Online First articles may not be available until 09:00 (UK time) Friday.

Press releases Saturday 16 December 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) Hospitals miss most patient safety incidents

(2) Intelligent children more likely to become vegetarian

(3) Obesity could bankrupt the health system, warn doctors

(4) Defibrillators should be available in ski resorts

(5) Just how useful are animal studies to human health?

Online First
(1) Hospitals miss most patient safety incidents
(Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.39031.507153.AE

Hospital reporting systems may significantly under-report patient safety incidents, particularly those resulting in harm, warns a study published on bmj.com today.

The authors suggest that the current system, which relies on voluntary reporting, may not be sufficient if the NHS is to gather accurate information on the extent of harm resulting from patient safety incidents.

Patient safety incidents are common in hospitals, and many of them lead to patient harm or extra cost. In 2003, the National Patient Safety Agency developed a national reporting and learning system to help the NHS identify, analyse, and learn from patient safety incidents.

All NHS hospitals now have routine incident reporting systems as part of their risk management programme.

To test the performance of these systems, researchers compared data from the routine reporting system with a review of case notes for the same patients in a large NHS hospital in England.

From a random sample of 1006 admissions, 324 patient safety incidents were identified. Case note review identified 303 (93%) of incidents, while the reporting system identified 54 (17%).

Of these 324 incidents, 136 (42%) resulted in patient harm. All of these were detected by the case note review but only 6 (5%) were detected by the reporting system.

The 21 incidents missed by case note review were minor, whereas the 130 incidents missed by the reporting system led to patient harm.

The routine reporting system in this large hospital missed most patient safety incidents that were identified by case note review and detected only 5% of those incidents that resulted in patient harm, say the authors. This suggests that the routine reporting systems considerably under-reports the scale and severity of patient safety incidents.

A recent report by the House of Commons Committee of Public Accounts was critical of the adequacy of the national reporting and learning system. This study provides empirical evidence that the data sent to the system may be biased.

More research is needed to help develop a reporting system that is capable of providing an accurate picture of the type, nature, and severity of incidents and at reasonable cost, they write. Healthcare organisations should consider routinely using structured case note review on samples of medical records as part of quality improvement, they conclude.

Contact:
Trevor Sheldon, Professor of Health Sciences, Department of Health Sciences, University of York, UK (secretary) Email: tas5@york.ac.uk

Online First
(2) Intelligent children more likely to become vegetarian
(IQ in childhood and vegetarianism in adulthood: 1970 British Cohort Study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.39030.675069.55

Intelligent children may be more likely to be vegetarian as adults, suggests a study published online by the BMJ today.

Recent evidence suggests that vegetarianism may be linked to lower cholesterol levels and a reduced risk of obesity and heart disease. This might help to explain why children who score higher on intelligence tests tend to have a lower risk of coronary heart disease in later life.

The study involved 8179 men and women aged 30 years whose IQ was tested at age 10 years.

Twenty years later, 366 (4.5%) of participants said they were vegetarian. Of these, 9 (2.5%) were vegan and 123 (33.6%) stated they were vegetarian but reported eating fish or chicken.

Vegetarians were more likely to be female, to be of higher occupational social class and to have higher academic or vocational qualifications than non-vegetarians, although these differences were not reflected in their annual income, which was similar to that of non-vegetarians.

Higher IQ at the age of 10 years was associated with an increased likelihood of being vegetarian at the age of 30. This relation was partly accounted for by better education and higher occupational social class, but it remained statistically significant after adjusting for these factors.

There was no difference in IQ score between strict vegetarians and those who said they were vegetarian but who reported eating fish or chicken.

The finding that children with greater intelligence are more likely to report being vegetarian as adults, together with the evidence on the potential benefits of a vegetarian diet on heart health, may help to explain why higher IQ in childhood or adolescence is linked with a reduced risk of coronary heart disease in adult life, write the authors.

Alternatively, the link may be merely an example of many other lifestyle preferences that might be expected to vary with intelligence, but which may or may not have implications for health, they conclude.

Contact:
Catharine Gale, Senior Research Fellow, MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK Email: crg@mrc.soton.ac.uk

Online First
(3) Obesity could bankrupt the health system, warn doctors
(Obesity ± can we turn the tide?)
http://bmj.com/cgi/content/full/333/7581/1261

If nothing is done, the rising prevalence of obesity could bankrupt the health system, warn doctors in this week±s BMJ.

In the United Kingdom, well over half the population is overweight and more than one in five adults is obese, write Naveed Sattar and colleagues. Obese people are at high risk of multiple health problems, while the cost of obesity to a country's health service is currently estimated at up to 9%, and the overall social cost of the condition is seen as a major hindrance to economic development.

So, can we reverse the rising trend in the prevalence of obesity, and if so, when?

People clearly have some responsibility for their health, but society and government also have a responsibility to make the preferred, easy choices healthier ones. It is increasingly apparent that most individuals are unable to make enough ±proactive± changes to prevent excess weight gain but are simply ±reactive± to their environment, say the authors.

What is provided is what is eaten so what is provided has to change, they add. Thus education alone will fail to halt this obesity epidemic, and environmental changes (physical, food, and fiscal policy) are urgently needed.

They believe that prevention is the only economic long term solution to the problem and recommend that: The food industry needs to take more responsibility for preventing obesity. And governments, as custodians of public health, should create the conditions for this to happen The advertising of energy dense foods needs to be substantially curtailed The basic principles of energy balance should be taught in primary schools, and education should be provided at all levels to change attitudes and behaviour towards diet and physical activity Obesity should be made a core part of all medical training Public health consequences should be considered for all decisions made in public life

Medical practice must adapt to the current epidemic of obesity and nutrition related diseases, while society must also accept that many people now need drugs (and in some cases, surgery) to cut risks of and disability from obesity, and to limit its progression, they write.

As the prevalence and costs of obesity escalate, the economic argument for giving high priority to obesity and weight management through a dedicated coordinating agency will ultimately become overwhelming. The only question is, will action be taken before it±s too late?

Contact:
Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, Scotland Email: nsattar@clinmed.gla.ac.uk


Online First
(4) Defibrillators should be available in ski resorts
(Personal View: Cardiac arrest on a ski slope)
http://bmj.com/cgi/content/full/333/7581/1276

As the ski season gets underway, doctors in this week±s BMJ say that more defibrillators should be placed in ski resorts to help prevent sudden cardiac deaths.

Automated external defibrillators (AEDs) are electrical devices used to restore a normal heartbeat. They are often placed in busy public places like airports and stadiums.

Downhill skiing is the most popular winter sport in the world and is a serious trigger for sudden cardiac deaths in people with a history of heart problems, high blood pressure, or those who are not used to strenuous exercise. There are 12,000 cardiac arrests in public places each year in the UK.

On a recent skiing holiday in Europe, Dr Sarah Davies assisted a man who had collapsed on the slopes. She was joined by two German nurses, one British paediatric nurse, one French dentist and a British nursing student.

All were familiar with the European Resuscitation Council guidelines and, despite language barriers, communicated well because they all knew what they were expected to do. But they were unable to locate a defibrillator in the first aid room.

±We were on the top of the mountain, a cable-car journey from either of the two local towns. The patient remained lying in the snow, as we were unable to move him,± she explains.

After eight minutes the emergency helicopter arrived with a defibrillator, and the patient was transferred to the local hospital.

This experience highlighted that internationally recognised guidelines and access to a defibrillator is of paramount importance, says Dr Davies. Research has also shown that non-medical personnel, such as ski patrollers, can be successfully trained to operate AEDs and this gives good weight to the argument that more AEDs should be made available, especially in isolated areas with relatively large numbers of people.

±We therefore support the suggestion that AEDs should be placed in public areas and that non-medical personnel should be trained to operate them,± they conclude.

Contact:
Dr Sarah Davies, Respiratory Registrar, Northampton General Hospital, UK Email: sarah.davies@doctors.org.uk

Online First
(5) Just how useful are animal studies to human health?
(Comparison of systematic reviews of animal trials with clinical trials)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.39048.407928.BE

Animal studies are of limited usefulness to human health because they are of poor quality and their results often conflict with human trials, argue researchers in a study on bmj.com today.

Before clinical trials are carried out, the safety and effectiveness of new drugs are usually tested in animal models. Some believe, however, that the results from animal trials are not applicable to humans because of biological differences between the species.

So researchers compared treatment effects in animal models with human clinical trials.

They used systematic reviews (impartial summaries of evidence from many different studies) of human and animal trials to analyse the effects of six drugs for conditions such as head injury, stroke and osteoporosis.

Agreement between human and animal studies varied. For example, corticosteroids did not show any benefit for treating head injury in clinical trials but did show a benefit in animal models. Results also differed for the drug tirilazad to treat stroke - data from animal studies suggested a benefit but the clinical trials showed no benefit and possible harm.

Some results did agree. For instance, bisphosphonates increased bone mineral density in both clinical trials and animal studies, while corticosteroids reduced neonatal respiratory distress syndrome in animal studies and in clinical trials, although the data were sparse.

Animal studies are generally of poor quality and lack agreement with clinical trials, which limits their usefulness to human health, say the authors. This discordance may be due to bias, random error, or the failure of animal models to adequately represent clinical disease.

Systematic reviews could help translate research findings from animals to humans. They could also promote closer collaboration between the research communities and encourage an interative approach to improving the relevance of animal models to clinical trial design, they conclude.

Contact:
Professor Ian Roberts, London School of Hygiene and Tropical Medicine, London, UK Email: ian.roberts@lshtm.ac.uk

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs DivisionBMA HouseTavistock SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)