DIAGNOSING HEART FAILURE - Br J Gen Pract 2006; 526:327-33
Do you have open access to echocardiography to help you gain those extra quality points? No, I don't suppose you have. Nor do we.
This study carried out in Durham, was a diagnostic accuracy trial assessing the usefulness of BNP and N-terminal BNP (NT proBNP) in diagnosing heart failure due to LV systolic dysfunction. The negative predictive value (NPV) for the NT proBNP was an impressive 92 per cent, and using this test was found to be able to reduce referrals to clinic/echo by 25 per cent.
Diagnosing heart failure in general practice is a difficult task and might be incorrect in up to 70 per cent of cases. That is what happens when you do not have access to the right tests. In our area - having had a BNP and proBNP local trial running - there is no money to fund the tests, so we shall just have to keep on dreaming of echoes.
NURSING HOME REGIMES - BMJ 2006; 332: 1,180-4
The researchers looked at 250 mentally functional, physically-impaired nursing home residents. They found, perhaps not surprisingly, that those who were given their food on trays, pre-plated with food selected two weeks before, did less well in terms of quality of life, physical performance and maintenance of body weight when compared with those who ate in family style. This meant having tablecloths, full cutlery, no plastic cups and no interruptions among other measures. The residents were treated with respect with resident-orientated care rather than task-orientated care.
PANDEMIC FLU PLANNING - Family Practice 2006; 23; 267-72
There is much talk about pandemic flu, but do you know what you are going to do when it hits? These researchers tried to establish just how well-prepared GPs were in Australia. On the one hand, they are a bit closer to the probable cradle of the epidemic, and on the other it is the one continent that could possibly keep it out. Anyway, apart from enthusiasm the Australian GPs seemed to have no definite plans, which made me feel much better about our own rather half-baked plans.
BEING HEALTHIER THAN AMERICANS - JAMA 2006; 295: 2,037-45
Once upon a time it was the folklore that England's NHS was reliable and cheap, making it terrific value for money. Now it is not thought of as cheap, and certainly not reliable, but is that fair or right or are we just doing ourselves down these days?
In this paper, certain unequivocal health markers were measured and compared in England and the US, and actually we do not come out badly at all. The study looked at 4,386 US residents and 3,681 English residents aged 55-64 in 2002.
The researchers gathered data on diabetes, hypertension, heart disease, MI, stroke, lung disease and cancer.
Within both countries there was a negative correlation between health and socio-economic status, but the really surprising thing was the difference between the two countries.
The authors concluded that 'US residents are less healthy than their English counterparts'.
HIV EDUCATION FOR SCHOOL CHILDREN - BMJ 2006; 332: 1,189-94
A Mexican interventional study involving 11,000 pupils in 40 high schools showed no change in sexual activity or risk-taking behaviour, despite increasing the HIV knowledge base.
This was a rigorously designed and implemented HIV education course.
We in the UK cannot take for granted that our health education interventions with teenagers necessarily do anything more than make us feel that we are doing something.
RESEARCH OF THE WEEK
ASPIRIN AND DIPYRIDAMOLE FOLLOWING TIA - Lancet 2006; 367: 1,665-73
In this study, over 2,500 patients within six months of having had a TIA or minor stroke were ascribed to either aspirin alone or aspirin with dipyridamole for prevention of further episodes.
Primary outcome events were defined as vascular death, non-fatal stroke or MI or major bleeding complication. Those were lower in the combined treatment group (13 per cent) than in the aspirin alone group (16 per cent), although more of the combination group gave up on their chosen treatment because of side-effects.
The trial used an average 75mg aspirin, but the most commonly prescribed combination product in the UK gives only 50mg of aspirin.
BNP testing can significantly reduce heart failure referrals.
Nursing home residents benefit from a conventional mealtime routine.
Australia has no definite plans to cope with a flu pandemic.
People in England are healthier than people in the US.
HIV education did not change teens' sexual activity.