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Press releases Saturday 20 November 2004
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(1) US SEES STEEP RISE IN 'NO INDICATED RISK' CAESAREANS
(2) ACUPUNCTURE BETTER THAN DRUGS ALONE FOR OSTEOARTHRITIS OF THE KNEE
(3) SMACKING LEGISLATION IS UNWORKABLE FOR DOCTORS
(4) NHS PATIENTS 'NOT FULLY ENGAGED' WITH THEIR OWN HEALTHCARE
(5) SOME HOSPITALS FACE FINANCIAL UPHEAVAL UNDER NEW NHS PAYMENT
(6) TIME TO DEVELOP NEW ANTIDOTES FOR CHEMICAL ATTACKS, URGE RESEARCHERS
(1) US SEES STEEP RISE IN 'NO INDICATED RISK' CAESAREANS
Online First
(Rise in "no indicated risk" primary caesareans in the United States,
1991-2001: cross sectional analysis)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38279.705336.0B
The United States has seen a steep rise in caesareans to women with no reported medical risk, according to research published today on bmj.com.
Researchers analysed information on four million births per year between 1991 and 2001, identifying mothers with no medical risk or labour and delivery complication noted on the birth certificate. From this group of mothers, they examined those cases where mothers had a first-time caesarean.
Results showed that caesarean rates increased by 67% among these mothers. First-time mothers aged 34 and over were the most likely to have a 'no indicated risk' caesarean, with almost 1 in 5 giving birth by caesarean in 2001.
Caesarean births also rose steeply for 'no indicated risk' mothers under 30, increasing by 58% between 1991 and 2001. For first-time mothers over 40, the odds of having a 'no indicated risk' caesarean were over 5 times that for mothers aged 20-24.
Undergoing caesareans where there is no reported medical indication raises serious questions, say the authors, not least for younger mothers who plan to have further children. More research is needed on whether the risks associated with surgery outweigh the benefits in these circumstances, they conclude.
Contact:
Professor Eugene Declercq, Maternal
and Child Health Department, Boston University School of Public Health, Boston,
USA
Email: declercq@bu.edu
(2) ACUPUNCTURE BETTER THAN DRUGS ALONE FOR OSTEOARTHRITIS OF THE KNEE
(Acupuncture as a complementary
therapy to the pharmacological treatment of osteoarthritis of the knee: randomised
controlled trial)
http://bmj.com/cgi/content/full/329/7476/1216
Acupuncture, as a complementary therapy to drug treatment for osteoarthritis of the knee, is more effective than drug treatment alone, find researchers from Spain in this week's BMJ.
Osteoarthritis of the knee is common, affecting almost a tenth of the population aged over 55. The role of acupuncture in osteoarthritis remains controversial and few studies comparing acupuncture and drug treatment have been conducted.
A total of 88 patients with osteoarthritis of the knee were randomly divided into two groups, one receiving acupuncture plus diclofenac (an anti-inflammatory drug) and the other dummy (placebo) acupuncture plus diclofenac. Treatment lasted 12 weeks and levels of pain, stiffness, and physical function were monitored using recognised scales.
The acupuncture group had a greater reduction in pain and stiffness, improved physical functioning and quality of life than the placebo group.
Although the 12-week monitoring period may be insufficient to evaluate the effects of treatment in the medium term, acupuncture as a complementary therapy to drug treatment for osteoarthritis of the knee is more effective than drug treatment alone, say the authors.
Future research should extend the observation period after treatment in order to evaluate the duration of the improvement obtained and to establish treatment protocols, they conclude.
Contact:
Jorge Vas,Chief Medical Officer,
Pain Treatment Unit, Centro de Salud, Distrito Sanitario Sevilla-Sur, Dos
Hermanas, Spain
Email: jvas@acmas.com
(3) SMACKING LEGISLATION IS UNWORKABLE FOR DOCTORS
(Legislation on smacking:
Health professionals will have to cope with consequences of recent poor decision)
http://bmj.com/cgi/content/full/329/7476/1195
The recent Commons' decision not to outlaw the physical punishment of children means that the law will offer its most vulnerable citizens (children) less protection from assault than is offered to adults, says an editorial in this week's BMJ.
Sarah Stewart-Brown, Professor of Public Health at Warwick Medical School, argues that smacking is at best ineffective and at worst leads to an escalation of unwanted behaviour. Harsh physical punishment is a cause of criminality and violence, says Professor Stewart-Brown.
Health professionals will be left to cope with the consequences of the new legislation. General practitioners, paediatricians, and primary care nurses will have to adjudicate on whether a punishment has left a mark or caused mental harm. Pronouncing that it has will be tantamount to criminalising their patients or patients' parents, and saying that it has not potentially leaves a child in danger.
An outright ban on physical punishment, coupled with widespread parenting education and support of the kind proposed in the recent national service framework for children is the best long-term solution, argues Professor Stewart-Brown.
Contact:
Sarah Stewart-Brown, Professor of
Public Health, Division of Health in the Community, Warwick Medical School,
University of Warwick, UK
Email: Sarah.Stewart-Brown@warwick.ac.uk
(4) NHS PATIENTS 'NOT FULLY ENGAGED' WITH THEIR OWN HEALTHCARE
(Full engagement in health:
Are we anywhere near?)
http://bmj.com/cgi/content/full/329/7476/1197
NHS patients lag behind other western countries in actively involving patients and communities in healthcare, says an editorial in this week's BMJ.
According to a new study from the Commonwealth Fund of New York, British patients receive less information about medicines, preventative advice or help with managing chronic disease at home. They also have poorer access to their records than other countries.
The study compared patients' experience of family doctors in the USA, Australia, New Zealand, Canada and the UK, drawing on a random survey of 8672 adults.
Researchers found that more than a third (37%) of surveyed UK patients taking regular prescription medicines said their doctor had not reviewed their medication in the past two years. And 39% said they had not received an explanation of likely side effects of their medicines ? a "notably worse result than the other countries", say the authors.
The report also showed that only 27% of British patients in the study felt their doctors had engaged them in making decisions about their healthcare, or offered them choices ? compared with 41% in New Zealand. And just 28% reported receiving advice on weight, nutrition and exercise, compared with 52% in the United States.
Substantial evidence indicates that patients engaging actively with healthcare is highly beneficial and often results in more cost effective use of health services and better health outcomes, say the authors. The new contract for family doctors does not recognise or encourage this, however. "The NHS should be supporting the public health push toward full engagement, not working against it", they conclude.
Contact:
Angela Coulter, Chief Executive,
Picker Institute Europe, Oxford, UK
Email: angela.coulter@pickereurope.ac.uk
(5) SOME HOSPITALS FACE FINANCIAL UPHEAVAL UNDER NEW NHS PAYMENT SYSTEM
(Dr Foster's case notes ?
counting hospital activity: spells or episodes?)
http://bmj.com/cgi/content/full/329/7476/1207
Some hospitals will face sizeable changes to their incomes under a new NHS payment system, say researchers at Dr Foster in this week's BMJ.
The "payment by results" system is essentially a way of paying health care providers a fixed price for each individual case treated. Under the new system, providers are paid for the actual activity that they undertake, instead of being commissioned through block contracts.
Previously, payments have been based on finished consultant episodes of care (the time spent under the care of one consultant), but from 2005-6, the new system across the NHS will be based on spells of care (a continuous period of time spent within one trust), which may include more than one episode.
Using hospital records, the research team compared spell based activity and episode based activity to examine the impact of using different criteria for determining numbers of heart attacks over time.
They found considerably more episodes of heart attack than there were spells. Measuring hospital activity by episode could therefore result in overestimates of up to 50% for heart attack. This carries obvious implications for estimating the incidence of disease and assessing healthcare outcomes, say the authors.
The new "payment by results" system should provide a more accurate method of calculating payments than using finished consultant episodes and will get around the problem of episode inflation, they write. However, the new system will give rise to considerable upheaval for some acute providers who risk sizeable changes to their financial incomes.
The move from episodes to spells, although potentially fairer, could exacerbate these problems, they conclude.
Contact:
Paul Aylin, Clinical Senior Lecturer,
Department of Epidemiology and Public Health, Imperial College London, UK
Email: p.aylin@imperial.ac.uk
*Dr Foster is an independent organisation that analyses the availability and quality of health care in the United Kingdom and worldwide (www.drfoster.com)
(6) TIME TO DEVELOP NEW ANTIDOTES FOR CHEMICAL ATTACKS, URGE RESEARCHERS
(Overcoming apathy in research
on organophosphate poisoning)
http://bmj.com/cgi/content/full/329/7476/1231
New antidotes for organophosphates are needed to prepare for chemical attacks in the West and to tackle pesticide poisoning in developing countries, argue researchers in this week's BMJ.
Organophosphates are a group of organic compounds containing phosphorus, some of which are used as pesticides. Organophosphates have also been used in chemical weapons and nerve gas attacks, such as the sarin attack in Japan.
Organophosphate poisoning is a leading cause of premature death in the developing world, while Western nations are concerned about terrorist use of chemicals. Yet no new antidotes have been tested in clinical trials in the last 30 years. An international collaboration is needed to make a concerted effort to develop and test new treatments that would benefit both groups of patients, write the authors.
Atropine is currently the only clearly proved and moderately effective treatment for organophosphate poisoning. Information on potential treatments has been available for years, but neither the military nor the pharmaceutical industry has attempted to test them or develop new drugs.
The pharmaceutical industry has little incentive to develop new drugs for use primarily in developing countries, add the authors. However, on humanitarian grounds alone, research into organophosphate pesticide poisoning in developing countries should become an international priority.
Recent concerns by government about having the means to respond to victims of chemical warfare and terrorist attacks means that the time is ripe to break this drug development impasse, they conclude.
Contact:
Nick Buckley, Associate Professor
in Clinical Pharmacology & Toxicology, South Asian Clinical Toxicology
Research Collaboration, The Australian National University
Email: Nick.Buckley@act.gov.au
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