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Press releases Saturday 3 July 2004
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(1) ADVERSE DRUG REACTIONS ARE A HUGE BURDEN ON NHS
(2) BETTER
INFORMATION NEEDED ABOUT HERB-DRUG INTERACTIONS
(3) VACUUM
ASSISTED DELIVERIES ARE SAFE ALTERNATIVE TO FORCEPS
(4) EFFECTS
OF PASSIVE SMOKING MAY HAVE BEEN UNDERESTIMATED
(1) ADVERSE DRUG REACTIONS ARE A HUGE BURDEN ON NHS
(Adverse drug reactions as
cause of admission to hospital: prospective analysis of 18 820 patients)
http://bmj.com/cgi/content/full/329/7456/15
Adverse drug reactions account for 1 in 16 hospital admissions and cost the NHS £466m a year, according to a study in this week's BMJ.
Researchers assessed 18,820 patients aged over 16 years who were admitted to two NHS hospitals in Merseyside over a six-month period. Drug history and symptoms were used to determine if the admission had been caused by an adverse drug reaction.
A total of 1,225 admissions were related to an adverse drug reaction, giving a prevalence of 6.5%. The average stay was eight days, which accounted for 4% of the hospital bed capacity. The projected annual cost to the NHS of such admissions was £466m.
Although most patients recovered, 28 (2.3%) died as a direct result of the reaction. Most reactions were either definitely or possibly avoidable. Low dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs were most commonly implicated. Gastrointestinal bleeding was the most common reaction.
Adverse drug reactions are an important cause of hospital admissions, resulting in a considerable use of NHS beds and a significant number of deaths, say the authors. Many may be preventable through simple improvements in prescribing.
Measures are urgently needed to reduce the burden on the NHS, they conclude.
Contact:
Munir Pirmohamed, Professor of Clinical
Pharmacology, Department of Pharmacology and Therapeutics, University of
Liverpool, UK
Email: munirp@liv.ac.uk
(2) BETTER INFORMATION NEEDED ABOUT HERB-DRUG INTERACTIONS
(Interaction of St John's
wort with conventional drugs: systematic review of clinical trials)
http://bmj.com/cgi/content/full/329/7456/27
Doctors and patients should beware of possible interactions of St John's wort with conventional drugs, but better information is needed to guide clinical practice, say researchers in this week's BMJ.
Some trials have found that St John's wort may cause important interactions, possibly leading to adverse events or drug resistance. But until now, the quality of this research has never been examined.
The team analysed the results of 22 trials examining drug interactions of St John's wort. The trials (published between 1999 and April 2004) studied an average of 12 participants and most used a "before and after" design.
Three trials found no important interaction, while 17 found a decrease in the blood concentration of conventional drugs when taken alongside St John's wort.
This review shows that St John's wort has the potential to reduce the availability of many conventional drugs in the body. However, the studies are small and limited in scope and methodological quality, say the authors.
"Clinicians and patients should beware of possible reductions in bioavailability of conventional drugs when taken concomitantly with St John's wort. Higher quality research is necessary to provide reliable information to guide clinical practice," they conclude.
Contact:
Edward Mills, Graduate Fellow, McMaster
Health Sciences Centre, Hamilton, Ontario, Canada
Email: millsej@mcmaster.ca
(3) VACUUM ASSISTED DELIVERIES ARE SAFE ALTERNATIVE TO FORCEPS
(Operative vaginal delivery
and neonatal and infant adverse outcomes: population based retrospective
analysis)
http://bmj.com/cgi/content/full/329/7456/24
Vacuum assisted deliveries are a safe alternative to forceps deliveries, despite a warning by the US Food and Drug Administration in 1998 that vacuum assisted deliveries may result in fatal complications, say researchers in this week's BMJ.
They compared the risk of death and birth injuries between vacuum extraction and forceps deliveries for over 11 million singleton live births in the United States.
The overall risk of death and birth injuries were similar between infants delivered by vacuum or by forceps, suggesting that vacuum extraction is at least as safe as forceps.
Furthermore, the relatively low rates of fatal complications among vacuum deliveries argue against the FDA warning, say the authors.
Encouraging instrumental vaginal deliveries may help to reduce the rates of caesarean section. Although delivery by vacuum extraction does have risks, it remains a safe alternative to forceps delivery.
These results also underscore the need for obstetric standards in performing instrumental deliveries, they conclude.
Contact:
Kitaw Demissie, Assistant Professor,
Division of Epidemiology, University of Medicine and Dentistry of New Jersey,
USA
Email: demisski@umdnj.edu
Online First
(4) EFFECTS OF PASSIVE SMOKING
MAY HAVE BEEN UNDERESTIMATED
(Passive smoking and risk
of coronary heart disease and stroke: prospective study with cotinine measurement)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38146.427188.55
The full effects of passive smoking may have been underestimated, according to a new study available on bmj.com.
Most studies on passive smoking have examined the risks of living with someone who smokes. Although this is an important component of exposure, it does not take account of additional exposure in workplaces and in public places (particularly pubs and restaurants). In contrast, cotinine (a by-product of nicotine) can provide a more accurate measure of exposure from all these sources.
Researchers at St George's Hospital Medical School and the Royal Free UCL Medical School examined the links between blood cotinine levels and risk of coronary heart disease (CHD) and stroke in 4,729 men from 18 British towns. The men were monitored for 20 years.
Higher concentrations of blood cotinine levels among the non-smokers were associated with a 50-60% greater risk of CHD. In earlier partner smoking studies, passive smoking is associated with a 25-30% increased risk. This suggests that the effects of passive smoking may have been underestimated in earlier studies, say the authors.
The risks were particularly increased during the early follow up periods, indicating that the association between cotinine levels and CHD seems to decline with time. This suggests a further possible source of underestimation of the effects of passive smoking, as long follow up periods have been a feature of many earlier studies, they add.
Further studies of the association between cotinine (or similar biomarkers) and risk of CHD will help to assess the effects of passive smoking on cardiovascular disease with greater precision. In the meantime, these results should add to the weight of evidence suggesting that exposure to passive smoking is a public health hazard and should be minimised, they conclude.
Contact:
Peter Whincup, Professor of Cardiovascular Epidemiology, Department of Community Health Sciences, St George's Hospital Medical School, London, UK. Email: p.whincup@sghms.ac.uk
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