Investigating renal colic . . . and other stories
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m52 (Published 16 January 2020) Cite this as: BMJ 2020;368:m52
Renal colic
A study in the US tracked more than 50 000 adults aged 18 to 64 who presented to an emergency department with renal colic (JAMA Netw Open doi:10.1001/jamanetworkopen.2019.16454). Although more than three quarters were investigated by computed tomography, fewer than 1 in 10 underwent any sort of urological procedure within the first month. Most were rapidly discharged and only 1 in 20 returned to hospital within the first week. These data imply that a large proportion of patients with renal colic pass their stone spontaneously and raise questions about the need for immediate investigation.
Magnesium sulfate
Magnesium sulfate is used increasingly for pre-eclampsia, eclampsia, and preterm fetal neuroprotection. It’s just as well then, that a systematic review of 197 studies, 40 of them randomised trials, discovered little evidence of adverse effects (PLoS Med doi:10.1371/journal.pmed.1002988). The findings for both the primary outcome of the review, perinatal death, and a long list of secondary outcomes including stillbirth, need for intubation, and intraventricular haemorrhage were reassuring. The only caveat is that many of the outcomes weren’t consistently recorded or reported.
Surgical check lists
Pre-surgery check lists are credited with reducing medical errors and improving patient safety. But they are sometimes skipped because it’s thought that if the questions are asked in front of patients they cause stress and anxiety. A small survey from a hospital in Switzerland suggests that the opposite is true (Eur J Anaesthesiol doi:10.1097/EJA.0000000000001138). Patients having ear, nose, and throat surgery were interviewed before the operation and on the first postoperative day. None reported that the questions caused them discomfort and they thought that the checklist was likely to reduce errors.
Antiviral drugs without a prescription
Oseltamivir is most effective if taken soon after the onset of symptoms of flu. So why not make it an over-the-counter medication which people can access quickly and easily? What’s more, if patients didn’t have to make contact with their general practices, there would be less likelihood of the virus being spread while they waited to obtain a prescription. On the other hand, allowing the drug to be obtained from pharmacies might lead to overuse or delayed diagnosis of infections mimicking flu. An infectious diseases expert weighs up the pros and cons in a blog (https://blogs.jwatch.org/hiv-id-observations/index.php/should-oseltamivir-become-an-over-the-counter-drug/2019/12/15/).
Statins and cognitive function in the elderly
A prospective study of 1000 community living Australians aged between 70 and 90 looked at trajectories of performance in tests of memory and cognition over a six year period (J Am Coll Cardiol doi:10.1016/j.jacc.2019.09.041). It found no differences between people who were taking statins and those who had never used them. If anything, statin use reduced decline in memory—especially in people with heart disease or who were carriers of apolipoprotein E4. Magnetic resonance brain imaging in a subgroup of the cohort detected no effect of statins on total brain volume or on hippocampal or parahippocampal volumes.