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(2) MORPHINE
SPRAY MORE EFFECTIVE THAN
INJECTION TO
RELIEVE PAIN IN YOUNG PEOPLE
(3) NON-STEROIDAL
ANTI-INFLAMMATORY DRUGS
ARE ASSOCIATED
WITH INCREASED RISK OF
MISCARRIAGE
IN PREGNANT WOMEN
(4) LARGE
SCALE SUPPLY OF MOSQUITO NETS
REDUCE MALARIA
(5) MEDICAL
SCHOOLS MUST NOT ACCEPT
DISHONEST BEHAVIOUR
AMONG STUDENTS
(1) LIVER DISEASE
MAY BE BEING MISSED IN
PRIMARY CARE
(How are abnormal results for liver
function tests dealt with in
primary care? Audit of yield and
impact)
http://bmj.com/cgi/content/full/322/7281/276
Treatable chronic liver disease may be
being missed in primary
care because abnormal test results for
liver function are often
not adequately investigated, according
to a study in this week's
BMJ.
Researchers from the Queen's Medical Centre
in Nottingham
followed up all adult patients who had
an abnormal result for
liver function based on a test requested
by their doctor
between January and June 1995. Of 873
patients followed up,
342 were not under hospital review. 157
of these patients
were thought to require further investigation,
yet no further
tests had been requested for 91. 66 patients
had been partially
investigated by their doctor and, in seven
patients, results
suggesting a treatable chronic liver disease
had not been
followed up and no referral had been made
to a
gastroenterologist.
Our findings show that many important diagnoses
- including
communicable, potentially life threatening
diseases - are
missed, say the authors. Patients with
persistently abnormal
test results should be referred to a hepatologist
or
gastroenterologist, they conclude.
Contact:
Stephen Ryder, Consultant Hepatologist,
Division of
Gastroenterology, Queen's Medical Centre,
Nottingham, UK.
Email: stephen.ryder@mail.qmcuh-tr.trent.nhs.uk
(2) MORPHINE SPRAY
MORE EFFECTIVE THAN
INJECTION TO RELIEVE PAIN IN YOUNG
PEOPLE
(Multicentre randomised controlled
trial of nasal diamorphine
for analgesia in children and teenagers
with clinical fractures)
http://bmj.com/cgi/content/full/322/7281/261
Nasal diamorphine spray is a safe and effective
method of pain
relief for young people in acute pain
with a limb fracture, and
should be used in place of morphine by
intramuscular injection,
finds a study in this week's BMJ.
Kendall and colleagues identified 404 patients,
aged between
3 and 16 years, attending an emergency
department with acute
pain resulting from a limb fracture. 204
patients were given
nasal diamorphine spray and 200 were given
intramuscular
morphine. They found that onset of pain
relief was faster in the
spray group than in the intramuscular
group, with lower pain
scores in the spray group at 5, 10 and
20 minutes after
treatment, but no difference between the
groups after 30
minutes. Furthermore, 80% of patients
given the spray showed
no obvious discomfort compared with 9%
given intramuscular
morphine, and no serious adverse events
were seen in patients
given the spray.
There should no longer be any reason to
give intramuscular
morphine to such children because the
spray is appropriate
wherever intramuscular morphine is being
considered,
conclude the authors.
Contact:
Jason Kendall, Consultant, Emergency Department,
Frenchay
Hospital, Bristol, UK
Email: frenchayed@cableinet.co.uk
(3) NON-STEROIDAL
ANTI-INFLAMMATORY DRUGS
ARE ASSOCIATED WITH INCREASED RISK
OF
MISCARRIAGE IN PREGNANT WOMEN
(Risk of adverse birth outcome and
miscarriage in pregnant
users of non-steroidal anti-inflammatory
drugs: population
based observational study and case-control
study)
http://bmj.com/cgi/content/full/322/7281/266
Taking non-steroidal anti-inflammatory
drugs during pregnancy
does not seem to increase the risk of
adverse birth outcome
(congenital abnormality, low birth weight,
or preterm birth) but
is associated with increased risk of miscarriage,
according to a
study in this week's BMJ.
Researchers in Denmark investigated 1,462
pregnant women
who had taken up prescriptions for non-steroidal
anti-inflammatory drugs during the period
30 days before
conception to birth. They also compared
4,268 women who
had miscarriages, of whom 63 had taken
non-steroidal
anti-inflammatory drugs, with 29,750 women
who had live
births.
They found no increased risk of adverse
birth outcome in
women who took up prescriptions for non-steroidal
anti-inflammatory drugs, but there was
a strong positive
association with miscarriage. However,
no firm conclusions as
to whether this association is causal
or due to other
confounding factors could be drawn from
the data, add the
authors.
Knowledge on the safety of taking non-steroidal
anti-inflammatory drugs while pregnant
is limited, say the
authors. Our observation of an increased
risk of miscarriage in
women exposed to non-steroidal anti-inflammatory
drugs is
new and needs to be confirmed, conclude
the authors.
Contact:
Gunnar Lauge Nielsen, Consultant, Department
of Medicine,
Odder Hospital, Odder, Denmark
Email: uxgln@aas.nja.dk
(4) LARGE SCALE
SUPPLY OF MOSQUITO NETS
REDUCE MALARIA
(Impact on malaria morbidity of a
programme supplying
insecticide treated nets in children
aged under 2 years in
Tanzania: community cross sectional
study)
http://bmj.com/cgi/content/full/322/7281/270
(Editorial: Insecticide treated bed
nets to prevent malaria)
http://bmj.com/cgi/content/full/322/7281/249
Mosquito nets treated with insecticide
and distributed as part
of a large scale social marketing programme
can substantially
reduce the prevalence of malaria and anaemia
in very young
children in Tanzania, finds a study in
this week's BMJ. This
strategy has high potential in the control
of malaria in
sub-Saharan Africa, say the authors.
Abdulla and colleagues investigated a random
sample of 748
children, aged under 2 years, living in
18 villages in southwest
Tanzania. The first survey was done at
the time of launching
the social marketing campaign (June 1997),
and two other
surveys were carried out at the same period
(June to August)
in the subsequent two years. They found
that ownership of
treated nets rose rapidly, from 10% to
61%. The prevalence
of severe anaemia decreased from 49% to
26% in the two
years studied, and the mean Haemoglobin
level in the children
rose from 80g/l to 89 g/l. Treated nets
had a protective
efficacy of 63% against both malaria and
anaemia.
Treated mosquito nets might therefore be
able to deliver
feasible and effective malaria prevention
on a large scale in
areas where malaria is highly endemic,
conclude the authors.
Contacts:
Dr Christian Lengeler, Project Leader,
Swiss Tropical
Institute, Basle, Switzerland
Email: Christian.Lengeler@unibas.ch
Dr Salim Abdulla, Ifakara Health Research
and Development
Center, Ifakara, Tanzania,
Email: ihrdc@twiga.com
(5) MEDICAL SCHOOLS
MUST NOT ACCEPT
DISHONEST BEHAVIOUR AMONG STUDENTS
(Are "tomorrow's doctors" honest?
Questionnaire study
exploring medical students' attitudes
and reported behaviour
on academic misconduct)
http://bmj.com/cgi/content/full/322/7281/274
(Editorial: Cheating at medical school)
http://bmj.com/cgi/content/full/322/7281/250
Academic misconduct does exist amongst
medical students
and needs to be taken seriously by medical
schools, finds a
study in this week's BMJ.
An anonymous questionnaire was completed
by 461 students
in all years at Dundee University medical
school. The
questionnaire had 14 scenarios in which
a fictitious student,
"John," engaged in dishonest behaviour.
For each scenario,
students were asked whether they felt
John was wrong and
whether they had done or would consider
doing the same.
Most students felt that most of the scenarios
were wrong.
However, the proportion of students reporting
that they had
engaged in or would consider engaging
in the scenarios varied
from 2% for copying answers in a clinical
examination to 56%
for copying directly from published text
and only listing it as a
reference. About a third of students reported
that they had
engaged in or would consider engaging
in behaviour described
in four of the scenarios: exchanging information
about an
examination, writing "nervous system examination
normal"
when this hadn't been performed, lending
work to others, and
copying published text without appropriate
referencing.
Some of these findings are worrying, as
they suggest that, in
some cases, there is no consensus among
students on what
constitutes unacceptable behaviour, say
the authors. Academic
misconduct needs to be taken seriously
by medical schools as
it casts doubt on the validity of qualifications,
they conclude.
Medical schools must make their institutional
position and their
expectations of students absolutely clear
from day one, writes
Shimon Glick in an accompanying editorial.
The future of the
medical profession depends on preserving
and restoring public
trust in doctors, but this trust must
be deserved and earned, he
concludes.
Contacts:
[Paper]: Carol Pope, Press Officer, University
of Dundee,
Scotland, UK
Email: c.l.e.pope@dundee.ac.uk
[Editorial]: Shimon Glick, Professor Emeritus,
Moshe Prywes
Center for Medical Education, Ben Gurion
University of the
Negev, Becr Sheva, Israel
Email: Gshimon@bgumail.bgu.ac.il
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