Saturday 12 January 2002
No 7329 Volume 324
Please remember to credit the BMJ as source when publicising
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the source BMJ article (URL's are given under titles).
(1)ASPIRIN PROTECTS PATIENTS AT HIGH RISK OF HEART ATTACK OR STROKE
(2) FLU IS NOT TO BLAME FOR EXCESS WINTER DEATHS
(3) OVERCOMING THE PROBLEMS OF PERFORMANCE LEAGUE TABLES
(4) GIVING PATIENTS MORE INFORMATION REDUCES ANTIBIOTIC USE
(1) ASPIRIN PROTECTS PATIENTS AT HIGH RISK OF HEART ATTACK OR STROKE
(Collaborative meta-analysis of randomised trials of antiplatelet
therapy for prevention of death, myocardial infarction, and stroke
in high
risk patients)
http://bmj.com/cgi/content/full/324/7329/71
Aspirin (or another antiplatelet drug)
protects patients at high risk of
serious vascular events, such as heart
attack or stroke, and should be
considered routinely for all such patients,
concludes a study in this
week's BMJ.
Researchers reviewed 287 trials, involving
over 200,000 patients, that
compared an antiplatelet drug with a control
or compared different
antiplatelet drugs.
They found that antiplatelet therapy reduced
the risk of any serious
vascular event by about one quarter; risk
of non-fatal heart attack was
reduced by one third, non-fatal stroke
by one quarter, and vascular death
by one sixth. Low dose aspirin (75-150mg
daily) seemed to be as effective
as higher doses for long term use.
In each of these high risk categories,
the benefits of antiplatelet therapy
far outweighed any hazards, yet only about
half (or less) of all patients
with a history of heart attack, angina,
or heart disease are currently
receiving antiplatelet therapy, say the
authors. These results clearly show
that it should be considered routinely
for all patients at high or
intermediate risk of vascular disease,
and it should be continued for as
long as the risk remains high.
In some clinical circumstances, adding
a second antiplatelet drug to
aspirin may produce additional benefits,
but more research into this
strategy is needed, they conclude.
An editorial and debate article accompanies this study.
Contact:
Antithrombotic Trialists' Collaboration,
Clinical Trial Service Unit,
Radcliffe Infirmary, Oxford, UK
(2) FLU IS NOT TO BLAME FOR EXCESS WINTER DEATHS
(Excess winter mortality: influenza or cold stress? Observational
study)
http://bmj.com/cgi/content/full/324/7329/89
Cold weather rather than influenza is to
blame for excess deaths and
demands on health services in winter,
according to a study in this week's
BMJ.
Researchers in London analysed deaths in
south east England from 1970 to
1999 for all causes and for influenza.
The maximum and minimum temperature
at Heathrow Airport each day was used
to assess the relation between
temperature and death. Annual deaths related
to influenza were then
calculated.
Of 1,265 annual excess winter deaths per
million over the last 10 years,
only 2.4% were due to influenza. Nationally,
these excess winter deaths
total 50,000 per year. The decline in
influenza related deaths is probably
due to immunisation and to a reduction
in the number of new viral strains,
say the authors.
With influenza causing such a small proportion
of excess winter deaths,
measures to reduce cold stress offer the
greatest opportunities to reduce
current levels of winter mortality. Campaigns
to reduce exposure to cold
outdoors provide obvious scope for future
preventive action, they conclude.
Contact:
William Keatinge, Emeritus Professor,
Division of Biomedical Sciences,
Queen Mary and Westfield College, London,
UK
Email: w.r.keatinge{at}qmul.ac.uk
(3) OVERCOMING THE PROBLEMS OF PERFORMANCE LEAGUE TABLES
(Performance league tables: the NHS
deserves better )
http://bmj.com/cgi/content/full/324/7329/95
NHS performance league tables are misleading
and should be replaced by a
more user friendly method of assessing
health service performance, argue
researchers in this week's BMJ.
There is little doubt that NHS providers
generally oppose the publication
of league tables and that publication
has a negative impact on public trust
and professional morale. Furthermore,
while the public has a right to know
about the quality of services, it is irresponsible
to provide information
that is of questionable validity or difficult
to comprehend, write the
authors.
Control charts are an alternative method,
used in the manufacturing
industry, that could be introduced in
their place, suggest the authors.
They overcome these problems by displaying
performance without ranking, and
promoting the use of a systems approach
to quality improvement.
This technique would have the dual advantage
of being less threatening to
providers of health services and would
be more easily understood and
correctly interpreted by patients, auditors,
and commissioners of services,
they conclude.
Contact:
Andrew Rouse, Senior Lecturer, Department
of Public Health and
Epidemiology, University of Birmingham,
Birmingham, UK
Email: andrew.rouse{at}hq.birminghamha.wmids.nhs.uk
(4) GIVING PATIENTS MORE INFORMATION REDUCES ANTIBIOTIC USE
(Reducing antibiotic use for acute bronchitis in primary care: blinded,
randomised controlled trial of patient information leaflet)
http://bmj.com/cgi/content/full/324/7329/91
General practitioners prescribe antibiotics
to three-quarters of UK adults
with acute bronchitis each year, even
though there is little evidence to
justify it. Yet, a study in this week's
BMJ finds that reassuring these
patients and sharing the uncertainty about
prescribing in an information
leaflet reduces antibiotic use.
In this study, over 250 adults with acute
bronchitis were divided into two
groups. In group A, 212 patients were
judged by their general practitioner
not to need antibiotics that day, but
were given a prescription to use if
they got worse and verbal reassurance.
Half of them were also given a
simple information leaflet. All 47 patients
in group B were judged to need
antibiotics that day and were given a
prescription and encouraged to use
it, and nearly all did.
The patient information leaflet reduced
the use of antibiotics by nearly a
quarter. If these results are extrapolated
to national figures, about
750,000 fewer courses of antibiotics could
be prescribed each year, say the
authors.
Of course some patients with acute respiratory
illness do benefit from
antibiotics and should receive them, say
the authors. But for the many
patients (around 80%) for whom the general
practitioner thinks that
antibiotics are not needed, we have shown
that sharing uncertainty about
prescribing openly and honestly with the
patient is safe and effective and
reduces antibiotic use, they conclude.
Contact:
John Macfarlane, Consultant Physician,
Respiratory Medicine, Nottingham
City Hospital, Nottingham, UK
Email: john.macfarlane{at}tinyworld.co.uk
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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