In Other Journals

DEADLY DOUBLE

Diabetes is well known as a risk factor for death from heart disease and other causes. But having depression as well magnifies the risk. So say Pan and colleagues from the Harvard School of Public Health, Boston, who studied 78 282 women aged 54 to 79 years enrolled in the US Nurses’ Health Study, over a 6-year period. Compared with women who did not have either diabetes or depression, those who had both conditions had approximately three times the risk of death. The researchers speculate that diabetic women who are depressed do not adhere well to diabetes management, and are more likely to be involved in unhealthy pursuits such as smoking and a sedentary lifestyle. There is a need for adequate psychological management and support for women with chronic conditions such as diabetes, they conclude.

Arch Gen Psychiatry 2011; 68: 42-50

EVACUATE BY AIR

Severely injured patients transported by helicopter to trauma centres are more likely to survive than those brought by ground ambulance. So say Brown and colleagues from the Department of Surgery at the University of Rochester School of Medicine. They studied 258 387 patients transported from the scene of injury either by helicopter or ground transport in 2007 in the US. Those who went by helicopter were more likely to survive, and were more likely to be discharged home after treatment, than those transported by ground. This was despite the fact the “helicopter patients” were more severely injured, had longer overall transport times, had somewhat further to travel, and needed more intensive treatment in trauma centres. A key factor was that helicopter patients were transported more quickly per unit of distance travelled, in part due to the fact that helicopters travel in a straight line and do not have to travel difficult terrain, as do ground ambulances. But there is a cost involved and the routine use of helicopters for civilians remains controversial.

J Trauma 2010; 69: 1030-1036

VACCINE AUTISM FRAUD

In 1998, The Lancet published a paper by Andrew Wakefield and others linking the measles-mumps-rubella (MMR) vaccine with a supposedly new syndrome of autism and bowel disease. But in the decade or so that followed, the research was found to be both scientifically and ethically flawed, the link between autism and MMR vaccine was discredited, and The Lancet retracted the publication. Now rival journal BMJ is publishing a series of articles by journalist Brian Deer that reveals the sequence of events that surrounded the original publication. Deer, who first raised the alarm 7 years ago, reports that Wakefield altered numerous facts about the patients’ medical histories in order to support his claims. The Royal Free Hospital and Medical School in London supported Wakefield as he sought to exploit the ensuing MMR scare for financial gain; and key players failed to investigate thoroughly when Deer raised his concerns. In an accompanying editorial, the BMJ editors say that though disgraced and stripped of his clinical and academic credentials, Wakefield remains unrepentant. They argue that other published articles by Wakefield and colleagues should be investigated, since perpetrators, they say, rarely commit just one fraud.

BMJ 2011; 342: c7452

SURGEONS, AWAKE!

Sleep deprivation adversely affects clinical performance in doctors. In the US, resident medical officers have had their shift hours capped at a maximum of 16 hours; however, no such restrictions exist for more experienced doctors. Should surgeons have been on call the night before and be sleep deprived, they may be at risk of mistakes in theatre next day, argue Nurok and colleagues. In their opinion piece, they cite a 2009 Harvard Medical School study that showed an 83% increase in the risk of complications (such as massive haemorrhage, organ injury, or wound failure) in patients who undergo elective daytime surgical procedures performed by surgeons who have had less than 6 hours’ sleep the night before. They argue that patients should have the right to know how much sleep their surgeon has had, and should then be given the choice of proceeding with the surgery, rescheduling it, or switching surgeons. Sleep-deprived doctors should not be permitted to proceed with elective surgery without a patient’s informed, written consent, they say. However, in a letter to the editor in the same issue of the NEJM, the American College of Surgeons argues that rather than be required to disclose their sleep status, surgeons should be trained to identify and address the problem themselves.

N Engl J Med 2010; 363: 2577-2579

PLUGGING THE LEAKS

After prostate-cancer surgery, most men are left with some residual stress and/or urge incontinence. But the quality of life of these men may be improved with behavioural therapy targeting the bladder, say researchers from the University of Alabama. They did a prospective randomised controlled trial of 208 older men with persistent incontinence following radical prostatectomy. One group received behavioural therapy, in the form of pelvic floor muscle training and bladder control. A second group received the same therapy plus additional biofeedback and electrical stimulation of the pelvic muscles. A third control group received no therapy. Among the first two treated groups, symptoms improved by approximately 50%, with no significant difference between the two groups. Symptoms in the control group improved by only 24%. Behavioural therapy is non-invasive and should be offered to men with persistent incontinence after prostatectomy, although there is no additional benefit from biofeedback and electrical stimulation, concluded the researchers.

JAMA 2011; 305: 151-159