eBMJ -- Press Releases

BMJ Press Releases, Saturday 16 November 1996
Volume 313 No 7067

EMBARGO: Friday 15 November 00.01

Doctors and nurses
[An Ethical Dilemma: A nurse is suspended]

A nursing sister with a blameless record was suspended and given a final formal warning for obeying the request of a consultant to give a patient a tranquilliser disguised in a cup of tea. A disciplinary inquiry exonerated the consultant but the action on the nurse has not been rescinded. The case is highlighted in the Education and Debate section of this week's BMJ.

Dr John Kellett of St George's Hospital Medical School, London, describes the case of patient WP - a 91 year old widower thought to have temporal lobe epilepsy- who became hypomanic and unsafe to return from day hospital to his old people's home. He refused treatment. Rather than attempting to inject a tranquilliser by force or send him to the home without treatment (putting at risk not only other residents but the elderly man's place in the home), the consultant decided to give him a tranquillising medicine disguised in a cup of tea.

As the only member of staff the patient trusted, the nursing sister gave WP the tea to which the consultant had added the tranquilliser haloperidol. It had the necessary calming influence and, when told about the medication the following day, WP agreed it had been the right course of action. A nephew also supported the action.

Four days later the sister was suspended on the orders of the chief nurse pending a hearing. She was issued with a final formal warning and instructed to have further training. "Already so depressed that she could hardly talk, she remained on sick leave for a further five weeks" states the BMJ article. Two years later the nurse still has the judgement on her record. In contrast, the consultant (who had been formally disciplined to await the results of a regional inquiry) was found not guilty of professional misconduct.

Dr Kellett says :"Regardless of the ethics of this case it seems surprising that a senior nursing officer can single out for discipline a conscientious and excellent nurse who was doing what she thought was her duty, while the consultant responsible was allowed to practise unhindered." Two geriatricians and two forensic psychiatrists comment on the case in the BMJ.

Contact:
Dr John Kellett
consultant geriatrician
Tel: 0181 725 5296 (Wed am)
or 0181 672 9911 (Thurs)
Fax: 0181 682 6868

Cancer and canaries [Editorial: Pet birds and lung cancer] [Avian exposure and risk of lung cancer in women in Missouri: population based case-control study] [Pet birds and risk of lung cancer in Sweden: a case-control study]

Keeping canaries, budgerigars or parrots as pets does not seem to be linked to lung cancer after all, according to articles in this week's BMJ.

Despite three previous European studies (Holland, Germany and Scotland) which found an association between keeping pet birds and an increased risk of lung cancer, new research from Missouri, US and Sweden, shows no evidence of a link. In fact, the Missouri study found that women who raised poultry had a significantly reduced risk of lung cancer. More research is needed and a question mark remains over any link between increased lung cancer risk and keeping pigeons - a bird not looked at in the two latest studies but considered in earlier papers.

Contact:
Dr John Britton
Respiratory Medicine,
University of Nottingham

Tel: 0115 962 8085
Fax: 0115 962 8087

Trials on trial
[Pharmaceutical trials in general practice: the first 100 protocols. An audit by the clinical research ethics committee of the Royal College of General Practitioners]

Research sponsored by pharmaceutical companies and performed in general practice does not appear to generate a high level of scientifically valid, clinically relevant findings, says a report in this week's BMJ.

Concerns about patient safety and levels of payments to doctors were the commonest reasons why 45 per cent of proposed drug trials submitted for approval to the clinical research ethics committee of the Royal College of General Practitioners required modification.

An audit by the committee of the first 100 multi-centre trials considered showed only 27 per cent of the approved trials were ever published. Of the 82 approved studies, 8 were not started. Shortfalls of GP investigators (of 30 per cent) and patients as subjects (of 37 per cent) plus an overall 23 per cent patient withdrawal rate, were responsible for a significant number of inconclusive results.

The authors emphasise the importance of giving prospective trial subjects adequate information. Notwithstanding difficulties in recruiting patients for trials, it was recognised that undue incentives to GP investigators could be a potential hazard, not only by fostering research through the wrong mechanisms, but "more dangerously, by encouraging enrolment of patients with borderline entry criteria." These findings are considered to be relevant indicators of areas of importance for a new set of audit committees shortly to be established in the UK.

Contact:
Dr Peter Wise

Mobile Tel: 0468 455 567
Fax: 0181 246 6802

More children surviving severe accidental injury
[Reducing accident death rates in children and young adults: the contribution of hospital care]

Over the seven year period 1989-95 the odds of dying after being admitted to hospital with severe injury declined by 16 per cent a year in children and young adults, says a report in this week's's BMJ.

Dr Ian Roberts, Director of the Child Health Monitoring Unit at University of London, writes that reductions in hospital case fatality have made an important contribution to reaching the Health of the National targets. A study based on 3,230 patients ranging from babies to 24-year-olds showed that after controlling for injury severity, there was an annual decline in the risk of death in hospital of 21 per cent for children under the age of five years, 13 per cent for children aged 5 to 14 years, and 17 percent for people aged 15 to 24 years.

Contact:
Dr Ian Roberts
Institute of Child Health

Tel: 0171 242 9789 x 2176
Fax: 0171 242 2723
e-mail: Ian.Roberts@ICH.UCL.ac.uk.

Are British hospitals ready for the next major incident?

In 1990, guidelines were issued for health service arrangements for major incidents. A paper in this week's BMJ says that only six of the 142 hospital action plans studied complied fully with these guidelines.

Contact:
Dr Simon Carley

Tel :0161 276 1234
Fax: 0161 276 8538

A shot in the arm for safer blood transfusion

How safe is a blood transfusion? Despite recent adverse publicity, it is possibly safer now than it has ever been, states an editorial in this week's BMJ.

In America, the commonest cause of transfusion related death is the transfer of ABO incompatible blood. There is no room for complacency here, however: a British survey revealed that wrong blood given to a patient because of poor patient identification, may affect as many as 1 in 30,000 transfusions. These incidents, and other near miss events, reveal serious deficiencies in the transfusion process, says the BMJ editorial.

Risk of infection - such as HIV or Hepatitis C - transmitted by transfusion is lower here than in the US, says the editorial . In England, current risks of HIV entering the blood supply are less than one in two million (cf 1 in 500,000 in the US) and risks of hepatitis C infectious donations entering the blood supply are less than 1 in 200,000 (cf 1 in 100,000 in the US).

Unlike the US, until now Britain has had no system of comprehensive monitoring of transfusion hazards. This gap is being filled with the launch of the SHOT initiative (serious hazards of transfusion) . SHOT is a voluntary confidential reporting system for transfusion related deaths and complications. The objective is to identify residual causes of transfusion hazard to ensure that future policy making is based on informed decisions.

Contact:
Dr Lorna Williamson

mobile: 0421 879 644
Fax: 01223 411618
e-mail: lorna.williamson@msmail.nbs.nhs.uk

Was it really flu?
[Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire.]

A survey of Glasgow health care workers revealed that only 30 per cent of workers who thought they had had influenza had their diagnosis confirmed by serological test results.

Of the 120 hospital workers (23 per cent) who were known from serological tests to have had "flu", 71 could not recall influenza and 32 could not recall any respiratory infection.

With such a common infection, and so many workers unaware of having it, cross infection risk to patients seems likely, say the authors and workers may need to be vaccinated.

Contact:
Dr William Carman

Tel :0141 330 4017
Fax: 0141 337 236

Editorial: Depression and the menopause and [Causality, menopause, and depression: a critical review of the literature]

Natural menopause has not been shown to cause depression in women, states an editorial in this week's BMJ. Research also suggests there is no link between oestrogen concentration and depression nor any conclusive evidence that Hormone Replacement Therapy improves depression any more than placebo. Clinical psychologist Myra Hunter writes :"to attribute depression in a middle aged woman automatically to the menopause is overly simplistic and unjustified."

Contact:
Myra S.Hunter
University College London

Tel: 0171 380 7895
Fax: 0171 916 1989

EMBARGO: 00.01 HRS FRIDAY 15 NOVEMBER 1996