Releases Saturday 13 September 2003
No 7415 Volume 327
Please remember to credit the BMJ as source when publicising
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(1) MIDWIFE SHORTAGES CONTRIBUTING TO
"NEAR MISSES" ON LABOUR WARDS
(2) SCHOOL
PE LESSONS DON'T REFLECT KIDS'
ACTIVITY LEVELS
(3) CONCERN
OVER RISE IN PEDESTRIAN AND
CYCLIST INJURIES
(4) MANY
ONCOLOGISTS UNAWARE OF CANCER
CLOT RISK
(1) MIDWIFE SHORTAGES
CONTRIBUTING TO
"NEAR MISSES" ON LABOUR WARDS
(Prospective semistructured observational
study to
identify risk attributable to staff
deployment, training, and
updating opportunities for midwives)
http://bmj.com/cgi/content/full/327/7415/584
Midwife shortages are contributing to adverse
events
and "near misses" on UK labour wards,
say researchers
in this week's BMJ.
The study took place on the labour wards
of seven
maternity units in the north west of England.
The lead
researcher observed the organisation of
care on each
labour ward, analysed records, and interviewed
all
midwives on duty.
All maternity units experienced midwifery
staffing
shortages and most units relied on bank
midwives to
maintain minimum staffing levels.
High-risk practices (such as giving drugs
to induce
labour and performing epidurals) continued
during
midwifery shortfalls in all units. Many
adverse events and
"near misses" were caused by these shortages,
and near
misses went unreported in all units. Staffing
shortages
also prevented uptake of scheduled training
sessions.
"We observed many latent failures ("accidents
waiting to
happen") in this study," write the authors.
Despite the exemplary dedication of midwives,
the
system cannot operate safely and effectively
when the
number of midwives is inadequate, midwives
are poorly
deployed, and they are unable to undertake
training and
update their skills, they conclude.
Contact:
Brenda Ashcroft, Lecturer, School of Health
Care
Professions, University of Salford, Greater
Manchester,
UK
(2) SCHOOL PE
LESSONS DON'T REFLECT KIDS'
ACTIVITY LEVELS
(Contribution of timetabled physical
education to total
physical activity in primary school
children: cross
sectional study)
http://bmj.com/cgi/content/full/327/7415/592
The total amount of physical activity done
by primary
school children does not depend on how
much physical
education is timetabled at school because
children
compensate out of school, finds a study
in this week's
BMJ.
Over seven days, researchers measured the
physical
activity of 215 children from three schools
with different
sporting facilities and opportunity for
physical education
in the curriculum.
School 1, a private school, had extensive
facilities and 9
hours a week of physical activity in the
curriculum.
School 2, a village school, offered 2.2
hours of physical
education a week, and School 3, an inner
city school
with limited sports facilities, offered
1.8 hours of physical
education a week.
As expected, pupils in school 1 recorded
most activity in
school time, but this was barely twice
that of pupils in
Schools 2 or 3, despite timetabling more
than four times
the amount of physical education. Surprisingly,
total
physical activity between schools was
similar because
children in Schools 2 and 3 did more activity
out of
school than children at School 1. These
findings are
unexpected, but encouraging, because the
amount of
timetabled physical education offered
in School 1 is
unlikely to be bettered elsewhere, and
children from
School 3 were not adversely affected,
say the authors.
Less encouraging is that girls do significantly
less physical
activity than boys, and may explain why
more girls than
boys develop type 2 diabetes in childhood.
"Our findings need confirmation but give
cause for
reflection on methods of collecting activity
data, the
provision of physical education in school,
and the
competing demands of the school curriculum,"
they
conclude.
Contact:
Terence Wilkin, Professor of Medicine,
Department of
Endocrinology and Metabolism, Peninsula
Medical
School, Plymouth Campus, UK
Email: terence.wilkin{at}pms.ac.uk
(3) CONCERN OVER
RISE IN PEDESTRIAN AND
CYCLIST INJURIES
(Severe traffic injuries to children,
Trent, 1992-7: time
trend analysis)
http://bmj.com/cgi/content/full/327/7415/593
Admission to hospital for severe injuries
to young
pedestrians and cyclists increased between
1992 and
1997, but admission rates for other transport
injuries fell,
say researchers in this week's BMJ.
The study involved children up to 14 years
old who were
admitted to hospital for pedal cycle,
pedestrian, or other
transport injuries in the Trent region
of the UK between
1992 and 1997.
During the study, 1,061 cyclists, 449 pedestrians,
and
426 others were admitted to hospital with
severe
injuries. Admission rates among cyclists
and pedestrians
increased by 5% and 10% each year, whereas
admission rates for other severe injuries
fell by 11% each
year.
These findings are surprising, given the
increasing number
of journeys made by car in this period,
say the authors.
Perhaps children's safety improved for
car passengers
but not for pedestrians or cyclists between
1992 and
1997, they suggest.
Injuries to pedestrians and cyclists can
be reduced by
traffic calming measures, and cycle helmets
reduce head
injuries. As national initiatives are
promoting walking and
cycling among schoolchildren, implementation
of
effective measures such as these should
be a priority for
local authorities and primary care groups
and trusts, they
conclude.
Contact:
Carol Coupland, Senior Lecturer in Medical
Statistics,
Division of Primary Care, University of
Nottingham, UK
Email: carol.coupland{at}nottingham.ac.uk
(4) MANY ONCOLOGISTS
UNAWARE OF CANCER
CLOT RISK
(Prophylaxis for venous thromboembolism
during
treatment for cancer: questionnaire
survey)
http://bmj.com/cgi/content/full/327/7415/597
Patients receiving cancer treatments are
at greater risk of
blood clots, yet more than a quarter of
oncologists do
not recognise their clotting effects and
preventive
measures are rarely used, finds a study
in this week's
BMJ.
Researchers in Manchester surveyed 106
oncologists in
northern England. The most common treatment
was
chemotherapy, used by 39% of oncologists,
9% used
hormone therapy, and 42% used radiotherapy.
A total of 29 (27%) thought their patients
were not at
risk of venous thromboembolism (blockage
of a blood
vessel by a blood clot) regardless of
the type of tumour
treated.
Seventy-one oncologists believed that hormone
therapy
posed little or no increased risk to patients,
83 thought
the same for chemotherapy and 96 for radiotherapy.
Of the 106 respondents, 84 reported not
routinely using
prophylaxis, such as aspirin or warfarin,
in
chemotherapy, 79 in hormone therapy, and
86 in
radiotherapy. A total of 19 oncologists
never used
prophylaxis for venous thromboembolism.
The good response rate to this questionnaire
demonstrates a reliable representation
of current practice
in the north of England, say the authors.
National
guidelines on prophylaxis for venous thromboembolism
during cancer treatment are needed, they
conclude.
Contact:
Gerard Byrne, Senior Lecturer in Surgical
Oncology
Education and Research Building, Wythenshawe
Hospital, Manchester, UK
Email: gedbyrne{at}compuserve.com
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Advancement of Science
(http://www.eurekalert.org)
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