Editor's Choice | This Week in BMJ | Press releases
BMJ No 7108 Volume 315 This week in brief Saturday 6 September 1997 Cognitive dysfunction is a risk factor for sustaining concussion Reassurance doesn't work in anxious patients Compression should be routine for venous leg ulcers Local health promotion initiatives on coronary heart disease can be cost effective Separating frozen beefburgers risks injury to the hand Drug misuse databases underestimate drug taking Cognitive dysfunction is a risk factor for sustaining concussionCognitive dysfunction after concussion has often been documented, but one problem is that cognitive function before the injury can usually be estimated only indirectly. In a population based study Teasdale and Engberg (p 569) report a raised rate of cognitive dysfunction among young men who sustained concussion less than one week before testing, compared with the rate in the general population of young men. An increased rate was also present, but much reduced, among men tested at longer intervals after concussion. Men tested before concussion showed a greater rate of cognitive dysfunction, suggesting that reduced cognitive function may be a risk factor for sustaining concussion. Reassurance doesn't work in anxious patientsPatients' responses to reassurance that they have no serious illness vary, and some are not reassured. Lucock et al (p 572) report a study investigating the natural time course of worry about health and of illness belief (belief that something is seriously wrong) after reassurance after gastroscopy. Although all patients showed an immediate reduction in worry and illness belief, those who had scored highly on the health anxiety questionnaire showed a resurgence in worry and illness belief within 24 hours, which lasted up to a year. The authors suggest that brief structured forms of reassurance should be developed and tested. Compression should be routine for venous leg ulcersVenous leg ulcers are common and expensive and are managed mainly in primary care, though wide variations exist in their management. Fletcher et al (p 576) undertook a systematic review of research on the effectiveness of compression delivered by bandaging, stockings, and pneumatic pumps and identified 24 randomised controlled trials. These showed that any compression is better than none, and that high compression systems seem more effective than those providing low compression. The promotion of any particular bandage is not supported by the data. Local health promotion initiatives on coronary heart disease can be cost effectiveSome form of heart health promotion programme is taking place in every
health district in England and in similar populations in many other
countries. On p 582 Baxter et al describe the impact of a focused
initiative called Action Heart in an area of high coronary heart
disease in Rotherham, England, compared with a si Two hand surgeons noticed an increasing number of hand injuries
caused by the patient trying to separate stacked items of frozen food,
typically beefburgers, with a knife. On p 580 Jigjinni et al summarise
27 cases in four hospitals: these included 16 nerve injuries, nine
tendon lacerations, and one volar plate injury. Two patients needed
revascularisation and two needed nerve grafting. The Department of
Trade's home accident surveillance database showed 32 similar injuries
in 1991. The authors urge manufacturers to make it easier to separate
frozen items and print warnings on packets.
Regional and national drug misuse databases in the UK represent a large
investment in drugs surveillance. Hickman et al assessed the accuracy
of the North Thames database by collecting a standard dataset on
everyone attending a random selection of the specialist drug agencies
in 1994 (p 581). Such agencies provide over 80% of reports to the
database. They found about 30% of drug misusers were unreported to the
database, ranging from 9% at drug dependency units to 63% at needle
exchanges. About 40% of this shortfall was due to underreporting, with
the rest due to the database's definition of an "episode"
excluding clients who attend more frequently than every six months. The
authors conclude that the database is inadequate for planning but needs
improving, not abandoning.
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