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Press releases Friday 6 June 2008
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(1) One in five adolescents are not sufficiently protected against meningitis C
(2) Simplistic NHS reforms are inadvertently damaging patient care
(3) New guidance on patient consent lacks substance, says expert
(1) One in five adolescents are not sufficiently protected against meningitis C (Seroprotection against serogroup C meningococcal disease in adolescents in the United Kingdom: observational study) www.bmj.com/cgi/content/short/bmj.39563.5452555.AE (Editorial: Seroprotection against serogroup C meningococcal disease) www.bmj.com/cgi/content/short/bmj.39577.487558.BE
One in five adolescents aged 11-13 years appear to have inadequate protection against meningitis C and a booster dose of vaccine may therefore be needed to sustain protection amongst teenagers, according to a study published on bmj.com today.
Adolescents always used to be considered a group at high risk of contracting meningitis C, but in 1999-2000 the government ran a mass meningitis C immunisation campaign vaccinating everyone aged 1-18 years, and the number of cases dropped dramatically. Since then the vaccine has been part of the routine infant immunisation programme.
Yet studies have shown that the vaccine's effectiveness in infants drops considerably over time as the level of their antibodies fall. Research has also shown that this doesn't happen in older children (aged 9-12 years) who are given the vaccine.
Researchers from the University of Oxford examined whether children aged 6-8 years when they were vaccinated as part of the national campaign, are still sufficiently protected. These children are now entering adolescence, a more high risk age. Dr Matthew Snape and colleagues studied the antibody levels in blood samples from 999 adolescents aged 11-20 years who were immunised as part of the 1999-2000 vaccination campaign.
They found that children who were aged 10 years or more when vaccinated, maintained protective levels of antibodies for longer. While the majority, aged 11-20 years, had sufficient levels of antibodies to remain protected, approximately 10% more of those aged 14-20 years had that level of protection compared to those aged 11-13 years. The researchers suggest that one possible cause is maturation of the immune system at around the age of ten.
A meningitis booster jab was introduced for 12 month old children in 2006, but it is currently unknown how effective this will be at providing long-term immunity. However, it is known that over the next five years, a group of children who did not receive a booster, and will therefore not have sufficient levels of antibodies to protect them, will be entering adolescence.
The researchers say that over 20%, 'a significant minority', of those aged 11-13 years have inadequate protection against meningitis C and a booster dose of vaccine may be needed to sustain protection against meningitis C amongst teenagers.
These findings emphasise how important age at vaccination is for protection and persistence with conjugate vaccines, say Lucieni Conterno and Paul Heath in an accompanying editorial.
The fact that children in certain age groups might lose their antibodies as they get older, highlights the importance of ongoing high quality surveillance even after the disease seems to have been controlled, they add.
Contacts:
Matthew Snape, Oxford Vaccine Group, Department of Paediatrics, University of Oxford, UK
Email: matthew.snape{at}paediatrics.ox.ac.uk
Lucieni Conterno, Marilia Medical School, São Paulo, Brazil
Email: lucieni{at}famema.br
(2) Simplistic NHS reforms are inadvertently damaging patient care (Personal View: The state of general practice - not all for the better) www.bmj.com/cgi/content/short/336/7656/1310
Simplistic and unpiloted NHS reforms are inadvertently damaging patient care in general practice, according to a group of academics writing in this week's BMJ.
Professor Howie, from the University of Edinburgh, writing with colleagues, criticises recent reforms in general practice and says if they "continue unchallenged [it] will result in the dismemberment of a primary care system that has been the envy of other countries."
They argue that the holistic care patients have always received from their GP, and which has worked in the individual patient's favour, is in danger of being harmed by recent changes.
The most serious of which is the way "tinkering" reforms will change the successful model of general practice which provides continuity of care by a known GP, to one in which patients are seen by a variety of healthcare workers in different sites who treat episodes of illness rather than the whole person. They argue that "the best of the past is in danger of being lost without sufficient proven benefit in return."
They point out that the government's insistence of using general practice to implement a public health agenda has had the knock-on effect of patients not being treated as individuals, because priority in consultations may be given to the public health agenda over the reasons the individual went to the GP in the first place.
In addition, they criticise "perverse incentives" such as the Quality and Outcomes Framework, which financially rewards GPs for hitting targets, and claim that it provides poor value for patients. "Ticking boxes," they say, may distract doctors from dealing with important topics during a consultation.
Both these factors have created extra work for family doctors, which in turn has led to it becoming increasingly difficult for patients to get timely access to care from their first choice of GP.
These reforms, they conclude, if allowed to continue will mean that "patients will lose holistic care, doctors will lose job satisfaction and the NHS will lose effectiveness and inefficiency."
Contact: John Walker, Newcastle University, Newcastle, UK Email: juneluddick{at}btinternet.com
(3) New guidance on patient consent lacks substance, says expert (Editorial: Patient consent—decisions or assumption?) www.bmj.com/cgi/content/short/336/7656/1259
Proposals to overhaul the approach to obtaining patient consent lack detail, contain advice that is non-specific, and might prevent doctors from making major changes to their practice warns an editorial in this week's BMJ.
Writing in response to the publication of the General Medical Council (GMC) guidance on patient consent to be implemented in June, Professor Glyn Elwyn argues that although the guidance appears radical and urges a change in the approach to informed consent, it fails to address how doctors will do this in busy clinical settings.
The process of obtaining consent from patients for procedures such as surgical operations often just involves patients signing a piece of paper declaring that they understand the nature of the procedure and its consequences, only a few hours before an operation. This rarely provides time for patients to read or consider the information about harms and benefits. In addition, evidence shows that patients want to be given more information about risks and consequences.
According to Elwyn, although the much needed GMC guidance encourages doctors and patients to discuss procedures and treatments to help patients make more informed decisions, it lacks important finer details. For example, the guidance provides no detail about suggested risk thresholds for specifying the problem of harm, or suggestions on how to achieve balance, to tailor information, or how to explore personal preferences.
Before the guidance is implemented more preparation needs to be done, he argues. Shared decision making needs to integrated into the way mutlidisciplinary teams are set up to provide care. Patients should receive information early and the process should have clearly defined steps at which information and patient preference should be considered and documented.
In addition, he says, new informative materials describing the intervention, likely outcomes and their probabilities, complete with guidance on how to clarify patients' preferences and deliberate about options should be made available.
Elwyn points out that although generating these materials will require considerable expertise and investment, there is a wealth of experience and decision support technologies and aids already available to produce such tools.
"As consent becomes increasingly regarded as a form of choice that involves a deliberate decision rather then just acceptance of professional advice, the shift to adopt decision support technologies as a means of achieving informed consent seems not only necessary, but inevitable", he concludes.
Contact: Glyn Elwyn, Department of Primary Care and Public Health, Cardiff University, Cardiff, Wales Email: elwyng{at}cardiff.cc.uk
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Student BMJ
Asylum seekers' care
UK medical students have published unreleased government plans to restrict failed asylum seekers' access to medical care
