What do we really know about the cost-effectiveness of telemedicine?

Telemedicine is still in its infancy, but undergoing rapid development. It is very difficult to evaluate telemedicine. We performed a literature survey (Medline). During the period 1990-8, over 1500 articles on telemedicine were published. Of these, 246 mentioned economic aspects in the abstract (16%). We selected 29 studies although few had demonstrated cost-effectiveness. Benefits for the patients in the form of reduced travel and waiting time must often be weighed against increased provider costs. Up to now, telemedicine in general has not had any significant effect on medical practice, or the structure and organization of health-care. In order to utilize the potential of telemedicine, its integration with traditional health-care is very important. There are country-specific variations in the health systems that make it difficult to generalize the results from one country to another.     

What do specialist registrars know about clinical governance?

Clinical governance is an essential part of quality assurance for everyday clinical practice. It is part of the generic curriculum for all specialist registrars (SpRs) training in medical specialities. The authors of this update undertook a survey of SpRs training in geriatric medicine to determine their perceived knowledge of clinical governance and whether they had received training in this area.     

Human papillomavirus infections and risks of cervical cancer: what do women know?

Human papillomavirus (HPV) is now known to be a risk factor for the development of cervical cancer. This study examines women's knowledge of cervical screening and dysplasia and HPV. The entire female work force of a medium-sized UK university received a questionnaire concerning knowledge of cervical screening, treatment for abnormalities and HPV. Four hundred women returned completed questionnaires. Knowledge of early cervical cancer detection and screening methods was good. However, risk factors for cervical cancer were not well known. Awareness and knowledge of HPV was very limited. Past experience of an abnormal smear result and colposcopy was significantly associated with good knowledge of cervical screening, but not with knowledge of HPV. It is essential to improve women's understanding of this area in the context of plans to include screening for HPV in the UK's national cervical screening programme.     

What do we really know about the ubiquitin-proteasome pathway in muscle atrophy?

Studies of many different rodent models of muscle wasting have indicated that accelerated proteolysis via the ubiquitin-proteasome pathway is the principal cause of muscle atrophy induced by fasting, cancer cachexia, metabolic acidosis, denervation, disuse, diabetes, sepsis, burns, hyperthyroidism and excess glucocorticoids. However, our understanding about how muscle proteins are degraded, and how the ubiquitin-proteasome pathway is activated in muscle under these conditions, is still very limited. The identities of the important ubiquitin-protein ligases in skeletal muscle, and the ways in which they recognize substrates are still largely unknown. Recent in-vitro studies have suggested that one set of ubquitination enzymes, E2(14K) and E3(alpha), which are responsible for the 'N-end rule' system of ubiquitination, plays an important role in muscle, especially in catabolic states. However, their functional significance in degrading different muscle proteins is still unclear. This review focuses on the many gaps in our understanding of the functioning of the ubiquitin-proteasome pathway in muscle atrophy, and highlights the strengths and limitations of the different experimental approaches used in such studies.     

What do medical students know about cause and epidemiology of the Creutzfeldt-Jakob disease in Germany?

Due to the increase of patients with the variant Creutzfeldt-Jakob disease (vCJD) in Great Britain and the first cases of autochthonous BSE cases in Germany, the study tried to investigate the knowledge of medical students about the epidemiology of CJD in Germany and how they assess the influence of different factors on the etiology of CJD. Altogether 63 first year medical students, 96 third year medical students and 50 nurses were included in an anonymous questionnaire survey. They were asked to estimate the annually incidence of CJD in Germany and to assess, by using analogue-scales, the influence of different factors on the risk of contracting CJD. For the medical students the median was 100 and for the nurses the median was 10 annual CJD cases. All participants, and especially the males, emphasised the influence of "risk behaviour" and "environmental factors" on the risk of contracting CJD, the factor "stress/ emotional strain" was seen as most unimportant. No significant differences between female and male participants in the knowledge about the incidence of CJD in Germany were found. It becomes obvious, that epidemiological knowledge about CJD in medical staff is associated with different and gender-specific views on the etiology. Medical education should consider this to avoid endangering medical staff and patients due to overprotection or insufficient precautions.     

What do we know about promoting mental health through schools?

There is a growing evidence base on what schools need to do to promote mental health effectively. There is strong evidence that they need first and foremost to use a whole school approach. This shapes the social contexts which promote mental health and which provide a backdrop of measures to prevent mental health disorders. In this context the targeting of those with particular needs and the work of the specialist services can be much more effective. Schools need to use positive models of mental health, which emphasise well being and competence not just illness--this will help overcome problems of stigma and denial and promote the idea of mental health as 'everyone's business'. The most effective programmes in schools which address mental health have the following characteristics: They provide a backdrop of universal provision to promote the mental health of all and then target those with special needs effectively. They are multi-dimensional and coherent. They create supportive climates that promote warmth, empathy, positive expectations and clear boundaries. They tackle mental health problems early when they first manifest themselves and then take a long term, developmental approach which does not expect immediate answers. They identify and target vulnerable and at risk groups and help people to acquire the skills and competences that underlie mental health. They involve end users and their families in ways that encourage a feeling of ownership and participation, and provide effective training for those who run the programmes, including helping them to promote their own mental health. Using these starting points, we need to develop a rigorous evidence-based approach on this issue. We also require the facilitation of the dissemination of such research findings while encouraging new and innovative approaches.     

What do we know about... Oral health for families?

The author outlines improvements in Britain's dental health and summarises practical advice to pass on to families with young children and adults of all ages. The importance of fluoride and moderating the frequency of snacks is emphasised. Current thinking on diet and dental decay is discussed, including new developments in our understanding of the part played by carbohydrates, which is less simplistic than previously thought.     

What do we know about... nutrition and older people?

Nutrition is important to the health and functioning of elderly people. This paper summarises the evidence that many old people suffer from undernutrition and outlines the insidious effects of this form of malnutrition. It discusses the physiological and practical difficulties elderly people face in achieving good nutrition, and the challenge this poses to health workers. Given the UK's ageing population, undernutrition in older people is a significant public health issue as well as one that should concern all health professionals involved in individual or group contacts with elderly clients.