BMJ  2006;332:904 (15 April), doi:10.1136/bmj.332.7546.904

Practice

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What's new this month in BMJ Journals

Pneumococcal vaccine helps over 65s with COPD

A controlled trial of pneumococccal vaccine (Pneumo23; Aventis Pasteur MSD) in 600 patients with chronic obstructive pulmonary disease (COPD) in Spain has shown that it protected people aged over 65 from pneumonia over the three year period of the study, with an effectiveness of 76%. It was particularly protective in those with severe airflow obstruction. However, there was no difference in mortality (about 19%) nor any significant difference for people under 65. The authors call for further studies in younger and more mildly affected patients to define the precise role of the vaccine.

Thorax 2006;61: 189-95[Abstract/Free Full Text]

Patients' complaints are "tip of an iceberg" in New Zealand

A survey in New Zealand has shown that only 0.4% of reported adverse events result in a complaint to the country's health and disability commissioner, the gateway to its "no-fault" (tort-free) compensation system. Contrary to statements frequently repeated in the lay media, fewer than 1% of adverse events to patients proved serious and preventable.

The study trawled the case notes of a random 1% sample of all hospital admissions in 1998, with adverse events identified and categorised by trained reviewers. Of a total of 850 events involving 6579 patients, only 48 were deemed serious and preventable. Just two of these had resulted in a complaint to the commissioner (as had just 0.4% of all adverse events).

Patients who were least likely to complain were those who were old, socioeconomically deprived, or of Pacific ethnicity. The authors point out that their findings do not support the views of those New Zealand physicians who claim they are "under siege" from a medicolegal environment that is "the most hostile in the world."

Qual Saf Health Care 2006;15: 17-22[Abstract/Free Full Text]

Regulate smokeless tobacco

Consumers and shopkeepers in two areas of the UK with large South Asian populations identified 11 popular brands of smokeless (chewing) tobacco, widely used by this community. Ten contained carcinogenic nitrosamines, and all contained another carcinogen (benzopyrene) and various heavy metals. Levels varied up to 175-fold. Nicotine availability varied from 0.1 mg/g to 63.2 mg/g. These products are an undoubted health hazard. Given their established use as part of South Asian culture, the investigators do not recommend a ban but rather setting toxin standards with a reasonable time scale for compliance. Users should be encouraged to quit—but not to substitute cigarettes, which are an even more dangerous way of delivering nicotine.

Tobacco Control 2006;15: 64-7[Abstract/Free Full Text]

People with epilepsy aren't warned of risk of sudden death

UK neurologists do not agree on whether to warn patients about the risk of sudden unexpected death in epilepsy. Although NICE states that all should be told, only 5% of neurologists do so. A further 25% say they discuss sudden unexpected death with most patients, 61% with very few, and 7% with none. Many consider such knowledge would not affect patients' quality of life, but a third believe it would create anxiety. Most stated that patients did not understand how the risk of sudden unexpected death compares with the risk of, say, smoking or developing lung or breast cancer. The investigators point out that NICE offers no guidance on how, when, and by whom the issue should be raised, nor how to put the risk in context with other, more everyday risks. They say that patient advocates and medical opinion leaders often deny patients' right not to know and undermine physicians' ability to treat patients as individuals.

J Neurol Neurosurg Psychiatry 2006;77: 199-202[Abstract/Free Full Text]

Hepatic encephalopathy and glial cell activation

Positron emission tomography of the brain in a patient with hepatic encephalopathy showing uptake of ligand PK 11195 by glial cells in the fronto-limbicbasal ganglia circuits. Patients with the highest binding were cognitively the most impaired in a study of five patients. The authors say these findings support the hypothesis, generated from animal studies, that hepatic encephalopathy is associated with glial activation.

 

Gut 2006;55: 547-53[Abstract/Free Full Text]

Achilles tenosynovitis points to high lipids

Patients presenting to their general practitioner with Achilles tenosynovitis have a high risk of familial hypercholesterolaemia, such that the former condition should provoke measuring their blood lipid profile. Of 133 patients with familial hypercholesterolaemia attending a clinic in Manchester, 62 had experienced one or more episodes of Achilles tendon pain (compared with 6/87 controls). Thirty five of the 62 had consulted a doctor, but no doctor had arranged to measure their lipids. Most had received anti-inflammatories and some were referred for orthopaedic surgery. The condition is caused by tendon xanthomata.

 

Ann Rheum Dis 2006;65: 312-5[Abstract/Free Full Text]

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Relevant Article

Compensation and complaints in New Zealand

Marie M Bismark
BMJ 2006 332: 1095. [Extract] [Full Text]

This article has been cited by other articles:

• Bismark, M. M (2006). Compensation and complaints in New Zealand.. BMJ 332: 1095-1095 [Full text]  

Rapid Responses:

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Compensation and complaints in New Zealand

Marie M Bismark
bmj.com, 17 Apr 2006 [Full text]