Journals Watch - Pneumonia and prostate cancer

Too busy to read all the journals? Let Dr Katrina Ford keep you up to date with the latest research.

Length of hospital stay for patients with pneumonia Thorax 2009; 64: 709-12
This retrospective study based in Nottingham City Hospital investigated whether patients admitted to hospital with non-severe community-acquired pneumonia, and managed initially by respiratory physicians, had a shorter length of stay compared with patients seen by general medical doctors.

Patients were grouped according to whether they were seen on their first post-take ward round by a respiratory consultant physician, a non-respiratory consultant physician, or on the weekend.

Patients in the first group had an average length of stay of 1.74 days, compared with 3.03 days for those in the second group.

There was a larger percentage of discharges within 24 hours for those in the first group, although this was not statistically significant.

In a control group of patients with cellulitis, there was no statistically significant difference between the groups for length of stay or for percentage discharges in the first 24 hours.

The authors hypothesised that respiratory consultants are more aware of severity assessment guidelines, and this coupled with more experience in managing community-acquired pneumonia means that discharge can be expedited.

Monitoring men with localised prostate cancer Br J Cancer 2009; 101: 390-94
NICE guidelines recommend that men with 'low risk' prostate cancer are managed conservatively by monitoring prostate-specific antigen (PSA) kinetics and by prostate re-biopsy.

In this study, 408 'low risk' patients were monitored with regular PSA tests over a mean period of 2.9 years.

Although monitoring of PSA kinetics did initially flag up a high proportion of the men significantly progressing, successive blood tests became increasingly less sensitive. The absolute PSA level compared with the reference range remained sensitive throughout the monitoring process.

In order to monitor such patients effectively, new methods need to be evaluated. Meanwhile, NICE guidelines should be used with caution when monitoring such patients.

Proprioceptive training to prevent ankle sprain  BMJ 2009; 339: b2,684
This Dutch randomised controlled trial based in primary care looked at 522 athletes aged 12-70 who sustained a lateral ankle sprain up to two months before inclusion into the study.

Both groups were allocated to 'usual care' and the intervention group received an eight-week home-based proprioceptive training programme.

Participants were followed up for one year and the main outcome measure was self-reported recurrence of ankle sprain.

During the follow up,145 patients had a repeat ankle sprain - 56 (22 per cent) in the intervention group and 89 (33 per cent) in the control group. The NNT to prevent one recurrence was nine, the difference in reduction of ankle sprains was significant and the training programme was associated with a 35 per cent reduction in risk of recurrence.

More details on this proprioceptive training programme could be useful in A&E and general practice.

Anticoagulation control in patients taking warfarin Br J Gen Pract 2009; 59: 590-4
Patients often take non-prescribed medication in addition to their regular medication. Doctors are not always aware of this - either because they do not enquire, or patients do not divulge the information.

Warfarin is a commonly prescribed medication. Patients may be unaware of the implication of interactions between supplements and warfarin, and unwittingly risk poor anticoagulant control and potentially life-threatening complications.

This retrospective study from primary care practices in Somerset and Devon investigated whether garlic alters the control of INR in patients on warfarin. It showed that there was no evidence that garlic as a food supplement or cooking ingredient, adversely affected the INR of anticoagulated patients.

Evaluating fatigue and exercise in cancer patients Clin Oncol 2009; 21: 473-82
It is difficult to estimate how active cancer patients receiving treatment should be. This observational study looked at over 200 patients being treated both radically and palliatively with chemotherapy and radiotherapy for genitourinary, gynaecological or breast cancers.

Patients were given information prior to the start of treatment on cancer and treatment-related fatigue and how to manage this with exercise, as well as information on associated workshops.

Questionnaires were used to monitor fatigue levels and assess usefulness of information. Over 88 per cent of patients exercised while on treatment and over 70 per cent thought the information was helpful.

Anxiety and depression as predictors of mortality Br J Psychiatry 2009; 195: 118-25
This large population survey of over 60,000 people used a comprehensive mortality database to investigate individual and combined anxiety/depression symptom loads (using the Hospital Anxiety and Depression Scale) and mortality over a three- to six-year period.

Depression is known to be associated with increased mortality, although underlying mechanisms are uncertain. In this study, depression was associated with an increased mortality (hazard ratio 1.52, 95% CI 1.35-1.72), comparable with that of smoking (hazard ratio 1.59, 95% CI 1.44-1.75).

However, anxiety with depression lowered mortality compared with depression alone.

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

The Quick Study

  • Community-acquired pneumonia patients have shorter inpatient stays when managed initially by respiratory physicians.
  • Monitoring PSA kinetics is recommended by NICE for management of low risk prostate cancer, but the absolute PSA value is also important.
  • Ankle sprain recurrence could be reduced with a self-performed, home-based proprioceptive training programme.
  • Warfarin does not appear to interact with garlic.
  • Cancer patients can be advised to exercise during treatment to reduce fatigue.
  • Depression and anxiety together are associated with a reduced mortality compared with depression alone.

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