New Eng J Med Vol 353
555 Would we get osteoporotic bones back to full strength more quickly by adding some parathyroid hormone to our bisphosphonates? This trial and the one on page 566 tried various ways to combine the two, but there was no sustained benefit above alendronate alone.
576 A big randomised trial confirming what the Cochrane review says — grommet insertion makes no difference to long-term outcomes in glue ear.
761 A revolution in the management of early failed pregnancy — vaginal misoprostol can spare surgery in 84% of incomplete miscarriages or non-viable early conceptions.
924 You won't see much dengue fever in your practice, but you or your patients might well be thinking of going somewhere where you could catch it — India, North Australia, Mexico. As this review explains, it isn't nice and there isn't any treatment. Wait until there's a quadrivalent vaccine.
977 The direct thrombin inhibitors hold out the promise of being the best oral anticoagulants, without the need for monitoring. Unfortunately the leading drug, ximelagatran, can damage the larynx of those who try to utter it, and the liver in some patients who swallow it.
Lancet Vol 366
455 The general superiority of aromatase inhibitors for preventing recurrence in post-menopausal, oestrogen-receptor positive breast cancer is further demonstrated in this trial, which switched women over from tamoxifen to anastrozole after 2 years, and found they did better. Time to audit your tamoxifen prescribing.
549 Antiretroviral treatment cannot eliminate HIV completely from resting T-cells, but there is an exciting new drug that might — sodium valproate.
563 At last, roflumilast. This is the name of a phosphodiesterase-4 inhibitor which, according to this short-term trial, may be our first really useful oral drug for chronic obstructive pulmonary disease.
660 A lot of paediatric screening has not survived critical scrutiny (see Arch Dis Childhood (90: 925) for the most sacred cow of all — failure to thrive), but detection of permanent hearing loss at birth can make a difference and screening is feasible.
726 Do homoeopaths really believe that water can contain therapeutic memories? I hope (but don't expect) that this is the last we hear about it.
742 Dreaming that you had fulfilled your brilliant destiny as a hospital consultant? Forget it, 40% of them feel disempowered and emotionally exhausted.
JAMA Vol 294
681 The ‘growing epidemic of skin cancer’ may in part be due to greater vigilance (see BMJ 331: 481 for melanoma) but rates of basal cell and squamous cell carcinoma in young people have definitely risen in the Olmsted County study.
706 A meta-analysis of studies shows that the longer you take warfarin, the less likely you are to get a second thromboembolism.
819 Have you been following the Stent Wars? There used to be battling fleets of stents, bare, radioactive, or covered in various chemicals, but the Force has favoured Sirolimus Eluting, Lord of the Stents. See also N Engl J Med (353: 653–663).
947 A review of fetal perception of pain, citing good evidence that pain signals don't reach the brain until about 29 weeks.
1043 Continuing medical education used to mean sleep-learning at lectures, so it doesn't surprise me that internet-based CME can be more effective. You can go and get a coffee any time.
Other Journals
Arch Intern Med (165: 1686) looks at whether normal doses of pseudoephedrine can affect blood pressure and pulse rate — yes, by 1mmHg and 3 bpm. On page 1698, the vexed question of physician participation in euthanasia is examined from the experience of 3614 Dutch GPs: it can be done within a rational and humane legal framework. The withholding of artificial hydration and feeding in advanced dementia is considered on page 1729. Ann Intern Med (143: 241) presents a strong case for warfarin plus aspirin in all myocardial infarct survivors at low risk of bleeding. On page 251, the Diabetes Prevention Program is reviewed wistfully: small successes at great cost. As a classical migraineur, I keep an eye on the literature linking migraine with brain damage. Brain (128: 2068) presents MRI evidence of micro-infarcts in 7.5% of patients who have migraine with aura — most of them in the cerebellum. No wonder I keep making typos and bumping into things. There is a new and better instrument for assessing very early dementia, according to Neurology (65: 559). ‘Use of the AD8 in conjunction with a brief assessment of the participant could improve diagnostic accuracy in general practice.’ Expect one at your next annual appraisal.
Plant of the Month: Euonymus grandiflorus
A big semi-evergreen shrub with wine-dark leaves and spectacular fruit in autumn.
- © British Journal of General Practice, 2005.
