Practice BMJ

What's new this month in BMJ Journals

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:476
  1. Harvey Marcovitch, syndication editor (h.marcovitch{at}
  1. BMJ

    Statins benefit community patients

    Statins have proved beneficial in community based patients with ischaemic heart disease, discounting the suggestion that they might be disproportionately effective when prescribed as part of a controlled trial. Evidence comes from an eight year follow-up among 1.18 million patients registered with 89 UK general practices. A first diagnosis of ischaemic heart disease (IHD) was made in 13 029 patients, of whom 2266 died. Patients with IHD who were prescribed statins had a 39% lower risk of death than those who were not. Benefit was seen within two years of treatment and also affected women, diabetic patients, and elderly people. Risk of death was reduced by 19% for each additional year of treatment. The authors claim that since community based patients are likely to have a higher risk than those entered into controlled trials, the benefits of statins may be even greater than expected from trial findings.


    Nicotine replacement isn't a risk for stroke or myocardial infarction

    Of more than 33 000 patients prescribed nicotine replacement therapy for the first time between 1985 and 2003, about 1300 suffered a stroke or myocardial infarction (MI). The incident rates for both conditions increased progressively in the period leading up to a first prescription—for example, myocardial infarction was 8.5 times more likely in the 14 days beforehand. In the 56 days after a prescription, risk did not increase in either condition. The safety profile was unaffected by formulation and the patients' medical history. It seems likely that prescriptions were offered preferentially to patients with a recent history of stroke or myocardial infarction and that the drugs themselves are safe even for patients with pre-existing cardiovascular disease.

    Congenital abnormality is uncommon in fetuses exposed to antiepileptics

    Almost 96% of babies born to women with epilepsy do not have a major congenital malformation. Prospective data were available from 3607 patients entered on the UK epilepsy and pregnancy register. The malformation rate for those receiving polytherapy was 6% (95% CI 4.5% to 8.0%) compared to 3.5% (1.8% to 6.8%) for those not taking antiepileptic drugs. The rate was greater in pregnancies exposed to valproate, whether alone or as part of polytherapy. The findings also lend support to the advice that lamotrigine may be a safer alternative for pregnant women who had been prescribed valproate, at least if the daily dose of lamotrigine is 200 mg or less.

    Most people would still trust doctors if euthanasia was legalised

    A fifth of a random sample of 1117 US adults stated they would trust their “personal physician” less if euthanasia were legal and doctors were allowed to help patients die, but 58% disagreed with the contention and 22% were neutral. Older people and African-Americans were more likely to report potential loss of trust. The survey provides little support for assertions that legalising physician assisted suicide or euthanasia would undermine trust in the profession (at least in the United States).

    Primary schoolchildren would like single sex changing rooms

    In the United Kingdom, children aged 8-12 often express concern about mixed changing rooms at school. A survey of 102 head teachers showed that 40 had received requests from children and 21 from parents for separate facilities. A minority offered separate facilities for children under 10 years, about half for those aged 10-11, and 80% for 11-12 year olds. Options were often ad hoc and inadequate, such as being surrounded by other children to provide a screen. The authors point out that by the age of 12, three quarters of girls would have some breast development and half would have stage 2 pubic hair, and three quarters of the boys would have testicular enlargement and half would be at penile stage 2. With earlier physical maturity, private facilities are indicated.

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    Credit: ILPO MUSTO/REX

    An unusual inferior vena cava anomaly

    A temporary pacing catheter inserted into a 52 year old man who had a myocardial infarction pursued an abnormal course. This prompted performing 3D reconstructed multislice computed tomography, which showed complete absence of the right inferior vena caval trunk. Venous blood entered the heart through a dilated azygos vein and superior vena cava, and the hepatic veins drained directly into the right atrium. The patient had no symptoms from this rare anomaly.

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