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Press releases Saturday 6 August 2005

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(1) RISK OF BREAST CANCER WITH HRT MAY BE LOWER THAN WE THINK

(2) MULTI-MILLION POUND IT INVESTMENT FOR THE NHS AT RISK WITHOUT STAFF BACKING

(3) WET COMBING FOUR TIMES MORE EFFECTIVE THAN CHEMICAL TREATMENTS FOR HEAD LICE

(4) MULTIVITAMINS DON’T PREVENT INFECTIONS IN OLDER PEOPLE

(5) NEW PATIENT SAFETY WEBSITE LAUNCHED

(1) RISK OF BREAST CANCER WITH HRT MAY BE LOWER THAN WE THINK

(Hormone replacement therapy and breast cancer: estimate of risk)
http://bmj.com/cgi/content/full/331/7512/347

A woman’s risk of developing breast cancer while taking hormone replacement therapy may be lower than we think, suggest researchers in this week’s BMJ.

The team, based at the New South Wales Breast Cancer Institute, used the latest data to estimate a woman’s individual risk of breast cancer up to age 79 years in relation to hormone replacement therapy. This is known as the cumulative absolute risk.

Until now, only population risk data have been available, so this analysis will help doctors to weigh the benefits and harms of treatment more accurately.

Cumulative absolute risk of breast cancer falls with increasing age in women who do not take hormone replacement therapy. The average baseline risk (from 40-79 years) is about 7.2% (1 in 14), reducing to 6.1% (1 in 16) at 50 years, and 4.4% (1 in 23) at 60 years.

Use of hormone replacement therapy increases a woman’s cumulative risk, but only slightly. For instance, use of oestrogen only hormone replacement or short term (about five years) use of combined therapy starting at age 50 hardly affects the cumulative risk (no use 6.1%, oestrogen only 6.3%, combined 6.7%).

Use of combined therapy for about 10 years increases the cumulative risk to 7.7%, while oestrogen only formulations have a minimal effect on risk of breast cancer, even with extended use. Studies estimate one half of Australian, European, or American women taking hormone replacement therapy are taking combined preparations.

The additional breast cancer risk is greater with combined therapy, especially if taken for more than five years. Five years’ use, starting at age 55, generates an extra 0.6% breast cancer risk and 10 years a further 1.8% risk. However, once hormone replacement therapy is stopped, a woman’s breast cancer risk quickly returns that of a never user of the same age.

“Although we found the additional breast cancer risk with hormone replacement therapy for an individual is very small, the effect on the general incidence of breast cancer would be greater, especially in populations with high levels of use,” said Professor John Boyages, the Director of the Institute

“The reasons for taking hormone replacement therapy vary and decisions about its use must be made at an individual level. Our analysis provides women and clinicians with better information to make these choices,” they conclude.

Contact:

Professor John Boyages, Executive Director, New South Wales Breast Cancer Institute, University of Sydney, Westmead Hospital, NSW, Australia
Email: johnb@bci.org.au After-hours email at home: terrigalb@aol.com

(2) MULTI-MILLION POUND IT INVESTMENT FOR THE NHS AT RISK WITHOUT STAFF BACKING

(Challenges to implementing the national programme for information technology (NPfIT): a qualitative study)
http://bmj.com/cgi/content/full/331/7512/331

The new National Programme for IT in the NHS (NPfIT) is at risk despite costing millions, because staff locally have been left feeling disengaged in the process, says a study in this week’s BMJ.

NPfIT - which will provide new information and technology systems, such as a centralised patient record that can be accessed across England - “promises far-reaching benefits for patients and throughout the NHS”, say the study’s authors.

But when they examined how well the programme was being implemented at four hospital trusts in England, they found that front line staff felt heavily demoralised about the project. And managers felt there was so little communication and consultation from NPfIT headquarters that it posed a threat to getting the programme up and running.

Researchers chose the hospitals for having various typical conditions – size, financial health, star ratings, etc. They talked to 23 senior managers and clinical staff involved in putting the programme in place in their hospitals.

They found that, although the Government allocated an extra £2.3bn for NPfIT in 2002, there was uncertainty amongst staff about when NPfIT systems would be implemented in hospitals, and what funding would be provided to support this at a local level. This uncertainty is deterring trusts from getting on with implementing local support systems, the researchers discovered.

Some trusts reported that local, existing IT systems for radiology and pathology urgently needed replacing– but these have been put on hold as implementation of NPfIT is phased in across the country. “Such delay may mean a risk of system failure, but buying a temporary solution is seen as costly”, say the researchers.

Many participants felt that local managers and challenges arising from local circumstances were not understood or ignored – leaving them feeling disempowered, and uncertain how to promote to staff a system without detailed information about its local application. As the implementation of NPfIT will mean considerable disruption for staff and difficult interim arrangements, this is a crucial problem, say the researchers.

Staff have shown a willingness to overcome the technical problems of getting NPfIT working, say the researchers, but it’s time the National Programme’s headquarters engaged with managers and health professionals to implement this programme. NPfIT’s success depends on it, they conclude.

Contacts:

Until Friday 5 August: Dr Jane Hendy, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
Email: jane.hendy@lshtm.ac.uk

From Friday 5 August: Dr. Naomi Fulop, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK

(3) WET COMBING FOUR TIMES MORE EFFECTIVE THAN CHEMICAL TREATMENTS FOR HEAD LICE

Online First
(Single blind randomised controlled trial comparing the Bug Buster kit with over the counter insecticide treatments against head lice in the United Kingdom)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38537.468623.E0

Fine combing of wet hair is far more effective than current over the counter chemical treatments for eliminating head lice, shows research published online by the BMJ today.

Head lice are parasites that usually infest the scalps of school age children. Current treatments include over the counter insecticide products or fine tooth combing of wet hair using a specially developed “Bug Buster” kit. However, chemical resistance is a problem, while wet combing is unproved as a treatment.

The study involved 126 young people with head louse infestation: 56 were allocated to the Bug Buster kit and 70 to insecticide treatments. Presence of head lice was assessed 2-4 days after the end of treatment.

Questionnaires to determine compliance and satisfaction with treatment and to obtain background information were also completed.

The Bug Buster kit was four times more effective than chemical products for eliminating head lice (57% cure rate versus 13%), suggesting that the kit is a viable alternative to over the counter insecticide treatments, say the authors.

Some may consider that the cure rate of only 57% detected with the Bug Buster kit is still unacceptable and may not provide an efficient treatment against head lice. At present there are no readily available products that provide fully effective control of head lice, and there is an urgent need to identify safe, novel insecticides of proved efficacy, they conclude.

Contact:

Nigel Hill, Head Science Officer, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Email: nigel.hill@lshtm.ac.uk

(4) MULTIVITAMINS DON’T PREVENT INFECTIONS IN OLDER PEOPLE

(Effect of multivitamin and multimineral supplements on morbidity from infections in older people (MAVIS trial): pragmatic, randomised double blind, placebo controlled trial)
http://bmj.com/cgi/content/full/331/7512/324

Multivitamin and mineral supplements don’t appear to prevent infections in older people living at home, finds a study in this week’s BMJ.

At least 10% of older people have a vitamin or mineral deficiency, which can lead to poor immunity and increased risk of infection. At least a quarter of older people in the UK take nutritional supplements, but it is unclear whether they have any influence on infections.

Researchers at Aberdeen University identified 910 men and women aged 65 or over who did not take vitamins or minerals. Participants were randomised to a daily multivitamin and multimineral supplement or a dummy (placebo) tablet for one year.

During this time, participants were asked to record contacts with primary care for infection, number of days with infection and quality of life. Numbers of antibiotic prescriptions and hospital admissions were also taken into account.

Supplementation did not seem to affect contacts with primary care, days with infection or overall quality of life. These results are consistent with several other studies on this issue.

Regular use of commonly available multivitamin and multimineral supplements is unlikely to reduce the number of self-reported infections or associated use of health services for people living at home, say the authors. It remains to be seen whether those at higher risk of infections, such as older people living in care, would benefit from supplementation.

Contact:

Alison Avenell, Clinical Research Fellow, Health Services Research Unit, School of Medicine, University of Aberdeen, Foresterhill, Aberdeen, Scotland
Email: a.avenell@abdn.ac.uk

(5) NEW PATIENT SAFETY WEBSITE LAUNCHED

(Editorial: The patient safety story)
http://bmj.com/cgi/content/full/331/7512/302

More people die as a result of medical errors than from other common causes of death including motor vehicle crashes, breast cancer, and AIDS.

As part of international efforts to improve patient safety, a new website has been created (www.saferhealthcare.org.uk), run by a partnership of the National Patient Safety Agency, the BMJ Publishing Group, and the US-based Institute for Healthcare Improvement.

Its aim is to be a valued source of peer reviewed tools and information to help practitioners make changes in their organisations.

In an editorial in this week’s BMJ, Glyn Elwyn, Editor of saferhealthcare, says: “It’s becoming clear that providing safe and effective care requires not only expert clinicians, but also well designed care processes and organisational supports. We are confident that this initiative is an important step towards embedding safe practice into everyday clinical behaviour.”

He calls on all health care professionals to get involved and become part of the patient safety story.

Contact:

Glyn Elwyn, Clinician Editor of saferhealthcare, Centre for Health Sciences Research, School of Medicine, Cardiff University, Cardiff, Wales
Email: elwyng@cardiff.ac.uk

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs DivisionBMA HouseTavistock SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)