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(2) COELIAC DISEASE MAY PREDICT SCHIZOPHRENIA
(3) NHS REFORMS HAVE LEFT NO TIME TO TRAIN SURGEONS
(1) ONE IN FIVE ASTHMATICS ARE HIGHLY SENSITIVE TO ASPIRIN
(Systematic review of prevalence
of aspirin induced asthma and its implications for clinical practice)
http://bmj.com/cgi/content/full/328/7437/434
One in five asthmatic patients are sensitive to aspirin, yet many are unaware that they are at risk of a potentially life threatening reaction known as aspirin induced asthma, warn researchers in this week's BMJ.
Aspirin induced asthma is a severe reaction to aspirin and other commonly used painkillers, but controversy exists over its prevalence.
Researchers analysed 21 studies of asthmatic patients and found the prevalence of aspirin induced asthma to be 21% in adults and 5% in children.
Most of these patients were also sensitive to over the counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and diclofenac, but only 7% of them were sensitive to paracetamol.
Since aspirin and NSAIDs are often self prescribed, patients diagnosed with asthma should be alerted to the possibility of aspirin induced asthma by their healthcare professional, say the authors.
They recommend including simple, standardised warnings on packs of aspirin and NSAIDs, alerting asthmatic patients to the potential risks.
Contacts:
Christine Jenkins, Head of Asthma Group, Royal Prince Alfred Hospital, Sydney, Australia Mobile: +61 0413 155 111 Email: crj@med.usyd.edu.au
John Costello, Clinical Director of Medicine,
King's College Hospital, London, UK
Email: john.costello@kcl.ac.uk
(2) COELIAC DISEASE MAY PREDICT SCHIZOPHRENIA
(Coeliac disease and schizophrenia:
population based case control study with linkage of Danish national registers)
http://bmj.com/cgi/content/full/328/7437/438
A history of coeliac disease (gluten intolerance) is a risk factor for developing schizophrenia, finds a study in this week's BMJ.
Previous studies have suggested an association between these two disorders.
Researchers identified 7,997 people older than 15 who were admitted to any Danish psychiatric unit for the first time between 1981 and 1998 with a diagnosis of schizophrenia.
For each case, they randomly selected 25 controls, matched by year of birth and sex, and identified any history of coeliac disease, ulcerative colitis, or Crohn's disease in cases, controls, and their parents.
They found a moderately strong risk relation between coeliac disease and schizophrenia. However, the authors stress that this reflects a small proportion of cases, since both disorders are rare.
Contact:
Professor William Eaton, Department of
Mental Health, Bloomberg School of Public Health, Johns Hopkins University,
Baltimore, USA
Email: weaton@jhsph.edu
(3) NHS REFORMS HAVE LEFT NO TIME TO TRAIN SURGEONS
(No time to train the surgeons)
http://bmj.com/cgi/content/full/328/7437/418
More and more reforms have resulted in less and less time to train the next generation of surgeons in the United Kingdom, warn doctors in this week's BMJ.
Reforms introduced in 1993 by Sir Kenneth Calman together with The European Working Time Directive have reduced training from 30,000 hours to an estimated 8,000 hours, and the Chief Medical Officer is proposing to reduce this even further to 6,000 hours.
To become a competent surgeon in one fifth of the time once needed either requires genius, intensive practice, or lower standards, write the authors.
The largest ever survey of senior house officers in orthopaedic surgery showed that a third of these trainees were not taught in theatre or clinic. As a result many junior trainees arrive at posts without any real competence in operative skills as basic as suturing.
"We cannot rely on highly able and motivated trainees and trainers to struggle on like this. Surgical training must be recognised as a priority," say the authors.
Most current trainees are supposed to become the new "generalist" surgeons who will carry out common procedures, referring more complex patients on to "specialist" consultant colleagues.
"We are left in the worrying situation where 6,000 hours of surgical training in its current state may not be enough to produce these new generalists, let alone provide consultants that can go on to become the kind of specialist consultant surgeon that we take for granted today," they conclude.
Contact:
Joanna Chikwe, Specialist Registrar, Royal
Brompton Hospital, London, UK
Email: j.chikwe@medschl.cam.ac.uk
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