Accuracy of symptoms and signs for CHD
Br J Gen Pract 2010; 60: e426-e257
GPs face a challenge of avoiding over-referral and investigation of chest pain, while ensuring to diagnose serious cardiac disease. ECGs and troponin estimations have limited value.
History and physical examination are the most valuable diagnostic tools.
This was a cross-sectional study of 1,249 patients with chest pain across 74 general practices in Germany.
Patients over 35 years with pain in the anterior chest were recruited over a 12-week period. Patients with a traumatic cause for chest pain were excluded.
The GPs used a standardised report form to take a history and perform a clinical examination. Patients were followed up after six weeks and six months.
Overall, 1,199 patients were analysed. Nearly 15 per cent were diagnosed with CHD and almost 6 per cent required urgent hospital admission.
Pain on exertion, known vascular disease or heart failure and the need for a home visit were useful indicators for CHD and predictors of admission.
Geographical differences in the prevalence of eczema
Br J Dermatol 2010; 162: 964-73
Eczema is a common presentation in general practice, and about 10 per cent of school children in western countries are affected, with the incidence rising in developing countries.
Environmental factors are thought to play a role in causation, and it is thought that eczema is more common in urban compared with rural communities.
The 'hygiene hypothesis' is the view that hygienic environments in modern society result in insufficient microbial stimulation in the immune system of newborns.
This systematic review and meta-analysis included 26 studies, 19 of these showed a higher risk for eczema in urban areas, of which 11 were significant.
Six studies showed a lower risk of eczema in urban areas, and only one study was significant. The effect was more evident in developed countries.
It was concluded that there is some evidence of a higher risk for eczema in urban compared with rural areas. Further work needs to be done identifying the environmental factors that appear to play a role in pathogenesis.
Effectiveness of different moisturisers in preventing dermatitis
Br J Dermatol 2010; 162: 1088-92
In this study the effect of five different moisturisers on skin barrier function was determined after repeated handwashing over a two-week period.
Assessments of transepidermal water loss, epidermal hydration and a visual assessment using the hand eczema severity index were made at days zero, seven and 14.
A total of 132 patients were enrolled and patients were excluded if their hands were regularly wet as part of their daily routine or profession, or if they had active clinically significant skin diseases such as eczema or contact dermatitis.
Subjects were randomised to one of five emollients and in a control group no moisturiser was used.
Participants had to wash their hands 15 times per day using the same antiseptic soap. A standardised procedure for handwashing was performed and standardised volumes of both soap and emollient were used.
Regular application of moisturiser was shown to offer a protective effect against repeated exposure to irritants.
Use of emollients did not reduce the barrier efficiency of the skin and offers a protective effect against repeated exposure to irritants.
Pessimistic beliefs and pain after knee replacement
J Bone Joint Surg Br 2010; 92B (6): 799-806
It is interesting to know that a negative outlook does predict poorer health outcomes. These negative beliefs lead to a self-fulfilling prophecy - patients who expect to have problems after surgery, are likely to have some difficulties. Those motivated to get up and get on with things seem to do better.
This American study identified 702 patients who had 894 primary knee replacements between 1993 and 2005. These people responded to follow-up surveys at two and five years.
Patients were categorised as 'pessimistic' or 'non-pessimistic' according to a personality optimism-pessimism scale.
The pessimists had significantly more moderate to severe pain at two years (but not at five years) and less improvement in knee function at two years.
There were no significant associations with moderate or severe limitation of activity at two and five years.
Fear of dying varies between ethnic groups
Postgrad Med J 2010; 86: 197e202
A large number of supportive relatives can increase fear of dying among elderly people from ethnic minorities, a UK study suggests.
Researchers examined attitudes to death and dying among 1,000 people aged 65 years or older, from an ethnically diverse sample of the population and a group of mostly white British people.
Two-thirds of the ethnically diverse group had large family networks prepared to help, compared with one in three of the British cohort.
However, more than half of ethnically diverse people had the worst scores for beliefs about death and dying and quality of life.
Practitioners should not assume fears about dying are the same in different social groups, or that extensive family support lessens this.
- Dr Ford is a sessional GP in Worcestershire and a member of our team who regularly review the journals
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