Journal rackBMJ 2003; 327 doi: https://doi.org/10.1136/bmjusa.02070002 (Published 19 November 2003) Cite this as: BMJ 2003;327:E124
From BMJ USA 2002;July:414
This section calls attention to new studies and systematic reviews, selected by the Editor from journals published just as this issue went into production (approximately 2 months before publication). The Journals hand-searched for the Journal Rack are: American Journal of Medicine, American Journal of Preventive Medicine, Annals of Internal Medicine, Circulation, JAMA, Journal of Family Practice, Journal of General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, and Pediatrics. Studies are noted that might directly influence clinical practice decisions in primary care and have been classified by type of problem addressed.
Cardiovascular—Two randomized trials, one in the US involving 569 patients and the other in the UK involving 1090 patients, found that immediate surgical repair of abdominal aortic aneurysms measuring 4–5.4 cm in diameter did not improve survival over ultrasound surveillance followed by surgery when the aneurysms enlarged beyond 5.5 cm or became symptomatic. In the British trial patients in the early surgery group had lower all-cause mortality after 8 years, a finding attributed to higher smoking cessation rates and healthier lifestyle (Lederle et al. N Engl J Med May 9 2002;346:1437–1444; The United Kingdom Small Aneurysm Trial Participants. N Engl J Med May 9 2002;346:1445–1452).
Endocrine—A randomized controlled trial involving 339 relatives of patients with type 1 diabetes who faced a >50% risk of developing the disease in 5 years found that administering low-dose insulin did not delay or prevent type 1 diabetes (Diabetes Prevention Trial—Type 1 Diabetes Study Group. N Engl J Med May 30 2002;346:1685–1691).
Geriatric—Modeling of survey and cohort data suggests that prescription analgesics increase the risk of falls among community-dwelling elders by 55–85% (Richardson et al. J Am Board Fam Pract May-June 2002;15:178–182).
Geriatric—A study in the Netherlands (where laws against euthanasia and assisted suicide are not enforced if certain conditions are met) found that euthanasia was requested by 35 (17%) of 279 patients with amyotrophic lateral sclerosis (Veldink et al. N Engl J Med May 23 2002;346:1638–1644).
Gynecologic—A meta-analysis of 12 studies concluded that estrogen replacement therapy more than doubles the risk of venous thromboembolism, more so in the first year of use, with an absolute rate increase of 1.5 venous thromboembolic events per 10 000 women in 1 year (Miller et al. Ann Intern Med May 7 2002;136:680–690).
Infectious Diseases—A national survey of 18 045 persons age 6 and older conducted in 1988–1994 found protective diphtheria and tetanus serum antibody levels in 61% and 72% of the population, respectively, due mainly to low titers in adults (McQuillan et al. Ann Intern Med May 7 2002;136:660–666).
Oncologic—A randomized trial involving more than 1000 women found that those who received tailored print materials and telephone counseling about breast cancer screening had greater knowledge, more accurate risk perceptions, and a 40% greater likelihood of obtaining mammography. The group that received print materials alone had lower screening rates than those receiving usual care (Rimer et al. Am J Prev Med May 2002;22:247–257).
Oncologic—Two cohort studies involving women with BRCA1 or BRCA2 mutations (one with 170 subjects and the other with 551 subjects) reported that prophylactic salpingo-oophorectomy lowered the risk of breast cancer and of BRCA-related gynecological cancer or coelomic epithelial cancer (Kauff et al. N Engl J Med May 23 2002;346:1609–1615; Rebbeck et al. N Engl J Med May 23 2002;346:1616–1622).
Orthopedic—A Dutch randomized trial involving 183 adults with nonspecific neck pain of at least 2 weeks' duration found that success rates at 7 weeks were 68% for manual therapy (mobilization or manipulation), 51% for physical therapy, and 36% for continued care by the general practitioner (Hoving et al. Ann Intern Med May 21 2002;136:713–722).
Pediatric—A 1995 survey of 6733 singleton births found that women with unwanted unintended pregnancies were 1.7 times as likely to defer or discontinue breast-feeding as were women with intended pregnancies (Taylor and Cabral. J Fam Pract May 2002;51:431–436).
Pediatric—A randomized trial involving 335 children age 2–6 with persistent asthma found that nebulized budesonide inhalation suspension achieved a lower exacerbation rate (1.23 vs 2.41 per year) and other reductions in asthma symptoms compared with cromolyn sodium nebulizer solution (Leflein et al. Pediatrics May 2002;109:866–872).
Pediatric—Mothers who were taught how to examine their infants for jaundice and to use an Ingram icterometer achieved positive predictive values of 55% and 44%, respectively, in identifying infants with a bilirubin level >12 mg/dL but identified all cases with bilirubin levels >17 mg/dL (Madlon-Kay. J Fam Pract May 2002;51:445–448).
Pediatric—A national survey found that smoking among Caucasian female adolescents was inversely associated with intake of milk, fruit, fruit juice, and vegetables (Wilson and Nietert. Am J Prev Med May 2002;22:240–246).
Prevention—A meta-analysis of 552 studies of strategies to improve adult immunizations and cancer screening found that the most effective measures involved organizational systems changes, followed by financial incentives for patients and patient reminders (Stone et al. Ann Intern Med May 7 2002;136:641–651).
Prevention—A telephone survey of 1203 adults in three US cities found that 66% believed annual physical examinations were necessary; greater than 90% expected to receive specific examination procedures, many of which are not supported by evidence, but only 33% remained interested in an annual physical when they learned about out-of-pocket costs (Oboler et al. Ann Intern Med May 7 2002;136:652–659).
Pulmonary—A Dutch study involving 141 patients with suspected pulmonary emboli reported that contrast-enhanced magnetic resonance angiography had a sensitivity of 77% in detecting the 35 cases of pulmonary emboli confirmed on conventional pulmonary angiography (Oudkerk et al. Lancet May 11 2002;359:1643–1647).
Pulmonary—A randomized trial involving 220 patients with acute bronchitis found that quality of life one week later was no better when patients were treated with azithromycin rather than the control treatment (vitamin C) (Evans et al. Lancet May 11 2002;359:1648–1654).
Rheumatologic—A meta-analysis of 11 studies concluded that S-adenosylmethionine, an alternative therapy for osteoarthritis, is as effective as nonsteroidal anti-inflammatory drugs in controlling pain and function and is associated with fewer reported adverse effects (Soeken et al. J Fam Pract May 2002;51:425–430).
Substance Abuse—Audiotapes of 68 encounters between general internists and patients who had previously screened positive for at-risk drinking revealed that providers asked questions and offered information but gave alcohol-related advice in only 21% of visits (Bradley et al. J Gen Intern Med May 2002;17:315–326).
Substance Abuse—A randomized trial involving 136 patients in moderate alcohol withdrawal found that carbamazepine and lorazepam were comparably effective in reducing withdrawal symptoms but carbamazepine performed better in preventing rebound withdrawal symptoms and in reducing post-treatment drinking (Malcolm et al. J Gen Intern Med May 2002;17:349–355).