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(2) GENITAL
INFECTION MAY BE LINKED TO
MISCARRIAGE
(3) PATIENTS
SHOULD BE MORE INVOLVED IN THE
CLINICAL TRIAL
PROCESS
(4) NURSING SHORTAGE MIGHT NOT EXIST
(5) ALTERNATIVE
THERAPIES MAY HELP PEOPLE
WITH DEMENTIA
(Effectiveness of appropriately trained
nurses in preoperative
assessment: randomised controlled
equivalence/non-inferiority
trial)
http://bmj.com/cgi/content/full/325/7376/1323
Reform of junior doctors' hours has increased
the pressure to
use non-medical staff to assess patients
before surgery. A
study in this week's BMJ finds that appropriately
trained
nurses perform no worse than pre-registration
house officers
in preoperative assessment, although neither
group performed
particularly well.
Researchers identified 1,874 patients attending
four NHS
hospitals for assessment before surgery.
House officers
assessed 926 patients and appropriately
trained nurses
assessed 948 patients. A specialist registrar
examined each
patient after the nurse or house officer
to judge their
performance.
Patients faced a one in seven chance of
a house officer failing
to detect something that might affect
their management and a
one in eight chance of an appropriately
trained nurse doing the
same.
Nurses were judged to be non-inferior to
house officers,
although there was variation among them
in terms of the
quality of history taking. House officers
ordered nearly twice
as many unnecessary tests as nurses.
For most hospitals in the United Kingdom
there will not be
enough house officers to carry out pre-operative
assessment,
say the authors. However, they conclude
that some
pre-operative assessment is necessary
for their training, and so
they cannot be entirely replaced by nurses,
even if this is seen
as a role within which nurses could develop
a career.
Contact:
John Primrose, Professor of Surgery, University
of
Southampton School of Medicine, Southampton
General
Hospital, Southampton, UK
Email: j.n.primrose@soton.ac.uk
(2) GENITAL INFECTION
MAY BE LINKED TO
MISCARRIAGE
(Association between bacterial vaginosis
or chlamydial
infection and miscarriage before
16 weeks' gestation:
prospective community based cohort
study)
http://bmj.com/cgi/content/full/325/7376/1334
The genital infection, bacterial vaginosis,
may be linked to
miscarriage during the second trimester
of pregnancy (13-15
weeks), concludes a study in this week's
BMJ.
Researchers at St George's Hospital Medical
School identified
1,216 pregnant women attending 32 general
practices and five
family planning clinics in London who
were less than 10 weeks
into their pregnancy.
Women were asked to provide a self administered
vaginal
swab and to complete a questionnaire at
16 weeks. The
questionnaire asked about personal characteristics,
medical
history, and pregnancy outcome.
Overall, 121 women miscarried before 16
weeks and 174
had bacterial vaginosis. Those who were
positive for bacterial
vaginosis had a higher risk of miscarriage
at 13-15 weeks
compared with women who were negative
for the infection.
Although bacterial vaginosis is not a strong
predictor of early
miscarriage, it is associated with miscarriage
in the second
trimester at 13-15 weeks, say the authors.
The presence of
chlamydial infection was too low for it
to be a major risk
factor for miscarriage.
The study also shows that screening for
genital infections using
self administered vaginal swabs is feasible
in pregnant women
in the community. This might be important
for prevention of
adverse outcomes related to infection
later in pregnancy, they
conclude.
Contacts:
Phillip Hay, Senior Lecturer, Department
of Genitourinary
Medicine, St George's' Hospital Medical
School, London,
UK
or
Pippa Oakeshott, Senior Lecturer in General
Practice,
Department of General Practice and Primary
Care, St
George's' Hospital Medical School, London,
UK
Email: oakeshot@sghms.ac.uk
(3) PATIENTS SHOULD
BE MORE INVOLVED IN THE
CLINICAL TRIAL PROCESS
(Informing participants of allocation
to placebo at trial closure:
postal survey)
http://bmj.com/cgi/content/full/325/7376/1329
Patients should be treated as participants
rather than subjects
during clinical trials, suggest researchers
in this week's BMJ.
At present, less than half of patients
receiving placebo as part
of a clinical trial are informed about
their treatment when the
trial is over, despite government recommendations
to ensure
that that the public have confidence in,
and benefit from,
quality research.
The team surveyed 107 investigators who
published a placebo
controlled randomised trial published
in 2000 in five leading
medical journals.
Over half (55%) of investigators did not
inform any participant
of their treatment allocation, or only
informed those who
asked. The main reasons for not informing
participants were
that the investigators never considered
this option or that they
wanted to avoid biasing results.
It is possible that the placebo response
may be disrupted
when the treatment is unmasked to patients,
say the authors.
For instance, a recent trial evaluating
the effects of
antidepressants found that when placebo
responders were
told that they were receiving a placebo
their mood
deteriorated. However, patients must be
well informed to
avoid negative thoughts, misconceptions,
or mistrust in health
professionals.
Effective and sensitive was of communicating
treatment
information to trial participants are
required, they conclude.
Contacts:
Zelda Di Blasi, PhD Student, Department
of Health Sciences,
University of York, UK Tel (currently
in California, USA ?
after 3pm UK time: +1 415 642 7877 Email:
zdb1@york.ac.uk
or
Jos Kleijnen, Director, NHS Centre for
Reviews and
Dissemination, University of York, UK
Tel (Thurs 5 Dec pm
only): +44 (0)1904 433 647
(4) NURSING SHORTAGE MIGHT NOT EXIST
(Letter: Retaining nurses in the
NHS)
http://bmj.com/cgi/content/full/325/7376/1362
The true extent of the NHS nursing shortage
- if it exists at all
- will be known only when nurses spend
all their time nursing,
argues Professor Steven Lewis in this
week's BMJ.
Evidence from the United States, Canada,
and Germany has
found that nurses spend time performing
functions not related
to their professional skills, such as
cleaning rooms or moving
food trays. Nurses also reported more
pressure to take up
management responsibility, taking them
away from the direct
care of patients.
This means that, although a shortage of
professional nursing
may exist, a shortage of nurses might
not. Nurses spend much
of their time doing things that should
be delegated to others
and not enough of their time doing what
they are educated to
do. This is inefficient and demoralising
and accounts for at
least some of the widespread job dissatisfaction
in the
profession, says the author.
Increasing the supply of new nurses may
turn out to be
perversely ineffective, he adds. If overall
numbers grow,
nurses perform even more non-nursing tasks,
and system
costs rise because highly trained people
are used inefficiently.
"Only when nurses are allowed to withdraw
from areas of
non-nursing activity and do what they
should be doing will we
know the true extent of the nursing shortage±if
it exists at all.
Achieving a proper division of labour that
respects and
maximises professionals' competencies
will make the
healthcare system more effective and efficient.
It will also
create a better motivated and contented
workforce," he
concludes.
Contact:
Steven Lewis, Adjunct Professor of Health
Policy, Calgary,
Canada
Email: Steven.Lewis@shaw.ca
(5) ALTERNATIVE
THERAPIES MAY HELP PEOPLE
WITH DEMENTIA
(Editorial: Sensory stimulation in
dementia)
http://bmj.com/cgi/content/full/325/7376/1312
Aromatherapy and bright light treatment
may have an
important role in managing behavioural
problems in people
with dementia, conclude researchers in
this week's BMJ.
Most older people with dementia develop
psychiatric
symptoms or behavioural disturbances such
as agitation,
aggression, depression, delusions, wandering,
sleep
disturbance, and hallucinations. Drugs
such as neuroleptics
and other sedatives are often prescribed
but are associated
with side effects.
A wide range of alternative approaches
has been tried but
reports have essentially been qualitative
and based on small
numbers of patients. However, two exceptions
are
aromatherapy and bright light treatment,
which have emerged
as promising treatments, write the authors.
Three trials on aromatherapy in the last
year have reported a
significant beneficial effect on agitation
compared with placebo
with almost complete compliance and no
side effects. Lemon
balm or lavender oil are the two main
agents used and are
delivered by either inhalation or skin
application.
Three recent trials on bright light therapy
have also shown a
particularly beneficial effect on sleep
disturbance.
People with dementia are among the most
vulnerable in our
society, say the authors. Symptoms often
need to be treated
expediently, and drugs, although moderately
effective, can be
hazardous. Aromatherapy and bright light
treatment seem to
be safe and effective and may have an
important role in
managing behavioural problems in people
with dementia, they
conclude.
Contact:
Alistair Burns, Professor of Old Age Psychiatry,
University of
Manchester Department of Psychiatry, Wythenshawe
Hospital, Manchester, UK
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