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BMJ No 7122 Volume 315 This week in brief Saturday 13 December 1997 Co-proxamol is no better than paracetamol alone Patients at high risk from carotid endarterectomy can be identified Preventing heart disease with pravastatin is economically viable Haemorrhagic strokes confer higher risk of seizures Asian general practitioners are not high cost prescribers Too many consultants are each managing too few cases of head and neck cancer Co-proxamol is no better than paracetamol alone Analgesic combinations of paracetamol and opiates are widely used, but controversy exists about whether they are more effective than paracetamol alone. Li Wan Po and Zhang (p 1565) conducted a meta-analysis of trials of paracetamol (650 mg) and of its combination with dextropropoxphene (32.5 mg) looking at sum of pain intensity difference and the proportion of patients who obtained at least moderate pain relief. In both direct and indirect comparisons (paracetamol v placebo and combination v placebo) the combination was no better than paracetamol alone. There were small, but probably unimportant, differences in rates of adverse drug reactions. Patients at high risk from carotid endarterectomy can be identified Although carotid endarterectomy reduces the risk of ischaemic stroke in severe carotid stenosis, the risk of stroke and death due to operation itself is about 6-8% for patients with symptomatic stenosis. It is important therefore to define characteristics that identify patients at particularly high operative risk. Rothwell et al (p 1571) used data from 36 studies that looked at the relation between clinical or angiographic characteristics and surgical risk together with unpublished data from the European carotid surgery trial, and examined the effect of 14 characteristics. Transient ocular ischaemia was associated with a lower operative risk than transient cerebral ischaemia, but female sex, age over 75, systolic hypertension, peripheral vascular disease, occlusion of the contralateral artery, and stenosis of the ipsilateral carotid syphon or external carotid artery were each associated with a significantly increased operative risk. Preventing heart disease with pravastatin is economically viable The West of Scotland coronary prevention study showed that pravastatin can prevent cardiovascular disease in men with hypercholesterolaemia. Caro et al (p 1577) used data from the study and from the Scottish record linkage system to estimate how many men would benefit and at what cost. For every 31 men with high cholesterol who start treatment, one will avoid a cardiovascular event over the subsequent five years. Pravastatin used in this way can be an efficient use of healthcare resources, though further research is needed to determine which patients would benefit most. Haemorrhagic strokes confer higher risk of seizures Cerebrovascular disease is an important cause of epilepsy, particularly in older people. Hospital based studies of seizures after stroke are subject to bias because patients with more severe strokes are more likely to be admitted. The Oxfordshire community stroke project avoids these sources of bias; on page 1582 Burn et al estimate the actuarial and relative risks of epileptic seizures after first stroke. Patients with either a haemorrhagic stroke or total anterior circulation infarction are at higher risk of seizures than other survivors. The 5 year actuarial risk of epilepsy in patients who survive to be independent at 1 month is less than 5%. Asian general practitioners are not high cost prescribers There is anecdotal evidence that doctors from the Indian subcontinent issue more prescriptions for more expensive items that do non-Asian doctors. Gill et al (p 1590) examined this claim by linking data from 155 single handed general practitioners and routine data sources. They found no significant difference between Asian doctors qualified in the Indian subcontinent and British trained Asian and white doctors in prescribing costs, number of items prescribed, and percentage of generic drugs prescribed. Too many consultants are each managing too few cases of head and neck cancer A team approach to managing head and neck cancers has long been recommended, but a survey of consultants in several disciplines by Edwards et al (p 1589) showed that of the 919 consultants managing these patients almost a quarter managed them alone, and over half managed fewer than 10 cases a year at any one anatomical site. Only 37 consultants used a standardised method of collecting data, and 40% and 35% respectively reported no access to nurse specialists or couselling services. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline