Journals Watch: Influenza, migraine and ski injuries

Short on time to catch up on research? Dr Bryan Palmer summarises his pick of the recent papers.

How to avoid catching a cold?
BMJ 2008; 336: 77-80

It has been said that the next flu pandemic will travel by plane and perhaps will have the potential to spread globally. This systemic review looked for evidence of the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses, using data from 138 papers.

Strategies aimed at preventing spread in children would have the greatest benefit. In preventing SARS they found that hand washing more than 10 times a day, wearing masks, wearing anti-particulate, N95 masks, wearing gloves and wearing gowns were all effective.

Gowns, masks, gloves and hand washing together reduced the NNT to 3. There was no evidence that screening at ports, social distancing or antiviral/antiseptic soaps were effective.

How practical this is at the population level during a pandemic is questionable but I'm going to look more like a surgeon than a GP if it hits.

Migraine treatment
Emerg Med J 2008; 25: 26-9

This research from the Antipodeans demonstrates a cultural difference in treatment of a common condition.

Based in an A&E in Melbourne this double-blind, randomised, placebo-controlled study was designed to see if they could reduce the re-attendance of migraine patients for the same attack.

Normal care was to give an IV dose of a phenothiazine and send them on their way, but for the trial group of 63 patients they were randomised to an oral dose of dexamethasone or placebo and then discharged.

The outcome was not favourable because there was no significant difference between the two groups in the numbers who came back when the injection wore off.

The moral of the story is to encourage people to self-treat. However, this is difficult in a country where patients who are vomiting dehydrate quicker in the heat and access to triptans is more difficult due to the country's prescribing restrictions.

Obesity and the mentally ill
JAMA 2008; 299: 185-93

It is bad enough having a psychotic illness, but the treatment is less than ideal. Weight gain, especially in the newer anti- psychotic medication can lead to medical co-morbidity superimposed on the psychiatric illness.

This study from China tried to reduce the weight gain by using metformin. It was a randomised controlled trial over two years involving 128 patients.

Patients continued their anti- psychotic medication and were randomly assigned to: 12 weeks of placebo; 750mg per day of metformin alone; 750mg per day of metformin and lifestyle intervention; or lifestyle intervention only.

The best result was the combination of metformin and lifestyle intervention, but like all interventions related to weight, the question is, would it stand the test for the long term rather than just two years?

Good old Uncle Sam
Ann Int Med 2008; 148: 55-75

It seems that UK politicians are trying to Americanise the NHS, but not everything is rosey across the pond. This report from the US points to a less than bright picture of their healthcare system and the money spent on it.

Currently health spending is at 16 per cent of GDP, this is expected to rise to 20 per cent of GDP by 2015. Its population don't live as long as other developed nations and its infant mortality rate is higher.

Per capita spending on health is more than double of most other comparable nations. The article cites a large number of recommendations which aim to move the US towards the best of how other countries run their healthcare systems.

It seems we are ahead of the game but wish to mimic a model that has many deficiencies.

The horsey set
Br J Sports Med 2008; 42: 22-4

Most race horses get to end their careers either on the track by the hand of the local vet or from exhaustion after being put out to stud, but what ends the careers of the jockeys who ride them?

This research from Melbourne used analysis of prospectively-collected injury database on professional jockeys.

They found that the majority of injuries occurred to the head, shoulder or torso. Fractures were the most common type of injury leading to a decision to end a career, followed by neurological injury to the head or spine.

The conclusion was that more attention should be paid to the headwear worn by the jockey.

Winter sports
Br J Sports Med 2008; 42: 55-8

I have never skied but I see from this review why health insurance make specific enquires about it in my policy.

This research comes from a tertiary trauma centre in the Alps. The objective was to analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding.

Over a six-year period they recorded 728 adult patient episodes: 73 were defined as having severe spinal injuries, of which 28 had fatal or persistent neurological injury.

They noted that the snowboard injuries were all in males, who were younger compared with the skiers. This group didn't have any persistent neurological injury (unless killed, of course).

The authors made several recommendations, although I suspect they were more common sense than evidence-based.

Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who reviews the journals.

The quick study:

Respiratory viruses are less likely to spread with the effective use of gowns, masks, gloves and hand washing.

Migraine patients should be encouraged to self-treat.

Weight gain associated with the use of antipsychotics may be best treated with a combination of metformin and lifestyle changes.

American healthcare faces the challenge of a higher infant mortality and lower life expectancy than other developed nations, despite high spending.

Spinal injuries account for a high percentage of outcomes in ski and snowboard accidents.

Fractures are the most common injury to end a jockey's career.

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