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(2) WHAT
CAUSES PATIENTS TO DELAY
SEEKING MEDICAL
HELP?
(3) HOSPITAL
MORTUARY SERVICES NEED
REGULAR INSPECTION
(4) SEX AT BIRTH LINKED TO LATITUDE
(5) STANDARDS
OF MEDICAL CARE ON
ADVENTURE HOLIDAYS
RAISE
CONCERNS
(1) SIMPLE BREATH
TEST MAY REPLACE
ENDOSCOPY
(Randomised trial of endoscopy with
testing for
Helicobacter pylori compared with
non-invasive H
pylori testing alone in the management
of dyspepsia)
http://bmj.com/cgi/content/full/324/7344/999
A simple breath test for detecting H pylori
infection
is as effective and safe as endoscopy
and is less
uncomfortable and distressing for the
patient,
conclude researchers in this week's BMJ.
The study involved 708 patients with indigestion
who had been referred to hospital for
endoscopic
investigation (examining the stomach using
a
tube-like viewing instrument).
A total of 356 patients received a non-invasive
breath test for H pylori and 352 received
endoscopy plus H pylori testing. Patients
were also
asked to score the degree of discomfort
or distress
caused by their test, and whether they
would have
the same test again.
After 12 months, non-invasive testing for
H pylori
was as effective and as safe as endoscopy.
Furthermore, it was as reassuring to the
patient as
endoscopy, less uncomfortable and distressing,
and
substantially cheaper than endoscopy.
"For these reasons, non-invasive H pylori
testing
seems to be the preferred investigation
for patients
with uncomplicated dyspepsia," conclude
the
authors.
Contact:
K McColl, Professor of Gastroenterology,
University Department of Medicine and
Therapeutics, Western Infirmary, Glasgow,
Scotland
Email: K.E.L.McColl@clinmed.gla.ac.uk
(2) WHAT CAUSES
PATIENTS TO DELAY
SEEKING MEDICAL HELP?
(Decision making processes in people
with
symptoms of acute myocardial infarction:
qualitative
study)
http://bmj.com/cgi/content/full/324/7344/1006
What causes patients with symptoms of a
heart
attack to delay seeking medical help?
Researchers in this week's BMJ interviewed
22
patients who had been admitted to hospital
with at
least one previous heart attack. Six themes
emerged that seemed to influence their
decision to
seek medical help.
Many patients thought that their symptoms
were
not severe enough to be a heart attack,
confusing
them with symptoms of angina or indigestion.
Some
who had already had treatment believed
they were
no longer at risk of another heart attack.
Twenty patients reported that the symptoms
were
not similar to those of any previous attack,
while
others admitted that, illogically, they
"hoped it
would go away."
All but one of the patients felt a concern
about
wasting NHS time and resources, especially
ambulances. Even those who had previously
been
told to phone an ambulance felt reluctant
to do so.
People were also reluctant to seek medical
help
during the night and at weekends.
The decision to seek medical help is a
complex
interaction of knowledge and experience,
beliefs,
emotions, and the context of the event,
say the
authors. Simply providing patients with
information
on symptoms of a heart attack, and what
to do in
the event of these symptoms, may not be
sufficient
to promote prompt action, they conclude.
Contact:
Jill Pattenden, Research Fellow, Department
of
Health Sciences, University of York, UK
Email: jp30@york.ac.uk
(3) HOSPITAL MORTUARY
SERVICES NEED
REGULAR INSPECTION
(Prospective audit of records of
deceased patients
received in hospital mortuary)
http://bmj.com/cgi/content/full/324/7344/1009
Recent stories about improper storage of
bodies
and organs in hospital mortuaries have
generated
public interest in both pathology and
mortuary
services.
A study in this week's BMJ suggests that
regular
audits are essential for a mortuary to
run effectively
and safely and to gain public confidence.
Researchers at the Walsall Hospitals NHS
Trust
audited the documents accompanying all
7,761
deceased patients in the hospital during
1996-2000. Bodies were received from funeral
directors and ambulance crews as well
as hospital
wards.
They checked wrist bands, labels, and identification
papers against the patients' registration
details for
any discrepancies. They also checked accuracy
of
recording the presence of a pacemaker
and
property for each body. Bodies for which
there
was one or more discrepancy were classified
as
failed cases.
In 1996-7, the failure rate for bodies
from all
sources was 10%. This figure fell in the
study
period to 3% in 1999-2000.
Although some of the discrepancies were
arguably
less important, such as errors in unit
number or
address, a substantial proportion could
have had
serious consequences, say the authors.
These
include misidentification of the body
(body received
in the mortuary with the wrong name) or
property
and non-identification of the pacemakers.
"The error rate fell during our study,
probably
because staff were regularly alerted to
errors as
part of the audit," say the authors. "We
therefore
believe that such audits are essential
to mortuary to
run effectively and safely and to gain
public
confidence."
Contact:
Ye Lin Hock, Consultant Histopathologist,
Walsall
Hospitals NHS Trust, Walsall, West Midlands,
UK
Email: Hocky@wht.walsallh-tr.wmids.nhs.uk
(4) SEX AT BIRTH LINKED TO LATITUDE
(Unexplained differences in sex ratios
at birth in
Europe and North America)
http://bmj.com/cgi/content/full/324/7344/1010
In Europe, significantly more boys are
born in
southern countries than in northern latitudes,
whereas the reverse is found in North
America. Yet
the reasons for this remain a mystery,
according to
a study in this week's BMJ.
Using data from the World Health Organisation,
researchers in Malta analysed and compared
the
male to female ratio in Europe and North
America
over 50 years.
Europe was banded by latitude into Southern
countries, Central Europe, and Nordic
countries.
The North American continent was divided
by
latitude into Canada, the United States,
and
Mexico.
They found that significantly more boys
were born
in southern countries, such as Greece,
Italy, and
Spain than in central Europe or the Nordic
countries. In contrast, a low male to
female ratio
was found in Mexico, a higher ratio in
the United
States, and an even higher ratio in Canada.
The authors are unable to explain these
findings, but
stress that a temperature related effect
cannot
account for the differences.
Contact:
Victor Grech, Consultant, Paediatric Department,
St Luke's Hospital, Guardamangia, Malta
Email: victor.e.grech@magnet.mt
(5) STANDARDS
OF MEDICAL CARE ON
ADVENTURE HOLIDAYS RAISE
CONCERNS
(Letter: Tour operators should tell
clients about
potential risks of adventure holidays)
http://bmj.com/cgi/content/full/324/7344/1040
Standards of medical care and safety provided
by
tour operators on adventure holidays in
remote
mountainous regions of the world are called
into
question in this week's BMJ.
Fionn Bellis, Specialist Registrar in Accident
and
Emergency Medicine, argues that although
some
companies provide their own medically
trained
staff, they may rely on doctors on holiday
with the
group to provide help.
Twice in the past year, she recalls treating
fellow
travellers with acute mountain sickness
while on
holiday - a common and potentially fatal
condition if
not treated correctly. In both cases the
group
leaders had exceeded the recommended rates
of
ascent, and the people concerned were
unaware of
the severity of the risks of travel to
high altitude,
says the author.
The public should be properly informed
about the
health and safety risks of certain destinations
before
departure, writes the author. Currently,
neither Air
Travel Organisers' Licensing (ATOL) nor
the
Association of British Travel Agents provides
guidance for this. The medical profession
should
also take a leading role in persuading
travel
companies to give their clients detailed
information
of the potential health risks of travel
so that they
can make informed decisions about whether
to visit
these destinations.
Adherence to standards of best medical
and safety
practice to prevent acute mountain sickness
and
other conditions should be mandatory for
tour
operators, she concludes.
Contact:
Fionn Bellis, Specialist Registrar in Accident
and
Emergency Medicine, Torbay Hospital, Torquay,
Devon, UK
Email: fionnbellis@hotmail.com
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