Releases Saturday 21 July 2001
No 7305 Volume 323
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(1) NEW STUDY SUPPORTS VIEW THAT THIRD
GENERATION PILL INCREASES RISK OF BLOOD
CLOTS
(2) STUDY
CASTS DOUBT ON VALUE OF EMERGENCY
BREATHING PROCEDURE
(3) PSYCHOTHERAPY CAN HELP SUICIDAL PATIENTS
(4) NHS
BREAST SCREENING TARGETS NEED TO BE
REVIEWED
(5) PATIENTS
RESISTANT TO BLOOD PRESSURE
TREATMENT DO
TAKE THEIR DRUGS
(1) NEW STUDY
SUPPORTS VIEW THAT THIRD
GENERATION PILL INCREASES RISK OF BLOOD
CLOTS
(Third generation oral contraceptives
and risk of venous
thrombosis: meta-analysis)
http://bmj.com/cgi/content/full/323/7305/131
(Editorial: The third generation
pill controversy ("continued"))
http://bmj.com/cgi/content/full/323/7305/119
Women taking third generation oral contraceptives
have a 1.7
fold increased risk of venous clotting
(thrombosis) compared
with those taking second generation oral
contraceptives,
concludes a study in this week's BMJ.
Although the risks are
small, they should be considered when
deciding which
contraceptive pill to use, report the
authors.
Researchers at the University Medical Centre
Utrecht in the
Netherlands pooled the results of studies
assessing risk of
venous clotting among women using oral
contraceptives
before October 1995. The team chose October
1995 as the
end date because at that time four studies
were published
highlighting the possible risk of third
generation pills, which
may have affected the results of later
studies. A sensitivity
analysis was applied to the results of
each study to ensure an
accurate estimate of overall risk.
Previous trials linking third generation
oral contraceptives to
venous thrombosis have been vigorously
debated, with
suggestions that flaws in the design and
analysis of the studies
can explain their findings. Although bias
can never be excluded
with certainty in some studies, say the
authors, the biases were
not large enough to account for the observed
results in our
analysis.
Contact:
Linda Minnen or Marjan Wolters, Public
Relations, University
Medical Center Utrecht, Utrecht, The Netherlands.
Email: M.Wolters{at}azu.nl
(2) STUDY CASTS
DOUBT ON VALUE OF EMERGENCY
BREATHING PROCEDURE
(Survival of trauma patients who
have prehospital tracheal
intubation without anaesthesia or
muscle relaxants:
observational study)
http://bmj.com/cgi/content/full/323/7305/141
For more than 20 years, paramedics in Britain
have performed
emergency intubation (passing a breathing
tube into the
windpipe to deliver oxygen to the lungs
of trauma patients)
without using anaesthesia. Yet a study
in this week's BMJ
finds that less than one per cent of these
patients survive,
casting serious doubt on the value of
this practice.
Over a six year period, researchers at
the Royal London
Hospital identified trauma patients who
had been intubated
outside hospital and without the use of
drugs by paramedics or
doctors. Of 486 patients, one survived
to hospital discharge.
Even in parts of the United States, where
it is standard
practice for paramedics and nurses to
use drugs to facilitate
prehospital intubation, failed intubation
rates can be high, say
the authors.
As almost all the trauma patients intubated
without the use of
drugs died, the value of this practice
is doubtful and deserves
further scrutiny, conclude the authors.
Contact:
Gareth Davies, Consultant in Accident and
Emergency and
Prehospital Care, Royal London Hospital,
London, UK
Email: gareth.davies{at}bartsandthelondon.nhs.uk
(3) PSYCHOTHERAPY CAN HELP SUICIDAL PATIENTS
(Randomised controlled trial of brief
psychological intervention
after deliberate self poisoning)
http://bmj.com/cgi/content/full/323/7305/135
(Commentary: Another kind of talk
that works?)
http://bmj.com/cgi/content/full/323/7305/135
Deliberate self poisoning is one of the
commonest reasons for
admission to hospital in the United Kingdom,
but there are no
effective treatments available. However,
a study in this week's
BMJ finds that psychotherapy may be a
valuable treatment for
these patients. This finding could be
a first step towards
improving the management of suicidal behaviour.
Over 100 adults who attended a hospital
emergency
department after deliberately poisoning
themselves were
included in the study. Patients were randomly
allocated to two
groups. The intervention group received
four sessions of
psychological therapy at their home. The
control group
received routine care, which in most cases
consisted of
referral back to their general practitioner.
After six months, patients receiving therapy
had less suicidal
thoughts compared with those receiving
routine care. They
were also more satisfied with their treatment
and were less
likely to report repeated attempts to
harm themselves.
These results are promising, but larger
studies in different
locations are needed to establish the
potential costs and
benefits of such treatments for patients
who poison
themselves, conclude the authors.
Contact:
Elspeth Guthrie, Senior Lecturer in Liaison
Psychiatry,
University of Manchester, Manchester Royal
Infirmary,
Manchester, UK
Email: elspeth.a.guthrie{at}man.ac.uk
(4) NHS BREAST
SCREENING TARGETS NEED TO BE
REVIEWED
(Risk of breast cancer in women who
attend the NHS breast
screening programme: cohort study)
http://bmj.com/cgi/content/full/323/7305/140
Women who attend the NHS breast screening
programme
have a higher risk of breast cancer than
women who decline to
participate, finds a study in this week's
BMJ. This "self
selection" for screening has important
implications for NHS
breast cancer detection targets.
Researchers at the University of Manchester
investigated over
40,000 women who were invited to participate
in the regional
NHS breast screening programme between
1989 and 1990.
Overall, 82% attended on at least one
occasion and 18%
never attended.
The number of non-attenders diagnosed with
breast cancer
was significantly less than expected,
suggesting that their risk
of breast cancer is lower than that in
the population targeted
for screening. Therefore, the risk in
those who attend must be
higher, say the authors. This might occur,
for example, if
women with a family history of breast
cancer were more likely
to attend.
These findings suggest that the proportion
of breast cancers
potentially detectable by screening is
higher than expected
when cancer targets were set. This may
partially explain the
apparent paradox that high interval cancer
rates have been
reported in the NHS breast screening programme
despite
many screening centres achieving their
detection targets, say
the authors. These targets now need to
be revisited, they
conclude.
Contact:
Ciaran Woodman, Professor of Cancer Epidemiology
and
Public Health, University of Manchester,
Withington,
Manchester, UK
Email: Ciaran.woodman{at}cce.man.ac.uk
(5) PATIENTS RESISTANT
TO BLOOD PRESSURE
TREATMENT DO TAKE THEIR DRUGS
(Relation between insufficient response
to antihypertensive treatment
and poor compliance with treatment:
a prospective
case-control study)
http://bmj.com/cgi/content/full/323/7305/142
Poor compliance with treatment is believed
to be the most
frequent reason why many patients with
high blood pressure
(hypertension) do not respond to drug
treatment. However, a
study in this week's BMJ finds no difference
in compliance
between treatment resistant and treatment
responsive patients.
Researchers at the University Hospital
in Basle, Switzerland
identified 103 patients with hypertension
who had been taking
between two and four drugs for at least
one month. Using
electronic pill boxes that record every
opening, they monitored
whether patients took their medication
over four weeks.
(Patients who took 80% or more of their
prescribed doses
were considered to be compliant).
No difference in compliance was found.
Forty (82%) of the
49 treatment resistant patients were compliant,
while 46
(85%) of the 54 patients responsive to
treatment were
compliant.
These findings challenge the common assumption
that
non-compliance with treatment occurs more
in patients not
responsive to antihypertensive drugs,
say the authors. They
suggest that other factors should be examined
to explain
treatment resistance.
Contact:
Edouard Battegay, Assistant Professor of
Internal Medicine,
University Hospital, Basle, Switzerland
Email: ebattegay{at}uhbs.ch
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