This week in the BMJ
Volume 330, Number 7505, Issue of 18 Jun 2005We need more evidence on ultrasound screening for DDH
We need more evidence on ultrasound screening for DDH
We don't know how justified general ultrasound screening is for developmental dysplasia of the hip (DDH) in newborns. A systematic review by Woolacott and colleagues (p 1413) identified a lack of clear evidence either for or against the screening, which is standard practice in some European countries but not in the United Kingdom, the United States, or Scandinavia. Studies that investigate the natural course of DDH, the optimal treatment, and the best strategy for ultrasound screening are required, say the authors.
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Giving birth: home can be better than hospital
For women with low risk pregnancies in North America, giving birth at home bears similar risks of intrapartum and neonatal mortality as giving birth in hospital, but planned home births are associated with lower rates of medical interventions. In a prospective cohort study, Johnson and Daviss (p 1416) evaluated the safety of home births involving certified midwives in 5418 women who intended to give birth at home when labour began. The study participants experienced substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospital.
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Perioperative care needs updating
Despite the abundant evidence for optimal perioperative care in colorectal surgery, day to day practice in Scotland, the Netherlands, Denmark, Sweden, and Norway differs substantially among these countries and deviates considerably from the best available evidence. Lassen and colleagues (p 1420) mailed a questionnaire with a hypothetical case to the head surgeons of all centres for digestive surgery in the five countries under study, which all belong to the Enhanced Recovery After Surgery Group. Surgical patients remain exposed to unnecessary starvation, suboptimal stress reduction, and fluid overload, the authors say.
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Should everyone over 50 take aspirin prophylaxis?
On pages 1440 and 1442, two sides of the argument are presented on whether aspirin should be used for primary prevention of vascular disease in all people over a certain age, and what that age should be. Elwood and colleagues believe that evidence shows that aspirin should be taken from around 50 years of age, but they also argue that the topic should be widely discussed and that the final decision should lie with each individual person. Baigent is not convinced by the available evidence and argues that such practice could result in net harm.
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Existing data could be used to better assess NHS performance
Until better data are available, a more rigorous analysis of currently collected routine data should be used to assess NHS performance in England. On page 1426, Lakhani and colleagues say that current measures don't adequately reflect improvements in services and outcomes achieved. They propose new indicators that should include improved measure of hospital case fatality, measures reflecting primary care, cancer survival, and comprehensive measurement of managing high blood pressure and stroke.
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