This week in the BMJ
Volume 329, Number 7478, Issue of 4 Dec 2004DTP immunisation is linked with survival
DTP immunisation is linked with survival
Infants in Burkina Faso who had a dose of diphtheria, tetanus, and pertussis (DTP) or tuberculosis immunisation were more likely to survive to age 2 years than unimmunised infants. A study by Vaugelade and colleagues (p 1309) among 9085 children contradicts a study in Guinea-Bissau which found that infants given BCG and measles vaccines were more likely to survive, but recipients of one dose of DTP vaccine had a higher mortality than those who received none of these vaccines.
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Low blood pressure affects fetus too
Both low and high maternal diastolic blood pressures during pregnancy are associated with lower birth weight of firstborn babies and higher perinatal mortality. Steer and colleagues (p 1312) prospectively observed 210 814 babies of mothers without high blood pressure before 20 weeks' gestation and found a U shaped relation between maternal blood pressure and both birth weight and perinatal death. Perinatal outcomes were best when the mother's highest recorded diastolic blood pressure during pregnancy was between 70 and 90 mm Hg.
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Mesh lowers recurrence of hernias in Scotland
Since mesh surgery was introduced in Scotland in 1993 for inguinal hernia repair, the rate of recurrent hernias has declined significantly. Atkinson and colleagues (p 1315) retrospectively identified 16 450 patients who underwent primary inguinal hernia repair and 1859 with recurrent inguinal hernia repair, looking at surgical techniques used. They found that in 1993 fewer than 1% of operations used mesh, but this increased to more than 90% by 2001. The total number of primary repairs increased significantly and the total rate of recurrent repairs decreased significantly.
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Triage, back care, and GP clinics help musculoskeletal problems
Targeted early access to musculoskeletal services (TEAMS), a programme introduced in northwest Wales to help manage demand for referrals from general practitioners, reduced waiting times for musculoskeletal hospital services and abolished duplicate referrals, even though referrals almost doubled. The intervention improved quality of care, say Maddison and colleagues (p 1325), and was associated with high levels of patient satisfaction. It offered central clinical triage, a specialised care pathway for back pain, and multidisciplinary clinics run by general practitioners for patients with uncomplicated musculoskeletal problems.
Prescribe NSAIDs for osteoarthritis of the knee cautiously
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce short term pain in osteoarthritis of the knee slightly better than placebo, but there is no evidence of long term benefit. In a meta-analysis of randomised, placebo controlled trials, Bjordal and colleagues (p 1317) analysed data on change in the overall intensity of pain for 7807 patients taking NSAIDs and 3038 receiving placebo. Given the serious adverse effects of NSAIDs, they recommend only limited use of these drugs in osteoarthritis of the knee.
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Drug errors hamper paediatric resuscitations
Medication errors occur frequently at all stages of paediatric resuscitation. Analysing eight mock paediatric resuscitations, Kozer and colleagues (p 1321) found that 21 of 125 drug orders were given without specifying the dosage of the drug, and in nine of 58 syringes analysed the concentration of the drug was not correct. Such errors may be a major source of morbidity and mortality among children undergoing resuscitation, say the authors.
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