“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.
- Does the SAFERSleep system reduce errors in recording and administration of drugs in anaesthesia?
- Are xanthelasmata and arcus corneae associated with increased risk of ischaemic vascular disease and death?
- Is the Find and Treat service cost effective for diagnosing and managing hard to reach patients with tuberculosis in London?
- How does smoking affect population rates of tuberculosis infection and mortality?
Tuberculosis: finding, treating, and preventing
As Ibrahim Abubakar and colleagues recently highlighted in the BMJ, the incidence of tuberculosis is increasing in many UK cities, although rates are stable or falling in most western European countries. Among the responses they discussed was the “Find and Treat” programme, funded by the English Department of Health to improve diagnosis and treatment of tuberculosis among hard to reach groups—such as homeless people—in whom high loss to follow-up is a problem. Mobile chest x-ray units actively seek out people with suspected tuberculosis and help them to negotiate the health and social care system so that they can complete treatment. This week, Mark Jit and colleagues report that the project is likely to be cost effective, too. To find out more about the Find and Treat programme, listen to a podcast on bmj.com in which clinical lead Al Story talks about the challenges of combating tuberculosis on the streets (http://bit.ly/qD05Az).
Efforts to reduce tuberculosis incidence have mainly focused on detection and prevention, but some countries are struggling despite advances in these areas, leading WHO to question whether tackling risk factors for infection is the way forward. One such risk factor is smoking, but it’s not been taken into account in previous models of the disease. Sanjay Basu and colleagues’ modelling study predicts dramatic increases in the rates of tuberculosis infection and deaths if smoking trends continue along their current trajectories. However, they estimate that aggressive tobacco control (a 1% decrease in smoking prevalence per year down to eradication) would avert 27 million smoking attributable deaths from tuberculosis by 2050. (Also looking at the prevention of tuberculosis this week are Laura Cunha Rodrigues and colleagues, who discuss the uncertainty about how long BCG vaccine protects against the disease.)
Quick and cheap cardiovascular predictor right before your eyes
Perhaps doctors are tired of reading about ways to predict cardiovascular risk, when they already have several nifty computer prediction models to do it for them, but Mette Christofferson and colleagues have investigated a new use for an old eye sign. The idea of any ophthalmic marker of systemic disease may sound ominous, conjuring the prospect of squinting down an ophthalmoscope towards barely visible pathologies. But readers can breathe a sigh of relief, because this study investigated the yellowish eyelid plaques known as xanthelasma.
Didn’t we already know xanthelasma was a marker of cardiovascular disease? In their editorial, Antonio Fernandez and colleagues explain that, in fact, evidence has been conflicting. Xanthelasma has previously only been established as a marker of hyperlipidaemia.
Christofferson and colleagues found that xanthelasma was useful in predicting cardiovascular risk, and perhaps there are some distinct advantages to watching out for this simple lesion. For example, the lesions are reasonably obvious to patients, unlike some other cardiovascular markers—such as hypertension—which are easier to ignore. Noting their presence or absence is quick, cheap, and practical even for clinicians working without computers.
Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units
Julie Robotham and colleagues found that screening and decolonisation could save costs in intensive care units where MRSA is sensitive to decolonising agents, and that universal polymerase chain reaction based screening accompanied by decolonisation is likely to be an efficient use of resources.
Estimating treatment effects for individual patients based on the results of randomised clinical trials
Using rosuvastatin treatment for primary prevention of cardiovascular disease as an example, Johannes Dorresteijn and colleagues assessed the value of using trial data to make treatment decisions for individual patients, based on a predicted absolute treatment effect.