Journals Watch - Febrile children and type-2 diabetes

Not had time to read the journals? Let Dr Lizzie Croton bring you up to date with the latest research.

The GP was the first preference for advice on febrile illness (Photograph: SPL)
The GP was the first preference for advice on febrile illness (Photograph: SPL)

Febrile children and urgent care services
Arch Dis Child 2011; 96: 810-16

This study looked at how parents navigate urgent and emergency care (U&EC) services when their child has a febrile illness. Parents of any febrile child under five years contacting U&EC services were asked to participate in a telephone questionnaire.

A total of 220 parents enrolled in the study making 570 contacts with services over the course of their child's illness. The illness lasted three days on average and parents' first preference for advice in-hours was their GP (67%) and when unavailable, NHS Direct (46%).

A total of 155 parents made more than one contact and the service provider initiated 63% of the repeat contacts. When parents received 'safety netting' advice (81%), they were less likely to return to U&EC services.

Parents also expressed a need for written, accurate take-home advice regarding fever and antipyretics.

Genital warts - cost of treatment and quality of life
Sex Transm Infect 2011; doi: 10.1136/sextrans-2011-050073

The impact of genital warts on the health service was examined in this cross-sectional multicentre study of eight UK sexual health clinics.

The study population included 895 individuals with genital warts. A secondary sample of 370 participants presenting with warts to a clinic between April and June 2007 was included in the case note review.

Quality of life was measured using the ED-5D questionnaire and the cost of an episode of care was derived from the case note review.

The results suggested that one episode of genital warts is equivalent to 6.6 days of healthy life lost per person. Furthermore, the weighted mean cost to the health service per episode of care was £94, not including the cost of an STI screen.

The authors believe such figures can assist the economic evaluation of the ongoing HPV vaccination campaign.

Nail polish and its effects on oxygen saturations
Emerg Med J 2011; 28: 783-5

Pulse oximetry is often measured in general practice. This study investigated the effects of different colours of nail polish on the accuracy of pulse oximetry.

The participants were all healthy adult females (n=33) who painted their nails in a variety of colours, henna and colourless polish. The same brand of polish was used in all cases and measurements of oxygen saturation were compared with undyed control fingers. Three separate pulse oximeters were used in the study for standardisation.

The authors found that the mean saturations obtained from blue, beige, purple and white polished fingers were significantly lower than for other colours and undyed control fingers. They postulate that oximetry readings on patients wearing such colours could, therefore, be inaccurate.

Soy isoflavones for the menopause
Arch Intern Med 2011; 171: 1363-9

Concerns about the long-term safety of HRT have led many women to use soy products for the treatment of menopausal symptoms, despite a lack of evidence as to their efficacy. This study randomised 248 women, all within five years of the menopause, to daily soy isoflavone tablets or placebo for two years.

The primary outcome was a change in bone mineral density in the lumbar spine, total hip and femoral neck at two-year follow-up. The authors found no significant differences between the two groups at the conclusion of the study in terms of bone mineral density in the spine, total hip or femoral neck.

A significantly larger proportion of women in the treatment group experienced hot flushes and constipation compared with those receiving placebo.

Daily isoflavone therefore does not prevent loss of bone mineral density or menopausal symptoms.

Lifestyle modification and prevention of type-2 diabetes
Arch Intern Med 2011; 171: 1352-60

This Japanese study investigated the effect of lifestyle modification on the incidence of type-2 diabetes among those with impaired fasting glucose levels.

A total of 641 overweight Japanese men were randomly assigned to a frequent intervention group or a control group.

They were followed up for 36 months with the primary outcome being type-2 diabetes as demonstrated on 75g oral glucose tolerance testing.

Overall, the estimated cumulative incidences of type-2 diabetes were 12.2% in the frequent intervention group and 16.6% in the control group.

The hazard ratio in the frequent intervention group was 0.56, which reduced to 0.41 among those with impaired glucose tolerance at baseline and to 0.24 among those with baseline HbA1c levels of 5.6% or more.

The authors conclude that lifestyle modification can prevent type-2 diabetes in patients with impaired fasting glucose.

Acute otitis media in general practice
Fam Pract 2011; doi: 10.1093/fampra/cmr042

Many experts recommend initial observation for children with acute otitis media (AOM), however, antibiotics should be considered in children under two years of age or in the presence of ear discharge.

This study examined the quality of AOM treatment in 1,175 patients recruited from six countries.

The authors found that Danish GPs had the lowest antibiotic prescription rate (72.7%) and GPs in Kaliningrad, Russia, had the highest (97.1%). GPs in Sweden and Denmark almost exclusively prescribed narrow spectrum penicillins while broader spectrum penicillins were preferred in Spain, Argentina, Kaliningrad and Lithuania.

Children with symptoms for more than three days, ear discharge and fever were most likely to receive antibiotic therapy.

The authors highlighted the considerable variation in prescribing rates and choice of antibiotics as the key finding of the study.

  • Dr Croton is a GP in Birmingham and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider providing written advice to parents of children with febrile illness and then audit to see if this reduces re-attendance rates to surgery and out-of-hours visits.
  • Run a training workshop for staff performing pulse oximetry and include the study information on nail polishes and oximetry results.
  • Run a practice audit on antibiotic prescribing and choice of antibiotic in acute otitis media. Consider circulating a practice protocol to guide treatment in this condition.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus