Releases Saturday 5 April 2003
No 7392 Volume 326

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(1) NEW CERVICAL SMEAR TESTS PERFORM NO
BETTER THAN CONVENTIONAL TESTS

(2) TOO FEW DOCTORS KNOW HOW TO
RESPOND TO A TERRORIST ATTACK

(3) ALL BAT HANDLERS SHOULD GET RABIES JAB



(1) NEW CERVICAL SMEAR TESTS PERFORM NO
BETTER THAN CONVENTIONAL TESTS

(Cross sectional study of conventional cervical smear,
monolayer ctology, and human papillomavirus DNA
testing for cervical cancer screening)
http://bmj.com/cgi/content/full/326/7392/733

New cervical smear tests are unreliable and should not
replace conventional tests (PAP smears) according to a
study in this week's BMJ.

Researchers in France studied 828 women referred to
hospital because abnormalities had been detected on
previous smears and 1,757 women attending for routine
smears.

Each woman underwent a conventional cervical smear
test. The remaining material was then tested using two
new methods (monolayer cytology and human
papillomavirus testing). These tests are replacing
conventional smear tests in several countries.

Conventional cervical smear tests were more often
satisfactory and had consistently better sensitivity and
specificity than monolayer cytology. Human
papillomavirus testing performed no better than
conventional smear tests.

These results support the superiority of conventional
smear testing, and have implications for regulation of
medical devices, clinical practice, and future research on
screening for cervical cancer, say the authors. They also
emphasise the need to improve the "hard evidence" in
studies of new technologies.

Monolayer testing is less reliable and more expensive
and should not replace conventional smear tests for
cervical cancer screening, while human papillomavirus
testing should be further evaluated, they conclude.

Contacts:

Philippe Vielh, Pathologist, President of the French
Society of Clinical Cytology, Institut Curie, Paris, France
Email: philippe.vielh@curie.net

Joël Coste, Professor of Medical Statistics,
Publique-Hôpitaux de Paris, Faculté de Médecine
Cochin-Port Royal, Université Paris V, France
Email: coste@cochin.univ-paris5.fr

(2) TOO FEW DOCTORS KNOW HOW TO
RESPOND TO A TERRORIST ATTACK

(Letter: Medical staff need to be aware of major incident
planning)
http://bmj.com/cgi/content/full/326/7392/762

Not enough medical staff are aware of their role in the
event of a terrorist attack, according to a letter in this
week's BMJ.

Researchers surveyed 107 doctors in North Bristol
NHS Trust about the local major incident plan. All these
doctors would have a role in the mobile medical team if
they were on duty during a major incident.

Of the 77 doctors who replied, 69 were aware of the
existence of the plan, but only 26 had read part or all of
it. Only 11 of the responding doctors were aware of
their potential role in the mobile medical team.

Of these 11 doctors, only three thought themselves
adequately trained for this position, and all three had
been trained as medical incident officers.

"As a trust we are currently considering several measures
to improve on our results," say the authors. "We suspect,
however, that our findings are not unique and encourage
other acute trusts to look closely at their staff's
knowledge and training and act accordingly," they
conclude.

Contact:

Press Office, Frenchay Hospital, Bristol, UK

(3) ALL BAT HANDLERS SHOULD GET RABIES JAB

(Editorial: Bat rabies)
http://bmj.com/cgi/content/full/326/7392/726

All bat handlers in the United Kingdom should be
immunised against rabies, following the death of a bat
conservationist in Scotland last year, according to an
expert in this week's BMJ.

In the UK, classic rabies was eliminated from the animal
reservoir in the 1920s, writes Derrick Pounder,
Professor of Forensic Medicine at the University of
Dundee. Last year's death was caused by a closely
related virus and was the first fatality since 1902 from
rabies acquired in the UK.

Bat rabies virus has been found in two bats in the UK.
Both infected bats found were Daubenton's bats, one of
16 bat species resident in Britain. They rarely roost in
houses and rarely come into contact with people, so the
risk of a member of the public coming into contact with
an infected bat seems very low, says the author.

However, more than 1000 volunteers in Britain are
handling bats regularly for conservation and welfare and
therefore should all be immunised against rabies.

Other occupations or recreational activities bringing
people into close contact with bats might also justify
immunisation, he adds. Currently available vaccines are
safe and effective against both bat viruses and the classic
rabies virus.

Contact:

Derrick Pounder, Professor of Forensic Medicine,
Department of Forensic Medicine, University of Dundee
Email: d.j.pounder@dundee.ac.uk


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