Journals Watch - GORD, HRT and head injury

Missed this week's journals? Dr Bryan Palmer brings you up to date with the latest research.

Lifestyle factors in gastro-oesophageal reflux disease are under-represented in existing guidelines
Lifestyle factors in gastro-oesophageal reflux disease are under-represented in existing guidelines

Patient knowledge of gastro-oesophageal reflux Fam Pract 2010 doi: 10.1093/fampra/cmq020
How much do patients know about reflux? According to the authors of this study, about 30 to 50 per cent of patients with gastro-oesophageal reflux disease experience refractory symptoms despite taking proton pump inhibitors.

Some studies suggest that lifestyle factors are involved but these are under-represented in existing guidelines.

To assess patient perceptions and potential for behavioural modifications semi-structured interviews with 23 patients (12 women and 11 men) aged 30 to 86 years were conducted. The authors' aim was to identify whether patients perceive lifestyle influences to affect their symptoms.

Patients reported a range of daily influences on their symptoms, such as diet (including the types of food eaten, as well as speed of eating and meal size), drinking with a meal, alcohol, gaining weight, stress and anxiety.

Many foods were identified as troublesome, but not all foods affected all patients. Eating late in the day and daytime tiredness were not identified as causes or consequences of night-time reflux.

The authors concluded that patients may not recognise all the lifestyle influences that they can change and that behavioural interventions may prove beneficial to these patients.

New diabetic drugs  Lancet 2010; 375 (9724): 1447-56
This study tested two new diabetic drugs - the human GLP-1 analogue liraglutide and the DPP-4 inhibitor sitagliptin - in patients with diabetes mellitus who are taking metformin and have inadequate HbA1c control.

Approximately 700 patients were randomised to either drug for 26 weeks.

Participants received either a higher dose of liraglutide (1.8mg), a lower dose (1.2mg) or sitagliptin (100mg) once daily. It is worth noting that the GLP-1 analogue is a once daily subcutaneous injection, whereas the DPP-4 inhibitor is a once daily oral treatment. The endpoints were change in HbA1c and any side-effects.

Although the endpoints show a superior reduction in HbA1c with liraglutide, this was at the expense of around 25 per cent of patients experiencing nausea and all groups experiencing about a 5 per cent hypoglycaemia incidence.

This is all well and good but reduction in numbers has to be translated into hard endpoint data and neither of these drugs have shown this to date.

HRT revisited  Fam Pract 2010 doi: 10.1093/fampra/cmq018
Just how did the 2002/3 art-icles on the risks of HRT affect prescribing habits? The aim of this Dutch study was to assess the prescription levels of HRT in general practice for women consulting with menopausal symptoms before and after publication of the Women's Health Initiative study in 2002, The Million Women Study, and the Lancet editorial in 2003, and to correlate these with comorbidity, co-medication and frequency of GP consultations.

This case control study showed a dramatic decrease in HRT scrips from 37 per cent in women who present to their GP with menopausal symptoms in 2002 to 14 per cent in 2003 and only 4 per cent in 2004.

Irrespective of HRT prescription, women who presented with menopausal symptoms had more nervous functional complaints, were prescribed more tranquillizers and visited the GP more frequently than women who did not consult for menopausal symptoms.

Head injury information Emerg Med J 2010; 27: 279-82
It seems patient information leaflets about minor head injury are not as helpful as they were thought to be, according to this study.

The authors from Scotland obtained discharge advice leaflets about minor head injury from 30 hospital sites. Readability of the 45 leaflets was assessed using two recognised formulae.

Legibility was assessed using Clear print guidelines from the Royal National Institute for the Blind. Content was also compared with the SIGN recommendations on the early management of head injury (SIGN 45).

Their conclusion estimated that less than 30 per cent of the population would understand more than 90 per cent of the leaflets.

Furthermore, fewer than half of the leaflets provide even half of the patient information recommended by the SIGN guidelines.

Homeopathy effect is no more than placebo  Med J Aust 2010; 192 (8): 458-60
The author of this paper is the director of complimentary medicine at The Peninsula Medical School, Exeter.

He searched the Cochrane database for systematic reviews of homeopathy and found six in line with the entry criteria.

The articles assessed the use of homeopathy in the following conditions: influenza, ADHD, asthma, dementia, cancer and induction of labour.

Most of the papers were authored or co-authored by homeopaths. However, none of these studies concluded that homeopathy is an effective treatment.

The author's conclusion was that a rational explanation would be that the positive outcomes of observational studies are caused by the non-specific effects of homeopathic treatments, such as the empathic and lengthy consultation typical of homeopathic services, while the controlled trials demonstrate that homeopathic remedies are little more than placebos.

  • Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team of regular research reviewers
The quick study

Gastro-oesophageal reflux and lifestyle modification knowledge is lacking in patients.

HbA1c reduction was greater in patients taking the GLP-1 analogue liraglutide than in those taking sitagliptin, but had more side-effects.

HRT rates fell from 37 per cent to 4 per cent between 2002 and 2004.

Minor head injury patient information leaflets lack readability and evidence-based information.

Homeopathy was shown to be little more than placebo.

 

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