This week in the BMJ
Volume 333, Number 7561, Issue of 29 Jul 2006Laparascopic donor nephrectomy minimises donor discomfort
Laparascopic donor nephrectomy minimises donor discomfort
Laparascopic donor nephrectomy results in faster recovery, less fatigue, and a better quality of life for the donor than mini incision open donor nephrectomy. Kok and colleagues (p 221) randomised 100 living kidney donors to laparascopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy and followed them for one year. They also found that the functioning of the graft and survival rate of the graft in the recipient at one year did not differ, and they advocate laparascopic donor nephrectomy for donation programmes using living kidney donors.
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How effective are antipsychotic treatments in the community?
The effectiveness of first and second generation antipsychotics in treating schizophrenia and schizoaffective disorders varies greatly in a real world setting. Tiihonen and colleagues (p 224) followed 2230 consecutive adults who were hospitalised for the first time because of schizophrenia for an average of 3.6 years. Patients treated with perphenazine depot, clozapine, or olanzapine had a lower risk of rehospitalisation or all cause discontinuation of their initial treatment than those treated with haloperidol. Excess mortality was seen in patients not using antipsychotic drugs.
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Community hospitals are cost effective for post-acute care of elderly patients
The health outcomes and costs associated with community hospital care for older people needing rehabilitation are similar to those of a department for care of elderly people in a district general hospital, say O'Reilly and colleagues on page 228. Within a randomised trial of 220 older patients, they assessed the cost-effectiveness of post-acute care in both settings and found that the mean quality adjusted life years score at six months and the mean costs per patient were similar.
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Consider subarachnoid haemorrhage
Subarachnoid haemorrhage should be suspected in someone with a sudden severe headache that peaks within minutes and lasts more than one hour. That person should be referred to a neuroscience unit as soon as the suspicion increases, say Al-Shahi and colleagues (p 235). This clinical review discusses the investigations, such as computed tomography and lumbar puncture, that are used to detect suspected subarachnoid haemorrhage and its causes. The authors explore the outcome and treatment of subarachnoid haemorrhage caused by a ruptured aneurysm, which represents three quarters of spontaneous cases. Patients should be managed by multidisciplinary teams that can help identify and manage complications, conclude the authors.
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Don't believe the relative risks and odds ratios in abstracts
Significant P values for relative risks and odds ratios in abstracts of published studies should generally be disbelieved, says Gøtzsche on page 231. He compared the distribution of P values in abstracts of 260 randomised trials with that in 260 observational studies (130 cohort studies and 130 case control studies) and checked P values between 0.04 and 0.06. A high proportion of abstracts of randomised controlled trials and observational studies had significant results, although many of these results were derived from subgroup analyses or biased selection of results. Also, errors in analysis and reporting were common.
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