Editor's Choice US editor's choice

US Highlights

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39057.387593.BE (Published 07 December 2006) Cite this as: BMJ 2006;333:0-g
  1. Douglas Kamerow, US editor (dkamerow{at}bmj.com)

    Many patients with mildly to moderately severe community-acquired pneumonia are switched from intravenous to oral antibiotics early in their hospital stay to cut costs and get them out of hospital. Jan Oosterheert et al tested this strategy on patients with severe pneumonia in a randomized trial (doi: 10.1136/bmj.38993.560984.BE). They found that if the patients were clinically stable on hospital day three, switching them to oral antibiotics was safe and led to a two-day decrease in hospital length of stay. Graham Mills and Richard Laing state in an editorial (doi: 10.1136/bmj.39050.672639.80) that the days of “one treatment fits all” for community acquired pneumonia are over and that more research should further define personally customized treatments for these patients.

    The ever-growing population of aging baby-boomers makes finding treatments for Alzheimer's dementia increasingly important. Maud Graff and colleagues conducted a randomized trial (doi: 10.1136/bmj.39001.688843.BE) in of 10 occupational therapy sessions for community dwelling Dutch patients with mild to moderate Alzheimer's. The result was a clinically significant improvement in daily function, helping both the patients and their caregivers. In a related editorial (doi: 10.1136/bmj.39051.484421.80), Jeannette Golden and Brian Lawlor point out that non-pharmacological treatments for Alzheimer's such as these complement drug therapy and are very much needed.

    Finally, RJ Heine and colleagues review (doi: 10.1136/bmj.39022.462546.80) the management of hyperglycemia in type 2 diabetes. While they concede there is little clinical trial evidence for the algorithm they propose, they advocate institution of lifestyle changes and metformin when the patient is first diagnosed with diabetes. Their advice is to stay ahead of hyperglycemia by adding a second oral agent or insulin before there is runaway hyperglycemia. Aggressively treating hyperglycemia offers the best chance of preventing complications and (possibly) slowing the decline of β-cell function.

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