This week in the BMJ
Volume 329, Number 7460, Issue of 31 Jul 2004New ethics committee regulations hinder research
New ethics committee regulations hinder research
Five papers and an editorial show how ethics committees impede, delay, and sometimes distort research. Ward and colleagues (p 277) believe that ethical committees' requirements regarding patient confidentiality resulted in a poor response rate from their community controls; an inadvertent change that Jones and Bamford (p 280) made to their protocol resulted in suspension of the project and incomplete datasets, affecting the validity of their study; Wald and colleagues (p 282) recount their experience of a 68 page application form that took 40 hours to fill in, and Jamrozik (p 286) reflects on a similar experience; and Parker and colleagues (p 288) scrutinise the boundary between research and clinical practice in rare genetic disorders.
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What would you tell Mrs Prior?
Mrs Prior, the patient in our current interactive case report, is a 40 year old housewife who has intermittent cystitis, generalised itching, and a rash that looks like seborrhoeic dermatitis. She has taken over the counter sodium citrate. Her biochemical analysis and full blood count are given on page 273. If you know what Mrs Prior has and what you should tell her, send your response to bmj.com.
Dronabinol has a modest analgesic effect in multiple sclerosis
A third of patients with multiple sclerosis have central pain. Cannabinoids have an analgesic effect, and a crossover trial by Svendsen and colleagues shows that they are effective in central pain also (p 253). The researchers randomised 24 patients with multiple sclerosis to dronabinol or placebo and found that patients taking the drug had modest pain relief, less intense pain, and better mental health. Patients taking dronabinol were more likely to have adverse effects, which included dizziness, than were those taking placebo.
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Suicide rates in people with schizophrenia have declined
Though suicide rates in people with schizophrenia declined over 20 years, they are stillmore likely to commit suicide than others of the same age and sex. Reviewing 18 744 people from Denmark who committed suicide between 1981 and 1997, Nordentoft and colleagues (p 261) found that the rate of suicide in the general population had declined, and so had the rate among people with schizophrenia. The reduction may be due to better psychiatric treatment, less access to the means to commit suicide, and better treatment of suicide attempts, say the authors—but the risk of suicide among people with schizophrenia is still 20 times higher than that in the general population.
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Nurses using oesophageal Doppler improve outcome after heart surgery
Optimising cardiac output immediately after heart surgery may shorten hospital stay. In a randomised study involving 174 patients carried out by McKendry et al (p 258), nurses used oesophageal Doppler flowmetry and a standardised protocol to monitor and guide stroke volume and compared this with standard postoperative care (which may include monitoring cardiac output). Patients in the intervention group were given more colloids, but had fewer complications and a shorter hospital stay.
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Training doctors did not improve careseeking in mothers
Training doctors to counsel mothers about when to seek care for their sick children did not improve mothers' careseeking behaviour, but it did affect their appreciation of the need to seek care. Mohan and colleagues trained a group of doctors from 12 primary care centres in rural India on how to educate mothers to detect signs of serious illness and seek medical attention (p 266). Although doctors' performance improved after training, six months later it had declined substantially.
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