No 7147 Volume 316
Press Releases Saturday 13 June 1998
(1) CARDIOTHORACIC SURGEONS ARE FURTHER
DOWN THE ROAD OF SELF-REGULATION
THAN WE
REALISE
(2) COMPARISON OF HOSPITAL AT HOME SCHEMES WITH INPATIENT CARE
(3) BOXING MATCHES COULDN'T BE HELD IF DOCTORS REFUSED TO BE AT THE RINGSIDE
(4) SUCCESSFUL SPECIALIST CARE FOR CYSTIC
FIBROSIS PATIENTS FROM INFANCY
TO ADULTHOOD
(1) CARDIOTHORACIC SURGEONS ARE FURTHER DOWN THE
ROAD OF SELF-REGULATION THAN WE REALISE
(Cardiac surgery: the fall guy in medical quality assurance)
http://www.bmj.com/cgi/content/full/316/7147/1759
The irony of recent investigations into performances of cardiothoracic
surgeons is that in the UK cardiothoracic surgery has better data and
is
more subject to internal scrutiny than any other specialty, says Bruce
Keogh of the Society of Cardiothoracic Surgeons of Great Britain and
Ireland in this week's BMJ.
The author details the development of an internal audit system within
the
Society over the past twenty years and how the information collected
has
become more accurate and more meaningful over this period.
He notes that
evidence based medicine indicates that those patients most likely to
benefit from cardiac surgery are usually the sickest, with the most
damaged
hearts and therefore those with the greatest surgical risk. Thus
the
auditing of performance based purely on mortality is imperfect and
would
ensure that patients who might otherwise benefit would be denied an
operation.
Keogh concludes that the specialty of cardiothoracic surgery is the
tip of
the iceberg in medical quality assurance and that the challenge is
for
other medical and surgical specialties to produce realistic, measurable
and
auditable outcomes.
Contact:
Dr Bruce Keogh, Chairman, Database and Information Committee, Society
of
Cardiothoracic Surgeons of Great Britain and Ireland, c/o Concorde
Services, 10 Wendell Road, London W12 9RT.
email: B.E.KEOGH{at}bham.ac.uk
(2) COMPARISON OF HOSPITAL AT HOME SCHEMES WITH
INPATIENT CARE
(Hospital at home: from red to amber)
http://www.bmj.com/cgi/content/full/316/7147/1761
(Randomised controlled trial comparing hospital at home care with inpatient
hospital care.
I: three month follow up of health
outcomes
http://www.bmj.com/cgi/content/full/316/7147/1786
II: cost minimisation analysis)
http://www.bmj.com/cgi/content/full/316/7147/1791
(Randomised controlled trial comparing effectiveness and acceptability
of
an early discharge, hospital at home scheme with acute hospital care)
http://www.bmj.com/cgi/content/full/316/7147/1796
(Hospital at home or acute hospital care? A cost minimisation
analysis)
http://www.bmj.com/cgi/content/full/316/7147/1802
Hospital at home schemes providing care which has traditionally been
given
in hospital, have grown in importance, but few studies have been undertaken
to evaluate their effectiveness and financial implications. Four
papers
(two conducted by the Division of Public Health and Primary Healthcare,
University of Oxford, and two by the Department of Social Medicine,
University Bristol) and an editorial in this week's BMJ tackle the
issue of
treating acute patients at home or in hospital.
The overall conclusion is that both methods of treatment appear to be
effective and acceptable to patients, but economic evaluations are
inconclusive. This will reassure advocates of hospital at home
schemes
without satisfying sceptics, says Steve Iliffe in his editorial
summarising the papers.
Contact:
Steve Iliffe, Reader in General Practice, University College and Royal
Free
Hospital Schools of Medicine, London
email: siliffe{at}ucl.ac.uk
Sasha Shepperd, Research Officer, Division of Public Health and Primary
Health Care, University of Oxford, Institute of Health Sciences,
Headington, Oxford
email: Sasha.Shepperd{at}dphpc.ox.ac.uk
Suzanne Richards, Research Associate, Department of Social Medicine,
University of Bristol, Bristol
email: suzanne.richards{at}bris.ac.uk
Joanna Coast, Lecturer in Health Economics, Department of Social Medicine,
University of Bristol, Bristol
email: jo.coast{at}bristol.ac.uk
(3) BOXING MATCHES COULDN'T BE HELD IF DOCTORS REFUSED
TO BE AT THE RINGSIDE
(Could boxing be banned? A legal and epidemiological perspective)
http://www.bmj.com/cgi/content/full/316/7147/1813
In an Education and Debate paper in this week's BMJ, Professor Hugh
Brayne
from the University of Sunderland writes that scientific evidence shows
that boxing, both professional and amateur, endangers health.
He notes that no boxing case has ever been heard in the courts and
so the
legal system has never been asked to consider the scientific evidence
against the sport. Even without legislation, says the author,
the law
could place limitations on the sport. Brayne considers the legal
implications of the sport, taking into account intent to cause bodily
harm
and the issue of consent. He suggests that two possible test
cases could
be considered in the event of a fight resulting in serious injury or
death:
a claim for compensation against the promoter or referee, or a criminal
prosecution based on the known scientific evidence.
He concludes that since medical cover is a legal requirement at all
boxing
promotions, the profession should consider whether members should
participate, in light of its own ethical standards. If they didn't,
boxing
would become an impossible activity.
Contact:
Professor Hugh Brayne, Sunderland Business School, University of
Sunderland, Sunderland
email: hugh.brayne{at}sunderland.ac.uk
Carol Brayne, Lecturer, Department of Community Medicine, University
of
Cambridge, Cambridge
(4) SUCCESSFUL SPECIALIST CARE FOR CYSTIC FIBROSIS
PATIENTS
FROM INFANCY TO ADULTHOOD
(Clinical outcome in relation to care in centres specialising in cystic
fibrosis: cross sectional study)
http://www.bmj.com/cgi/content/full/316/7147/1771
The longer-term prognosis of patients with cystic fibrosis can be improved
if patients are treated at both paediatric and adult cystic fibrosis
centres. Therefore it is the clinical responsibility of all physicians
to
ensure that specialist care begins in childhood and is continued throughout
adult life, says Dr Ravi Mahadeva et al in their study, published in
this
week's BMJ.
Based on research conducted at two adult cystic fibrosis centres in
Manchester and Cambridge, the authors conclude that even though previous
studies have supported a clinical benefit from specialist teams providing
care in cystic fibrosis centres, their study provides good evidence
to
justify the system.
Contact:
Dr Diana Bilton, Consultant Physician, Cystic Fibrosis Unit, Papworth
Hospital NHS Trust, Papworth Everard, Cambridge Press Office:
Kate
Lancaster
FOR ACCREDITED JOURNALISTS
Embargoed press releases:
These are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;jshepher{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science (http://www.eurekalert.org)
Please remember to credit the BMJ as source when publicising an article
and to inform your readers that they can read its full text on the
journal's web site (http://www.bmj.com).
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