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US Highlights

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39036.470278.3A (Published 16 November 2006) Cite this as: BMJ 2006;333:0-g
  1. Douglas Kamerow, US editor (dkamerow{at}bmj.com)

In a new analysis of the saline versus albumin fluid evaluation (SAFE) study, the investigators examined (doi: 10.1136/bmj.38985.398704.7C) clinical outcomes of over 6000 Australian patients in intensive care who had been randomized to receive either saline or albumin for their fluid resuscitation. Whether their initial serum albumin levels were high or low, there was no difference in mortality, length of stay, or other outcome variables between the two groups. In an accompanying editorial (doi: 10.1136/bmj.39029.490081.80), J L Vincent points out that the SAFE study was undertaken to establish not whether albumin was better than saline, but whether it was as safe, which it was. He argues that no one would use albumin for all patients needing fluids and advocates a trial comparing albumin and saline in ICU patients who are at increased risk of complications.

Can increased physical activity reduce weight in preschool children? John Reilly et al performed a randomized controlled trial (doi: 10.1136/bmj.38979.623773.55) in 36 Scottish preschools with 545 children. Half the schools received a physical activity intervention consisting of three 30 minute physical education classes, classroom posters, and home resource packs. The other half served as controls. At six and 12 months, there was no difference between the BMI scores in the two groups of children, although the intervention group children had better movement skills. Antronette Yancey writes in an editorial (doi: 10.1136/bmj.39021.605683.BE) that this result is unsurprising given the “dose” of the intervention and the fact that it was probably applied inconsistently in real world settings. Correct implementation of programs, as well as increased comprehensiveness, are probably needed to show a change in children's weights.

Finally, this week's issue has an ethical debate (doi: 10.1136/bmj.38950.645799.55) about whether it can ever be ethical to withhold prenatal testing. The case in point involves a fetus at risk for the gene for Huntington's disease, which is detectable in utero. The disease is universally fatal but does not appear until young adulthood. Some ethical guidelines call for providing prenatal diagnosis only if the parents are planning to abort a fetus that is found to be affected. Martin Delatycki argues that it is appropriate to withhold the test if the parents are not planning an abortion on the grounds of autonomy—otherwise they will be denying their future child the right to determine when and if he learns his diagnosis. Rony Duncan and Bennett Foddy disagree, citing several arguments: in the first trimester, the fetus is part of the mother's body and she should not be denied knowledge about her own body; a couple can never “know” with 100% certainty whether or not they will abort a fetus; and no one should be placed in the untenable position of having to lie to obtain a medical diagnostic test. As genetic medicine becomes more widespread, dilemmas such as this will likely increase.

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