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(2) EPISIOTOMY
INCREASES THE RISK OF ANAL
INCONTINENCE
(3) ONE
SIXTH OF EPILEPTIC PATIENTS CONCEAL
SEIZURES FROM
DOCTORS
(1) CHILDREN RECEIVE
APPROPRIATELY TESTED
MEDICINES
(Survey of unlicensed and off label
drug use in paediatric
wards in European countries)
http://www.bmj.com/cgi/content/full/320/7227/79
Children in Europe are being denied the
same rights as adults
in relation to receiving treatment with
drugs that have been
fully tested, report a team of European
researchers in this
week's BMJ. Unlicensed and "off label"
drug prescribing in
children is a problem across Europe that
needs action
conclude Sharon Conroy from the University
of Nottingham
and colleagues from Sweden, Germany, Italy
and the
Netherlands.
Many drugs are not tested in children,
which means they are
not specifically licensed for use in children,
say the authors.
However, because clinical trials of drugs
are usually not
performed on this age group, licensed
drugs are often
prescribed outside the terms of the product
license in relation
to age, dose, frequency or the intended
use of the drug. Using
licensed drugs in this manner renders
them "off label". As a
result, considerable concern exists within
Europe and the
United States about the use of unlicensed
and off label drugs
in children, report the team.
Conroy et al investigated the prescribing
practices in the
children's wards of five hospitals in
Derby, Uppsala,
Marburg, Bergamo and Rotterdam. They found
that over a
four week period during 1998, 2,262 drug
prescriptions
were administered to 624 children in the
five hospitals.
Almost half of all the drug prescriptions
(1036) were either
unlicensed or off label (872 were off
label and 164 were
unlicensed). This led to two thirds of
the children (67 per
cent) receiving an unlicensed or off label
drug prescription
during their stay in hospital. The most
frequently prescribed
off label drugs were those used in the
treatment of asthma
and pain relief, say the authors.
Conroy et al conclude that based on their
findings, the use of
off label or unlicensed drugs to treat
children is widespread
and that this problem is likely to affect
children throughout
Europe. They say that this requires action
from the European
Union, national departments of health
and politicians as well
as the European Medicines Evaluation Agency.
Contact:
Professor Imti Choonara, Academic Division
of Child Health
(University of Nottingham), Derbyshire
Children's Hospital,
Derby
Email: Imti.Choonara@nottingham.ac.uk
(2) EPISIOTOMY
INCREASES THE RISK OF ANAL
INCONTINENCE
(Midline episiotomy and anal incontinence:
retrospective
cohort study)
http://www.bmj.com/cgi/content/full/320/7227/86
Women who undergo episiotomy during childbirth
have
higher rates of anal incontinence during
the first six months
after giving birth compared to women who
did not have
episiotomies and even compared to those
who experienced
perineal tearing, report researchers in
this week's BMJ.
Dr Lisa Signorello and colleagues from
Harvard Medical
School investigated 209 women who underwent
a midline
episiotomy whilst delivering a full term
singleton baby
vaginally; 206 who experienced spontaneous
perineal tearing
and 211 who experienced neither. They
found that compared
with women who tore naturally, episiotomy
tripled the risk of
faecal incontinence and doubled the risk
of flatus incontinence
in the six months after giving birth.
Signorello et al also determined that this
effect of episiotomy
was not due to its frequent association
with instrumental
delivery (for example forceps) and was
independent of
maternal age and complications during
labour.
Based on their findings the authors conclude
that episiotomy
is not effective in protecting the perenium
and sphincters
during child birth and that the restricted
use of episiotomy
may prevent anal incontinence.
Contact:
Dr Lisa Signorello, Study Co-ordinator,
International
Epidemiology Institute, Rockville, USA
Email: lbsignore@aol.com
Or
Dr Bernard Harlow, Obstetrics and Gynaecology
Epidemiology Center, Brigham and Women's
Hospital,
Harvard Medical School, Boston, USA
(3) ONE SIXTH
OF EPILEPTIC PATIENTS CONCEAL
SEIZURES FROM DOCTORS
(Cross sectional study of reporting
of epileptic seizures to
general pratitioners)
http://www.bmj.com/cgi/content/full/320/7227/94
One sixth of patients who experienced seizures
in the past
year, did not reveal details to their
general practitioner, finds a
study published in this week's BMJ. Dr
Jamie Dalrymple
from the University of East Anglia and
Dr John Appleby from
the King's Fund in London suggest that
a reluctance to
report seizures may be because epilepsy
affects their eligibility
for a driving licence and access to various
employment and
leisure activities.
Dalrymple and Appleby analysed responses
from 111
epileptic patients to an anonymous questionnaire.
42 patients
had previously admitted to their family
doctor that they had
experienced a seizure within the last
twelve months, however
in the anonymous questionnaire 60 patients
admitted to a
recent seizure. Of these 40 per cent held
a driving licence,
only a quarter of whom admitted this to
their doctor, say the
authors.
They conclude that some patients clearly
perceive that the
benefits of concealment of seizures outweigh
the risks, but
that such concealment can lead to inadequate
treatment - if
doctors don't know that they have experienced
a seizure
then they will be unable to treat them
appropriately. They say
that doctors need to put more effort into
explaining this to
patients.
Contact:
Dr Jamie Dalrymple, General Practitioner,
Schools of Health,
University of East Anglia, Norwich
Email: j.dalrymple@uea.ac.uk
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