Risk of depression raised by watching television and driving
Mayo Clin Proc 2015; 90(2): 184-93
Just under 5,000 patients were involved in this longitudinal study which looked at sedentary habits, specifically watching television and driving a car, and features of depression. People who spent more than nine hours a week in the car had a 28% greater risk of developing symptoms of depression than those driving for less than five hours a week.
People who watched TV for more than 10 hours a week had a 52% increased risk of depressive symptoms compared with those watching for less than five hours.
Those spending more than 19 hours a week in a combination of the two activities had 74% increased risk compared with those spending less than 12 hours driving and/or watching TV. Physical activity mitigated these risks.
Despite raising questions about programmes watched and the purpose of the car journeys, this study will complement advice to patients with low mood.
Device to narrow the coronary sinus in refractory angina
N Engl J Med 2015; 372: 519-27
Patients with treatment-resistant angina, for whom revascularisation procedures such as percutaneous coronary intervention or CABG are not an option, may have little hope of symptom control. This study involved a trial of just over 100 patients, split into a treatment group and a sham procedure. Treatment involved inserting a device into the coronary sinus which narrows its diameter, raising 'back' pressure in the arterial beds to improve myocardial perfusion; in a sense, continuous positive airway pressure for the heart.
In the treatment group, 35% of patients showed an improvement compared to 15% in the sham procedure.
At one year, one patient in the treatment group had had an MI, compared with three patients from the sham control group. The procedure is a way off, but should give patients hope.
Mortality and vascular events in women with type 1 diabetes
Lancet Diabetes Endocrinol 2015 doi: http://dx.doi.org/10.1016/S2213-8587(14)70248-7
Diabetes prevention and management is a national strategy and for good reason. The more information we have to inform our planning and practice, the better. This meta-analysis compared mortality between the genders in patients with type 1 diabetes, involving 26 studies covering more than 200,000 patients. All cause mortality, as well as specific cause mortality, was analysed.
The standardised mortality ratio (SMR) for all cause mortality, women:men was 1.37. The SMR (women:men) was 1.37 for stroke, 1.44 for fatal kidney disease and 1.86 for fatal CVD. Women were 2.54 times more likely than men to have CHD.
The study highlights the need to close this gender gap as a matter of priority. Are women with type 1 diabetes under-treated or genuinely at higher risk of all cause mortality?
Comprehensive geriatric care for patients with hip fractures
Lancet 2015 doi: http://dx.doi.org/10.1016/S0140-6736(14)62409-0
Orthogeriatrics is a relatively new specialty but it is of interest. This RCT compared usual care along an orthopaedic pathway versus comprehensive care on a geriatric ward for patients over the age of 70 with a hip fracture. The study involved 400 patients with the primary outcome measure being mobility at four months postsurgery for hip fracture. To be eligible, patients must have been able to walk at least 10 metres independently pre-fracture. Those living in nursing homes were excluded.
Mobility scores were significantly better in the geriatric care group rather than usual care. This will inevitably lead to questions about social costs and longer-term outcomes but the data can not be ignored.
Readmissions for heart failure, acute MI, or pneumonia
BMJ 2015; 350: h411
Admissions and readmissions impact negatively on costs and patients' quality of life. A significant proportion of readmissions are avoidable. High-volume conditions include heart failure, acute MI and pneumonia. It is critical to understand the nature of readmissions to learn how to prevent them. This large US-based study aimed raise awareness of, and address, this issue.
It showed heart failure accounted for the greatest number of readmissions, followed by pneumonia and MI. The risk of readmission fell by 50% after 38 days of hospitalisation for heart failure, 25 days for pneumonia and 13 days for MI.
It is interesting that different conditions had different readmission risk profiles and important to identify the tipping point for each patient; for example, what was the NYHA grade of the readmitted heart failure patients, or were they not followed up after discharge?
I have no doubt case-by-case research is required to enable learning and to avoid unplanned readmissions for millions of patients.
- Dr Thakkar is a GP in Wooburn Green, Buckinghamshire, and a member of our team who regularly review the journals
|CPD IMPACT: EARN MORE CREDITS|
These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.