HAZARDS OF EXTREME SPORTS
Br J Sports Med 2006; 40: 230-4
Those who followed the snowboard competition at the Winter Olympics might just be interested in this paper, especially if you are thinking of taking up the sport.
This research from Norway looked at a period of one year and the 135 injuries suffered by 258 snowboard athletes. They showed that elite athletes suffered more wrist and back injuries compared to recreational users, who suffered more knee injuries.
With your feet strapped to the board, I am surprised ankles were not the joint injured the most. Assuming each snowboarder suffered one injury, more than 50 per cent reported a problem during the year. Time to check your winter sports insurance?
SURVIVAL AFTER RESUSCITATION
BMJ 2006; 332: 479-82
It's a brave person who tries to overcome political correctness and in a society that seems to be trying to prevent death at all costs, daring to suggest an alternative approach is always going to be a tough task.
Here, the authors looked at rates of survival from resuscitation to discharge of patients in different settings and labelled their article controversial.
The only successful CPR I've seen has been on a CCU and this was mirrored in the results that showed a 30 per cent success rate. The overall rate in acute hospitals is 14 per cent, in public places 5-10 per cent, with two thirds having moderate to severe neurological impairment, and in nursing or residential homes, 0-6 per cent (US data).
The authors challenged the value of offering a treatment that was almost certainly doomed to fail and the default position of it being offered in residential or nursing homes.
The researchers were accused of being ageist in the press, but I would say they were being realist. Perhaps we should all think about having DNR (do not resuscitate) tattooed on our chests.
VITAMIN D AND THE MENOPAUSE
N Engl J Med 2006; 354: 669-83
Reading this, I realised that yet another basic assumption has been blown away. In this study, 35,000 healthy post-menopausal women were randomised to receive calcium and vitamin D or placebo and followed up for seven years.
Women who took the supplements had greater hip bone density than those on placebo, but no difference in total fracture rate of hip and total fractures. Those on the supplements had higher rates of renal stones.
I suspect it will be some time before we stop all those prescriptions.
Emerg Med J 2006; 23: 210-13
I often prescribe an IM dose of opiate and an anti-emetic to patients in severe pain when required. Do they need both? The authors challenged this and randomised 259 patients receiving morphine to metoclopramide or placebo. Perhaps surprisingly, they found that the incidence of nausea was low in both groups and the metoclopramide did not make a significant difference. They do say that half of what you learn at medical school is wrong.
DON'T THROW OUT THE BETA-BLOCKERS JUST YET
Ann Intern Med 2006; 144:229-38
At last, support for the beta-blocker. Relegated to treating erectile dysfunction, bad dreams and cold hands, it now looks like things might be on the up. This paper showed that patients already on statins and beta-blockers with atherosclerosis were less likely to present with MI and more likely to exhibit stable angina. It was suggested that this might be due to the plaques being stabilised by the combination. Hands up if you want a beta-blocker.
- Dr Palmer is a GP in Fareham, Hampshire, and a member of our team who review the journals.
- Elite winter sports athletes suffer more injuries than recreational users.
- Resuscitation has a very low success rate.
- Post-menopausal women taking vitamin D and calcium do not show a reduced level of fractures.
- Metoclopramide does not make a significant difference to nausea from opiates.
- Beta-blockers in combination with statins might help patients with atherosclerosis.
RESEARCH OF THE WEEK
Lancet 2006; 367:543-6
Remember the days of ISIS-2? Things moved on and now the research is called ASSENT-4 and it is looking at immediate angioplasty with or without clot busters.
The trial was planned to look at 4,000 people, but was stopped early when it became clear that adding clot busters was to the detriment of the patient. A systemic review of 17 trials, covering 4,500 patients, also agreed with this finding of more adverse events and higher mortality.
The conclusion was 'How much delay to primary angioplasty is acceptable before thrombolysis treatment should be given instead?' My question is, does your hospital even offer immediate angioplasty, because mine certainly doesn't.