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Press releases Saturday 22 July 2006

(1) DOCTORS RELUCTANT TO TESTIFY IN CHILD PROTECTION CASES

(Royal college rewrites child protection history)
http://bmj.com/cgi/content/full/333/7560/194

BMJ Volume 333, pp194-196

(Editorial: The evidence base in child protection litigation)
http://bmj.com/cgi/content/full/333/7560/160

Doctors are increasingly unlikely to testify in child abuse cases because of high-profile cases in recent years, according to an editorial in this week’s BMJ.

The reluctance of doctors to speak up in such cases has been caused by adverse publicity and the consequences of the cases involving Professors Roy Meadow and David Southall, according to an editorial in the journal.

Roy Meadow was struck off by the GMC in July 2005 for giving flawed statistical evidence in a trial, but was reinstated in February by the High Court. David Southall was found guilty of serious professional misconduct and banned from child protection work for three years after reporting his suspicions of abuse in the same case.

The editorial is written by David Chadwick, a retired child abuse paediatrician from the USA, who has provided expert testimony in many cases.

Dr Chadwick says in his editorial: “In the United Kingdom, the risks of testifying that a child has been abused have become formidable and many doctors are reluctant to testify.

“Yet each case of suspected abuse is unique and the applicability of the evidence base will always differ from case to case. This makes the testimony of doctors who specialise in the study of child abuse particularly valuable and important. Without such testimony from expert witnesses children may be unprotected from abuse.”

Dr Chadwick was writing an editorial to accompany an analysis piece in the journal by freelance journalist Jonathan Gornall.

Mr Gornall’s report raises concerns that a recent handbook called Child Protection Companion produced by the Royal College of Paediatrics and Child Health omits any direct references to original research done by Professors Meadow and Southall, although the college denies references were deliberately omitted.

“Paediatricians, already feeling beleaguered thanks to a concerted public and media campaign against individual doctors, will be dismayed that Roy Meadow and David Southall seem to have been written out of the medical history book by their own college,” writes Mr Gornall.

Contact:

David Chadwick, Director Emeritus, Chadwick Center for Children and Families, Rady Children's Hospital and Health Center, San Diego, USA
Email: dlchadwick1@earthlink.net

Jonathan Gornall, freelance journalist, London
Email: Jgornall@mac.com

(2) COMMUNITY HOSPITAL CARE AS COST-EFFECTIVE AS REGULAR HOSPITAL CARE FOR OLDER PEOPLE

Online First
(A cost effectiveness analysis within a randomised controlled trial of post-acute care of older people in a community hospital)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38887.558576.7C

A community hospital is as cost effective as a district general hospital for post-acute care of older people, according to a study published on bmj.com today.

Community hospitals are a long established component of healthcare provision in England, and their potential to provide intermediate care has been recognised. But previous health economic studies of community hospital care have been methodologically weak and difficult to interpret.

So researchers compared the cost effectiveness of post-acute care at a community hospital and a district general hospital in Yorkshire, England.

They identified 220 patients (average age 85 years) needing rehabilitation after an acute illness that required admission to hospital. 141 patients were randomised to a community hospital and 79 patients were randomised to an elderly care department in a district general hospital.

The health of each patient was measured at the start of the study, one week after discharge, and three and six months after randomisation. These measures were used to calculate a quality of life score. Health and social care costs for each patient were also calculated.

At six months, the average quality of life score was marginally (but non-significantly) higher for the community hospital group than for the district general hospital group. The average costs per patient were similar for the community hospital and district general hospital groups (£7233 v £7351).

Further analyses were carried out to test the robustness of these results, but they did not alter the overall findings.

“These results suggest that a locality based community hospital is as cost effective as a district general hospital for post acute care of older people,” conclude the authors.

Contact:

John Green, Senior Research Fellow, Academic Unit of Elderly Care and Rehabilitation, St Luke's Hospital, Bradford
Email: John.Green@bradfordhospitals.nhs.uk

(3) DON’T USE ANTIBIOTICS FOR RUNNY NOSES, SAY RESEARCHERS

Online First
(Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38891.681215.AE

Antibiotics should not be given to patients with acute purulent rhinitis (a runny nose with coloured discharge), a familiar feature of the common cold, concludes a study published on bmj.com today.

General practitioners often prescribe antibiotics for respiratory tract infections when nasal discharge is purulent. Most guidelines recommend against their use for this condition, but this advice is based on one study that showed no effect.

So researchers in New Zealand searched the scientific literature for trials comparing antibiotics with placebo for acute purulent rhinitis (duration less than 10 days).

They identified seven trials. Pooling the results showed that antibiotics for acute purulent rhinitis may be beneficial. The numbers needed to treat ranged from 7 to 15, meaning that, at best, six patients get no benefit for every one who gets benefit.

Harms attributed to antibiotics were mainly vomiting, diarrhoea, and abdominal pain, but also included rashes and hyperactivity. The numbers needed to harm ranged from 12 to 78.

No serious harm occurred in the placebo arm in any of the trials. This fits with the medical view that this is not a serious condition, write the authors.

Antibiotics are probably effective for acute purulent rhinitis, say the authors. They can cause harm but most patients will get better without antibiotics.

So, although these findings differ from the guidelines in terms of the effectiveness of antibiotics for acute purulent rhinitis, the authors support the current “no antibiotic as first line” advice and suggest that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients.

Contact:

Bruce Arroll, Professor and Head of Department of General Practice and Primary Health Care, University of Auckland, New Zealand
Email: b.arroll@auckland.ac.nz

(4) DOCTORS MUST EMBRACE REGULATION CHANGES

(Editorial: Regulation and revalidation of doctors)
http://bmj.com/cgi/content/full/333/7560/161

Doctors should accept the main proposals to change regulation of the medical profession as the best way of restoring public confidence, according to an editorial in this week’s BMJ by a leading member of the GMC.

Professor Mike Pringle, a GMC member and professor of general practice, writes about his strong belief that the recommendations of the Department of Health to update medical regulation are taking the right approach.

The chief medical officer’s review of medical regulation published last week proposed that doctors face MoT style revalidation checks every five years and that the GMC should no longer have the role of judging whether a doctor is fit to practise in cases of serious complaints – a role that will be passed to an independent tribunal panel.

Professor Pringle agrees, writing: ‘A profound loss of public, and to a lesser extent professional, confidence has cast a dark shadow over medical regulation and the GMC for the past few years.”

The separation of the GMC’s responsibility to adjudicate in serious cases is overdue and will reassure the public, he adds, as it moves towards a system of “partnership regulation” rather than professionally-led regulation.

“It would be a political disaster if the medical profession were to reject the main thrust of these recommendations which offer a coherent way forward for public confidence in medical regulation and the GMC,” writes Professor Pringle.

“Public and patients’ confidence in the system should be greatly enhanced, and doctors will need to accept the rebalancing of interests that this entails.”

Contact:

Mike Pringle, Professor of General Practice, Division of Primary Care, School of Community Health Sciences, University of Nottingham
Email: mike.pringle@nottingham.ac.uk

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