What's new this month in BMJ Journals
http://www.100md.com
《英国医生杂志》
A survey of general practitioners in Leicestershire (UK) has shown they are seriously dissatisfied with the systems in place for handling controlled drugs such as opiates. Their drugs registers were often a "do-it-yourself" design not always complying with the government's misuse of drugs regulations. Policies varied on destroying unused drugs, with two practices claiming to store them indefinitely as the police had refused to collect them for authorised disposal.
Fewer than half the practices had been inspected in the preceding 10 years despite the requirement for regular inspections under the Misuse of Drugs Act 1971. It seems that abolishing the regional medical officer posts in 1991 has led to the inspection system being degraded, and the arrangements for ensuring regulations are followed have largely lapsed with successive NHS reorganisations.
Most GPs carry opiates for use in emergencies such as acute myocardial infarction or to manage terminal care. Those questioned expressed anxiety about the potential for diversion and misuse of such drugs. The review of the mass murderer Harold Shipman's clinical practice recommended that an effective system should be introduced to inspect GPs' controlled drugs registers and that they should record batch numbers of the drugs they administer in case notes and registers, with a duplicate held by pharmacists.
The authors call on the National Patient Safety Agency to collaborate with others, such as the Home Office, to make sure that police and pharmacists, as well as doctors, address these issues.
Qual Safety Health Care 2004;13: 21-5
Many medical researchers feel stressed and bullied
A questionnaire survey of younger doctors undertaking research has shown that bullying is perceived as common, and that many feel isolated and overworked and are worried about their finances. Nearly 70% were worried about writing up their work. Negative perceptions were greater in those who felt their supervisors and colleagues were unhelpful. In all, 38% would not recommend their post to others. The authors say that it is time to move away from a professional culture that expects and accepts stress as inevitable.
Postgrad Med J 2004;80: 93-6
Fibromyalgia can be helped by a brief treatment programme
A self management programme for 84 randomly selected patients with fibromyalgia has improved their quality of life, compared with normally treated controls. Over six weeks, participants attended 12 sessions of swimming pool based exercise, relaxation, and advice on daily living, as well as education and discussion. Six months after treatment, patients were assessed with quality of life and symptom questionnaires and by doctors. In particular, patients felt less fatigued, depressed, or anxious and had greater vitality. No change in pain level was seen.
Ann Rheum Dis 2004;63: 290-6
$100 fines fail to reduce mobile phone use in New York
New York state's ban on drivers using handheld mobile phones has proved ineffective, 16 months after implementation. Researchers observed whether drivers were using phones at several controlled intersections in New York and in Connecticut, a neighbouring state without such a law. Immediately before the law came into effect, 2.3% of drivers passing the intersections were on the phone. One month later this had halved, but 16 months after the ban was brought in 2.1% of drivers were seen to be using a mobile, not significantly differently from before the ban or in the control state. This longer term return to previous usage levels was the same in men and women, in people estimated to be over 60 compared with younger drivers, and in car and van drivers. It seems that vigorous enforcement campaigns and continuing publicity will be needed to achieve compliance.
Credit: MIKE DERER/AP PHOTO
Injury Prevention 2004;10: 11-5
Parents can measure their (older) child's pulse accurately
In comparison to the reading from a pulse oximeter, parents were able to count their school aged child's pulse accurately, but they found much greater difficulty with preschool children's pulses. It is probably unrealistic, therefore, to expect even well educated parents to use pulse rate as a guide to the severity of illness in infants.
Fewer than half the practices had been inspected in the preceding 10 years despite the requirement for regular inspections under the Misuse of Drugs Act 1971. It seems that abolishing the regional medical officer posts in 1991 has led to the inspection system being degraded, and the arrangements for ensuring regulations are followed have largely lapsed with successive NHS reorganisations.
Most GPs carry opiates for use in emergencies such as acute myocardial infarction or to manage terminal care. Those questioned expressed anxiety about the potential for diversion and misuse of such drugs. The review of the mass murderer Harold Shipman's clinical practice recommended that an effective system should be introduced to inspect GPs' controlled drugs registers and that they should record batch numbers of the drugs they administer in case notes and registers, with a duplicate held by pharmacists.
The authors call on the National Patient Safety Agency to collaborate with others, such as the Home Office, to make sure that police and pharmacists, as well as doctors, address these issues.
Qual Safety Health Care 2004;13: 21-5
Many medical researchers feel stressed and bullied
A questionnaire survey of younger doctors undertaking research has shown that bullying is perceived as common, and that many feel isolated and overworked and are worried about their finances. Nearly 70% were worried about writing up their work. Negative perceptions were greater in those who felt their supervisors and colleagues were unhelpful. In all, 38% would not recommend their post to others. The authors say that it is time to move away from a professional culture that expects and accepts stress as inevitable.
Postgrad Med J 2004;80: 93-6
Fibromyalgia can be helped by a brief treatment programme
A self management programme for 84 randomly selected patients with fibromyalgia has improved their quality of life, compared with normally treated controls. Over six weeks, participants attended 12 sessions of swimming pool based exercise, relaxation, and advice on daily living, as well as education and discussion. Six months after treatment, patients were assessed with quality of life and symptom questionnaires and by doctors. In particular, patients felt less fatigued, depressed, or anxious and had greater vitality. No change in pain level was seen.
Ann Rheum Dis 2004;63: 290-6
$100 fines fail to reduce mobile phone use in New York
New York state's ban on drivers using handheld mobile phones has proved ineffective, 16 months after implementation. Researchers observed whether drivers were using phones at several controlled intersections in New York and in Connecticut, a neighbouring state without such a law. Immediately before the law came into effect, 2.3% of drivers passing the intersections were on the phone. One month later this had halved, but 16 months after the ban was brought in 2.1% of drivers were seen to be using a mobile, not significantly differently from before the ban or in the control state. This longer term return to previous usage levels was the same in men and women, in people estimated to be over 60 compared with younger drivers, and in car and van drivers. It seems that vigorous enforcement campaigns and continuing publicity will be needed to achieve compliance.
Credit: MIKE DERER/AP PHOTO
Injury Prevention 2004;10: 11-5
Parents can measure their (older) child's pulse accurately
In comparison to the reading from a pulse oximeter, parents were able to count their school aged child's pulse accurately, but they found much greater difficulty with preschool children's pulses. It is probably unrealistic, therefore, to expect even well educated parents to use pulse rate as a guide to the severity of illness in infants.