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BMJ No 7124 Volume 316 Papers - Abstracts Saturday 3 January 1998
Compression ultrasonography for diagnostic management of patients
with clinically suspected deep vein thrombosis: prospective cohort
study Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort studyAlberto Cogo, Anthonie W A Lensing, Maria M W Koopman, Franco Piovella, Sergio Siragusa, Philip S Wells, Sabina Villalta, Harry R Büller, Alexander G G Turpie, Paolo Prandoni See Editorial by Davidson and Deppert, p 2 AbstractObjective: To evaluate the safety of withholding anticoagulant treatment from patients with clinically suspected deep vein thrombosis but normal findings on compression ultrasonography.Design: Compression ultrasonography was done with a simplified diagnostic procedure limited to the common femoral vein in the groin and the popliteal vein extending down to the trifurcation of the calf veins. Patients with normal ultrasonography findings at presentation were retested 1 week later. Main outcome measure: The incidence of venous thromboembolic complications during follow up for 6 months in patients in whom anticoagulant treatment was withheld on the basis of normal results on two ultrasonography tests 1 week apart. Setting: University research centres in four hospitals. Results: A total of 1,702 patients were included in the study. Abnormal results on compression ultrasonography at presentation or at 1 week were found in 400 and 12 patients, respectively, for a prevalence of deep vein thrombosis of 24%. None of the patients were lost to follow up. Venous thromboembolic complications during the week of serial testing occurred in a single patient and in eight patients during 6 months' follow up, resulting in a cumulative rate of venous thromboembolic complications of 0.7% (95% confidence interval 0.3% to 1.2%). The mean number of extra hospital visits and additional tests required per initially referred patient was 0.8. Conclusion: It is safe to withhold anticoagulant treatment from patients with clinically suspected deep vein thrombosis who have a normal result on compression ultrasonography at the time of presentation and at 1 week.
Istituto di Semeiotica
Medica, Policlinico San Matteo, HGH McMaster Clinic, Centre for Vascular Medicine,
Correspondence to: Dr Lensing
Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding studyAndrea C Wilson, J Stewart Forsyth, Stephen A Greene, Linda Irvine, Catherine Hau, Peter W Howie
AbstractObjective: To investigate the relation of infant feeding practice to childhood respiratory illness, growth, body composition, and blood pressure.Design: Follow up study of a cohort of children (mean age 7.3 years) who had detailed infant feeding and demographic data collected prospectively during the first two years of life. Setting: Dundee. Subjects: 674 infants, of whom 545 (81%) were available for study. Data on respiratory illness were available for 545 children (mean age 7.3 (range 6.1- 9.9) years); height for 410 children; weight and body mass index for 412 children; body composition for 405 children; blood pressure for 301 children (mean age 7.2 (range 6.9-10.0) years). Main outcome measures: Respiratory illness, weight, height, body mass index, percentage body fat, and blood pressure in relation to duration of breast feeding and timing of introduction of solids. Results: After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower (17.0% (95% confidence interval 15.9% to 18.1%) for exclusive breast feeding, 31.0% (26.8% to 35.2%) for partial breast feeding, and 32.2% (30.7% to 33.7%) for bottle feeding. Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood (21.0% (19.9% to 22.1%) v 9.7% (8.6% to 10.8%)). It was also associated with increased percentage body fat and weight in childhood (mean body fat 18.5% (18.2% to 18.8%) v 16.5% (16.0% to 17.0%); weight standard deviation score 0.02 (-0.02 to 0.06) v -0.09 (-0.16 to 0.02). Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk (mean 94.2 (93.5 to 94.9) mm Hg v 90.7 (89.9 to 91.7) mm Hg). Conclusions: The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease. Departments of
Child Health,
Correspondence to: Dr Forsyth Preventing fatal diseases increases healthcare costs: cause elimination life table approachLuc Bonneux, Jan J Barendregt, Wilma J Nusselder, Paul J Van der MaasAbstractObjectives: To examine whether elimination of fatal diseases will increase healthcare costs.Design: Mortality data from vital statistics combined with healthcare spending in a cause elimination life table. Costs were allocated to specific diseases through the various healthcare registers. Setting and subjects: The population of the Netherlands, 1988. Main outcome measures: Healthcare costs of a synthetic life table cohort, expressed as life time expected costs. Results: The life time expected healthcare costs for 1988 in the Netherlands were £56,600 for men and £80,900 for women. Elimination of fatal diseases - such as coronary heart disease, cancer, or chronic obstructive lung disease - increases health-care costs. Major savings will be achieved only by elimination of non-fatal disease - such as musculoskeletal diseases and mental disorders. Conclusion: The aim of prevention is to spare people from avoidable misery and death not to save money on the healthcare system. In countries with low mortality, elimination of fatal diseases by successful prevention increases healthcare spending because of the medical expenses during added life years. Department of Public Health,
Correspondence to: Dr Bonneux
Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk scoreArthur Jackson, Clare Wilkinson, Margaret Ranger, Roisin Pill, Paul August
AbstractObjectives: To establish whether a questionnaire incorporating MacKie's risk factor flow chart can identify patients at high risk for melanoma so that they can be targeted for primary and secondary prevention. To validate the risk score derived from the questionnaire and test the feasibility of self completion by comparing patients' self reported skin characteristics with a skin examination performed by an experienced general practitioner.Design: Prospective questionnaire survey followed by a comparative study. Setting: 16 randomly selected group practices in a health district in Cheshire, United Kingdom. Subjects: Questionnaire survey - 3,105 consecutive patients aged 16 years and over attending for a primary care consultation; comparative study - a self selected subsample of 388 of the 3,105 patients. Main outcome measures: MacKie risk group for melanoma. Comparison of high risk skin characteristics reported by patients and those noted during a skin examination by a doctor (|gk statistic). Results: 4.3% of patients (87% women) were in the highest risk group and 4.4% (79% men) were in the second highest risk group, as defined by the MacKie score. Agreement between patients' self appraisal of skin characteristics and clinical skin examinations was reflected in |gk values of 0.67 for freckles, 0.60 for moles, and 0.43 for atypical naevi. Conclusion: This questionnaire helped to identify a group at high risk for melanoma. Furthermore, good agreement was found when the patient's risk scores were compared with results of the clinical skin examination. This risk score is potentially useful in targeting primary and secondary prevention of melanoma through general practice.
Department of General Practice, Department of
Dermatology,
Correspondence to: Dr Jackson, email: 100131.1162@compuserve.com
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