Press releases Monday 7 June to Friday 11 June 2010
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) Smoke-free laws in England associated with 1200 fewer heart attack admissions in following year (2) Warning over eye injuries from laser pointers (3) Inexpensive drug to stop sight loss shown to be effective (4) Family carers share the illness experience of the dying patient
(1) Smoke-free laws in England associated with 1200 fewer heart attack admissions in following year
(Research: Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction )
http://www.bmj.com/cgi/content/abstract/340/jun08_1/c2161
There were 1200 fewer emergency heart attack hospital admissions during the 12 month period after the introduction of smoke-free laws in England, according to a study published today on bmj.com today.
The research, led by Dr Anna Gilmore from the University of Bath, shows that the introduction of a law where all enclosed workplaces and public places in England became smoke-free was followed by a 2.4% reduction in heart attack admissions and this has important public health benefits given the high rates of heart disease globally.
It has long been established that exposure to secondhand smoke increases the risk of heart disease and smoke-free laws have been introduced in different countries, states and cities to tackle this issue.
In order to investigate the impact of smoke-free laws in England, which were introduced on 1 July 2007, the authors collected data on emergency hospital admissions for patients aged 18 or older from July 2002 to September 2008. They subsequently compared the records for the five years before the introduction of smoke-free laws to the period after legislation came into force.
Previous research looking at the effects of smoke-free legislation have had varying results with the largest reductions in heart attack admissions being reported in smaller US studies.
Dr Gilmore's research has a number of advantages to previous studies – firstly the size (with a population of 49 million, England is the largest jurisdiction to go smoke-free) and secondly, the authors adjusted the data to take into account underlying trends in admissions and variations in other factors such as seasonal temperature and population size.
The authors also speculate that a further reason for a smaller reduction in heart admissions in their study is because smoke-free legislation in England was introduced at a time when many public places and workplaces were already smoke-free.
Dr Michelle Sims, first author of the paper, explained, "a 2.4% reduction may sound small, but given we were looking at the whole of England it actually means the prevention of 1200 emergency admissions during the first year of the smoke-free law."
Dr Gilmore concludes that smoke-free public places may result in reductions in hospital admissions for heart attacks, even in countries with pre-existing smoking restrictions. She adds that given the high rate of heart attacks, "even the relatively small reduction seen in England has important public health benefits."
Contact:
Katharine Barker, University of Bath Press Office, Bath, UK
Email: press@bath.ac.uk
(2) Warning over eye injuries from laser pointers
(Letter: Maculopathy from handheld green diode laser pointer)
http://www.bmj.com/cgi/content/extract/340/jun08_1/c2982
Doctors in this week's BMJ are warning about the use of high powered handheld laser pointers after treating a young patient with serious eye injuries.
Dr Kimia Ziahosseini and colleagues from the Royal Liverpool University Hospital and Manchester Royal Eye Hospital describe the case of a teenager who presented with central scotomas (dark spots) after he bought a green diode laser pointer over the internet and shone the laser beam into his eyes while playing with it.
His visual acuity was poor and tests revealed burns to the surface of the eye and disturbances to the retina, the light sensitive tissue at the back of the eye. Two months later, his visual acuity improved but some retinal damage remained.
The authors warn that, although lasers may cause only a transient afterimage, they can lead to permanent retinal damage and visual loss in later years.
The UK Health Protection Agency has received no previous reports of such injury from laser pointers, they write. It advises that laser products sold to the general public for use as laser pointers should be restricted to devices with laser power less than 1 Milliwatt (mW), in accordance with the British Standard, and be accompanied by sufficient information on their safe operation.
Contact:
Kimia Ziahosseini, Specialist Trainee, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
Email: kim.z@doctors.org.uk
(3) Inexpensive drug to stop sight loss shown to be effective
(Research: Bevacizumab for neovascular age related macular degeneration (ABC Trial): multicentre randomised double masked study)
http://www.bmj.com/cgi/content/abstract/340/jun09_4/c2459
(Editorial: Bevacizumab for the treatment of neovascular age related macular degeneration )
http://www.bmj.com/cgi/content/extract/340/jun09_4/c2834
An inexpensive, but unlicensed drug to help prevent severe sight loss in older people has been shown to be safe and effective, finds a study published on bmj.com today.
Bevacizumab (Avastin) is licensed as a treatment for bowel cancer, but it is widely used “off label” as a considerably cheaper alternative to the approved drug ranibizumab (Lucentis) to prevent wet age related macular degeneration (AMD) and several large trials comparing the two drugs are now underway.
Although ranibizumab was not included in this study (it was not licensed for use when the trial began) the researchers support its immediate implementation in healthcare systems whose budgetary limitations prevent patients’ access to ranibizumab. In the majority of countries in the world, where either no treatment or inferior therapies are available to patients with wet AMD, the appropriate use of bevacizumab, a highly cost effective intervention, would have an immediate impact in reducing incident blindness from this condition, they say.
Wet AMD is the leading cause of visual loss in people over the age of 50 in Europe and North America. Visual loss is a result of progressive loss of light sensitive cells at the back of the eye due to damage from abnormal, leaking blood vessels. Sufferers do not go blind, but find it virtually impossible to read, drive, or do tasks requiring fine, sharp, central vision.
In 2006, researchers based at three UK eye centres, set out to test whether bevacizumab is an effective and safe treatment for wet AMD compared with standard NHS care available at the time.
A total of 131 patients aged at least 50 years with wet AMD were randomised to either bevacizumab injections at six week intervals or standard care (one of three different treatments available on the NHS at the start of the study). Visual acuity was measured at the start of the study (baseline) and then monitored over one year (54 weeks).
At one year, 32% of patients in the bevacizumab group gained 15 or more letters from baseline visual acuity compared with 3% in the standard care group.
In addition, the proportion of patients who lost fewer than 15 letters of visual acuity from baseline was significantly greater among those receiving bevacizumab treatment (91%) compared with 67% in the standard care group.
Average visual acuity increased by seven letters in the bevacizumab group with a median of seven injections compared with a decrease of 9.7 letters in the standard care group, and the initial improvement at week 18 was sustained to week 54.
Bevacizumab treatment was associated with a low rate of serious adverse events.
These results show that bevacizumab injections given at six weekly intervals for wet AMD is superior to the standard care available at the start of the trial, say the authors. This trial provides level-one evidence for the use of bevacizumab injections for the treatment of wet AMD, they conclude.
In an accompanying editorial, Professor Usha Chakravarthy from the Royal Victoria Hospital in Belfast says that, although this trial fills a gap in the evidence base and shows robustly that bevacizumab is better than previously employed treatments, it does not tell us whether the drug is as effective as ranibizumab. And she warns that “the off label use of bevacizumab should not be encouraged until the large randomised trials comparing it with ranibizumab report their findings.”
Contacts:
Adnan Tufail, Consultant Ophthalmologist, Moorfields Eye Hospital NHS Foundation Trust, London, UK
Email: adnan.tufail@moorfields.nhs.ukEditorial: Usha Chakravarthy, Professor of Ophthalmology and Vision Science, Royal Victoria Hospital, Belfast, UK
Email: u.chakravarthy@qub.ac.uk
(4) Family carers share the illness experience of the dying patient
(Research: Archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer: secondary analysis of serial qualitative interviews)
http://www.bmj.com/cgi/content/abstract/340/jun09_4/c2581
Family carers need to be supported throughout the whole illness of their loved ones as they witness and share much of the experience of the dying person, according to research published on bmj.com today.
It has already been established that individuals dying from cancer experience distress particularly at four key time points – at diagnosis, at home after initial treatment, at recurrence, and during the terminal stage, says the study.
The authors, led by Professor Scott Murray from the University of Edinburgh, are now suggesting that family caregivers may also experience typical patterns of wellbeing and distress that their relatives are going through.
Professor Murray and colleagues carried out 42 interviews with patients with lung cancer and 46 interviews with their family carers. The interviews took place every three months for up to a year or until the patient died.
The results show that carers were generally in better health than the patients, but any health problems they had could diminish their ability to care.
The authors say that carers often felt run down and that they were sharing the illness, especially as time went on and death approached. They write: “Carers, like patients, often felt they were on an emotional rollercoaster, experiencing peaks and troughs at key times of stress and uncertainty in the cancer trajectory.”
The authors conclude that psychological and existential support should be targeted at carers at the four key stages of the terminal illness. “It may also be empowering for carers to know that it is common to feel stressed and in need of support at certain times,” they add.
Contact:
Scott Murray, St Columba's Hospice Professor of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, University of Edinburgh, Scotland, UK
Email: scott.murray@ed.ac.uk
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