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(2) SIMPLE
TEST FOR ASTHMA PATIENTS PREDICTS
LENGTH OF HOSPITAL
STAY
(3) PERINEAL
MASSAGE IN LABOUR FAILS TO
PREVENT PERINEAL
DAMAGE
(4) MUCOLYTIC
DRUGS MAY BENEFIT PATIENTS
WITH SEVERE
PULMONARY DISEASE
(1) OVER A THIRD
OF DEATHS AFTER DISCHARGE
FROM INTENSIVE CARE ARE PREVENTABLE
(Reduction in mortality after inappropriate
early discharge
from intensive care unit: logistic
regression triage model)
http://bmj.com/cgi/content/full/322/7297/1274
Death after discharge from intensive care
may be reduced
by 39% if at risk patients were to stay
in intensive care for
another 48 hours, finds a study in this
week's BMJ.
Data from nearly 14,000 patients who were
discharged
from 20 UK intensive care units from 1989
to 1998 were
used to develop a predictive model to
identify those most at
risk from inappropriate early discharge.
Thirty-four per cent
of patients were identified as at risk
and had a discharge
mortality of 25% compared with a 4% mortality
among
those not at risk.
The researchers calculated that, if these
patients were to
stay in intensive care for another two
days, mortality after
discharge could be reduced by 39%, although
this would
require an estimated 16% more intensive
care beds.
The model may help doctors to make the
difficult clinical
decision of whom to discharge to make
room for a patient
requiring urgent admission to the unit,
say the authors.
However, neither this, nor discharge guidelines
published by
the Department of Health in 1996, will
have much impact
until and unless the shortfall in provision
of intensive care
beds is corrected, they conclude.
Contact:
R W S Chang, Consultant Transplant Surgeon,
St George's
Hospital, London, UK
Email: renechang@compuserve.com
(2) SIMPLE TEST
FOR ASTHMA PATIENTS PREDICTS
LENGTH OF HOSPITAL STAY
(Peak expiratory flow sequence in
acute exacerbations of
asthma)
http://bmj.com/cgi/content/full/322/7297/1281
Measuring the change in a patient's ability
to blow three
times in quick succession into a peak
flow meter during an
acute asthma attack predicts the length
of time they will
stay in hospital. If confirmed, use of
this simple measure
could improve patient outcome, say the
authors of a
research pointer in this week's BMJ.
The team recruited 43 successive patients
presenting with
acute exacerbation of asthma to two hospitals.
Each patient
was asked to blow deeply, three times,
into a peak flow
meter, ensuring a gap of less than 10
seconds between
blows. Using these three sequential readings,
the team
calculated the ratio of the first to last
peak expiratory flow
(last:first ratio) by dividing the third
peak expiratory flow by
the first and related this to length of
hospital stay.
Fifteen patients had a last:first ratio
of less than 1, and 28
had a ratio of 1 or more. Length of hospital
stay for the
group with a ratio of less than 1 was
three days compared
with only one day for the group with a
ratio of 1 or more.
This association suggests that the change
in flow with
repeated blows is likely to reflect a
physiological
phenomenon such as the effects of deep
inspiration on
airway calibre, explain the authors. Patients
with a low ratio
therefore might have recovered more slowly
because of
greater inflammation of their airways,
they conclude.
Contact:
Dr Chris Brightling, Clinical Research
Fellow, Department
of Respiratory Medicine, Glenfield Hospital,
Leicester, UK
Email: chris.brightling@uhl-tr.nhs.uk
(3) PERINEAL MASSAGE
IN LABOUR FAILS TO
PREVENT PERINEAL DAMAGE
(Perineal massage in labour and prevention
of perineal
trauma: randomised controlled trial)
http://bmj.com/cgi/content/full/322/7297/1277
Damage to the perineum (the area between
the genital
organs and the anus) during vaginal birth
affects the
sexuality, self esteem and quality of
life of countless women
every year. However, a study in this week's
BMJ finds that
perineal massage during labour does not
have any effect on
the likelihood of an intact perineum or
reduce the risk of
persistent pain, sexual, urinary and faecal
problems after
childbirth.
Over 1300 women expecting a normal vaginal
birth of a
single baby were randomised into two groups.
Women in
the intervention group received massage
and stretching of
the perineum with each contraction during
the second stage
of labour. For women in the control group,
midwives were
instructed to use their usual technique,
but to refrain from
using perineal massage.
The research team found no benefit from
massage on rates
of intact perineums and damage, pain,
or urinary, faecal,
and sexual problems. There were fewer
serious (third
degree) tears in the massage group, but
larger trials are
needed to assess whether massage can protect
against the
risk of this rarer outcome, add the authors.
Despite these findings, this trial does
show that perineal
massage is not harmful, and that in itself
may be of value,
say the authors. "We suggest that midwives
follow their
usual practice while taking into account
the preferences of
individual women," they conclude.
Contact:
Georgina Stamp, Senior Research Fellow
(Adjunct),
University of South Australia, Adelaide,
Australia
Email: georgie.stamp@unisa.edu.au
(4) MUCOLYTIC
DRUGS MAY BENEFIT PATIENTS
WITH SEVERE PULMONARY DISEASE
(Oral mucolytic drugs for exacerbations
of chronic
obstructive pulmonary disease: systematic
review)
http://bmj.com/cgi/content/full/322/7297/1271
Patients who suffer frequent, prolonged
or severe
recurrences of chronic bronchitis and
chronic obstructive
pulmonary disease (COPD) may benefit from
regular use
of mucolytic drugs for at least two months,
according to a
review in this week's BMJ.
Mucolytic drugs are thought to help to
clear congestion in
the chest by reducing sputum viscosity,
but are not
prescribed for COPD in the United Kingdom
and
Australasia because they are thought to
be ineffective.
Researchers in New Zealand reviewed 23
trials that
compared at least two months of regular
oral mucolytic
drugs with placebo. They found that, compared
with
placebo, mucolytic therapy significantly
reduced the number
of recurrences and days of illness per
patient per month.
The number of patients who had no recurrences
in the
study period was greater in the mucolytic
group and there
was no difference in lung function or
in adverse events
reported between treatments.
Clinicians and patients will need to judge
for themselves
whether the reductions are large enough
to warrant daily
treatment for at least three to six months
a year, say the
authors. Nevertheless, if these findings
are confirmed, they
may help to reduce the illness and healthcare
costs
associated with progressively severe disease,
particularly in
patients who have frequent or prolonged
recurrences or
those who are repeatedly admitted to hospital,
they
conclude.
Contact:
Phillippa Poole, Senior Lecturer, Department
of Medicine,
University of Auckland, New Zealand
Email: p.poole@auckland.ac.nz
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