In Other Journals

Woman performs own caesar

A 40-year-old multiparous woman, with a previous obstetric history of death- in-utero, took drastic action when she found herself unable to deliver her ninth pregnancy vaginally at home, say the mostly Mexican authors of a case report. After taking three glasses of “hard liquor”, the woman used a kitchen knife in three attempts to slice her abdomen in the right paramedial region and cut her uterus longitudinally to deliver a male infant. Another of her children summoned help; a local nurse arrived to find the mother unconscious and eviscerated. The woman survived the ordeal, which included an 8-hour car trip to the nearest hospital and two exploratory laparotomies, as did her infant. The family live in a small village deprived of running water, electricity and sanitation, as well as prenatal care.

Int J Gynaecol Obstet 2004; 84: 287-290

Pre-hospital adverse events

Researchers studying adverse events in patients admitted to a Canadian teaching hospital have called for quality-improvement efforts in ambulatory care. The Ottawa Hospital Patient Safety Study identified 64 patients with adverse events in a randomly selected sample of 502 adult hospital patients. Three in five events occurred before admission, and half of these occurred in an ambulatory setting — in the patient’s home or nursing home or a doctor’s offices. Adverse events of this type were almost always adverse drug events and were often preventable, the researchers said.

CMAJ 2004; 170: 1235-1240

Intensive lipid lowering

A group of international researchers has suggested that target low-density lipoprotein (LDL) cholesterol levels for secondary prevention may need to be lowered even further in light of new findings. PROVE IT — the Pravastatin or Atorvastatin Evaluation and Infection Therapy trial, conducted in 4162 patients in eight countries — has shown intensive statin therapy (80 mg atorvastatin daily) to be superior to standard therapy (40 mg pravastatin daily) in terms of major cardiovascular deaths in the first few years after either acute myocardial infarction or high-risk unstable angina. However, there were more liver-related side effects with high-dose atorvastatin than with standard-dose pravastatin. The mean LDL cholesterol level in the atorvastatin group was 1.6 mmol/L.

N Engl J Med 2004; 350: 1495-1504

“Lids for Kids”

Community agencies wanting to reduce both childhood injuries and socioeconomic inequalities should consider providing free bicycle helmets together with an educational pack, say UK researchers. These measures increased not only helmet ownership but also helmet use in their trial involving more than a thousand nine- and 10-year-old schoolchildren from nearly 30 primary schools in deprived areas of Nottingham.

Arch Dis Child 2004; 89: 330-335

Professional misconduct

A doctor practising complementary medicine has been removed from the Register of Medical Practitioners in New Zealand for professional misconduct — among other things, the doctor was found to have made untenable diagnoses via undue reliance on an implausible technique (peak muscle resistance testing) to the exclusion of conventional medical diagnostic methods and when not supported by the clinical presentation. A report of the NZ Medical Practitioners Disciplinary Tribunal’s decisions said there is an onus on doctors who practise alternative or complementary medicine to inform patients not only of the nature of the alternative medicine offered, but also the extent to which it is consistent with conventional theories of medicine and has, or does not have, the support of the majority of practitioners. “Patients consult them [doctors] to get the ‘best of both worlds’ and to avoid those aspects of alternative medicine which are extreme or incredible,” the report said.

www.nzma.org.nz/journal/ 117-1191/825/

Antidepressants in youth

Antidepressant drugs cannot confidently be recommended as a treatment option, let alone as first-line treatment, for depression in childhood and adolescence, according to Australian authors. Jureidini and colleagues had reviewed six published randomised controlled trials involving newer antidepressant agents such as selective serotonin reuptake inhibitors and venlafaxine. They said that study investigators’ conclusions exaggerated the benefits and downplayed the adverse effects of such treatment.

BMJ 2004; 328: 879-883

— Dr Ann Gregory, MJA