This week in the BMJ
Volume 328, Number 7452, Issue of 5 Jun 2004Chemoprophylaxis reduces the risk of meningitis
Chemoprophylaxis reduces the risk of meningitis
In people who had contact with patients with meningococcal infection, antibiotic prophylaxis reduced the risk of developing meningitis. Reviewing more than 100 papers, Purcell and colleagues (p 1339) identified five good quality studies, including 1249 cases of meningitis and 4271 household contacts, of whom 1742 had had chemoprophylaxis. Treatment reduced the risk of developing meningitis by 89%, and the estimated number needed to treat to prevent one case was 218 people. Index patients should have chemoprophylaxis before discharge from hospital, as at least 3% will still be carrying the infection despite treatment.
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Be honest when talking to patients
Patients and their relatives want open and honest information about their illnesses. Kirk and colleagues (p 1343) interviewed 37 cancer patients receiving palliative care and their relatives, and found that patients want full and honest information about their illness, which they share with their families. Many were dissatisfied with the communication process they had experienced, and they used secondary sources of information to increase their awareness. The authors conclude that healthcare workers should be honest, clear, accurate, and provide hope. As illness progressed, patients were less interested in prognosis and focused on daily living concerns and on managing symptoms.
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ELPS is the way forward
Authors find it acceptable for the BMJ to publish long versions of their research papers on the web and shorter versions in the printed journal (the ELPS process). Schroter and colleagues (p 1350) surveyed 317 authors submitting papers to the BMJ and found that 70% liked ELPS and over 30% thought the shortened version was more readable. There were concerns about the long term fate of electronic information; authors disliked the idea of printing only abstracts in the journal but favoured rapid publication on the web of their papers.
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Doctors trained abroad are less likely to win merit awards
Consultants who trained abroad are under-represented among holders of NHS distinction awards in England and Wales. Lambert and colleagues (p 1347) analysed all merit awards given between 1998 and 2002 and found that, compared with before 1998, under-representation of women and doctors from ethnic minorities had diminished substantially or disappeared. However, doctors who trained abroad, both white and non-white, remained less likely to receive awards.
Venous leg ulcers are best treated at home
Most patients with venous leg ulcer can be managed in the community. Early identification of risk factors, along with a tailored approach with compression bandaging, leg elevation, improved mobility and nutrition, and close supervision by a specialist nurse, are important, say Simon and colleagues (p 1358). Up to 85% of ulcers are associated with venous hypertension, but surgery on the superficial veins is clearly indicated only for patients with superficial venous incompetence, and antibiotics have little effect on ulcer healing. The authors say that the focus should move from treatment to prevention.
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Patients with chronic fatigue syndrome are not treated properly
General practitioners are ambivalent about chronic fatigue syndrome and may not be treating patients according to best evidence. Raine and colleagues (p 1354) interviewed 46 general practitioners in England and found that some hold negative stereotypes for chronic fatigue syndrome, but not for irritable bowel syndrome. This antipathy was due to the lack of bodily location, patients failing to conform to the work ethic and traditional "sick role," and disagreement with patients over causes and management. Referral for mental health interventions was unlikely because doctors were unfamiliar with them or thought them unavailable or unnecessary.
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