H pylori, HRT and pharmacist advice

No time to read through the publications? Let Dr Lizzie Croton guide you through the latest research

Research of the week 

Dietary sodium and cardiovascular disease
BMJ 2007; 334: 885–8 

We know that reducing salt intake lowers BP. The second instalment of the salt battle is found in Cook et al’s follow-up study of participants from two RCTs (1987–95).

These original studies concluded that reducing dietary sodium led to a reduced BP.

In this study the original subjects were re-contacted to ascertain whether reductions in BP also translated into a reduction in cardiovascular events. Data from three quarters of the original participants showed that after 10–15 years, the risk of cardiovascular events was a quarter lower in people who had cut their intake of salt in the preceding 18 months.

This became a reduction of 30 per cent after adjustment for baseline sodium excretion and weight. 

Two therapies for H pylori eradication
Ann Intern Med 2007; 146: 556–63 

Three hundred patients with dyspepsia or peptic ulcers were randomly assigned to receive either standard triple therapy (pantoprazole, clarithromycin and amoxicillin) twice daily for 10 days or a 10-day sequential regimen. This consisted of 40mg pantoprazole, 1g amoxicillin and placebo twice daily for five days followed by 40mg pantoprazole, 500mg clarithromycin and 500mg tinidazole twice daily for the remaining five days. Both researchers and patients were blinded to treatment.

The eradication rate for H pylori was 91 per cent with the sequential regimen compared with 78 per cent for standard treatment. Both regimens caused few side-effects with 5 per cent of patients in both groups having minor abdominal discomfort and 3–5 per cent having mild diarrhoea.

HRT and ovarian cancer
Lancet 2007 doi: 10.1016/S0140-6736(07)60534-0 

A large UK cohort study found that HRT is associated with an increased risk of ovarian cancer in postmenopausal women. The risk works out at one extra ovarian cancer for every 2,500 women taking HRT.

The study followed 900,000 postmenopausal women for an average of seven years. Of the 2,000 women who developed ovarian cancer, 1,591 subsequently died. The increased risk was confined to women who had taken HRT for at least five years. Past users were unaffected.

It is not clear why synthetic hormones should cause ovarian cancer in older women when they appear to be protective in premenopausal women.

Pharmacist advice in medication reviews
BMJ doi:10.1136/bmj.39164.568183.AE 

This randomised trial looked at patients with heart failure following an emergency admission.

The intervention group received two home visits from a community pharmacist between two and eight weeks after discharge. The pharmacist reviewed drugs with the patients and gave them advice on self-management. The control group received usual care. The community pharmacist intervention did not lead to a reduction in hospital readmissions. This is in contrast to the reduction in admissions found with heart failure patients who were visited at home by specialist heart failure nurses.

Children performing effective chest compressions
BMJ doi:10.1136/bmj.39167.459028.DE  

This was a study based in four Cardiff schools. The children were aged 9–14 and spread across three school years. They were taught basic life support in a lesson lasting 20 minutes and were then asked to perform chest compressions on a manikin for three minutes. Children aged 9–10 were unable to compress the chest to the depth required.

Nineteen per cent of children aged 11–12 were able. In children aged 13–14, this figure was 34 per cent. The ability to provide adequate chest compression depth was related to the child’s age and weight rather than sex or height.

Antipsychotic prescription in nursing homes
Arch Intern Med 2007; 167: 676–83 

Excessive prescribing of antipsychotic medication in nursing homes is a concern. This study looked at prescribing rates in nursing homes in Canada. In total 32.4 per cent of residents were prescribed an antipsychotic drug.Residents in facilities with high prescribing rates for these drugs were almost three times as likely to receive them when compared with homes with lower rates. This was irrespective of the clinical indications for these drugs. 

Dr Croton is a GP registrar in Birmingham and a member of our team of regular journal reviewers

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