BMJ 18 Nov 2006

This year, British GPs have suddenly been required to keep registers of chronic kidney disease, based on lab returns of estimated GFR from samples we have sent opportunistically. We have devoted at least three full practice meetings to the subject, while various partners have nobly gone off to hear renal physicians present their (vigorously dissenting) views. Here is a Norwegian study showing that this exercise is unlikely to alter clinical management or the incidence of end-stage renal failure. So the score is: Government interference, 23 (QOF) points; clinical logic, 0.

Here’s a good old fashioned clinical review of chronic constipation in children. There is the Bristol poo chart for those interested. Management continues to consist of disimpaction, best achieved with high oral doses of mineral oil or polyethylene glycol (PEG), and maintenance therapy which can also involve PEG in preference to lactulose.

This descriptive paper is a welcome restatement of the fact that success in methadone maintenance—i.e. abstinence from illicit drug use – is generally achieved with doses over 60mg and there is no upper limit. But current attitudes and procedures mean that “highly tolerant patients most in need of treatment are least likely to receive it