BMJ  2007;334 (31 March), doi:10.1136/bmj.39169.480775.3A

Editor's Choice

US editor's choice

Evidence based parenting and anticoagulating

Antisocial behavior and conduct disorders are increasingly common in children, especially in those from single parent homes or disadvantaged areas. Often the parents of children with conduct disorders have poor parenting skills. Judy Hutchings and colleagues performed a pragmatic, community based, randomized controlled trial of the effectiveness of a parenting program called "Incredible Years" to prevent conduct disorder in high risk Welsh children aged 3 to 5 (doi: 10.1136/bmj.39126.620799.55). Parents of 153 high risk children were randomized either to attend 12 weekly parenting group sessions or to be put on a waiting list. At baseline and follow-up, the parents and children were tested with validated instruments. After six months, both parenting skills and child behavior were significantly improved in the intervention group compared with controls. The authors conclude that an evidence based parenting skills program can make a significant difference in the behavior of high risk children.

An accompanying cost-effectiveness analysis by Rhiannon Edwards et al (doi: 10.1136/bmj.39126.699421.55) found that the program achieved these changes at a modest cost, making it more likely to be implemented widely. Stephan Scott puts the trial in context in a related editorial (doi: 10.1136/bmj.39161.370498.BE). He points out that the interventions are well proven but the difficulty will be consistent implementation of the programs with trained providers.

Many patients with uncomplicated deep vein thrombosis or pulmonary embolism are anticoagulated for six months, despite guidance that only three months' treatment is necessary. J A Campbell and associates randomized over 700 UK patients with one of these conditions to either three or six months oral anticoagulation and followed them for a year (doi: 10.1136/bmj.39098.583356.55). They found no significant difference in clinical outcomes between the groups, but patients anticoagulated for six months had an increased chance of major hemorrhage.

John Eikelboom et al conclude in an editorial that extending anticoagulation for unprovoked venous thromboembolism from three to six months results in no benefits and clear evidence of harm (doi: 10.1136/bmj.39161.665579.BE). Unless warfarin is to be continued indefinitely, there is no compelling evidence for a six month anticoagulation regimen.

Finally, Stuart Smellie reviews the causes of spurious hyperkalemia in medical patients (doi: 10.1136/bmj.39119.607986.47). Fortunately, although severe hyperkalemia is life threatening, most high potassium levels seen in patients with normal renal function are pseudohyperkalemia secondary to sampling conditions or storage or transport problems. A high index of suspicion and repeat sampling can avoid the distress and expense of urgent hospital referral.

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