Published: 26/05/2005, Volume II5, No. 5957 Page 31

Professionals in dark over remedy mix risk

Health professionals are endangering patients by failing to warn them of the risks of mixing herbal remedies with conventional drugs, a survey of arthritis patients has found.

Herbal remedies and arthritis drugs can be a potentially dangerous mix, but the survey of 238 outpatients suggested that ignorance of the risks extends beyond patients to health professionals themselves.

Almost half (44 per cent) of patients had used a herbal or over-thecounter remedy in the preceding six months, with as many as one in ten taking remedies that could interact with their conventional drugs, risking conditions such as liver toxicity and bleeding disorders.

Not only were 24 of the 26 patients who had put themselves at risk unaware they had done so, 10 of them had sought advice from a healthcare professional first.

'Doctors may not recognise the potential effects associated with herbal remedies, ' say the researchers. 'Patients and prescribers need more information on the risks and potential interactions of these preparations.' Ann Rheum Dis 2005;64:790

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Fears over emergency endoscopy shortage

Patients may be dying because half of UK hospitals are not properly equipped to deal with emergency upper gastrointestinal bleeding, a survey has found.

Upper gastrointestinal bleeding is a common cause of hospital admission and has a 14 per cent mortality rate.

For patients to survive, the timing of endoscopy can be critical, with mortality rates in hospitals with a dedicated bleeding unit half that of the national average.

The survey of 150 endoscopy units revealed that half of the hospitals had no emergency on-call rotas to deal with acute upper gastrointestinal bleeding, and that in many cases appropriately timed endoscopy was lacking. Often emergency endoscopy was in unfamiliar surroundings helped by staff unfamiliar with endoscopy.

The researchers say that 'smaller units should consider combining with larger ones to provide cross-cover and rectify a shortfall in the service that is essentially manpower related'.

BMJ 2005;330:1000

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Diagnosed angina on the increase

A study has demonstrated the ongoing need for health service resources for angina despite falling rates of heart attack and coronary death.

The study of 7,735 men aged 40-59 showed a drop in major coronary events since the late '70s by an average of 3.6 per cent per year. In contrast, the first diagnosed angina increased by an average of 2.6 per cent per year, resulting in no apparent change in the overall incidence of diagnosed coronary heart disease.

The trend in angina may be due to changes in diagnostic practices, rather than a real increase in incidence, say the authors. Nevertheless, it raises concerns for health service resources and highlights the need for continued emphasis on the prevention of coronary heart disease.

BMJ 2005; 330:1046

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