All you need to read in the other general journalsBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39520.681991.80 (Published 20 March 2008) Cite this as: BMJ 2008;336:636
Regular personal support helps high risk slimmers maintain weight loss
Losing weight is hard enough, but keeping it off is an even greater challenge, say researchers. All the successful slimmers in their recent trial gradually regained weight. Those left to their own devices regained significantly more than those who had regular telephone and face to face support, but the difference was disappointingly modest—at 30 months controls had regained 5.5 kg, whereas those given personal support had regained 4 kg (P=0.01)⇑.
A third group had access to an interactive website where they could set goals, plot their progress, and learn how to keep motivated. This group did better than controls for about two years, but had regained as much weight as controls by the end of the 30 month follow-up.
All 1032 participants were overweight or obese with a high risk of cardiovascular disease at the start of the trial. They lost a mean of 8.5 kg in a six month run-in period before randomisation. Weight regain is likely to be even more of a problem in unselected populations without a good track record.
All three groups kept control of their calorie intake during follow-up. Exercise was more of a problem. Participants managed an extra 48 minutes a week during the six month weight loss phase, but couldn’t maintain it after randomisation.
Men still hold the power in biomedical publishing
Between 1970 and 2005, 16 of the most influential medical journals had 118 editors in chief. A study of sex equality in biomedical publishing found that only eight of them were women. The same journals had 3237 editorial board members, 371 of whom were women. Equality has improved over the years—16% of editorial board members were female in 2005 up from 1.4% in 1970—but men still hold the lion’s share of the power. Eleven of the 16 journals studied, including the BMJ, had no female editors during the 35 year study period.
The authors found that general medical journals from the UK and Canada appointed significantly more women to their editorial boards (29/107; 27%) than similar journals from the US (6/50; 12%), although these figures are just a snapshot of five journals in the year 2000, so they should be treated with caution.
Does it matter if senior positions at biomedical journals are top heavy with men? At least one prominent female editor thinks so. Sex biased editorial boards means sex biased journal content, she writes in a linked editorial, and a skewed influence on the wider community (p 449). Journals should start by encouraging women reviewers and making sure they are considered alongside men for a place on the editorial board.
The kiss of death for the kiss of life?
When emergency services personnel in Arizona abandoned traditional cardiopulmonary resuscitation for out of hospital cardiac arrests and adopted a new protocol—which emphasises repeated chest compressions with minimal artificial ventilation—survival to hospital discharge increased from 1.8% to 5.4% (4/218 v 36/668; odds ratio 3.0, 95% CI 1.1 to 8.9). Patients who had a witnessed cardiac arrest from ventricular fibrillation did even better (4.7% (2/43) to 17.6% (23/131); 8.6,1.8 to 42.0).
The new protocol, called minimally interrupted cardiac resuscitation, starts with two minutes of chest compressions. Rescuers then do a rhythm check and give one shock if indicated, followed immediately by another two minutes of chest compressions. The cycle is repeated while the patient has high flow oxygen but no positive pressure ventilation for at least three cycles. Adrenaline is given early.
There are good theoretical reasons why the new method might work better than chest compressions interrupted by attempts at ventilation and repeated shocks, writes an editorial (p 1188). Guidelines are already moving away from overenthusiastic artificial ventilation during cardiopulmonary resuscitation, and these observations support that general trend. The improvements reported here look impressive, but it is too early to say if the new protocol was entirely responsible. Proper clinical trials should come next.
Most adults with sinusitis don’t need antibiotics
A new meta-analysis looking at the effects of antibiotics in people with possible sinusitis reports a number needed to treat of 15⇑. That means one extra person would be cured for every 15 people treated with antibiotics. Are antibiotics justified? Probably not, say the authors and a linked comment (p 874). The confidence intervals around this figure were very wide and the upper limit included the possibility that antibiotics do net harm compared with placebo (one less patient cured for every 190 given antibiotics).
Patients with relatively severe or longlasting symptoms were no more likely to benefit from antibiotics than anyone else. Those with a purulent nasal discharge took longer to get better, but antibiotics did not reliably speed their recovery in this analysis. Symptoms such as face pain, tooth pain, and pain on bending did not help identify patients likely to have a bacterial infection that would respond to antibiotics. The authors conclude that watchful waiting and symptomatic treatments are enough for most adults with symptoms of sinusitis. Most trials, however, excluded people with a high fever, periorbital swelling, erythema, or intense facial pain.