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(2) NO RATIONALE FOR GIVING PENICILLIN FOR A SORE THROAT
(3) MORE DOUBTS OVER VALUE OF DEFIBRILLATORS
(4)
PATIENTS AND DOCTORS LACK KNOWLEDGE ABOUT ADRENALINE
INJECTIONS
(1) NEW REPORT REVEALS LONG STANDING PROBLEMS
IN NHS RESEARCH STRATEGY
(Increasing the impact of health services research)
http://bmj.com/cgi/content/full/327/7427/1339
(Editorial: Health
services research)
http://bmj.com/cgi/content/full/327/7427/1301
Health services research
is still not making its full contribution to
improvements in patient
care, according to a new report from
The Health Foundation and
the Nuffield Trust, summarised in
this week's BMJ.
Health services research
accounts for 2-3% of the £4530m
spent on health research
in the UK each year, but it is unclear
how much of the information
generated is translated and used to
inform practical decisions.
Research for the report involved
interviews with 35 senior health
service researchers, NHS
managers, policy makers, and research
commissioners in the UK.
It shows that, despite many
attempts to streamline NHS research
funding, funders, researchers,
and the users of research are
uncertain about how best
to work together.
It reveals that both managers
and researchers are frustrated
about the applicability
of some health services research, while
responsibility for communicating
the results of research to the
people who need it is also
unclear.
The report proposes several
ways that research could be
strengthened, including
a UK Academy for Health Services
Research, the development
of "knowledge translators", and
fellowships that build strategic
alliances between the NHS,
academics, and policy makers.
Everyone involved in health
services research recognises
the existence of long-standing
problems, say the authors.
The best chance of progress
lies in bringing together funders,
users, and researchers to
develop solutions, as has been
achieved in the United States
and Canada.
The Health Foundation is
calling for comments on a range
of proposals for action
to support a new programme of
activity to help develop
health services research. The Nuffield
Trust will also be taking
forward a number of initiatives in this area.
Contact:
Gemma Marenghi, Media &
Communications Officer, The
Health Foundation, London,
UK Email:
gemma.marenghi@health.org.uk
(2) NO RATIONALE FOR GIVING PENICILLIN FOR
A SORE THROAT
(Penicillin for acute
sore throat in children: randomised,
double blind trial)
http://bmj.com/cgi/content/full/327/7427/1324
Most children should not
be given penicillin for a sore throat,
finds a study in this week's
BMJ.
Dutch researchers identified
156 children aged 4-15 who
visited their family doctor
with a severe sore throat. The
children were randomly assigned
to penicillin for seven
days, penicillin for three
days followed by placebo for four
days, or placebo for seven
days.
Penicillin did not reduce
the duration of symptoms, nor
did it affect school attendance
or recurrences of sore throat.
Penicillin may, however,
reduce the development of
complications, such as quinsy
or scarlet fever. Although,
once a complication is diagnosed,
sufficient time is left to
start antibiotic treatment,
say the authors.
The authors advocate prudent
prescription behaviour with
respect to penicillin. General
practitioners should treat
children with an acute sore
throat only when they are severely
ill or are at high risk
of developing serious complications,
they conclude
Contact:
Sjoerd Zwart, General Practitioner,
Julius Center for Health
Sciences and Primary Care,
University Medical Center
Utrecht, Netherlands Email:
S.Zwart@med.uu.nl
(3) MORE DOUBTS OVER VALUE OF
DEFIBRILLATORS
(Use of automated external
defibrillator by first
responders in out
of hospital cardiac arrest:
prospective controlled
trial)
http://bmj.com/cgi/content/full/327/7427/1312
(Cost effectiveness
and cost utility model of public
place defibrillators
in improving survival after
prehospital cardiopulmonary
arrest)
http://bmj.com/cgi/content/full/327/7427/1316
Use of defibrillators by
police and fire fighters to emergency
calls shows only a modest
benefit, finds a study in this week's
BMJ. A second study shows
that public place defibrillators
are not good value for money.
In the first study, defibrillators
were provided to one fire
brigade region and two police
districts in and around Amsterdam.
Half of the fire brigade
region and police districts served as
the control area. Every
four months the experimental and
control areas changed over.
Use of defibrillators did
not significantly increase survival to
hospital discharge, although
it did improve return of spontaneous
circulation and admission
to hospital. The authors suggest that
improved dispatch procedures
should increase the success of
the programme.
In the second study, researchers
calculated the cost efficiency of
locating defibrillators
in all major airports, railway stations, and
bus stations across Scotland.
They concluded that public
place defibrillators exceed the
commonly used cut-off levels
for funding and represent poorer
value for money than some
alternative strategies.
Contacts:
Study 1: Anouk van Alem,
Department of Cardiology, Academic
Medical Centre, Amsterdam,
Netherlands
Email: a.p.vanalem@amc.uva.nl
Study 2: Jill Pell, Consultant
in Public Health Medicine, Greater
Glasgow NHS Board, Scotland
or Andrew Walker, Senior
Lecturer in Health Economics,
University of Glasgow, Scotland
(4) PATIENTS AND DOCTORS LACK KNOWLEDGE
ABOUT ADRENALINE INJECTIONS
(Knowledge about using
auto-injectable adrenaline: review
of patients' case
notes and interviews with general
practitioners)
http://bmj.com/cgi/content/full/327/7427/1328
Patients and general practitioners
lack knowledge of how and
when to use devices to inject
adrenaline after anaphylaxis
(severe allergic reactions),
finds a study in this week's BMJ.
Researchers assessed the
knowledge of 60 patients (or
their parents) who had been
prescribed injectable adrenaline
and 50 general practitioners
about their understanding of
when and how injectable
adrenaline should be used.
Two of the 14 adults and
the parents of only 16 of the 46
children knew when and how
to use injectable adrenaline.
Overall, fewer than a third
of patients or parents had adequate
knowledge of when and how
to use the device.
Only one general practitioner
knew how to use the device,
because of a personal history
of anaphylaxis.
None of the general practitioners
personally showed patients
how or when to use the device,
and over half (26) would not
advise patients to go to
hospital after taking adrenaline for
anaplylaxis. This is in
contrast to recommended practice.
Current provision in the
United Kingdom for patients with
allergies is poor, and patients
may have to wait between
diagnosis of anaphylaxis
and assessment by a specialist, say
the authors. Prescribers
should therefore ensure that patients
and parents are properly
educated, they conclude.
Contact:
Dr Amolak Bansal, Clinical
Immunologist, Epsom and St Helier
NHS Trust, Carshalton, Surrey,
UK
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