New Eng J Med Vol 353
164 A review of screening for osteoporosis from the US, taking a conservative approach and reserving dual-energy X-ray scans for women over 65 years and those with previous low-impact fractures.
229 A study of the histology of benign breast lesions in relation to later breast cancer. Most benign lumps are truly benign, but those showing cellular atypia do carry an increased risk of later malignancy.
341 As a garden plant, Echinacea angustifolia is not to be sneezed at, but to prevent or relieve colds, it is quite useless.
349 Don't be surprised if the pre-operative assessment nurse suggests that some of your high-risk patients should be put on a β-blocker for their elective surgery. This can cut in-hospital mortality by nearly a half, according to this big retrospective study; but we need confirmation from big prospective trials — see BMJ (331: 313).
468 Time to buy a treadmill for your surgery — exercise capacity is one of the best measures for cardiovascular risk and general prognosis. Here are the nomograms for women of all ages.
Lancet Vol 366
136 One of the few trials to find that real acupuncture is better than sham acupuncture — for knee osteoarthritis. Not by much, and perhaps not by needles — see the editorial on page 100.
205 For stopping fits in children, buccal midazolam seems like the winner — a drug for the emergency bag?
237 An excellent review of the many questions surrounding attention-deficit disorder and its treatment.
287 A long letter makes a reasoned plea for the retention of co-proxamol, the much-loved analgesic.
293 For the cure of seminoma, radiotherapy is very effective but a single dose of carboplatin may be just as good, with fewer long-term effects.
314 Haemochromatosis is due to a single gene mutation and can be screened for in whole populations using cheek cell sampling.
409 This review asks what we can do for menopausal symptoms now that hormone replacement is out of favour. The options are summarised in a useful table on page 413.
JAMA Vol 294
47 Low-dose aspirin did not reduce the rate of cancers or myocardial infarction in 20 000 women who took it for 10 years.
56 If you still doubt that PSA stands for Perfectly Stupid Attributes, read this paper about its predictive characteristics in the population, and also the paper 3 weeks later (page 433) showing that it does not even reliably predict clinical progression in prostate cancer.
91 Measures of sexual satisfaction in Australian women show no relation to levels of testosterone and androstenadione, although there is a weak correlation with dehydroepiandrosterone. Nevertheless, testosterone patches did seem to alleviate ‘hypoactive sexual desire disorder’ in a study of oophorectomised women (Arch Intern Med 165: 1582).
97 Coffee consumption protects against type 2 diabetes.
183 A survey of women's experiences after stopping menopausal hormone treatment. Most of them go back to square one.
218 A study of the most highly cited research papers (‘medical breakthroughs’) finds that many are either contradicted or weakened over the following 10 years.
326 A study of various lipids and inflammatory markers in women, showing that the total cholesterol:high density cholesterol ratio is much more predictive than total cholesterol alone.
557 Mao's Great Leap Forward, which killed millions of people from starvation, confirms earlier findings showing that those born to severely malnourished mothers are twice as likely to develop schizophrenia.
563 There is a treatment that can cut the risk of repeated self-harm — cognitive behavioural therapy.
Other Journals
Arch Intern Med (165: 1541) looks at the long-term outcome of ‘white-coat’ hypertension — most of it turns into permanent hypertension. The next study (page 1547) finds a new hazard of non-steroidal anti-inflammatory (NSAID) use in men — a doubling of acute urinary retention. And more bad news for type 2 diabetics: they are at increased risk of fractures (page 1612) and cognitive decline (page 1651). Ann Intern Med (143: 100) looks at the predictive value of a clinical score (‘Wells score’) and D-dimer for excluding deep vein thrombosis and concludes they are not good enough, although a miss rate of less than 3% seems pretty good to me. Does hard water really stop you getting heart attacks? Not likely, says a Swedish study in Epidemiology (16: 570). Some people literally can't stand the smell of cooking cauliflower and cabbage — see Allergy (60: 969) for a little known cause of occupational asthma.
Plant of the Month: Clematis × jouiniana
This abundant tumbling clematis has pale bluish flowers with a milky scent in autumn.
- © British Journal of General Practice, 2005.
