MinervaBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3598 (Published 08 September 2009) Cite this as: BMJ 2009;339:b3598
A retrospective study in a Canadian hospital reported that iatrogenic adverse incidents were common in the coronary care unit, especially bleeding, which was more common than recurrent ischaemic events (Circulation: Cardiovascular Quality and Outcomes 2009; published online 18 August, doi:10.1161/circoutcomes.108.846493). 194 patients were included in the study. Of the patients who had died in hospital, 53% had sustained an iatrogenic adverse event which was causally linked to their death, and 6% of these were judged potentially preventable.
In the Netherlands, doctors must be convinced of unbearable and hopeless suffering before granting a request for euthanasia. But when non-physical aspects of suffering are central to the issue, GPs, consultants, and euthanasia review committees seem to differ in their judgment. Presented with such a case scenario, GPs were less likely to deem the patient’s suffering unbearable than were consultants and committee members. The suffering of patients with dementia and those who were “tired of living” were least often considered to be unbearable by all three groups (Journal of Medical Ethics 2009;35:502-7, doi:10.1136/jme.2008.028779).
Most of the cost of a hip replacement is the cost of staying in hospital. The factors that most directly influence length of stay were investigated by surgeons in Bristol. Prolonged stays were largely predetermined by case mix—by older age, degree of medical co-morbidity, length of operation, and long incisions. The investigators say that these factors should be considered when units are compared for performance with a view to remuneration (Annals of the Royal College of Surgery 2009;91:500-4, doi:10.1308/003588409X432356).
A randomised controlled study of purified air administered to the “breathing zone” at night to people with allergic asthma found that active treatment over ten weeks resulted in improved health related quality of life compared with placebo. The novel treatment used temperature related laminar airflow with a very low particle concentration directed to the breathing zone of sleeping teenagers and young adults with mild to moderate allergic asthma. Bronchial inflammation also improved after five weeks. Changes in lung function, however, were not significant (Respiratory Medicine 2009;103:1313-9, doi:10.1016/j.rmed.2009.03.020).
A study in the Journal of Clinical Epidemiology concludes that blinding is often inadequately reported in research protocols and articles describing randomised controlled trials. Just 4% of 73 trials reported blinding in their protocols, while the proportion of “double-blind” trials with a clear description of the blinding of participants increased from 11 of 58 based on published information to 39 when the information provided in the protocol was added. In 90% of publications it remained unclear whether all patients, healthcare providers, and data collectors had been blinded (2009;62:967-73, doi:10.1016/j.jclinepi.2009.04.003).
An article in Nature Medicine describes how bacteria in the intestinal flora can cause colon cancer (2009; published online 30 July, doi:10.1038/nm.2015). A toxic form of Bacteroides fragilis can trigger colonic inflammation and tumours, in a process associated with increased cellular signalling by interleukin-17. When researchers blocked interleukin-17 or interleukin-23 (which amplifies interleukin-17), the bacteria was prevented from causing inflammation and tumour formation. The identification of this interleukin-17 dependent pathway for cancer provides a new insight into both mechanism and potential treatment.
Do drugs given routinely in labour affect rates of breast feeding? Data from the Cardiff Births Survey of almost 50 000 healthy women delivering healthy single babies at term found an association between drugs given in labour and breast feeding at 48 hours postpartum. Forty-three percent of these women were not breast feeding at 48 hours, and regression analysis showed associations with administration of epidural analgesia, intramuscular opioid analgesia, and ergometrine. The use of oxytocin to prevent postpartum haemorrhage was not so clearly linked to breast feeding (BJOG 2009; doi:10.1111/j.1471-0528.2009.02256.x).
Most studies of physical activity and obesity are usually limited by short follow-up periods and genetic selection bias—but here’s a 30 year study of 16 twin pairs who were discordant for leisure time physical activity habits in 1975, and who remained so throughout the next 30 years. Magnetic resonance imaging assessed visceral, liver and intramuscular fat (the so called high risk fat) over time, and the authors conclude that regular physical activity seems to be an important factor in preventing high risk fat accumulating, even after controlling for genes and childhood environment (International Journal of Obesity 2009; published online 1 September, doi:10.1038/ijo.2009.170).
In 2004 a law was passed in Bahrain with the aim of reducing genetic disease. The law states that anyone wishing to marry must undergo genetic screening and counselling, but there’s no obligation to accept the advice (Bahrain Medical Bulletin 2009;31:113-5). Four years later, a survey found that 91% of service users reported no substantial problems getting an appointment and 97% had no problems during the consultation. Most couples wanted their certificate of proof of attendance stamped whilst they were in the clinic itself, and 78% received their laboratory results within a week.
Cite this as: BMJ 2009;339:b3598