Drug-eluting stents and superheroes

Don't have enough time to read all the journals? Let Dr Simon Hunter give you a brief summary

Research of the week

Binge drinking in young women 'the norm'
J Pub Health 2007; 29: 13–6

Alcohol consumption in young women in the UK has doubled in the past four years.

This study found that only half of female school-leavers going to university knew the daily recommended alcohol limit. Half knew the alcohol content of their favourite drink, and one in seven used the UK unit system to guide their drinking habits. Binge drinking was the norm.

The biggest area of concern was in the students' definition of binge drinking. The variation was huge. The conclusion given was that we need the Sensible Drinking advice rewritten, but I'm not convinced. To reverse this we need a deeper societal change, perhaps looking to a French model of generations drinking together. 

Drug-eluting stents
NEJM 2007; 356: 1,009–19 

The drug-eluting stent was developed to address the problem of restenosis. It releases an anti-thrombotic agent to protect the stent. However, there have been reports that these do not work well in practice and this study confirms those concerns.

It found that there was no difference in MI and death rates between bare-metal and drug-eluting stents up to six months, but after that there was a 1 per cent increased risk of death or MI in the drug-eluting stents per year. This translated into a long-term increase in mortality of 18 per cent. Clearly there needs to be a rethink on the routine use of these devices.

Effectiveness of mental health workers
BJGP 2007; 57: 196–203 

The NHS Plan said there should be a new army of mental health workers to support primary care. The effectiveness of the mental health workers at 16 practices in Birmingham was examined in a controlled trial including 284 patients.

In this study, patients who had a mental health worker were found to have increased levels of satisfaction with their care. But it had no real effect on their clinical condition. Ironically this reflects New Labour's attitude to the NHS. It doesn't matter whether it works as long as it looks good.

Moisturisers dry out the skin
BJ Derm 2007; 156: 492–8 

Moisturisers are used by people with healthy skin, and they are recommended to patients with dry skin conditions.

This study looked at the effect of different moisturisers on the skin. Many were found to interfere with its complex functioning. Some of them, especially the more simple ones, appeared to have an opposite effect to the one that you would expect: they increased transepidermal water loss. The authors conclude that more research is needed to determine the best moisturiser ingredients for various skin conditions, and for once I agree. Normally this sounds a bit of a cop-out at the end of a paper, but there really does seem to be room for improvement here.

Superhero injuries
Arch Dis Child 2007; 92: 242–3 

This case report includes five cases of serious injury in children wearing superhero costumes. The children dressed up as Superman or Spiderman then tested out their superpowers, only to discover they lacked the ability to fly. Fortunately all the children were successfully treated, and lived to fight supervillains again another day. The moral of the story is that if you allow children to dress in a superhero costume, make sure they know reality from fantasy.

Paper and Electronic Referrals
BJGP 2007;57:223-225 

With Choose and Book rumbling on, more referrals are being generated electronically than by paper form. This study compared the quality of the data between the two forms.

Electronic referrals were better for demographic data such as NHS number, telephone number and repeat prescription list, but the paper referral was far superior when it came to clinical data.

Use of electronic referral may lead to it being rejected or misclassified as non-urgent through paucity of clinical information.  

Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our regular team of GP research reviewers 

The quick study
Binge drinking is common in young women in the UK, many of whom do not know the recommended daily alcohol limit.

Mental health workers increase patient satisfaction but do not improve clinical outcome.

Moisturisers may, in some cases, increase the skin's rate of moisture loss.

Superheroes set dangerous examples for young children.

Electronic referrals lack clinical data and can lead to referrals being rejected.

Drug eluting stents increase mortality risk by 18 per cent compared to bare metal stents. 

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