CPR after out-of-hospital cardiac arrest
Lancet 2011; 377: 301-11
Poor survival rates for out-of-hospital cardiac arrest exist, in part, because standard CPR provides only 25 per cent of healthy blood flow to the heart and brain.
Augmentation of negative intrathoracic pressure during the decompression phase has been shown to increase cardiac and cerebral perfusion.
This study compared standard CPR with active compression-decompression CPR with augmented negative intrathoracic pressure. This was done using an impedance-threshold device.
Emergency services in the US were randomised to use one of these devices or traditional CPR. There were 800 patients in each group and the endpoint was survival with a favourable neurological outcome.
Six per cent of the traditional CPR group and 9 per cent of the intervention group survived to discharge with a favourable neurological outcome. Survival rates were the same one year post-discharge. Adverse events were similar in both groups.
Laparoscopic duodenal switch for morbid obesity
Br J Surg 2011; 98: 79-84
This study aimed to determine the safety and efficacy of the laparoscopic duodenal switch as a treatment for morbid obesity.
The average preoperative BMI of the 121 patients studied was 55kg/m2. The median excess weight loss was 75 per cent at 12 months and 90 per cent at 24 months.
Within a year, 90 per cent of diabetic patients had complete resolution of their diabetes and 40 per cent had resolution of their hypertension. There was no mortality. Some early problems with protein malabsorption were resolved within two weeks and vitamin A and D deficiencies were corrected with oral supplementation.
The authors concluded that this was a safe and effective treatment for morbid obesity.
Treatment modalities for frozen shoulder
Br J Sports Med 2011; 45: 49-56
Frozen shoulder is a common problem that can last up to four years. This paper looked at studies of different treatment modalities for frozen shoulder. The authors noted that there were few long-term studies and that follow up was usually three months.
They found there was strong evidence that steroid injections were effective in the short term and moderate evidence that they were effective in the medium term. Interestingly, it does not seem to matter what steroid, what dose or what approach is used.
There was also evidence that oral steroids can help in the short term. Mobilisation showed some benefit in both the short and long term and arthroscopic distension helps in the short term.
The authors suggested that trials with longer follow up are needed.
Patient self-management of mild symptoms
Br J Gen Pract 2011; 61: 12-7
The symptom iceberg describes the phenomenon where most symptoms are managed in the community without consulting a healthcare professional.
In this study, a symptom and demographics questionnaire was completed by 2,474 adults under 60 years of age.
Participants were given a list of 25 symptoms (including tiredness, headaches, joint pain, backache, poor sleep, vomiting, abdominal pain, depression and anxiety) and asked how many they had experienced in the past two weeks. The numbers of symptoms experienced ranged from 0 to 22 and the average number was 3.66.
The three most frequently experienced symptoms were tiredness, headaches and joint pain. There was little variation in different demographics, such as age or sex.
However, those with a chronic condition or who were unemployed reported more symptoms.
Br J Gen Pract 2011; 61: 38-9
AF is common in those over 50 years of age. As symptoms can be mild or absent, sometimes AF does not present until a major event has occurred.
There is currently no screening programme in the UK.
This study looked at whether a new device could be used to accurately screen for AF.
This device fits on to the finger like a pulse oximeter and is connected to a computer to analyse the pulse waveform pattern.
Comparative analysis of the device with the gold-standard diagnostic method (ECG) was undertaken in 594 patients. Readings were taken with the device and an ECG followed immediately. The ECG was seen by a cardiologist who was blind to the patient and the pulse waveform reading.
The device was able to detect all cases of AF (100 per cent sensitivity) at specificity of 91.9 per cent (8.1 per cent false positives).
The authors suggest that this equipment could pave the way for AF screening in the community.
Symptoms of the H1N1 virus
Arch Dis Child 2011; 96: 96-8
This study looked at the symptoms of 43 children admitted to an Australian hospital with H1N1 influenza during the 2009 pandemic.
Only 88 per cent fulfilled the diagnostic criteria for flu, and fever and cough were the most common symptoms. Almost half of children had consolidation on chest X-ray and a third were dehydrated. There were no deaths and the median stay was two days.
Almost half of those admitted had an underlying medical problem. Three patients were admitted with encephalopathy and two with diabetic ketoacidosis.
The authors suggest that because of the wide range of presentations, the diagnosis should be considered in any child with fever, or who is unwell.
- Dr Hunter is a GP in Bishops Waltham, Hampshire and a member of our team who regularly review the journals.
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