Journals Watch - Abortion, Alzheimer's and angina

Too busy to keep up with the journals? Let Dr Gwen Lewis be your guide to the latest research.

NEGATIVE EXPERIENCES OF ABORTION SERVICES - J Fam Plann Reprod Health Care 2006; 32: 15-18

One of the government's targets is to reduce teenage pregnancy but at present the NHS is struggling to manage demand for abortion both in teenagers and older women who do not wish to continue with their pregnancy.

The study examined case notes of women referred for abortion in Durham, and their GPs and the women themselves were surveyed about the referral. I was particularly concerned to read that 15 per cent of the women had to make a second appointment with a second GP before the referral to secondary care took place, obviously extending this traumatic time.

The women themselves wanted to be treated with respect most especially, to be given appropriate information about the referral and the procedure, and to be referred promptly.

It was also alarming to read that in this study fewer than a third of the abortions were carried out within the national standard of three weeks from first appointment with the referring doctor. There is lots of room for improvement in this service provision.

A WALK A DAY KEEPS DEMENTIA AT BAY - MJA 2006; 184: 68-70

If this study is to be believed, then the older patient should drink in moderation, garden daily and, if male, take a daily walk in order to reduce the risk of dementia.

The study followed 2,805 men and women aged 60 years and over initially free of any cognitive impairment over 16 years, during which time about 10 per cent developed dementia.

Any intake of alcohol predicted a 34 per cent lower risk, and daily gardening a 36 per cent lower risk, while for men daily walking predicted a 38 per cent lowering of risk. Severe depression raised the risk by 50 per cent.

So when I reach that age I know what I shall be doing. Here's to that glass or two of Chianti in the garden after a brisk walk.

PREDICTING PROGNOSIS IN STABLE ANGINA - BMJonline doi: 10.1136 38695.605440

Is there any way of predicting more serious cases of angina? This multicentre pan-European survey looked at 3,031 patients over 12 months following a new diagnosis of angina with death and non-fatal MI as the main outcome measure. This measure was found to be 2.3 per cent per 100 patient years.

Adverse outcome was associated, not surprisingly, with co-morbidity, diabetes, shorter duration of symptoms, increasing severity of pain, abnormal ventricular function, resting ECG changes and the absence of stress test.

It was proposed that a score could be devised based on the simple variables which could be used to differentiate between those patients at high and low risk.

BP MEASUREMENT PITFALLS - Fam Pract 2006; 23: 20-2

BP measurement is of huge importance but just how accurate are the BP readings we take? A recent review in GP made a point in favour of electronic sphygmomanometers which will remove observer error (20 January), but BP is known to vary.

This study looks at the considerable variation in different BP measuring methods as suggested in guidelines. These methods included a single BP reading, or mean of two initial readings, or at least four readings with mean of the last three readings taken, or first two consecutive readings with maximum of 5mmHg difference.

Differences between methods was up to 7.9mmHg and could obviously therefore lead to overestimation of mean BP. The study did not come up with a conclusion as to the most accurate measuring method.

Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals

INFORMING PATIENTS

Abortion provision needs much improvement, with fewer than a third of abortions carried out within the national standard period.

Dementia risk in men is reduced by daily walks.

Angina prognosis could be measured by a scoring system based on simple variables, researchers hope.

Mean BP can vary depending on measurement methods, leading to it being overstated.

RESEARCH OF THE WEEK

An unusual treatment for snoring - BMJonline doi:10.1136 38693.465023

If you snore, or better still, if your partner snores, then go and buy a didgeridoo. Effects of didgeridoo playing on daytime sleepiness and other outcomes related to sleep and on snoring were studied.

Didgeridoo players had improved daytime sleepiness and apnoea/dyspnoea index, and partners reported less sleep disturbance.

Taking up didgeridoo playing sounds like a good and cheap suggestion to make to patients complaining of snoring. I'm not sure that their neighbours will approve though.

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