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Press releases Saturday 19 May 2007

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(1) "Functional foods" must be monitored to assess their long-term safety and effectiveness

(2) 25,000 needless deaths each year due to failure to tackle blood clots in hospital

(3) Innovative education scheme sees fewer rugby players suffering spinal injuries

(4) IT delays putting patient safety at risk, say senior NHS staff



(1) "Functional foods" must be monitored to assess their long-term safety and effectiveness
(Functional foods: the case for closer evaluation)
http://www.bmj.com/cgi/content/full/334/7602/103

So-called ±functional foods± need to be systematically monitored because not enough is known about their long-term safety and effectiveness, say a group of scientists writing in today±s British Medical Journal.

Functional foods are modified foods which claim to improve health, quality of life and/or well-being, for example, yoghurts or margarines which improve the health of your gut or heart.

These foods are rapidly increasing in popularity. Between January and April 2005 200 functional foods were launched onto the market and with a turnover of ±316 million in 2005, the active health-drink market is one of the fastest growing in the UK.

Current EU rules focus primarily on evaluating the safety of these foods before they reach the supermarket. As yet, the Dutch scientists say, there are no regulations dealing with aspects which arise after these products have been marketed.

There is "little understanding of the circumstances under which the foods are eaten, whether target groups are reached, and if targeted education programmes or health policies should be recommended. Very little is known about exposure, long term or otherwise, and safety under free conditions of use, and whether and how functional foods interfere with drugs designed for the same target".

Nynke de Jong and her colleagues from the National Institute for Public Health and the Environment in the Netherlands stress that to date there is no evidence that these foods cause harm, although the data is limited to 5-6 years of use. But they say scientific developments with food and pharmacology are ongoing and so data supported assessments are now possible.

They pay specific attention to the group of products enriched with phytosterol and stanol which work to reduce the amount of ±bad± cholesterol entering the bloodstream. These are intended for people with mildly elevated cholesterol levels. Within the population as a whole these people are often unaware of their cholesterol level. It therefore follows say the writers that these enriched foods may only be eaten by people with much higher levels of cholesterol, who know they have a problem and are thus more likely to be taking medication as well. This, they say, inherently increases the potential for interactions with the drugs.

They warn "functional foods may influence the effectiveness of drugs and patients± compliance" and list a number of areas which need further study, for example there is some concern that phytosterols could increase fatty deposits in the arteries.

The scientists say a systematic monitoring programme would mean the public could ultimately have access to practical and unbiased information about when, how and if to eat functional foods. They conclude "we need to invest more in finding out what functional foods can contribute to individual and public health in relation to the promises made by manufacturers".

Contacts:
Nynke de Jong, Project Director, National Institute for Public Health and the Environment (RIVM), Bilthoven, 3720 BA, Netherlands
Email: nynke.de.jong@rivm.nl


(2) 25,000 needless deaths each year due to failure to tackle blood clots in hospital
(Editorial: Thromboprophylaxis for adult hospital in-patients)
http://www.bmj.com/cgi/content/full/334/7602/1017

Up to 25,000 people may die needlessly each year due to the failure to prevent blood clots known as venous thromboembolisms (VTE) in UK hospitals, say experts in this week±s BMJ.

Their warning follows the publication of official guidelines on the issue last month by the National Institute for Health and Clinical Excellence (NICE), which are also summarised in this week±s journal.

It is estimated that VTE kills around 60,000 people every year in the UK and the condition accounts for 10% of all hospital deaths, write David Fitzmaurice and Ellen Murphy from the University of Birmingham. This is 10 times greater than deaths due to MRSA and five times more deaths than breast cancer, AIDS and road traffic accidents combined.

People who have recently had surgery are particularly at risk.

Trials show that drugs can reduce the rate of VTE by up to 65%, yet a Health Select Committee report in 2005 found that only one in five patients at risk were getting them.

The committee instructed NICE to produce guidelines and called for an expert working group to develop a strategy and report back to the chief medical officer.

The expert group±s report and the chief medical officer±s response were published last month, recommending that every adult should have a mandatory VTE risk assessment on admission to hospital and that core standards be set to ensure full compliance with these assessments.

But despite the huge evidence base for preventative treatment, it remains poorly implemented in the UK, say the authors.

A combination of factors may be responsible, they say. For example, health professionals lack awareness due to poor education and venous thromboembolism often occurs after discharge from hospital. Prescribing costs may also be a barrier.

The Health Select Committee±s report two years ago provided an opportunity to change practice, say the authors. Meanwhile, 25,000 people may have died needlessly each year because of the failure to implement simple thromboprophylaxis in UK hospitals, they conclude.

Contact:
David Fitzmaurice, Professor of Primary Care, University of Birmingham, UK
Email: .a.fitzmaurice@bham.ac.uk

(3) Innovative education scheme sees fewer rugby players suffering spinal injuries
(Effect of Nationwide Injury Prevention Programme on Serious Spinal Injuries in New Zealand Rugby Union: An Ecologic Study)
BMJ Online First

A scheme educating coaches and referees in the dangers of the rugby scrum could be a key reason for a reduction in the number of spinal injuries suffered by rugby players, says a researcher writing in this week±s BMJ.

Spinal cord injuries, although rare, are a major cause of permanently disabling injuries and death in rugby.

In 2001 a wide-ranging injury prevention programme was introduced by the New Zealand Rugby Union in partnership with the Accident Compensation Corporation. Known as RugbySmart it focuses on educating participants about physical conditioning, injury management and safe techniques in the contact elements of rugby.

Referees and coaches, who have a key role in educating teams how to play more safely, must complete the course annually. Coaches who do not complete RugbySmart have their team withdrawn from the competition; referees are not assigned matches. Mr Quarrie says as a result the reach and influence has been extensive.

The New Zealand study assessed the number and cause of spinal injuries resulting in permanent disability preceding the introduction of RugbySmart and compared them with data gathered since 2001.

There were 77 injuries recorded between 1976 and 2005. Based on the figures from 1976 to 2000 the researchers calculated there should have been 18.9 spinal injuries between 2001 and 2005. In reality there were eight.

It was also found that before 2001 the scrum was the most dangerous part of the game accounting for 48% of spinal injuries. Yet between 2001 and 2005 it was the cause of 12.5% of injuries. There was one spinal injury from the scrum in this period, the predicted number was nine.

There was little change in the number of spinal injuries in the other contact areas of rugby - the tackle, ruck and maul. There were seven instead of the predicted nine spinal injuries in these elements of play between 2001 and 2005. Yet where tackles had accounted for 36% of spinal injuries between 1976 and 2000, between 2001 and 2005 that percentage rose to 87.5.

The education scheme has not been successful in reducing the number of spinal injuries unrelated to the scrum says Mr Quarrie. This could be because compared to the relatively controlled environment of the scrum, the direction and size of forces applied to player±s bodies in the tackle, ruck and maul are much less predictable.

Furthermore, as the initiative was introduced country-wide there was no control group which means it is difficult to assess the impact of other factors on the reduction in spinal injuries. There is no way for example to take into account evidence from international matches which indicates a long-term decrease in the number of scrums per match.

He concludes that while it is unclear whether the programme has had an effect on injuries suffered during other phases of play: "Educational initiatives seem to represent a viable option for decreasing the rate of serious spinal injuries in rugby union scrums."

Contact:
Kenneth L Quarrie, Manager, Research & Injury Prevention, New Zealand Rugby Union, Wellington, 6001, New Zealand
Email: ken.quarrie@nzrugby.co.nz


(4) IT delays putting patient safety at risk, say senior NHS staff
(Implementing the NHS information technology programme: qualitative study of progress in acute trusts)
BMJ Online First

Senior NHS staff support IT modernisation but say that continuing delays are putting patient safety at risk, according to a study published on bmj.com today.

The NHS information and technology programme is the largest civilian IT programme in the world with projected expenditure of over ±12bn. The main features of the programme are a new networking service, called N3; electronic booking, called Choose and Book; electronic transfer of prescriptions; and a nationally accessible summary of patients± records, called "the spine."

Researchers interviewed 25 senior managers and clinicians responsible for implementing the programme in four NHS hospitals in England. Interviews were conducted in two stages, 18 months apart, to compare progress and perceived challenges over time.

Interviewees unreservedly supported the goals of the programme, but had several concerns.

In the first round of interviews, the main concerns were about financial deficits, delays in replacing patient administration systems, and poor communication between Connecting for Health (the agency responsible for delivering the programme) and local managers.

Eighteen months later, the issue of financial deficits was even more acute. There was also concern that managers could not focus on implementing the system because of competing financial priorities.

Continuing delays in replacing patient administration systems and poor communication were also still apparent in the second interviews. Respondents reported uncertainty about the timetable for delivery and felt disempowered and frustrated with the lack of consultation.

Furthermore, the delays were now seen as an unacceptable risk to patient safety. One respondent said: "Our path system is extremely out of date - it±s a huge risk to the trust that we±re still carrying this path system." Another warned, "there are a number of risks that are associated with our old system, some very serious risks "

Respondents also questioned whether NHS-wide connectivity would ever be achieved.

Finally, there was little support for Choose and Book and none of the interviewees was optimistic about the ability of Connecting for Health to deliver the systems. "The software is not fit for purpose," said one director of information management and technology.

"The staff we interviewed were unreservedly in favour of IT modernisation," say the authors, "but this support will quickly diminish unless more progress is achieved."

They believe that Connecting for Health needs to address the uncertainty experienced by trusts and take responsibility for advising about interim decisions, while trust managers urgently need concrete information about implementation timetables, long term goals of the programme, and value for money. Trusts also need help in prioritising IT modernisation, they conclude.

Contact:
Jane Hendy, Research Fellow, Innovation Studies Centre, Imperial College, London, UK
Email: j.hendy@imperial.ac.uk

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