Releases Saturday 1 July 2000
No 7252 Volume 321
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(1) ASPIRIN MAY CAUSE MORE HARM THAN BENEFIT
IN PREVENTING CORONARY HEART DISEASE
(2) NO
RISK OF DEVELOPING CREUTZFELDT-JAKOB
DISEASE FROM
BLOOD TRANSFUSION
(3) DRAWING
BLOOD: THE EARLOBE IS LESS
PAINFUL THAN
THE THUMB
(4) ARE
WE TOO PESSIMISTIC ABOUT THE FUTURE
OF THE NHS?
(5) IMPROVING
PREVENTATIVE CARE FOR
CORONARY BYPASS
PATIENTS
(1) ASPIRIN MAY
CAUSE MORE HARM THAN BENEFIT
IN PREVENTING CORONARY HEART DISEASE
(Determination of who may derive
most benefit from aspirin
in primary prevention: subgroup
results from a randomised
controlled trial)
http://bmj.com/cgi/content/full/321/7252/13
Taking low dose aspirin as a preventive
measure against
coronary heart disease may result in more
harm than benefit
in some men, according to a study in this
week's BMJ.
Researchers at the Wolfson Institute of
Preventive Medicine
in London identified over 5,000 UK men,
aged between 45
and 69 years, who were at increased risk
of coronary heart
disease but had not previously had heart
trouble. The men
had been randomly divided into four different
treatment
groups to accurately establish the effect
of aspirin.
The authors found a greater beneficial
effect of aspirin in men
with low rather than high blood pressures,
not only for
coronary heart disease but also for stroke.
Men with higher
pressures may derive no protective benefit
from aspirin but
will risk possible serious bleeding, suggest
the authors. They
add that, even in men with low blood pressures,
the benefit
does not necessarily outweigh the risk
of bleeding.
Given the widespread use of aspirin for
the prevention of
coronary heart disease, these findings
have important
implications for clinical practice, although
further trials are
needed to confirm the results, say the
authors. What is
certain, they conclude, is the importance
of controlling blood
pressure for those in whom the preventive
use of aspirin is
being considered. Men who have previously
had heart
trouble and strokes and are taking aspirin
should continue to
do so.
Contact:
(via Carolan Davidge, MRC Press Office):
T W Meade,
Director, MRC Epidemiology and Medical
Care Unit,
Wolfson Institute of Preventive Medicine,
London EC1M
6BQ.
Email: carolan.davidge{at}headoffice.mrc.ac.uk
(2) NO RISK OF
DEVELOPING CREUTZFELDT-JAKOB
DISEASE FROM BLOOD TRANSFUSION
(Risk of acquiring Creutzfeldt-Jakob
disease from blood
transfusions: systematic review
of case-control studies)
http://bmj.com/cgi/content/full/321/7252/17
There is no association between blood transfusion
and
development of sporadic Creutzfeldt-Jakob
disease,
according to research in this week's BMJ.
Canadian researchers analysed five studies,
involving over
2,000 patients from around the world,
to determine the
strength of association between history
of blood transfusion
and development of Creutzfeldt-Jakob disease.
Despite the
recent increased attention to the possibility
of transmission of
the disease via blood, all studies showed
a trend towards a
lower risk of Creutzfeldt-Jakob disease
in patients who had
received a blood transfusion, suggesting
a protective effect of
transfusion. However, the authors are
clear to highlight the
limitations of these findings - case-control
studies are
susceptible to bias, they say, which may
account for the
apparently "spurious" result.
Yet, despite these limitations, it seems
unlikely that blood
transfusions contribute towards development
of sporadic
Creutzfeldt-Jakob disease, say the authors.
Similar studies
also show a lack of association, while
others have not
reported any cases of Creutzfeldt-Jakob
disease developing
in patients who received blood from a
donor who was later
diagnosed with the disease. This review,
conclude the
authors, emphasises the importance of
having well-designed
studies if we are to accurately assess
the risk of developing
variant Creutzfeldt-Jakob disease from
blood transfusion.
[Please Note: The results of this systematic
review pertain to
the transmissibility of sporadic Creutzfeldt-Jakob
disease and
should not be generalised to variant Creutzfeldt-Jakob
disease (the form of the disease possibly
associated with
BSE)]
Contact:
Kumanan Wilson, Assistant Professor, Division
of General
Internal Medicine, University of Ottawa,
Ottawa, Ontario,
Canada
Email: kwilson{at}lri.ca
(3) DRAWING BLOOD:
THE EARLOBE IS LESS
PAINFUL THAN THE THUMB
(An open prospective randomised trial
to reduce the pain of
blood glucose testing: ear versus
thumb)
http://bmj.com/cgi/content/full/321/7252/20
Blood samples taken from the earlobe are
less painful for
patients than those taken from the thumb,
suggests a study in
this week's BMJ.
Carley and colleagues from Hope Hospital
in Salford
obtained blood from either the thumb or
the earlobe of 60
patients attending a hospital emergency
department. Once the
blood was obtained, the level of pain
was measured using a
recognised scoring method. The pain scores
clearly show that
skin puncture of the earlobe is less painful
than that of the
thumb. The reason for the difference,
say the authors, is
unclear. However, they suggest that the
density of pain
receptors may be lower in the ear than
in the thumb, or that
less pain is perceived as the patient
cannot see the ear being
tested.
The authors conclude that further research
may be needed to
assess the impact of repeat testing at
the same site on patients
who require frequent blood monitoring.
As blood glucose
testing is one of the most commonly performed
procedures in
clinical practice, these findings will
benefit healthcare
professionals at all levels.
Contact:
Simon D Carley, Specialist Registrar in
Emergency Medicine,
Department of Emergency Medicine, Manchester
Royal
Infirmary, Manchester M13 9WL
Email: s.carley{at}btinternet.com
(4) ARE WE TOO
PESSIMISTIC ABOUT THE FUTURE
OF THE NHS?
(Education and debate: The limits
to demand for health care)
http://bmj.com/cgi/content/full/321/7252/40
(Commentary: An open debate is not
an admission of failure)
http://bmj.com/cgi/content/full/321/7252/40
The widespread belief that the NHS is doomed
to failure - as
demand continues to exceed supply - is
called into question in
this week's BMJ.
Frankel and colleagues at the University
of Bristol suggest
that conventional assumptions of an imbalance
between
demand and supply are not supported by
evidence. Similarly,
pessimism about future trends in demand
as the population
ages, new technologies appear, and public
expectations rise,
are unsupported by good evidence.
The authors criticise the current process
of rationing for being
unscientific and selective. There are
examples of failure to
meet demand, they say, but the discrepancies
are "trivial"
and "there seem to be no real barriers"
to demand being
satisfied. They also question the "doomsday
scenarios" often
predicted as the population ages and new
technologies
appear, citing evidence that healthcare
expenditure does not
depend on age and that many new technologies
cut costs.
They conclude that "much of the failure
to meet demand is
unnecessary" and see public expectations
and professional
self interest as greater problems.
In an accompanying commentary, independent
health policy
analyst Bill New, praises the authors
for producing "an
excellent catalogue of evidence opposing
the view that the
NHS is incapable of coping," but suggests
that "demand will
always exceed the ability of resources
to satisfy it and that,
therefore, some kind of rationing is inevitable."
He argues that
an open debate about rationing "is not
an admission of failure
but an attempt to sustain the NHS by being
brutally honest
about its inevitable limitations as well
as its considerable
capabilities."
Contacts:
[Paper] Stephen Frankel, Professor of Epidemiology
and
Public Health Medicine, Department of
Social Medicine,
University of Bristol, Bristol BS8 2PR
Email: stephen.frankel{at}bris.ac.uk
[Commentary] Bill New, Independent Health
Policy Analyst,
9 Countess Road, London NW5
Email: bill.new{at}virgin.net
(5) IMPROVING
PREVENTATIVE CARE FOR
CORONARY BYPASS PATIENTS
(Ten year audit of secondary prevention
in coronary bypass
patients)
http://bmj.com/cgi/content/full/321/7252/22
Treatment of risk factors in patients who
have had coronary
bypass surgery has improved considerably
over the past
decade, although cholesterol levels remain
high in many
patients, according to research in this
week's BMJ.
Researchers in Scotland identified a random
sample of 100
coronary artery bypass patients each year
from 1988 to
1997. Questionnaires were sent to their
general practitioners
to determine what measures were being
taken to manage
each patient's risk factors such as smoking
status, blood
pressure and cholesterol concentration.
In general, the standard of preventative
care was good for
well-established risk factors. For instance,
virtually all patients
were taking aspirin, had good blood pressure
control and
only 10% still smoked, following their
operation. However,
the authors found that patients' cholesterol
was often not well
managed, particularly in those patients
who had bypass
surgery before studies showing the benefit
of reducing
cholesterol were made public. "We believe
we have
identified a partly forgotten population"
say the authors.
"Patients who had surgery before these
important trials may
not be easily identified on GP's disease
registers and so are
less likely to be receiving cholesterol
lowering treatment."
To address this problem, Lothian Health
has initiated a
project to identify these patients and
ensure they are assessed
within general practice. "This project
is a positive step
towards improving the management of cholesterol
in many
patients with coronary heart disease"
conclude the authors.
Contact:
(available until Thursday 29 June only):
Peter Bloomfield,
Consultant Cardiologist, Department of
Cardiology, Royal
Infirmary of Edinburgh, Edinburgh EH3
9YW
Email: PSBloomfield{at}compuserve.com
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