Hospital transmission of multiresistant organisms
Med J Aust 2011; 195: 276-9
Microbiologists at a tertiary hospital in Sydney conducted this prospective study to collect and analyse reusable venesection tourniquets for the presence of multiresistant organisms (MROs) - MRSA, vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase and metallo-beta-lactamase-producing enterobacteriaceae.
Tourniquets were randomly collected and tested in a 10-week period between September and November 2010. They found the overall colonisation rate of 100 tourniquets from general wards, ambulatory care and critical care was 78 per cent.
MROs were isolated from 25 tourniquets collected from a variety of hospital locations, including general wards, the intensive care unit, burns unit and anaesthetic bay. MRSA was isolated from 14 tourniquets and VRE from 19; both MRSA and VRE were isolated from nine tourniquets.
The authors postulated that disposable tourniquets might replace reusable ones as another measure to reduce the spread of these organisms.
Screening for osteoporotic fracture prevention
Fam Pract 2011; doi: 10.1093/fampra/cmr069
This qualitative study was designed to explore the views of older women and GPs on the acceptability of screening to prevent fractures.
The study involved face-to-face semistructured interviews with 30 women aged 70-85 years and 15 GPs. Data were analysed thematically. Women and GPs viewed screening positively, recognising its potential to improve fracture prevention and future health.
Attending screening was not found to result in anxiety or excessive activity restriction. Showing cost-effectiveness was key to the acceptability of screening among GPs. Implementing similar screening in routine care would require consideration of access to bone density scans, information provision to participants and mode of administration.
These findings suggest effective screening to reduce osteoporotic fractures could be implemented in routine care and would be well received by women and GPs.
Commercial providers and weight loss treatment
Lancet 2011: doi: 10.1016/S0140-6736(11)61344-5
WeightWatchers sponsored this study comparing weight loss by standard treatment in primary care with that achieved after referral to a commercial provider. In this parallel group, non-blinded RCT, 772 overweight and obese adults were recruited by primary care practices in Australia, Germany and the UK.
Participants were randomly assigned to receive 12 months of standard care as defined by national guidelines, or 12 months' free membership to a commercial programme, and followed up for 12 months. A total of 377 participants were assigned to the commercial programme, of whom 230 completed the 12-month assessment; 395 were assigned to standard care, of whom 214 completed the assessment.
Mean weight change at 12 months was -5.06kg for those in the commercial programme versus -2.25kg for those receiving standard care. The conclusion was that weight loss programmes work but so, in my opinion, would a change in the food industry output of overly calorific foods.
Rivaroxaban versus warfarin in non-valvular AF
Engl J Med 2011; 365: 883-91
In this double-blind trial these authors randomly assigned 14,264 patients with non-valvular AF who were at increased risk of stroke to receive rivaroxaban (20mg daily) or dose-adjusted warfarin.
The aim was to determine whether rivaroxaban was noninferior to warfarin for the primary endpoint of stroke or systemic embolism.
The primary endpoint occurred in 188 patients in the rivaroxaban group (1.7% per year) and 241 in the warfarin group (2.2% per year). Major and non-major clinically relevant bleeding occurred in 1,475 patients in the rivaroxaban group and 1,449 in the warfarin group, with significant reductions in intracranial haemorrhage (0.5% versus 0.7%) and fatal bleeding (0.2% versus 0.5%) in the rivaroxaban group. These data suggest rivaroxaban is superior to warfarin.
Adenoidectomy in children with recurrent URTI
BMJ 2011; 343: d5154
This RCT aimed to assess the effectiveness of adenoidectomy in children with recurrent URTI. It included 111 children aged one to six years with recurrent URTI selected for adenoidectomy in 11 general hospitals and two academic centres.
The children were assigned to immediate adenoidectomy with or without myringotomy or initial watchful waiting. During the median follow-up of 24 months, there were 7.91 episodes of URTI per person-year in the adenoidectomy group and 7.84 in the watchful waiting group.
No relevant differences were found for days of URTI and middle ear complaints with fever, nor for health-related quality of life. The prevalence of URTI decreased over time in both groups. Two children had complications related to surgery. The conclusion was that surgery was of no benefit.
Malignant mesothelioma after exposure to asbestos
Med J Aust 2011; 195: 271-4
Using the Western Australian Mesothelioma Register, this study reviewed all cases of malignant mesothelioma diagnosed in western Australia between 1960 and the end of 2008, and determined the primary source of exposure to asbestos.
Since 1981, 87 cases (55 in men) were attributed to asbestos exposure in home maintenance and renovation, and an increasing trend in such cases, in men and women, was seen.
The latency period for people exposed to asbestos during home renovation was significantly shorter than that for all other exposure groups. Cases related to renovation will probably continue to increase because many homes contain asbestos products. It should come as no surprise that there can be downsides to DIY.
- Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who regularly review the journals.
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