This week in the BMJ
Volume 330, Number 7489, Issue of 26 Feb 2005Choice of antipsychotics for dementia doesn't affect risk of stroke
lactams for community acquired pneumonia
Choice of antipsychotics for dementia doesn't affect risk of stroke
The choice between atypical and typical antipsychotic drugs to manage behavioural and psychological symptoms of dementia in elderly people should not be based on concerns about the risk of stroke. In a population based retrospective cohort study including 32 710 people aged 65 years and older, Gill and colleagues (p 445) compared the incidence of stroke in those taking atypical and typical antipsychotics. After adjusting for potential confounders, they found no difference in risk of ischaemic stroke (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26).
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Warm-up programme prevents knee and ankle injuries
A structured warm-up programme designed to improve awareness and knee and ankle control during landing and pivoting movements may halve the incidence of knee and ankle injuries among young people participating in sports. A cluster randomised controlled trial by Olsen and colleagues (p 449) compared the programme to no intervention in 1837 handball players aged 15-17. During the season, injury rates were significantly lower in the group that received the intervention (relative risk 0.53, 95% confidence interval 0.35 to 0.81).
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Implantation of cardioverter defibrillators reflects inequalities
Use of implantable cardioverter defibrillators varies among English health regions, but it is not commensurate with need. Parkes and colleagues (p 454) assessed equity by using proxy measures for the need for the devices (regional standardised mortality ratios for ischaemic heart disease and population fifths of deprivation based on the census data). The crude rate of implantation of new devices rose from 12 per million population in 1998 to 30 per million in 2002, but the data indicated that an inverse care law may be operating. A similar pattern has been seen for coronary revascularisation.
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Give 
lactams for community acquired pneumonia
The antibiotics of initial choice in treating adults with non-severe community acquired pneumonia should be lactams. In a systematic review of 18 randomised controlled trials including 6749 adults, Mills and colleagues (p 456) compared lactams with antibiotics active against atypical pathogens. They found no significant difference in relative risk for treatment failure (0.97, 95% confidence interval 0.87 to 1.07). Atypical antibiotics were more successful only against Legionella species, but this pathogen rarely caused pneumonia in the included trials.
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Should ethics be different in research and audit?
Ethics committees, funding agencies, and journal editors often do not require evidence of ethical review for audits, whereas they impose strict ethical considerations in research—so researchers might be tempted to label research as audit. On page 468, Derick Wade argues that differences between audit and research are scarce and largely bureaucratic. He gives several case scenarios of ethical dilemmas, and concludes that ethical aspects should be considered for every action within health systems, and external ethical review sought according to the nature and extent of moral conflict rather that the labelling of a study.
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Trying to make sense of the Middle East
Deborah Cohen, the studentBMJ editor, spent six days in Israel and the occupied Palestinian territories, talking to both Israelis and Palestinians about health care and the problems facing West Bank inhabitants (p 474). In her diary account, she reports on the use of ambulances for transporting militants, weapons, and explosives, and on movement restrictions, women giving birth at checkpoints, sick people not receiving medical help, breakdown in herd immunity, the escalation of intermarriage, and a rise in domestic violence.
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