Press releases Saturday 8 May 2004
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(1) ANEURYSM SCREENING COULD SAVE LIVES
(2) TRAINING CARERS
REDUCES STROKE BURDEN AND SAVES MONEY
(3) STRIKING DIFFERENCES
FOUND IN SELF HARM SERVICES
(4) NEW STRATEGY
AIMS TO HALVE MALARIA DEATHS BY 2010
(1) ANEURYSM SCREENING COULD SAVE LIVES
(Screening for abdominal aortic
aneurysms in men)
http://bmj.com/cgi/content/full/328/7448/1122
(Editorial: National screening
programme for aortic aneurysm)
http://bmj.com/cgi/content/full/328/7448/1087
A national aortic screening programme in the UK could save lives at reasonable cost, say researchers in this week's BMJ.
Every year in England and Wales about 6,000 men die from a ruptured aortic aneurysm (caused by ballooning of the artery wall) yet aortic aneurysms can be detected with a simple ultrasound scan.
A recent study found that screening reduced deaths by 42% and is as cost effective as other current screening programmes.
In Gloucestershire, an aneurysm screening programme has been running for 13 years and deaths from aneurysm disease in the region have fallen. The project shows the potential benefits of a national programme and how it could be run.
The scientific arguments for a national screening programme for aneurysms are cogent, write the authors. "We believe that the United Kingdom's family doctor based health system puts it in an ideal position to be the first country to start national screening. The final decision is now political."
If the Gloucestershire pilot were reproduced nationally, the cost would be less than £50m per year, and ruptured abdominal aortic aneurysm could become a national rarity, says a surgeon in an accompanying editorial. However, more data are needed before adopting a national programme.
Contact:
Brian Heather, Consultant Surgeon,
Gloucestershire Royal Hospital, Gloucester, UK
Email: Earnshaw@rudford.demon.co.uk
(2) TRAINING CARERS REDUCES STROKE BURDEN AND SAVES
MONEY
(Training care givers of
stroke patients: randomised controlled trial and economic evaluation)
http://bmj.com/cgi/content/full/328/7448/1102
(Editorial: Informal care
giving for disabled stroke survivors)
http://bmj.com/cgi/content/full/328/7448/1085
Training carers of disabled stroke patients in basic nursing skills improves quality of life and saves money, according to two studies in this week's BMJ.
Informal care givers support disabled stroke patients at home but often feel inadequately trained, poorly informed, and dissatisfied with the support available.
The studies involved 300 stroke patients and their care givers. Care givers provided either conventional support, or were trained in basic nursing tasks, moving and handling skills, and personal care techniques. All patients and care givers were assessed at three and 12 months.
Trained care givers experienced less anxiety, depression, and had a significantly higher quality of life than non-trained care givers.
Although patient deaths and disability were not influenced by caregiver training, patients whose care givers had received training reported significantly improved quality of life and psychological wellbeing.
The costs of care over one year for patients whose care givers had received training were also significantly lower (£10,133 v £13,794).
Although the practical importance of the effects of any intervention on quality of life can be difficult to interpret, the significant improvements associated with caregiver training are likely to indicate an important effect that has implications for clinical practice, conclude the authors.
Contact:
Lalit Kalra, Professor of Stroke
Medicine, Department of Medicine, Guy's, King's and St Thomas's School of
Medicine, London, UK
Email: lalit.kalra@kcl.ac.uk
(3) STRIKING DIFFERENCES FOUND IN SELF HARM SERVICES
(Variations in the hospital
management of self harm in adults in England: observational study)
http://bmj.com/cgi/content/full/328/7448/1108
Striking differences exist in the care of self harm patients in hospitals in England, finds a study in this week's BMJ.
Each year in England and Wales, more than 140,000 people present to hospital after an episode of self harm. Improving the general hospital management of these people is a key area in preventing suicide.
The study, by researchers from the Universities of Bristol, Oxford and Leeds, involved a random sample of 32 hospitals. Each hospital was assessed on 21 recommended self harm service standards and each hospital did an eight-week audit of their management of self harm.
A designated self harm liaison service was available at 23 of the 32 hospitals. At 11 hospitals, more than half of the 21 recommended service structures were not in place.
Guidelines for assessing the risk of suicide were available at 17 hospitals. Only 14 hospitals had self harm service planning meetings. Routine contact with patients' general practitioners within 24 hours of discharge from emergency departments happened at only half of the hospitals.
During the audit, there was no significant difference in the proportion of assessments, admissions, or monitoring arrangements between hospitals with and without a designated service. However, at hospitals with a designated service, assessments were less likely to be undertaken by junior psychiatrists.
Variability in organisation and provision of services for patients with self harm was striking, say the authors. There was a two-fold difference across hospitals in levels of psychosocial assessment, four-fold variation in the proportion of attendances leading to admission to a hospital bed, and 10-fold variation in the proportion admitted to a psychiatric bed.
There were also wide variations in the implementation of the recommended service structures.
Future research should examine the relationships between the patient management and service structures described here and indicators such as repetition and suicide, they conclude.
Contacts:
David Gunnell, Professor of Epidemiology,
Department of Social Medicine, University of Bristol, UK
Email: d.j.gunnell@bristol.ac.uk
Dr Cherry Lewis, Research Publicity
Officer, Public Relations Office, University of Bristol, UK
Email: cherry.lewis@bristol.ac.uk
(4) NEW STRATEGY AIMS TO HALVE MALARIA DEATHS BY
2010
(Linking disease control
programmes in rural Africa: a pro-poor strategy to reach Abuja targets and
millennium development goals)
http://bmj.com/cgi/content/full/328/7448/1129
(Editorial: Roll Back Malaria:
a failing global health campaign)
http://bmj.com/cgi/content/full/328/7448/1086
Linking malaria programmes to other disease control strategies in Africa could help to halve deaths from malaria by 2010, say researchers in this week's BMJ.
This target was set in 1998 through the Roll Back Malaria initiative, but progress has been slow. Currently, one million people die every year from malaria, mostly in Africa.
David Molyneux and Vinand Nantulya propose a strategy in which the distribution of bed nets is linked to other disease control programmes. This would not only improve access to poor and hard to reach communities, but would potentially save costs.
Such linkages also offer the opportunity to extend other public health benefits, such as improved nutrition and provision of clean water, to hard to reach rural populations, say the authors. Other programmes, based on drug donations, have helped to reduce anaemia and intestinal worms. Such an approach could reduce maternal and child mortality and reduce frequency of malaria fevers.
For example, the distribution of free nets was recently linked to a measles vaccination campaign in remote rural districts of Zambia and Ghana. The campaign achieved the global target for net coverage in one week.
Programmes currently focused on single diseases should now create linkages at national, district, and community level, write the authors. They urge a shift in malaria control strategies to maximise opportunities for bringing improved health to vulnerable communities, which are more proactive than current aproaches.
Journalists are invited to put their questions to the authors at a press briefing on Thursday 6 May, 10.30am, at the Science Media Centre, 21 Albermarle Street, London W1.
Contact:
David Molyneux, Director, Lymphatic
Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool,
UK
Email: fahey@liv.ac.uk; ljb@liv.ac.uk
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