New Eng J Med Vol 354
119 This paper is worth finding and keeping handy — it tells you which exotic disease your patient is likely to bring back from which exotic destination.
229 Some pretty exotic substances are used to treat cystic fibrosis these days (see the excellent editorial on page 291), but the latest is the most abundant on the Earth's surface — hypertonic saline. Inhaled regularly, it helps to clear secretions and reduce infective episodes — possibly because it makes patients cough a lot.
296 You don't have to kill bacteria to get rid of them — you can just disarm their invasive mechanisms. This may be the best way to eliminate Vibrio cholerae.
333 Smoking more than 30 cigarettes a day carries a high risk of lung cancer whatever your ethnic origin. Below that, the risk may be higher in African–Caribbean patients in the UK, as it is in African–Americans in this US study.
462 This study managed to find hundreds of US babies with infant botulism and treated them with anti-botulinum globulin. The botulism isn't the work of Al Qa'ida but due to Clostridium in the infant bowel.
Lancet Vol 367
122 Cervical cytology has used the same crude sampling technique for decades — wouldn't it be better to change to liquid-based cytology? Not according to this systematic review.
303 When the influenza pandemic arrives, forget about being able to cure everybody with antivirals. This systematic review rubbishes amantadine and rimantadine, and finds that the neuraminidase inhibitors are useless for prevention and not much better for treatment.
314 A wonderful decline in sudden infant death syndrome followed the simple observation that it happened more to babies sleeping face down. The strong remaining message is that nobody should ever sleep with a baby on a sofa.
320 If you don't want to become a vegetable, eat more of them. This meta-analysis shows that fruit and veg prevent stroke in a dose-related manner.
397 A paper that should change your practice and save lives. If a child has a high fever, leg pains, and cold peripheries, bear in mind that these can herald meningococcal disease, and act accordingly.
JAMA Vol 295
172 David Sackett first showed us how to use diagnostic tests in a Bayesian way, and this is well illustrated by the use of D-dimer for pulmonary embolism and deep vein thrombosis (see page 199). It's not that D-dimer itself is definitive: it's the way you use it — a triumph of Sackett over serum.
285 Rationing of hernia referrals has already arrived, but is it evidence-based? Sort of: inguinal hernias rarely incarcerate, but often get bigger and uncomfortable, at which point get them mended.
306 A systematic review showing that low-dose aspirin does work for primary prevention of stroke in women and heart attacks in men; odd that it failed in the British Doctors' study of the 1980s.
499 Pregnancy does not protect against depression: women who give up their antidepressants when they get pregnant usually relapse.
536 How to diagnose peripheral arterial disease rationally: get a hand-held Doppler.
Arch Intern Med Vol 166
38 The study that finally confirms that PSA stands for Perfectly Stupid Attributes in screening for prostate cancer: even digital rectal examination is of unproven value.
101 Consider asking your patients, ‘Are you at peace?’ when they are dying, and be prepared to find them spiritual support if they need it.
201 Erectile dysfunction is common in men referred for coronary disease investigations, and increases the risk of a positive result; in primary care (page 213), it may precede vascular disease, but we lack, er, hard evidence.
Ann Intern Med Vol 144
73 In late middle age, stop thinking about exercise and do some: it may prevent dementia.
172 Kidney buffs tell us we should calculate the Glomerular Filtration Rate rather than glance at the creatinine, and they get support from this study, which shows that it correlates with outcomes in high-risk hypertensives.
Guest Journal: Queueing Systems
As your PCT seeks ever-more creative ways of managing demand without lengthening waiting times, perusal of this journal becomes increasingly essential. Of particular interest is Argon and Androttir's ‘Partial Pooling in Tandem Lines with Cooperation and Blocking’ (52: 5–30).
Plant of the Month: Skimmia ‘Kew Green’
Thriving on any kind of soil (and neglect), this small evergreen shrub forms a handsome mound with wonderfully fragrant yellow-green flower-heads.
- © British Journal of General Practice, 2006.
