Releases Saturday 24 March 2001
No 7288 Volume 322
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(1) TIME TO TACKLE UNETHICAL ATTITUDES AND
BEHAVIOUR IN MEDICINE
(2) MEN
AND WOMEN RECOVER DIFFERENTLY AFTER
SURGERY
(3) HOME
EXERCISE CAN PREVENT FALLS IN ELDERLY
PEOPLE
(4) SEDATIVES
NOT LINKED TO HIP FRACTURES IN
ELDERLY PEOPLE
(1) TIME TO TACKLE
UNETHICAL ATTITUDES AND
BEHAVIOUR IN MEDICINE
(Understanding the clinical dilemmas
that shape medical students'
ethics development: questionnaire
survey and focus group study)
http://bmj.com/cgi/content/full/322/7288/709
(Editorial: Closing the gap between
professional teaching and
practice)
http://bmj.com/cgi/content/full/322/7288/685
(Personal View: Learning respect)
http://bmj.com/cgi/content/full/322/7288/743
Nearly half of medical students often feel
under pressure to act
unethically during training and almost
two thirds regularly witness
a clinical teacher behaving unethically,
finds a study in this week's
BMJ. These worrying findings highlight
the need for a national
policy to help protect the needs and rights
of both patients and
students in medical education.
Over 100 clinical students, who were about
one year away from
completing medical school at the University
of Toronto, were
surveyed about ethical dilemmas they had
encountered during
their clinical training. Nearly half (47%)
reported that they had
often been placed in a clinical situation
in which they had felt
pressure to act unethically, and 61% reported
witnessing a
clinical teacher acting unethically.
Three categories of ethical dilemma were
identified, based on
examples reported by 20 students during
four focus groups. For
example, reports of physical examination
of patients for purely
educational reasons without patients'
prior consent indicated a
conflict between medical education and
patient care. Students
also reported being given responsibility
beyond their capacity,
and involvement in patient care which
they perceived to be
substandard and unacceptable. The study
also suggested that
these dilemmas are seldom resolved during
medical school.
The Toronto study's results are likely
relevant to medical
education in medical schools across the
world. The need to
enforce a national policy to help prevent
abuses of both patients
and students in medical education system
is highlighted by Len
Doyal, Professor of Medical Ethics at
St Bartholomew's and the
Royal London School of Medicine and Dentistry,
in an
accompanying editorial. This will ensure
that the students of
today will be proud rather than distressed
that they have chosen
to be the doctors of tomorrow, he writes.
The view that patient consent is needed
for training procedures
as well as treatment is reiterated in
a personal view by Andrew
West and colleagues. "The medical profession
urgently needs to
learn respect for the living and for the
dead, and thereby earn the
public respect that is its lifeblood,"
they conclude.
Contacts:
[Paper:] David W Robertson, Medical Student,
University of
Toronto, Faculty of Medicine, Toronto,
Canada
Email: davidw.robertson{at}utoronto.ca
[Editorial:] Len Doyal, Professor of Medical
Ethics, St
Bartholomew's and the Royal London School
of Medicine and
Dentistry, London, UK
Email: l.doyal{at}mds.qmw.ac.uk
[Personal View:] Andrew West, Senior Registrar,
Park Hospital
for Children, Oxford, UK
(2) MEN AND WOMEN
RECOVER DIFFERENTLY AFTER
SURGERY
(Sex differences in speed of emergence
and quality of recovery
after anaesthesia: cohort study)
http://bmj.com/cgi/content/full/322/7288/710
Women emerge more quickly than men from
general
anaesthesia, but have a slower return
to former health after
surgery, according to a study in this
week's BMJ.
Researchers at Alfred Hospital in Australia
studied 241 men and
222 women for three days after undergoing
surgery to identify
differences in the quality of recovery
between the sexes. They
found that women emerged significantly
more quickly than men
from general anaesthesia but overall quality
of recovery was
worse. Women had a 25% slower rate of
return to their
preoperative health status and were more
likely to have minor
postoperative complications, such as nausea
and vomiting,
headache, backache and sore throat.
Underlying physiological differences between
men and women
may help to explain these findings, say
the authors. For example,
postoperative nausea and vomiting has
been related to the phase
of the menstrual cycle and women have
a higher incidence of
migraine and tension headaches generally
(a risk factor for
postoperative headache). Postoperative
backache may also be
attributed to anatomical differences between
men and women.
Such differences, which have previously
received limited
attention, are genuine and important,
they conclude.
Contact:
Paul S Myles, Head of Research, Department
of Anaesthesia
and Pain Management, Alfred Hospital,
Prahran, Victoria,
Australia
Email: p.myles{at}alfred.org.au
(3) HOME EXERCISE
CAN PREVENT FALLS IN ELDERLY
PEOPLE
(Effectiveness and economic evaluation
of a nurse delivered
home exercise programme to prevent
falls. 1: randomised
controlled trial, 2: controlled
trial in multiple centres)
http://bmj.com/cgi/content/full/322/7288/697
Exercise programmes delivered by trained
nurses can reduce
falls in elderly people and are cost effective
in those aged 80
years and older, report two studies in
this week's BMJ.
In the first study, 121 men and women aged
75 years and older
received an individually tailored home
based exercise
programme by a trained nurse (exercise
group). A further 119
received usual care (control group). Over
one year, falls were
reduced by 46% in the exercise group compared
with the
control group. Five falls required hospital
admission; all from the
control group and all aged over 80 years.
The programme cost
$NZ1803 (£523) per fall prevented.
In the second study, participants aged
80 years and older
received the exercise programme at general
practices, resulting in
a 30% reduction in falls. The programme
cost $NZ1519 (£441)
per fall prevented.
Based on these findings, we recommend a
home based exercise
programme delivered by trained nurses,
particularly for those
aged 80 years and older, say the authors.
Since falls are the
costliest type of injury among elderly
people, researchers, public
health administrators, and health practitioners
can work together
to benefit elderly people in the community,
they conclude.
Contact:
A John Campbell, Professor of Geriatric
Medicine, Department
of Medical and Surgical Sciences, Otago
Medical School, New
Zealand
(4) SEDATIVES
NOT LINKED TO HIP FRACTURES IN
ELDERLY PEOPLE
(Benzodiazepines and hip fractures
in elderly people: case
control study)
http://bmj.com/cgi/content/full/322/7288/704
Currently, the role of benzodiazepines
(sedatives) in hip fracture
is unclear, but a study in this week's
BMJ finds that, in general,
exposure to benzodiazepines does not increase
the risk of hip
fracture in people aged over 65. However,
patients using two or
more of these drugs may be at higher risk.
From January 1996 to July 1997, researchers
in France
assessed all patients aged over 65 presenting
to two hospital
emergency departments with acute hip fracture
resulting from a
fall that was not related to cancer, a
traffic accident or
aggression. Except for one individual
drug, lorazepam,
benzodiazepines were not associated with
an increased risk of
hip fracture. Hip fracture was, however,
associated with the use
of two or more benzodiazepines.
Study limitations mean that these findings
must remain tentative,
explain the authors. However they suggest
that patients using
lorazepam or certain other benzodiazepines
may be at a higher
risk of hip fracture.
Contact:
Professor Nicholas Moore, Department of
Pharmacology,
Victor Segalen University, Bordeaux, France
Email: nicholas.moore{at}pharmaco.u-bordeaux2.fr
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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