Journals Watch - Sinusitis, asthma and PPIs

Too busy to catch up on the latest research? Let Dr Lizzie Croton update you on recent papers.

Quality of life following oesophageal cancer surgery Br J Surg 2008; 95: 1,121-6

This Swedish study aimed to assess the health-related quality of life in patients with surgically cured oesophageal cancer. The patients underwent oesophagectomy between 2001 and 2004.

Oesophageal cancer patients continue to have poor quality of life

Validated European Organisation for Research and Treatment of Cancer quality of life questionnaires were used to assess quality of life at six months and three years after surgery.

Of 358 patients, 117 (32.7 per cent) were alive at three years postoperatively and, of these, 87 patients (74.4 per cent) responded.

Six months after surgery, patients reported a worse quality of life than the reference population, with no improvement at three years. Patients alive at three years reported poor social function and significantly more problems with fatigue, diarrhoea, appetite loss, nausea and vomiting.

The health-related quality of life in such patients appears not to improve between six months and three years after surgery and is worse than that in a comparable reference population.

Antibiotics in the treatment of acute sinusitis Lancet Infect Dis 2008; 8: 543-52

This meta-analysis of randomised controlled trials assessed the therapeutic role of antibiotics for acute sinusitis in 17 trials (three including children).

In nine trials, sinusitis was diagnosed using clinical criteria, imaging was used in six trials and microbiological or laboratory methods in two. Oral amoxicillin was used in 10 out of 23 antibiotic treatment groups.

Compared with placebo, antibiotics were associated with a higher rate of cure or improvement (odds ratio 1.64). Their use was also associated with increased cure alone but at the expense of more adverse effects.

The rate of symptom resolution was faster with antibiotics, although they had no effect on disease complication or recurrence rate. The researchers conclude that antibiotics should be reserved for patients with a higher probability of bacterial disease.

Asthma self-management education Thorax 2008; 63: 778-83

This randomised equivalence trial involving 567 patients aimed to determine whether well-trained lay people could deliver asthma self-care management education with comparable outcomes to that achieved by primary care nurses.

The methods involved an initial consultation of up to 45 minutes offered by either a lay educator or a practice nurse.

This was followed up by a second shorter face-to-face consultation and telephone follow up for one year.

Outcome measures were the consequent unscheduled need for healthcare together with patient satisfaction and the use of oral steroids.

During the first two sessions, lay educators made more management changes than nurses.

Using an intention to treat analysis, both groups required similar amounts of unscheduled care. Despite the fact that all patients had been prescribed regular preventive therapy, 29 per cent of patients required oral steroids during the year.

Patient satisfaction was similar in both groups.

Pneumonia risk with proton pump inhibitors Ann Intern Med 2008; 149: 391-8

Recent studies suggest that proton pump inhibitors (PPIs) may increase the risk of community-acquired pneumonia (CAP).

This was a case - control study using the General Practice Research Database from 1987 to 2002. The subjects were adult patients with at least six months of initial pneumonia-free follow up in the database.

Case patients (80,066) were defined as those who received an incident diagnosis of CAP. Control patients (799,881) were selected using validated statistical methods. The use of a PPI within 30 days before the index date was measured.

Current PPI use was not associated with an increased risk of CAP. There was a strong increase in CAP risk associated with PPI medication that had been started in the preceding 2-14 days but no association for longer-term PPI therapy. An obvious limitation was the assumption that PPI compliance was 100 per cent.

Lifestyle factors and mortality BMJ 2008; 337: a1,440

Data from the US Nurses' health study was used in this prospective cohort study evaluating the impact of combinations of lifestyle factors on mortality in middle-aged women. The participants were 77,782 women aged 34-59 who were free from cardiovascular disease and cancer in 1980.

The main outcome measures were the relative risk of mortality during the 24 years of follow up in relation to five lifestyle factors: being overweight, smoking, taking little exercise, light to moderate alcohol intake and low diet quality score.

There were 8,882 deaths including 1,790 from cardiovascular disease and 4,527 from malignant disease.

If all five lifestyle risk factors were present, the relative risks were 3.26 for cancer mortality, 8.17 for cardiovascular mortality and 4.31 for all-cause mortality. Smoking alone contributed to 28 per cent of deaths and 55 per cent were attributed to a combination of smoking, being overweight, little exercise and poor diet. Interestingly, the addition of alcohol did not change these estimates.

Swimming goggles and intraocular pressure Br J Ophthalmol 2008; 92: 1,218-21

Many swimmers wear goggles to improve underwater visibility. Tension from the goggle headband may cause an elevation in intraocular pressure (IOP). Continuously elevated IOP is a risk factor for the development and progression of glaucoma.

This was both a pilot and validation study. The researchers measure IOP while swimmers wore 13 different styles of goggles. The IOP was measured before wear, two minutes after application, 20 minutes after application and after removal.

The pilot study investigated the changes in IOP while wearing five different types of goggles. A validation study then examined IOP changes to clarify whether they were sustained throughout the goggle wear.

IOP increased while wearing goggles by a mean of 4.5mmHg with this pressure being sustained for the duration of goggle wear. A smaller goggle face area was associated with greater IOP elevation. These findings were not while swimming but suggest that IOP may be raised by some swimming goggles.

Dr Croton is a salaried GP in Birmingham and a member of our panel who regularly review the journals

The quick study

  • Oesophagectomy patients continue to have a poor health-related quality of life post surgery.
  • Acute sinusitis has a faster symptom resolution when treated with antibiotics.
  • Asthma self-management education can be provided by lay educators as effectively as practice nurses.
  • Proton pump inhibitors may increase the risk of community-acquired pneumonia.
  • Poor lifestyle factors, such as smoking and poor diet, increased mortality in middle-aged women.
  • Intraocular pressure may be increased by wearing swimming goggles.

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