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July ezine 2005
It’s a crying shame!
Working as usual in A&E, I recently came across a lovely young man aged 22 of no fixed abode. He was a haemophiliac and once again was suffering from a haemarthrosis which had not resolved since his last attendance. On that occasion he had been admitted but soon after self-discharged without staying for the completion of his treatment that he so badly needed.
When I saw him he was desperately apologetic about what had happened. We started chatting. He was a self confessed heroin addict and he left because he needed a fix. This time he promised he would stay. He was supposed to keep his Factor VIII concentrate in a fridge but clearly living on the street this was not possible. Instead he lived from crisis to crisis requiring hospital intervention on each occasion. His father had disowned him. He was in touch with his mother but unable to stay with her on account of his drug habit.
We talked about his past. He had started heroin at age 19. I asked him whether he thought that was the worst thing that had ever happened and he readily agreed. He badly wanted to kick his habit and his name is down on a waiting list for a drug rehabilitation programme. I was so saddened. We talked about his future and how he still had ample opportunity to make a fresh start, find work and live a fulfilling life once he was off drugs. In the meantime though, he has to wait because somehow the great NHS cannot provide for him, rather they would have him carry on his dangerous lifestyle living on the street. Maybe he will be arrested for stealing to maintain his habit, maybe he will become septicaemic, develop endocarditis, contract Hepatitis or HIV. All for no other reason than a waiting list. It’s a crying shame.
Cathy Wield
SpR in A&E Queen Alexandra Hospital, Portsmouth
Research Digest
Moncrieff and Kirsch have written a thought-provoking article in the BMJ this month (1). They argue that recent data fail to show a clinically meaningful advantage of selective serotonin reuptake inhibitors (SSRIs) over placebo for depression, and go further suggesting the ‘small degree of superiority shown over placebo’ is due to methodological artefact. They state that ‘given doubt about their [SSRIs] benefits and concern about their risks, current recommendations for prescribing antidepressants should be reconsidered’. In the article they argue that the NICE guidelines on the management of depression ignore the data. Unfortunately articles such as this do little but cause concern and confusion. Moncrieff and Kirsch obviously have an agenda, and in pursuing this agenda make the same errors they accuse the authors of the NICE guidelines of making. They make erroneous statements about NICE guideline recommendations and are selective in only using evidence that adds to their case (see the rapid response by Stephen Pilling et al for further details). Though there is a real need to improve the evidence base for the management of depression, articles such as this, though provocative, may do more harm than good by undermining confidence in the guidelines themselves and ultimately doing a disservice to people suffering from depression. (See also the Commentary by S.Hatcher in the same issue).
Gross et al have examined the prevalence, comorbidity, disability and treatment of social anxiety disorder (SAD) in primary care (2). They found the lifetime prevalence of SAD 5.7%, and that substance use disorders were far more common among patients with SAD than with other psychiatric disorders. They were functionally impaired and made fewer visits to primary care per year than other patients with mental health problems. They estimated that less than 50% received treatment, and that there was a substantial unmet need for care for this population despite effective treatments being available.
McPerson et al have written a useful review of the effectiveness of psychological treatments for treatment-resistant depression (3). They found only 12 studies which could be included in their review, and only 4 for which treatment effect sizes could be calculated (ranging form 1.23 to 3.10). They concluded that though psychological treatments are frequently delivered to depressed patients after failure of an antidepressant medication , there remains little evidence for their use in these situations.
Corney and Simpson have examined the 36 month outcomes from a trial of counselling with chronically depressed patients in primary care (4). They found that there was no evidence to demonstrate a long-term effect of improved outcomes to those referred to counselling, though fewer patients referred to counselling were still ‘cases’ at 6 and 12 months.
Cindy Dennis reports the outcome of a systematic review of psychosocial and psychological interventions for the prevention of postnatal depression (PND) (5). She concluded that despite diverse psychosocial and psychological interventions for pregnant women none significantly reduced the number of women who developed PND though intensive, professionally based post-partum support was the most promising.
(1) Moncrieff J and Kirsch I. Efficacy of antidepressants in adults. BMJ. 2005. 331: 155-159
(2) Gross R et al. Social anxiety disorder in primary care. General Hospital Psychiatry. 2005. 27; 161-168
(3) McPherson S et al The effectiveness of psychological treatments for treatment-resistant depression: a systematic review. Acta. Psych. Scand. 2005. 111: 331-340
(4) Corney R and Simpson S. Thirty-six month outcome data from trial of counselling with chronically depressed patients in a general practice setting. Psychology and psychotherapy: theory, research and practice. 2005. 78: 127-138
(5) Dennis C-L Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. BMJ 2005. 331: 15
Paul Walters
Some important events:
First International Annual Primary Health Care Conference in the Emirate of Abu Dhabi : The Challenges in Primary Care
Abu Dhabi-UAE. Jan 21-23 , 2006
Department of Primary Health Care & Preventive Services
Division of Health Affairs
General Authority for Health Services for the Emirate of Abu Dhabi
Under the Patronage of H.H. Sheikh Hammed Bin Zayad Al Nahyan
In Collaboration with
Council of Health Ministers Cooperation for GCC States
International Primary Care Research Network
Middle-East Primary Care Research Network
SIG-WONCA
Australia medi+WORLD International
The vision of GAHS is “To Provide World Class Healthcare." In accordance with this vision the Department of Primary Health Care and Preventive Services is planning the First International Primary Health Care Conference in the Middle-East.
Major changes continue to occur in Primary Care, and Medical Practice. There are increasing external and internal pressures to improve the quality of patient care, education and to emphasize prevention. Hence the conference on “The Challenges in Primary Care” will embrace the following:
Key Features of the conference
· Models of Primary Care
· Family Medicine Development
· Primary Care research
· Prevention in practice
· Maternal and Child Health
· Elderly Care
· Cultural issues and health beliefs
· Evidence-based Practice
· Information Technology
· Quality in Patient Care
· Social and Public Health Medicine
· Ethics in Healthcare
· Primary Health Care Issues
· Dental and Oral Health
The Conference will take place in the Emirate of Abu Dhabi between Jan 21st to Jan 23rd , 2006.
The conference will consider issues in Primary Care Practice and Education, sharing and evaluating experiences of clinicians and other healthcare professionals from the Middle-East and around the world on matters affecting patient care and education.
Speakers well known in their field will be invited from the Middle-East, Europe, Australia, and the USA in addition to local speakers.
Call for Papers
All Health Care Professionals are invited to submit abstract(s) of papers concerned with research and new concepts in patient care and healthcare education, for the First First International Annual Primary Health Care Conference in the Emirate of Abu Dhabi. The accepted abstracts will be divided into oral presentation and poster sessions. Some submissions will be accepted as posters or demonstrations and you may indicate in your abstract, your preferred presentation method and any equipment required.
Guidelines
Quoted references in the paper cited in the summary should be listed at the end, and the Vancouver Reference styles should be followed. The following points would be used in rating submitted abstracts:
Papers describing work in progress are eligible for submission. Both quantitative and qualitative research papers are welcomed.
Please note that the conference organizers will determine allocation of presentation slots throughout the meeting. Authors are requested to register for meeting as delegates.
You can submit your abstract by e-mail attachment to the address below. We look forward to receiving your abstracts by 30 Nov 2005.
Sincerely,
A. Abyad, MD, MPH, AGSF
Co Chairman of the first international Primary Care Conference
Consultant Family Medicine
General Authority for Health Services for the Emirate of Abu Dhabi
Editor, Middle-East Journal of Family Medicine
Editor, Middle-East Journal of Age & Aging
Chairman, Middle-East Academy for Medicine of Aging
President , Middle-East Association of Age & Aging & Alzheimer’s
http://www.mejfm.com , http://www.me-jaa.com
Coresponding address:
GAHS
P.O.Box : 5674
Abu Dhabi -UAE
Tel : 971-24493333 ext
Mobile : UAE : 971-50-3846567
Lebanon : 961-3-201901
E-mail : ,
Conferences :
Sheffield Hallam Universi Telephone +44 (0)114 225 2373 Faculty of Health and Wellbeing Fax +44 (0)114 225 2394 Post-experience and E-mail Postgraduate Office [email protected] Collegiate Crescent Campus Web www.shu.ac.uk Sheffield S1 1WB
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