Journals Watch - CVD in siblings, dress code and AMD

Too busy to keep up with the journals? Let Dr Raj Thakkar be your guide to the latest research.

CVD risk in siblings

JAMA 2005; 294 (24): 3,117-23

We often ask patients about parental cardiovascular disease (CVD) when assessing their own cardiac risk because parental disease doubles the risk of CVD in offspring. How often do we ask about brothers and sisters, and is it relevant?

Prospective data involving nearly 2,500 patients were analysed in the Framingham offspring cohort. Participants were followed up for eight years.

Results demonstrated an 1.5 increased risk of CVD in those whose siblings already had heart disease.

Unless we consider parental and sibling links when taking a history, we may significantly underestimate cardiovascular risk.

Antioxidants and age-related macular degeneration

JAMA 2005; 294 (24): 3,101-7

Age-related macular degeneration (AMD) is the commonest cause of blindness in the West, particularly in older age groups.

Vitamin supplements slow disease progression but this study aimed to investigate whether antioxidants could prevent AMD. Food questionnaires were used to assess dietary intake in the early 1990s and participants were followed up until 2004. The minimum age for the Dutch cohort was 55 and the mean follow-up period was eight years.

The study concluded that higher dietary levels of vitamin E and zinc was only associated with a lower incidence of AMD as the confidence intervals were questionable. Combination intake of beta-carotene, vitamin C, vitamin E and zinc, however, reduced the risk by 35 per cent.

GP and nurse consultations

Br J Gen Pract 2005; 55: 938-43

Some studies show similar clinical outcomes between doctors and nurses with greater patient satisfaction with nurses.

Nurses spend more time with patients than doctors. The authors concluded that nurses spent twice as long as GPs, spending more time discussing treatments and the practical application of these treatments.There was some weak evidence to suggest nurses were more likely to discuss social implications of disease and the side-effects of medication.

Behaviour in trainee doctors

N Engl J Med 2005; 353: 2,673-82

This controlled study looking at the behaviour of trainee doctors in the US and subsequent disciplinary action during their careers.

A review of 235 graduates disciplined by the state medical board revealed these doctors were three times as likely to behave unprofessionally at medical school. Doctors were more likely to be disciplined if they struggled for a place at medical school or suffered poor grades in the first two years of college. Perhaps we should consider medical school reports when recruiting.

Dress nicely for your patients

BMJ 2005; 331:1,524-7

First impressions last. This study included 202 inpatients and 249 outpatients who were presented with photographs of doctors in various outfits to patients in a New Zealand hospital.

A validated scale was used to assess how comfortable patients were with each dress style.

Semi-formal wear was the preferred dress. Doctors who smiled scored very highly. White coats ranked higher than formal suits, followed by jeans and casual clothes.

Patients tended to be more comfortable when doctors wore formal items of clothing such as long sleeves and closed shoes rather than short tops and facial piercing. Jeans seemed to be acceptable. Patients liked to be called by their first name, to be introduced to doctors by their full title and to be able to see the doctor's name badge.

- Dr Thakkar is a GP in Woodburn Green, Buckinghamshire, and a member of our team who regularly review the journals


Siblings with CVD increase a patient's own cardiac risk.

Nurse consultations will include twice as much time discussing treatments as GPs.

Doctors' behaviour is better if they have struggled to enter medical school.

Smartly dressed doctors make patients feel more comfortable.


Identifying higher risk rectal bleeding

Br J Gen Pract 2005; 55: 949-55

Rectal bleeding is a common presenting complaint. This study included more than 300 patients over the age of 34 and aimed to define factors that increased the likelihood of colorectal cancer.

Fifteen consultations per 1,000 per year in those over 34 years were related to rectal bleeding; 3.4 per cent of these patients had colorectal cancer. If associated with a change in bowel habit, the prevalence of cancer increased to 9.2 per cent and to 11.1 per cent in the absence of perianal symptoms. Just over a third had a rectal mass palpable on digital examination.

It is imperative that we take directed histories and examinations and investigate appropriately.

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