Journals Watch - Cannabis, hip fracture and HRT

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

DRINK, DRUGS AND DRIVING
BMJ 2005; 331: 1,371-4

This French study looked at the risk of dying in a car crash under the influence of cannabis and, or alcohol. It was commissioned to examine whether a change in the law is necessary in relation to driving under the influence of drugs.

The researchers took drug and alcohol samples from the at-fault party in any road traffic accident that resulted in a fatality. Seven per cent of drivers were positive for cannabis, and 21 per cent for alcohol, although there was considerable overlap.

They concluded that cannabis at least triples your chance of crashing. However, alcohol outstrips it by a country mile as the cause of crashes in France. I don't know if the case has been proven to justify routine testing for cannabis from this study.

BYPASS VERSUS BALLOON ANGIOPLASTY
Lancet 2005; 336: 1,925-34

Limb ischaemia is on the increase, due to the rise in diabetes and the slow rate of reduction in smoking, leading to a rise in the numbers of patients seen by vascular surgeons.

This study compared balloon angioplasty to bypass surgery in patients admitted with acute leg ischaemia due to inguinal disease. The trial ran for five and a half years and the end points were death or amputation. The results were similar, with balloon angioplasty being a third cheaper over the first year. Half of all patients were deemed unsuitable for any intervention, and of the intervention groups only half were alive and retaining a full limb count.

HIP FRACTURE DEATH RATES
BMJ 2005; 331: 1,374-6

We all know that a hip fracture in the elderly can be dangerous, but this study drove home just how perilous the condition is.

For all patients, there was a 10 per cent mortality rate at 30 days, and 33 per cent at a year. For patients who developed heart failure post op (which occurred in 5 per cent of patients), these rates increased to 65 and 92 per cent respectively. Chest infections occurred in 9 per cent of patients and this led to a 30-day mortality of 65 per cent.

The more co-morbidities such as CHD a patient had, the more likely they were to develop a post-op complication.

HRT AND QUALITY OF LIFE
Am J Med 2005; 118: 1,232-39

HRT has suffered a bit of late. It has gone from hero to zero with a few well-placed kicks, but it still had some of its reputation intact.

Even if HRT might kill you, while you are alive it might make you look and feel younger.

This study examined whether this is true in respect to physical and mental functioning. HRT was compared to placebo in a three- year, double-blind trial. Cognition, balance, mobility, ability to rise from a chair and falls were compared between the two groups and there was no difference except in balance.

PAEDIATRIC SSRI PRESCRIBING
BMJ 2005; 331: 1,451-152

The bad press that SSRIs have had in relation to a possible increase in suicide risk in children and the advice to avoid their use is well known.

This study looked at the recent trend in prescribing antidepressants to children in Ireland between 2001 and 2004. The researchers found that despite the warnings, prescription levels had not dropped.

This indicates that there is still a real need for pharmacotherapy in this age group, and although there are warnings not to use these agents, the doctors actually doing the work still need to use something.

INFORMING PATIENTS

Smoking cannabis and driving triples your chance of crashing your car.

Balloon angioplasty is a third cheaper for limb ischaemia than bypass surgery.

Hip fractures in the elderly have a high rate of post-operative complications.

Child depression warrants the development of antidepressants aimed at children.

RESEARCH OF THE WEEK

BREAST CANCER AND INSURANCE
BMJ 2005; 331: 1,438-39
 

This study looked at a range of life insurance companies' assessment of a fictitious patient aged 35 with a maternal family history of breast cancer.

One scenario had just this information, the second had the patient on regular (normal) mammography and in the third scenario the patient had undergone bilateral mastectomy and oophorectomy.

Of the insurance companies that replied, more would load the life insurance premium under scenario one than under two or three.

This gives us some reassurance that although insurance companies might look at family history, they also take into account measures patients undertake to reduce the breast cancer risk.

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