Releases Saturday 15 November 2003
No 7424 Volume 327
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(1) CHANGING PARTNER INCREASES RISK OF
PRETERM BIRTH
(2) WOMEN
FEEL UNPREPARED FOR OPERATIVE
DELIVERIES
(3) MANY
DIAGNOSTIC TESTS ARE NOT BASED
ON GOOD EVIDENCE
(4) STUDY
REVEALS DRAMATIC RISE IN
ALLERGIC DISEASES
(5) CRIMINALISING
MEDICAL MISTAKES IS
QUESTIONABLE
(1) CHANGING PARTNER
INCREASES RISK OF
PRETERM BIRTH
(Effects on pregnancy outcome of
changing partner
between first two births: prospective
population study)
http://bmj.com/cgi/content/full/327/7424/1138
Women who change partner between their
first two
births are at an increased risk of having
a preterm, low
birthweight baby compared with women who
have the
same partner for both births, finds a
study in this week's
BMJ.
Researchers from Norway compared pregnancy
outcomes in 31,683 women who changed partner
between their first two births and 456,458
women with
the same partner for both births.
After taking into account the mother's
age and education,
interval between births, and decade of
birth, the risk of
having a preterm, low birthweight baby
with an increased
risk of infant death was higher for women
who changed
partner between their first two births
compared with
those who had the same partner for both
births.
One theory implies that women who change
partner have
a higher prevalence of risk taking behaviour,
such as
heavier smoking and alcohol consumption
and poorer
nutrition, which may affect pregnancy
outcomes, suggest
the authors.
Contact:
Professor Lars Vatten, Department of Public
Health and
General Practice, Norwegian University
of Science and
Technology, Trondheim, Norway
Email: lars.vatten{at}medisin.ntnu.no
(2) WOMEN FEEL
UNPREPARED FOR OPERATIVE
DELIVERIES
(Women's views on the impact of operative
delivery in
the second stage of labour: qualitative
interview study)
http://bmj.com/cgi/content/full/327/7424/1132
Antenatal classes do not adequately prepare
women for
operative deliveries (caesarean sections,
use of ventouse
or forceps), according to study in this
week's BMJ.
Researchers interviewed 27 women who had
undergone
operative delivery in the second stage
of labour at two
UK hospitals between 2000 and 2002.
Many women felt unprepared for operative
delivery and
thought that their birth plan or antenatal
classes had not
catered adequately for this event. "The
emotional impact
of the caesarean just wasn't dealt with
anywhere," said
one woman. Operative delivery also had
a noticeable
impact on women's views about future pregnancy
and
delivery.
Some had difficulty understanding the need
for operative
delivery, despite a review by medical
and midwifery staff
before discharge. Many would welcome an
in-depth
explanation of the delivery when they
had recovered
from the initial trauma of childbirth.
Maternal satisfaction with the birth experience
must now
be addressed, even within the context
of adverse clinical
events, say the authors.
Improvements in antenatal preparation for
delivery, a
realistic approach to the birth plan,
and effective
postnatal review are good places to start,
they conclude.
Contact:
Professor Deirdre Murphy, Department of
Obstetrics
and Gynaecology, Ninewells Hospital and
Medical
School, University of Dundee, Scotland
Email: D.J.Murphy{at}dundee.ac.uk
(3) MANY DIAGNOSTIC
TESTS ARE NOT BASED
ON GOOD EVIDENCE
(Retrospective analysis of evidence
base for tests used in
diagnosis and monitoring of disease
in respiratory
medicine)
http://bmj.com/cgi/content/full/327/7424/1136
Many diagnostic tests and tests used to
monitor disease
are not supported by high quality evidence,
finds a study
in this week's BMJ.
Researchers examined how many common clinical
tests
used in one respiratory medicine clinic
in the UK were
based on high quality evidence (evidence
was graded
according to a recognised quality scale).
Only half the tests that were used to make
or exclude a
diagnosis and a fifth of the tests used
to assess a known
condition were supported by high quality
evidence.
This study reflects the practice in a single
unit and the
proportion of evidence based tests used
elsewhere may
be higher, stress the authors. Nevertheless,
there is a
clear need for further high quality research
into medical
tests, at least in this specialty. There
is also a need for an
evidence base for the use of trials of
therapy.
Contact:
Paul Sullivan, Consultant, Department of
Cardiorespiratory Medicine, Hope Hospital,
Manchester, UK
Email: Paul.sullivan{at}srht.nhs.uk
(4) STUDY REVEALS
DRAMATIC RISE IN
ALLERGIC DISEASES
(Increasing hospital admissions for
systematic allergic
disorders in England: analysis of
national admissions
data)
http://bmj.com/cgi/content/full/327/7424/1142
Dramatic increases in admissions to hospital
for allergic
diseases have occurred in England over
the last decade,
finds a study in this week's BMJ.
Researchers in London used national hospital
discharge
statistics from 1990-1 to 2000-1 to identify
trends in
admissions for four allergic conditions
(anaphylaxis,
angio-oedema, food allergy, and urticaria).
Over 49,000 admissions occurred during
the 11-year
study period. Total admissions increased
from 1,960 in
1990-1 to 6,752 in 2000-1. This almost
certainly
reflects an increase in incidence, say
the authors.
The largest increases in rates were for
anaphylaxis and
food allergy. Anaphylaxis rates rose from
6 to 41 per
million, and food allergy rates rose from
5 to 28 per
million over this period. Admissions for
urticaria and
angio-oedema have risen more modestly,
from 20 to 43
per million and 10 to 17 per million respectively.
They suggest that these changes could be
caused by
increasing exposure to environmental risk
factors (such
as peanuts and other foods or latex),
to an increased
susceptibility in the population to these
allergens, or to a
combination of these factors.
Contact:
Ramyani Gupta, Department of Community
Health
Sciences, St George's Hospital Medical
School,
Cranmer Terrace, London, UK
Email: rgupta{at}sghms.ac.uk
(5) CRIMINALISING
MEDICAL MISTAKES IS
QUESTIONABLE
(Editorial: The criminalisation of
fatal medical mistakes)
http://bmj.com/cgi/content/full/327/7424/1118
Using the criminal justice system to punish
doctors who
make mistakes is questionable, according
to a barrister
in this week's BMJ.
Citing the case of Feda Mulhem, who was
sentenced to
eight months in prison after supervising
the mistaken
injection of a drug into the spine of
a teenager with
cancer, Jon Holbrook argues that he was
not seeking to
harm his patient. In fact he was intending
to further his
recovery.
His "crime" was that he made a mistake;
he confused a
drug that is injected intravenously with
a drug that is
injected into the spine. Even the most
diligent,
conscientious, and competent practitioner
will make
mistakes, he says.
The recent increase in prosecutions for
medical
manslaughter reflects society's changed
attitude towards
the notion of gross negligence, he writes.
Our modern
day intolerance of accidents as innocent
events has
tended to turn medical mistakes resulting
in death into
tragedies calling for criminal investigation.
"Dr Mulhem
was not the first doctor to be convicted
of killing by
accident and sadly he is unlikely to be
the last."
Contact:
Jon Holbrook, Barrister, London, UK
Email: Jon.Holbrook{at}Btinternet.com
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Advancement of Science
(http://www.eurekalert.org)
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