Journals Watch - IUD checks, vitamin D and pneumonia

Not had time to read the journals? Let Dr Louise Newson bring you up to date on the latest research.

Annual checks may be unnecessary following the insertion of an IUD, according to one study (Photograph: SPL)
Annual checks may be unnecessary following the insertion of an IUD, according to one study (Photograph: SPL)

Are IUD checks a waste of time?
J Fam Plann Reprod Health Care 2012; 38: 15-18

Many GPs still advise women to have their IUDs checked annually, despite NICE guidance in 2004 stating that this practice is actually unnecessary.

This UK retrospective study was undertaken to examine the evidence for a routine check. Its results showed that frequent check attenders showed adverse events earlier, or at no significant time difference, to infrequent attenders.

The authors concluded that in women who have had an IUD for a minimum of two years, there was no evidence of harm occurring in those who attended infrequently compared with frequent attenders.

It may be feasible then, that after an initial check following insertion of an IUD, women can be asked to attend as needed and only be recalled for smears and then for removal of the IUD.

Low vitamin D levels are associated with atopy
Eur Respir J 2011: 38: 1320-7

Vitamin D deficiency is very common in the UK and its incidence seems to be increasing.

Vitamin D has been linked in some studies with atopyand asthma-associated phenotypes in children with established disease.

In this study, serum vitamin D was assayed in more than 900 six-year-olds and in 1,380 14-year-olds in western Australia. The results showed that levels of serum vitamin D in children of both ages were negatively associated with concurrent allergic phenotypes.

In addition, vitamin D levels in children (especially males) at age six years were significant predictors of subsequent atopy/asthma-associated phenotypes at age 14 years. This is another reason to ensure that our younger patients have adequate vitamin D levels.

Prescribing antibiotics for children with community-acquired pneumonia
Arch Dis Child 2012; 97: 21-7

It is well accepted that antibiotics are recommended for the primary care management of community-acquired pneumonia. However, a recent UK study reported that most children admitted to hospital had not actually received antibiotics.

This study from New Zealand was undertaken to look at primary care antibiotic use for children under the age of five years who had been hospitalised with community-acquired pneumonia.

The results found that less than half of the children had received an antibiotic before hospital admission. In around 40% of the children there had been an opportunity prior to admission to receive antibiotics which had been missed.

Although in some cases this was because parents had failed to obtain the prescribed antibiotics, in about one in five cases it was because either pneumonia was diagnosed but no antibiotic was prescribed or the diagnosis was not even made, despite symptoms suggestive of pneumonia being present.

This study illustrates the importance of recognising and promptly treating community-acquired pneumonia in children.

Antihypertensives are shown to reduce mortality
JAMA 2011; 306: 2588-93

This study used data from the systolic hypertension in the elderly programme, which involved patients aged 60 years or over with isolated systolic hypertension.

At the end of a 4.5-year randomised phase of the study, where patients were randomly allocated to receive treatment with chlorthalidone 12.5mg daily or placebo, all patients were advised to receive chlorthalidone therapy.

Their results showed that chlorthalidone treatment significantly reduced mortality and increased life expectancy.

Each month of antihypertensive therapy was associated with a one-day prolongation of life expectancy free from cardiovascular death. This gain in life expectancy occurred among people with a mean age of 72 years at baseline.

This study obviously has important implications.

Posterior MIs are still underdiagnosed
Emerg Med J 2012; 29: 15-18

Isolated posterior ST-elevation MI (STEMI) accounts for up to 7% of STEMIs. However, the diagnosis is notoriously difficult because there are only indirect anterior-lead ECG changes and confirmation requires the presence of ST-elevation in posterior leads (V7-V9).

In this study, doctors and paramedics were asked to interpret a 12-lead ECG and identify posterior STEMI. Their ability to identify posterior STEMI was compared with their ability to diagnose anterolateral STEMI on a 12-lead ECG.

Only 44 of the 117 doctors (38%) and 10% of the paramedics identified posterior STEMI as a potential diagnosis. Both doctors and paramedics were significantly better at diagnosing anterolateral STEMI than posterior STEMI.

These results may mean that the majority of posterior MIs are being missed. This is important as patients with a posterior MI still benefit from prompt reperfusion therapy to reduce their morbidity and mortality.

  • Dr Newson is a GP in the West Midlands 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.

  • Perform an audit of children who have been admitted to hospital with community-acquired pneumonia. Assess the proportion who were given antibiotics prior to their admission.
  • Have a meeting with your local family planning consultant. Consider changing your follow-up criteria for women with an IUD in situ (if necessary).
  • Consider having a practice meeting with a local cardiologist to be updated on ECGs, including the appearance of ECGs in patients with acute MIs.

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