Journals Watch - Diverticulitis, statins and cancer

A review of this week's research impacting primary care. By GP Dr Alison Glenesk

Diverticulitis: further research will address the question of whether hospital admission is appropriate (Photograph: SPL)
Diverticulitis: further research will address the question of whether hospital admission is appropriate (Photograph: SPL)

Antibiotics in acute uncomplicated diverticulitis
Br J Surg 2012; 99: 532-9

Treatment with antibiotics for patients with left-sided abdominal pain and fever has been the accepted dogma for years, because diverticulitis was assumed to be due to bacterial infection, despite any evidence to support this.

This multicentre trial randomised 623 patients with acute uncomplicated left-sided diverticulitis (proven on CT scan) into two groups. One group received antibiotics, the other did not.

The study found no significant difference in complications such as abscesses, median hospital stay and recurrent admissions with diverticulitis between the groups.

The question is whether hospital admission is appropriate for this group of patients. Should we be re-evaluating our approach to this condition?

Use of statins and arthritis of the knee
Ann Rheum Dis 2012; 71: 642-7

The pathogenesis of arthritis of the knee is multifactorial. The aim of this study was to determine whether statins could influence the development of arthritis.

A total of 2,921 people aged 55 and over were recruited to this prospective population-based cohort study. X-rays of the knee and hip were taken at baseline and after 6.5 years, and scored for osteoarthritis.

Information on statin use was obtained from pharmacies. The overall progression of arthritis was compared between users and non-users of statins.

Overall progression of knee and hip arthritis occurred in 6.9% and 4.7% of cases, respectively. The adjusted OR for overall progression of knee arthritis in statin users was 0.43.

The authors concluded that statin use is associated with a more than 50% reduction in progression of osteoarthritis of the knee, but not the hip.

As yet, it is difficult to determine whether this is clinically important or an interesting observation.

Telephone consultations before outpatient clinics
Clin Med 2012; 12: 140-5

This study describes an innovative approach to the problem of patients failing to attend out-patient clinic appointments.

The setting was the respiratory outpatients department of a London teaching hospital. A total of 100 consecutive referrals were chosen for postal invitation to participate in a pre-clinic telephone consultation with the consultant, who took a history and ordered investigations.

A total of 100 consecutive referrals were chosen for postal invitation to participate in a pre-clinic telephone consultation with the consultant (Photograph: JH Lancy)

Non-responders were allocated a face-to-face standard consultation and there was also a comparison group.

Hospital attendances were recorded for the following six months.

Of the participant group, 20.8% had three or more attendances, compared with 42.9% of the non-participant group and 44.7% of the comparator group.

The conclusion is that this approach reduces visits, seems to improve compliance and may save costs associated with non-attendance and follow-up.

Functional health literacy and mortality in older adults
BMJ 2012; 344: e1602

In this prospective cohort study, 7,857 adults aged over 52 taking part in the English longitudinal study of ageing were monitored for 5.3 years on average.

Participants completed a four-item test of functional health literacy, which assessed understanding of written instructions for taking an aspirin.

Data on all-cause mortality were obtained from the NHS central data registry. Health literacy was categorised as high (67.2%) medium (20.3%) and low (12.5%). Low health literacy was associated with older age, poorer health and lower socioeconomic position.

A total of 621 deaths occurred in follow-up, 321 (6.1%) in the high literacy group, 143 (9%) in the medium group and 157 (16%) in the low group. After adjusting for socioeconomic status, age, sex and baseline health, the hazard ratios for all-cause mortality were 1.40 for the low group and 1.15 for the medium.

The authors draw no inferences here, although it would be nice to think improving literacy levels might reduce death rates.

Identifying suspected renal cancer in primary care
Br J Gen Pract 2012; 62: e251-60

This study aimed to produce an algorithm to predict the incidence of renal tract cancers, using symptoms and baseline risk factors. The QResearch database was used to develop risk prediction models.

Two-thirds of the QResearch practices were allocated to the derivation dataset (2,358,168 patients) and the remaining third to the validation dataset (1,240,722 patients). Patients were aged 30-84 years and free from renal symptoms.

The primary outcome was development of renal tract cancer in the next two years. There were 2,878 cases of renal tract cancers in the study period. Predictors for males and females included age, smoking status, haematuria, abdominal pain, weight loss and anaemia.

The 10% of patients with the highest predicted risk contained 87% of all renal cancers diagnosed over the next two years.

The authors suggest using a web-based calculator to help GPs assess risk and decide about referrals.

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

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

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

  • Perform a survey of a sample of your 'did not attend' patients. Can you do anything to reduce their number?
  • Look at a sample of your patient information leaflets and perhaps give them to some of your older patients for comment. Are they comprehensible by most people?
  • Search for your renal tract cancer patients in the past few years and look at their risk factors. Would the risk calculator have predicted them?

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