In singleton pregnancies, offering elective delivery at or beyond term (40 weeks gestation) reduces perinatal mortality.
Dodd and colleagues report the results of a randomised controlled trial of...]]>
It has now been over 15 years since the publication of the landmark study by Sazawal et al
Prelabour rupture of the membranes (rupture of the membranes prior to the onset of labour) occurs in 20% of all births.
Emergency department (ED) patients have a high prevalence of alcohol use problems making it potentially an opportune setting to intervene. Brief interventions for alcohol misuse have demonstrated efficacy in other medical settings, but within the ED it has been less clear.
The study randomised 889 adult ED patients who screened positive for hazardous...]]>
Hospitalisation represents a potent ‘teachable moment’ for the delivery of smoking cessation interventions. Many smokers are hospitalised for tobacco-related diseases that personalise the risks of persistent smoking and thereby enhance motivation to quit and receptivity to tobacco cessation assistance. Most hospitals are smoke-free and many have adopted broad, smoke-free campus policies that further restrict smoking on hospital grounds, making smoking during hospitalisation particularly difficult and inconvenient. These external restrictions increase the likelihood of smokers being amenable to the use of tobacco cessation medications to help manage symptoms of acute nicotine withdrawal. Recognising the potential value of promoting smoking cessation during hospitalisation, the US Joint Commission has established a set of tobacco cessation performance indicators in an effort to improve quality of care for hospitalised...]]>
Thangaratinam and colleagues, studied the value of pulse oximetry screening of neonates for critical congenital heart disease (CCHD). CCHD is usually defined as a congenital heart disease (CHD) that requires treatment in the neonatal period to prevent death or severe morbidity; most of these neonates have ductus-dependent lesions. About 25–40% of children born with CHD have CCHD, and 10–35% of these infants leave hospital undiagnosed. Some die at home, and others return to hospital critically ill, with resulting higher operative mortality and morbidity, increased hospital costs and suboptimal outcomes.
Pulse oximetry has been recommended to decrease these missed diagnoses, but the sensitivity and specificity of this screening method have not been thoroughly evaluated. Two large studies in...]]>
Postpartum depression (PPD) is a debilitating mental health disorder that negatively affects maternal functioning and child outcomes. Prevalence rates demonstrate that up to 19.2% of women will develop a major or minor depressive episode within the first 3 months postpartum.
Azithromycin, a widely used broad-spectrum macrolide antibiotic, belongs to the same class of antibiotics as erythromycin and clarithromycin, both of which have been associated with an increased risk of potentially lethal arrhythmias. Azithromycin has generally been viewed as ‘safe’ from a cardiovascular standpoint, but recently several reports of azithromycin-associated QT interval prolongation have been published. In an effort to ascertain whether azithromycin carries any cardiovascular risk, Ray et al evaluated the effect of its use on risk of death in a large Tennessee Medicaid cohort.
The cohort study included patients (aged 30–74 years who took azithromycin from 1992 to 2006 (347 795 prescriptions)). Subjects were excluded if they had life-threatening non-cardiovascular illness, history of drug abuse, residency in a nursing home or hospitalisation...]]>
Despite the availability of effective modern contraceptive methods, unplanned pregnancy continues to be a major problem worldwide. In 2008, the worldwide abortion rate was found to be 28/1000 women aged 15–44, unchanged from 2003 rates of 29/1000 women.
Clopidogrel inhibits the P2Y12 platelet receptor and is used in patients with acute coronary syndromes or ischaemic stroke to prevent recurrent vascular events. Proton pump inhibitors (PPIs), however, have been shown to reduce the pharmacodynamic effect of clopidogrel upon platelet inhibition, and have been linked in retrospective studies to a higher rate of ischaemic outcomes in patients taking clopidogrel.
A total of 24 471 patients in the General Practice Research Database in the UK (beginning in 2003) concurrently prescribed aspirin and clopidogrel were included. There were 12 439 (50%) patients receiving a PPI at some point during the study. The exposure of interest was prescription of a PPI, divided into strong CYP 2C19 inhibitors (omeprazole, esomeprazole and lansoprazole)...]]>
It has become clear that conflicts of interest can influence scientific judgement and reporting of research results in the medical literature.
In 2001, a Cochrane review of mammography screening questioned whether screening reduces breast cancer mortality, and a more comprehensive review in Lancet, also in 2001, reported considerable overdiagnosis and overtreatment. This led to a heated debate and a recent review of the evidence by UK experts intended to be independent.
To explore if general medical and specialty journals differed in accepting the results and methods of three Cochrane reviews on mammography screening.
We identified articles citing the Lancet review from 2001 or updated versions of the Cochrane review (last search 20 April 2012). We explored which results were quoted, whether the methods and results were accepted (explicit agreement or quoted without caveats), differences between general and specialty journals, and change over time.
We included 171 articles. The results for overdiagnosis were not quoted in 87% (148/171) of included articles and the results for breast cancer mortality were not quoted in 53% (91/171) of articles. 11% (7/63) of articles in general medical journals accepted the results for overdiagnosis compared with 3% (3/108) in specialty journals (p=0.05). 14% (9/63) of articles in general medical journals accepted the methods of the review compared with 1% (1/108) in specialty journals (p=0.001). Specialty journals were more likely to explicitly reject the estimated effect on breast cancer mortality 26% (28/108), compared with 8% (5/63) in general medical journals, p=0.02.
Articles in specialty journals were more likely to explicitly reject results from the Cochrane reviews, and less likely to accept the results and methods, than articles in general medical journals. Several specialty journals are published by interest groups and some authors have vested interests in mammography screening.
The readers of our journal most likely have busy clinical, administrative and/or teaching roles. As such, time is of the essence when thinking about answering clinical questions that arise in patient care. DiCenso and colleagues recently published a hierarchy of pre-appraised evidence called the 6S model.
To update the evidence published in a previous systematic review and meta-analysis that compared the effect of breastfeeding on risk of coeliac disease (CD).
A systematic review of observational studies published between 1966 and May 2004 on the subject was conducted in 2005. This update is a systematic review of observational studies published between June 2004 and April 2011. Pubmed, EMBASE and Cinahl were searched for published studies that examined the association between breastfeeding and CD.
After duplicates were removed 90 citations were screened. Four observational studies were included in the review. Two of three studies which had examined the duration of breastfeeding and CD reported significant associations between longer duration of breastfeeding and later onset of CD (OR ranged from 0.18 to 0.665). Breastfeeding during the introduction of gluten to the infant was reported to have a protective effect in two studies.
Our findings support previous published findings that breastfeeding seems to offer a protection against the development of CD in predisposed infants. Breastfeeding at time of gluten introduction is the most significant variable in reducing the risk. Timing of gluten introduction may also be a factor in the development of CD.
Egg allergy is now one of the most common food allergies in infants and children in Australia, North America, the UK and Europe. Although the natural history of egg allergy is for tolerance and resolution in a significant portion of children, emerging trends suggest that this resolution may be less common and occur at an older age than previously believed.
Egg and egg proteins are ubiquitous and strict avoidance is both difficult and burdensome for the individual, family and school. Avoidance of allergen forms the mainstay of current treatment for food allergy. It is therefore a therapeutic priority to establish safe and effective means of desensitising or accelerating natural tolerance to food allergens. Egg allergy is...]]>
Diabetic nephropathy is the commonest cause of end-stage renal disease (ESRD)
Prematurity prevention continues to be one of the biggest challenges in perinatal medicine. Most pregnancies complicated by preterm birth occur in gestations without any historical risk factors. The most effective therapeutic approach for the asymptomatic patient with a short cervix continues to evolve. For over 50 years, the cervical pessary has been used to treat women at risk of cervical insufficiency and preterm delivery. However, the value of the pessary in preventing prematurity in patients without historical risk factors has not been properly studied.
The cervical pessary in pregnant women with a short cervix (PECEP) trial by Goya and colleagues, represents the largest randomised study of cervical pessary in asymptomatic...]]>
Lung cancer is the leading cause of cancer death worldwide.
In 2005, the US Preventive Services Task Force (USPSTF) updated its 2002 hormone replacement therapy recommendations, advising against the routine use of oestrogen and progestin (E+P) and unopposed oestrogen (E) to prevent chronic conditions in menopausal women. Menopausal hormone therapy (MHT) had been commonly prescribed to prevent conditions such as cardiovascular disease, dementia and osteoporosis. Clinical trial data dramatically changed clinical practice. The Heart and Estrogen/Progestin Replacement Study (HERS) examined conjugated equine oestrogen (CEE)+medroxyprogesterone acetate in women with coronary disease; hormone therapy did not decrease coronary events. Primary prevention was studied in the Women's Health Initiative (WHI) trial: E+P or E in women with hysterectomy. Both trials were terminated prematurely...]]>
Urinary tract infection (UTI) is a common clinical problem that often recurs, leading to the institution of preventive measures for recurrent UTI (rUTI).
Diabetes increases the risk of death twofold; identifying novel modifiable risk factors could improve patient outcomes and focus healthcare spending in areas with the highest return. Non-adherence to prescribed medications and clinic appointments may be independent risk factors for excess mortality.
Currie and colleagues performed a database review of insulin-treated patients with type 2 diabetes who followed up for 6 months prior to insulin initiation and at least 30 months post-insulin initiation during which compliance with any medications and appointments were evaluated. Mortality was assessed from the end of 36 months (index date) which fell between 2000 and 2009. Information from 15 984 charts was collected until death or data censorship (median and IQR observation time was 3.16 (1.50 to 5.37)...]]>
Calcium supplementation is widely used to maintain bone health. Growing data suggests that calcium supplementation, but not dietary calcium intake, may harm cardiovascular (CV) health.
The Heidelberg prospective cohort of the European Prospective Investigation into Cancer and Nutrition study data was examined to evaluate the associations of calcium intake (total or separated dairy and non-dairy sources) and calcium supplementation with myocardial infarction (MI), stroke and...]]>
The paper by Li et al addresses a topic that has been much studied and debated over the last several decades: the relationship between type of infant feeding and growth in the first year of life. This study adds a new twist, however: the consideration of bottle feeding, even among infants who receive breast milk via the bottle, rather than formula. Although formula and other nonhuman milk can be provided only by bottle, breast milk can be provided either via the breast or the bottle. Many breastfeeding mothers, particularly those who choose to or are obligated to return to work during breastfeeding, will pump their milk to provide bottled breast milk for their infants during their absence.
The effect of coffee consumption on health is being re-examined based on new evidence suggesting a beneficial effect of components in coffee other than caffeine,
Induction of labour can be utilised to intervene in a pregnancy when the risks of ongoing pregnancy outweigh that of intervention. Elective induction of labour is labour induction without a clear medical or obstetric indication. It is widely believed to increase caesarean delivery, posing unnecessary risks to mother and fetus.
While many past observational studies
Ballard C, Corbett A. Randomised controlled trial: A small proportion of people with dementia and neuropsychiatric symptoms experience clinically significant worsening when antidepressants are discontinued. Evid Based Med 2013;18:27–28. The following Acknowledgement statement was omitted from the original article: "The authors thank the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London for supporting the work for this manuscript. This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health."
]]>Two recent articles have demonstrated a strong positive correlation between population-level consumption of either chocolate
Interestingly, some ‘low Nobel prize’ countries (eg, China and Japan) with low milk consumption have a high prevalence of adult lactose intolerance, whereas in ‘high Nobel prize’ countries (eg, Sweden, Denmark, UK) this is rare. As such, we feel that the milk consumption hypothesis (either...]]>