BMJ  2006;332:653 (18 March), doi:10.1136/bmj.332.7542.653

Practice

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What's new this month in BMJ Journals

NICE's head injury guidelines aren't cost beneficial

Guidelines introduced to the NHS in 2003 by the National Institute for Health and Clinical Excellence (NICE) for managing head injury have resulted in increasing use of computed tomography and a reduction in x rays of the skull but increases in radiation dosage and cost. Successive audits at Barnet Hospital, England, have shown a threefold increase in CT requests for computed tomography (75% out of hours) over the pre-existing local guidelines derived from the Royal College of Radiologists' recommendations. The admission rate was unchanged but reattendances increased, possibly because patients who weren't scanned didn't have the reassurance of a skull x ray. No patient with brain injury was missed in either audit period. The estimated extra cost to the hospital was £15 278 (22 400; $26 600) per 100 head injuries. Extrapolated to the whole of England and Wales, this estimates an extra cost to the NHS of £31.5m-75.5m.

Emerg Med J 2006;23: 109-13[Abstract/Free Full Text]

Preservative-free eye drops are easily contaminated

A survey of 95 multidose eye drop bottles containing preservative-free medication has shown that, after three days of inpatient use or seven days of outpatient use, eight were contaminated by bacteria. Antibiotic preparations remained sterile throughout, but 60% of those containing hypromellose were contaminated, as were 21% of steroid drops. Only one of the seven organisms isolated was a normal conjunctival commensal. No commercially available multidose container has been proved to be resistant to contamination, and single unit vials cost nearly 1200% as much. The authors recommend caution when prescribing preservative-free eye drops to patients who have experienced untoward reactions to preservatives or who need to apply eye drops frequently—especially when the patient is known to have compromised ocular surface defences.

Br J Ophthalmol 2006;90: 139-41[Abstract/Free Full Text]

Heart surgery prolongs active life

A survey of 706 octogenarians from a cohort of 12 000 consecutive patients who underwent cardiac surgery in Cambridge, England, between 1996 and 2003 has shown that those operated on tend to outlive those not operated on. Their survival rate at five years was 82% compared with an age-sex matched general population mean survival of 56%.

Heart (Online First August 2005) doi: 10.11e6/hrt.2005.064451

Unpowdered gloves reduce latex related symptoms

Over 1000 hospital nurses in Trieste, Italy, were assessed for symptoms and signs of latex sensitivity before and after powderless gloves were introduced. Although 21.8% had glove related symptoms, these were mostly mild—hand erythema and itching. However, 38 had contact urticaria and 24 had asthma or rhinitis (or both) associated with positive skin prick reaction to latex. After the introduction of powderless gloves, a significant number lost their symptoms (but not those with asthma). The authors recommend avoiding wearing gloves except when necessary, using non-powdered gloves only, and—for people with known sensitivity—using latex-free gloves.

Occup Environ Med 2006;63: 121-5[Abstract/Free Full Text]

A laugh a day could keep the cardiologist at bay

Brachial artery flow mediated vasodilatation (FMD) was measured repeatedly in 20 healthy volunteers randomly assigned to watch a 15-30 minute extract from a film that provoked either mental stress (the start of Saving Private Ryan) or laughter (There's Something about Mary). Private Ryan reduced FMD by a mean of 35% and Mary increased it by 22%. The first figure is similar to that induced by performing mental arithmetic and the second to the amount seen after aerobic activity or starting statins. The mechanism is unclear but may relate to activation of nitric oxide synthase or attenuation of neuroendocrine hormones.

Credit: BURGER/PHANIE/REX

Heart 2006;92: 261-2[Free Full Text]

Pharmacists are reluctant to report errors

A survey of community pharmacists in England has disclosed they are unlikely to comply with the national reporting and learning system launched in 2004 in the hope of coordinating the reporting of incidents affecting patient safety.

Credit: PHOTOS.COM

Community pharmacists were presented with clinical vignettes involving adverse clinical events associated with varying degrees of pharmacists' culpability. They were asked whether or not they would report such a case should they happen to witness it occurring. The likelihood of reporting, either internally or to a national body, was low and depended more on pharmacists' interpretation of whether protocols had been followed than whether a patient had been harmed. Many were not convinced that the advantages of a reporting system outweigh the consequences of blame.

Qual Saf Health Care 2006;15: 48-52[Abstract/Free Full Text]

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