Journals Watch - Whooping cough, stirrups and sleep

Too busy to read the journals? Let Dr Simon Hunter be your guide to the latest research.

CONSIDER WHOOPING COUGH

BMJ 2006; 333: 174-7, doi:10.1136/bmj.38870.655405.AE

A child with a chronic cough, but no overt cause, might be labelled and treated as asthmatic, or referred.

This study has suggested whooping cough as a potential diagnosis for schoolchildren who have a cough lasting more than 14 days. The researchers looked at 172 schoolchildren aged five to 16, and 37 per cent of children with a cough of more than 14 days' duration were found to have serological evidence of recent Bordetella pertussis infection.

Of these children, 89 per cent were fully immunised. Immunisation will attenuate the illness. Erythromycin is no use in alleviation after two weeks of cough.

CERVICAL EXAMINATIONS

BMJ 2006; 333: 171, doi:10.1136/bmj.38888.588519.55

In the US it is standard practice to perform cervical smears with the patient in the dorsal lithotomy position in stirrups. It is accepted that women do not look forward to such examinations. This randomised clinical trial compared stirrups and no stirrups,in 197 women. Sense of vulnerability was lowered by 44 per cent, and physical discomfort by 43 per cent in the group with no stirrups.

Sense of loss of control was not significantly different. While it will not affect practice in this country, it is always worth considering methods to make patients more comfortable and thus more likely to attend.

TREATING PLANTAR FASCIITIS

Arch Intern Med 2006; 166: 1,305-10

A customised insole was considered to be the benchmark treatment for plantar fasciitis, but this study questions this. The patients were randomised to a sham foam insole, an 'off the shelf' insole and a semi-rigid plastic customised orthosis.

At three months, the two proper orthoses had a significant effect on improving function, but not pain, over the sham insole. There was no difference between the prefabricated and the customised orthoses, and there was no difference between the three insoles at 12 months. A rethink on podiatry referrals should be in order.

POLYPHARMACY IN THE ELDERLY

Br J Gen Pract 2006; 56: 504-10

As patients age and multiple things go wrong with the body, polypharmacy is often needed. However, the elderly are less able to deal with the multiple medications taken. This makes prescribing in the elderly more complex and regular reviews even more important.

This Dutch study looked at the records of patients in residential homes on more than four drugs. They concluded that 98 per cent would benefit from some form of prescribing optimisation.

Of these they felt a third should definitely have their medication changed.

It was considered that 61 per cent should have medication added. It serves as a reminder that medicine reviews are a good idea.

SLEEP LINKED TO INCOME

Am J Epidemiol 2006; 164: 5-16

In this US study, researchers looked at 669 subjects aged 38-50 for three days and recorded for how long they slept, how long they took to fall off to sleep (latency) and the percentage of time in bed asleep (efficiency).

Mean time in bed was 7.5 hours; mean sleep duration was 6.1 hours; mean sleep latency was 29 minutes and efficiency 81 per cent. Higher income meant a better night's sleep, and black individuals slept less than white subjects in all income brackets.

- Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly review the medical journals.

INFORMING PATIENTS

  • Whooping cough is a possible diagnosis for children with coughs lasting more than 14 days.
  • Speculum examinations without stirrups are preferred by women.
  • Customised insoles are not more effective than prefabricated insoles in plantar fasciitis.
  • Medicine reviews should be performed in the elderly.
  • A good night's sleep is linked to socio-economic status and race.

RESEARCH OF THE WEEK

Coffee prevents diabetes

Arch Intern Med 2006; 166: 1,311-6

In a time when diabetes is becoming an epidemic, it is good to read about something that is not a traditional health food, and which has a beneficial effect on diabetes.

Coffee, and in particular decaffeinated coffee, seems to reduce the incidence of diabetes.

In this study, women who drank six cups a day had a 22 per cent lower risk of diabetes. The mechanism causing this is unclear.

Shame it is not tea, which, in my opinion, is the far superior drink.

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