DO HOSPITALS TAKE MORE BLOOD THAN THEY NEED?

One of the most common complaints of hospitalized patients is that they feel like pincushions--stuck with needles every day for routine blood tests.

That's how Jocelyn M. Hicks, chairwoman of the Department of Laboratory Medicine at Children's National Medical Center in Washington, felt recently when she was confined to "a major university hospital" for treatment of Guillain-Barre syndrome, a rare form of nerve damage triggered by an infection.

Guillain-Barre in its most severe form causes total but temporary paralysis from which most of its victims recover.

In a letter to the New England Journal of Medicine published last week, Hicks, who spent two weeks in an intensive care unit, said she was "shocked at the amount of blood drawn for my tests."

She wrote that her hematocrit, a measurement of oxygen-carrying red cells in the blood, dropped from 43 to 31.

Hicks said she asked the phlebotomist to draw less blood, but her request was rebuffed because the technician said she had to follow the physician's orders.

"While I was completely paralyzed I began to think about why hospitals draw so much blood," Hicks wrote.

She said she suspected that the practice dated back about 20 years when laboratory instruments required large volumes of blood to test samples.

After her recovery, Hicks sent questionnaires to 24 American hospitals and received 19 responses, including seven from children's hospitals.

She found that the 10 university hospitals and two community hospitals required 2.5 to 10 times the amount of blood that the seven children's hospitals did, even though the blood tests were the same for adults and children and the equipment was identical or similar.

"I am concerned that . . . we are drawing far more blood from adults than is necessary," Hicks concluded. "This issue is of particular importance" for the growing elderly population, she added, calling on "all physicians and laboratorians to change this practice."

--Sandra G. Boodman

TOURISM NOT AFFECTED BY BAN ON SMOKING

Bans on smoking in restaurants do not generally hurt tourism, and may even give the local tourist industry a boost, a study of three states and six cities suggests.

"This study debunks the tobacco industry allegation that smoke-free restaurant laws adversely affect tourism, including international tourism," researchers concluded.

The study was conducted by researchers from the Institute for Health Policy Studies at the University of California at San Francisco. Their findings appeared last week in the Journal of the American Medical Association.

Researchers used hotel revenue as the measure of tourism business before and after passage of laws making restaurants smoke-free. The study looked at three states (California, Utah and Vermont) and six cities (Boulder, Colo.; Flagstaff and Mesa, Ariz.; Los Angeles; New York and San Francisco) where the potential effect on tourism had been an issue during the debate over whether restaurants should be smoke-free.

A spokesman for R.J. Reynolds Tobacco Co. said he had not seen the study but that the company opposes smoking bans on the grounds that decisions about allowing smoking in businesses should be up to the individual business owner.

International tourism either increased or was unaffected after implementation of laws banning smoking in restaurants, the study found.

Researchers called that finding "surprising because of the commonly held belief that Europeans are more willing to tolerate secondhand smoke and less supportive of clean indoor air regulations than are Americans."

Laws making restaurants smoke-free were associated with a significant increase in hotel revenue in four localities, no significant change in four other localities and a slowing of the growth rate in one (Flagstaff).

When all nine localities were lumped together, there was no apparent change in the proportion of retail sales accounted for by hotel revenue.

"Contrary to industry claims, these ordinances were not associated with significant drops in tourism," the study concluded. "Quite the contrary, in several locales the ordinances were associated with significant increases in tourism."

--Don Colburn

ALCOHOL LINKED TO DEATHS FROM ACCIDENTS, MURDER

Almost one-third of people who are murdered or who die of injuries not caused by motor vehicles are legally drunk at the time of death, a new study reports. The rates are almost the same as for people who die in car crashes.

Researchers at the Johns Hopkins School of Public Health in Baltimore, using a blood alcohol level of at least 100 milligrams per deciliter as evidence of intoxication, found that the victims were intoxicated in 32 percent of homicides, 31 percent of accidental injuries not involving cars and 23 percent of suicides. Among victims of fatal car accidents, the rate is 33 percent.

To examine alcohol's role in violent death, associate professor Gordon S. Smith and two colleagues identified 65 studies published by medical examiners between 1975 and 1995 that contained data detailed enough for analysis.

The studies contained information on 28,696 homicides, 19,347 suicides and 7,459 accidental injuries not involving motor vehicles. The team did not study car crashes because extensive data is already available from the federal government.

Within each category, the frequency of intoxication varied with the cause of death. Among injury cases, for example, 42 percent of burn victims and 41 percent of people dying of hypothermia were intoxicated, but only 21 percent of gunshot victims.

People who took their own lives were most often intoxicated if they died by poisoning (35 percent) or shot themselves (31 percent). In contrast, only 4 percent of those who jumped to their deaths were drunk at the time.

The research team found that few data exist on how age or sex affects alcohol use as a factor in such deaths.

There is also very little information on how often murderers--as opposed to murder victims--are drunk at the time of the crime.

The study was published in the June issue of the Journal of Emergency Medicine.

--Susan Okie