Research of the week
Strategies for reducing treatment in mild, persistent asthma,
New Engl J Med 2007; 356: 2,027-39
This interesting US study compared the use of fluticasone plus salmeterol versus montelukast in those currently controlled on twice-daily steroid inhalers. Of 500 patients, 169 continued the twice-daily regimen, the remainder being split into the regimens above. All groups were blinded.
Some 20 per cent of patients who were receiving twice daily fluticasone or daily fluticasone plus salmeterol had treatment failure compared with 30.3 per cent for montelukast.
Despite these data, those on montelukast still managed to be symptom free for nearly 80 per cent of treatment days. The trial, however, certainly favoured the use of steroid and salmeterol in the control of asthma.
Effects of football matches on ambulance call-outs
Emerg Med J 2007; 24: 405-7
World sporting events have, anecdotally, altered attendance rates in hospital and GP settings. This interesting study analysed ambulance call-outs during the World Cup last year.
Data were collected from the Hampshire ambulance trust during the first weekend of the World Cup.
On the first day, a 50 per cent increase in calls was received compared with an average Saturday. Calls were particularly high just before and just after the first match.
Alcohol-related emergencies accounted for much of the burden, particularly at the end of the match and in the evenings. These data should help ambulance trusts and hospitals plan effectively during major sporting events.
LHRH agonists in breast cancer treatment
Lancet 2007; 369: 1,711-23
Breast cancer in pre-menopausal women has had significant media coverage over the years. Trials to assess LHRH agonists as a treatment strategy have, until now, failed to demonstrate a significant outcome. This study pooled data from published trials focusing on receptor-positive disease, considering recurrence or death after recurrence as endpoints.
While LHRH agonists were not effective as sole adjuvant therapy, the addition of these drugs to either tamoxifen, chemotherapy or both significantly reduced recurrence and death after recurrence by 12.7 per cent and by 15.1 per cent respectively. LHRH agonists were ineffective in receptor-negative disease.
Abdominal aortic aneurysm screening
Ann Int Med 2007; 146(10): 699-706
Screening for abdominal aortic aneurysm (AAA) is a topical subject, but is it effective? This UK-based study looked at mortality and cost-effectiveness of screening, compared with a control group. Nearly 70,000 men aged 65-74 were randomised to either group and followed up for seven years. Those found to have an AAA in the screening group were treated appropriately.
The hazard ratio in the screening group was 0.53 (95 per cent CI, 0.42 to 0.68) for AAA-related deaths whereas the all-cause mortality ratio was 0.96 (CI, 0.93 to 1.00).
The authors calculated screening to be increasingly more cost effective the longer participants lived. In an ageing population, AAAs may be on the increase, but can a struggling NHS afford to look for business and treat even more patients?
Pharmacist intervention in heart failure
Ann Int Med 2007; 146(10): 714-25
The heart failure burden is on the increase for a number of reasons, age and increased survival post MI being particularly important factors.
Multiple trials have shown the benefits of drugs including ACE inhibitors, cardioselective beta-blockers and spironolactone. It follows that patients' health is at risk with poor adherence.
This randomised study assessed pharmacist intervention in adherence rates in low-income patients with cardiac failure.
Adherence and health outcomes were both measured. Secondary measures included health-related quality of life, patient satisfaction with pharmacy services and cost.
Adherence during nine months intervention was 67.9 per cent in the usual care group and 78.8 per cent in the pharmacist group.
After the intervention period, adherence dropped in the pharmacy group to 70.6 per cent. There was a 19.4 per cent difference in visits to the accident and emergency department and admissions in favour of the intervention group.
It is clear we must place adherence high on our priority when managing our patients.
Dr Thakkar is a GP in Wooburn, Buckinghamshire, and a member of our team of GP research reviewers.
The quick study
Ambulance calls increase when key football matches are played.
LHRH agonists in combination with standard treatment can reduce recurrence and death from receptor-positive breast cancer.
Abdominal aortic aneurysm related deaths are reduced when AAA is screened for.
Heart failure patients have greater adherence to their treatment following pharmacist intervention.