{"id":12440,"date":"2011-11-11T11:11:19","date_gmt":"2011-11-11T10:11:19","guid":{"rendered":"https:\/\/stg-blogs.bmj.com\/bmj\/?p=12440"},"modified":"2011-11-11T11:11:19","modified_gmt":"2011-11-11T10:11:19","slug":"research-highlights-11-november-2011","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2011\/11\/11\/research-highlights-11-november-2011\/","title":{"rendered":"Research highlights &#8211; 11 November 2011"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/research-methods-and-reporting.jpg\" alt=\"Research questions\" width=\"160\" height=\"110\" align=\"left\" \/>&#8220;Research highlights&#8221; is a weekly round-up of research papers appearing in the print <em>BMJ<\/em>. We start off with this week\u2019s research questions, before providing more detail on some individual research papers and accompanying articles.<!--more--><\/p>\n<ul>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6462\">Can exercise referral schemes improve health outcomes in individuals with or without pre-existing conditions?<\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6404\">How do outcomes of elective surgery differ between independent sector treatment centres and NHS providers?<\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6788\">What part do receptionists play in the quality and safety of repeat prescribing in general practice?<\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d5824\">What are the experiences and needs of men who develop erectile dysfunction after colorectal cancer treatment?<\/a><\/li>\n<\/ul>\n<p><strong>Exercise referral schemes: a case for disinvestment?<br \/>\n<\/strong>We have guidance on how much exercise to do, how often, what the health benefits are, and how to adapt exercise in disease and at different times of life. But how should doctors help their patients to meet these targets? Should they give advice, give leaflets, or use specific exercise referral schemes?<\/p>\n<p>In 2006 there was insufficient evidence to support exercise referral schemes, according to the UK National Institute for Health and Clinical Excellence. But they called for more trials to investigate how good the schemes were. <a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6462\">In their systematic review<\/a>, Toby Pavey and colleagues examine whether such schemes have increased exercise or improved health outcomes.<\/p>\n<p>Interpreting their findings is challenging because of heterogeneity; schemes and their outcomes differed, and some were of poor quality. Despite small increases in short term exercise and a reduced level of depression, Pavey\u2019s team seem unconvinced that exercise referral schemes are worth it. Similar improvements can be achieved by brief advice and written materials provided by a general practitioner, <a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6615\">writes Nefyn Williams in a linked editorial<\/a>. Where does that leave referral schemes at a time when finances are limited?<\/p>\n<p>Given these new findings, doctors may feel more inclined to revisit some recent publications, such as Karim Khan and colleagues\u2019 list of 10 practical steps on how to prescribe exercise (<a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4141\">BMJ 2011;343:d4141<\/a>). It links to other helpful resources, such as a Swedish physical activity guide, and websites containing useful patient information leaflets about exercise for those with specific diseases. Useful to bookmark for patients inspired to exercise in the run-up to the London Olympics.<\/p>\n<p><strong>Men\u2019s experiences of erectile dysfunction after treatment for colorectal cancer<br \/>\n<\/strong>\u201cI presumed it to be an effect of chemotherapy which surprised me, I did some Googling and found that it was in fact most likely an effect from the surgery and to be honest I was annoyed that I didn\u2019t know about it,\u201d explained one man in this <a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d5824\">qualitative interview study by George Dowswell and colleagues<\/a>. Another, aged 72 reported: \u201cHe said \u2018at your age I don\u2019t think it will matter\u2019 and he was nearly as old himself (Laughs) I thought \u2018that\u2019s a bloody cheek.\u2019 You know, I said to myself \u2018well he\u2019s nearly as old as me.\u2019\u201d<\/p>\n<p>Such reports of ageism and inadequately informed surgical consent make uncomfortable reading. The authors rightly avoid extrapolating too far from their interview study with 28 men, but they don\u2019t pull their punches. Given these qualitative findings, and the same team\u2019s earlier survey showing that 75% of men report erectile dysfunction after treatment for colorectal cancer (J Sex Med 2010;7:1488-96), the authors conclude in their <em>BMJ<\/em> pico summary that \u201cmost men with colorectal cancer develop erectile dysfunction after treatment. This paper suggests that clinicians are inadvertently neglecting, misleading, and offending such patients.\u201d<\/p>\n<p><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6366\">In a linked editorial colorectal surgeon Larissa Temple<\/a> notes the study\u2019s limitations, but says it has generated important hypotheses for future research. She also calls for clinical practice guidelines on identifying and managing functional problems after treatment for colorectal surgery. Disappointingly, this week\u2019s summary of NICE guidance on the diagnosis and management of colorectal cancer doesn\u2019t mention erectile dysfunction among the harms of treatment.<\/p>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6617\">Dietary fibre, whole grains, and risk of colorectal cancer<br \/>\n<\/a><\/strong>Dagfinn Aune and colleagues\u2019 systematic review and meta-analysis found that high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. They found no significant evidence of an association with intake of fibre from fruit, vegetables, or legumes.<\/p>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6829\">Prognostic effect size of cardiovascular biomarkers in datasets from observational studies versus randomised trials<br \/>\n<\/a><\/strong>Cardiovascular biomarkers often have less promising results in the evidence derived from randomised controlled trial populations than from observational studies, report Ioanna Tzoulaki and colleagues.<\/p>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d6500\">Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity<br \/>\n<\/a><\/strong>In the \u201cLighten Up\u201d randomised controlled trial, Kate Jolly and colleagues found that commercially provided weight management services were more effective and cheaper than primary care based services led by specially trained staff.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;Research highlights&#8221; is a weekly round-up of research papers appearing in the print BMJ. We start off with this week\u2019s research questions, before providing more detail on some individual research papers and accompanying articles. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2011\/11\/11\/research-highlights-11-november-2011\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-12440","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/12440","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=12440"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/12440\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=12440"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=12440"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=12440"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}