Hand washing in schools

Bandolier has reported a study on improving washing of hands is schoolchildren. A study in Detroit showed handwashing to be effective in reducing absence through illness in elementary school children. A school with 305 children aged 5-12 years in 14 classes was chosen, and classes were divided into experimental and control without formal randomisation. Six classrooms with 143 children formed the experimental group and eight with 162 children the control group.

The intervention was that children in the hand washing classes were required by their teachers to wash their hands after arrival at school, before eating lunch, after the lunch break and before going home. This was done as a class activity. Children in the control group had no required hand washing.

The outcome was absence from school, recorded daily and monitored by telephone contact with parents to investigate the nature of any illness. Illness was regarded as respiratory if it included cough, sneeze, sinus trouble etc, and gastrointestinal if it included abdominal pain or diarrhoea or vomiting. Both were used, and total days of absence for illness. Children with both respiratory and gastrointestinal reasons for absence were included in both groups, so the total may be less than the sum of these two reasons.

Absences were recorded as a percentage of the total number of possible days of attendance. Absences were lower in the hand washing than in the control group. For total illness absence and gastrointestinal reasons, the reduction was statistically significant.

This study was not randomised, nor was it blind. Both these defects could have contributed to a result that might be biased. But there is so little evidence for the effectiveness of hand washing in the community that this study is worth a look. It also reports that it performed a literature review, though no details are given. There are perhaps three other studies in children, usually in special circumstances. Mostly they showed reduction in illness, and we know that in other settings washing hands frequently makes a difference.

What is surprising is that there is so little information about so basic an activity. Where are the trials, and where are the reviews of trials that can help us determine how and where washing hands can help, both in the community, as here with schoolchildren, and in healthcare to reduce infections?     

Ref: web

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New guidance for England and Wales on the use of electroconvulsive therapy (ECT) reduces the indications for its use considerably in response to patient groups, concerned about long-term side effects.

The guidance, which was issued last week by the National Institute for Clinical Excellence (NICE), restricts the use of ECT to the rapid and short term relief of severe depressive or manic symptoms and catatonia after all other treatment options have failed and suicide is a risk.

But the Royal College of Psychiatrists special committee on ECT, supported by the Scottish ECT Audit Network, believes that the guidance is too restrictive. “We do not agree that ECT should be reserved for treatment resistant depression”, these two groups say in a joint statement, adding that it is “perverse” to prevent moderately ill patients from freely choosing ECT until their symptoms deteriorate badly.

They point out that mild and moderately depressed patients form the bulk of the trial evidence on which NICE based its guidance, as severely ill patients were excluded from the trials because they could not give informed consent. They also disagree with NICE about the use of maintenance ECT, which, they say, is warranted in some patients.

The college lost its appeal, however, to widen the inclusion criteria.  It is thought that NICE deliberately wants to curb the use of ECT because of unresolved concerns about side effects, particularly memory loss.

Professor Peter Littlejohns, clinical director of NICE, who described ECT as “a controversial intervention,” said that doctors opting to treat outside the guidance would have to show clearly that patients’ and professional views had informed their decision.  The guidance emphasises the need for fully informed patient consent, with a thorough understanding of the risks, and makes it clear that no patient should be coerced into treatment.  It recommends the creation of national information leaflets.

To coincide with the guidance, the Royal College of Psychiatrists announced a new voluntary quality assurance scheme for ECT clinics, the ECT accreditation service, which will be trialled in the summer.

The mental health charity MIND, which has lobbied hard to curb the use of ECT, welcomed the moves, but its chief executive, Richard Brook, said: “Revisions to the current Mental Health Act are essential in order to provide a legal framework in which they can be enforced.”

Ref: web

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This is another story from the National Electronic Library for Health which comments on newspaper reports of medical research.

The story that a 'Star Trek-style wand', which is swiped over a patient's body, was able to find tumours, was reported in the Daily Mail and The Sun on 12 June 2003. The articles referred to two independent research studies conducted in Italy, one on the detection of prostate cancer and the other on breast cancer. The newspaper articles appeared to be based on a report published in the New Scientist that discussed the two research studies.

The Daily Mail reported that the scanner was able to detect 93% of prostate tumours that were later confirmed by biopsy, but only 66% of breast cancer tumours. The Sun reported that the scanner could detect 93% of cancer cases later confirmed by biopsy without specifying the type of cancer. Neither of the articles reported on the proportion of people wrongly identified as having a tumour. Without this it is not possible to determine how useful such a test may be in practice.

Neither of the research studies on which the newspaper articles were based had been published, so it has not been possible to comment on the reliability of the findings.

Ref: web

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