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Press releases Saturday 14 October 2006

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

(1) NHS SHOULD NOT ENCOURAGE COMMERCIAL BLOOD BANKING

(2) CONCERN OVER NEW RULES ON MOBILE PHONES IN HOSPITALS

(3) ARTHRITIS SELF-MANAGEMENT DOES NOT REDUCE PAIN LEVELS OR GP VISITS

(1) NHS SHOULD NOT ENCOURAGE COMMERCIAL BLOOD BANKING

(NHS maternity units should not encourage commercial banking of umbilical cord blood)
http://bmj.com/cgi/content/full/333/7572/801

NHS maternity units should not encourage commercial banking of umbilical cord blood, argues a senior doctor in this week’s BMJ.

Instead, women should be encouraged to donate altruistically to public blood banks.

Umbilical cord blood is rich in stem cells that can be used to treat diseases such as childhood leukaemia. Bone marrow is used for this purpose, but cord blood is cheaper and easier to obtain and less likely to trigger a harmful immune response or rejection in the recipient.

For these reasons interest has been growing in banking cord blood as insurance against future disease, but this has worrying implications for NHS services and little chance of benefit, says Dr Leroy Edozien, a Consultant Obstetrician and Gynaecologist at St Mary’s Hospital, Manchester.

Cord blood banks generally fall into two groups. Public banks collect cord blood which has been altruistically donated. The blood is used to treat unrelated recipients or is collected from families with a known genetic disease that is treatable by blood stem cell transplantation.

Since 1996, the NHS has been banking donated cord blood through designated public banks run by the National Blood Service and there is universal approval of the storage of this blood.

In contrast, commercial (private) banks operate collection and storage of a baby’s cord blood for later use by that person or their siblings should they develop an illness. This ‘just-in-case’ collection has been criticised by numerous medical bodies and is not recommended.

Scientific arguments against commercial cord blood banking include the chances of the blood being used are very small, the alternatives such as bone marrow, and the speculative claims about how cord blood could be used to treat disease.

But, whatever the scientific merits or demerits, commercial blood banking also raises serious resource, legal, and ethical issues for NHS maternity units, warns the author.

Taking the arguments for and against into consideration, the balance is tilted strongly against NHS trusts collecting cord blood for commercial banking. It should therefore be NHS policy not to facilitate umbilical cord blood collection by its staff, he concludes.

Contact:

Leroy Edozien, Consultant Obstetrician and Gynaecologist, St Mary’s Hospital, Manchester, UK
Email: leroy.edozien@cmmc.nhs.uk

(2) CONCERN OVER NEW RULES ON MOBILE PHONES IN HOSPITALS

(Editorial: Use of mobile phones in hospitals)
http://bmj.com/cgi/content/full/333/7572/767

Researchers in this week’s BMJ raise concerns about new rules on mobile phone use in hospitals.

Restrictions were originally put in place because of concerns about patient safety. But a lack of evidence has led the Medicines and Healthcare products Regulatory Agency (MHRA) to propose a relaxation of restrictions.

This relaxation is welcome, say the authors, but they warn that fresh anxieties are leading to a new wave of regulations that are even more restrictive than the old ones.

For example, the Department of Health has recommended that camera phones should not be allowed in hospitals because they may undermine the privacy of patients, and it has also suggested that some ring tones might be mistaken for medical device alarms.

The most important concern with mobile phones is interference with sensitive medical equipment, but a study by the Medical Devices Agency found that, in general, the interference was merely an irritation and ultimately harmless to the patient, they write.

Beeping, ringing, and singing ring tones can also be a nuisance, but do not endanger patients.

Mobile phones also have many benefits, they add. A recent survey of American Anaesthesiologists found that only 2.4% had ever experienced interference between a medical device and a mobile. In contrast 15% indicated that a delay in communication had led to a medical error or injury, and such delays were less frequent among those who used mobiles instead of pagers.

The authors believe that doctors and pharmacists would benefit from using mobile phones rather than pagers, and many patients in hospital would welcome the opportunity to relieve their isolation without resorting to expensive hospital phones that are cumbersome to use.

They urge hospital managers and clinical directors to adopt a more flexible approach to the use of mobile phones on the basis that the advantages clearly outweigh their largely mythical risks.

Contacts:

Stuart Derbyshire, Senior Lecturer in Psychology, University of Birmingham, UK
Email: s.w.derbyshire@bham.ac.uk

or

Adam Burgess, Senior Lecturer in Sociology, University of Kent, UK
Email: A.Burgess@kent.ac.uk

(3) ARTHRITIS SELF-MANAGEMENT DOES NOT REDUCE PAIN LEVELS OR GP VISITS

Online First
(Randomised controlled trial of arthritis self-management in primary care)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38965.375718.80

Self-management programmes for people with osteoarthritis do not reduce pain, or the number of visits patients make to their GP, a new study reveals today.

Osteoarthritis affects around five million people in the UK (8% of the population). Patient-centred arthritis self-management programmes tested on volunteers in the USA indicated a beneficial effect on pain, depression, exercise taken, communication with doctors and participants’ self-perception about their capacity to manage their condition

Researchers from London undertook one of the largest trials to measure the effects of arthritis self-management programmes on patients. The findings showed that whilst these programmes helped to reduce levels of anxiety for arthritis patients, they did little to reduce physical pain. The authors say their findings suggest that more research needs to be done to support the roll-out of the government’s Expert Patient Programme – a generic self-management programme for arthritis and other chronic diseases.

The study involved 812 participants with osteoarthritis in their hips and/or knees. They were divided into two groups. The first were placed on a six-session arthritis self-management programme and education booklet, the second received the education booklet alone. The participants were asked to complete a questionnaire at the start of the trial, then after four months, and again after a year. Those on the self-management programme experienced a reduction in anxiety levels and improved confidence in managing their symptoms. Neither group experienced a significant reduction in pain, improved physical functioning, or made fewer visits to their GP.

The authors conclude that there is “little doubt that self-management techniques provide some benefit for those with chronic or long-term conditions” but add that in terms of arthritis self-management programmes “there is currently insufficient evidence to justify a policy of active recruitment of patients from primary care settings”

Contact:

Marta Buszewicz, senior lecturer, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Holborn Union Building, London, UK
Email: m.buszewicz@pcps.ucl.ac.uk

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