BMJ  2003;327:833 (11 October), doi:10.1136/bmj.327.7419.833

BMJ family highlights

What's new this month in BMJ Journals

High dose inhaled steroids pose cataract risk

A case-control study using the UK general practice research database has found that elderly people using high doses of inhaled corticosteroids are at greater risk of cataract than controls. Each group consisted of more than 15 000 patients treated for asthma or chronic obstructive pulmonary disease. Those receiving up to 400 µg daily were not at increased risk, after adjustment for use of systemic steroids. The odds ratio for those taking more than 1600 µg was 1.69 (95% confidence interval 1.17 to 2.43), and there was a gradient with increased duration of use. The authors calculated, assuming the association was causal, that 41% of their risk was attributable to the drugs. This risk needs to be carefully balanced against the likely benefit of high dose treatment, especially in patients with chronic obstructive pulmonary disease.

Br J Ophthalmol 2003;87: 1247-51[Abstract/Free Full Text]

Starvation brings ethical dilemmas

A carefully reasoned paper in the Journal of Medical Ethics explores the psychological changes induced in hunger strikers and how this might affect their doctor's decisions on intervention. Doctors dealing with hunger strikers recognise the conflict between their duty to preserve life and their respect for the patient's autonomy. Most published ethical guidelines tend to weight the latter more than the former. Legal decisions vary between countries; British courts are more likely than those in the United States to support the right to refuse food. As starvation progresses, however, the subject's judgment may be impaired by the physiological and psychological changes accompanying starvation. Doctors need to consider this when briefing hunger strikers on possible consequences. The author says that this paper may also be useful for those treating patients with anorexia nervosa.

J Med Ethics 2003;29: 243-7[Abstract/Free Full Text]

GPs are competent at spirometry

After appropriate training, general practitioners (and their assistants) in the Netherlands performed as well as those working in specialist lung function laboratories when undertaking spirometry on patients with chronic obstructive pulmonary disease. Values obtained by GPs and laboratories may differ, so are not interchangeable, but the results support the trend towards testing in general practice settings.

Thorax 2003;58: 861-6[Abstract/Free Full Text]

View larger version (36K): [in this window] [in a new window]   Traffic calming reduces road traffic injuries A systematic review has uncovered 16 "before and after" studies of deaths and injuries related to the introduction of neighbourhood traffic calming measures. Meta-analysis showed that the pooled injury rate fell by 11%. All but one study had collected data for at least two years before and after the intervention. All studies were in Europe or Australia, so the results may not apply to low and middle income countries. Injury Prevention 2003;9: 200-4[Abstract/Free Full Text]

Dyspepsia is partly due to cognitive factors

Dietary fat can provoke unpleasant symptoms in some patients with functional dyspepsia. It now seems that symptoms can be modified by what patients know about what they have eaten. Researchers from Adelaide, South Australia, have confirmed that eating high fat yoghurt increases symptoms of fullness and bloating as well as plasma concentrations of cholecystokinin and gastric volume. However, when they deliberately misinformed patients as to the fat content of their meal, symptoms were exacerbated if they were misled into thinking they had eaten a high fat, rather than a low fat, yoghurt. This cognitive factor did not alter gastric volume or plasma cholecystokinin.

Gut 2003;52: 1414-8[Abstract/Free Full Text]

A young man presented with a chronically swollen painful left ankle. Investigations for inflammatory disease were negative and a plain x ray showed only periarticular osteopenia and a joint effusion (left). Multiple resonance imaging showed a 1 cm diameter rounded nidus (arrow, right) with surrounding synovitis (high signal intensity). This proved to be an osteoid osteoma. It was removed and a good prognosis was expected. Plain x rays may miss small bony tumours. Ann Rheum Dis 2003;62: 920-1[Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?