Press Releases Saturday 25 July 1998
No 7153 Volume 317
Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on
the
journal's web site (http://www.bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URLs are given under titles).
(1) CONCERNS RAISED OVER BLOOD PRODUCT GIVEN TO CRITICALLY
ILL PATIENTS
(2) FETAL GROWTH RATE AFFECTS RISK OF HEART DISEASE
(3) CANCER PATIENTS FROM DEPRIVED AREAS OF SOUTH-EAST
ENGLAND
AREN'T RECEIVING OPTIMUM
TREATMENT
(4) ACCIDENTS AND VIOLENCE ARE A MAJOR CAUSE OF HEALTH INEQUALITIES
(5) PLANS TO IMPLEMENT TOTAL PURCHASING INITIATIVES
IN GENERAL
PRACTICE WILL REQUIRE
A BIGGER MANAGERIAL BUDGET
(6) RADICAL RETHINK OF BLOOD DONATION IS NEEDED IN THE UK
(7) DOES TV REFLECT THE REALITY OF CHILDBIRTH?
(1) CONCERNS RAISED OVER BLOOD PRODUCT GIVEN TO CRITICALLY
ILL PATIENTS
(Human albumin administration in critically ill patients: systematic
review of randomised controlled trials)
http://www.bmj.com/cgi/content/full/317/7153/235
Human albumin solution, a blood product, has been used in the treatment
of
patients with injuries and burns for more than 50 years. Currently
albumin
is licenced for use in the emergency treatment of shock and burns,
and
illnesses accompanied by hypoproteinaemia (abnormally low levels of
protein
in the blood). In this week's BMJ a report by the Cochrane Injuries
Groupsuggests that this practice is likely to have caused thousands
of
deaths. Consequently the authors call for an urgent review of
the use of
human albumin solution in critically ill patients.
The Group conducted a review of 30 randomised controlled trials which
included over 1400 (1419) patients. They found that overall,
the risk of
death in patients treated with albumin was six per cent higher than
in
patients not given albumin. The authors note that their results
must be
interpreted with caution as they are based on relatively small trials.
However, they believe that a reasonable conclusion from their research
is
that the use of human albumin in the management of critically ill patients
should be urgently reviewed.
Contact:
Dr Ian Roberts, Cochrane Injuries Group, Department of Epidemiology
and
Public Health, Institute of Child Health, London
email: Ian.Roberts{at}ich.ucl.ac.uk
or
Francis Tuke, Press Office, Great Ormond Street Children's Hospital
For your information: there is also a cluster of letters in this
week's
BMJ relating to whether fluid resuscitation should be conducted with
colloid or crystalloid solutions.
(Excess mortality after human albumin administration in critically ill
patients. If it is true what should be do about it?)
http://www.bmj.com/cgi/content/full/317/7153/223
In a linked editorial in this week's BMJ, Dr Martin Offringa, a consultant
neonatologist from Emma Children's Hospital in Amsterdam writes that
the
review by the Cochrane Injuries Group appears to be scientifically
robust
and albumin administration is [....] harmful in certain categories
of
patients, (but) favourable effects in particular patients cannot yet
be
excluded. He stresses that an effort must be made to identify
these
patients. The author explains why it may be that albumin
supplementation
might make things worse for critically ill patients and discusses
alternative treatments.
Dr Offringa concludes that the administration of albumin should be halted
until [...] the results of a high quality large clinical trial are
available.
Contact:
(2) FETAL GROWTH RATE AFFECTS RISK OF HEART DISEASE
(Reduced fetal growth rate and increased risk of death from ischaemic
heart
There has been much research into whether circumstances affecting a
fetus
In their study of 14,611 babies delivered at the Uppsala Hospital, Sweden
Contact:
(3) CANCER PATIENTS FROM DEPRIVED AREAS OF SOUTH-EAST
(Deprivation and emergency admission for cancers of colorectum, lung
and
A major reorganisation of cancer services is underway in England and
Wales
Pollock and Vickers found that people with these cancers living in deprived
For most cancers, the stage at which patients report their symptoms
is the
Contact:
(4) ACCIDENTS AND VIOLENCE ARE A MAJOR CAUSE OF
(Inequality among men in standardised years of potential life lost,
In a short report in this week's BMJ, Dr David Blane from Imperial College
Contact:
(5) PLANS TO IMPLEMENT TOTAL PURCHASING INITIATIVES IN GENERAL
(Evaluation of total purchasing pilots in England and Scotland and
Total purchasing was introduced into the NHS in 1995, whereby volunteer
Contact:
(6) RADICAL RETHINK OF BLOOD DONATION IS NEEDED IN THE UK
(UK Blood Donation Needs Reorganisation)
Fifty years since the National Blood Service started collecting blood
from
Contact:
(7) DOES TV REFLECT THE REALITY OF CHILDBIRTH?
(Television gives a distorted picture of birth as well as death)
In a climate of concern about the portrayal of the clinical world in
soap
Dr Clement concludes that the effects of television are more akin to
those
Contact:
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
the EurekAlert website, run by the American Association for the
Dr Martin Offringa, Consultant Neonatologist, Emma Children's Hospital,
Academic Medical Centre, Amsterdam, Netherlands
email: m.offringa{at}AMC.UVA.NL
disease: cohort study of 15,000 Swedish men and women born 1915-1929)
http://www.bmj.com/cgi/content/full/317/7153/241
during pregnancy can affect the risk of cardiovascular disease in adult
life. To date much of the research into this area has not been
conclusive.
In this week's BMJ, Dr David Leon from the Department of Epidemiology
and
Population Health at the London School of Hygiene and Tropical Medicine
and
colleagues from the Universities of Uppsala and Stockholm in Sweden
provide
by far the most persuasive evidence yet of an association between size
at
birth and eventual death from heart disease.
during 1915-1919, the authors show that among men, the risk of death
from
ischaemic heart disease declines as birth weight increases (the heavier
the
baby the less likely he is to die from heart disease in later life).
They
suggest that it is in fact the rate at which the fetus grows
rather than
the ultimate size of the baby at birth that is the important determinant
of
the risk. However, Leon et al are not certain what factors determine
the
rate of growth of the baby in the womb.
Dr David Leon, Reader, Department of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine, London
email: dleon{at}lshtm.ac.uk
ENGLAND AREN'T RECEIVING OPTIMUM
TREATMENT
breast in south east England: ecological study)
http://www.bmj.com/cgi/content/full/317/7153/245
in response to the Calman-Hine Report (1994), with the aim of improving
access to and quality of cancer treatment. In this week's BMJ
Dr Allyson
Pollock and Neil Vickers from St George's Hospital Medical School in
London
report their findings in the first study in the UK to consider
sociodemographic differences in the treatment of patients with lung,
bowel
and breast cancers.
areas in the Thames region, were more likely to be admitted as emergencies
and ordinary inpatients than their counterparts from more affluent
areas.
They also found that patients with lung or breast cancers from deprived
areas were less likely to receive surgical treatment.
single most important determinant of their outcome - the earlier a
diagnosis is made the more likely a patient is to survive. The
authors
conclude that if reductions in mortality are to be achieved, more effective
early diagnostic and referral procedures are required in primary care
in
deprived areas. They also suggest that hospital mergers and plans
for
service reconfiguration and bed closures must take into account the
current
inequities in access to treatment among residents in deprived areas.
Dr Allyson Pollock, Senior Lecturer in Public Health Medicine, Department
of Public Health Sciences, St George's Hospital Medical School, London
HEALTH INEQUALITIES
1970-93)
http://www.bmj.com/cgi/content/full/317/7153/255
School of Medicine and Frances Drever from the Office for National
Statistics note that deaths of men from accidents and violence tend
to
occur earlier in adulthood and more often in the manual working class.
Thus, say the authors, accidents and violence contribute substantially
to
the overall health inequalities among men of working age and they call
upon
the Government to tackle accidents and violence as a potentially prompt
strategy for achieving a reduction in health inequalities.
Dr David Blane, Reader in Medical Sociology, Department of Behavioural
and
Cognitive Science, Imperial College School of Medicine, London
email: d.blane{at}cxwms.ac.uk
PRACTICE WILL REQUIRE A BIGGER MANAGERIAL
BUDGET
implications for primary care groups in England: personal interview
and
analysis of routine data)
http://www.bmj.com/cgi/content/full/317/7153/256
fundholding general practices received a delegated budget from their
local
health authority to purchase all the hospital and community health
services
for their patients. In this week's BMJ, an evaluation of the
achievements
of the 52 first wave total purchasing pilot schemes in England and
Scotland, is reported by Dr Nicholas Goodwin et al from the King's
Fund and
colleagues from the University of Birmingham. They conclude that
to be
successful, primary care groups will need to invest heavily in
organisational development and this, they say, will require additional
short term funding rather than the reduction in NHS management spending
planned by the Government.
Dr Nicholas Goodwin, Research Officer, Policy and Development Directorate,
King's Fund, London
http://www.bmj.com/cgi/content/full/317/7153/281/a
volunteers in the UK, donation still takes place predominantly in church
halls and community centres. In a letter in this week's BMJ,
Frank Booth,
a consultant haematologist at Torbay Hospital in Devon, argues that
"...the
time has come for a radical rethink of blood collection in the UK".
He
writes that the National Blood Service should set up collection centres
in
all district general hospitals and that they should be more flexible
about
collecting blood from donors, at times that suit people who work.
He
suggests that the system whereby patients scheduled for surgery can
give
blood in advance (then in the event of a transfusion being needed their
own
blood could be used) should be better administered, as to date this
procedure has been introduced haphazardly.
Frank Booth, Consultant Haematologist, Haematology Department, Torbay
Hospital, Torquay, Devon
email: Boot{at}VMSmail.sdevonhc-tr.swest.nhs.uk
http://www.bmj.com/cgi/content/full/317/7153/284/b
operas, Dr Sarah Clement from the Department of General Practice, Guy's
and
St Thomas's United Medical and Dental School in London writes in this
week's
BMJ on her misgivings about the representation of childbirth on
television. Her analysis of 92 depictions of childbirth broadcast
on
British TV during 1993(originally published in the British Journal
of
Midwifery, January 1997), revealed unrealistically high maternal and
perinatal deaths. In the 92 births, four babies and one mother
died and a
further five babies and four mothers experienced life threatening
complications. "Labour was portrayed as being a quick and unpredictable
process... resulting in an unexpected event... in an unexpected
place...
in 22 of the 58 fictional births shown."
of an aerosol spray than of a hypodermic needle; only some
of the
images broadcast ...hit a target, with most of them drifting away.
She
suggests that further research should be conducted to ascertain just
how
penetrating television's portrayals of birth (and death) really
are.
Dr Sarah Clement, Lecturer, Department of General Practice, Guy's and
St
Thomas's United Medical and Dental School, London
email: s.clement{at}umds.ac.uk
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;jshepher{at}bma.org.uk)
and from:
Advancement of Science
(http://www.eurekalert.org)
