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BMJ No 7128 Volume 316
This week in brief Saturday 31 January 1998
Topical non-steroidals are effective and safe
A third of children diagnosed with epilepsy before age 16 are free
of seizures by age 23
Use of unlicensed or off label drugs is widespread in children
in hospital
Medical students with the most clinical experience do not perform
best in final exams
There is little evidence to support common interventions for
shoulder disorders
More patients with suspected myocardial infarction now
receive aspirin
Topical non-steroidals are effective and safe
There is scepticism that topical non-steroidal anti-inflammatory drugs are effective. Moore et al (p 333) performed a systematic review of randomised controlled trials in acute and chronic painful conditions to test the evidence for effectiveness. Placebo controlled trials in acute conditions in 1747 treated patients had an overall number needed to treat of 3.9 and in chronic conditions in 547 treated patients an overall number of 3.1. Small trials (fewer than 40 treated patients) exaggerated treatment efficacy. Adverse effects were rare and no different from those seen with placebo.
A third of children diagnosed with epilepsy before age 16 are free of seizures by age 23
Little is known about the long term outlook for children with epilepsy. Kurtz et al used the National Child Development Study cohort (17,414 children born in 1958) to review their experience of epilepsy (p 339). By age 23 the cumulative incidence of epilepsy was 8.4/1,000. In only 25% of cases was seizure onset related to a specific cause. Children with uncomplicated epilepsy were less likely to continue to have seizures in adult life than those with neurological impairment or other medical conditions; one third diagnosed by age 16 were off medication and seizure free at 23. Six died between the ages of 17 and 23.
Use of unlicensed or off label drugs is widespread in children in hospital
Many drugs used to treat children in hospital are either not licensed
for use in children or are prescribed outside the terms of the licence
(off label). To find out how often drugs were used in these ways Turner
et al st
Medical students with the most clinical experience do not perform best in final exams
Two cohorts of medical undergraduates were followed from application to final examination to assess whether learning styles relate to final exam performance or to the extent of clinical experience. On p 345 McManus et al report that the amount of knowledge gained from clinical experience was related to strategic and deep learning styles at both the time of application and the final year. Grades at A level did not correlate with either study habits or clinical experience, and success in the final examination was not related to students' clinical experience. The authors question the validity of final examinations and suggest that medical schools should assess their applicants' learning styles, not just their examination results.
There is little evidence to support common interventions for shoulder disorders
Although many accepted standard forms of treatment for shoulder pain exist, evidence for their efficacy is not well established. In a systematic review on p 354 Green et al assess the efficacy of these common interventions and explore the ways in which shoulder pain is categorised and assessed. They found little evidence to support or refute the efficacy of common interventions for shoulder pain. There is a need for further clinical trials investigating current treatments for shoulder pain, as well as standardisation of the way shoulder disorders are defined, classified, and measured.
More patients with suspected myocardial infarction now receive aspirin
In 1995 an audit of general practitioners' administration of aspirin and opiates in suspected myocardial infarction found that only 3% of patients received aspirin, with a low rate of opiate use. Prasad et al repeated the audit among 249 patients referred with chest pain to a coronary care unit by their general practitioners (p 353). 58% of patients with acute myocardial infarction or angina had been given extra aspirin; as before, only a fifth (54) were given intravenous opiates, with 24 inappropriately receiving intramuscular opiates.
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