Press releases Monday 12 October to Friday 16 October 2009
Please remember to credit the BMJas source when publicising an article and to tell your readers that they can
read its full text on the journal's website (http://www.bmj.com).
(1) Over half of cot deaths occur whilst co-sleeping
(1) Exercise reduces fatigue in cancer patients undergoing chemotherapy
(3) Study finds rise in rate of undesirable events at start of academic year
(1) Over half of cot deaths occur whilst co-sleeping
(Research: Hazardous co-sleeping environments and risk factors amenable to change: case control study of SIDS in Southwest England)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3666
(Editorial: Risk factors for SIDS)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3466
More than half of sudden unexplained infant deaths occur while the infant is sharing a bed or a sofa with a parent (co-sleeping) and may be related to parents drinking alcohol or taking drugs, suggests a study published on bmj.com today.
Although the rate of cot death in the UK has fallen dramatically since the early 1990s, specific advice to avoid dangerous co-sleeping arrangements is needed to help reduce these deaths even further, say the researchers.
The term sudden infant death syndrome (SIDS) was introduced in 1969 as a recognised category of natural death that carried no implication of blame for bereaved parents.
Since then, a lot has been learnt about risk factors, and parents are now advised to reduce the risk of death by placing infants on their back to sleep, placing infants in the "feet to foot" position at the bottom of the cot, and keeping infants in a smoke-free environment.
But it is not clear which risk messages have been taken on board in different social or cultural groups, and little is known about the emergence of new or previously unrecognised risk factors.
So a team of researchers at the Universities of Bristol and Warwick studied all unexpected infant deaths from birth to two years in the southwest region of England from January 2003 to December 2006.
To investigate a possible link between SIDS and socioeconomic deprivation, they compared these deaths with a control group at ‘high risk' for SIDS (young, socially deprived mothers who smoked) as well as a randomly selected control group.
Parents were interviewed shortly after the death and information was collected on alcohol and drug use. A detailed investigation of the scene and circumstances of death was also conducted by trained professionals.
Of the 80 SIDS deaths analysed, more than half (54%) occurred whilst co-sleeping compared to 20% co-sleeping rate amongst both control groups.
Much of this risk may be explained by the combination of parental alcohol or drug use prior to co-sleeping (31% compared with 3% random controls), and the high proportion of co-sleeping deaths on a sofa (17% compared with 1% random controls), say the authors.
A fifth of SIDS infants were found with a pillow for the last sleep and a quarter were swaddled, suggesting potentially new risk factors emerging.
The risk factors were similar whichever group the SIDS cases were compared with, suggesting that these risk factors for SIDS apply to all sections of the community and are not just a consequence of social deprivation.
Some of the risk reduction messages seem to be getting across and may have contributed to the continued fall in the SIDS rate, say the authors. However, the majority of the co-sleeping SIDS deaths occurred in a hazardous sleeping environment. The safest place for an infant to sleep is in a cot beside the parental bed in the first six months of life, they write.
Parents need to be advised to never put themselves in a situation where they might fall asleep with a young infant on a sofa. They also need to be reminded that they should never co-sleep with an infant in any environment if they have been drinking or taking drugs.
We have learnt that SIDS is largely preventable, says Edwin Mitchell, Professor of Child Health Research at the University of Auckland, in an accompanying editorial. It is important to monitor parents' knowledge and infant care practices to inform health education and promotion.
Implementing what we already know has the potential to eliminate SIDS, the challenge now is how to change behaviour, he concludes.
Contacts:
Research: Peter Fleming, Professor of Infant Health and Development Physiology, Department of Community Based Medicine, University of Bristol, UK
Email: peter.fleming@bris.ac.uk
Editorial: Edwin Mitchell, Professor of Child Health Research, Department of Paediatrics, University of Auckland, New Zealand
Email: .mitchell@auckland.ac.nz
(2) Exercise reduces fatigue in cancer patients undergoing chemotherapy
(Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3410
Supervised exercise programmes that include high and low intense cardiovascular and resistance training can help reduce fatigue in patients with cancer who are undergoing adjuvant chemotherapy or treatment for advanced disease. The exercise training also improves patients' vitality, muscular strength, aerobic capacity and emotional well-being, according to research published on bmj.com today.
However, the research also concludes that the mixed high and low intense exercise programme does not improve the overall quality of life for these patients.
An increasing number of cancer patients are being treated with chemotherapy, either given alone or with surgery and/or radiotherapy. While chemotherapy treatments have improved, patients still suffer from side-effects, including nausea, vomiting, pain, insomnia, appetite loss and fatigue. Surveys show that fatigue is one of the most frequent and burdensome side-effects, says the study.
Lead author, Professor Lis Adamsen from Copenhagen University Hospitals, says this is one of the first studies to examine how a mixed intensity exercise programme affects individuals undergoing chemotherapy.
Two hundred and sixty nine cancer patients took part in the study across two hospitals in Copenhagen, 196 participants were female and 73 were male. The ages ranged from 20 to 65, with an average age of 47. The study included 21 different diagnoses of cancer.
The exercise training included high and low intensity cardiovascular and resistance training, relaxation and body awareness and massage. Participants in the study group received nine hours of weekly training for six weeks in addition to conventional care.
Established research criteria were used to rate patients' views at the end of the study. The results show that patients who took part in the study experienced significantly less fatigue than the group who did not undergo exercise training, and even patients with advanced disease could benefit.
Although male patients participated, there was a clear majority of female patients, and exercise training should be developed with greater appeal to male patients, add the authors.
Despite the failure to improve overall health status, they conclude that "there is a considerable rationale for promoting multimodal exercise interventions to improve physical capacity, vitality, physical and mental well-being and relieving fatigue during chemotherapy; thereby supporting cancer patients' daily living activities."
Contacts:
Research: Professor Lis Adamsen, The University Hospitals Centre for Nursing and Care Research, Copenhagen University Hospital, Denmark
Email: la@ucsf.dk
(3) Study finds rise in rate of undesirable events at start of academic year
(Research: Rate of undesirable events at beginning of academic year: retrospective cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3974
(Editorial: Reducing variation in adverse events during the academic year
)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3949
The rate of undesirable events in teaching hospitals increases at the beginning of the academic year, regardless of trainees' level of clinical experience, concludes new research from Australia published on bmj.com today.
At the beginning of an academic year, teaching hospitals around the world accept an influx of new trainees and fellows, and doctors who are already in specialist training move on to the next post within their training scheme. This transition phase is often considered to be the worst time of the year to be admitted to hospital. Previous studies have been inconclusive, but most have concluded that the quality of care remains uniform throughout the academic year.
To investigate this further, an international team of researchers set out to examine whether patients having an anaesthetic procedure carried out by first to fifth year trainees at the beginning of the academic year had a higher rate of undesirable events than patients operated on later in the year. They also analysed the trend in the rate of undesirable events throughout the year.
Using administrative and patient record data from a University affiliated hospital in Melbourne, Australia, the team analysed 19,560 patients over a period of five years (1995-2000).
The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (137 v 107 events per 1000 patient hours).
This excess risk was seen for all trainees regardless of their level of clinical experience, suggesting that seniority of trainees does not protect patients from undesirable events.
The effect decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year, particularly for events related to technical performance and overall management of patients.
The fact that more experienced trainees have as many undesirable events as new trainees suggests that lack of technical skills is not the only mechanism explaining this phenomenon, say the authors. They suggest that new trainees are unfamiliar with the working environment, supervision is insufficient, and communication suffers.
Possible strategies to minimise this include improving trainees' orientation and integration during their first weeks of employment, increasing intensity of supervision of advanced trainees, and developing early training sessions aimed at improving technical and teamwork skills, they conclude.
These findings suggest that the current clinical system cannot absorb the effects of new personnel at the beginning of a new academic year, say researchers in an accompanying editorial.
Professor Paul Barack from Utrecht Medical Center in the Netherlands and Professor Julie Johnson from the University of New South Wales in Australia believe that reducing variation in patient care at the start of the academic year requires developing resilient systems in which individuals, teams, and their organisations can adapt and compensate for the disruptions of incoming inexperienced trainees.
Trainees need practice and mentorship, with increased patient awareness, closer supervision, and graduated clinical responsibilities, they conclude.
Contacts:
Research: Guy Haller, Consultant, Department of Anaesthesia, Pharmacology and Intensive Care, Division of Clinical Epidemiology, Geneva University Hospital, University of Geneva, Switzerland
Email: Guy.Haller@hcuge.ch
Editorial: Paul Barach, Visiting Professor, Department of Anaesthesia, Utrecht Medical Center, Utrecht, Netherlands
Email: p.barach@umcutrecht.nl
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