Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://www.bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(2) PEOPLE
MOST AT RISK OF HEART DISEASE LEAST
LIKELY TO GET
BEST CARE
(3) EACH
CIGARETTE KNOCKS 11 MINUTES OFF
YOUR LIFE
(4) HEALTH
EFFECTS OF WATE DISPOSAL SITE ARE
UNCLEAR
(5) CONSISTENT
APPROACH TO ADVANCE
DIRECTIVES
NEEDED ACROSS NHS
(1) EXPERT WITNESSES
SHOULD BE SUBJECT TO THE
SAME PRINCIPLES OF CLINICAL GOVERNANCE
AS ALL DOCTORS
(Conviction by mathematical error?)
http://www.bmj.com/cgi/content/full/320/7226/2
Guidelines for using probability theory
in criminal cases are
urgently needed, writes Stephen Watkins
from Stockport
Health Authority in an editorial in this
week's BMJ. Dr
Watkins says that the basic principles
of probability theory
are not difficult to understand and judges
could be trained to
recognise and rule out misunderstandings.
Watkins bases his editorial on the case
of Sally Clark who
was convicted in November of smothering
her two infant
children. During her case an eminent paediatrician
testified
that the chances of two cot deaths happening
in her family
was "vanishingly small" (one in 73 million),
but, says
Watkins, this statistic was wrong. "It
is speculation whether
Sally Clark would have been acquitted
without this evidence.
But with this mathematical error prominent
the conviction is
unsafe," he writes.
He explains that the more realistic probability
is one in 8,500
but that this figure in itself is meaningless,
because with the
large number of births occurring, such
events are bound to
happen from time to time by chance. He
explains that if cot
deaths are random events, two cot deaths
will occur in the
same family somewhere in England once
every seven years.
But cot deaths are not random events says
Watkins -
previous studies have found cases of "recurrence"
and these
were able to distinguish cot death from
accident, illness,
murder and neglect. The incidents will
therefore be even
higher about once very year and a half,
says the author.
Watkins concludes that when errors occur
we expect them to
be admitted, learnt from and corrected.
He says that expert
witnesses can hold a substantial part
of defendants' lives in
their hands and that defendants deserve
the same protection
as patients. He therefore speculates as
to whether clinical
governance should be extended to the courtroom.
Contact:
Dr Stephen Watkins, Director of Public
Health, Stockport
Health Authority
(2) PEOPLE MOST
AT RISK OF HEART DISEASE LEAST
LIKELY TO GET BEST CARE
(Effect of socioeconomic deprivation
on waiting time for
cardiac surgery: retrospective cohort
study)
http://www.bmj.com/cgi/content/full/320/7226/15
Socioeconomically deprived people are thought
to be more
likely to develop coronary heart disease
and yet they are less
likely to be examined for the condition
or offered surgery
once it has developed, say researchers
from Scotland in this
week's BMJ. Dr Jill Pell from Glasgow
Royal Infirmary and
colleagues also report that these patients
are further
disadvantaged by having to wait longer
for surgery as they
are given lower priority than more affluent
patients.
Pell et al studied over 26,000 patients
from 1986 - 1997 on
NHS waiting lists in Scotland. They found
that the most
deprived patients tended to be younger
and were more likely
to be women and on average, the most deprived
patients
waited about three weeks longer for surgery
than the most
affluent. The authors also found that
the most deprived
patients were half as likely to have their
operations classified
as urgent.
They conclude that in addition to their
greater burden of
disease, worse prognosis and poorer access
to investigation
and surgery, socioeconomically deprived
patients may be
further disadvantaged by having to wait
longer for surgery
because of being given lower priority.
Contact:
Dr Stuart Cobbe, Walton Professor of Medical
Cardiology,
Department of Cardiology, Glasgow Royal
Infirmary,
Glasgow
Or
John Norrie, Senior Statistician, Robertson
Centre for
Biostatistics, University of Glasgow
(3) EACH CIGARETTE
KNOCKS 11 MINUTES OFF
YOUR LIFE
(Time for a smoke? One cigarette
reduces you life by 11
minutes)
http://www.bmj.com/cgi/content/full/320/7226/53
Each cigarette you smoke knocks eleven
minutes off your life,
claim researchers from the University
of Bristol in a letter
published in this week's BMJ.
Dr Mary Shaw and colleagues calculated
that if a man
smokes an average number of cigarettes
a year (5772 -
about 16 a day) from the average starting
age of 17 until his
death at 71, he will consume 311,688 cigarettes
in his
lifetime. Given that on average a male
smoker loses six and a
half years of life, each cigarette costs
a males smoker eleven
minutes of life.
Shaw et al point out that their calculation
is crude and that it
relies on averages, assumes that the health
effects of smoking
are evenly spread throughout a lifetime,
presupposes that the
number of cigarettes smoked across a lifetime
is constant and
ignores the problems of classifying people
as either lifetime
smokers or non-smokers. However, they
say that it does
show the high cost of smoking in a way
that everyone can
understand.
The authors also construct a list of activities
that could be
undertaken with the time saved by not
smoking, which are
detailed in the table below:-
|--------------------+----------------->
|
|
|
| Number of
| Lifetime lost |
| cigarettes smoked |
|
|
|
|
|--------------------+----------------->
>------------------------------------------|
|
|
| Opportunity gain
|
|
|
>------------------------------------------|
|--------------------+----------------->
| | |
| One | 11 minutes |
| | |
|--------------------+----------------->
>------------------------------------------|
| |
| Call a friend; read newspaper; brisk
|
| walk; fairly frantic sexual intercourse
|
| |
>------------------------------------------|
|--------------------+----------------->
| | |
| Pack of 20 | 3 hours 40 |
| minutes |
| | |
|--------------------+----------------->
>------------------------------------------|
| |
| Watch Titanic; watch two football |
| matches; one shopping trip; Eurostar
|
| from London to Paris and visit a café;
|
| run the London marathon; tantric sex
|
| |
>------------------------------------------|
|--------------------+----------------->
| | |
| Carton of 200 | 1.5 days |
| | |
|--------------------+----------------->
>------------------------------------------|
| |
| Visit friends or family; one very |
| serious shopping trip; Wagner opera;
fly |
| around the world; a romantic night away
|
| |
>------------------------------------------|
Shaw et al conclude that as the first day
of the year is
traditionally a time when many smokers
try to give up, the
realisation that each cigarette reduces
life by eleven minutes
might spur them on to stop.
Contact:
Dr Mary Shaw, Economic and Social Research
Council
Research Fellow, School of Geographical
Sciences,
University of Bristol, Bristol
Dr Richard Mitchell, Research Fellow
Dr Danny Dorling, Reader
(4) HEALTH EFFECTS
OF WATE DISPOSAL SITE ARE
UNCLEAR
(Assessment of impact on health of
residents living near the
Nant-y-Gwyddon landfill site: retrospective
analysis)
http://www.bmj.com/cgi/content/full/320/7226/19
Residents living near the Nant-y-Gwyddon
landfill site in
South Wales have been at an increased
risk of having a baby
with a congenital malformation, both before
and after the site
became operational, say researchers from
Wales in this
week's BMJ.
Dr Hilary Fielder from University of Wales
College of
Medicine et al report on their ecological
study of five areas in
the valleys of South Wales near the landfill
site and compare
them to 22 areas in the same region that
are not in the vicinity.
They discovered a greater maternal risk
of having a baby with
a congenital abnormality in residents
near the site, both before
its opening and after.
Fielder et al found that from 1983 to 1987
(before the site
was opened) and from 1990 to1996 (after
the site opened)
the rate of congenital malformations in
the area exposed to
the site was nearly twice (1.9 times)
the rate of unexposed
populations. However, in the two years
during which the site
was being developed and first used (1988-9)
the rate of
congenital malformations in the exposed
areas was 3.6 times
higher. The research team also found that
there was an
increase in the number of cases of gastroschisis
[a congenital
defect in the abdominal wall] after the
site was opened, which
they report as "unusual".
The study was undertaken after residents
living near
Nant-y-Gwyddon raised concerns in 1996
that odours from
the landfill site causing illnesses, say
the authors (the authors
conclude that these odours are probably
caused by hydrogen
sulphide emitting from the site). Nant-y-Gwyddon,
which is
used for household, commercial and industrial
waste, was
opened in 1988 and covers 24 hectares
within 3km of a
population of 20,000.
The authors conclude that further studies
of the reproductive
risk in such communities are needed to
examine the safety of
waste disposal sites.
Contact:
Professor Stephen Palmer, Chair, Welsh
Combined Centres
for Public Health, Heath Park, Cardiff
Email: palmers@cardiff.ac.uk
(5) CONSISTENT
APPROACH TO ADVANCE
DIRECTIVES NEEDED ACROSS NHS
(Advance directives: questionnaire
survey of NHS trusts)
http://www.bmj.com/cgi/content/full/320/7226/24
National guidelines should be developed
in the UK to
support a consistent approach to caring
for dying patients
who have written advance directives, say
Dr Peter Diggory
and Marion Judd in this week's BMJ.
An "advance directive" gives patients the
legal right to give or
withold consent to specific medical treatments
prior to these
treatments becoming necessary, explain
the authors. They say
that this provides people with some reassurance
about the
dying process being managed in accordance
with their wishes
however, apprehension could be further
allayed if people
could feel assured that the legal status
of advance directives
as consistently applied across the NHS.
In 1998, a survey of 218 general practitioners
found that only
half (49 per cent) were aware that advance
directives carry
legal force say Diggory and Judd. In 1999
the NHS
Executive issued guidance on witholding
consent to treatment
and the General Medical Council issued
guidance on the
current legal position of advance directives.
They say that it
remains unclear how NHS trusts have responded
to this
guidance and to what extent people can
expect their wishes
to be respected.
Diggory and Judd surveyed 463 NHS trusts
to find out what
provision they had made to recognise advance
directives.
They found that only around one quarter
of all NHS trusts
had developed or intended to develop policies
on advance
directives. Few trusts provided information
and advice for
patients about advance directives and
none routinely advised
patients that advance directives may be
discussed with
healthcare staff.
The authors conclude that national guidelines
should be
developed to support a consistent approach
to end of life
care for patients with advance directives,
across the NHS.
Contact:
Marion Judd, Clinical Audit Co-ordinator,
(Institution )
Torrington Gardens, London
Email: juddery@cwcom.net
For information: Developments at the BMJ:
Within the next few weeks the BMJ expects
to join three
separate initiatives which together will
make the journal
available to many more people. It will
be the first general
medical journal to join PubMed Central,
a project
masterminded by the US National Institutes
for Health to
make the results of original research
in the life sciences freely
available to everyone via the internet.
The BMJ is also set to
use the services of JSTOR a not-for-profit
organisation which
will digitise all BMJ journals from 1840
to December 1993
(when the BMJ's online archive currently
begins).
Finally, a company called WorldSpace will
make the most
recent issue of the BMJ freely available
to health
professionals responsible for the healthcare
of the world's
most disadvantaged people. The company
uses satellites to
deliver signals containing media rich
material (such as what
now appears on the web) to portable receivers.
For many
parts of the developing world, this may
offer a better short
term option than the internet. WorldSpace
hopes to
broadcast to Africa, Central and South
America and Asia
(4.8 billion people).
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)