This week in the BMJ
Volume 330, Number 7506, Issue of 25 Jun 2005Staying in was safer than evacuation in a chemical incident
Staying in was safer than evacuation in a chemical incident
Residents who took shelter in their houses had fewer adverse health consequences after a chemical incident in a plastics factory in southwest England than those who were evacuated. Kinra and colleagues (p 1471) used a questionnaire to explore health outcomes in 1096 residents—299 who were evacuated and 797 who stayed. The mean number of adverse symptoms and the proportion of residents who had at least four symptoms (cases) were higher in evacuated people than in those who stayed in their houses (symptom score 1.9, 19.7% cases v score 1.0, 9.5% cases, respectively; P < 0.001).
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Early treatment is vital for meningococcal disease
Adequate early treatment is vitally important for the final outcome of meningococcal disease in children. In a national blinded case-control study including 498 children, Ninis and colleagues (p 1475) compared the standard of care in the first 24 hours after admission to hospital in children who died from meningococcal disease and those who survived. Three factors were independently associated with an increased risk of death: not being cared for by a paediatrician, junior staff working with not enough supervision, and failure of staff to administer adequate inotropes.
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Hysterectomy doesn't seem to affect long term mortality
Having a hysterectomy doesn't seem to significantly increase women's mortality from all causes, cardiovascular disease, or cancer in the long term. Iversen and colleagues (p 1482) included 3705 women who had a hysterectomy and 3705 women who did not into a nested cohort study with a mean follow-up of more than 20 years. Neither all cause mortality nor mortality due to cardiovascular disease or cancer were significantly different between women who had a hysterectomy and those who did not.
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Methods of hysterectomy: the hierarchy is clear
Vaginal hysterectomy should be the preferred surgical method in women with benign disease, and where vaginal hysterectomy is not possible, the laparoscopic method is preferable to abdominal hysterectomy. The systematic review and meta-analysis by Johnson and colleagues (p 1478) included 27 trials and 3643 participants. Outcomes such as return to normal activities, duration of hospital stay, and unspecified infections and febrile episodes were significantly better in vaginal and laparoscopic hysterectomies than in abdominal hysterectomies. Laparoscopic hysterectomies were associated with more than two and a half times more urinary tract injuries than abdominal hysterectomies.
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ABC: principles of war surgery
In the sixth in a series of 12 articles, Mannion and Chaloner (p 1498) address the management of war wounds by non-specialist surgeons with limited resources and expertise. The authors describe the wounding patterns of gunshot wounds and blast injuries and take the reader step by step through treating war injuries: initial measures, wound assessment, wound excision, and delayed primary closure, and also describe the principles of amputation surgery for war wounds.
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Doctors and managers working together on costs
Programme budgeting and marginal analysis has the potential to align the goals of both doctors and managers, argue Ruta and colleagues (p 1501), offering this economic approach to priority setting as one of the possible ways to tackle the recent NHS reform that gave doctors more responsibility for use of resources. The strengths of this economic approach to priority setting include explicit presentation, evaluation, and the recording of contextual information, evidence, and subjective judgments. The approach fosters the need to balance clinical autonomy with financial responsibility, say the authors.
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