Journals watch: HIV prevention, knee replacement and breast cancer.

Too busy to read all of the research? Dr Alison Glenesk selects some papers of interest to GPs.

Social networking technologies as a tool for HIV prevention

Ann Int Med 2013; 159: 318-24

This US study describes an attempt to use social networking for health education and awareness-raising in HIV. African-Americans and Latinos in Los Angeles, California, have a high incidence of HIV and 82% are men who have sex with men.

Sixteen peer leaders were identified and randomised to an intervention or a control group. Both groups communicated with their peers via Facebook, after guidance from trainers, giving general health information, while the intervention group also gave information on HIV.

Almost 95% of intervention participants and 73% of control participants voluntarily communicated using Facebook. A total of 25 of 57 intervention participants (44%) requested home-based HIV testing, and 36% of these mailed the test back, compared with 11 of 55 (20%) control participants, of whom only 18% mailed the test back.

Contralateral prophylactic mastectomy in breast cancer

Ann Intern Med 2013; 159: 373-81

This cross-sectional study considered women's knowledge, decision-making perceptions and experiences of contralateral mastectomy in breast cancer. Data were obtained from eight centres in the US.

From the records of 550 women aged 40 years or less who had breast cancer between 2006 and 2010, 123 who had undergone bilateral mastectomy following unilateral cancer were surveyed.

A total of 98% said they had contralateral mastectomy to decrease their risk of cancer and 94% to increase their survival chances, but only 18% believed women who had the procedure lived longer than those who did not.

Women with BRCA mutations estimated future risk more accurately than those without, who tended to overestimate their risk of cancer in the contralateral breast.

Patient satisfaction with total knee replacement

Bone Joint J 2013; 95-B (10): 1359-65

This study aimed to evaluate the interactions and predictive capacity of data collected preand postoperatively on patient satisfaction following total knee replacement (TKR).

The authors were concerned that preoperative variables are increasingly being used to determine eligibility for TKR. A group of 22,798 patients who had TKR between 2008 and 2010 were identified.

A total of 22% rated their operative results as 'excellent' and the majority (71%) 'much improved'. The strongest predictors of satisfaction, obtained from postoperative data, related to symptom improvement and quality of life scores. Preoperative variables were much less important, although the best predictions of satisfaction occurred when preand postoperative factors were taken together.

Long-term cognitive impairment after critical illness

N Engl J Med 2013; 369 (14): 1306-16

Survivors of critical illness often have prolonged cognitive impairment.

In this study, 821 adults who had been in ICU with shock or respiratory failure were assessed for in-hospital delirium.

Executive functioning and global cognition were assessed at three and 12 months after discharge.

Delirium developed in 74% of the cohort during their acute admission. At three months, 40% had global cognition scores 1.5 SD below the population mean (similar to moderate traumatic brain injury) and 26%, two SD below the mean, comparable with mild Alzheimer's disease.

Development of cognitive impairment was independent of age and persisted at one year in 34% and 24% of patients as above.

The duration of delirium was independently associated with severity of outcome, but drug administration was not thought to be a factor.

Aircraft noise and cardiovascular disease near Heathrow airport

BMJ 2013; 347: 5432

Experimental studies have suggested that noise exposure can increase the risk of hypertension.

These authors looked at hospital admissions and mortality from stroke, CHD and cardiovascular disease in the 3.6m people exposed to aircraft noise around Heathrow airport.

Data were obtained from hospital records and area-level data on confounding factors, such as deprivation, ethnicity and smoking.

During 2001-5, there were 189,226 first episodes of hospital stay in a given year for cardiovascular disease (64,448 CHD and 16,983 stroke) and 48,347 deaths for these conditions.

Comparing areas experiencing the highest and lowest levels of aircraft noise, the relative risk of hospital admission was 1.24 for stroke, 1.21 for CHD and 1.14 for cardiovascular disease, with mortality figures showing a similar trend.

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

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

  • There is a great deal of potential for using social networking for health promotion. Discuss this with your partners and if they agree, approach your IT support to look at how this might be implemented.
  • Conduct a small survey of satisfaction on patients having knee replacement in the past two years. Note common factors for success or failure, such as age, weight and adherence to exercise regimen.

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

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