“A new discipline is born: comparative health-systems studies […]
Lancet 2 Dec 2006
Category: Richard Lehman’s weekly review of medical journals
Arch Intern Med 27 Nov 2006
This meta-analysis of statins for the primary prevention of cardiovascular disease looks at seven major trials which included people without known cerebral, coronary or peripheral artery disease. A variety of statins all produced a reduction in major coronary and cerebrovascular events, but no significant reduction in mortality. […]
Fungus of the Week: Lepista nuda
This is the wood blewit, common in late autumn and early winter along paths among leaf-litter. The cap is purplish brown and usually a bit twisted, and the gills and stem are a distinct purple. This effectively distinguishes this excellent edible fungus from any poisonous species. […]
JAMA 22/29 Nov 2006
The Spine Patient Outcomes Research Trial (SPORT) tried to randomise patients with disc herniation and radicular signs to receive either open discectomy or non-operative treatment. But the referee couldn’t keep control, and players kept changing sides and leaving before full time –fun to watch if you like that sort of thing. […]
NEJM 23 Nov 2006
The influenza season is now upon us, so it’s time again to lie awake thinking about the possibility of pandemic avian influenza A. You may remember that when The Rational Clinical Examination asked “Does this patient have influenza? […]
BMJ 25 Nov 2006
As a jobbing clinician, how often do you use a prognostic scoring system? Never, would be the answer for most of us, though we have a vague idea about the prognostic significance of various (mostly cancer-related) terms such as Duke’s C or Gleason 6. When I looked at prognostic scoring systems for heart failure […]
Lancet 25 Nov 2006
Ever heard of ancrod? It’s a tissue plasminogen activator which improves stroke outcomes slightly if given within a short time. However, this study shows no benefit in patients with acute ischaemic stroke who receive it at between 3 and 6 hours after the event. […]
Ann Intern Med 21 Nov 2006
I’m sure that individual susceptibility to the effect of drugs has been known from before the dawn of civilisation: in oral epics, most chieftains hold their drink better than underlings. As soon as there was Mendelian genetics, there was phamacogenetics – the linking of particular genes to particular drug responses. Now we have pharmacogenomics […]
Fungus of the Week: Amanita muscaria
You are unlikely to find the story-book red spotted caps of this fungus so late in the season, but I nominate it for illustrating that primitive tribes – in this case from Siberia – can show a sophisticated understanding of pharmacology. Groups of Siberian tribesmen would get their women to chew the fungus […]
JAMA 15 Nov 2006
Working in a urology unit thirty years ago, I was struck by the discrepancy between male patients’ symptoms of urgency, frequency and nocturia and the size of their prostates, which in those days we were very keen to remove. We tended to ignore the bladder, though that is where the problem often lies. […]