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(2) RADICAL
SOLUTIONS NEEDED TO TACKLE
NHS NURSING
SHORTAGE
(3) ARE
PEOPLE WITH MENTAL ILLNESS MORE
VIOLENT THAN
OTHER PEOPLE?
(4) BENEFITS
OF DISCUSSING TEENAGE HEALTH
CONCERNS ARE
SMALL BUT ENCOURAGING
(1) BENEFIT OF
PUBLIC DEFIBRILLATORS IS
MARGINAL
(Potential impact of public access
defibrillators on
survival after out of hospital cardiopulmonary
arrest:
retrospective cohort study )
http://bmj.com/cgi/content/full/325/7363/515
(Editorial: Outcome after cardiac
arrest outside hospital)
http://bmj.com/cgi/content/full/325/7363/503
Making defibrillators widely available
in public places
such as airports and shopping centres
is not justified by
the marginal improvement in survival,
finds a study in this
week's BMJ.
Researchers in Scotland used records of
all out of
hospital cardiac arrests due to heart
disease from
1991-1998 to estimate the potential impact
of public
access defibrillators on overall survival
after out of
hospital cardiac arrest.
Of 15,189 arrests, 79% occurred in sites
not suitable for
the location of public access defibrillators,
such as the
person's home or a friend's home. Only
453 (3%)
occurred in possibly suitable sites, such
as buses and
multi-storey car parks, and 18% occurred
in suitable
sites, such as shops, places of business,
and sports
centres.
The authors predict that locating public
access
defibrillators only in suitable sites
would increase the
survival rate from 5.0% to 6.3%. If defibrillators
were
located in suitable and possibly suitable
sites, the survival
rate would increase only slightly further
to 6.5%.
This predicted increase in survival is
less than the increase
achievable through expansion of early
defibrillation
provision to non-ambulance first responders,
such as
other emergency services or community
schemes, or of
bystander cardiopulmonary resuscitation,
explain the
authors. Even so, the Department of Health
is committed
to providing 700 public access defibrillators
in 72 sites
across England and Wales.
Additional resources for wide scale coverage
of public
access defibrillators are probably not
justified by the
marginal improvement in survival, they
conclude.
Contacts:
Jill Pell, Honorary Clinical Senior Lecturer,
Department
of Medical Cardiology, University of Glasgow,
Glasgow,
Scotland
or
(From Thurs 5 September): Stuart Cobbe,
Professor,
Department of Medical Cardiology, University
of
Glasgow, Glasgow, Scotland
Email: stuart.cobbe@clinmed.gla.ac.uk
(2) RADICAL SOLUTIONS
NEEDED TO TACKLE
NHS NURSING SHORTAGE
(Mind the gap: the extent of the
NHS nursing shortage)
http://bmj.com/cgi/content/full/325/7363/538
(Mind the gap: the policy response
to the NHS nursing
shortage)
http://bmj.com/cgi/content/full/325/7363/541
Current government initiatives to tackle
the problems of
recruiting and retaining nurses may not
resolve the crisis
fast enough, and more radical solutions
may need to be
considered, say researchers in this week's
BMJ.
Problems in recruiting and retaining nurses
are hampering
the "modernisation" of the NHS. The underlying
causes
of these problems include pay, the changing
nature of
jobs, how valued the staff feel, and other
employment
opportunities, write Belinda Finlayson
and colleagues
from the King's Fund in London.
The crisis is most acute in inner cities
and teaching trusts,
particularly in London, where some turnover
rates range
from 11% to 38%. High turnover results
in higher costs
and lower morale and may affect patient
care.
Although the government is tackling the
crisis, problems
persist, they say. Overall progress has
been slow; staff
are unaware of the new opportunities available
to them;
some tarare modest; and little effort
has been made to
evaluate the impact of these initiatives.
Furthermore, workforce issues are still
nowhere near the
top of the agenda for managers or trust
boards, who
have other managerial "must do's," such
as reducing
waiting lists and times, managing emergency
admissions,
and breaking even financially, they add.
If fully implemented on time, the national
initiatives will
help, but it is questionable whether they
will turn the tide,
say the authors. In the meantime, more
radical
suggestions for a complex redesign of
the healthcare
workforce are being proposed. The merits
of these
proposals should be openly debated and
their evidence
base evaluated, they conclude.
Contact:
Andrew Bell, Press Office, Health Care
Policy
Programme, King's Fund, London, UK
Email: a.bell@kingsfund.org.uk
(3) ARE PEOPLE
WITH MENTAL ILLNESS MORE
VIOLENT THAN OTHER PEOPLE?
(Editorial: Violence in society±contribution of mental
illness)
http://bmj.com/cgi/content/full/325/7363/507
The contribution of mental illness to societal
violence is
modest, despite increasing public concern
about the
potential for violence among mentally
ill patients who
have been treated and reside in the community,
write
researchers in this week's BMJ.
Recent studies suggest that patients with
psychotic illness
alone have a modest increase in risk for
violent
behaviour, but the greatest risk is associated
with
personality disorder, substance abuse,
say the authors.
Variables such as male sex, young age,
and lower
socioeconomic status contribute a much
higher
proportion to societal violence than the
modest amount
attributable to mental illness.
If a person with mental illness is violent,
however, it does
not necessarily mean that this is due
to the illness; it may
be due to other coexisting risk variables,
add the authors.
Overall, it seems that less than 10% of
serious violence,
including homicide, is attributable to
psychosis.
The evidence also contradicts the theory
that the closing
of large psychiatric institutions over
the past 30 years
have meant that a greater proportion of
societal violence
is attributable to those with mental disorder.
Fear and stigma of mentally ill people
have been
exaggerated by high profile and occasionally
sensationalist reporting of rare, albeit
tragic, violent acts.
Yet the scientific literature refutes
the stereotyping of all
patients with severe mental illness as
dangerous, say the
authors. It is inappropriate that mental
health policy and
legislation should be driven by preoccupation
with risk of
violence, rather than the delivery of
effective treatments in
the community, they conclude.
Contact:
Elizabeth Walsh, Clinical Lecturer, Section
of Forensic
Mental Health, Guy's King's College and
St Thomas's
School of Medicine, Institute of Psychiatry,
London, UK
Email: sppmemw@iop.kcl.ac.uk
(4) BENEFITS OF
DISCUSSING TEENAGE HEALTH
CONCERNS ARE SMALL BUT ENCOURAGING
(Health promotion for adolescents
in primary care:
randomised controlled trial)
http://bmj.com/cgi/content/full/325/7363/524
Teenagers welcome the opportunity to discuss
health
concerns with a health professional, but
the effect on their
actual lifestyles is modest, finds a study
in this week's
BMJ.
Researchers identified 1,516 teenagers
(aged 14-15
years) from eight general practices in
Hertfordshire,
England. Teenagers in the intervention
group received an
appointment for a 20 minute consultation
with the
practice nurse to discuss health concerns
and develop
plans for healthier lifestyles. Teenagers
in the control
group received usual care. Both groups
were asked to
complete questionnaires at three months
and 12 months.
Some 970 teenagers completed questionnaires;
23%
smoked, 35% had been drunk in the previous
three
months, 64% considered they ate unhealthily,
39% took
little exercise, and 36% had possible
depression.
Three quarters (225) indicated at least
one behaviour
they would like to work on changing; the
most common
were diet (50%), exercise (36%), dealing
with stress
(23%), and smoking (13%).
At three months, marginally more teenagers
in the
intervention group than in the control
group reported
positive change in at least one of four
areas of health
related behaviour (diet, exercise, smoking,
and drinking
alcohol), but this did not persist at
12 months.
All teenagers but one were satisfied with
their
consultations. Most said they had felt
able to talk about
all the issues they wanted to, and 97%
would
recommend the service to a friend.
The results of the trial are somewhat disappointing
in that
benefits (even where significant) were
small, say the
authors. However, the results do provide
an encouraging
start, providing an opportunity to identify
and tackle
mental and physical health problems and
encourage
healthy lifestyles.
The intervention was well received and
relatively cheap,
suggesting a way for practices to create
an atmosphere
that welcomes teenagers, they conclude.
Contact:
Joy Townsend, Professorial Fellow, Health
Promotion
Research Unit, London School of Hygiene
and Tropical
Medicine, London, UK
Email: joy.townsend@lshtm.ac.uk
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