Otitis media in children: NICE gets it right Br J Gen Pract 2010; 60: 101-5
NICE has recommended that children with otitis media are not routinely given antibiotics as the impact on the recovery period is minimal.
The exception is when there is discharge, although this did not seem to be particularly based on evidence, especially as discharge is merely an indication the tympanic membrane has perforated.
This study compared the clinical course of children with otitis media who presented with discharge and those who presented without.
They found that those with discharge actually comprised a distinctly different group. They had more severe systemic symptoms, higher temperatures, higher pulse rate and were more likely to have pain at one week and hearing difficulties at three months.
These findings support NICE guidance and also observe that a swab at presentation is good practice as a minority are resistant to amoxicillin.
Emergency contraception Lancet 2010; 375: 555-62
The current main form of emergency contraception is levonorgestrel 1,500mg as a single dose.
This works by interfering with ovulation and is most effective when given within 72 hours of sexual intercourse. It is also better when given in the first half of the menstrual cycle. After 73 hours a coil can be fitted but this is obviously not as convenient.
There is a new oral emergency contraception treatment - ulipristal acetate at a dose of 30mg which is a progesterone-receptor modulator.
In this randomised non-inferiority trial and meta-analysis, 1,696 women presenting within five days of sexual intercourse were randomised to either levonorgestrel or ulipristal.
When given within 72 hours, there were 15 pregnancies in the ulipristal group and 22 in the levonorgestrel group.
In 200 women using emergency contraception between three and five days post sexual intercourse there were three pregnancies, all in women who had taken levonorgestrel.
Ulipristal does seem to be effective and can be used up to five days after unprotected sex.
Preventing upper respiratory symptoms in athletes Br J Sports Med 2010; 44: 127-133
Upper respiratory symptoms are more common in athletes in the period before and after competition. This can affect performance.
Not all these upper respiratory symptoms are infective; only 30 per cent are infective and the rest seem inflammatory.
To this end, a cohort of athletes were given Difflam anti-inflammatory throat spray for a week before and two weeks after a half-marathon. Controls were given placebo.
They found that the number of reported episodes of upper respiratory symptoms were the same in both groups but the severity was 29 per cent less in the intervention group.
Systemic inflammatory markers were the same in both groups, but local salivary inflammatory markers were greater in the Difflam group. This is good news for amateur runners.
Childhood obesity in Leeds Arch Dis Child 2010; 95 :94-9
It is widely observed that childhood obesity is a growing problem in the UK and across the world. It is a serious problem with little in the way of treatment and obese children tend to become obese adults.
This study looked broadly at childhood BMI across Leeds but also looked at surprisingly small groups, for example, of similar housing.
Certain findings were predictable; as children get older they get fatter showing a cumulative effect and supporting the evidence that obese children become obese adults. The study showed that 13-year-olds were three times as likely to be obese as three-year-olds.
Those from deprived areas had a higher BMI, but what was not predicted was there were 'hotspots' of obesity in affluent areas. This paper shows that being middle class does not protect children from obesity.
GPs' non-verbal cues during consultations Br J Gen Pract 2010; 60: 83-7
When assessing a patient, we look for the non-verbal cues. We are taught to do this but it is also something that we do naturally. It is not surprising then that this happens the other way round as well; patients assess our non-verbal communication.
In this study set in Poland, patients were interviewed after seeing their GP in nine separate sites. Two thirds of patients noted non-verbal cues such as tone of voice, eye contact and facial expression but also clothing, presentation of room, touch, gestures, interpersonal space and posture.
We are all aware of the strong influence of the placebo effect and so it is a good idea to be aware of our non-verbal communication and use it to good therapeutic effect and not let it damage the consultation.
- Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly review the journals
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