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(2) NO
BENEFIT TO "NIL BY MOUTH" AFTER
SURGERY
(3) STUDY
CASTS DOUBT OVER VALUE OF
POPULAR PMS
TREATMENT
(4) PUBLIC
SATISFACTION WITH DOCTORS
HIGH, DESPITE
BAD PRESS
(5) NHS
POLICIES FAIL TO STRIKE A BALANCE
BETWEEN EQUITY
AND EFFICIENCY
(1) COMMUNICATION
PROBLEMS AFFECT ONE
IN FOUR 999 AMBULANCE CALLS
(Communication difficulties during
999 ambulance calls:
observational study)
http://bmj.com/cgi/content/full/323/7316/781
Communication problems affect more than
a quarter of
emergency ambulance calls, finds a study
in this week's
BMJ.
A sample of 999 calls received by West
Midlands
Ambulance Service and Derbyshire Ambulance
Service
during one week of December 1998 was assessed
for
communication difficulties.
Of 1830 calls, 26% were associated with
a
communication problem that delayed ambulance
dispatch or prevented delivery of first
aid advice. The
emotional state of the caller was the
most common
reason for communication problems occurring.
Calls
from mobile phones and payphones also
generated a
higher rate of problems than those from
land lines.
Although the increasing use of mobile phones
may help
to reduce the time taken to notify the
emergency
services, the advantages of this must
be weighed against
the high rate of communication problems,
stress the
authors. Problems related to the emotional
state of the
caller highlights the need to train call
receivers in dealing
with people in emotional states, they
add.
Use of a standard land line, appropriate
training of
public service personnel, such as police
and fire
services, and further public education
about the
information required when making 999 calls
may reduce
the extent of communication problems,
they conclude.
Contact:
Matthew Cooke, Senior Lecturer, Emergency
Medicine Research Group, University of
Warwick,
Coventry, UK
(2) NO BENEFIT
TO "NIL BY MOUTH" AFTER
SURGERY
(Early enteral feeding versus "nil
by mouth" after
gastrointestinal surgery: systematic
review and
meta-analysis of controlled trials)
http://bmj.com/cgi/content/full/323/7316/773
(Editorial: Postoperative starvation
after gastrointestinal
surgery)
http://bmj.com/cgi/content/full/323/7316/761
There is no benefit in keeping patients
"nil by mouth" (a
period of starvation) after gastrointestinal
surgery,
suggests a study in this week's BMJ. These
findings
should challenge doctors to consider starting
early
feeding in these patients.
Eleven trials comparing enteral (tube)
feeding within 24
hours after surgery with nil by mouth
management were
reviewed. Not only was there little evidence
that
keeping patients nil by mouth is beneficial
after surgery,
but early feeding reduced the risk of
infection and
shortened hospital stay.
These studies alone are insufficient to
conclude that
early feeding is of proved benefit, say
the authors, but
we believe that there is a good case for
a high quality
trial to confirm or refute the benefits
of this treatment,
they conclude.
These results provide compelling arguments
in favour of
a change in clinical practice, write two
consultants at the
Central Middlesex Hospital, in an accompanying
editorial. They suggest that such a trial
should also
assess surgical fatigue, muscle function,
quality of life
after discharge from hospital, and cost
effectiveness.
Contact:
Steven Thomas, Senior Lecturer, Department
of
Maxillofacial Surgery, University of Bristol,
UK Mob:
Email: steve.thomas@bristol.ac.uk
(3) STUDY CASTS
DOUBT OVER VALUE OF
POPULAR PMS TREATMENT
(Efficacy of progesterone and progestogens
in
management of premenstrual syndrome:
systematic
review)
http://bmj.com/cgi/content/full/323/7316/776
Treatment of premenstrual syndrome with
the hormone
progesterone or progestogens (a group
of drugs similar
to progesterone) is unlikely to be effective,
despite the
continued popularity of these treatments
in the United
Kingdom and the United States, concludes
a study in
this week's BMJ.
Researchers at Keele University reviewed
14 trials of
progesterone or progestogen therapy, involving
over
900 women with premenstrual syndrome.
They found
no evidence to support the claimed effectiveness
of
progesterone and suggest that progestogens
are also
unlikely to be effective in the management
of
premenstrual syndrome.
This is not surprising, as there are reliable
data to refute
the theory the premenstrual syndrome is
caused by a
progesterone deficiency, say the authors.
With this
review, there is no convincing evidence
to support the
continued prescription of progesterone
or progestogens
for the management of premenstrual syndrome,
they
conclude.
Contacts:
Shaughn O'Brien, Head of Academic Obstetrics
and
Gynaecology or Paul Dimmock, Research
Fellow
Keele University and North Staffordshire
Hospital,
Stoke-on-Trent, UK
Email: pma06@keele.ac.uk
or
oga03@keele.ac.uk
(4) PUBLIC SATISFACTION
WITH DOCTORS
HIGH, DESPITE BAD PRESS
(Bad press for doctors: 21 year survey
of three national
newspapers)
http://bmj.com/cgi/content/full/323/7316/782
National newspapers in the UK contain twice
as many
negative stories about doctors as positive
ones, yet
89% of the public remain satisfied with
the way that
doctors do their jobs, finds a study in
this week's BMJ.
Every article published about doctors in
the Daily
Telegraph, Guardian, and Daily Mail in
November from
1980 to 2000 were studied and coded as
positive,
negative, or neutral towards doctors.
Taken together, the Daily Telegraph, Guardian,
and
Daily Mail contained more than twice as
many negative
stories about doctors as positive ones,
but there was no
significant change in the ratio of negative
to positive
stories over time. The total number of
articles about
doctors increased over time.
Several peaks in negative reports were
related to
several incidents being reported at the
same time (for
example, Dr Kervokian, Dr Shipman, and
Mr Ledward
in 1998-9). This suggests that UK newspapers
respond
to incidents, rather than deliberately
campaigning against
doctors, say the authors.
"Although we did not directly measure the
language
used to describe doctors, we noticed that
it seems to
have become more negative. In spite of
this, 89% of the
public is satisfied with the way that
doctors do their
jobs," they conclude.
Contact:
Peter White, Senior Lecturer, St Bartholomew's
and
the Royal London School of Medicine and
Dentistry,
Queen Mary College, London, UK
Email: p.d.white@mds.qmw.ac.uk
(5) NHS POLICIES
FAIL TO STRIKE A BALANCE
BETWEEN EQUITY AND EFFICIENCY
(Equity versus efficiency: a dilemma
for the NHS)
http://bmj.com/cgi/content/full/323/7316/762
The NHS is facing a dilemma between the
goals of
equity and efficiency. An editorial in
this week's BMJ
reports that there is no consensus on
how to deal with
policies that may cause conflict, often
leading to
inconsistent judgements in the development
of health
policies.
The authors cite several examples of inconsistency
among current NHS policies. For instance,
using
economic incentives to general practitioners
to maximise
coverage of cervical cancer screening
fails to address
the issue of low participation by many
women at high
risk (particularly those in disadvantaged
socioeconomic
groups).
Likewise, the policy indicating when universal,
rather
than selective, screening for sickle cell
disease in
newborn babies should be used may reflect
an
aspiration to equal access for equal need,
but at a very
high cost.
More examples of inconsistency can be found
among
current NHS policies, say the authors.
But is it realistic
to expect health policymakers to address
the equity
versus efficiency dilemma? Recent evidence,
showing a
complete neglect of the equity dimension
in studies of
healthcare economic evaluations, suggests
that both
researchers and policy makers share responsibility
for
the inconsistent pursuit of equity in
the NHS, they
conclude.
Contact:
Franco Sassi, Lecturer in Health Policy,
London School
of Economics and Political Science, London,
UK
Email: f.sassi@lse.ac.uk
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