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(2) CANNABINOIDS
MAY PREVENT CHEMOTHERAPY
RELATED SICKNESS
(3) RESUSCITATION
TRAINING NOT COMPULSORY IN
SOME UK MEDICAL
SCHOOLS
(4) TREATMENT
FOR MENSTRUAL PROBLEMS MAY BE
MISDIRECTED
(5) MORE
SENIOR DOCTORS NEEDED TO IMPROVE UK
EMERGENCY CARE
(1) CANNABINOIDS
GIVE NO MORE PAIN RELIEF
THAN CODEINE TABLETS
(Are cannabinoids an effective and
safe treatment option in the
management of pain? A qualitative
systematic review)
http://bmj.com/cgi/content/full/323/7303/13
(Editorial: Cannabinoids for pain
and nausea)
http://bmj.com/cgi/content/full/323/7303/2
Cannabinoids (the active substances in
cannabis) are no more
effective than conventional analgesics
in controlling pain and
have undesirable side effects, concludes
a study in this week's
BMJ. Their introduction into mainstream
clinical practice for
pain management is therefore undesirable,
report the authors.
Campbell and colleagues reviewed nine trials,
involving over
200 patients, to establish whether cannabinoids
are an
effective and safe treatment option in
the treatment of acute or
long-term (chronic) pain. In all trials,
cannabinoids were given
as tablets or by intramuscular injection.
The authors found no
studies on smoked cannabis.
In eight of the nine trials, cannabinoids
were no more effective
than codeine tablets in controlling acute
and chronic pain.
Furthermore, side effects associated with
the cannabinoids
were common and sometimes severe.
In acute postoperative pain, cannabinoids
are unlikely to be
useful, but may be effective in chronic
non-cancer pain, say
the authors. Cannabis is clearly unlikely
to usurp existing
effective treatments for postoperative
pain, they conclude.
Contact:
Fiona Campbell, Consultant in Anaesthetics
and Pain
Management, Pain Management Centre, Queen's
Medical
Centre, Nottingham, UK
Email: fiona.campbell@mail.qmcuh-tr.trent.nhs.uk
(2) CANNABINOIDS
MAY PREVENT CHEMOTHERAPY
RELATED SICKNESS
(Cannabinoids for control of chemotherapy
induced nausea
and vomiting: quantitative systematic
review)
http://bmj.com/cgi/content/full/323/7303/16
(Editorial: Cannabinoids for pain
and nausea)
http://bmj.com/cgi/content/full/323/7303/2
Cannabinoids (the active substances in
cannabis) are more
effective than conventional drugs at preventing
nausea and
vomiting in patients undergoing chemotherapy,
and patients
prefer them, finds a study in this week's
BMJ. However,
potentially serious side effects, even
when taken short term,
are likely to limit their widespread use,
conclude the authors.
Thirty trials, involving over 1300 patients,
were analysed to
quantify the effectiveness and safety
of cannabis in preventing
sickness induced by chemotherapy. Three
different
cannabinoids were given either as tablets
or by intramuscular
injection.
Across all trials, cannabinoids were more
effective than
conventional anti-sickness drugs, although
no difference was
found for patients receiving very low
or very high levels of
chemotherapy. Most patients also preferred
cannabinoids for
future chemotherapy cycles. Patients reported
more side
effects with cannabinoids than with conventional
drugs.
Although some were potentially beneficial
(euphoria, "high",
sedation or drowsiness), others were harmful
(dizziness,
depression, hallucinations).
These results offer arguments both for
and against the use of
cannabinoids in chemotherapy patients,
say the authors. They
suggest that, in selected patients, cannabinoids
may be useful
as mood enhancing aids for controlling
chemotherapy related
sickness.
Contact:
Martin Tramer, Staff Anaesthetist. Departement
d'Anaesthesiologie, Hopitaux Universitaires,
Geneve,
Switzerland
Email: martin.tramer@hcuge.ch
(3) RESUSCITATION
TRAINING NOT COMPULSORY IN
SOME UK MEDICAL SCHOOLS
(Training in basic and advanced life
support in UK medical
schools: questionnaire study)
http://bmj.com/cgi/content/full/323/7303/22
Researchers in this week's BMJ find that
some UK medical
schools do not provide compulsory resuscitation
training and
that the extent of training in other schools
is variable, even
though newly qualified doctors are expected
to take part in
resuscitation from their first day.
Both the General Medical Council and The
Royal College of
Physicians recommend training during the
undergraduate
course, but there is no obligation on
medical schools or trusts
to provide a defined standard of resuscitation
training.
A survey was devised in consultation with
BMA student
representatives of all 27 UK medical schools.
Completed
questionnaires were received from 23 schools
and results
were sent to the deans of all 27 schools.
Three schools failed
to respond both to postal reminders and
to the mailings sent to
the deans.
The results show that most medical schools
provide some
form of compulsory advanced life support
training. However,
two (8%) of the medical schools do not
provide any
compulsory training, and it is possible
that the three schools
that failed to respond also provide no
training. Once students
qualify, their time for training is limited
and they have no
allocated study budget until after their
first year, explain the
authors. Those who attend advanced life
support courses
usually do so in their own time and with
their own money.
The authors believe that training in advanced
life support
should become a standardised and mandatory
component of
all medical school undergraduate curriculums,
but more work
needs to be done in evaluating the right
level of training for
medical students.
The launch of a one-day immediate life
support course by the
UK Resuscitation Council later this year
may provide optimal
standardised resuscitation training for
medical students,
conclude the authors.
Contact:
Seamus Phillips, Senior House Officer,
London
Email: seamusphillips@hotmail.com
(4) TREATMENT
FOR MENSTRUAL PROBLEMS MAY BE
MISDIRECTED
(Referral for menstrual problems:
cross sectional survey of
symptoms, reasons for referral,
and management)
http://bmj.com/cgi/content/full/323/7303/24
Many women who seek help for menstrual
problems are
referred to gynaecology clinics for treatment
of menorrhagia
(excessive blood loss during menstruation)
when actually they
have pain or broader problems with their
period. This may
result in women receiving inappropriate
care, conclude the
study authors in this week's BMJ.
A research team in Scotland surveyed 952
women, newly
referred for menstrual complaints to gynaecology
clinics in
Glasgow and Edinburgh, about their menstrual
experience and
their main reason for seeking help. Responses
were compared
to reasons for referral extracted from
general practitioners'
letters.
Only 38% of women reported excessive menstrual
loss as a
severe problem. However, 76% of general
practitioners gave
it as the predominant reason for referral.
Overall, of the 725
women referred for excessive bleeding,
less than half had
reported it as a reason for seeking help.
This tendency for women's menstrual complaints
to be
interpreted as excessive bleeding at referral
and during
treatment is a concern because treatment
typically involves
potent drugs or invasive surgery, with
60% of women having
hysterectomy within 5 years. It may also
explain the finding in
other studies that the majority of women
referred with
menorrhagia have a normal volume of blood
loss. Assessment
of menstrual complaints needs to be reviewed,
conclude the
authors.
Contact:
Pamela Warner, Lecturer in Medical Statistics,
Department of
Community Health Sciences, University
of Edinburgh Medical
School, Edinburgh, Scotland.
Email: p.warner@ed.ac.uk
(5) MORE SENIOR
DOCTORS NEEDED TO IMPROVE UK
EMERGENCY CARE
(Improving care in accident and emergency
departments)
http://bmj.com/cgi/content/full/323/7303/39
A study in this week's BMJ finds that most
care in accident
and emergency departments in the United
Kingdom is
delivered by junior medical staff, often
in their first
post-registration job. As a result, many
patients attending
these departments could be managed better.
Researchers at Derriford Hospital in Plymouth
analysed 56
studies published between 1996 and 2000
that were critical of
accident and emergency care in the UK.
Problems were found
in 35 different areas. Doctors bore the
criticism in about half
of the studies. Other criticisms were
directed at various
aspects of service provision, and almost
all the studies made
some recommendations for improvement.
The authors conclude that more middle and
senior grade
doctors are needed to improve the standard
of care. This
would allow more experienced doctors to
participate in the
care of most or all patients and would
also allow junior staff to
spend an introductory period shadowing
a more experienced
doctor, before starting clinical work.
The UK government believes that there must
be a "guarantee
of excellence for all patients." Most
doctors would agree with
this aim, but the cost must be acknowledged,
write the
authors. An excellent service is not achievable
when an
emergency department is staffed mainly
by senior house
officers, they add.
Contact:
Lee Wallis, Accident and Emergency Department,
Derriford
Hospital, Plymouth, UK.
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