No 7149 Volume 316

Press Releases Saturday 27 June 1998

(1) LEAGUE TABLES ARE INACCURATE IN RANKING HOSPITAL DEATH RATES

(2) WHAT DOES THE BRISTOL CASE MEAN FOR THE FUTURE?

(3) GOOD NEWS FOR THE TREATMENT OF PANCREATIC CANCER

(4) CHANGES IN THE PREVALENCE OF ASTHMA IN BOYS AND GIRLS
      DURING PUBERTY MAY BE DUE TO HORMONES

(5) POOR KNOWLEDGE OF THE PILL COULD BE IMPROVED WITH EDUCATION

(6) UK SHOULD LEARN LESSONS FROM US WHEN DEALING
      WITH RACISM IN HEALTHCARE

(1) LEAGUE TABLES ARE INACCURATE IN RANKING HOSPITAL DEATH RATES

(Annual league tables of mortality in neonatal intensive care units:
longitudinal study)
http://www.bmj.com/cgi/content/full/316/7149/1931

The UK Government believes that publishing hospital death tables is an
important step towards meeting its commitment to monitoring services and
spreading best practices within the National Health Service.  But annual
league tables are not a reliable indicator of performance or best practice,
conclude Gareth Parry et al, based on their study of nine neonatal
intensive care units in the UK, published in this week's BMJ.

The authors found that league tables are unreliable in comparing death
rates - over a period of six years the hospitals that they studied
fluctuated wildly in the rankings, year on year.  They state that
amalgamating league tables over several years may pinpoint the most
successful hospitals, but will not identify best practices and suggest,
therefore, that policies based on annual league tables may cause as much
harm as good.

Contact:
Mr Gareth Parry, Research Fellow in Health Services Research, Medical Care
Research Unit, School of Health and Related Research, University of
Sheffield, Sheffield
email: g.parry{at}sheffield.ac.uk
 

(2) WHAT DOES THE BRISTOL CASE MEAN FOR THE FUTURE?

(All changed, changed utterly.  British medicine will be transformed by the
Bristol case)
http://www.bmj.com/cgi/content/full/316/7149/1917

In an editorial in this week's BMJ, Dr Richard Smith, Editor, says that the
Bristol case will probably prove much more important to the future of
health care in Britain than the reforms suggested in the white papers:
"...the Bristol case is a once in a lifetime drama that has held the
attention of doctors and patients in a way that a white paper can never
hope to match."

Dr Smith discusses the issues raised by the Bristol case, with the future
of the doctor-patient relationship at the core of his discussion.  He says
that Frank Dobson was wrong to say that all three of the doctors involved
in the case should have been struck off and wonders how the Secretary of
State for Health will now proceed with the concept of self-regulation
within the medical profession.  The author believes that the Government
will not attempt an overhaul of the General Medical Council as this would
miss the point.  He believes that the Royal Colleges and postgraduate
deans have a much stronger everyday influence on the practice of doctors
and that they must recognise their role in self regulation.

Dr Smith concludes that the failure of doctors' organisations to implement
much better mechanisms for ensuring high quality of care might lead to the
micromanagement of doctors that is routine in the United States.

Contact:
Jill Shepherd, Press Office, BMJ, BMA House, Tavistock Square, London
email:  jshepher{at}bma.org.uk

Cardiac surgical services in Bristol are now of high quality
http://www.bmj.com/cgi/content/full/316/7149/1986

In a letter in this week's BMJ from the United Bristol Healthcare Trust,
Peter Wilde, Clinical Director of Cardiothoracic Services, and David
Hughes, Clinical Director of Children's Services, recognise that, in light
of the recent GMC inquiry, in the past there was a major problem with
paediatric cardiac surgery at the Bristol Royal Infirmary.  However, they
note that in the mass of reporting it is easy to overlook that the last of
the events in question occurred some three years ago.  They draw attention
to the fact that the BRI cardiac unit now has a sophisticated audit system,
which has shown that the unit is now producing excellent results which will
soon be publicly available to reassure patients, their families and their
doctors.

Contact:
Dr Peter Wilde, Clinical Director of Cardiothoracic Services or David
Hughes, Clinical Director of Children's Services, United Bristol Healthcare
Trust, Bristol
email: peter.wilde{at}bris.ac.uk
 

(3) GOOD NEWS FOR THE TREATMENT OF PANCREATIC CANCER

(Effect of flutamide on survival in patients with pancreatic cancer:
results of a prospective, randomised, double blind, placebo controlled
trial)
http://www.bmj.com/cgi/content/full/316/7149/1935

Pancreatic cancer is difficult to diagnose and unsatisfactory to treat,
with most patients dying within six months of diagnosis.  At present,
surgery offers the only prospect of longer survival.  In this week's BMJ,
Brian Greenway from the Hinchingbrooke Hospital in Cambridge, presents the
results of his study to ascertain whether androgen receptor blockers
improve survival and, by implication, if testosterone promotes the growth
of pancreatic cancer.

The author found that patients taking flutamide (a pure androgen receptor
blocking agent) doubled their chances of survival, with minimal side
effects.  He also concludes that testosterone is indeed a growth factor in
pancreatic cancer.

Contact:
Brian Greenway, Consultant Surgeon, Department of Surgery, Hinchingbrooke
Hospital, Huntingdon, Cambridge
 

(4) CHANGES IN THE PREVALENCE OF ASTHMA IN BOYS AND GIRLS
      DURING PUBERTY MAY BE DUE TO HORMONES

(Questionnaire study of effect of sex and age on the prevalence of wheeze
and asthma in adolescence)
http://www.bmj.com/cgi/content/full/316/7149/1945

In early childhood wheezing and asthma are more common in boys than girls.
This difference has either disappeared or reversed by early adulthood.  In
this week's BMJ, Andrea Venn et al from the City Hospital in Nottingham
report the findings of their study of nearly 30,000 (27,826) children aged
11-16 years (51 per cent of whom were boys) in the Nottingham area.

The authors found that there is a gender reversal around the time of
puberty, due to both an increase in reported wheeze in girls and a decrease
in boys.  Venn et al conclude that, based on evidence from previous
studies, there may be a hormonal influence and advocate further research in
this area.

Among the alternative explanations given, girls may experience different
exposures to the things which trigger wheezing, such as smoking, and boys
may have a relatively greater increase in airway size at this age.

Contact:
Andrea Venn, Medical Statistician, Division of Respiratory Medicine, City
Hospital, Nottingham
email: Andrea.Venn{at}nottingham.ac.uk
 

(5) POOR KNOWLEDGE OF THE PILL COULD BE IMPROVED WITH EDUCATION

(Effect of educational leaflets and questions on knowledge of contraception
in women taking the combined contraceptive pill:  randomised controlled
trial)
http://www.bmj.com/cgi/content/full/316/7149/1948

Poor knowledge of taking the pill may be responsible for one in five
unwanted pregnancies and so Dr Paul Little et al from primary care
facilities in Hampshire investigated whether educational leaflets and/or
one-to-one question and answer sessions with GPs could improve knowledge.
They found that only 12 per cent of women in their study had a good
knowledge of the dos and don'ts concerning their contraceptive pills.  They
publish their findings in this week's BMJ and conclude that women attending
surgeries for check-ups for repeat prescriptions of the pill should be
provided with education leaflets on contraception and asked questions to
help improve their knowledge.  Using leaflets and asking questions may be
time consuming, but is the best method of conveying information that is
remembered.

The factors associated with pill failure are:  severe diarrhoea; vomiting;
missing a pill by twelve hours; starting a packet late and taking some
types of antibiotic.  If pill failure has occurred, women should continue
taking their pill but take extra contraceptive precautions (barrier
methods), during pill failure and for seven more days.  If a pill has been
missed during the past week, the user should run two packets together.  If
a packet has been started late and sexual intercourse has taken place
during the missed week then emergency contraception should be sought.

Contact:
Dr Paul Little, Wellcome Training Fellow, Primary Medical Care, Faculty of
Health Medicine and Biological Sciences, Aldermoor Health Centre,
Southampton
email: pmc1{at}soton.ac.uk (Thursday and Friday only).
 

(6) UK SHOULD LEARN LESSONS FROM US WHEN DEALING
      WITH RACISM IN HEALTHCARE

(Spectre of racism in health and health care:  lessons from history and the
United States)
http://www.bmj.com/cgi/content/full/316/7149/1970

Racism in healthcare institutions needs to be driven out, says Professor
Raj Bhopal from the University of Newcastle in this week's  BMJ.  He says
that in the UK the spotlight has mainly been on racism directed at ethnic
minority staff, but with growing concerns about the quality of healthcare
delivered to ethnic minority groups and evidence of continuing racist
attitudes in the UK, the spotlight is likely to shift to racism in patient
care.  He suggests that lessons from the experience in the US, particularly
difficulties in pinpointing racism and in narrowing inequalities, may guide
our actions in the UK.

Contact:
Professor Raj Bhopal, Department of Epidemiology and Public Health Medical
School, University of Newcastle, Newcastle upon Tyne
email: r.s.bhopal{at}ncl.ac.uk

Also, see a collection of letters in this week's BMJ looking into the issue
of racial discrimination in the merit awards system.
 
 

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