This week in the BMJ
Volume 331, Number 7518, Issue of 24 Sep 2005Stuttering can be treated by early intervention
Stuttering can be treated by early intervention
Early intervention in the preschool years is effective in treating stuttering. In a pragmatic, open plan, randomised trial of 54 children, Jones and colleagues (p 659) used the Lidcombe programme and found that children who were treated had significantly fewer stuttered syllables after nine months than children in the control group. Although some children who stutter in their preschool years improve without treatment, identifying them in advance is impossible. Treatment should begin in the preschool years because it is more effective then.
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Antenatal steroids reduce respiratory distress in babies
Antenatal steroids and delaying delivery until 39 weeks reduce respiratory distress in babies born by elective caesarean section. Stutchfield and colleagues (p 662) randomised nearly 1000 women from 10 maternity units in Wales to receive two intramuscular doses of 12 mg of betamethasone 48 hours before delivery or to get usual care. Fewer children from mothers who had had betamethasone were admitted to a special care baby unit with respiratory distress. The rate of such admission fell with increasing gestation, supporting the recommendation to delay elective section until 39 weeks.
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Antenatal steroids may have no long term side effects
Another study looks at the long term effects of antenatal exposure to betamethasone and finds that a single course does not alter psychological functioning in adult life. Dalziel and colleagues (p 665) followed up 192 babies of mothers in the Auckland, New Zealand steroid trial conducted in the early 1970s. An editorial by Steer (p645), however, warns that although the immediate benefits of antenatal steroids in reducing respiratory distress are clear, the long term effects of repeated courses continue to be debated.
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Algorithm reduces antimicrobial prescriptions in urinary infections
A multifaceted intervention targeted at doctors and nurses can reduce the number of prescriptions for antimicrobials for urinary tract infections in the residents of nursing homes. Loeb and colleagues (p 669) did a cluster randomised trial of more than 4000 residents in 12 North American nursing homes. A diagnostic and treatment algorithm successfully reduced the rate of antimicrobial use for suspected urinary tract infection. The intervention had no effect on the overall rate of prescribing of antimicrobials for other infections in the nursing homes.
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Assisted dying: the debate goes on
A cluster of articles presents various opinions about assisted dying, which will be debated next month in the House of Lords. Branthwaite (p 681) argues that people who want assisted suicide should have the same rights as patients who can end their lives by refusing life sustaining treatment. George and colleagues (p 684) say that legalised euthanasia would leave vulnerable groups open to therapeutic killing without consent. Sommerville (p 686) says that the BMA has adopted a neutral policy to allow parliament to decide. Tännsjö (p 689) presents three moral outlooks and concludes that permitting euthanasia in limited circumstances seems the most beneficial approach. And a Dutch group reflects on a deade of monitoring euthanasia in the Netherlands (p 691).
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Treat status epilepticus with benzodiazepine followed by phenytoin
An evidence based clinical review of status epilepticus (p 673) finds few randomised trials and little evidence to support one treatment regimen over another. Walker advises that all patients with status epilepticus who have not responded to benzodiazepine and phenytoin should be referred to a neurologist for further management, as should all patients with suspected non-convulsive status epilepticus. Health professionals who care for patients with epilepsy should warn patients not to stop taking their drugs suddenly as this is one cause of status epilepticus.
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