This week in the BMJ

Volume 325, Number 7358, Issue of 3 Aug 2002

Travel medicine $---$ a growing specialty
Olanzapine increases risk of diabetes
Daily progestogen protects the endometrium
Trust mergers do not save money
Home blood pressure testing is preferred
Trials funded by for profit organisations favour the intervention
New cancer drugs: little extra benefit, higher price
Learning from adverse incidents

Travel medicine $---$ a growing specialty

Malaria is an important health risk, as cases continue to rise due to the increase in international travel. Internationalarrivals worldwide by any form of transport were around 664 millionin 2000, and an 80% increase in travel to long haul destinationsis expected by 2010. On page 260 Jane Zuckerman outlines the recentdevelopments in travel medicine, which has grown rapidly in responseto the needs of the travelling population. Specialists in travelmedicine, she says, have to consider diverse aspects of travelrelated health, including fitness to travel and health relatedrisks of travelling.

Olanzapine increases risk of diabetes

Patients taking olanzapine are at higher risk of developing diabetes than those taking conventional antipsychotic drugs, sayKoro and colleagues (p 243). Patients taking the antipsychoticrisperidone had a non-significant increased risk. The authorssay that weight gain and disruption of glucose metabolism arepossible mechanisms for the association between diabetes and useof antipsychotics $---$ and doctors should consider the metabolic consequencesofantipsychotics.

Daily progestogen protects the endometrium

Hormone replacement therapies that include continuous progestogen are associated with less endometrial damage, when used longterm, than sequential oestrogen-progestogen regimens. A prospectivestudy by Wells and colleagues (p 239) found no cases of endometrialhyperplasia or malignancy in women taking combined therapy. Continuousdaily progestogen, the authors say, seems to keep the endometriumnormal and correct hyperplasia that may develop during standardsequential regimens.

Trust mergers do not save money

Mergers of NHS trusts do not achieve target savings in management costs in the first two years after merger and can have unintendednegative consequences that disrupt services, and set back developmentsin services. In a cross sectional study of nine trusts, and casestudy in four trusts Fulop and colleagues (p 246) conclude thatthe benefits of mergers were mostly the stated objectives, butdrawbacks arose during the process of merging, and were not consideredwhen the decision on whether to merge wasmade.

Home blood pressure testing is preferred

Patients rate home measurements of blood pressure as the most acceptable method of blood pressure assessment. Little and colleagues(p 254) recruited 200 patients to test the acceptability of differentmethods of the repeated measuring of blood pressure. They foundthat 10% of patients regarded measurement by a doctor as the mostacceptable method, 18% preferred ambulatory monitoring, and 23%preferred measurement by a nurse, whereas 44% of the patientsrated home measurement as the "best measurement for them."

(Credit: ULRIKE PREUSS)

Trials funded by for profit organisations favour the intervention

Authors' conclusions in randomised clinical trials were significantly more favourable towards the experimental interventionwhen trials were funded only by for profit organisations. In Kjaergardand Als-Nielsen's study of trials published in the BMJ (p 249),authors' conclusions were appraised on a six point scale and comparedwith financial, personal, academic, or political competing interests.The association, the authors say, could occur because for profitorganisations, by skill or by chance, fund only those trials inwhich the intervention is better than the control, or it couldbe due to publication bias.

New cancer drugs: little extra benefit, higher price

New anticancer drugs reaching the European market in 1995-2000 offer few or no substantial advantages over existing preparationsyet cost several times as much. Garattini and Bertele' (p 269)outline the features of the 12 new anticancer drugs approved formarketing and say that the general population of cancer patientswill gain no benefit from them. It is hoped, however, that somenew anticancer drugs, such as anti-angiogenic agents and resistantrevertants, will soon undergo adequate clinical testing and showbenefits over current treatments.

(Credit: RAY TANG/REX)

Learning from adverse incidents

Adverse incidents with medical devices are caused by a variety of factors and not simply by faulty devices or user error.Each year about 400 people are killed or seriously injured inadverse incidents with medical devices. Amoore and Ingram (p 272)describe the development of a feedback note on adverse incidents;the note describes the incident and gives generic details of theequipment and lessons to be learnt by staff. A careful analysisof each adverse incident, the authors say, can reveal the multifactorialcauses of the incident and the good practices that can help minimiserepetitions.