Releases Saturday 23 September 2000
No 7263 Volume 321
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(1) TOO FEW INTENSIVE CARE COTS FOR
NEWBORNS TO COPE WITH DEMAND
(2) BABIES
BORN TO DIABETIC MOTHERS FOUR
TIMES AS LIKELY
TO DIE AS THOSE BORN TO
HEALTHY MOTHERS
(3) FINDINGS
OF GRIFFITHS REVIEW INTO
ALLEGATIONS
OF RESEARCH MISCONDUCT
FUNDAMENTALLY
FLAWED
(4) TWINS
ARE SIGNIFICANTLY LESS LIKELY TO
HAVE ASTHMA
THAN SINGLETONS
(5) ABRUPT
WITHDRAWAL OF DRUGS TO PREPARE
FOR SURGERY
CAN BE DANGEROUS
(1) TOO FEW INTENSIVE CARE COTS FOR
NEWBORNS TO COPE WITH DEMAND
(National census of availability
of neonatal intensive care)
http://bmj.com/cgi/content/full/321/7263/727
Demand for neonatal intensive care in the
UK outstrips
supply, finds research in this week's
BMJ.
Field and colleagues conducted a census
on the availability of
neonatal intensive care in the UK's 37
largest regional
perinatal centres dealing with high risk
births. The study ran
between April and June last year.
During the three months of the study, 309
transfers were
made, equivalent to over 1200 a year,
of which 264 were
made before the baby had been born. Sixty
five of these
transfers involved a multiple birth. The
most common reason
given for the transfer was lack of neonatal
beds, which
includes lack of appropriate staff and
equipment even if the
bed is empty, rather than inability of
the centre to provide the
service. Regions differed considerably
in their ability to cope
with demand, with the highest numbers
of transfers in Wales
with a rate of 5.24 per 1000 births, followed
closely by the
South and West region, with a rate of
5.16, and the Trent
region with a rate of 3.52.
Most deliveries in the UK take place in
district general
hospitals, but when delivery units are
full or there are
complications, these hospitals will refer
to perinatal units. But,
say the authors, the findings of this
study indicate that they will
find considerable difficulty in obtaining
a place. And
anecdotal evidence suggests the problem
is growing, say the
authors.
Transfers will always be part of obstetrics,
say the authors,
and there is no evidence to suggest that
the health of either
mothers or their babies is compromised
by these transfers.
But the psychological and financial burdens
borne by the
families involved are considerable, they
say. National
standards or targets set for the NHS,
and a comprehensive
nationwide strategy to deal with high
risk perinatal care are
needed to alleviate the "chaotic" situation.
Contacts:
Dr Janet Rennie, King's College Hospital, London
Professor Philip J Steer, Chelsea &
Westminster Hospital,
London
Email: P.Steer{at}ic.ac.uk
(2) BABIES BORN
TO DIABETIC MOTHERS FOUR
TIMES AS LIKELY TO DIE AS THOSE BORN
TO
HEALTHY MOTHERS
(Outcome of pregnancy in diabetic
women in northeast
England and in Norway, 1994-97)
http://bmj.com/cgi/content/full/321/7263/730
The babies of diabetic mothers in northeast
England are four
times as likely to die as those born to
healthy mothers, finds a
study in this week's BMJ. The risk is
six times higher in the
UK than it is in Norway, the research
shows.
Hawthorne and colleagues compared the rates
of death and
complications among babies born to diabetic
and
non-diabetic mothers in northeastern England
and Norway
between 1994 and 1997.
The babies of diabetic mothers were over
four times as likely
to die as those born to non-diabetic mothers
in the UK and
six times as likely to die as those born
to non-diabetic
mothers in Norway. In Norway, just over
10 in every 1000
births to diabetic mothers resulted in
death compared with
almost seven in every 1000 births to non-diabetic
mothers.
Comparable figures in northeast England
were almost 43 and
10 per 1000 births, respectively. The
risk of having a baby
with birth defects was also 2.5 times
as high in diabetic as in
non-diabetic women in northeast England,
while no increase
was seen in Norway.
The differences are not explained by the
way in which data
on diabetes and stillbirths are collected,
say the authors, so
there must be other reasons for the differences.
Contacts:
Professor Rolf T Lie, Professor of Medical
Statistics,
University of Bergen, Norway (available
Tuesday 19 -
Thursday 21 September)
Email: rolv.lie{at}smis.uib.no
Professor L M Irgens, University of Bergen,
Norway
(3) FINDINGS OF
GRIFFITHS REVIEW INTO
ALLEGATIONS OF RESEARCH MISCONDUCT
FUNDAMENTALLY FLAWED
(Investigating allegations of research
misconduct: the vital
need for due process)
http://bmj.com/cgi/content/full/321/7263/752
(Commentary: Response from members
of the Griffiths
inquiry)
http://bmj.com/cgi/content/full/321/7263/752#resp1
(Editorial: Inquiring into inquiries)
http://bmj.com/cgi/content/full/321/7263/715
"Almost every statement made about the
design, conduct,
and reporting of the neonatal CNEP trial
in the Griffiths
report was ill informed, misguided, or
factually wrong,"
concludes a review of its findings in
this week's BMJ.
The internal review chaired by Professor
Rod Griffiths was
set up in February 1999 after several
parents alleged that
their premature babies had been entered
into a controlled trial
of a breathing support technique, known
as continuous
negative extrathoracic pressure (CNEP),
without their
consent. The resulting report was published
in May this year.
Dr Edmund Hey, a retired paediatrician
from Newcastle
upon Tyne, and Dr Iain Chalmers, director
of the UK
Cochrane Centre in Oxford, conducted their
review on behalf
of the Medical Defence Union. In their
swingeing critique the
authors raise serious doubts about the
reliability of the report,
the review, and the appropriateness of
the ensuing
recommendations.
The authors defend the trial's design,
which, they claim, the
panel had failed to understand. They refute
the allegation that
no external peer review had been conducted
and they accuse
the panel of making "an unwarranted slur
on the
professionalism and skill of all the nurses
concerned." They
say that a consent document existed among
the research
records for every child in the study.
Assertions made by a
small number of parents about events up
to 10 years ago
went unchecked, say the authors, yet now
form the basis for
recommending major changes to the governance
of clinical
research in the NHS.
"We can still agree that there has been
a scandal, but suspect
that the scandal is what has been done
to, not what was done
by, the medical and nursing staff in Stoke
on Trent."
Responding to the criticisms, the members
of the panel say
that Hey and Chalmers have completely
misunderstood the
terms of reference of the investigation
and have ignored the
main substance of the report. Constrained
by the fact that
some of the issues and individuals involved
are still being
legally investigated, they nevertheless
claim that the consent
forms did not contain all the necessary
information and that
there were discrepancies between the stated
ages at which
babies were entered into the trial. Parental
recall may indeed
be faulty, they agree, but add: "this
does not mean that all
parents are wrong and all researchers
are right."
An accompanying editorial by Richard Smith
says that the
whole system of such inquiries needs to
be re-evaluated, and
that their process, including the appointment
of the members
and the purpose of the investigation,
should be made clear
from the outset. "Inquiries should publish
their material and
methods, check oral allegations against
documentary
evidence, and send drafts of evidence
accusing individuals to
those individuals, so that errors of fact
can be corrected."
Contacts:
Dr Iain Chalmers, UK Cochrane Centre, Oxford.
Email: ichalmers{at}cochrane.co.uk
Professor Rod Griffiths, NHS Executive,
West Midlands
Regional Office, Birmingham.
Dr Richard Smith, Editor BMJ, London.
Email: pressoffice{at}bma.org.uk
(4) TWINS ARE
SIGNIFICANTLY LESS LIKELY TO
HAVE ASTHMA THAN SINGLETONS
(Reduced risk of hospital admission
for childhood asthma
among Scottish twins: record linkage
study)
http://bmj.com/cgi/content/full/321/7263/732
Twins run less risk of developing asthma
than singletons,
reports a study in this week's BMJ.
Strachan and colleagues analysed the admission
data for
respiratory illness of twins and singletons
up to the age of 10
among Scottish hospitals. The study covered
the years 1981
to 1994.
They found that twins�overall risk of admission
for
respiratory disease was significantly
lower than that of
singletons. Although twins were more likely
to be admitted
for acute bronchitis and bronchiolitis,
they were much less
likely than singletons to be admitted
to hospital for asthma.
The authors conclude that the difference
in admission rates
might have been exaggerated if the admission
of one twin with
asthma led to preventive treatment of
the other, but suggest
that this is unlikely to explain the large
difference in admission
rates. Nor can birthweight explain the
difference as low
birthweight is associated with increased
risk of asthma, but
twins weigh less than singletons. Rather,
they suggest that
twinship is a special case of the protective
effect of large
families on allergies.
Contact:
Dr David Strachan, Department of Public
Health Sciences, St
George's Hospital Medical School, London.
Email: d.strachan{at}sghms.ac.uk
(5) ABRUPT WITHDRAWAL
OF DRUGS TO PREPARE
FOR SURGERY CAN BE DANGEROUS
(Editorial: The risks of interrupting
drug treatment before
surgery)
http://bmj.com/cgi/content/full/321/7263/719
Abruptly stopping drug treatments before
surgery can be
dangerous and increase the risk of postoperative
complications, suggests an editorial in
this week's BMJ.
Surgery, particularly major abdominal surgery,
affects the rate
at which stomach contents are emptied,
so reducing the
absorption of drugs. Patients may therefore
have to wait
several days before they can resume their
normal medical
routine.
Noble and Kehlet cite research showing
a significantly
increased risk of adverse outcomes among
patients whose
drug regimens had been stopped before
surgery. Patients
taking therapeutic drugs that were unrelated
to their surgery
were three times as likely to have complications
as those not
taking medicines. And the longer the duration
of abstinence,
the higher was the complication rate.
Doctors need to ensure that drug treatments
are resumed as
soon as possible, write the authors, by
providing alternative
routes, medicines, and by reducing the
need for opioid
anaesthesia. But the pharmaceutical industry
also needs to do
more, they say. Guidance should be included
in drug
information leaftlets and in national
drug formularies to help
doctors provide alternative medicines
and be aware of the
symptoms associated with sudden withdrawal
from treatment.
"Such is the scale of the problem that
failing to prevent the
consequences of drug withdrawal in the
postoperative period
should possibly be considered equivalent
to those medication
errors that have been called 'worse than
a crime', "
conclude the authors.
Contact:
Dr David Noble, Department of Anaesthesia,
Intensive Care
and Hyperbaric Medicine, Grampian University
Hospitals,
Aberdeen, Scotland.
Email: david.noble{at}arh.grampian.scot.nhs.uk
FOR ACCREDITED JOURNALISTS
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
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Advancement of Science
(http://www.eurekalert.org)
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