Dermatitis, incontinence and vital signs

Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers.

Steroid plus emollient: an effective treatment for recurrent dermatitisRelapses in atopic dermatitis Br J Dermatol 2008; 158: 801-7
We often seem to be 'fire-fighting' with eczema - treating relapses with steroid creams only to have a recurrence a few weeks later - so I found this concept appealing.

In a multi-centred, double-blind, randomised, controlled trial, 221 patients who had been treated for severe or very severe flare up of atopic dermatitis were randomised to receive 16 weeks of either emollient only, or emollient plus twice-weekly methylprednisolone aceponate.

The time to relapse was longer in the steroid-treated patients, with the probability of remaining relapse free at 16 weeks being 87.1 per cent as opposed to 65.8 per cent in the control group.

The authors conclude that this treatment appears to be effective and safe, and I should think appropriate for use in general practice.

Vital signs in acute infections Br J Gen Pract 2008; 58: 236-41
NICE has recommended that all children presenting with febrile illness should have temperature, heart rate, respiratory rate and capillary refill time measured.

This survey sets out to find out how often GPs make these measurements and what part this plays in decision-making.

A total of 162 GPs working near Oxford responded to the questionnaire, designed to gather data in the under five years age group. Half of the GPs measured temperature, 21 per cent monitored pulse and 17 per cent measured respiratory rate, at least weekly. Almost half never measured capillary refill time.

When asked what values they would consider normal, there was little consensus. Doctors generally considered observations of behaviour and activity, and their own global judgment more useful than vital signs.

The authors feel that if NICE guidelines are to be followed, GPs need to improve their rates of measurement and appreciation of normal ranges of vital signs.

Cancer in women with CIN 3 Lancet Oncol, April 2008. DOI: 10.1016/S1470-2045(08)70103-7
This unusual New Zealand based study aimed to establish the risk of invasive disease in patients with cervical intraepithelial neoplasia 3 (CIN 3).

Between 1965 and 1974, a number of patients with CIN 3 were not treated. This group of patients was compared to those who received conventional treatment; 1,063 women were included in the study.

Of those who were managed by biopsy alone, with no further intervention, the risk of cervical cancer was 31.1 per cent at 30 years, whereas 0.7 per cent of women in the treatment group developed the disease over the same period of time.

The study reveals a clear risk estimate for invasive disease in patients with CIN 3 and demonstrates the advantage for active management in such patients.

Urinary incontinence treatments Ann Intern Med 2008; 148: 459-73
Urinary incontinence is a common presentation, increasing with age. We all have our favourite treatments and this review of 96 randomised controlled trials attempts to give some answers as to what works and what doesn't.

All kinds of urinary incontinence were included, although preferred treatments for pure stress incontinence will usually differ from detrusor instability.

Pelvic floor muscle training when combined with bladder training was effective, although bladder training on its own had no effect. Also the time-honoured drugs, such as oxybutynin and tolterodine, showed consistent effect. Injectable bulking agents showed an inconsistent improvement, while electrical stimulation was ineffective.

Paradoxically, oral hormone administration made incontinence worse, while vaginal and transdermal oestrogen improved the situation. The relatively new treatment for stress incontinence, duloxetine, increased improvement rates and quality-of-life scores but failed to show better curative effects than placebo.

It is comforting to know that what we are already doing in general practice appears to give most benefit in this distressing condition.

Statins and colorectal cancer Pharmacoepidemiol Drug Saf 2008; Online first
Statins are often implicated in potential non-lipidogenic effects and there has been recent press coverage on the effect of statins on BP lowering.

This interesting case-controlled study, using the General Practice Research Database, aimed to establish whether statins are protective against colorectal cancer.

To qualify as a statin user, participants had to be taking standard-dose statins cumulatively for at least five years. Some 4,432 cases of colorectal cancers were identified with approximately 10 controls used per case.

Analysis showed that statins were not significantly protective but their use tended towards a reduction in colorectal cancer. Further data is required to establish whether statins are indeed protective against this cancer, whether this is a class effect and if statin dosage influences the outcome.

Dr Glenesk is a GP trainer in Aberdeen

The quick study

  • Recurrent dermatitis can be treated safely and effectively with emollient plus methylprednisolone aceponate.
  • Vital signs should be measured by GPs in all children presenting with febrile illness, as well as relying on observations and judgment.
  • Cervical cancer risk in women with CIN 3 is significantly greater in those who are not treated than in those who receive conventional treatment.
  • Urinary incontinence can be effectively treated using pelvic floor muscle training combined with bladder training.
  • Statins may have a protective effect against colorectal cancer but more research is needed.

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