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(2) SHOULD
AMBULANCE CREWS PERFORM
EMERGENCY BREATHING
PROCEDURE?
(3) TEXT
MESSAGES COULD LEAD TO HEALTH
INEQUALITIES
(4) CONCERNS
OVER NATIONAL POLICY ON
INFERTILITY
TREATMENT
(1) HEART FAILURE
IS MORE COMMON BUT LESS
FATAL IN SOUTH ASIAN PEOPLE
(Prognosis for South Asian and white
patients newly
admitted to hospital with heart
failure in the United
Kingdom: historical cohort study)
http://bmj.com/cgi/content/full/327/7414/526
In the UK, more South Asian people are
admitted to
hospital with heart failure but are less
likely to die than
white people, according to a study in
this week's BMJ.
Researchers in Leicestershire compared
hospital
admissions and deaths from heart failure
in 5,789 South
Asian and white patients between 1998
and 2001.
Compared with white patients, the incidence
of heart
failure was up to four times higher in
South Asian
patients. At the time of first hospital
admission, South
Asians were also on average eight years
younger and
were more likely to have heart disease
or diabetes than
white patients. Yet survival was similar,
if not better, for
South Asian patients.
These findings are clinically important
to the UK South
Asian population, among whom heart disease
and
diabetes are common, say the authors.
They also
indicate that ethnicity is a significant
factor in the
development and course of the disease.
Further studies are required to define
the cause, clinical
course, and prognosis of heart failure
in different
communities worldwide, they conclude.
Contact:
Iain Squire, Senior Lecturer, University
of Leicester
Department of Medicine and Therapeutics,
Leicester
Royal Infirmary, Leicester, UK
Email: is11@le.ac.uk
(2) SHOULD AMBULANCE
CREWS PERFORM
EMERGENCY BREATHING PROCEDURE?
(Prehospital tracheal intubation
in severely injured
patients: a Danish observational
study)
http://bmj.com/cgi/content/full/327/7414/533
A study in this week's BMJ questions whether
ambulance crews can master the skills
needed to provide
emergency intubation (passing a breathing
tube down the
throat of severely injured patients) before
they reach
hospital.
Researchers in Denmark identified 220 severely
injured
patients who were intubated out of hospital
by a mobile
emergency care unit, staffed with an anaesthetist,
between 1998 and 2000.
The mobile unit brought 172 of these patients
to hospital,
and 74 (43%) were intubated before reaching
hospital.
Of these, 62 (84%) received anaesthetics.
Thirty-six (58%) of patients who were given
anaesthetics
and one (8%) who were not survived at
least six months.
These results contrast with a study of
the emergency
helicopter service in London, which found
intubation
without drugs was hopeless.
The environment out of hospital is different
from in
hospital and support and resources are
limited, say the
authors. "We question whether anaesthesia
and
intubation of trauma patients can be mastered
and
routinely be maintained by ambulance personnel."
Contact:
Erika Christensen, Consultant Anaesthetist,
Department
of Anaesthesiology and Intensive Care
Medicine,
University Hospital of Aarhus, Denmark
Email: erika@akh.aaa.dk
(3) TEXT MESSAGES
COULD LEAD TO HEALTH
INEQUALITIES
(Letters: reminding patients by text
message)
http://bmj.com/cgi/content/full/327/7414/564
Reminding patients of appointments with
their doctor by
text messages is generally a good idea,
but may increase
health inequalities, according to a letter
in this week's
BMJ.
Sending text reminders is clearly a good
initiative, but
one concern is that it may increase health
inequalities as it
applies only to people who can afford
to own mobile
phones, argues Daragh Fahey, a public
health doctor at
Camden Primary Care Trust, London.
This means that people in higher socioeconomic
groups
are less likely to miss appointments and
thus are more
likely to receive better health care,
he concludes.
Contact:
Daragh Fahey, Camden Primary Care Trust,
St Pancras
Hospital, London, UK
Email: daragh.fahey@camdenpct.nhs.uk
(4) CONCERNS OVER
NATIONAL POLICY ON
INFERTILITY TREATMENT
(Editorial: In vitro fertilisation
for all?)
http://bmj.com/cgi/content/full/327/7414/511
Decisions about providing fertility treatment
on the NHS
should be made locally according to need
and priority,
rather than through national policy, argues
a leading
medical ethicist in this week's BMJ.
His comments follow guidelines by the National
Institute
of Clinical Excellence (NICE) that all
couples meeting
certain criteria should have up to three
cycles of in vitro
fertilisation free on the NHS.
The debate about publicly funding assisted
conception is
in essence a debate about values and priorities
rather
than a debate about what works, writes
Richard
Ashcroft of Imperial College London. Under
a publicly
funded NHS it is a political decision,
not a clinical one,
about how far we as a society want to
provide fertility
services and to whom. Even with these
guidelines it is
unclear whether the government will ensure
that
appropriate resources are made available
centrally. It is
more likely that the guidelines will simply
have to fit into
existing locally made spending plans,
he adds.
The guidelines from NICE temper local arbitrariness
and
unfairness, but they also tie the hands
of the local
decision makers whose job it is to set
priorities.
We should be wary of making reproduction
a major
theme in our national politics, he warns.
As long as
people have reliable information and decision
makers are
accountable for the reasonableness of
their decisions,
why should there be national policy?
Contact:
Richard Ashcroft, Leverhulme Senior Lecturer
in
Medical Ethics, Department of Primary
Health Care and
General Practice, Imperial College London,
London,
UK
Email: r.ashcroft@imperial.ac.uk
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