Releases Saturday 19 May 2001
No 7296 Volume 322
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(1) SMALLER PACKS OF ANALGESICS HAVE
REDUCED OVERDOSE DEATHS
(2) MOST
PATIENTS CAN BE TREATED SAFELY AT
HOME FOR DEEP
VEIN THROMBOSIS
(3) PATIENT
INFORMATION BOOKLETS FAIL TO
REDUCE CONSULTATION
RATES
(4) BMJ
EDITOR RESIGNS AFTER UNIVERSITY
ACCEPTS TOBACCO
MONEY
(1) SMALLER PACKS
OF ANALGESICS HAVE
REDUCED OVERDOSE DEATHS
(Effects of legislation restricting
pack sizes of paracetamol
and salicylate on self poisoning
in the United Kingdom:
before and after study)
http://bmj.com/cgi/content/full/322/7296/1203
The number of deaths from self poisoning
with
paracetamol and salicylates has decreased
significantly
since legislation limiting the number
of tablets per pack
was introduced in the United Kingdom in
1998, finds a
study in this week's BMJ.
Data including drug related deaths, cases
of liver
poisoning, numbers of liver transplantations,
and sales
data, were used to assess the impact of
the legislation. The
number of tablets in packets of paracetamol
and salicylate
preparations decreased markedly in the
12 months after
the legislation. The annual number of
deaths from
paracetamol poisoning decreased by 21%
and the number
from salicylates decreased by 48%.
There was also a decrease in the number
of liver
transplants and admission to liver units
with paracetamol
poisoning, and in the number of overdoses
of paracetamol
and salicylates in which large numbers
of tablets were
taken.
The legislation has been relatively successful,
say the
authors, with the results indicating that
the main factor was
the reduction in the number of tablets
per pack. An even
smaller maximum pack size for pharmacy
sales might have
had a greater impact still, they conclude.
Contact:
Keith Hawton, Professor of Psychiatry,
Centre for Suicide
Research, Warneford Hospital, Oxford,
UK
Email: keith.hawton{at}psych.ox.ac.uk
(2) MOST PATIENTS
CAN BE TREATED SAFELY AT
HOME FOR DEEP VEIN THROMBOSIS
(Eligibility for home treatment of
deep vein thrombosis:
prospective study)
http://bmj.com/cgi/content/full/322/7296/1212
(Editorial: Routine home treatment
of deep vein
thrombosis)
http://bmj.com/cgi/content/full/322/7296/1192
New, effective therapies for acute deep
vein thrombosis
mean that most patients do not need to
be admitted to
hospital, according to a study in this
week's BMJ. These
results challenge the traditional notion
that these patients
must be treated in hospital and adds to
the evidence that
home treatment of deep vein thrombosis
is now routinely
feasible.
Between November 1998 and August 1999,
117
outpatients presenting to the vascular
diagnostics unit of
the University Hospital Dresden in Germany
were
diagnosed as having acute deep vein thrombosis.
Of these,
92 received home treatment ? that is,
they were not
admitted at all. Those who did require
admission
depended mainly on factors to do with
infrastructure
rather than medical reasons, say the authors,
and no
serious complications were noted in patients
treated at
home.
However, several caveats must be borne
in mind when
applying these results to everyday practice,
warn
consultant haematologists, John Eikelboom
and Ross
Baker, in an accompanying editorial. For
instance,
successful home treatment requires adequate
resources to
enable rapid clinical assessment, diagnostic
testing and
home support when needed. They also point
out the need
for education of patients undergoing home
treatment and
call for routine monitoring of the safety
and effectiveness
of home treatment programmes in individual
centres.
Contacts:
[Paper]: Thomas Schwarz, Clinical Research
Fellow,
Division of Vascular Medicine, University
Hospital,
Dresden, Germany
Email: tho_schwarz{at}hotmail.com
[Editorial]: John Eikelboom, Consultant
Haematologist,
Department of Haematology, Royal Perth
Hospital, Perth,
Australia
Email: john.eikelboom{at}health.wa.gov.au
(3) PATIENT INFORMATION
BOOKLETS FAIL TO
REDUCE CONSULTATION RATES
(Randomised controlled trial of self
management leaflets
and booklets for minor illness provided
by post)
http://bmj.com/cgi/content/full/322/7296/1214
(Assessment of impact of information
booklets on use of
healthcare services: randomised
controlled trial)
http://bmj.com/cgi/content/full/322/7296/1218
(Editorial: Written information for
treating minor illness)
http://bmj.com/cgi/content/full/322/7296/1193
Widespread distribution of information
booklets on minor
illness is unlikely to reduce demand for
health services and
therefore may have a limited role in the
National Health
Service, conclude two studies in this
week's BMJ.
The first study included almost 4,000 patients
in England
who were sent either a booklet with information
on 40
common health problems (entitled 'What
should I do'), a
summary card covering mainly respiratory
illness, or a
leaflet giving the surgery times and how
to contact the
doctor in an emergency. Most patients
found the
information useful, and it helped their
confidence in
managing illness. A small reduction in
the number of
doctor-patient contacts in those receiving
information
booklets and leaflets was found, but the
effect on overall
contacts was not significant. "This raises
important
questions about whether such booklets
provide sufficient
benefit to justify the use of NHS funds,"
conclude the
authors.
The second study involved nearly 10,000
patients in
Scotland who were sent either the 'What
should I do'
booklet, a health care manual covering
50 common health
problems, or nothing. Again, receipt of
either booklet had
no significant effect on health service
use. The authors
conclude: "If reduction in demand for
services is the aim,
then more sophisticated interventions
are required which
build on the available evidence surrounding
patient
behaviour."
Such studies are welcome because, although
leaflets are
widely used, there is little evidence
about their usefulness,
writes primary care specialist, Dr Fitzmaurice,
in an
accompanying editorial. But he is not
surprised by their
findings. He believes that written material,
when given
within the context of a consultation,
may be useful as part
of a multifaceted approach to modifying
health seeking
behaviour.
Contacts:
[Paper 1]: Paul Little, MRC Clinician Scientist,
Primary
Medical Care Group, Aldermoor Health Centre,
Southampton, UK
Email: psl3{at}soton.ac.uk
[Paper 2]: David Heaney, Research Fellow,
Department
of Community Health Sciences, University
of Edinburgh,
Edinburgh, UK
Email: david.heaney{at}ed.ac.uk
[Editorial]: D A Fitzmaurice, Senior Lecturer,
Department
of Primary Care and General Practice,
University of
Birmingham Medical School, Birmingham,
UK
Email: D.A.Fitzmaurice{at}bham.ac.uk
(4) BMJ EDITOR
RESIGNS AFTER UNIVERSITY
ACCEPTS TOBACCO MONEY
(News: Editor resigns from post after
tobacco gift)
http://bmj.com/cgi/content/full/322/7296/1200/e
Dr Richard Smith, editor of the BMJ, has
resigned from
his position as professor of medical journalism
at the
University of Nottingham, following its
acceptance of
£3.8m from British American Tobacco
(BAT) to fund an
international centre for the study of
corporate social
responsibility.
The decision was made by readers, who were
asked to
vote on bmj.com whether the university
should return the
money and whether Dr Smith should resign
as professor
of medical journalism if it didn't.
Of 1075 people who voted online during
4-10 May, 84%
were in favour of the university returning
the money and
54% felt that Dr Smith should resign if
it refused.
In a letter to Sir Colin Campbell, the
university's vice
chancellor, Dr Smith describes the university's
acceptance
of the money as "a serious mistake and
has damaged the
university." He explains that the reason
the vote on
whether he should resign was much closer
than the vote
on returning the money was "because people
were divided
over whether I should dissociate myself
from the
University or stay in position and argue
my case."
"I am resigning both because I said that
I would do what
the BMJ's readers said I should do and
because I've
argued so strongly that the University
shouldn't have taken
this money," he writes.
A full copy of the letter will be available
on bmj.com at
00:01 hours, Friday 18 May 2001 (UK time).
Contact:
Richard Smith, Editor, BMJ, BMA House,
London, UK (via Emma Wilkinson, Press
Officer)
Email: ewilkinson{at}bmj.com
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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