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(1) PASSIVE SMOKING KILLS 30 PEOPLE A DAY IN THE UK
(2) HEART SURGEONS PUBLISH DEATH RATES
(3) SOME HIV PATIENTS AT RISK OF EXHAUSTING TREATMENT OPTIONS
(4) HIV TESTING SHOULD NO LONGER BE ACCORDED ANY SPECIAL STATUS
(1) PASSIVE SMOKING KILLS 30 PEOPLE A DAY IN THE UK
OnlineFirst
(Estimate of deaths attributable to passive smoking among UK adults:
database analysis)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38370.496632.8F
Passive smoking kills at least 30 people every day at work and at home in the United Kingdom, according to a study published online by the BMJ today.
Using national UK databases, Professor Konrad Jamrozik calculated the number of deaths due to passive smoking at home and at work in employees of the hospitality industry (pubs, bars, nightclubs, hotels and restaurants), the general workforce, and the general population of the United Kingdom.
To ensure the calculations did not overestimate the risks of passive smoking, the author re-analysed the data using different levels and risks of exposure from other published studies.
His calculations show that:
Passive smoking at work is likely to be responsible for the deaths of more than two employed people every working day in the UK (617 deaths per year)
The death of at least one employee in the hospitality industry each week (54 deaths a year) is attributable to passive exposure to tobacco smoke
Passive smoking at home might account for a further 2700 deaths in people aged 20-64 years (approaching 8 a day) and a further 8000 deaths a year among people aged 65 or over, mainly from strokes and heart disease
He suggests that exposure at work might contribute up to one fifth of all deaths from passive smoking in the general population aged 20-64 years, and up to half of such deaths among employees of the hospitality industry.
Adoption of smoke free policies in all workplaces in the United Kingdom and reductions in the general prevalence of active smoking would prevent several thousand premature deaths each year, he concludes.
Contact:
Konrad Jamrozik, Professor of Evidence
Based Healthcare, School of Population Health, University of Queensland,
Brisbane, Australia
Email: k.jamrozik@sph.uq.edu.au
(2) HEART SURGEONS PUBLISH DEATH RATES
(Named surgeon mortality
data for adult cardiac surgery: a retrospective examination)
http://bmj.com/cgi/content/full/330/7490/506
(Editorial: Mortality in
adult cardiac surgery)
http://bmj.com/cgi/content/full/330/7490/489
Twenty five heart surgeons in Northwest England publish their individual mortality rates in this week's BMJ. The results show that all surgeons are performing to satisfactory standards.
This type of analysis will become increasingly common under the Freedom of Information Act, which is now law in the UK, and should help to promote a culture of openness and transparency in healthcare delivery, they say.
The Bristol Royal Infirmary inquiry into child heart surgery deaths recommended that patients must be able to see information about the relative performance of individual consultants operating within hospitals. But so far, this information has not been available for any operations in the UK, and publication of 'raw' figures has been criticised as being unfair to those surgeons who carry out the most difficult operations on the most ill patients.
The cardiac surgeons of Northwest England collected and analysed mortality data for patients undergoing two types of heart operation (coronary artery surgery or aortic valve replacement) for the first time between April 2001 and March 2004.
The data was then risk-adjusted, to take into account the complexity and severity of the patients' illness, and the figures were compared with national data.
A total of 10,163 patients had surgery under the care of 25 surgeons. The average number of patients per surgeon was 363 for coronary surgery and 44 for aortic valve surgery. The proportion of high risk surgery was 17% for coronary surgery and 50% for aortic valve surgery.
The average mortality for coronary surgery was 1.8% and for aortic valve surgery was 1.9%. All surgeons' mortality fell below the national average for both operations.
"We feel that it is essential to stratify surgeon outcomes by risk to be fair to surgeons and prevent them from taking on only the easiest and least severe cases," say the authors. "The public is now able to see the outcomes of individual surgeons and can be reassured that all are performing to satisfactory standards."
This type of analysis could stimulate improvements in systems of care, as long as it does not lead to systematic denial of surgery to higher risk patients who may benefit from an operation, they conclude. An accompanying editorial argues that named surgeons' outcomes may not be appropriate for all operations.
Contact:
Ben Bridgewater, Consultant Surgeon,
Wythenshawe Hospital, Manchester, UK
Email: ben.bridgewater@smuht.nwest.nhs.uk
(3) SOME HIV PATIENTS AT RISK OF EXHAUSTING TREATMENT OPTIONS
Online First
(Treatment exhaustion of highly active antiretroviral therapy (HAART)
among individuals infected with HIV in the United Kingdom: multicentre cohort
study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38369.669850.8F
A small but growing proportion of HIV infected patients in the United Kingdom may be in danger of exhausting current treatment options, says a paper published online by the BMJ today.
Highly active antiretroviral therapy (HAART) has had a dramatic impact on the health of individuals infected with HIV. But some patients experience problems while receiving HAART and may have to switch drugs on one or more occasions, raising the concern that these patients may exhaust all currently available treatment options.
Researchers at six large HIV centres in southeast England monitored 16,593 individuals who had attended one of the centres for care between 1996 and 2002.
They found that, although patients infected with HIV are becoming increasingly exposed to different antiretroviral treatments over time, immunological and virological profiles of these patients continue to improve.
Currently little evidence exists to indicate that a large proportion of patients are starting to experience therapeutic failure, say the authors. However, for a small number, treatment options are in danger of becoming exhausted.
New drugs with low toxicity, which are not associated with cross resistance to existing drugs, are urgently needed for such patients, they conclude.
Contact:
Caroline Sabin, Professor of Medical
Statistics and Epidemiology, Department of Primary Care and Population Sciences,
Royal Free and UC Medical School, London, UK
Email: c.sabin@pcps.ucl.ac.uk
(4) HIV TESTING SHOULD NO LONGER BE ACCORDED ANY SPECIAL STATUS
(Editorial: HIV testing)
http://bmj.com/cgi/content/full/330/7490/492
HIV testing should no longer be accorded any special status, argue two senior doctors in this week's BMJ.
Voluntary HIV counselling and testing has been accepted practice for more than 10 years, but uptake has been poor, even among those at high risk, resulting in late diagnosis and ongoing spread of infection.
Unless further initiatives are undertaken the epidemic will worsen, they warn.
They believe that HIV testing should be widely accepted, without conventional voluntary counselling and testing, as patients at risk of cancer do not receive voluntary counselling and testing before chest x-rays, or patients with chest infections do not receive voluntary counselling and testing before investigations are carried out.
The current combination of a lack of time for pre-test counselling and denial by patients has resulted in late diagnoses and ongoing spread of infection, they say. They propose that if a patient freely consents to be investigated, a doctor can initiate tests aimed at excluding serious diseases without an in-depth discussion of all possible results, provided that the test result, positive or negative, should benefit the patient.
Routine voluntary counselling and testing was appropriate to the 1980s, but times have changed and the benefits of early diagnosis of HIV are multiple. HIV testing should now not be accorded any special status. Doctors should now undertake the test by using the same approach as used in any other test with serious implications, they conclude.
Contact:
Kaveh Manavi, Specialist Registrar,
Department of Genitourinary Medicine, Royal Infirmary of Edinburgh, Scotland
Email: tirbad@yahoo.com
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