Releases Saturday 17 August 2002
No 7360 Volume 325
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(1) NO LINK BETWEEN EPIDURALS AND
BACKACHE
(2) ALL
HAJJ PILGRIMS SHOULD GET MENINGITIS
JAB
(3) TWOFOLD
DIFFERENCE IN REFERRAL RATES
BETWEEN US
AND UK
(4) SATISFACTORY
CONSULTATIONS DO NOT
HAVE TO BE
LONG
(1) NO LINK BETWEEN
EPIDURALS AND
BACKACHE
(Randomised study of long term outcome
after epidural
versus non-epidural analgesia during
labour)
http://bmj.com/cgi/content/full/325/7360/357
Epidural pain relief during labour is not
associated with
long term backache, find researchers in
this week's BMJ.
An original study involved 369 women: 184
were
randomised to receive an epidural and
185 were
randomised to other forms of pain relief.
All these women
were then invited to participate in a
follow up study (151
from the epidural group and 155 from the
non-epidural
group agreed to participate).
Self reported low back pain, disability,
and limitation of
movement were assessed through interviews
with a
physiotherapist or a questionnaire. Physical
measurements of spinal mobility were also
used.
The team found no significant differences
in any of the
measurements of mobility. There were also
no differences
in responses to questions about everyday
tasks that may
be more difficult in the presence of low
back pain.
The authors conclude: "After childbirth
there are no
differences in the incidence of long term
low back pain,
disability, or movement restriction between
women who
receive epidural pain relief and women
who receive other
forms of pain relief."
Contact:
Charlotte Howell, Consultant Anaesthetist,
Academic
Department of Obstetrics and Gynaecology,
North
Staffordshire Hospital (NHS) Trust, Stoke
on Trent,
Staffordshire, UK
Email: charlotte{at}kogs.freeserve.co.uk
(2) ALL HAJJ PILGRIMS
SHOULD GET MENINGITIS
JAB
(Acquisition of W135 meningococcal
carriage in Hajj
pilgrims and transmission to household
contacts:
prospective study)
http://bmj.com/cgi/content/full/325/7360/365
Seventeen per cent of those returning from
the annual
Islamic pilgrimage to Mecca and Medina
(Hajj) are
carrying meningococcal bacteria, finds
a study in this
week's BMJ. As such, vaccination should
become
mandatory for all Hajj pilgrims, and should
also be
considered for their families, say the
researchers.
Throat swabs were taken from 204 Malay
pilgrims
18-72 days before their departure for
the 2001 Hajj
pilgrimage. Repeat swabs were taken from
84% of the
pilgrims up to 45 days after their return.
Seventeen per cent of pilgrims were menningococcal
carriers, with 90% carrying the W135 clone
? the strain
that caused an international outbreak
of meningococcal
disease during the Hajj 2000. Carriage
was significantly
higher in pilgrims who had not taken antibiotics.
The returning pilgrims reported between
1 and 10 people
living in their household. The level of
meningococcal
carriage in 233 of these contacts was
8.2%, of whom
42% were carrying the W135 clone.
Many countries currently give meningococcal
vaccine
(covering A and C strains) to Hajj pilgrims,
say the
authors. However, vaccination with the
quadrivalent
meningococcal vaccine (also covering W135)
should
become mandatory for all Hajj pilgrims
and be
considered for their household contacts.
Transmission of this clone from vaccinated
Hajj returnees
to their unvaccinated household contacts
was substantial,
putting contacts at particular risk of
developing invasive
disease, they add.
"Our findings support a policy of administering
antibiotics
to pilgrims before their return to their
countries of origin
to eradicate carriage and protect household
contacts,"
they conclude.
Contacts:
Annelies Wilder-Smith, Travellers' Health
and
Vaccination Centre, Tan Tock Seng Hospital,
Singapore
Email: epvws{at}pacific.net.sg
or
Nicholas Paton, Head, Deaprtment of Infectious
Diseases, Tan Tock Seng Hospital, Singapore
(3) TWOFOLD DIFFERENCE
IN REFERRAL RATES
BETWEEN US AND UK
(Comparison of specialty referral
rates in the United
Kingdom and the United States: retrospective
cohort
analysis)
http://bmj.com/cgi/content/full/325/7360/370
Patients are twice as likely to be referred
to a specialist in
the United States compared with patients
in the United
Kingdom, find researchers in this week's
BMJ. Low
availability of specialists, and resultant
long waiting lists, in
the UK is an important explanation for
these differences.
The study involved 384,693 patients from
five health
maintenance organisations in the US and
757,680
patients from the general practice research
database in
the UK.
About one in three patients in the US were
referred to a
specialist annually compared with one
in seven in the UK.
The twofold difference held for the healthiest
as well as
the sickest patients. The supply of specialists
in the US
exceeds that in the UK by twofold, and
just 1% of US
patients wait four months or longer for
elective surgery
compared with 33% of UK patients.
The low availability of specialists, and
resultant long
waiting lists, in the UK is an important
explanation for
these differences, say the authors. Other
possible
explanations include a less intensive
practice style among
UK physicians, the common practice of
self referral
among US patients, and a broader scope
of practice
among UK physicians.
Given the low rates of referral in the
UK relative to the
US, it seems unlikely that referral guidelines,
which have
been proposed as a method to reduce pressure
on UK
outpatient services, will dramatically
enhance specialty
capacity by decreasing demand, they conclude.
Contact:
Christopher Forrest, Associate Professor
of Health
Policy and Management and Paediatrics,
Johns Hopkins
Medical Institutions, Baltimore, USA
Email: cforrest{at}jhsph.edu
(4) SATISFACTORY
CONSULTATIONS DO NOT
HAVE TO BE LONG
(Letter: Consultations do not have
to be longer)
http://bmj.com/cgi/content/full/325/7360/388
Consultations with general practitioners
do not have to be
longer to satisfy patients' needs, according
to researchers
in this week's BMJ.
A total of 243 patients were asked about
what they
wanted from their visit to their general
practitioner. They
were subsequently asked what they felt
they had got from
the consultation.
Patients wanted most to talk to their general
practitioner.
At least half also wanted to participate
in decisions about
treatment, wanted the doctor to listen
to what they
thought was wrong, have the problem and
the treatment
explained to them, and receive a diagnosis.
The range of
consultation time for all patients was
from 2 minutes to 21
minutes.
There was wide variation in what patients
wanted from
their consultation ? ranging from none
to all 12 things they
were asked about. However, after the consultation,
75%
of patients received than they had wanted.
Although others have found that longer
consultations are
associated with better quality care for
patients, these
findings indicate that consultations do
not have to be
longer for patients to have good outcomes,
and even the
shortest of consultations can provide
all that patients
want, say the authors.
"From the patient's perspective it seems
that satisfactory
consultations do not have to be long ones,"
they
conclude.
Contact:
Linda Jenkins, Research Fellow, Department
of General
Practice and Primary Care, Guy's, King's
College, and St
Thomas's School of Medicine, London, UK
Email: linda.Jenkins{at}kcl.ac.uk
FOR ACCREDITED JOURNALISTS
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(http://www.eurekalert.org)
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