This week in the BMJ
Volume 327, Number 7409, Issue of 2 Aug 2003The best way to protect infants is to ban smoking in the home
The best way to protect infants is to ban smoking in the home
Banning smoking in the home had a small but significant effect in reducing infants' exposure to environmental tobacco smoke, and less strict strategies have no effect. In a cross sectional survey in two British cities, Blackburn and colleagues (p 257) examined the measures used by parents who smoked to protect their infants from exposure to tobacco smoke in the home. Though most parents used harm reduction strategies such as keeping windows open and avoiding smoking near the baby, the authors found—by testing urinary cotinine to creatinine ratios in the infants—that only banning smoking made a difference.
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Enzyme potentiated desensitisation fails to prevent hay fever
Allergy injections don't work against severe summer hay fever. In a randomised controlled trial Radcliffe and colleagues (p 251) tested the effectiveness of enzyme potentiated desensitisation in 183 patients with seasonal allergic rhinitis who had not responded to standard treatment. They found no differences between the intervention and placebo groups in the number of problem free days, quality of life, severity of symptoms, and adverse reactions. Six previous smaller studies had found the enzyme (
glucuronidase) to be effective.
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Diabetes review articles don't include POEMs
Clinicians relying on review articles written by experts on the treatment of type 2 diabetes may be misled. Shaughnessy and Slawson (p 266) examined whether patient oriented evidence that matters (POEMs) was present in 35 published reviews of the United Kingdom prospective diabetes study (UKPDS). They found that only six of the reviews included the POEM that tight blood glucose control had no effect on diabetes related mortality or overall mortality, and only seven emphasised that metformin treatment was associated with decreased mortality. The authors say that clinical practice needs to be based on reviews that strictly evaluate both relevance and validity. In an accompanying commentary, Fitzmaurice (p 269) argues that despite the dubious value of review articles, most general practitioners in Britain have got the key messages of the UKPDS.
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Informed patients donate tissue to the commercial sector
Almost all surgical patients in a district hospital agreed to donate any tissue surplus to diagnostic needs to be used for research by commercial companies. Jack and Womack (p 262) reviewed the records of patients undergoing surgery at Peterborough District Hospitals, whose tissue banks supply human tissue to the commercial biomedical and pharmaceutical sectors. A research nurse interviews patients before their operation and provides information about the tissue bank and its commercial aspects. Of 3140 patients interviewed between October 1998 and September 2002, 38 declined, only two explicitly because of commercial involvement.
Vitamin A given soon after birth increases survival of newborns
Giving newborn infants vitamin A soon after birth can reduce mortality before 6 months of age by over 20%. In a community based randomised double blind, placebo controlled trial Rahmathullah and colleagues (p 254) studied 11 619 infants born in rural Tamil Nadu. The infants received two doses of vitamin A or placebo shortly after birth. During the first six months of life, 23% fewer infants given vitamin A died. The efects were limited to low birthweight infants.
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GPs must act as gatekeepers to bowel cancer services
The policy that all patients with suspected bowel cancer should be seen by a specialist within two weeks will overwhelm secondary care unless general practitioners act as efficient gatekeepers. Thompson and colleagues (p 263) discuss the guidelines for identifying patients at high and low risk in primary care and suggest appropriate management strategies within primary care for patients at low risk.
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