Journals Watch - Aneurysm screening and fibrates

Missed out on the latest research? Let Dr Simon Hunter bring you up to date with the journals.

MRI scan showing an aneurysm of the abdominal aorta at the level of the kidneys (Photograph: SPL)
MRI scan showing an aneurysm of the abdominal aorta at the level of the kidneys (Photograph: SPL)

Benefits of abdominal aortic aneurysm screening Br J Surg 2010; 97: 826-34
Any screening test should be both clinically and cost effective for it to be rolled out as a national campaign.

This Danish study compared men aged 64-73 years randomised to be screened for abdominal aortic aneurysm, and those who were not screened

They found there was a 66 per cent relative risk reduction in abdominal aortic aneurysm-related mortality in those screened, although only a non-significant 2 per cent fall in all-cause mortality. The researchers found screening to be cost effective as well.

This was not a small study, with nearly 13,000 patients involved, and I believe the results make a strong case for screening.

Electronic patient records speed up chlamydia treatment Sex Transm Infect 2010; doi 10.1136/sti.2010.042432
A study has shown that the introduction of electronic patient records reduces the time to treat interval for chlamydia patients.

The date of first attendance at the clinic, first positive test result, first attempted patient contact, and attendance for treatment were all recorded for more than 100 sexual health clinic patients who were treated either before or after electronic records were introduced.

After electronic records were introduced the average time taken to treat a patient after a positive chlamydia test fell from 15 days to 3.5 days.

The proportion of patients treated within two weeks of receiving a positive test result increased from 38 per cent to 94 per cent once electronic records were introduced.

The authors conclude that clinics using paper notes should consider switching to electronic patient records as a means of improving STI recall efficiency.

Second-hand smoke and cardiovascular disease risk Heart 2010; 96: 854-9
Previous research has suggested passive smoking increases the risk of CHD by 1.3 times. Later studies re-examined this using cotinine blood levels, a stable metabolite of nicotine, and found levels of cotinine may increase CHD risk by 1.4 times.

In this prospective study they looked at 8,512 60-79-year-old men and women who were found to be passive smokers by their raised serum cotinine levels. In this case, the levels were quite low with a mean level of 0.15ng/ml cotinine.

At this level there was no increase in risk of MI or stroke. This does not negate previous research of higher cotinine levels but it is reassuring that light exposure may be safe.

Use of fibrates in dyslipidaemia Lancet 2010; 375: 1875-84
Fibrates are known to raise HDL and reduce triglyceride levels but there is doubt over their ability to reduce morbidity or mortality.

This systematic review and meta-analysis looked at all the trials since 1950, comprising 45,000 patients. The findings were encouraging.

Fibrates produced a 10 per cent relative risk reduction for major cardiovascular events and a 13 per cent relative risk reduction in coronary events. They had no effect on stroke, all-cause mortality and sadly no effect on cardiovascular death, but did reduce the risk of albuminuria progression by 14 per cent.

There were no particular problems with serious adverse events. There does seem to be a place for fibrates in high-risk patients with combined dyslipidaemia.

Differences in telephone and face-to-face consultations Br J Gen Pract 2010; 60: 341-7
To improve access to primary care services and to cope with rising demand, there is more emphasis on telephone consultations. However, there remains concern that telephone conversations may not be as safe or effective as face-to-face consultations.

In this Scottish study, face-to-face and telephone consultations were recorded and analysed to assess the similarities and differences. Both patients and doctors viewed telephone consultations as suitable for single topic consultations. There were fewer periods of silence in a telephone consultation and obviously fewer non-verbal cues to pick up on.

Secondary issues tended not to be elicited or volunteered in telephone consultations. Telephone consultations seemed to be better for follow up or established conditions and new conditions generally ended in an invitation to attend in person.

There was one note of caution: in a telephone consultation when a patient self-diagnosed, there was too little questioning of the patient.

Overall, telephone consultations were found to be quicker than face-to-face consultations, and appropriately used by both patients and doctors.

Supervised injectable heroin Lancet 2010; 375: 1885
At least 10 per cent of heroin addicts fail to benefit from the usual treatment of supervised oral methadone, and evidence is emerging to support the use of injectable medicinal heroin (diamorphine or diacetylmorphine). Often injectable methadone is used instead of injectable heroin as a second line treatment

This London team compared injectable heroin with injectable methadone and with optimised oral methadone in chronic heroin addicts who were still using street heroin despite oral methadone treatment.

Success was defined as not using street heroin as detected by weekly urine testing. The results were quite compelling.

In the injectable heroin versus oral methadone arm, 72 per cent on injectable heroin did not subsequently use street heroin compared with only 27 per cent on optimised oral methadone.

There was no significant difference between injectable and oral methadone. For those addicts who fail on oral methadone, injectable heroin seems to be a better treatment.

  • Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team of regular research reviewers
The quick study

Abdominal aortic aneurysm screening in men was shown to reduce mortality.

Chlamydia patients' treatment time was reduced from 15 days to 3.5 days with the use of electronic patient records.

Second-hand smoking exposure was shown not to be related to CHD or stroke risk in older men and women.

Fibrates may benefit individuals at high risk of cardiovascular events and those with combined dyslipidaemia.

Telephone consultations seemed to be better for follow up or established conditions.

Supervised injectable heroin was shown to significantly lower use of street heroin in long-term heroin addicts.

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