The main perceived barriers were obstacles to good communication and relationships, conflicts of interest and financial pressures. Participants suggested varied and innovative ways to improve communication and integration, and suggestions for organisations.

Conclusions: Our results support the importance of secondary care input and highlight communication, organisation and integration as three goals for organisations to work towards. Successful achievement of these objectives could have financial implications for organisations as well as benefits for patient care.

Multiple clinical trials have shown that aspirin can reduce all cardiovascular events in primary and secondary prevention and yet there is a large population in whom aspirin fails. This review brings together the evidence and controversies surrounding the definition of 'aspirin treatment failure', its clinical significance and the possible approaches to managing such patients. Several different assays have been developed to measure the biochemical action of aspirin. At present there is no 'gold standard' and there is massive disparity between methods. Studies thus far have shown inconsistent results and to date the treatment of aspirin therapy failure is left to the discretion of the leading physician.

Objectives: That health is now global is increasingly accepted. However, a 'mismatch between present professional competencies and the requirements of an increasingly interdependent world' has been identified. Postgraduate training should take account of the increasingly global nature of health; this paper examines the extent to which they currently do.

Design: Trainees across 11 medical specialties reviewed the content of their postgraduate curriculum.

Setting: Not relevant. PARTCIPANTS: None.

Main outcome measures: Competencies were coded as 'UK' (statement only relevant to UK work), 'global' (statement with an explicit reference to aspects of health outside the UK) or generic (relevant both to the UK and international settings).

Results: Six of the 11 curricula reviewed contained global health competencies. These covered the global burden or determinants of disease and appropriate policy responses. Only one College required trainees to 'be aware of the World Health Organization', or 'know the local, national and international structures for health care'. These cross-cutting competencies have applicability to all specialties. All 11 curricula contained generic competencies where a global health perspective and/or experience could be advantageous, e.g. caring for migrant or culturally different patients.

Conclusion: Trainees in all specialties should achieve a minimum requirement of global health awareness. This can be achieved through a small number of common competencies that are consistent across core curricula. These should lead on from equivalent undergraduate competencies. Addressing the current gap in the global health content of postgraduate medical curricula will ensure that the UK has health professionals that are trained to meet the health challenges of the future.

Objectives: The phrase 'Initial Clinical Experience' in a manuscript's title implies that the described technique offers promise of future clinical relevance. We assessed, using rates of subsequent citations, the actual academic relevance of such articles in comparison to articles not containing the phrase.

Design: We searched ISI database for articles that included the studied phrase in their titles between 1975 and 2009 and grouped the results by the related medical specialty. We excluded articles from journals with no available impact factor. For each identified article, we extracted number of included patients, citations/year, the average impact factor of the publishing journal over the last five years and the proportion of articles published in the same journal that garnered zero subsequent citations.

Setting: Retrospective review of a scientific database.

Participants: None.

Main outcome measures: Citation rate.

Results: Among a total of 982,127 articles published in 186 journals representing eight major publishing medical specialties, 531 (0.05%) were Initial Clinical Experience articles. Thirty percent of Initial Clinical Experience articles were never cited compared with 7% of the overall article volume (p < 0.0001). Citations/year for Initial Clinical Experience articles were significantly lower than the median impact factor (p < 0.0001). There was no correlation between citations and number of patients described in the Initial Clinical Experience articles (p = 0.61).

Conclusions: Initial Clinical Experience articles are cited less frequently than the average, especially in Cardiovascular, Radiology and Ophthalmology journals.