This week in the BMJ
Volume 324, Number 7340, Issue of 30 Mar 2002Neonatal autopsies give valuable information
Neonatal autopsies give valuable information
Over a quarter of neonatal autopsies yield important new information,
and in 3% of cases this information is crucial for future counselling.
Brodlie and colleagues (p 761) say that these findings are likely to be
of use to bereaved families when they are considering giving permission
for an autopsy. They are also relevant in view of the recent negative
publicity surrounding neonatal autopsies and the general decline in the
neonatal autopsy rate.
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Allergens and viruses act together to exacerbate asthma
Common allergens and viruses may act together to exacerbate asthma.
Green and colleagues (p 763) found that 66% of patients admitted to
hospital with asthma were sensitised and exposed to house dust mite or
cat or dog allergens compared with patients with stable asthma (37%)
and inpatient controls (15%). They suggest that domestic exposure to
allergens acts synergistically with viruses in sensitised patients,
increasing the risk of hospital admission.
(Credit: HARTLEY/REX) 
(Credit: BURGESS/SPL)
Renal colic shows a circadian pattern
Episodes of renal colic show a highly significant circadian pattern,
with a morning peak and an afternoon low. Manfredini and colleagues
(p 767) reviewed all episodes of renal colic in an emergency
department over a six year period and found this pattern in both men
and women. They say that the reason for this observation is that the
lithogenic risk for calcium oxalate stones is highest when urine output
is minimal, usually at the end of the night or during the early
morning.
Autologous blood transfusion is more cost effective than allogenic transfusion
Autologous blood transfusion is more cost effective than allogenic
transfusion and has better clinical outcomes. Autologous transfusion
currently accounts for over 5% of blood donated in the United States
and some European countries. It is used much less in the United
Kingdom. It is one of several techniques used since the AIDS epidemic
of the early 1980s to reduce the need for allogenic transfusion. In
their clinical review, Vanderlinde and colleagues (p 772) discuss the
three main types of autologous transfusion: predeposit transfusion
(which requires repeated preoperative phlebotomy), intraoperative
haemodilution (where whole blood is removed preoperatively in the
operating theatre and replaced with crystaloid or colloid), and
intraoperative and postoperative salvage (where blood lost during
surgery is collected and reinfused).
(Credit: TEKIMAGE/SPL)
Flowcharts in children's notes increase documentation of possible intentional injury
A simple flowchart added to the attendance notes of all injured
preschool children increases documentation of possible intentional injury and improves referral rates. In a quality improvement report, Benger and Pierce (p 780) discuss how a two stage audit of 1000 children before and after a reminder flowchart was used resulted in
more referrals for further assessment. Records of compatibility of
history with injury and consistency of injury increased from less than
2% to more than 70%. The second audit showed an increased general
level of awareness and vigilance, even for children whose records
did not contain a flowchart.
(Credit: MARAZZI/SPL)
Diagnostic tests are overused
General practitioners may need more help in explaining to their
patients the rationale of using, or not using, some diagnostic tests.
Winkens and Dinant (p 783) explain that in daily practice doctors'
decisions are often affected by pressure from patients. They recommend
intervention to reduce the often illogical overuse of diagnostic tests
and suggest using a combination of methods to influence doctors' behaviour.
Triple combination therapy for HIV is effective
New evidence supports the use of up to three antiretroviral drugs to
treat people with HIV. Jordan and colleagues (p 757) report that
combinations of up to three drugs are consistently and significantly
more effective, but there is inadequate evidence on the effectiveness
of four or more drugs. Further work is needed on the effectiveness of
quadruple therapies and the relative effectiveness of specific
combinations of drugs.
(Credit: SUSAN STERNER/SPL)
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