Releases Saturday 10 May 2003
No 7397 Volume 326
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(1) AVAILABILITY OF CO-PROXAMOL SHOULD
BE RESTRICTED
(2) MANY
NEW DOCTORS FEEL UNPREPARED
FOR THEIR FIRST
JOBS
(3) INCREASED
ANTIDEPRESSANT PRESCRIBING
LINKED WITH
FEWER SUICIDES
(4) FEWER
COMPLICATIONS WITH
LAPAROSCOPIC
HERNIA REPAIR
(5) UK
SHOULD INTRODUCE A NO-FAULT
COMPENSATION
SYSTEM
(1) AVAILABILITY
OF CO-PROXAMOL SHOULD
BE RESTRICTED
(Co-proxamol and suicide: a study
of national mortality
statistics and local non-fatal self
poisonings)
http://bmj.com/cgi/content/full/326/7397/1006
The painkiller co-proxamol is the second
most common
prescribed drug that people use to commit
suicide in
England and Wales, and its availability
should be
restricted, say researchers in this week's
BMJ.
National and local records were used to
compare the
numbers of suicides from poisoning with
co-proxamol,
paracetamol, and trycyclic antidepressants
in England
and Wales between 1997 and 1999. Fatal
and non-fatal
poisonings were also compared to estimate
the relative
fatality of overdoses with these three
drugs.
Of 4,162 drug related suicides, 18% involved
co-proxamol alone, 22% trycyclic antidepressants
alone,
and 9% paracetamol alone. Co-proxamol
poisoning was
significantly higher in 10-24 year olds
than in other age
groups. The odds of dying after overdose
with
co-proxamol was twice that for trycyclic
antidepressants
and 28 times that for paracetamol.
Fatal overdoses due to co-proxamol are
the second
most frequent means of suicide with prescribed
drugs in
England and Wales, say the authors.
Self poisoning with co-proxamol is particularly
dangerous and contributes substantially
to drug related
suicides, say the authors. Restricting
availability could
have an important role in suicide prevention,
they
conclude.
Contact:
Keith Hawton, Professor of Psychiatry,
Centre for
Suicide Research, University of Oxford
Department of
Psychiatry, Warneford Hospital, Oxford,
UK
Email: keith.hawton{at}psych.ox.ac.uk
(2) MANY NEW DOCTORS
FEEL UNPREPARED
FOR THEIR FIRST JOBS
(Pre-registration house officers'
views on whether their
experience at medical school prepared
them well for
their jobs: national questionnaire
survey)
http://bmj.com/cgi/content/full/326/7397/1011
Over 40% of newly qualified doctors say
that their
medical training did not fully prepare
them for work as a
pre-registration house officer (PRHO),
finds a study in
this week's BMJ.
Researchers at the University of Oxford
surveyed 3,446
doctors who graduated from medical schools
in the
United Kingdom in 1999 and 2000. Participants
were
asked to state their level of agreement
with the statement:
"My experience at medical school prepared
me well for
the jobs I have undertaken so far."
Only 4% strongly agreed that their training
had prepared
them well for the jobs they had undertaken
so far; 32%
agreed; 23% neither agreed or disagreed;
30%
disagreed; and 12% strongly disagreed.
Differences between men and women were
small.
However, differences between medical schools
were
large, ranging from 20% strongly agreeing
or agreeing at
one medical school to 73% at another.
At the end of the questionnaires, respondents
were
invited to comment on any aspects of their
training,
career choices, or work. Comments included:
"Medical
school provided excellent factual preparation
for PRHO
jobs but was limited to basic problems
found on the
wards," "Not enough emphasis on real life
situations,"
and "Felt inadequately prepared for surgical
house jobs ?
but you can pick it up very quickly."
Since this survey, curriculum changes have
placed
greater emphasis on practical experience,
say the
authors. However, systematic, in-depth
feedback to
medical schools from their graduates is
needed.
Decisions also need to be made about the
distribution of
work and training across the time spent
in medical
school, the pre-registration year, and
the senior house
officer years, they conclude.
Contact:
Professor Michael Goldacre, Department
of Public
Health, University of Oxford, Institute
of Health
Sciences, Oxford, UK
Email: michael.goldacre{at}dphpc.ox.ac.uk
(3) INCREASED
ANTIDEPRESSANT PRESCRIBING
LINKED WITH FEWER SUICIDES
(Association between antidepressant
prescribing and
suicide in Australia, 1991-2000:
trend analysis)
http://bmj.com/cgi/content/full/326/7397/1008
In Australia, suicide rates have fallen
most in those
groups of people most exposed to antidepressant
drugs,
especially older people.
This link suggests that the increase in
prescribing of
antidepressants, mainly by general practitioners,
has
produced a benefit for mental health,
say researchers in
this week's BMJ.
The team examined the association between
antidepressant prescribing and trends
in suicide from
1991 to 2000, when there was a dramatic
increase in
prescribing of antidepressants, especially
the selective
serotonin reuptake inhibitors (SSRIs).
Overall, the suicide rate in Australia
has remained
constant over the ten year period studied.
Suicide deaths
declined in older men and women but youth
suicide
increased rapidly.
By analysing the suicide data according
to age and
antidepressant use, the team found that
age groups with
the highest exposure to antidepressant
drugs had the
largest decline in suicide rate. Alcohol
consumption,
unemployment and changes in quality of
life of older
people did not explain the changes in
suicide rates.
These results probably reflect improved
access to
treatment of depression by general practitioners,
who
prescribe most antidepressants in Australia,
conclude the
authors.
Contact:
Andrea Mant, Associate Professor, School
of Public
Health and Community Medicine, University
of New
South Wales, Sydney, Australia
Email: l.wright{at}unsw.edu.au
(4) FEWER COMPLICATIONS
WITH
LAPAROSCOPIC HERNIA REPAIR
(Prospective randomised controlled
trial of laparoscopic
versus open inguinal hernia mesh
repair: five year follow
up)
http://bmj.com/cgi/content/full/326/7397/1012
Laparoscopic hernia repair results in fewer
long term
complications than open repair surgery,
finds a study in
this week's BMJ.
A total of 403 patients underwent either
open hernia
repair or laparoscopic repair at two London
hospitals
between May 1995 and December 1996. Five
years
later, 242 patients (120 open repair and
122
laparoscopic repair) were reviewed.
Fifty two patients in the open repair group
(43%) had
complications compared with 13 (11%) of
the
laparoscopic group. Numbness and groin
pain were
significantly reduced, and there were
no serious
complications in the laparoscopic group.
In the United Kingdom, the National Institute
for Clinical
Excellence (NICE) recently recommended
that open
repair should be the preferred surgical
procedure for
hernias.
Further studies are needed before any firm
conclusions
on the most appropriate technique are
drawn, say the
authors. Until then, it is best to take
the pragmatic
approach and use the technique that a
centre is most
familiar with, they conclude.
Contact:
D L Stoker, Consultant Surgeon, North Middlesex
University Hospital, London, UK
Email: dls{at}dr.com
(5) UK SHOULD
INTRODUCE A NO-FAULT
COMPENSATION SYSTEM
(Editorial: No-fault compensation
systems)
http://bmj.com/cgi/content/full/326/7397/997
It is time for the UK to introduce a no-fault
compensation system in dealing with clinical
negligence,
argues a senior doctor in this week's
BMJ.
The current system is based on the law
of tort, which
requires the claimant to prove harm caused
by a breech
of the duty of care. The adversarial and
blame orientated
nature of this system is not conducive
to the culture of
openness required by clinical governance
and the NHS
Plan, writes the author.
Supporters of the current system point
to the threat of
litigation as a deterrent to substandard
care, yet any
deterrent role is becoming increasingly
redundant in the
face of more effective risk management,
clinical
governance, peer review, and monitoring
by hospital
authorities and the General Medical Council.
The British Medical Association regards
the present
system as harmful, unpredictable, and
unjust for both
patients and medical staff.
A no-fault system would increase compliance
with the
mandatory reporting of adverse clinical
events and would
facilitate the culture of openness demanded
by clinical
governance, the NHS Plan, and the modern
approach to
look for errors in the organisations instead
of blaming
individuals, says the author.
It should be introduced on a limited pilot
basis and
monitored closely for some years, he concludes.
Contact:
William Gaine, Consultant Orthopaedic Surgeon,
Falkirk
Royal Infirmary, Forth Valley Healthcare
Trust,
Scotland, UK
Email: wgaine{at}yahoo.co.uk
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