Hypertension, obesity and anaemia

Too busy to catch up on the latest research? Let Dr Lizzie Croton update you on recent papers.

Hip fracture surgery and anaemiaAge Ageing 2008; 37(2): 173-8
Post-operative anaemia after hip fracture surgery may hinder physical performance and rehabilitation.

In this study, 487 consecutive hip fracture patients were treated with a standardised rehabilitation programme and haemoglobin was measured on each of the first three post-operative days.

The anaemic patients were less likely to walk independently in the immediate post-operative period and a correlation was found between haemoglobin and functional score, with anaemic patients showing decreased functional mobility scores during the first three post-operative days.

The authors argue for a liberal transfusion policy to improve the rehabilitation potential of hip fracture patients with anaemia.

Hypertension screens in A&EEmerg Med J 2008; 25: 196-9
Hypertension screening is not usually part of the remit of an A&E department; however, many patients may not have a GP and so use the A&E department as their main point of access to healthcare.

A study based in Southampton randomised 400 ambulatory patients attending the A&E department. BP was measured in the intervention group; those with raised BP received written information about hypertension and had a letter sent to their GP containing their BP reading and explaining the study.

The control group received no measurement or advice. Participants from both groups were contacted by telephone at three and six months.

The outcome measures were new drug treatment for hypertension in both groups at three and six months.

None of the trial participants started new antihypertensive medication. BP screening frequently takes place in primary care and the fact that follow-up was limited to those patients with a GP may partially explain the results: a population without a GP is less likely to have had their BP screened and may be more likely to benefit from screening in A&E.

Expectation bias among controls and poor compliance with follow-up instructions may also play a part.

Male partner violenceLancet 2008; 371: 1,165-72
Male partner violence against women is associated with ill health and this WHO ten-country study attempted to quantify the extent of the problem.

Population-based surveys were conducted between 2000 and 2003 when 24,097 women aged 15-49 years were interviewed and asked about personal experience of domestic violence involving a current or former male partner.

Those who had suffered physical abuse were asked about resulting injuries. There was an association between self-reported poor health in those with experience of domestic violence.

Domestic violence was also associated with specific health problems such as difficulty walking, memory loss and vaginal discharge. For those with at least one episode of partner violence, there was an increased incidence of emotional distress, suicidal thoughts and suicide attempts.

Home defibrillatorsN Engl J Med 2008 (10.1056/NEJMoa0801651)
Outside of the hospital, a sudden cardiac arrest is more likely to occur at home than anywhere else. An automated external defibrillator (AED) may increase survival rates.

The study randomised 7,001 patients with previous anterior wall myocardial infarction to either a traditional response in the event of arrest (calling an ambulance and CPR) or to the use of an AED followed by calling the paramedics.

None of these patients were candidates for an implantable cardioverter-defibrillator. Overall, 450 patients died (228 controls and 222 in the AED group). Only 160 deaths were thought to be due to an arrhythmia, of which 117 occurred at home and AEDs were used in 32 cases. Of these, 14 patients received an appropriate shock and four survived to hospital discharge.

The authors conclude that mortality was not reduced by the presence of an AED in the house.

Obesity in pregnancyN Engl J Med 2008; 358: 1,444-53
This US study used electronic notes to collect data from 13,442 pregnancies among women over the age of 18. All pregnancies studied resulted in live or still births.

The researchers assessed the association between BMI and use of healthcare services.

Women who were overweight or obese had longer lengths of stay in hospital.

A higher BMI was also associated with more prenatal fetal tests, more ultrasounds, more medications dispensed from the out-patient department pharmacy and more antenatal visits. Most of the increases in length of stay for obese women were due to the increased rates of caesarean sections and obesity-related high risk conditions in this group.

Chronic patellar tendinopathyRheumatology (Oxford) 2008; 47(4): 467-71

There are few established treatment options for chronic patellar tendinopathy (PT). One intervention being used currently is low intensity pulsed ultrasound (LIPUS).

A small sample of 37 patients with PT were randomised to receive either active LIPUS (n=17) or inactive placebo LIPUS (n=20) for a period of 12 weeks.

Patients self-administered the treatment for 20 minutes each day, seven days a week. Both groups also participated in a daily standardised exercise programme based on best practice.

There was no significant difference between the groups' pain scores at the end of the study, concluding that LIPUS had no effect on pain scores in chronic PT.

Dr Croton is a salaried GP in Birmingham and a member of our team who regularly review the journals

The quick study

  • Post-operative anaemia after hip fracture surgery leaves patients with decreased functional mobility during the first three post-operative days.
  • BP screening in an A&E department did not lead to patients starting new antihypertensive medication.
  • Cardiac arrest deaths were not reduced by the presence of an AED in the house.
  • Domestic violence against women is associated with specific health problems such as difficulty walking and memory loss.
  • Pregnant women with a high BMI need more healthcare services during and after their pregnancy.
  • Patellar tendinopathy pain was not significantly reduced with the use of low intensity pulsed ultrasound.

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