Online First articles may not be available until 09:00 (UK time) Friday.
Press releases Saturday 4 December 2004
Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).
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please include a link back to the source BMJ article (URL's are given
under titles).
(1) CANNABIS INCREASES RISK OF PSYCHOSIS
(2) MEDICAL NEGLIGENCE SYSTEM IS "SECRETIVE, UNACCOUNTABLE AND UNREGULATED"
(3) EMERGENCY DEPARTMENTS FAILING TO MEET ESSENTIAL STANDARDS FOR CHILDREN
(4) MEDICATION ERRORS IN SICK CHILDREN MAY BE HIGHER THAN PREVIOUSLY THOUGHT
(5) GUIDANCE ON CHAPERONES HARD TO IMPLEMENT IN GENERAL PRACTICE
(6) IS THE INTERNET ENCOURAGING SUICIDE PACTS?
(1) CANNABIS INCREASES RISK OF PSYCHOSIS
Online First
(Prospective cohort study of cannabis use, predisposition for psychosis,
and psychotic symptoms in young people)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38267.664086.63
Frequent cannabis use during adolescence and young adulthood increases the risk of psychotic symptoms later in life, according to a new study published on bmj.com today.
The risk of developing symptoms was much higher in young people with a pre-existing vulnerability to psychosis.
Please note, the embargo for this paper will be lifted at 11.00 hrs on Wednesday 1 December 2004, when the author will present the full findings at a press briefing at the Science Media Centre, 21 Albemarle Street, London W1.
The study took place in Germany and involved 2437 young people aged 14 to 24 years. Participants were assessed for substance use, predisposition for psychosis, and psychotic symptoms, and were monitored for four years.
After adjusting for influential factors, such as social and economic status and use of other drugs, tobacco, and alcohol, cannabis use moderately increased the risk of psychotic symptoms. This effect was much stronger in those with any predisposition for psychosis.
Contact:
Professor Jim van Os, Department
of Psychiatry and Neuropsychology, South Limburg Mental Health Research and
Teaching Network, Maastricht University, Netherlands
E-mail: j.vanos@sp.unimaas.nl
(2) MEDICAL NEGLIGENCE SYSTEM IS "SECRETIVE, UNACCOUNTABLE AND UNREGULATED"
(The negligence of medical
experts)
http://bmj.com/cgi/content/full/329/7478/1353
The current system for determining medical negligence is "secretive, unaccountable and unregulated", according to an opinion piece in this week's BMJ.
Central to the system are expert witnesses, but these are not subject to regulatory code, audit, appraisal or peer review. Quality of reports provided by expert witnesses varies greatly, and many present source material for their opinions which "they would not dare to offer" to their medical colleagues, says Michael Bishop, a consultant urological surgeon.
Expert witnesses may also be selected for reasons other than their expertise in the field, such as how quickly they produce reports, or their registration with a particular organisation.
Medical negligence claims are mostly considered in closed sessions, attended by medical experts, defence organisations, the NHS litigation authority and solicitors with varying levels of expertise. Damage limitation, rather than a vigorous defence through intellectual argument, is often the outcome says Mr Bishop. Litigation is expensive, but cross-examination in open court provides the only opportunity for experts to be challenged under the existing system.
The public expects expert witnesses to be up to date with the latest thinking in their speciality and unbiased, says Mr Bishop, but this is often not the case. A new system is needed, based on a national register of coded incidents and their outcomes. This would promote consistency in the treatment of negligence claims and enable doctors to better learn from errors.
At a time when several high profile expert witnesses have been called into question, the profession must make itself transparent to restore the faith of its medical colleagues and ensure the protection of the public, concludes Mr Bishop.
Contact:
Michael Bishop, Consultant Urological
Surgeon, Nottingham City Hospital, Nottingham, UK
Email: tguyler@ncht.trent.nhs.uk
(3) EMERGENCY DEPARTMENTS FAILING TO MEET ESSENTIAL STANDARDS FOR CHILDREN
Online First
(Implementation of recommendations for the care of children in UK
emergency departments: national postal questionnaire survey)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38313.580324.F7
Five years after accident and emergency departments were found to be lacking in essential services for children, many still fail to meet the minimum standards, says a study on bmj.com this week.
In 1999 a comprehensive review of A&E services for children made 32 essential recommendations to be implemented by 2004. Children require specialised treatment, said the review, particularly in emergency cases, including assessment on arrival (triage) by appropriately trained nurses. A&E staff should also be trained to provide specialist paediatric emergency care while awaiting children's intensive care units to become available.
The new study looked at 139 emergency departments, seeing more than 18,000 children per year. It showed that a quarter of departments do not have separate triage facilities for children, and 36% of A&E consultants have not had specialist training in paediatric emergency care. Of those with paediatric triage facilities, 23% do not use an appropriately trained nurse to carry out the assessment.
In addition, A&E staff should undertake courses and refresher training in paediatric life support, but almost half (47%) of nurses had no such training.
Researchers also found that the number of hospitals providing for children in major incident plans had fallen to just over 10% of those surveyed in 2004.
Though the Government has recognised unacceptable variations in standards of emergency care for children, many A&E departments are still running with few if any appropriately trained staff. Many of the minimum, essential standards recommended five years ago are yet to be met, say the researchers. More structured investment is vital if we are to provide our children with proper emergency care, they conclude.
Contact:
Dr Ian Maconochie, Consultant in
Paediatric Emergency Medicine, St. Mary's Hospital, London, UK
Email: i.maconochie@imperial.ac.uk
(4) MEDICATION ERRORS IN SICK CHILDREN MAY BE HIGHER THAN PREVIOUSLY THOUGHT
(Prospective observational
study on the incidence of medication errors during simulated resuscitation
in a paediatric emergency department)
http://bmj.com/cgi/content/full/329/7478/1321
The level of medication errors in sick children might be substantially higher than previously estimated, according to a study in this week's BMJ.
Medication errors are common in paediatric emergency departments, but the incidence of errors during paediatric resuscitation has not been fully investigated.
Eight mock resuscitations were conducted in the emergency department of a children's hospital. The exercises were videotaped and drugs ordered and administered during the resuscitation were recorded. Syringes and drugs prepared during the resuscitation were collected and analysed for concentrations and actual amounts.
Medication errors were identified in seven of the eight mock resuscitations. Frequent and potentially serious errors occurred at all stages of resuscitation, and both physicians and nurses made errors.
Many errors could be detected only by analysis of syringe content, suggesting that the incidence of medication errors during resuscitations is substantially higher than previously estimated.
Resuscitation is an extremely stressful and uncontrolled situation for medical staff and calculating drug doses under these conditions is challenging. Yet improved communication within the team could reduce errors, they add say the authors.
They suggest that every paediatric emergency department should have regular team training of physicians and nurses.
Contact:
Professor Anna Jarvis, c/o Lisa
Lipkin, Public Affairs, Hospital for Sick Children, Toronto, Canada
Email: lisa.lipkin@sickkids.ca
(5) GUIDANCE ON CHAPERONES HARD TO IMPLEMENT IN GENERAL PRACTICE
Online First
(Chaperones for intimate examinations: cross sectional survey of attitudes
and practices of general practitioners)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38315.646053.F7
Guidance about the use of chaperones for intimate examinations is difficult to implement fully in general practice, according to a study published on bmj.com today.
The conduct of intimate examinations in medical settings has been a subject of controversy for many years. As such, the medical royal colleges, the General Medical Council, and the defence organisations now recommend that these examinations are not done by unaccompanied doctors.
Researchers surveyed over 1,200 general practitioners in England about the use of chaperones during intimate examinations.
A total of 517 (68%) male GPs and 24 (5%) female GPs usually or always offered a chaperone, while 410 (54%) males and 9 (2%) females usually or always used a chaperone. Only 60 males (8%) never used one compared to 344 (70%) females.
Use of chaperones was correlated with increasing age, belonging to a non-white ethnic group, and working in a smaller practice.
Practice nurses were the most common chaperones, but a non-clinical member of the practice staff, a student or GP registrar, or another doctor, were alternatives.
Use of chaperones by male doctors has substantially increased since the 1980s and '90s, but use by female doctors remains low, despite one third of practices having a policy, say the authors.
Record keeping about the offer and use of chaperones is poor, and significant barriers, such as confidentiality and time constraints, still exist. The recommendations of the royal colleges and other bodies are, therefore, difficult to implement fully.
More flexible guidance is needed for general practice as well as further research into patients' views and wishes on the use of chaperones, they conclude.
Contact:
Joe Rosenthal, Senior Lecturer in
General Practice, Department of Primary Care and Population Sciences, Royal
Free and University College Medical School, University College London, UK
Email: j.rosenthal@pcps.ucl.ac.uk
(6) IS THE INTERNET ENCOURAGING SUICIDE PACTS?
(Editorial: suicide pacts
and the internet)
http://bmj.com/cgi/content/full/329/7478/1298
A disturbing new trend in suicide pacts involving strangers meeting over the internet (cybersuicide) is emerging, warns a consultant psychiatrist in this week's BMJ.
The deaths of nine people in Japan in October 2004, who met over the internet and planned the tragedy via special suicide websites, have brought the relatively rare phenomenon of suicide pacts into the limelight, writes Sundararajan Rajagopal.
Traditional suicide pacts account for less than 1% of all suicides and almost always involve people well known to each other, mostly spouses, most of them childless. About half have psychiatric disorders and a third have physical illnesses.
An increasing number of websites graphically describe suicide methods, including details of doses of medication that would be fatal in overdose. Such websites can perhaps trigger suicidal behaviour in predisposed individuals, particularly adolescents, says the author.
The recent suicide pacts in Japan might just be isolated events in a country that has been shown to have the highest rate of suicide pacts, he adds. Alternatively, they might herald a new disturbing trend in suicide pacts, involving strangers meeting over the internet, becoming increasingly common.
If the latter is the case, then the epidemiology of suicide pacts is likely to change, with more young people living on their own, who may have otherwise committed suicide alone, joining with like minded suicidal persons to die together.
General practitioners and psychiatrists should continue to remain vigilant against the small but not insignificant risk of suicide pacts, he concludes.
Contact:
Sundararajan Rajagopal, Consultant
Psychiatrist, South London and Maudsley NHS Trust, Adamson Centre for Mental
Health, St Thomas' Hospital, London, UK
Email: sundararajan.rajagopal@slam.nhs.uk
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