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Press releases Saturday 5 August 2006
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(1) PATIENTS RECEIVING TREATMENT WITH RADIOISOTOPES MAY TRIGGER SECURITY ALARMS
(2) LONGER NEEDLES BEST FOR INFANT IMMUNISATION
(3) EXAMINATION NOT SENSITIVE ENOUGH TO DETECT BREECH BABIES
(4) RESEARCH ETHICS REQUIREMENTS COMPROMISING QUALITY OF HEALTH RESEARCH
(1) PATIENTS RECEIVING TREATMENT WITH RADIOISOTOPES
MAY TRIGGER SECURITY ALARMS
(Lesson of the Week: Triggering
radiation alarms after radioiodine treatment)
http://bmj.com/cgi/content/full/333/7562/293
(Editorial: What to tell patients
about radioiodine therapy)
http://bmj.com/cgi/content/full/333/7562/271
Patients receiving treatment with radioisotopes should be warned that they may trigger radiation alarms, say doctors in this week’s BMJ.
Their advice follows the case of a patient who activated an airport radiation detector six weeks after receiving radioiodine therapy. He was detained and subjected to extensive search and questioning. Luckily he was carrying his treatment card with him and was released after a prolonged delay and considerable embarrassment.
Treatment of disease with radiotherapy is common (usually with x-rays or ingestion of radioisotopes). Radioisotopes are used in many diagnostic and therapeutic procedures. These render patients temporarily radioactive, which can activate radiation detectors.
But doctors show a worrying lack of awareness about such potential problems, argue the authors. As a result, patients are not adequately warned about persisting radioactivity and precautions that need to be taken.
They searched the literature and found four other cases that further highlight the problem. One involved two patients attempting to enter the White House in the US for a public tour, and another involved a man triggering the security alarm at his bank.
Patients receiving Iodine-131 therapy should be particularly careful because they may trigger an alarm up to 95 days after treatment, they add.
Following this incident their Nuclear Medicine department has now amended the radionuclide card given to patients receiving radioiodine treatment to read: “Airport alarms may be triggered for up to 12 weeks after receiving your therapy dose.”
“Airports worldwide are deploying more sensitive radiation detection systems and hence one would expect more such cases unless we take responsibility of forewarning our patients,” they write. “Hence, we felt it was important to dissipate this information in the hope that this will prevent further unnecessary harassment and embarrassment to patients.”
An accompanying editorial suggests that, based on current evidence, doctors should advise patients who are about to receive radioisotopes to avoid close contact with other people, don’t try to conceive, and take their radiation certificates when flying.
This practical advice should be incorporated into the new guidelines on the use of radioiodine for thyroid disease that are to be published later this year by the Royal College of Physicians, they conclude.
Contacts:
Dr Kalyan Kumar Gangopadhyay, Specialist
Registrar in Diabetes & Endocrinology, City Hospital, Birmingham, UK
Email: jaykal69 @hotmail.com
Editorial: Daniel Cuthbertson,
Clinical Lecturer in Diabetes & Endocrinology, Ninewells Hospital and
Medical School, Dundee, Scotland, UK
Email: d.j.r.cuthbertson@dundee.ac.uk
(2) LONGER NEEDLES BEST FOR INFANT IMMUNISATION
Online First
(The effect of needle size on the immunogenicity and reactogenicity
of vaccines in infancy: a randomised controlled trial)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38906.704549.7C
Infants vaccinated with a long needle experience fewer reactions but get the same protection (immunogenicity) as a shorter needle, finds a study published on bmj.com today.
In the UK, primary care practitioners administer infant immunisations at 2, 3 and 4 months of age. Despite recommendations for use of a wide-long (23G, 25mm) needle, many UK practitioners immunise infants using a narrow-short (25G, 16mm) needle and uncertainty has arisen because of insufficient data to define best practice.
In a previous study, researchers from Oxford found that the wider-longer needle significantly reduced local reactions at 4 months of age. However, they did not know whether this was due to difference in needle length or gauge, or whether needle size affected vaccine immunogenicity.
To answer these questions, they carried out another trial comparing three needle sizes varying in length and diameter.
696 infants were randomly immunised with either a wide-long (23G, 25mm); a narrow-short (25G, 16mm); or a narrow-long (25G, 25mm) needle at 2, 3 and 4 months. Parents recorded local and general reactions for 3 days following each dose and antibody concentrations were measured 28-42 days after the third dose.
Local reactions decreased significantly with wider-longer over narrower-shorter needles.
Significantly fewer infants vaccinated with the longer needle experienced severe local reactions. Immunogenicity following injection with the longer needle was, however, comparable to that achieved with the shorter needle.
Comparisons between the same length, different gauge needles showed little difference in local reaction or immune response suggesting that needle length, rather than gauge, is responsible.
The results show a clear benefit of using the longer needle at each dose whilst achieving comparable immunogenicity, say the authors. They suggest that vaccine manufacturers and national policymakers use this evidence in recommendations for infant immunisation.
With increasing parental attention focused on the safety rather than the efficacy of vaccines, simple interventions, such as the use of a longer needle, that reduce local reactions should be welcomed, they conclude.
Contact:
Linda Diggle, Principal Research
Nurse, Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical
Medicine, Department of Paediatrics, University of Oxford, UK
Email: linda.diggle@paediatrics.ox.ac.uk
(3) EXAMINATION NOT SENSITIVE ENOUGH TO DETECT BREECH BABIES
Online First
(Diagnostic accuracy of clinical examination for detection of non-cephalic
presentation in late pregnancy: cross sectional analytic study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38919.681563.4F
The routine examination doctors use to check if a baby is lying in the correct position before birth is not sensitive enough, concludes a study published on bmj.com today.
The authors suggest that there is room for improvement by all pregnancy care providers.
The position of a baby in the womb in late pregnancy is important because if it is not lying in the normal head-down position (known as cephalic presentation) vaginal delivery may be difficult or impossible. Diagnosis of non-cephalic presentation after the onset of labour is associated with increased complications and death.
Fetal presentation is usually assessed by palpating the abdomen, but little is known about the accuracy of this in late pregnancy. So researchers in Australia decided to examine the diagnostic accuracy of this procedure.
They identified 1633 women with a single pregnancy at 35-37 weeks’ gestation attending an antenatal clinic at an obstetric hospital in Sydney. Each woman underwent clinical examination to assess the position of their baby. This was followed by an ultrasound scan to confirm the diagnosis.
Clinical examination detected 70% of non-cephalic presentations. Correct diagnosis was greater for women with a previous pregnancy and lower body mass index.
If this figure was applied to a general maternity population of 1000 women, clinical examination would identify 101 women as having a non-cephalic presentation but in only 56 would this be correct; 24 women with non-cephalic presentation would be missed altogether, say the authors.
Introduction of routine ultrasonography to assess fetal presentation in late pregnancy would improve diagnostic accuracy, but costs, resource availability, and feasibility need to be considered, as well as the potential deskilling of care providers in performing clinical examination, they write. However, lower rates of accuracy found among overweight or obese women suggest that ultrasonography in late pregnancy for these women is required.
Clinical examination to assess fetal presentation is a relatively simple procedure and, with ongoing diligence and regular audit and feedback, accuracy may be increased. Variability in accuracy rates by examiner and level of experience also suggest there is room for improvement by all pregnancy care providers, they conclude.
Contacts:
Natasha Nassar, Research Associate,
Centre for Perinatal Health Services Research, School of Public Health, University
of Sydney, Australia
Email: natashan@ichr.uwa.edu.au
or
Emily Olive, Research Fellow in
Obstetrics, Centre for Perinatal Health Services Research, School of Public
Health, University of Sydney, Australia
Email: eco1@optusnet.com.au
(4) RESEARCH ETHICS REQUIREMENTS COMPROMISING QUALITY OF HEALTH RESEARCH
(Overcoming barriers to recruitment
in health research)
http://bmj.com/cgi/content/full/333/7562/300
Current research ethics requirements are compromising the scientific quality of health research, warn senior doctors in this week’s BMJ.
Many ethics committees now insist that researchers approach only people who respond positively to a letter from their doctor informing them about an opportunity to take part in research – that is, people must opt in to being contacted by a researcher.
But the ethical benefits of this approach are not proved and it can lead to low response rates, wasted resources, and research of limited validity, argue Professors Jenny Hewison of Leeds University and Andy Haines of the London School of Hygiene and Tropical Medicine.
They believe that some kind of trade-off between confidentiality costs and health benefits is unavoidable, and call for public debate about what it means to protect patients’ interests.
The evidence suggests that public concern about an opt-out approach to being contacted by a researcher is minimal. Particularly sensitive topics might justify a different strategy, but ethics committees should presume that opting out is the best approach and that opting in might occasionally need to be used, they write.
Certain kinds of research have suffered more than others under the present system, but winners and losers are determined by administrative factors not research priorities, they add. The full impact of an opt-in system is seen in those projects that require records to be searched and letters to be sent: recruitment rates are lower and more practice time must be spent recruiting. The arrangement is often unsuccessful and may lead to failure of the study.
They suggest therefore that all NHS users should receive brief information about the potential use of personal information for research and that a strategy to inform individuals about how such research can contribute to improved health should be promulgated.
Since participation in research is likely to be determined by perceptions of trust and fairness, the NHS must have a robust and forthright communications strategy to explain why research using personal information is needed and the importance of ensuring high participation rates, they conclude.
Contact:
Professor Jenny Hewison, University
of Leeds, Institute of Health Sciences and Public Health Research, Leeds,
UK
Email: j.hewison@leeds.ac.uk
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