Journals Watch - Bowel cancer and depression

A research review, this week covering bowel cancer, pneumonia, depression and BMI. By Dr Jonathan Holliday

Half of those investigated had a polyp varying from 1mm to 80mm (Photograph: SPL)
Half of those investigated had a polyp varying from 1mm to 80mm (Photograph: SPL)

The first three years of the National Bowel Screening programme
Colorectal Dis 2012; 14(2): 166-73

This paper reports the experience of one screening centre in the first 35 months of the programme.

As GPs we see completed reports coming through about our patients, so it is interesting to see the broader statistics.

Of 98,815 faecal occult blood test (FOBT) kits issued, 42,523 were returned (43% uptake); 1,339 of 1,488 (90%) FOBT-positive participants attended the nurse clinic. Of these, 1,057 had colonoscopy, 115 had computed tomography colonoscopy, and eight had a flexible sigmoidoscopy.

In total, 517 procedures (44%) were negative (no polyps or cancers) while 80 individuals (6% of those investigated, 0.2% of those who returned the test) had colorectal cancer; 50% of those investigated had a polyp varying in size from 1mm to 80mm.

In total, 1,200 colonoscopies were performed, resulting in 13 adverse events. There was one 30-day post-surgical mortality, one perforation, and no colonoscopy-related mortality.

Nursing home-acquired pneumonia in Germany
Thorax 2012; 67: 132-8
Data for patients hospitalised for community acquired pneumonia (CAP) and nursing home acquired pneumonia (NHAP) were compared for aetiology, initial antimicrobial treatment choices and outcomes.

Patients with NHAP presented with more severe disease (when assessed for confusion, respiratory rate, BP, age ≥65 years) but received the same frequency of mechanical ventilation and less antimicrobial combination treatment.

Streptococcus was the most important pathogen in both groups, with potential multidrug resistant pathogens rare (<5%).

Only Staphylococcus aureus was more frequent in the NHAP group (still only 2.3% of the total, compared with 0.7% in the CAP group). Shortand long-term mortality was higher among NHAP than CAP patients (26.6% versus 7.2%, and 43.8% versus 14.6%).

Although these data are from Germany, this is nonetheless salutary for those of us caring for patients in nursing homes.

Recognising depression in primary care
Fam Pract 2012; 29(1): 16-23
This prospective study of 1,293 consecutive general practice attendees compared outcome at six, 12 and 39 months. Presence and severity of a major depressive disorder (MDD) were assessed using standard questionnaires (including PHQ-9).

At baseline, 170 (13%) of the participants had MDD, of whom 36% were recognised by their GP. The RR of being depressed after 39 months was 1.35 for those with recognised compared with unrecognised depression.

At baseline, participants with recognised depression had more depressive symptoms and worse mental function than those with unrecognised depression. After 12 and 39 months, mean scores for each group did not differ but were worse than for those without depression.

Sarcopenia and mortality in nursing homes
J Am Med Dir Assoc 2012; 13(2): 121-6
Sarcopenia is not a term familiar to me. I certainly had no idea there was a European working group on sarcopenia in older people, and that it had determined that sarcopenia exists where there is low muscle mass plus either low muscle strength or low physical performance.

This study was conducted at the teaching nursing home of the Catholic University of Rome, where among 122 residents aged ≥70 years, 40 (32.8%) were identified as affected by sarcopenia. The primary outcome measure was survival after six months.

Sarcopenia is more common in men than women (in this study, 68% were men). Having adjusted for age, gender, cerebrovascular disease, osteoarthritis, COPD, activity of daily living impairment and BMI, residents with sarcopenia were more likely to die than those without sarcopenia (adjusted HR 2.34).

Of course, this does not tell us why or what to do about it. But for those of us working in nursing homes, awareness may be the start of possible intervention.

Trends in BMI in US youngsters
JAMA 2012; 307(5): 483-90

Data for this survey came from the national health and nutrition examination survey 2009-2010. Childhood obesity is known to have increased in the 1980s and 1990s but there were no significant changes between 1999-2000 and 2007-2008 in the US.

This cross-sectional survey included 4,111 US children and adolescents, from birth to 19 years; 9.7% of infants and toddlers had a high weight-for-recumbent length and 16.9% of children and adolescents aged two to 19 years were obese.

There was no difference in obesity prevalence among males or females between 2007-2008 and 2009-2010. However, trend analysis over 12 years indicated an increase in obesity prevalence between 1999-2000 and 2009-2010 in males aged two to 19 years, but not in females.

  • Dr Holliday is a GP in Berkshire and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Audit the proportion of FOBT kits returned. Is it similar to the rate above and should your practice do more to promote screening?
  • Audit weight and BMI readings of residents in your care home. Consider whether nutritional intake is adequate.
  • At a clinical meeting discuss the practice's response to requests for unscheduled care at nursing homes. Are the thresholds right for intervening?

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