Continuing professional development (CPD) for healthcare professionals is an important strategic instrument for improving health. The Department of Health identifies CPD as a way of maintaining standards of care; improving the health of the nation; and recruiting, motivating, and retaining high quality staff. To this end, direct NHS spending on continuing professional development in 1999-2000 was about £1bn. If we regard CPD as any method to improve health professionals’ skills the total resources devoted to it are probably much greater, particularly with the recent increased participation in response to the need for re-certification and revalidation. To ensure the maximum gain from participation in CPD, these resources must be used efficiently.

To assess the efficiency of participating in CPD, economic criteria are needed. Resources for health care are scarce, and money spent on CPD could otherwise be used for direct patient care. These opportunity costs are explicitly considered in the economic methods of cost benefit analysis and costs effectiveness analysis. Casebeer et al highlighted the need for economic evaluation of CPD activities, but they emphasised the use of cost benefit analysis, which requires monetary values to be assigned to measures of effectiveness. Cost benefit analysis is generally used to ascertain whether an intervention should be undertaken. Cost effectiveness analysis is used to decide which interventions (out of a number of alternatives) should be undertaken.

However, cost effectiveness analysis in education research is rare. The quality of such research is also often poor: Clune found that only 1% of 541 “cost-effectiveness” studies of elementary and secondary education between 1991 and 1996 could be considered reliable, with strong design and analysis. In contrast, economic evaluation of healthcare technologies is increasing, and the methods for making such analysis are rapidly evolving.

There is a sizeable literature on the effectiveness of CPD interventions (over 100 randomised controlled trials are thoroughly reviewed by Davis et al), but the evidence on the cost effectiveness of CPD has not been systematically investigated. In this article we therefore investigate the quantity and quality of the evidence on the cost effectiveness of CPD for healthcare professionals.

The literature that assesses the cost effectiveness of CPD interventions in health care. A literature search showed that economic evaluations of CPD are rare. It is impossible to draw any feasible conclusions regarding the cost effectiveness of different modes of CPD for healthcare professionals.

Interpreting the results is difficult since uniform methods of costing or analysis are not applied. The “ingredients” included in costs analysis are not identified in a standard form: development costs and the opportunity costs of the participants needed to be included. In addition, the resource implications of an educational intervention (such as for additional screenings) would need to be included in a cost benefit analysis but not in a cost effectiveness analysis. Often, the evidence seemed to be directed at both forms of analysis, despite these analyses being methodologically and purposively distinct.

Overall the literature on the effectiveness of CPD continues to expand, but effectiveness is not a sufficient criterion for implementation. For scarce resources to be devoted to CPD, the relative cost effectiveness of different educational interventions must be established, and those offering the most value for money must be implemented. An investment in high quality evaluations would therefore reap health benefits for the public and ease policy makers’ decisions about resource allocation.

The hot flush (or flash) is the most characteristic manifestation of the climacteric. The climacteric can be defined as all the physiological and pathological events that directly follow the onset of reduced ovarian function, both before and after the last menstrual period (the menopause).

The aetiology of the hot flush is complex and is still uncertain but is probably caused by lability in the thermoregulatory centre of the hypothalamus induced by falling oestrogen and progesterone levels. Instability of the thermoregulatory centre leads to sudden, transient and erratic peripheral vasodilation in the skin blood vessels with a concomitant sensation of flushing and a measurable increase in skin temperature. Hot flushes can occur with differing severity and at different frequency during the day or night. At night, these changes may be recognised and referred to as night sweats. Together, hot flushes and night sweats are described as vasomotor symptoms

A Cochrane Collaboration examined double-blind, randomised, placebo-controlled trials of oral HRT therapy for at least three months duration were chosen.

Study participants totalled 2,511. Trial duration ranged from three months to three years. There was a significant reduction in the weekly hot flush frequency for HRT compared to placebo. This was equivalent to a 77% reduction in frequency for HRT relative to placebo.

Symptom severity was also significantly reduced compared to placebo. Withdrawal for lack of efficacy occurred significantly more often on placebo therapy. Withdrawal for adverse events, commonly breast tenderness, oedema, joint pain and psychological symptoms, was not significantly increased for HRT therapy. In women who were randomised to placebo treatment, a 51% reduction in hot flushes was observed between baseline and end of study.

Oral HRT is highly effective in alleviating hot flushes and night sweats. Therapies purported to reduce such symptoms must be assessed in blinded trials against a placebo or a validated therapy. Withdrawals due to side-effects were only marginally increased in the HRT groups despite the inability to tailor HRT in these fixed dose trials. Comparisons of hormonal doses, product types or regimens require analysis of trials with these specific "within study" comparisons.

Ref: web