This week in the BMJ
Volume 329, Number 7463, Issue of 21 Aug 2004Patients' personalities affect admission to ICU
Patients' personalities affect admission to ICU
Doctors may be using unfair criteria to admit patients to intensive care units. Evaluating 232 questionnaires from intensive care doctors in Switzerland, Escher and colleagues (p 425) found that the availability of beds, the prognosis, wishes of the patients, age, and personality influenced their decisions on admission to intensive care units. Doctors did not discriminate against patients with low socioeconomic status, psychiatric illness, or cancer. They must be aware of unconscious value judgments about personality, say the authors, to avoid unfair treatment of patients.
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New cardiac surgeons improve their results over time
The outcome of surgery under newly appointed cardiac surgeons improves during the first four years of independent practice. Reviewing surgical outcomes in 18 913 people undergoing coronary artery surgery in northern England between 1997 and 2003, Bridgewater and colleagues (p 421) found that mortality in patients operated on by 15 newly appointed surgeons was similar to mortality in patients of established colleagues, and that it decreased from 2.2 % in the first year to 1.2% in the fourth year of independent practice. These data should be interpreted with caution, says Treasure in a commentary (p 424), as conclusions about learning curves based on such a small difference in mortality are insecure.
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Reducing heroin availability decreases drug use
Reducing the supply of heroin may decrease the use of injecting drugs. Day and colleagues (p 428) analysed the number of needles and syringes distributed in New South Wales, Australia, after a decrease in heroin availability and used this as a proxy for changes in the number of injecting drug users and the frequency of injecting. Their finding that the number of distributed needles decreased 28% from the onset of the shortage indicates that a reduced supply results in less use of injecting drugs.
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Prescribing behaviour can be improved
Changing prescribing behaviour is difficult—but feasible. Welschen and colleagues (p 431) randomised 100 general practitioners to a multiple intervention consisting of group training on indications for and use of antibiotics for respiratory tract symptoms, training in communication skills, monitoring and feedback on prescribing behaviour, group education for general practitioners' assistants and pharmacists, and patient education material, or to no training. After nine months, doctors in the intervention group were less likely to prescribe antibiotics, and patients' satisfaction remained high.
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Radial artery is the preferred approach
The radial artery is the access route of choice for most percutaneous coronary procedures. On page 443 Archbold and colleagues say that the radial artery may be used safely for most coronary procedures, with a low incidence of complications, reduced hospital stay and costs, and good patient satisfaction. A minority of patients with insufficient ulnar artery flow are not suitable for the procedure, but using the radial artery approach may change post-procedure recovery: wards will have armchairs, say the authors, rather than beds.
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More efforts needed for HIV vaccine
Research into the development of an HIV vaccine is progressing and is being supported by the public sector, but international collaboration is needed for success. Tucker and Mazithulela (p 454) describe the South African Vaccine Initiative, established in 1999 by the South African government. Global integration and collaboration, maximising international partnerships, and resource mobilisation are the key strategies adopted. An HIV vaccine is our best hope for eradicating HIV, say the authors, and broad support from governments and the private sector is paramount.
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