This week in the BMJ
Volume 328, Number 7451, Issue of 29 May 2004Filtered blood shortens hospital stay
Filtered blood shortens hospital stay
Transfusing leucocyte depleted blood may reduce hospital stay and risk of multiorgan failure in patients undergoing major surgery. Van Hilten and colleagues (p 1281) randomised 1051 patients to filtered blood or to standard care after abdominal surgery. Infection rates and duration of stay in intensive care did not differ, and the only patients in the intervention group with better survival were those who had gastrointestinal surgery. However, time spent in hospital was 2.4 days shorter and multiorgan failure was 30% less likely in the intervention group.
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Soya food may reduce the risk of endometrial cancer
Regular consumption of soya may decrease the risk of endometrial cancer. Xu and colleagues (p 1285) studied 1678 women in China (832 with endometrial cancer) and found that, compared with the quarter of women with the lowest soya protein intake, the risk of endometrial cancer was reduced with increasing soya protein intake. The reduction was more pronounced among women with high body mass index or waist:hip ratio.
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Older age doesn't affect time spent in hospital before death
The number of days spent in hospital before death does not increase with older age. Reviewing more than 250 000 in hospital deaths during 1999-2000 in England, Dixon and colleagues (p 1288) found that, on average, patients were admitted 3.6 times, and for 23 days, in the last three years of life. The length of stay increased with age up to 45 years old, but was fairly stable thereafter. Patients use more healthcare resources because they are dying, say the authors, not because they are older.
Individual patient data reveal antibiotic resistance
Individual patient data have added value for research on the outcome of prescribing. Analysing data on 166 000 patients from 28 general practices in the Tayside region, Donnan and colleagues (p 1297) found significant variation in the prevalence of trimethoprim resistance (26-50% of bacteria isolated) and trimethoprim prescribing (67-357 prescriptions per 100 practice patients) among practices. Resistance was associated with age, sex, and individual-level exposure to trimethoprim or to other antibiotics within the previous six months but not with practices' overall prescribing patterns. Anonymised individual data facilitate research and protect confidentiality, says Wilson (p 1300) in a commentary, and a proper legal framework is needed for the use of anonymisation techniques.
HRT increases unnecessary tests after breast cancer screening
Useless tests after initial screening for breast cancer are more likely in women who are, or were, taking hormone replacement therapy. Banks and colleagues (p 1291) reviewed data from more than 87 000 postmenopausal women screened in the NHS, and found that 3% of those with a negative screening had subsequent tests. Tests (and biopsies) were more likely in women still taking hormone replacement therapy and in past users.
A negative test for human papillomavirus may not reassure
In women with borderline or dyskaryotic cervical smears, testing negative for human papillomavirus infection did not reduce anxiety. Surveying 1376 women participating in the English pilot study of cytology followed by testing for human papillomavirus infection, Maissi et al (p 1293) found that, among women with abnormal smears, testing positive for human papillomavirus infection increased anxiety and distress. However, testing negative was no more reassuring than not testing at all.
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