Journals Watch - Angioplasty and type-1 diabetes

Too busy to read all the journals? Let Dr Bryan Palmer bring you up to date on the latest research.

Door to balloon time in acute STEMI - BMJ 2009; 338: b1807
This prospective cohort study of 43,801 acutely infarcting (ST elevated) patients showed that if they received a balloon angioplasty within 90 minutes, the associated mortality from the infarct was 4.3 per cent but if that time lapsed to three hours it was almost doubled at 8.4 per cent.
Balloon angioplasty

At 30 minutes the associated mortality from the infarct reduced further to 3 per cent. It has to be said, 30 minutes represents an astonishingly fast pace of action.

The US authors' conclusion was that any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.

Food for thought for those working in acute care centres and policy makers.

Food advertising ban during children's TV - Arch Dis Child 2009 doi:10.1136/adc.2008.151019
TV adverts for less healthy foods are thought to contribute to childhood obesity problems.

New laws came into effect in the UK in April 2007 to prohibit advertisements for 'less healthy' foods during or around programmes 'of particular appeal to children'. In Canada, a code of conduct was also recently strengthened.

Using the UK guidelines the authors watched one week of Canadian and UK terrestrial TV in 2006 and identified and linked foods in the adverts to relevant nutritional data.

A total of 2,315 food-related adverts were broadcasted in Canada and 1,365 in the UK. Of these, 52-61 per cent were for 'less healthy' food and 5-11 per cent were 'of particular appeal to children'.

Only 5 per cent of adverts would have been banned under the guidelines. The content of the foods was equally unhealthy in those that were and were not designed to appeal to children.

This legislation seems to have missed the target and would appear to be just a pacifier to action groups.

Type-1 diabetes rates in under 15s - Lancet 2009 doi: 10.1016/S0140-6736(09)60568-7
Type-1 diabetes is on the increase and to help with health funding planning the EURODIAB study group sought to predict trends for the next 15 years.

Twenty population-based registers in 17 countries were used to identify 29,311 children under the age of 15 with type-1 diabetes. Using age-specific log rates, published incidence rates and expected population rises predictions were made for 2005, 2010, 2015 and 2020.

The overall annual increase was 3.9 per cent, giving a prediction of 24,400 new cases by 2020, with a doubling in the under-5s and a 70 per cent rise in prevalence.

Only time will tell if Europe has the money for the associated increase in health costs.

Antidepressants plus pain self-management - JAMA 2009; 301: 2,099-110
Pain and depression are the most common physical and psychological symptoms in primary care. They co-occur 30-50 per cent of the time.

The authors' objective was to see if a medication and pain programme would help both symptoms.

They used a randomised controlled trial with the amusing acronym of SCAMP (stepped care for affective disorders and musculoskeletal pain). Only 250 patients were involved and were randomised to usual care or 12 weeks of antidepressants followed by a self-management programme over 12 weeks and then a continuation phase of six months.

At 12 months, 37.4 per cent of the intervention patients had a 50 per cent reduction or better in depression scores compared with 16.5 per cent in the usual care group. Also pain scores and disability were lower in the intervention group.

It seems a combination of problems benefits from a combination of treatment.

Radiofrequency ablation eradicates Barrett's dysplasia - N Engl J Med 2009; 360: 2,277-88
Barrett's oesophagus is known to be associated with an increased risk of adenocarcinoma of the oesophagus. However, the treatment and progression is still a bit of a mystery.

The US authors of this study wished to evaluate the use of radio-frequency ablation and its role in treatment and prevention of oesophageal cancer.

A multi-centred controlled trial involved 127 patients who were randomly assigned in a 2:1 ratio to either ablation or a sham procedure and endoscoped at 12 months.

Those with low-grade dysplasia had a 90.5 per cent eradication compared with 22.7 per cent in the control group. Those with high-grade dysplasia had an 81 per cent eradication compared with 19 per cent in the control group.

Patients in the ablation group had less disease progression (3.6 versus 16.3 per cent) and fewer cancers (1.2 versus 9.3 per cent) at the cost of one upper GI bleed and five strictures.

I suspect we will see less surveillance and more active treatment in the future.

  • Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who regularly review the journals

VIEW OUR ONLINE HEALTHY CHOLESTEROL LIFESTYLES RESOURCE CENTRE

THE QUICK STUDY

  • Balloon angioplasty should be received as quickly as possible by post-MI patients.
  • Advertising bans on unhealthy food during children's TV are not effective.
  • Type-1 diabetes rates are set to double in children under 5 years old by 2020.
  • Pain and depression improved when patients used a self-management plan along with antidepressants.
  • Barrett's dysplasia can be eradicated in most patients using radiofrequency ablation.

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