Intra-articular corticosteroids for OA - J Am Acad Orthop Surg 2009; 17: 638-46
This was a systematic review of papers on intra-articular corticosteroid injections for knee osteoarthritis (OA). Five papers compared steroid with placebo, and four compared different steroids.
There was a significant reduction in pain at one week between the corticosteroid and placebo groups, but only one study showed improvement at three weeks.
Two out of four studies found triamcinolone to be the most effective steroid.
The authors conclude that steroid injections have no real place in the long-term management of OA, and should be used for specific reasons only. This is disappointing, as we have little to offer these patients until they need a knee replacement.
Long-term mortality after bariatric surgery - Arch Surgery 2009; 144: 914-20
There has been a lot of interest in bariatric surgery recently, with increasing numbers of patients going abroad for cheaper operations. This study examined factors associated with mortality up to three years following surgery in the US.
A total of 856 patients who had undergone surgery between January 2000 and December 2006 were identified, with a mean age of 54. Most (96.9 per cent) had received a gastric bypass and 73 per cent were men.
In general, bariatric surgery is a fairly low-risk operation, with one year mortality less than 1 per cent. However, in this group, who were older and predominantly male, the 30-day mortality was 1.3 per cent, 90-day 2.1 per cent, one-year 3.4 per cent.
By the end of 2006, 6.3 per cent of the study population had died.
Not surprisingly, the super obese (BMI >50) and those with existing co-morbidities were most at risk - unfortunately this is the group who stand to benefit most from weight reduction.
Frequency of medical absences in secondary school - Arch Dis Childhood 2009; 94: 763-7
It is uncommon to find any medical reason for frequent absences from school, and this study corroborates this.
The objectives were to determine the prevalence of frequent absence (>20 per cent of the school year) for reasons recorded as 'medical' in pupils in the first four years of a cross section of state secondary schools in Edinburgh, and to perform further analysis on the reasons for absence. More than 8,000 pupils were involved.
While 2.2 per cent (198) met the criteria for frequent absence, only 92 took part in the analysis for various reasons. These were matched for age, sex and deprivation indices with 92 controls from among the best attenders.
Of these 92, 8 per cent had serious organic disease, 11 per cent had symptom-defined syndromes (for example, chronic fatigue) compared with none of the controls, and the remainder had symptom complaints only.
Interestingly, 45 per cent of cases had had a psychiatric diagnosis during the previous year compared with 17 per cent of controls. There was also a link with social deprivation.
Only a minority of those with a psychiatric diagnosis had been referred to secondary care.
This study confirms the suspicion that non-physical factors are behind many school absences, but the fact that so much psychiatric morbidity is involved is surprising, and should be taken seriously.
Which practices are high antibiotic prescribers? - Br J Gen Pract 2009; 59: e315-e320(1)
The aim of this study is to establish the degree of variation in prescribing between practices in England, and to identify the characteristics of higher prescribing practices.
A data set was constructed of 8,057 practices, containing census data, QOF achievement data and antibiotic prescribing between April 2004 and March 2005, and location in the north of England, Midlands or south of England.
There was a five-fold difference in antibiotic prescribing volumes between the top and bottom prescribers. Practices offering shorter appointment times prescribed more, as did older GPs, male GPs, and those qualified overseas.
Practices in the north of England were, in general, higher prescribers than those in the other areas.
The authors conclude that these data will be useful when targeting future campaigns to reduce antibiotic prescribing. Further examination of prescribing at consultation level might help to explain the observed variation and guide future interventions.
Collars and physiotherapy for cervical radiculopathy - BMJ 2009; 339: b3883
This randomised controlled trial was carried out in three Dutch hospitals involving 205 patients who had experienced symptoms and signs of cervical radiculopathy for less than four weeks.
They were assigned to one of three groups: treatment with a semi-hard collar and rest for three to six weeks, twice-weekly physiotherapy and home exercises, or normal activity.
Pain was evaluated using 100mm visual analogue scale. Outcomes at six weeks were significantly better in the two intervention groups compared with the control group.
This is interesting as the use of cervical collars has gone out of fashion here in recent years, but presumably may soon make a comeback. I also wonder how easy it would be to have patients seen, assessed and started on physiotherapy within the required time in Britain.
|The quick study|
Steroid injections are of no use in long-term management of osteoarthritis.
Bariatric surgery may have higher risks associated when performed on older, male patients.
School absences for medical reasons were infrequent in secondary school children.
Antibiotic prescribing was found to be higher in older GPs, male GPs, and those qualified overseas.
Cervical collar use and physiotherapy improved pain scores in patients with cervical radiculopathy.
- Dr Glenesk is a GP trainer in Aberdeen and a member of our team who regularly review the journals