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Co-proxamol overdose is an important means of suicide
In England and Wales deaths due to co-proxamol overdose
represented 18% of all drug poisoning deaths and contributed 5% of all suicides. Hawton and colleagues (p 1006) found this in their study
of 4162 drug related suicides in 1997-9 in England and Wales. The risk
of death associated with an overdose with co-proxamol seems to be far
higher than for tricyclic antidepressants or paracetamol. Restricting
availability of co-proxamol could help to reduce the number of suicides
due to drug overdose. Strategies to achieve this could include
educating clinicians to the dangers to patients and others in the
household, restricting amounts prescribed in individual cases,
instructing patients to dispose of unwanted supplies, and using
alternative strategies to manage pain.
(Credit: MEDISCAN.CO.UK)
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Over a third of preregistration house officers in Britain think
medical school does not equip them well for their first job. Goldacre
and colleagues (p 1011) sent all graduates from 1999 and a quarter of
those from 2000 a questionnaire on their careers that included a
statement that medical school had prepared them well for their first
jobs. Overall 36% agreed that it had prepared them well and 40%
disagreed. Differences between medical schools were marked, ranging
from 19% agreeing at one school to 73% at another. The authors warn
that the findings raise questions about the purpose of medical school
education and the differences between long term and short term needs.
Accounts of the pilot scheme offering preregistration house
officers the opportunity to sample general practice for four months are
unanimous about the educational benefits. Illing and colleagues (p 1019) assessed the strengths and weaknesses of these rotations. They found that despite the benefits, the scheme is not expanding, mainly because of the additional supervisory burden on trainers. This
may be resolved by offering placements to senior house officers, who
require less supervision.
In Australia the largest declines in suicide in men and women
occur in the groups with the highest exposure to antidepressant drugs.
Hall and colleagues (p 1008) examined the association between antidepressant prescribing and rates of suicide from 1991 to 2000, when
there was a large increase in prescribing of antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs). The
authors concluded that antidepressant prescribing probably contributed
to the decline in suicides because it reflected improvements in the
management of depression by general practitioners, who are now
responsible for treating most cases of depression in
Australia.
Selective serotonin reuptake inhibitors and tricyclic
antidepressants are equally effective when given to patients in primary care, concludes a systematic review, but more patients taking tricyclic
antidepressants withdraw from treatment. MacGillivray et al (p 1014)
performed a systematic review and meta-analysis of 11 studies with 2951 participants and used mean depression scores and the clinical global
impression score to measure outcome. They also found that more patients
receiving a tricyclic antidepressant stopped treatment owing to side
effects than patients receiving a selective serotonin reuptake
inhibitor. The authors say that these dropout rates were lower than in
reviews of studies based in secondary care, so they conclude that the
study setting is probably an important factor in assessing efficacy and
tolerability of antidepressant drugs.
In follow up of 242 patients five years after a randomised trial
of laparoscopic versus open inguinal hernia repair Douek et al
(p 1012) showed a lower rate of complications after the laparoscopic procedure. The 242 patients were 65% of the original group; 52 of the open group (43%) had complications compared with 13 (11%) of the laparoscopic group; numbness and groin pain were significantly reduced, and there were no serious complications in the
laparoscopic group. Severe pain occurred only in the open group.
(Credit: ARGENTUM/MEDISCAN.CO.UK)
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