Itching, NHS reforms and CT scans

Running short of time to read the journals? Allow Dr Bryan Palmer to be your guide to the latest findings

Research of the week

Aspirin for women
Arch Intern Med 2007; 167: 562–72

So what do nurses ever do for us? Well, 79,439 enrolled in the Nurses’ Health Study.

This US research could potentially re-ignite the debate over ubiquitous aspirin use. After 24 years the study assessed the relative risk of those women taking aspirin versus those not taking it for death from cardiovascular disease and cancer.

The women who took aspirin showed a reduction in cardiovascular death after five years and a reduction in cancer death after 10 years.

Does this amount to proof that all women over a certain age should take low-dose aspirin? I am unsure but it might be good news for aspirin manufacturers.

Itchy and scratchy
Br J Dermatol 2007; 156: 629–34

A useful test as a parent of how much pain your child is in is to stamp on their toe. If they start complaining about the toe pain you have succeeded in distracting them from the more minor pain that they are belly aching about. This research suggests a similar mechanism showing that scratching or applying heat or cold a few centimetres from an itch can be as satisfying as scratching the itch.

The reason behind this observation is that the more noxious stimuli distract the sensory signals from the area of the itch. You might recall how your dermatological patients with itch often use creative methods including very hot and cold showers to achieve relief from what can be the most frustrating of stimuli.

Out of outpatients
Arch Surg 2007; 142: 263–8

Post-op complications can be predicted by a simple score that assigns two points for general anaesthesia and a single point for any of the following: age over 65, operating time longer than two hours, cardiac disease, PVD, cardiovascular disease, malignancy, HIV infection and regional anaesthesia. The need for hospital admission increases steadily as the score increases.

Applying these principles should reduce the risk of urgent admissions and reduce the likelihood of GPs picking up the pieces.

NHS reforms
Emerg Med J 2007; 24: 265–9

Some time ago a paper in the BMJ suggested that NHS Direct had not changed the health of people; it just gave the punters another person to call. So, I was pleased to read about how well the next plan had worked; that of the NHS walk-in centre.

The authors compared eight hospitals with co-located emergency departments and walk-in centres with eight matched hospitals that were not so fortunate. They undertook site visits and conducted postal questionnaires on those fortunate enough not to be admitted. Their conclusion was that the walk-in centres showed no evidence of any effect on attendances, process, costs or outcome of care.

CT and wrist fractures
Emerg Med J 2007; 24: 248–50

Just to make you all jealous: I have direct access to CT, MRI, echo, thallium stress tests, bone scans and angiograms here in the southern hemisphere. This paper from the world of emergency medicine shows that correctly targeted CT can be useful.

The authors compared the accuracy of CT versus plain X-rays. They found that CT had 100 per cent specificity and sensitivity compared with 83.3 per cent and 69.7 per cent, respectively. It was suggested that CT should be considered in anyone suspected of having a wrist fracture along with a normal X-ray.

Genetic factors in hip replacement
Ann Rheum Dis 2007; online

Just for a change this article is currently only published in its online form at cgi/content/abstract/ard.2006.062018v1.

It might be that your pre-op total hip replacement check might also include a genetic test. In a study of 312 patients with osteoarthritis who had undergone surgery researchers found that one gene, allele, more than tripled the risk of joint failure due to aseptic loosening compared to controls.

I am not sure if league tables for surgeons will factor that into the equation and, although I like the idea of fast publishing online, I am not sure if these long reference addresses will catch on.

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