This week in the BMJ
Volume 332, Number 7552, Issue of 27 May 2006Different methods for managing miscarriage have same infection rates
Different methods for managing miscarriage have same infection rates
Gynaecological infection after management of miscarriage in the first trimester is uncommon (2-3%), and the rate is independent of the method of management used—medical, surgical, or expectant. Trinder and colleagues (p 1235) randomised 1200 women with early fetal demise or incomplete miscarriage to one of the three modes of management. The authors found no differences in the rates of infection, but more unplanned admissions and unplanned surgical curettage occurred after expectant and medical management than after surgical management.
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Identifying patients' agendas improves consultations
Training doctors to elicit patients' agendas or asking patients to write down what they want from their consultation increases the number of problems identified during the consultation. Middleton and colleagues (p 1238) carried out a randomised controlled trial of education to increase awareness of patients' agendas in consultations with 46 UK general practitioners, plus an embedded clustered trial of a patient agenda form in almost 1000 consultations. Both the doctors' education and the agenda form increased the numbers of problems identified and improved patient satisfaction, but they also increased the length of consultations.
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To call your patient after a suicide attempt may help
Telephoning patients who have attempted suicide one month after their discharge from an emergency department may help reduce the number who reattempt suicide in the next year. Vaiva and colleagues (p 1241) randomised 605 people who had attempted suicide to telephone contact (to evaluate the success of recommended treatment or to adjust it) at one or three months or to standard care (usually referral to their general practitioner). Fewer participants contacted by telephone at one month reattempted suicide compared with controls, but those contacted at three months showed no significant difference from controls.
Alcohol drinking patterns have different CHD outcomes in men and women
The inverse association between drinking alcohol and risk of coronary heart disease (CHD) seems to be independent of drinking frequency in women but not in men. Tolstrup and colleagues (p 1244) looked at alcohol drinking patterns in a cohort of more than 50 000 middle aged women and men free of cardiovascular disease at baseline. After a median follow-up of six years, women who drank alcohol on at least one day a week had a reduced risk of CHD compared with those who drank less often, but above this frequency intake mattered more than frequency. Among men, frequency mattered more than intake, with the lowest risk in those who drank daily.
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Insecticide treated curtains and water jar covers control dengue vector
Window curtains and domestic water container covers treated with insecticide can reduce the population of the mosquito vector for dengue fever and potentially reduce disease transmission. Kroeger and colleagues (p 1247) conducted a cluster randomised controlled trial in 36 urban sectors in Mexico and Venezuela. Sectors were paired according to mosquito infestation, and one sector per pair allocated to intervention. Although reduction in infestation was not significantly bigger in the intervention group after follow-up of 9 or 12 months, the intervention reduced mosquito populations in neighbouring control clusters.
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