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Press releases Saturday 17 July 2004
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(1) CANNABIS
EXTRACT REDUCES PAIN IN MULTIPLE SCLEROSIS PATIENTS
(2) SIMPLE
MEASURES CAN ERADICATE MRSA
(3) WHO SHOULD
GENETIC INFORMATION BELONG TO?
(4) SMALL INCREASED RISK OF INFERTILITY AMONG GULF WAR VETERANS
Online First
(1) CANNABIS EXTRACT REDUCES
PAIN IN MULTIPLE SCLEROSIS PATIENTS
(Does the cannabinoid dronabinol
reduce central pain in multiple sclerosis? Randomised double blind placebo
controlled crossover trial)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38149.566979.AE
The cannabis extract, dronabinol, reduces pain in patients with multiple sclerosis, finds new research published on bmj.com today.
The study involved 24 patients with multiple sclerosis and central pain attending a hospital clinic in Denmark.
Patients were given either dronabinol capsules or identical looking placebo capsules for three weeks. Pain intensity in the last week of treatment was assessed and patients completed a quality of life questionnaire.
Pain intensity was significantly lower and pain relief was higher during dronabinol treatment than during placebo treatment. Pressure evoked pain also tended to decrease, and patients reported better quality of life with dronabinol compared with placebo.
Adverse events, including dizziness, were more frequent with dronabinol than with placebo during the first week of treatment, but these decreased during treatment.
Dronabinol has a modest but clear and clinically relevant analgesic effect on central pain in patients with multiple sclerosis and should be available for patients whose central pain is not sufficiently treated with alternative drugs, conclude the authors.
Contact:
Flemming Bach, Associate Clinical
Professor, Danish Pain Research Center and Department of Neurology, Aarhus
University Hospital, Denmark
Email: fbach@akh.aaa.dk
(2) SIMPLE MEASURES CAN ERADICATE MRSA
(Eradication of methicillin
resistant Staphylococcus aureus by "ring fencing" of elective orthopaedic
beds)
http://bmj.com/cgi/content/full/329/7458/149
Ring fencing of hospital wards and simple infection control measures can eradicate MRSA in patients having planned operations and allow more patients to be treated, show researchers in this week's BMJ.
Their study involved all patients undergoing elective hip or knee replacement at Broomfield Hospital in Essex. In April 1998, all orthopaedic surgery was centralised to this hospital from a dedicated stand-alone orthopaedic hospital. Twenty-nine new cases of MRSA occurred in the first year after the move.
For one year, rates of postoperative infections were recorded. Then in July 2000, the 28 beds in the elective orthopaedic ward were "ring fenced." Only patients having elective orthopaedic surgery were admitted to the ward and infection control measures were rigorously enforced.
These measures led to a significant decrease in all postoperative infections and also allowed 17% more patients to be treated without increasing the number of operating lists, beds, or surgeons. No cases of MRSA occurred after ring fencing.
"We strongly recommend the ring fencing of elective orthopaedic patients and simple infection control measures to reduce the risk of postoperative infection and allow an increase in the number of patients treated," conclude the authors.
Contact:
Leela Biant, Specialist Registrar
- Trauma and Orthopaedic Surgery, Lister Hospital, Stevenage, UK
Email: lcbiant@yahoo.com
(3) WHO SHOULD GENETIC INFORMATION BELONG TO?
(Genetic information: a joint
account?)
http://bmj.com/cgi/content/full/329/7458/165
Should the results of genetic tests be considered personal, or should health professionals be able to use them in providing health care to the whole family, ask researchers in this week's BMJ.
Currently genetic information is considered personal, with the emphasis on respect for patient confidentiality. But patients often only seek genetic testing because of their family history, so results could more appropriately be viewed as necessary information for treating the whole family, write the authors.
The current "personal account model" emphasises patient centredness in medicine. Under this model, an individual patient's information is kept confidential unless there is a strong reason for it to be disclosed, eg serious harm to a relative.
However, this approach means that relatives can miss out on important information and health care, say the authors. Instead genetics could adopt a "joint account model", which classes genetic information as familial rather than personal, and makes it available for the treatment of other family members except where there are good reasons not to do so.
Which of these models should apply in practice? The personal model is consistent with good practice in other areas of medicine, say the authors. Nevertheless, the familial nature of genetics means that under this approach, relatives may not receive appropriate healthcare due to lack of information. In the interests of justice, they argue, sharing genetic information should become routine, except in special circumstances.
Changing to a joint model is controversial, but where there is no risk of serious harm to patients or their relatives, it would extend the benefits of testing to the whole family, they conclude.
Contact:
Michael Parker, Reader in Medical
Ethics, Oxford Genetics Knowledge Park, Ethox Centre, University of Oxford,
UK
Email: michael.parker@ethox.ox.ac.uk
Online First
(4) SMALL INCREASED RISK OF INFERTILITY AMONG GULF WAR VETERANS
(Infertility among male UK
veterans of the 1990-1 Gulf war: reproductive cohort study)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38163.620972.AE
UK Gulf war veterans are at a small increased risk of infertility, according to new research published on bmj.com today.
Researchers at the London School of Hygiene and Tropical Medicine surveyed 24,379 male Gulf war veterans and a matched comparison group of 18,439 non-deployed servicemen.
Risk of reported infertility was higher among Gulf war veterans than among the comparison group of non-Gulf veterans. For instance, failure to achieve conceptions was 2.5% for Gulf veterans and 1.7% for non-Gulf veterans, while failure to achieve a live birth was 3.4% for Gulf veterans and 2.3% for non-Gulf veterans.
This small effect did not decline with time since the war and was observed whether or not the men had fathered children before the war, consistent with a theory of sperm damage. Pregnancies fathered by Gulf veterans who did not report fertility problems also took longer to conceive.
These results should be treated with caution, and at this stage no firm conclusions can be drawn, stress the authors.
However, put together with previous finding of increased miscarriage among pregnancies fathered by male UK Gulf veterans, these results justify further research into the reproductive health of men deployed to the Gulf region, including a prospective investigation of veterans of the recent conflict in Iraq, they conclude.
Contacts:
Noreen Maconochie, Senior Lecturer
in Epidemiology and Medical Satistics or Pat Doyle, Reader in Epidemiology,
London School of Hygiene and Tropical Medicine, UK
Email: noreen.maconochie@lshtm.ac.uk
/ pat.doyle@lshtm.ac.uk
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