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US Highlights

BMJ 2006; 333 doi: (Published 14 December 2006) Cite this as: BMJ 2006;333:0-g
  1. Douglas Kamerow, US editor ( (dkamerow{at}

    Does vaccinating nursing home staff against influenza make a difference? To answer this question, Andrew Hayward and colleagues performed a randomized controlled trial (doi: 10.1136/bmj.39010.581354.55) in 44 UK nursing homes. For two flu seasons, the staff in half the homes were offered influenza vaccine and those in the other half were not. During the 2003-4 flu season there were significant reductions in mortality, influenza-like illnesses and hospitalizations, and doctor visits for influenza-like symptoms. In 2004-5, a season of low influenza incidence, there were no significant differences. The authors conclude that vaccinating nursing home staff is effective in preventing mortality, illness, and health care utilization due to influenza. In an accompanying editorial (doi: 10.1136/bmj.39050.408044.80), Rachel Jordan and Jeremy Hawker calculate that vaccinating nursing home staff against influenza is cost-effective as well, and they urge aggressive vaccination campaigns among all who work in elderly care establishments.

    Drug eluting coronary artery stents have been much in the news lately. In an editorial (doi: 10.1136/bmj.39058.554884.BE), A H Gershlick and G Richardson discuss their risks and benefits. Compared to bare metal stents, the drug eluting variety have a lower incidence of in-stent restenosis, but at a cost of longer lasting injury to coronary artery wall endothelium. As a result, a small excess number of patients with drug-eluting stents have early thrombosis and even death. While the authors feel the small extra risk of stent thrombosis with drug eluting stents is outweighed by the 60-70% decrease in restenosis compared with bare metal stents, they advocate obtaining informed consent about these issues from patients.

    Finally, Kenneth Poole and Juliet Compston review (doi: 10.1136/bmj.39050.597350.47) the management of osteoporosis, which is caused by decreased bone mass and disruption of bone micro-architecture, and is an important risk factor for vertebral and hip fractures. Falls are another important risk factor. Conditioning and environmental programs have been shown to prevent falls but not fractures. The keystones of osteoporosis treatment are dietary calcium, weight bearing exercise, smoking cessation, and pharmacotherapy with one of several effective classes of drugs.

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